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"content": "\u003cp>Destination: Bulgaria. A tiny country in Eastern Europe typically overlooked by American tourists. But my husband’s father grew up in Bulgaria, so it’s long been on our travel list.\u003c/p>\n\u003cp>It’s also on the list of countries with measles outbreaks. Bulgaria has had almost 800 cases this year, \u003ca href=\"https://www.who.int/immunization/monitoring_surveillance/burden/vpd/surveillance_type/active/measles_monthlydata/en/\" target=\"_blank\" rel=\"noopener\">according to the World Health Organization\u003c/a>.\u003c/p>\n\u003cp>In California, four of the five outbreaks that occurred in the state this year were linked to international travel. Most travelers were infected in the Philippines or Ukraine, which are experiencing severe outbreaks, and 37% of cases were imported from Europe overall. New measles infections continue to be reported, with California now at 65 cases \u003ca href=\"https://www.cdph.ca.gov/Programs/CID/DCDC/Pages/Immunization/measles.aspx\" target=\"_blank\" rel=\"noopener\">as of Aug. 14\u003c/a>.\u003c/p>\n\u003cp>[aside tag='measles' label='More on measles']\u003c/p>\n\u003cp>Measles is highly contagious. If someone who’s sick visits a popular tourist site and coughs, or rides the subway and sneezes, the virus can live in the air for two hours after they leave. If people who are unvaccinated pass through the same place, 90% of them will get sick.\u003c/p>\n\u003cp>That’s why my travel nurse wanted to check on my vaccination status before I left for Bulgaria. This is routine for Gen Xers and Millennials born in the ’70s and ’80s because when the measles, mumps, rubella vaccine (MMR) was first introduced in 1971, scientists recommended just one dose. But over the years, they noticed some kids still got measles. It wasn’t until 1989 that they \u003ca href=\"https://www.cdc.gov/mmwr/preview/mmwrhtml/00041753.htm\" target=\"_blank\" rel=\"noopener\">changed the guidelines\u003c/a> to two doses.\u003c/p>\n\u003cp>But a lot of people, like me, who are now in their 30s and 40s, aren’t sure if they ever got the second dose.\u003c/p>\n\u003cp>So my travel nurse recommended I go to the lab to get a blood test to check my immunity. It’s a basic test that looks for antibodies to measles and should come back positive or negative, yes or no.\u003c/p>\n\u003cdiv>\n\u003caside class=\"alignright\">\u003cb>Vaccinated, But Still Getting Sick?\u003c/b>\n\u003cp>\u003cspan style=\"font-weight: normal\">\u003cbr>\nIn California, the vast majority of measles cases have been \u003ca href=\"https://www.cdph.ca.gov/Programs/CID/DCDC/Pages/Immunization/measles.aspx\" target=\"_blank\" rel=\"noopener\">in adults – 77%\u003c/a>. What’s more, a majority of cases – 51% – have been in people who were already vaccinated: 44% had two doses of the measles vaccine and 7% had one. How is this possible?\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: normal\">Back in the 1970s, when the current measles vaccine was first developed, health officials recommended people get one dose. But over the years, they noticed it only worked for 93% of people who got it – about 7% still got sick.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: normal\">So, in 1989, they recommended people get two doses of the vaccine. And that worked for 97% of people. But that still leaves 3% of people who are fully vaccinated susceptible to the disease.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: normal\">“We do believe that there are some people who get two doses of measles vaccine and were never immune,” said Dr. James Watt, chief of communicable disease control at the California Department of Public Health. “For some reason their body just didn’t respond to the vaccine. And that’s why the vaccine is 97% effective and not 100% effective.”\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: normal\">That’s why you can have people who are fully vaccinated still get measles. And in California, we have a high vaccination rate. So because we have more vaccinated people, they make up a higher proportion of those who get sick.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: normal\">“Just an illustration of that is that some of the adult cases we have had have been in health care workers, who tend to have a higher vaccination coverage than the general population,” he said.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: normal\">The takeaway, Watt said, is that the measles vaccine is still one of the most effective vaccines we have. It’s the reason measles was declared eradicated from the U.S. almost 20 years ago. Today, most measles cases we see here are imported from other countries.\u003cbr>\n\u003c/span>\u003c/p>\u003c/aside>\n\u003c/div>\n\u003cp>But my results came back “borderline.” In other words, maybe I’m immune, maybe I’m not.\u003c/p>\n\u003cp>“The blood test is imperfect,” said Dr. Art Reingold, a professor of epidemiology at UC Berkeley. “If you have antibodies, then we’re pretty certain you’re immune. But if you don’t have antibodies you may still be immune, but your antibodies are not detectable by the test.”\u003c/p>\n\u003cp>So it’s possible I got a false negative. But there’s no way to know for sure.\u003c/p>\n\u003cp>“I know a lot of people who would say that’s a good reason not to do testing,” Reingold said with a laugh. “Because you get these results, you don’t know how to interpret them, people worry.”\u003c/p>\n\u003cp>So now what? My doctor suggested getting another dose of measles vaccine. It’s safe. But when I look into it, it turns out, there are some side effects in adults that don’t occur in babies: \u003ca href=\"https://www.ncbi.nlm.nih.gov/books/NBK234372/\" target=\"_blank\" rel=\"noopener\">25% of women and teenage girls\u003c/a> get acute arthritis one to three weeks after getting the vaccine.\u003c/p>\n\u003cp>That would be right in the middle of my trip, right when my husband and I are due to arrive at Bulgaria’s Black Sea Coast.\u003c/p>\n\u003cp>I imagined lying on the beach, meditating on the rolling waves — wracked with joint pain.\u003c/p>\n\u003cp>“That would suck,” I said to my husband, when we talked it through.\u003c/p>\n\u003cp>“Yeah,” he replied. “But wouldn’t it be more of a bummer to get measles?”\u003c/p>\n\u003cp>So I went back to the experts. This time I spoke with Dr. Lisa Winston, an epidemiologist at San Francisco General Hospital.\u003c/p>\n\u003cp>“I can fully appreciate getting measles is not something you want,” she said.\u003c/p>\n\u003cp>She tells me not to worry about the acute arthritis, which really means sudden onset and short lived. And she says the joint pain is typically mild, nothing a couple ibuprofen wouldn’t take care of.\u003c/p>\n\u003cp>On top of that, the side effect is caused by the rubella part of the measles, mumps, rubella vaccine, and rarely occurs in women who have had one dose of MMR already.\u003c/p>\n\u003cp>“I would say that if the choice is between ‘I’m a little worried that I may get this arthritis or some joint pain,’ versus ‘I’m going someplace where I’m really going to be at risk for measles,’ the balance would swing towards being vaccinated for sure,” Winston said.\u003c/p>\n\u003cp>[pullquote size='medium' align='right' citation='Dr. Lisa Winston, an epidemiologist at San Francisco General Hospital']‘I would say that if the choice is between “I’m a little worried that I may get this arthritis or some joint pain,” versus “I’m going someplace where I’m really going to be at risk for measles,” the balance would swing towards being vaccinated for sure.’[/pullquote]\u003c/p>\n\u003cp>But before I went through the trouble of another medical visit, I wanted to make sure I really needed it. My mom was a nurse, and she kept my pediatric vaccine records. Squeezed in the margin, scrawled in black pen, it says that I got a second dose of the vaccine when I was 11. But the handwriting is hard to read and it looks so … unofficial. This is why I got the blood test.\u003c/p>\n\u003cp>Winston tells me, in general, medical records are more reliable than the blood test.\u003c/p>\n\u003cp>“For somebody who knows that they have been vaccinated, who has their history, you would actually be considered immune regardless of what your blood test shows,” she said.\u003c/p>\n\u003cp>Bottom line, if you’re not sure what your vaccination status is and you’re traveling to a country with a known measles outbreak, there’s no harm getting a second dose of vaccine. But if you know you’ve had two doses, there’s no benefit to getting a third.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Destination: Bulgaria. A tiny country in Eastern Europe typically overlooked by American tourists. But my husband’s father grew up in Bulgaria, so it’s long been on our travel list.\u003c/p>\n\u003cp>It’s also on the list of countries with measles outbreaks. Bulgaria has had almost 800 cases this year, \u003ca href=\"https://www.who.int/immunization/monitoring_surveillance/burden/vpd/surveillance_type/active/measles_monthlydata/en/\" target=\"_blank\" rel=\"noopener\">according to the World Health Organization\u003c/a>.\u003c/p>\n\u003cp>In California, four of the five outbreaks that occurred in the state this year were linked to international travel. Most travelers were infected in the Philippines or Ukraine, which are experiencing severe outbreaks, and 37% of cases were imported from Europe overall. New measles infections continue to be reported, with California now at 65 cases \u003ca href=\"https://www.cdph.ca.gov/Programs/CID/DCDC/Pages/Immunization/measles.aspx\" target=\"_blank\" rel=\"noopener\">as of Aug. 14\u003c/a>.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Measles is highly contagious. If someone who’s sick visits a popular tourist site and coughs, or rides the subway and sneezes, the virus can live in the air for two hours after they leave. If people who are unvaccinated pass through the same place, 90% of them will get sick.\u003c/p>\n\u003cp>That’s why my travel nurse wanted to check on my vaccination status before I left for Bulgaria. This is routine for Gen Xers and Millennials born in the ’70s and ’80s because when the measles, mumps, rubella vaccine (MMR) was first introduced in 1971, scientists recommended just one dose. But over the years, they noticed some kids still got measles. It wasn’t until 1989 that they \u003ca href=\"https://www.cdc.gov/mmwr/preview/mmwrhtml/00041753.htm\" target=\"_blank\" rel=\"noopener\">changed the guidelines\u003c/a> to two doses.\u003c/p>\n\u003cp>But a lot of people, like me, who are now in their 30s and 40s, aren’t sure if they ever got the second dose.\u003c/p>\n\u003cp>So my travel nurse recommended I go to the lab to get a blood test to check my immunity. It’s a basic test that looks for antibodies to measles and should come back positive or negative, yes or no.\u003c/p>\n\u003cdiv>\n\u003caside class=\"alignright\">\u003cb>Vaccinated, But Still Getting Sick?\u003c/b>\n\u003cp>\u003cspan style=\"font-weight: normal\">\u003cbr>\nIn California, the vast majority of measles cases have been \u003ca href=\"https://www.cdph.ca.gov/Programs/CID/DCDC/Pages/Immunization/measles.aspx\" target=\"_blank\" rel=\"noopener\">in adults – 77%\u003c/a>. What’s more, a majority of cases – 51% – have been in people who were already vaccinated: 44% had two doses of the measles vaccine and 7% had one. How is this possible?\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: normal\">Back in the 1970s, when the current measles vaccine was first developed, health officials recommended people get one dose. But over the years, they noticed it only worked for 93% of people who got it – about 7% still got sick.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: normal\">So, in 1989, they recommended people get two doses of the vaccine. And that worked for 97% of people. But that still leaves 3% of people who are fully vaccinated susceptible to the disease.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: normal\">“We do believe that there are some people who get two doses of measles vaccine and were never immune,” said Dr. James Watt, chief of communicable disease control at the California Department of Public Health. “For some reason their body just didn’t respond to the vaccine. And that’s why the vaccine is 97% effective and not 100% effective.”\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: normal\">That’s why you can have people who are fully vaccinated still get measles. And in California, we have a high vaccination rate. So because we have more vaccinated people, they make up a higher proportion of those who get sick.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: normal\">“Just an illustration of that is that some of the adult cases we have had have been in health care workers, who tend to have a higher vaccination coverage than the general population,” he said.\u003c/span>\u003c/p>\n\u003cp>\u003cspan style=\"font-weight: normal\">The takeaway, Watt said, is that the measles vaccine is still one of the most effective vaccines we have. It’s the reason measles was declared eradicated from the U.S. almost 20 years ago. Today, most measles cases we see here are imported from other countries.\u003cbr>\n\u003c/span>\u003c/p>\u003c/aside>\n\u003c/div>\n\u003cp>But my results came back “borderline.” In other words, maybe I’m immune, maybe I’m not.\u003c/p>\n\u003cp>“The blood test is imperfect,” said Dr. Art Reingold, a professor of epidemiology at UC Berkeley. “If you have antibodies, then we’re pretty certain you’re immune. But if you don’t have antibodies you may still be immune, but your antibodies are not detectable by the test.”\u003c/p>\n\u003cp>So it’s possible I got a false negative. But there’s no way to know for sure.\u003c/p>\n\u003cp>“I know a lot of people who would say that’s a good reason not to do testing,” Reingold said with a laugh. “Because you get these results, you don’t know how to interpret them, people worry.”\u003c/p>\n\u003cp>So now what? My doctor suggested getting another dose of measles vaccine. It’s safe. But when I look into it, it turns out, there are some side effects in adults that don’t occur in babies: \u003ca href=\"https://www.ncbi.nlm.nih.gov/books/NBK234372/\" target=\"_blank\" rel=\"noopener\">25% of women and teenage girls\u003c/a> get acute arthritis one to three weeks after getting the vaccine.\u003c/p>\n\u003cp>That would be right in the middle of my trip, right when my husband and I are due to arrive at Bulgaria’s Black Sea Coast.\u003c/p>\n\u003cp>I imagined lying on the beach, meditating on the rolling waves — wracked with joint pain.\u003c/p>\n\u003cp>“That would suck,” I said to my husband, when we talked it through.\u003c/p>\n\u003cp>“Yeah,” he replied. “But wouldn’t it be more of a bummer to get measles?”\u003c/p>\n\u003cp>So I went back to the experts. This time I spoke with Dr. Lisa Winston, an epidemiologist at San Francisco General Hospital.\u003c/p>\n\u003cp>“I can fully appreciate getting measles is not something you want,” she said.\u003c/p>\n\u003cp>She tells me not to worry about the acute arthritis, which really means sudden onset and short lived. And she says the joint pain is typically mild, nothing a couple ibuprofen wouldn’t take care of.\u003c/p>\n\u003cp>On top of that, the side effect is caused by the rubella part of the measles, mumps, rubella vaccine, and rarely occurs in women who have had one dose of MMR already.\u003c/p>\n\u003cp>“I would say that if the choice is between ‘I’m a little worried that I may get this arthritis or some joint pain,’ versus ‘I’m going someplace where I’m really going to be at risk for measles,’ the balance would swing towards being vaccinated for sure,” Winston said.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "‘I would say that if the choice is between “I’m a little worried that I may get this arthritis or some joint pain,” versus “I’m going someplace where I’m really going to be at risk for measles,” the balance would swing towards being vaccinated for sure.’",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>But before I went through the trouble of another medical visit, I wanted to make sure I really needed it. My mom was a nurse, and she kept my pediatric vaccine records. Squeezed in the margin, scrawled in black pen, it says that I got a second dose of the vaccine when I was 11. But the handwriting is hard to read and it looks so … unofficial. This is why I got the blood test.\u003c/p>\n\u003cp>Winston tells me, in general, medical records are more reliable than the blood test.\u003c/p>\n\u003cp>“For somebody who knows that they have been vaccinated, who has their history, you would actually be considered immune regardless of what your blood test shows,” she said.\u003c/p>\n\u003cp>Bottom line, if you’re not sure what your vaccination status is and you’re traveling to a country with a known measles outbreak, there’s no harm getting a second dose of vaccine. But if you know you’ve had two doses, there’s no benefit to getting a third.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cp>Diabetics skipping regular checkups. Young asthmatics not getting preventive care. A surge in expensive emergency room visits.\u003c/p>\n\u003cp>Doctors and public health experts warn of poor health and rising costs they say will come from sweeping Trump administration changes that would deny green cards to many immigrants who use Medicaid, as well as food stamps and other forms of public assistance.\u003c/p>\n\u003cp>Some advocates say they’re already seeing the fallout even before the complex 837-page rule takes effect in October.\u003c/p>\n\u003cp>President Donald Trump’s administration trumpeted its aggressive \u003ca href=\"https://apnews.com/f440cbe61eb642c99f4d9a47e437c526\" target=\"_blank\" rel=\"noopener\">approach\u003c/a> this past week as a way to keep only self-sufficient immigrants in the country, but health experts argue it could force potentially millions of low-income migrants to choose between needed services and their bid to stay legally in the U.S.\u003c/p>\n\u003cp>“People are going to be sicker. They’re not going to go get health care, or not until they have to go to an emergency room,” said Lisa David, president and CEO of Public Health Solutions, New York’s largest public health organization. “It’s going to cost the system a lot of money.”\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Immigrants who want permanent legal status, commonly called a green card, have long been required to prove they won’t be “a public charge.”\u003c/p>\n\u003cp>The Trump administration announced Monday that would redefine the term to mean those who are “more likely than not” to receive public benefits over a certain period. U.S. Citizenship and Immigration Services will also now consider other factors, including income, education and English proficiency.\u003c/p>\n\u003cp>“We want to see people coming to this country who are self-sufficient,” said Ken Cuccinelli, the agency’s acting director. “That’s a core principle of the American dream. It’s deeply embedded in our history, and particularly our history related to legal immigration.”\u003c/p>\n\u003cp>\u003ca href=\"https://apnews.com/21e2d0d8ebad45d5932f400184a566fd\" target=\"_blank\" rel=\"noopener\">Two\u003c/a> California counties and attorneys general in 13 states sued, \u003ca href=\"https://apnews.com/a185c08acfd84c548e8a679f57b07305\" target=\"_blank\" rel=\"noopener\">saying\u003c/a> the changes will increase public health risks.\u003c/p>\n\u003cp>There are signs that is already happening in cities including Chicago, Detroit and New York, immigrant advocates say.\u003c/p>\n\u003cp>Within hours of the announcement, a Minnesota immigration attorney said she received a flurry of calls from worried clients about whether to leave Medicaid.\u003c/p>\n\u003cp>A Detroit nonprofit helping Latinos and immigrants with social services said its usually jam-packed lobby was empty the day after the rules were unveiled.\u003c/p>\n\u003cp>New York’s largest public health organization, Public Health Solutions, which serves a large immigrant population, reported a 20% drop in food stamps enrollment since the rule was first proposed in the fall.\u003c/p>\n\u003cp>There is precedent for such a chilling effect.\u003c/p>\n\u003cp>After 1996 welfare and immigration changes that limited public assistance for some immigrants, the use of benefits dropped steeply among U.S. citizen children and refugees, groups who were still eligible.\u003c/p>\n\u003cp>Studies based on data following that change showed people disenrolled from Medicaid at rates ranging from 15% to 35%, according to Harvard University’s François-Bagnoud Center for Health and Human Rights. And, it found, this came at a high cost: Asthma-related school absences in 1996 led to $719 million in lost parental productivity.\u003c/p>\n\u003cp>Federico Mason, who emigrated from Mexico over two decades ago, said he is worried about the new criteria because he is low-income and doesn’t speak English well. The Chicago resident said he has no immediate plans to remove his 8- and 15-year-old sons, who are U.S. citizens, from Medicaid, but the new rule has made him more fearful about providing for his family and about applying for a green card.\u003c/p>\n\u003cp>“If one day I want to adjust my status, it will be more difficult because of these unfair policies that continue to discriminate against me,” he said in Spanish.\u003c/p>\n\u003cp>Overall, non-citizen low-income immigrants use public benefits at a much \u003ca href=\"https://www.apnews.com/460423ab286a4014bfe458a6989cc3f9\" target=\"_blank\" rel=\"noopener\">lower rate\u003c/a> than low-income U.S.-born citizens, but there’s the possibility that millions of people could drop benefits out of fear or confusion.\u003c/p>\n\u003cp>Estimates vary. It could be as high as 24 million people, according to the nonpartisan Fiscal Policy Institute, which includes in its count anyone in a family that has received food, health or housing support and where at least one person is a non-citizen.\u003c/p>\n\u003cp>Dr. Deanna Behrens, a pediatric critical-care physician in suburban Chicago who wrote public testimony opposing the rule change, said children are the most vulnerable.\u003c/p>\n\u003cp>She said non-citizen parents might hesitate to apply for their children who are U.S. citizens, mistakenly fearing that if their children get benefits it will destroy their own chances of getting a green card and tear their families apart.\u003c/p>\n\u003cp>That will lead to people being unable to afford care for chronic diseases like asthma and diabetes, as well as preventative measures. Instead, they’ll rely on far more costly emergency rooms.\u003c/p>\n\u003cp>“This has forced the immigrant families into an impossible choice,” Behrens said. Roughly 544,000 people apply for green cards annually, with about 382,000 falling into categories that would be subject to the new review, according to the government.\u003c/p>\n\u003cp>Esperanza Health Centers, which runs four Chicago-based clinics that serve low-income and largely immigrant populations, has seen an increase in the number of uninsured children. Since a draft of the new rule was released in the fall, the clinics report having 600 children without insurance, including those who have disenrolled from Medicaid. Typically, it’s about 200, according to Jessica Boland, director of behavioral health.\u003c/p>\n\u003cp>“We’re condemning people to having a much more unhealthy lifestyles because we believe that there is something awful about their request for what we think for most people is a right and not a privilege: health care,” said Dr. Kenneth Davis, president and CEO of Mount Sinai Health System, which covers eight hospitals in New York.\u003c/p>\n\u003cp>Over a dozen major patient groups, including the March of Dimes and the American Heart Association, have written fierce opposition to the rule.\u003c/p>\n\u003cp>The issue is personal for Dr. Jasmine Saavedra, a pediatrician who works at an Esperanza clinic in a heavily Latino Chicago neighborhood.\u003c/p>\n\u003cp>She is convinced that if new Trump administration criteria were in effect for her parents three decades ago, she would have had a far different future. Her parents emigrated from Mexico in the 1980s unable to speak English and with little education.\u003c/p>\n\u003cp>While working low-wage jobs, they relied on food stamps for a short time to get by. Her mother later quit public assistance because of the stigma, but Saavedra said there were days when her mother wouldn’t eat so her children could. She believes that helped her become a doctor and her two sisters become an accountant and a nurse.\u003c/p>\n\u003cp>“Maybe when certain people think about immigrant families, they do think of it as a burden on this country, the way people would tell my mom she was when she was receiving assistance,” Saavedra said.\u003c/p>\n\u003cp>“But my parents, with no education, not speaking this language, being impoverished with a little bit assistance when they could, got us out and they have three successful daughters.”\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003cem>Associated Press video journalist Mike Householder in Detroit contributed to this report.\u003c/em>\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Diabetics skipping regular checkups. Young asthmatics not getting preventive care. A surge in expensive emergency room visits.\u003c/p>\n\u003cp>Doctors and public health experts warn of poor health and rising costs they say will come from sweeping Trump administration changes that would deny green cards to many immigrants who use Medicaid, as well as food stamps and other forms of public assistance.\u003c/p>\n\u003cp>Some advocates say they’re already seeing the fallout even before the complex 837-page rule takes effect in October.\u003c/p>\n\u003cp>President Donald Trump’s administration trumpeted its aggressive \u003ca href=\"https://apnews.com/f440cbe61eb642c99f4d9a47e437c526\" target=\"_blank\" rel=\"noopener\">approach\u003c/a> this past week as a way to keep only self-sufficient immigrants in the country, but health experts argue it could force potentially millions of low-income migrants to choose between needed services and their bid to stay legally in the U.S.\u003c/p>\n\u003cp>“People are going to be sicker. They’re not going to go get health care, or not until they have to go to an emergency room,” said Lisa David, president and CEO of Public Health Solutions, New York’s largest public health organization. “It’s going to cost the system a lot of money.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Immigrants who want permanent legal status, commonly called a green card, have long been required to prove they won’t be “a public charge.”\u003c/p>\n\u003cp>The Trump administration announced Monday that would redefine the term to mean those who are “more likely than not” to receive public benefits over a certain period. U.S. Citizenship and Immigration Services will also now consider other factors, including income, education and English proficiency.\u003c/p>\n\u003cp>“We want to see people coming to this country who are self-sufficient,” said Ken Cuccinelli, the agency’s acting director. “That’s a core principle of the American dream. It’s deeply embedded in our history, and particularly our history related to legal immigration.”\u003c/p>\n\u003cp>\u003ca href=\"https://apnews.com/21e2d0d8ebad45d5932f400184a566fd\" target=\"_blank\" rel=\"noopener\">Two\u003c/a> California counties and attorneys general in 13 states sued, \u003ca href=\"https://apnews.com/a185c08acfd84c548e8a679f57b07305\" target=\"_blank\" rel=\"noopener\">saying\u003c/a> the changes will increase public health risks.\u003c/p>\n\u003cp>There are signs that is already happening in cities including Chicago, Detroit and New York, immigrant advocates say.\u003c/p>\n\u003cp>Within hours of the announcement, a Minnesota immigration attorney said she received a flurry of calls from worried clients about whether to leave Medicaid.\u003c/p>\n\u003cp>A Detroit nonprofit helping Latinos and immigrants with social services said its usually jam-packed lobby was empty the day after the rules were unveiled.\u003c/p>\n\u003cp>New York’s largest public health organization, Public Health Solutions, which serves a large immigrant population, reported a 20% drop in food stamps enrollment since the rule was first proposed in the fall.\u003c/p>\n\u003cp>There is precedent for such a chilling effect.\u003c/p>\n\u003cp>After 1996 welfare and immigration changes that limited public assistance for some immigrants, the use of benefits dropped steeply among U.S. citizen children and refugees, groups who were still eligible.\u003c/p>\n\u003cp>Studies based on data following that change showed people disenrolled from Medicaid at rates ranging from 15% to 35%, according to Harvard University’s François-Bagnoud Center for Health and Human Rights. And, it found, this came at a high cost: Asthma-related school absences in 1996 led to $719 million in lost parental productivity.\u003c/p>\n\u003cp>Federico Mason, who emigrated from Mexico over two decades ago, said he is worried about the new criteria because he is low-income and doesn’t speak English well. The Chicago resident said he has no immediate plans to remove his 8- and 15-year-old sons, who are U.S. citizens, from Medicaid, but the new rule has made him more fearful about providing for his family and about applying for a green card.\u003c/p>\n\u003cp>“If one day I want to adjust my status, it will be more difficult because of these unfair policies that continue to discriminate against me,” he said in Spanish.\u003c/p>\n\u003cp>Overall, non-citizen low-income immigrants use public benefits at a much \u003ca href=\"https://www.apnews.com/460423ab286a4014bfe458a6989cc3f9\" target=\"_blank\" rel=\"noopener\">lower rate\u003c/a> than low-income U.S.-born citizens, but there’s the possibility that millions of people could drop benefits out of fear or confusion.\u003c/p>\n\u003cp>Estimates vary. It could be as high as 24 million people, according to the nonpartisan Fiscal Policy Institute, which includes in its count anyone in a family that has received food, health or housing support and where at least one person is a non-citizen.\u003c/p>\n\u003cp>Dr. Deanna Behrens, a pediatric critical-care physician in suburban Chicago who wrote public testimony opposing the rule change, said children are the most vulnerable.\u003c/p>\n\u003cp>She said non-citizen parents might hesitate to apply for their children who are U.S. citizens, mistakenly fearing that if their children get benefits it will destroy their own chances of getting a green card and tear their families apart.\u003c/p>\n\u003cp>That will lead to people being unable to afford care for chronic diseases like asthma and diabetes, as well as preventative measures. Instead, they’ll rely on far more costly emergency rooms.\u003c/p>\n\u003cp>“This has forced the immigrant families into an impossible choice,” Behrens said. Roughly 544,000 people apply for green cards annually, with about 382,000 falling into categories that would be subject to the new review, according to the government.\u003c/p>\n\u003cp>Esperanza Health Centers, which runs four Chicago-based clinics that serve low-income and largely immigrant populations, has seen an increase in the number of uninsured children. Since a draft of the new rule was released in the fall, the clinics report having 600 children without insurance, including those who have disenrolled from Medicaid. Typically, it’s about 200, according to Jessica Boland, director of behavioral health.\u003c/p>\n\u003cp>“We’re condemning people to having a much more unhealthy lifestyles because we believe that there is something awful about their request for what we think for most people is a right and not a privilege: health care,” said Dr. Kenneth Davis, president and CEO of Mount Sinai Health System, which covers eight hospitals in New York.\u003c/p>\n\u003cp>Over a dozen major patient groups, including the March of Dimes and the American Heart Association, have written fierce opposition to the rule.\u003c/p>\n\u003cp>The issue is personal for Dr. Jasmine Saavedra, a pediatrician who works at an Esperanza clinic in a heavily Latino Chicago neighborhood.\u003c/p>\n\u003cp>She is convinced that if new Trump administration criteria were in effect for her parents three decades ago, she would have had a far different future. Her parents emigrated from Mexico in the 1980s unable to speak English and with little education.\u003c/p>\n\u003cp>While working low-wage jobs, they relied on food stamps for a short time to get by. Her mother later quit public assistance because of the stigma, but Saavedra said there were days when her mother wouldn’t eat so her children could. She believes that helped her become a doctor and her two sisters become an accountant and a nurse.\u003c/p>\n\u003cp>“Maybe when certain people think about immigrant families, they do think of it as a burden on this country, the way people would tell my mom she was when she was receiving assistance,” Saavedra said.\u003c/p>\n\u003cp>“But my parents, with no education, not speaking this language, being impoverished with a little bit assistance when they could, got us out and they have three successful daughters.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cp>U.S. Sen. Kamala Harris walked onstage Wednesday night for her second presidential debate with a lot of pressure and high expectations hanging over her head — and she mostly delivered.\u003c/p>\n\u003cp>[pullquote size='small' align='right' citation='Former Vice President Joe Biden']‘This is not a Republican talking point; Republicans are trying to kill Obamacare.’[/pullquote]Harris, who is viewed as one of a few frontrunners in the crowded Democratic field, found herself at the center of the stage alongside former Vice President Joe Biden — and at the center of many attacks from her fellow Democrats on issues ranging from health care to her record as a prosecutor.\u003c/p>\n\u003cp>Biden, especially, came out swinging at Harris, a turnaround from his lackluster response to her attacks in the first debate in June.\u003c/p>\n\u003cp>“The senator has had several plans,” Biden said, referring to Harris’ flip-flopping on whether she supports eliminating private insurance coverage. “You can’t beat Donald Trump with double-talk on this.”\u003c/p>\n\u003cp>Harris — whose \u003ca href=\"https://www.kqed.org/news/11757814/kamala-harris-swings-at-joe-biden-while-eric-swalwell-strives-to-stand-out-in-democratic-debate\">standout performance\u003c/a> during the first debate boosted her poll numbers and breathed life into her campaign — appeared a bit nervous as the night began, but seemed to pick up steam as the debate wore on.\u003c/p>\n\u003cp>After greeting Biden casually — “Hey, Joe,” she said, with him responding, “Go easy on me, kid” — Harris quickly pivoted to attacking the vice president.\u003c/p>\n\u003cfigure id=\"attachment_11764808\" class=\"wp-caption alignnone\" style=\"max-width: 800px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-11764808\" src=\"https://ww2.kqed.org/news/wp-content/uploads/sites/10/2019/07/07312019_democratic-primary-debate_detroit_election-2020-qut-800x533.jpg\" alt=\"Democratic presidential hopefuls wave from the stage ahead of the second Democratic primary debate of the 2020 presidential campaign season hosted by CNN at the Fox Theatre in Detroit, Michigan, on July 31, 2019.\" width=\"800\" height=\"533\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2019/07/07312019_democratic-primary-debate_detroit_election-2020-qut-800x533.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2019/07/07312019_democratic-primary-debate_detroit_election-2020-qut-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2019/07/07312019_democratic-primary-debate_detroit_election-2020-qut-1020x680.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2019/07/07312019_democratic-primary-debate_detroit_election-2020-qut-1200x800.jpg 1200w, https://cdn.kqed.org/wp-content/uploads/sites/10/2019/07/07312019_democratic-primary-debate_detroit_election-2020-qut.jpg 1920w\" sizes=\"auto, (max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Democratic presidential hopefuls wave from the stage ahead of the second Democratic primary debate of the 2020 presidential campaign season hosted by CNN at the Fox Theatre in Detroit, Michigan, on July 31, 2019. \u003ccite>(Jim Watson/AFP/Getty Images)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>The first portion of the debate focused heavily on health care, with Biden and Harris sparring over their competing proposals. But neither candidate seemed as fluent talking about the complicated policy issue as Sens. Elizabeth Warren and Bernie Sanders did Tuesday night.\u003c/p>\n\u003cp>Still, Harris did land some punches. She \u003ca href=\"https://www.vox.com/2019/7/29/8933257/kamala-harris-medicare-for-all-bernie-sanders-private-insurance\">unveiled her own health care plan this week\u003c/a> — a proposal she calls “Medicare for All,” but that would still include private insurers — and spent a significant amount of time attacking Biden for his more \u003ca href=\"https://www.vox.com/2019/7/16/20694598/joe-biden-health-care-plan-public-option\">modest proposal,\u003c/a> which would keep the current health care structure in place but let people buy into a public option.\u003c/p>\n\u003cp>“Your plan does not cover everyone in America — by your staff’s, and everyone’s, definition — 10 million people will not have access to health care,” Harris told Biden. “In 2018, in America, for a Democrat to be running on a health care plan that doesn’t cover everyone is without excuse.”\u003c/p>\n\u003cp>[pullquote size='small' align='right' citation='U.S. Sen. Kamala Harris']‘I think you can judge people by when they are under fire and it’s not about some fancy opinion on a stage, but when they’re in the position to actually make a decision — what do they do.’[/pullquote]Harris, as she did in the last debate, also sought to rise above the rest of the field as they bickered. This time, it was during the health care debate when she told the other candidates, “We cannot keep going with the Republican talking points on this. You gotta stop.”\u003c/p>\n\u003cp>Biden pushed back: “This is not a Republican talking point; Republicans are trying to kill Obamacare.”\u003c/p>\n\u003cp>Harris also found herself on the defensive over her record as a prosecutor and California attorney general, with both Biden and Hawaii Rep. Tulsi Gabbard taking her to task over problems that arose during her tenure — like a \u003ca href=\"https://www.washingtonpost.com/politics/crime-lab-scandal-rocked-kamala-harriss-term-as-san-francisco-district-attorney/2019/03/06/825df094-392b-11e9-a06c-3ec8ed509d15_story.html?utm_term=.9b3cfde54ca0\">drug lab scandal\u003c/a> that resulted in hundreds of criminal cases being dismissed.\u003c/p>\n\u003cp>[aside tag='election-2020' label='Election 2020 Coverage']But it was Gabbard’s accusation that Harris “blocked evidence from being revealed” in a death row case — an apparent reference to the Kevin Cooper appeals — that led the California senator to push back.\u003c/p>\n\u003cp>Harris said she has been opposed to the death penalty her entire career.\u003c/p>\n\u003cp>“That is my background, that is my work. I am proud of it. I think you can judge people by when they are under fire and it’s not about some fancy opinion on a stage, but when they’re in the position to actually make a decision — what do they do,” she said. “When I was in the position of having to decide whether or not to seek a death penalty on cases I prosecuted, I made a very difficult decision that was not popular to not seek the death penalty.”\u003c/p>\n\u003cp>Overall, Harris had a good night, but not a stellar one that could significantly change the tenor of the race in any significant way.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\u003c/p>\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>Harris, who is viewed as one of a few frontrunners in the crowded Democratic field, found herself at the center of the stage alongside former Vice President Joe Biden — and at the center of many attacks from her fellow Democrats on issues ranging from health care to her record as a prosecutor.\u003c/p>\n\u003cp>Biden, especially, came out swinging at Harris, a turnaround from his lackluster response to her attacks in the first debate in June.\u003c/p>\n\u003cp>“The senator has had several plans,” Biden said, referring to Harris’ flip-flopping on whether she supports eliminating private insurance coverage. “You can’t beat Donald Trump with double-talk on this.”\u003c/p>\n\u003cp>Harris — whose \u003ca href=\"https://www.kqed.org/news/11757814/kamala-harris-swings-at-joe-biden-while-eric-swalwell-strives-to-stand-out-in-democratic-debate\">standout performance\u003c/a> during the first debate boosted her poll numbers and breathed life into her campaign — appeared a bit nervous as the night began, but seemed to pick up steam as the debate wore on.\u003c/p>\n\u003cp>After greeting Biden casually — “Hey, Joe,” she said, with him responding, “Go easy on me, kid” — Harris quickly pivoted to attacking the vice president.\u003c/p>\n\u003cfigure id=\"attachment_11764808\" class=\"wp-caption alignnone\" style=\"max-width: 800px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-11764808\" src=\"https://ww2.kqed.org/news/wp-content/uploads/sites/10/2019/07/07312019_democratic-primary-debate_detroit_election-2020-qut-800x533.jpg\" alt=\"Democratic presidential hopefuls wave from the stage ahead of the second Democratic primary debate of the 2020 presidential campaign season hosted by CNN at the Fox Theatre in Detroit, Michigan, on July 31, 2019.\" width=\"800\" height=\"533\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2019/07/07312019_democratic-primary-debate_detroit_election-2020-qut-800x533.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2019/07/07312019_democratic-primary-debate_detroit_election-2020-qut-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2019/07/07312019_democratic-primary-debate_detroit_election-2020-qut-1020x680.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2019/07/07312019_democratic-primary-debate_detroit_election-2020-qut-1200x800.jpg 1200w, https://cdn.kqed.org/wp-content/uploads/sites/10/2019/07/07312019_democratic-primary-debate_detroit_election-2020-qut.jpg 1920w\" sizes=\"auto, (max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Democratic presidential hopefuls wave from the stage ahead of the second Democratic primary debate of the 2020 presidential campaign season hosted by CNN at the Fox Theatre in Detroit, Michigan, on July 31, 2019. \u003ccite>(Jim Watson/AFP/Getty Images)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>The first portion of the debate focused heavily on health care, with Biden and Harris sparring over their competing proposals. But neither candidate seemed as fluent talking about the complicated policy issue as Sens. Elizabeth Warren and Bernie Sanders did Tuesday night.\u003c/p>\n\u003cp>Still, Harris did land some punches. She \u003ca href=\"https://www.vox.com/2019/7/29/8933257/kamala-harris-medicare-for-all-bernie-sanders-private-insurance\">unveiled her own health care plan this week\u003c/a> — a proposal she calls “Medicare for All,” but that would still include private insurers — and spent a significant amount of time attacking Biden for his more \u003ca href=\"https://www.vox.com/2019/7/16/20694598/joe-biden-health-care-plan-public-option\">modest proposal,\u003c/a> which would keep the current health care structure in place but let people buy into a public option.\u003c/p>\n\u003cp>“Your plan does not cover everyone in America — by your staff’s, and everyone’s, definition — 10 million people will not have access to health care,” Harris told Biden. “In 2018, in America, for a Democrat to be running on a health care plan that doesn’t cover everyone is without excuse.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>Harris, as she did in the last debate, also sought to rise above the rest of the field as they bickered. This time, it was during the health care debate when she told the other candidates, “We cannot keep going with the Republican talking points on this. You gotta stop.”\u003c/p>\n\u003cp>Biden pushed back: “This is not a Republican talking point; Republicans are trying to kill Obamacare.”\u003c/p>\n\u003cp>Harris also found herself on the defensive over her record as a prosecutor and California attorney general, with both Biden and Hawaii Rep. Tulsi Gabbard taking her to task over problems that arose during her tenure — like a \u003ca href=\"https://www.washingtonpost.com/politics/crime-lab-scandal-rocked-kamala-harriss-term-as-san-francisco-district-attorney/2019/03/06/825df094-392b-11e9-a06c-3ec8ed509d15_story.html?utm_term=.9b3cfde54ca0\">drug lab scandal\u003c/a> that resulted in hundreds of criminal cases being dismissed.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>But it was Gabbard’s accusation that Harris “blocked evidence from being revealed” in a death row case — an apparent reference to the Kevin Cooper appeals — that led the California senator to push back.\u003c/p>\n\u003cp>Harris said she has been opposed to the death penalty her entire career.\u003c/p>\n\u003cp>“That is my background, that is my work. I am proud of it. I think you can judge people by when they are under fire and it’s not about some fancy opinion on a stage, but when they’re in the position to actually make a decision — what do they do,” she said. “When I was in the position of having to decide whether or not to seek a death penalty on cases I prosecuted, I made a very difficult decision that was not popular to not seek the death penalty.”\u003c/p>\n\u003cp>Overall, Harris had a good night, but not a stellar one that could significantly change the tenor of the race in any significant way.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cp>When Daniel Giles blinks, it looks like he might be wearing eye makeup. He has a tattoo across each of his eyelids that says “Born Dead.”\u003c/p>\n\u003cp>“It’s kind of like an existential reminder not to live in the past and to remember that I’m not always promised a tomorrow,” he says of his ink. “They’re a symbol of where I’ve been and what I’ve been through.”\u003c/p>\n\u003cp>[aside postID=\"news_11760625,news_11754493\" label=\"Related Coverage\"]\u003c/p>\n\u003cp>Giles was working in a redwood lumber mill in Humboldt County when his hand got crushed in an accident. He got hooked on the opiate pills the doctor prescribed for pain. Then he graduated to heroin. As he watched his friends overdose, he was afraid he was next.\u003c/p>\n\u003cp>But the drug treatment options there were slim. A friend told him about some great services in San Francisco.\u003c/p>\n\u003cp>“So I came down here. I raised a white flag of surrender, and I just came down here and checked myself in,” he says.\u003c/p>\n\u003cp>Giles has been in treatment since last November. San Francisco is one of the first counties in the state to roll out new updates to the Drug Medi-Cal program. Now the state gets more federal money to provide residential treatment for more people. But each county is responsible for running its own program. So while some bigger counties have gone all in, many rural counties, for financial or political reasons, have implemented the changes on a smaller scale; 18 opted out altogether.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>“That creates a really perverse incentive,” says Stanford psychiatry professor Keith Humphreys, warning that some counties could exploit others’ willingness to act by doing nothing.\u003c/p>\n\u003cp>In Santa Clara County, where he lives, services are so generous that patients refer to it as Santa Claus County.\u003c/p>\n\u003cp>“So if you are a county that decides to invest a lot in addiction and mental health, does that lead other counties to say, ‘Why don’t we just give people bus tickets, rather than putting up our own money?’ ” Humphreys says.\u003c/p>\n\u003cp>[pullquote size=\"medium\" align=\"right\" citation=\"Keith Humphreys, Stanford University psychiatry professor \"]“So if you are a county that decides to invest a lot in addiction and mental health, does that lead other counties to say, ‘Why don’t we just give people bus tickets, rather than putting up our own money?’ “[/pullquote]\u003c/p>\n\u003cp>San Francisco was afraid of this. It considered a rule that said people who wanted to come here for treatment had to establish residency in the county first. That can take 60 days.\u003c/p>\n\u003cp>Treatment providers flipped.\u003c/p>\n\u003cp>“They could die! They could literally die between today and tomorrow,” says Vitka Eisen, CEO of HealthRIGHT 360, which has been testing the new Drug Medi-Cal program at its treatment centers in San Francisco for two years.\u003c/p>\n\u003cp>“A person who comes in for substance use disorder treatment today needs it today,” she says. “Because if they don’t, if we put any barrier up, they’re not going to get that treatment. What they might do is go around the corner and use drugs.”\u003c/p>\n\u003cp>In the end, San Francisco decided to admit people from other counties into residential treatment right away, as long as they agree to transfer their Medi-Cal benefits from their home county to San Francisco. But the state doesn’t pay until the transfer goes through, leaving San Francisco on the hook for those bills during the 60-day interim.\u003c/p>\n\u003cp>It’s unclear if other counties in a similar position will be that generous.\u003c/p>\n\u003cp>[pullquote size=\"medium\" align=\"right\" citation=\"Vitka Eisen, CEO of HealthRIGHT 360\"]“A person who comes in for substance use disorder treatment today needs it today. Because if they don’t, if we put any barrier up, they’re not going to get that treatment. What they might do is go around the corner and use drugs.”[/pullquote]\u003c/p>\n\u003cp>“There’s a lot of both confusion and tension around this county-by-county thing, particularly services that not every county has, like methadone treatment for opioid addiction,” says Margaret Kisliuk, the behavioral health administrator at Partnership HealthPlan, the insurer that is working to implement the new Drug Medi-Cal program in rural counties in Northern California. “It’s really hard if some counties are in and some are out.”\u003c/p>\n\u003cp>Humboldt County has an aggressive plan to implement the new program, she says, but it hasn’t yet. So residential treatment wasn’t available to Daniel Giles there when he decided he was ready to get sober. But he says he didn’t really want to do it in Humboldt anyway.\u003c/p>\n\u003cp>“Because I had two years on the streets. I knew a lot of people, and I know myself,” Giles says. “So, when I got out I think that it would have been really hard for me to separate myself in a small town from the people I’d gotten to know.”\u003c/p>\n\u003cp>He was in treatment for seven months — three in intensive residential treatment and four in outpatient treatment while he lived in one of San Francisco’s county-funded transitional housing units. He says, for him, starting his life over was best to do someplace far from home.\u003c/p>\n\u003cp>\u003c/p>\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>“That creates a really perverse incentive,” says Stanford psychiatry professor Keith Humphreys, warning that some counties could exploit others’ willingness to act by doing nothing.\u003c/p>\n\u003cp>In Santa Clara County, where he lives, services are so generous that patients refer to it as Santa Claus County.\u003c/p>\n\u003cp>“So if you are a county that decides to invest a lot in addiction and mental health, does that lead other counties to say, ‘Why don’t we just give people bus tickets, rather than putting up our own money?’ ” Humphreys says.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>San Francisco was afraid of this. It considered a rule that said people who wanted to come here for treatment had to establish residency in the county first. That can take 60 days.\u003c/p>\n\u003cp>Treatment providers flipped.\u003c/p>\n\u003cp>“They could die! They could literally die between today and tomorrow,” says Vitka Eisen, CEO of HealthRIGHT 360, which has been testing the new Drug Medi-Cal program at its treatment centers in San Francisco for two years.\u003c/p>\n\u003cp>“A person who comes in for substance use disorder treatment today needs it today,” she says. “Because if they don’t, if we put any barrier up, they’re not going to get that treatment. What they might do is go around the corner and use drugs.”\u003c/p>\n\u003cp>In the end, San Francisco decided to admit people from other counties into residential treatment right away, as long as they agree to transfer their Medi-Cal benefits from their home county to San Francisco. But the state doesn’t pay until the transfer goes through, leaving San Francisco on the hook for those bills during the 60-day interim.\u003c/p>\n\u003cp>It’s unclear if other counties in a similar position will be that generous.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>“There’s a lot of both confusion and tension around this county-by-county thing, particularly services that not every county has, like methadone treatment for opioid addiction,” says Margaret Kisliuk, the behavioral health administrator at Partnership HealthPlan, the insurer that is working to implement the new Drug Medi-Cal program in rural counties in Northern California. “It’s really hard if some counties are in and some are out.”\u003c/p>\n\u003cp>Humboldt County has an aggressive plan to implement the new program, she says, but it hasn’t yet. So residential treatment wasn’t available to Daniel Giles there when he decided he was ready to get sober. But he says he didn’t really want to do it in Humboldt anyway.\u003c/p>\n\u003cp>“Because I had two years on the streets. I knew a lot of people, and I know myself,” Giles says. “So, when I got out I think that it would have been really hard for me to separate myself in a small town from the people I’d gotten to know.”\u003c/p>\n\u003cp>He was in treatment for seven months — three in intensive residential treatment and four in outpatient treatment while he lived in one of San Francisco’s county-funded transitional housing units. He says, for him, starting his life over was best to do someplace far from home.\u003c/p>\n\u003cp>\u003c/p>\n\u003c/div>\u003c/p>",
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"slug": "a-black-mother-told-not-to-scream-in-labor-asks-can-california-fix-racism-in-maternity-care",
"title": "A Black Mother Told Not to Scream in Labor Asks: Can California Fix Racism in Maternity Care?",
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"content": "\u003cp>Bettye Jean Ford was in her second trimester when the pressure she had been feeling in her abdomen for weeks turned to excruciating pain. She rushed to a Los Angeles emergency room, where she was diagnosed with a urinary tract infection and sent home with antibiotics. Still cramping severely, the first-time expectant mother spent the next 24 hours trying to sleep.\u003c/p>\n\u003cp>The next morning, her obstetrician found her dilated and sent her to the hospital next door where an ultrasound confirmed she was in labor. Rather than being admitted, she was sent back to the clinic with paperwork to finish.\u003c/p>\n\u003cp>Finally, at 23 weeks and six days, Ford gave birth to a premature baby girl while a nurse told her to close her mouth so as not to scream while pushing. After delivery, the new mother was sedated; her child, whom she had named Kally, had died by the time she awoke.\u003c/p>\n\u003cp>That was 2006. Since then, California has worked hard to improve health care for pregnant women—so hard, in fact, that the state is now often held up as a national success story in improving maternal outcomes.\u003c/p>\n\u003cp>But for African American mothers, that improvement has remained elusive. \u003ca href=\"https://www.youtube.com/watch?v=FSjHIr1Z7kc&feature=youtu.be\">Statewide\u003c/a> as well as \u003ca href=\"https://www.cdc.gov/mmwr/volumes/68/wr/mm6818e1.htm?s_cid=mm6818e1_w\">nationally\u003c/a>, black women are substantially more likely than white women to suffer life-threatening complications during pregnancy, give birth prematurely, die in childbirth and lose their babies.\u003c/p>\n\u003cp>\u003c!-- iframe plugin v.4.3 wordpress.org/plugins/iframe/ -->\u003cbr>\n\u003ciframe loading=\"lazy\" src=\"https://e.infogram.com/8e172bc0-8640-4937-9869-c974fddc198a?src=embed\" title=\"Maternal Morbidity\" width=\"800\" height=\"752\" scrolling=\"no\" frameborder=\"0\" style=\"border:none;\" allowfullscreen=\"allowfullscreen\" class=\"iframe-class\">\u003c/iframe>\u003cbr>\n Mortality rates among black infants in California are triple those of white infants, according to state birth records. California Department of Public Health statistics show the rate of preterm births among black mothers to be nearly twice that of white mothers, and the rate of maternal mortality to be quadruple, in part because of complications from underestimated or undiagnosed cardiovascular conditions.\u003c/p>\n\u003cp>A host of factors underlie this health gap, but studies consistently point to an ugly one: the persistence of racial bias in perinatal care \u003ca href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2847630/\">for women of color\u003c/a>.\u003c/p>\n\u003cp>[aside tag='childbirth' label='Maternity in California']Even when studies control for socioeconomic differences, the health care experience for black mothers is particularly—and often lethally—inadequate compared to that of other ethnic groups, not to mention traumatizing.\u003c/p>\n\u003cp>“Giving birth was horrible,” said Ford. “It was just an awful experience emotionally, physically.”\u003c/p>\n\u003cp>Democratic state Sen. Holly Mitchell—who represents Los Angeles, where Ford still lives—is carrying \u003ca href=\"https://leginfo.legislature.ca.gov/faces/billStatusClient.xhtml?bill_id=201920200SB464\">legislation\u003c/a> that would make California the first state to mandate implicit bias training for obstetricians, delivery nurses and other perinatal health care providers at hospitals and birthing centers. \u003ca href=\"https://leginfo.legislature.ca.gov/faces/billTextClient.xhtml?bill_id=201920200SB464\">Senate Bill 464\u003c/a> would require that providers be taught to spot bias, to communicate across identities and be educated on how racial bias impacts maternal and infant health.\u003c/p>\n\u003cp>Mitchell’s bill, called the Dignity in Pregnancy and Childbirth Act, would also require maternal deaths to be registered more consistently on death certificates by requiring coroners to list whether a woman was pregnant at the time of her death or in the year preceding.\u003c/p>\n\u003cp>Advocacy groups including \u003ca href=\"https://www.bwwla.org/aboutus/\">Black Women for Wellness\u003c/a> and\u003ca href=\"https://wclp.org/about-us/\"> The Western Center on Law and Poverty\u003c/a>, an anti-poverty organization, sponsored the bill after noticing how racial discrimination persists in medicine regardless of a patient’s ability to pay. The issue has also drawn national attention.\u003c/p>\n\u003cfigure id=\"attachment_11760930\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-11760930\" src=\"https://ww2.kqed.org/news/wp-content/uploads/sites/10/2019/07/RS38059_BLACK-MOTHERS-PHOTO-1-qut-800x533.jpg\" alt=\"\" width=\"800\" height=\"533\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2019/07/RS38059_BLACK-MOTHERS-PHOTO-1-qut-800x533.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2019/07/RS38059_BLACK-MOTHERS-PHOTO-1-qut-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2019/07/RS38059_BLACK-MOTHERS-PHOTO-1-qut-1020x680.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2019/07/RS38059_BLACK-MOTHERS-PHOTO-1-qut-1200x800.jpg 1200w, https://cdn.kqed.org/wp-content/uploads/sites/10/2019/07/RS38059_BLACK-MOTHERS-PHOTO-1-qut.jpg 1920w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Bettye Jean Ford holds the tiny urn containing the ashes of her first child Kally. Complications Ford says she wasn’t warned of resulted in a birth so premature that the child died within hours. \u003ccite>(Iris Schneider/CALmatters)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Tennis star \u003ca href=\"https://www.cnn.com/2018/02/20/opinions/protect-mother-pregnancy-williams-opinion/index.html\">Serena Williams\u003c/a> underscored the dangers facing pregnant black women in sharing her labor and delivery experience. Singer Beyoncé echoed her concerns. And in Congress, California Sen. Kamala Harris, a presidential contender, has proposed the \u003ca href=\"https://www.harris.senate.gov/imo/media/doc/ERN18510.pdf\">Maternal Care Access and Reducing Emergencies (CARE) Act\u003c/a>, which would provide $125 million to train for the detection of high-risk pregnancies.\u003c/p>\n\u003cp>Nourbese Flint, policy director at Black Women for Wellness, said supporters of SB 464 drew inspiration in part from Harris’ legislation. Just as civil rights advocates have initiated tough conversations about race in the classroom or in the criminal justice system, she said, moms and nurses believe it’s time to have “the talk” about the doctor’s office.\u003c/p>\n\u003cp>“Delivering a baby is probably a moment in time when you feel the most vulnerable,” Mitchell said. “And to have to layer on top concerns about whether or not your health care provider sees you, hears you, listens to you—is an unfair burden black women are bearing.”\u003c/p>\n\u003cp>Though the bill has influential supporters, including nurses and MomsRising, a multicultural organization with more than 1 million members, physicians say the bill is too abstract and unwieldy to implement.\u003c/p>\n\u003cp>“It’s not a question of whether this training is needed, just how best to do it,” said Anthony York, spokesman for the influential California Medical Association.\u003c/p>\n\u003cp>\u003c!-- iframe plugin v.4.3 wordpress.org/plugins/iframe/ -->\u003cbr>\n\u003ciframe loading=\"lazy\" src=\"https://e.infogram.com/b5579ce1-479e-4be4-b5d1-f4570b28592c?src=embed\" title=\"Physicians by race\" width=\"800\" height=\"817\" scrolling=\"no\" frameborder=\"0\" style=\"border:none;\" allowfullscreen=\"allowfullscreen\" class=\"iframe-class\">\u003c/iframe>\u003cbr>\n Doctors don’t dispute there’s discrimination. A \u003ca href=\"https://www.pnas.org/content/113/16/4296\">2016 University of Virginia\u003c/a> study found biological myths about black patients still persist among white medical students, such as the notions that African Americans have less sensitive nerve endings, can tolerate more pain and have thicker skin. In other \u003ca href=\"https://www.medscape.com/features/slideshow/lifestyle/2017/womens-health#page=11\">surveys\u003c/a>, one in seven ob/gyns said that a patient’s race impacted treatment.\u003c/p>\n\u003cp>But while the California Hospital Association supported the bill after requesting technical changes, doctors have called Mitchell’s bill unenforceable since \u003ca href=\"https://calmatters.org/economy/2019/06/california-dynamex-gig-worker-classification-independent-contractors-uber-lyft-strippers-truckers-freelancers/\">physicians are not employees\u003c/a>.\u003c/p>\n\u003cp>Researchers agree that a physicans’ employment status is an obstacle.\u003c/p>\n\u003cp>[pullquote size='medium' align='right' citation='Monica McLemore, reproductive health researcher at UCSF']‘I think we’ve done a real disservice where you have a health care workforce that does not live, work, play, pray, thrive in the same communities where they actually provide care.’[/pullquote] Doctors throughout the state contract with hospitals so they don’t receive the same oversight or accountability as an employee would, and they cannot be disciplined or rewarded for biased care, said Monica McLemore, a reproductive health researcher at University of California, San Francisco, who has focused on \u003ca href=\"https://reproductive-health-journal.biomedcentral.com/track/pdf/10.1186/s12978-019-0729-2\">inequality and mistreatment during pregnancy and childbirth\u003c/a>.\u003c/p>\n\u003cp>“The same institutions and mechanisms that we use for accountability within organizations don’t exist for contract individuals,” she said. “There’s no established mechanisms to be able to enforce whether or not individuals actually deal with their own bias.”\u003c/p>\n\u003cp>McLemore said that, despite the legislation’s good intentions, it’s naive to believe systemic change will occur by leaving the implementation of implicit bias training up to health care facilities. A better solution, she said, would be more diversity in the health care workforce, with a push similar to campaigns for more \u003ca href=\"https://hechingerreport.org/whats-wrong-white-teachers/\">teachers who reflect the students in their classrooms.\u003c/a>\u003c/p>\n\u003cp>[ad fullwidth]\u003cbr>\nA 2018 \u003ca href=\"https://www.chcf.org/wp-content/uploads/2018/06/CAPhysicianSupply2018.pdf\">report\u003c/a> by the California Health Care Foundation found that Latinos and African Americans are profoundly underrepresented in the state’s physician workforce. Latinos, for instance, make up 38% of California’s population but only 5% of the state’s active physicians. African Americans make up 3% of the physician workforce, compared to 6% of the state population. And while the proportion of white doctors largely mirrors the rest of the state, Asians are overly represented in the field, with twice their share of the population.\u003c/p>\n\u003cp>“I think we’ve done a real disservice where you have a health care workforce that does not live, work, play, pray, thrive in the same communities where they actually provide care,” McLemore said.\u003c/p>\n\u003cp>And without buy-in from doctors, advocates say, California will continue to have a tough time making experiences like Ford’s a thing of the past for women of all races.\u003c/p>\n\u003cfigure id=\"attachment_11760958\" class=\"wp-caption alignnone\" style=\"max-width: 800px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-11760958\" src=\"https://ww2.kqed.org/news/wp-content/uploads/sites/10/2019/07/RS38061_BLACK-MOTHERS-PHOTO-3-qut-800x533.jpg\" alt=\"\" width=\"800\" height=\"533\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2019/07/RS38061_BLACK-MOTHERS-PHOTO-3-qut-800x533.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2019/07/RS38061_BLACK-MOTHERS-PHOTO-3-qut-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2019/07/RS38061_BLACK-MOTHERS-PHOTO-3-qut-1020x680.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2019/07/RS38061_BLACK-MOTHERS-PHOTO-3-qut-1200x800.jpg 1200w, https://cdn.kqed.org/wp-content/uploads/sites/10/2019/07/RS38061_BLACK-MOTHERS-PHOTO-3-qut.jpg 1920w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Bettye Jean Ford at home with her 11-year-old daughter, Skylar, June 21, 2019. Skylar was born a year and a day after the due date of Ford’s first child. \u003ccite>(Iris Schneider/CALmatters)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Since the\u003ca href=\"https://www.cmqcc.org/who-we-are\"> California Maternal Quality of Care Collaborative\u003c/a> was adopted in 2006 to improve health outcomes for mothers and infants in California, the overall maternal mortality rate in the state has declined 55%—far better than most of the U.S. In 2017, the national maternal mortality rate was 21.6 deaths per 100,000 live births compared to 8.7 deaths per 100,000 live births in California.\u003c/p>\n\u003cp>Women of color, however, continue to face worse outcomes.\u003c/p>\n\u003cp>“While we have been somewhat successful, we can’t really be jumping for joy yet,” said Holly Smith of the California Nurse-Midwives Association, which supports mandating racial bias training.\u003c/p>\n\u003cp>During Ford’s preterm delivery, for example, she was unaware that black women are \u003ca href=\"http://www.nationalpartnership.org/our-work/health/reports/black-womens-maternal-health.html\">three times more likely\u003c/a> than white women to have fibroids, which can have a harmful impact on \u003ca href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3874080/\">fertility and pregnancy\u003c/a>. Ford said her doctor never warned her that the ones resting on her uterus could complicate her own childbirth.\u003c/p>\n\u003cp>[aside tag='women-of-color' label='More on women of color']\u003c/p>\n\u003cp>When Ford did get pregnant again, she took extra precautions fearing she would have to relive her trauma. It wasn’t until she was 27 weeks along that she and her husband felt comfortable enough to bring the crib intended for her first daughter back into their home.\u003c/p>\n\u003cp>A year and one day after Kally’s due date, Ford gave birth to her daughter Skylar, who is now 11.\u003c/p>\n\u003cp>“I really appreciate every day with my daughter,” says the therapist, who sought help to cope with her own grief and anger. “But I have a niece and a goddaughter who were born right around the time that Kally was born. So watching the three of these girls grow up, I always have this feeling of like there should be one more.”\u003c/p>\n\u003cp>Her first born, she said, is never far from memory. Her remains rest in a tiny urn at Ford’s home.\u003c/p>\n\u003cp>\u003ca href=\"http://calmatters.org/\">\u003cem>CALmatters.org\u003c/em>\u003c/a>\u003cem> is a nonprofit, nonpartisan media venture explaining California policies and politics.\u003c/em>\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n",
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"title": "A Black Mother Told Not to Scream in Labor Asks: Can California Fix Racism in Maternity Care? | KQED",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Bettye Jean Ford was in her second trimester when the pressure she had been feeling in her abdomen for weeks turned to excruciating pain. She rushed to a Los Angeles emergency room, where she was diagnosed with a urinary tract infection and sent home with antibiotics. Still cramping severely, the first-time expectant mother spent the next 24 hours trying to sleep.\u003c/p>\n\u003cp>The next morning, her obstetrician found her dilated and sent her to the hospital next door where an ultrasound confirmed she was in labor. Rather than being admitted, she was sent back to the clinic with paperwork to finish.\u003c/p>\n\u003cp>Finally, at 23 weeks and six days, Ford gave birth to a premature baby girl while a nurse told her to close her mouth so as not to scream while pushing. After delivery, the new mother was sedated; her child, whom she had named Kally, had died by the time she awoke.\u003c/p>\n\u003cp>That was 2006. Since then, California has worked hard to improve health care for pregnant women—so hard, in fact, that the state is now often held up as a national success story in improving maternal outcomes.\u003c/p>\n\u003cp>But for African American mothers, that improvement has remained elusive. \u003ca href=\"https://www.youtube.com/watch?v=FSjHIr1Z7kc&feature=youtu.be\">Statewide\u003c/a> as well as \u003ca href=\"https://www.cdc.gov/mmwr/volumes/68/wr/mm6818e1.htm?s_cid=mm6818e1_w\">nationally\u003c/a>, black women are substantially more likely than white women to suffer life-threatening complications during pregnancy, give birth prematurely, die in childbirth and lose their babies.\u003c/p>\n\u003cp>\u003c!-- iframe plugin v.4.3 wordpress.org/plugins/iframe/ -->\u003cbr>\n\u003ciframe loading=\"lazy\" src=\"https://e.infogram.com/8e172bc0-8640-4937-9869-c974fddc198a?src=embed\" title=\"Maternal Morbidity\" width=\"800\" height=\"752\" scrolling=\"no\" frameborder=\"0\" style=\"border:none;\" allowfullscreen=\"allowfullscreen\" class=\"iframe-class\">\u003c/iframe>\u003cbr>\n Mortality rates among black infants in California are triple those of white infants, according to state birth records. California Department of Public Health statistics show the rate of preterm births among black mothers to be nearly twice that of white mothers, and the rate of maternal mortality to be quadruple, in part because of complications from underestimated or undiagnosed cardiovascular conditions.\u003c/p>\n\u003cp>A host of factors underlie this health gap, but studies consistently point to an ugly one: the persistence of racial bias in perinatal care \u003ca href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2847630/\">for women of color\u003c/a>.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>Even when studies control for socioeconomic differences, the health care experience for black mothers is particularly—and often lethally—inadequate compared to that of other ethnic groups, not to mention traumatizing.\u003c/p>\n\u003cp>“Giving birth was horrible,” said Ford. “It was just an awful experience emotionally, physically.”\u003c/p>\n\u003cp>Democratic state Sen. Holly Mitchell—who represents Los Angeles, where Ford still lives—is carrying \u003ca href=\"https://leginfo.legislature.ca.gov/faces/billStatusClient.xhtml?bill_id=201920200SB464\">legislation\u003c/a> that would make California the first state to mandate implicit bias training for obstetricians, delivery nurses and other perinatal health care providers at hospitals and birthing centers. \u003ca href=\"https://leginfo.legislature.ca.gov/faces/billTextClient.xhtml?bill_id=201920200SB464\">Senate Bill 464\u003c/a> would require that providers be taught to spot bias, to communicate across identities and be educated on how racial bias impacts maternal and infant health.\u003c/p>\n\u003cp>Mitchell’s bill, called the Dignity in Pregnancy and Childbirth Act, would also require maternal deaths to be registered more consistently on death certificates by requiring coroners to list whether a woman was pregnant at the time of her death or in the year preceding.\u003c/p>\n\u003cp>Advocacy groups including \u003ca href=\"https://www.bwwla.org/aboutus/\">Black Women for Wellness\u003c/a> and\u003ca href=\"https://wclp.org/about-us/\"> The Western Center on Law and Poverty\u003c/a>, an anti-poverty organization, sponsored the bill after noticing how racial discrimination persists in medicine regardless of a patient’s ability to pay. The issue has also drawn national attention.\u003c/p>\n\u003cfigure id=\"attachment_11760930\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-11760930\" src=\"https://ww2.kqed.org/news/wp-content/uploads/sites/10/2019/07/RS38059_BLACK-MOTHERS-PHOTO-1-qut-800x533.jpg\" alt=\"\" width=\"800\" height=\"533\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2019/07/RS38059_BLACK-MOTHERS-PHOTO-1-qut-800x533.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2019/07/RS38059_BLACK-MOTHERS-PHOTO-1-qut-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2019/07/RS38059_BLACK-MOTHERS-PHOTO-1-qut-1020x680.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2019/07/RS38059_BLACK-MOTHERS-PHOTO-1-qut-1200x800.jpg 1200w, https://cdn.kqed.org/wp-content/uploads/sites/10/2019/07/RS38059_BLACK-MOTHERS-PHOTO-1-qut.jpg 1920w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Bettye Jean Ford holds the tiny urn containing the ashes of her first child Kally. Complications Ford says she wasn’t warned of resulted in a birth so premature that the child died within hours. \u003ccite>(Iris Schneider/CALmatters)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Tennis star \u003ca href=\"https://www.cnn.com/2018/02/20/opinions/protect-mother-pregnancy-williams-opinion/index.html\">Serena Williams\u003c/a> underscored the dangers facing pregnant black women in sharing her labor and delivery experience. Singer Beyoncé echoed her concerns. And in Congress, California Sen. Kamala Harris, a presidential contender, has proposed the \u003ca href=\"https://www.harris.senate.gov/imo/media/doc/ERN18510.pdf\">Maternal Care Access and Reducing Emergencies (CARE) Act\u003c/a>, which would provide $125 million to train for the detection of high-risk pregnancies.\u003c/p>\n\u003cp>Nourbese Flint, policy director at Black Women for Wellness, said supporters of SB 464 drew inspiration in part from Harris’ legislation. Just as civil rights advocates have initiated tough conversations about race in the classroom or in the criminal justice system, she said, moms and nurses believe it’s time to have “the talk” about the doctor’s office.\u003c/p>\n\u003cp>“Delivering a baby is probably a moment in time when you feel the most vulnerable,” Mitchell said. “And to have to layer on top concerns about whether or not your health care provider sees you, hears you, listens to you—is an unfair burden black women are bearing.”\u003c/p>\n\u003cp>Though the bill has influential supporters, including nurses and MomsRising, a multicultural organization with more than 1 million members, physicians say the bill is too abstract and unwieldy to implement.\u003c/p>\n\u003cp>“It’s not a question of whether this training is needed, just how best to do it,” said Anthony York, spokesman for the influential California Medical Association.\u003c/p>\n\u003cp>\u003c!-- iframe plugin v.4.3 wordpress.org/plugins/iframe/ -->\u003cbr>\n\u003ciframe loading=\"lazy\" src=\"https://e.infogram.com/b5579ce1-479e-4be4-b5d1-f4570b28592c?src=embed\" title=\"Physicians by race\" width=\"800\" height=\"817\" scrolling=\"no\" frameborder=\"0\" style=\"border:none;\" allowfullscreen=\"allowfullscreen\" class=\"iframe-class\">\u003c/iframe>\u003cbr>\n Doctors don’t dispute there’s discrimination. A \u003ca href=\"https://www.pnas.org/content/113/16/4296\">2016 University of Virginia\u003c/a> study found biological myths about black patients still persist among white medical students, such as the notions that African Americans have less sensitive nerve endings, can tolerate more pain and have thicker skin. In other \u003ca href=\"https://www.medscape.com/features/slideshow/lifestyle/2017/womens-health#page=11\">surveys\u003c/a>, one in seven ob/gyns said that a patient’s race impacted treatment.\u003c/p>\n\u003cp>But while the California Hospital Association supported the bill after requesting technical changes, doctors have called Mitchell’s bill unenforceable since \u003ca href=\"https://calmatters.org/economy/2019/06/california-dynamex-gig-worker-classification-independent-contractors-uber-lyft-strippers-truckers-freelancers/\">physicians are not employees\u003c/a>.\u003c/p>\n\u003cp>Researchers agree that a physicans’ employment status is an obstacle.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp> Doctors throughout the state contract with hospitals so they don’t receive the same oversight or accountability as an employee would, and they cannot be disciplined or rewarded for biased care, said Monica McLemore, a reproductive health researcher at University of California, San Francisco, who has focused on \u003ca href=\"https://reproductive-health-journal.biomedcentral.com/track/pdf/10.1186/s12978-019-0729-2\">inequality and mistreatment during pregnancy and childbirth\u003c/a>.\u003c/p>\n\u003cp>“The same institutions and mechanisms that we use for accountability within organizations don’t exist for contract individuals,” she said. “There’s no established mechanisms to be able to enforce whether or not individuals actually deal with their own bias.”\u003c/p>\n\u003cp>McLemore said that, despite the legislation’s good intentions, it’s naive to believe systemic change will occur by leaving the implementation of implicit bias training up to health care facilities. A better solution, she said, would be more diversity in the health care workforce, with a push similar to campaigns for more \u003ca href=\"https://hechingerreport.org/whats-wrong-white-teachers/\">teachers who reflect the students in their classrooms.\u003c/a>\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cbr>\nA 2018 \u003ca href=\"https://www.chcf.org/wp-content/uploads/2018/06/CAPhysicianSupply2018.pdf\">report\u003c/a> by the California Health Care Foundation found that Latinos and African Americans are profoundly underrepresented in the state’s physician workforce. Latinos, for instance, make up 38% of California’s population but only 5% of the state’s active physicians. African Americans make up 3% of the physician workforce, compared to 6% of the state population. And while the proportion of white doctors largely mirrors the rest of the state, Asians are overly represented in the field, with twice their share of the population.\u003c/p>\n\u003cp>“I think we’ve done a real disservice where you have a health care workforce that does not live, work, play, pray, thrive in the same communities where they actually provide care,” McLemore said.\u003c/p>\n\u003cp>And without buy-in from doctors, advocates say, California will continue to have a tough time making experiences like Ford’s a thing of the past for women of all races.\u003c/p>\n\u003cfigure id=\"attachment_11760958\" class=\"wp-caption alignnone\" style=\"max-width: 800px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-11760958\" src=\"https://ww2.kqed.org/news/wp-content/uploads/sites/10/2019/07/RS38061_BLACK-MOTHERS-PHOTO-3-qut-800x533.jpg\" alt=\"\" width=\"800\" height=\"533\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2019/07/RS38061_BLACK-MOTHERS-PHOTO-3-qut-800x533.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2019/07/RS38061_BLACK-MOTHERS-PHOTO-3-qut-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2019/07/RS38061_BLACK-MOTHERS-PHOTO-3-qut-1020x680.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2019/07/RS38061_BLACK-MOTHERS-PHOTO-3-qut-1200x800.jpg 1200w, https://cdn.kqed.org/wp-content/uploads/sites/10/2019/07/RS38061_BLACK-MOTHERS-PHOTO-3-qut.jpg 1920w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Bettye Jean Ford at home with her 11-year-old daughter, Skylar, June 21, 2019. Skylar was born a year and a day after the due date of Ford’s first child. \u003ccite>(Iris Schneider/CALmatters)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Since the\u003ca href=\"https://www.cmqcc.org/who-we-are\"> California Maternal Quality of Care Collaborative\u003c/a> was adopted in 2006 to improve health outcomes for mothers and infants in California, the overall maternal mortality rate in the state has declined 55%—far better than most of the U.S. In 2017, the national maternal mortality rate was 21.6 deaths per 100,000 live births compared to 8.7 deaths per 100,000 live births in California.\u003c/p>\n\u003cp>Women of color, however, continue to face worse outcomes.\u003c/p>\n\u003cp>“While we have been somewhat successful, we can’t really be jumping for joy yet,” said Holly Smith of the California Nurse-Midwives Association, which supports mandating racial bias training.\u003c/p>\n\u003cp>During Ford’s preterm delivery, for example, she was unaware that black women are \u003ca href=\"http://www.nationalpartnership.org/our-work/health/reports/black-womens-maternal-health.html\">three times more likely\u003c/a> than white women to have fibroids, which can have a harmful impact on \u003ca href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3874080/\">fertility and pregnancy\u003c/a>. Ford said her doctor never warned her that the ones resting on her uterus could complicate her own childbirth.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>When Ford did get pregnant again, she took extra precautions fearing she would have to relive her trauma. It wasn’t until she was 27 weeks along that she and her husband felt comfortable enough to bring the crib intended for her first daughter back into their home.\u003c/p>\n\u003cp>A year and one day after Kally’s due date, Ford gave birth to her daughter Skylar, who is now 11.\u003c/p>\n\u003cp>“I really appreciate every day with my daughter,” says the therapist, who sought help to cope with her own grief and anger. “But I have a niece and a goddaughter who were born right around the time that Kally was born. So watching the three of these girls grow up, I always have this feeling of like there should be one more.”\u003c/p>\n\u003cp>Her first born, she said, is never far from memory. Her remains rest in a tiny urn at Ford’s home.\u003c/p>\n\u003cp>\u003ca href=\"http://calmatters.org/\">\u003cem>CALmatters.org\u003c/em>\u003c/a>\u003cem> is a nonprofit, nonpartisan media venture explaining California policies and politics.\u003c/em>\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cp>A controversial ballot measure that would give San Franciscans universal mental health care is being pushed from the November 2019 ballot to the March 2020 ballot to give lawmakers more time to come to an agreement as to how it should be implemented.\u003c/p>\n\u003cp>\u003ca href=\"https://sfgov.legistar.com/View.ashx?M=F&ID=7293146&GUID=0878CB8C-6BDA-4380-A39B-5F88AF974CD1\">The measure\u003c/a>, dubbed “Mental Health SF”, was announced in May. After the announcement, Mayor London Breed and the San Francisco Department of Public Health, which would be in charge of implementing the program, expressed concern about the high costs of implementation and a lack of input from the city’s health experts.\u003c/p>\n\u003cp>Now it seems that all parties are working together to come up with a compromise for the March 2020 ballot. \u003c/p>\n\u003cp>“It is important that we take a comprehensive, inclusive process to build on the progress we have made to strengthen our mental health system,” Breed said in a press release. She also emphasized the advancements already made this year including the passing of a contentious conservatorship law and the opening of 200 new behavioral health beds. \u003c/p>\n\u003cp>If passed by residents, the program would provide free and immediate access to mental health care to San Franciscans with or without insurance. It would also require the creation of a new 24 hours a day, 7 days a week drop-in center for people seeking psychological help or help with substance abuse. \u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>The city controller and city’s economist gave preliminary numbers that annual costs would be as high as $100 million per year, not including start-up costs for building the drop-in center. \u003c/p>\n\u003cp>San Francisco Supervisor Hillary Ronen says she’s hopeful but not positive that the supervisors will come to a consensus with the mayor and DPH about how to address the problem, although they plan to meet weekly to negotiate.\u003c/p>\n\u003cp>[aside tag=\"mental-health-sf\" label=\"More on Mental Health SF.\"]\u003c/p>\n\u003cp>Ronen said she didn’t initially consult with the DPH because in early hearings about the problem, representatives were initially “obfuscating and denying that the problem was as grave as it is.”\u003c/p>\n\u003cp>She said if the supervisors can’t come to a consensus, she and Supervisor Matt Haney, the co-author of the bill, will still put the measure on the ballot.\u003c/p>\n\u003cp>Ultimately Ronen said the legislation is crucially important to address San Francisco’s mental health and homelessness crisis, and the delay is necessary to get the bill right. \u003c/p>\n\u003cp>“What we’re proposing is a complete overhaul and creation of a new universal system, and that doesn’t happen overnight,” she said. \u003c/p>\n\u003cp>The measure would be financed through the city’s proposed Excessive CEO Salary Tax — another ballot measure that would be imposed on CEOs making more than 100 times the median wage worker. That proposal will also be on the March 2020 ballot, having been moved from the November 2019 ballot. \u003c/p>\n\u003cp>\u003c/p>\n\u003cp>The San Francisco Chamber of Commerce didn’t immediately respond to a request for comment on the Excessive CEO Salary Tax. \u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>A controversial ballot measure that would give San Franciscans universal mental health care is being pushed from the November 2019 ballot to the March 2020 ballot to give lawmakers more time to come to an agreement as to how it should be implemented.\u003c/p>\n\u003cp>\u003ca href=\"https://sfgov.legistar.com/View.ashx?M=F&ID=7293146&GUID=0878CB8C-6BDA-4380-A39B-5F88AF974CD1\">The measure\u003c/a>, dubbed “Mental Health SF”, was announced in May. After the announcement, Mayor London Breed and the San Francisco Department of Public Health, which would be in charge of implementing the program, expressed concern about the high costs of implementation and a lack of input from the city’s health experts.\u003c/p>\n\u003cp>Now it seems that all parties are working together to come up with a compromise for the March 2020 ballot. \u003c/p>\n\u003cp>“It is important that we take a comprehensive, inclusive process to build on the progress we have made to strengthen our mental health system,” Breed said in a press release. She also emphasized the advancements already made this year including the passing of a contentious conservatorship law and the opening of 200 new behavioral health beds. \u003c/p>\n\u003cp>If passed by residents, the program would provide free and immediate access to mental health care to San Franciscans with or without insurance. It would also require the creation of a new 24 hours a day, 7 days a week drop-in center for people seeking psychological help or help with substance abuse. \u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Ronen said she didn’t initially consult with the DPH because in early hearings about the problem, representatives were initially “obfuscating and denying that the problem was as grave as it is.”\u003c/p>\n\u003cp>She said if the supervisors can’t come to a consensus, she and Supervisor Matt Haney, the co-author of the bill, will still put the measure on the ballot.\u003c/p>\n\u003cp>Ultimately Ronen said the legislation is crucially important to address San Francisco’s mental health and homelessness crisis, and the delay is necessary to get the bill right. \u003c/p>\n\u003cp>“What we’re proposing is a complete overhaul and creation of a new universal system, and that doesn’t happen overnight,” she said. \u003c/p>\n\u003cp>The measure would be financed through the city’s proposed Excessive CEO Salary Tax — another ballot measure that would be imposed on CEOs making more than 100 times the median wage worker. That proposal will also be on the March 2020 ballot, having been moved from the November 2019 ballot. \u003c/p>\n\u003cp>\u003c/p>\n\u003cp>The San Francisco Chamber of Commerce didn’t immediately respond to a request for comment on the Excessive CEO Salary Tax. \u003c/p>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>Telehealth turned Jill Hill’s life around.\u003c/p>\n\u003cp>The 63-year-old lives on the edge of rural Grass Valley, an old mining town in the Sierra Nevada foothills of northern California. She was devastated after her husband Dennis passed away in the fall of 2014 after a long series of medical and financial setbacks.\u003c/p>\n\u003cp>“I was grief-stricken and my self-esteem was down,” Hill remembers. “I didn’t care about myself. I didn’t brush my hair. I was isolated. I just kind of locked myself in the bedroom.”\u003c/p>\n\u003cp>Hill says knew she needed therapy to deal with her deepening depression. But the main health center in her rural town had just two therapists. Hill was told she’d only be able to see a therapist once a month.\u003c/p>\n\u003cp>Then, Brandy Hartsgrove called to say Hill was eligible via MediCal (California’s version of Medicaid) for a program that could offer her 30-minute video counseling sessions twice a week. The sessions would be via a computer screen with a therapist who was hundreds of miles south, in San Diego.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Hartsgrove co-ordinates telehealth for the \u003ca href=\"https://chapa-de.org/\" target=\"_blank\" rel=\"noopener\">Chapa-de Indian Health Clinic\u003c/a>, which is a 10-minute drive from Hills’s home. Hill would sit in a comfy chair facing a screen in a small private room, Hartsgrove explained, to see and talk with her counselor in an otherwise traditional therapy session.\u003c/p>\n\u003cp>Hill thought it sounded “a bit impersonal;” but was desperate for the counseling. She agreed to give it a try.\u003c/p>\n\u003cfigure id=\"attachment_11759542\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-11759542\" src=\"https://ww2.kqed.org/news/wp-content/uploads/sites/10/2019/07/20190627_npr_telemedicine_029_a-copy_custom-f3228875c407b98325b47961a319f0152f6037f1-s800-c85-800x532.jpg\" alt=\"\" width=\"800\" height=\"532\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2019/07/20190627_npr_telemedicine_029_a-copy_custom-f3228875c407b98325b47961a319f0152f6037f1-s800-c85.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2019/07/20190627_npr_telemedicine_029_a-copy_custom-f3228875c407b98325b47961a319f0152f6037f1-s800-c85-160x106.jpg 160w\" sizes=\"auto, (max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Coordinator Brandy Hartsgrove demonstrates how the telehealth connection works at The Chapa-de Indian Health Clinic in Grass Valley, Calif. Via this video screen, patients can consult doctors hundreds of miles away. \u003ccite>(Salgu Wissmath for NPR)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Hill is one of a growing number of Americans turning to telehealth appointments with medical providers in the wake of widespread hospital closings in remote communities, and a shortage of local primary care doctors, specialists and other providers.\u003c/p>\n\u003cp>Long-distance doctor-to-doctor consultations via video also fall under the “telehealth” or “telemedicine” rubric.\u003c/p>\n\u003cp>A recent NPR poll of rural Americans found that nearly a quarter have used some kind of telehealth service within the past few years; 14% say they received a diagnosis or treatment from a doctor or other health care professional using email, text messaging, live text chat, a mobile app, or a live video like FaceTime or Skype. And 15% say they have received a diagnosis or treatment from a doctor or other health professional over the phone.\u003c/p>\n\u003cp>\u003ca href=\"https://apps.npr.org/dailygraphics/graphics/rural-telehealth-20190517?mode=childlink&utm_source=nprnews&utm_medium=app&utm_campaign=storyredirect\">\u003cem>\u003cstrong>Don’t see the graphic above? Click here.\u003c/strong>\u003c/em>\u003c/a>\u003c/p>\n\u003cp>Those survey findings are part of the second of \u003ca href=\"https://media.npr.org/documents/2019/may/NPR-RWJF-HARVARD_Rural_Poll_Part_2.pdf\" target=\"_blank\" rel=\"noopener\">two recent polls on rural life and health\u003c/a> conducted by NPR, the Robert Wood Johnson Foundation and the Harvard T.H. Chan School of Public Health.\u003c/p>\n\u003cp>The Chapa-de clinic offers telehealth services not only for consultations in behavioral health and psychiatry, but also in cardiology, nephrology, dermatology, endocrinology, gastroenterology and more.\u003c/p>\n\u003cfigure id=\"attachment_11759543\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-11759543\" src=\"https://ww2.kqed.org/news/wp-content/uploads/sites/10/2019/07/20190627_npr_telemedicine_085_a-copy_custom-1a637914e39a25b065a49562157a54ac7fdeb747-s800-c85-800x532.jpg\" alt=\"The Chapa-de Indian Health Clinic building.\" width=\"800\" height=\"532\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2019/07/20190627_npr_telemedicine_085_a-copy_custom-1a637914e39a25b065a49562157a54ac7fdeb747-s800-c85.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2019/07/20190627_npr_telemedicine_085_a-copy_custom-1a637914e39a25b065a49562157a54ac7fdeb747-s800-c85-160x106.jpg 160w\" sizes=\"auto, (max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">The Chapa-de Indian Health Clinic in Grass Valley, Calif., offers telehealth services for various specialties, including dermatology, gastroenterology and psychiatry. \u003ccite>(Salgu Wissmath for NPR)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Hill feels fortunate; she knows most rural health facilities don’t include telehealth services, which means most patients living in remote areas would need their own broadband internet access at home to get therapy online.\u003c/p>\n\u003cp>And that’s out of reach for many, says \u003ca href=\"https://www.hsph.harvard.edu/robert-blendon/\" target=\"_blank\" rel=\"noopener\">Robert J. Blendon\u003c/a>, co-director of NPR’s poll and professor of health policy and political analysis at the Harvard Chan School.\u003c/p>\n\u003cp>The poll found that one in five rural Americans say getting access to high-speed internet is a problem for their families.\u003c/p>\n\u003cp>Blendon says advances in online technology have brought a “revolution” in healthcare that has left many rural patients behind.\u003c/p>\n\u003cp>“They lose the ability to contact their physicians, fill prescriptions and get follow-up information without having to go see a health professional,” he says.\u003c/p>\n\u003cp>Critical care pediatrician \u003ca href=\"https://health.ucdavis.edu/publish/providerbio/children/516\" target=\"_blank\" rel=\"noopener\">James Marcin\u003c/a> at UC Davis Children’s Hospital, directs the University of California, Davis, Center for Health and Technology and regularly consults via a telehealth monitor with primary care doctors in remote hospitals in rural areas.\u003c/p>\n\u003cp>“We’re able to put the telemedicine cart [virtually] at the patient’s bedside,” Marcin says, “and within minutes our physicians are able to see the child and talk with the family members and help assist in the care that way.”\u003c/p>\n\u003cp>If not for telehealth, Marcin says, the costs of getting what should be routine care “are significant barriers for those living in rural communities.”\u003c/p>\n\u003cp>“We have patients that drive to our Sacramento offices and they have to drive the night before,” he says, “and spend the night in a hotel because it’s a five-hour trip each way.” And there are additional costs for many patients, he says, such as childcare services, and missed days of work.\u003c/p>\n\u003cp>With telehealth, “a video is truly worth a thousand words,” he says; it can mean patients don’t have to make costly time-consuming trips to see a specialist.\u003c/p>\n\u003cp>Though Hill initially had reservations about meeting with a therapist online, she says she’s been amazed by how helpful the sessions have been.\u003c/p>\n\u003cp>“She gives me assignments and works me really hard,” Hill says, “and I have grown so much — especially just in the last few months.”\u003c/p>\n\u003cp>Her latest assignment in therapy: writing down positive characteristics of herself. Initially, she could only come up with three: loyalty, compassion and resilience. But the therapist questioned that, and encouraged Hill to consider that there might be more.\u003c/p>\n\u003cfigure id=\"attachment_11759544\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-11759544\" src=\"https://ww2.kqed.org/news/wp-content/uploads/sites/10/2019/07/20190627_npr_telemedicine_220_a_custom-38c1aa4ffa8a0888af2fd48aee63e1b05914c810-s800-c85-800x532.jpg\" alt=\"Jill Hill in a harden is touching tall pink flowers.\" width=\"800\" height=\"532\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2019/07/20190627_npr_telemedicine_220_a_custom-38c1aa4ffa8a0888af2fd48aee63e1b05914c810-s800-c85.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2019/07/20190627_npr_telemedicine_220_a_custom-38c1aa4ffa8a0888af2fd48aee63e1b05914c810-s800-c85-160x106.jpg 160w\" sizes=\"auto, (max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Hill says she’s in a ‘super growth” mode these days psychologically, and says the support she’s received in therapy has been key to that. She speaks with a clinical psychologist via a telehealth session twice a week for 30 minutes, and completes assigned homework in between those appointments. \u003ccite>(Salgu Wissmath for NPR)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>“She wanted 10,” says Hill, who proceeded to work through some other issues and talk more with therapist. “Now I’ve got like 15 at least,” Hill says, “and I keep adding to the list; once I started writing things down, I started really seeing that I have a lot of strengths I didn’t even know I had.”\u003c/p>\n\u003cp>Attorney \u003ca href=\"https://www.telehealthpolicy.us/about/staff\" target=\"_blank\" rel=\"noopener\">Mei Kwong\u003c/a>, executive director of the Center for Connected Health Policy in Sacramento, says telehealth services have the potential to remove many barriers to good health care in rural America.\u003c/p>\n\u003cp>But policies that regulate which telehealth services get paid for “lag way behind the technology,” Kwong says. Many policies are 10 to 15 years behind what the technology is able to do, she says.\u003c/p>\n\u003cp>For example, high-resolution photos can now be taken – and sent anywhere digitally — of skin conditions that many doctors say are better than “the naked eye looking at the condition,” she says. But the policies on the books of what Medicare, Medicaid and private insurers will pay for often means these services are not fully covered.\u003c/p>\n\u003cp>That’s unfortunate, Kwong says, especially for underserved communities where there is a shortage of specialists.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>Changes are starting to be made in state, federal and private insurance policies, Kwong says. But it’s “slow going.”\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2019 NPR. To see more, visit https://www.npr.org.\u003cimg decoding=\"async\" src=\"https://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=With+Rural+Health+Care+Stretched+Thin%2C+More+Patients+Turn+To+Telehealth+&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Telehealth turned Jill Hill’s life around.\u003c/p>\n\u003cp>The 63-year-old lives on the edge of rural Grass Valley, an old mining town in the Sierra Nevada foothills of northern California. She was devastated after her husband Dennis passed away in the fall of 2014 after a long series of medical and financial setbacks.\u003c/p>\n\u003cp>“I was grief-stricken and my self-esteem was down,” Hill remembers. “I didn’t care about myself. I didn’t brush my hair. I was isolated. I just kind of locked myself in the bedroom.”\u003c/p>\n\u003cp>Hill says knew she needed therapy to deal with her deepening depression. But the main health center in her rural town had just two therapists. Hill was told she’d only be able to see a therapist once a month.\u003c/p>\n\u003cp>Then, Brandy Hartsgrove called to say Hill was eligible via MediCal (California’s version of Medicaid) for a program that could offer her 30-minute video counseling sessions twice a week. The sessions would be via a computer screen with a therapist who was hundreds of miles south, in San Diego.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Hartsgrove co-ordinates telehealth for the \u003ca href=\"https://chapa-de.org/\" target=\"_blank\" rel=\"noopener\">Chapa-de Indian Health Clinic\u003c/a>, which is a 10-minute drive from Hills’s home. Hill would sit in a comfy chair facing a screen in a small private room, Hartsgrove explained, to see and talk with her counselor in an otherwise traditional therapy session.\u003c/p>\n\u003cp>Hill thought it sounded “a bit impersonal;” but was desperate for the counseling. She agreed to give it a try.\u003c/p>\n\u003cfigure id=\"attachment_11759542\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-11759542\" src=\"https://ww2.kqed.org/news/wp-content/uploads/sites/10/2019/07/20190627_npr_telemedicine_029_a-copy_custom-f3228875c407b98325b47961a319f0152f6037f1-s800-c85-800x532.jpg\" alt=\"\" width=\"800\" height=\"532\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2019/07/20190627_npr_telemedicine_029_a-copy_custom-f3228875c407b98325b47961a319f0152f6037f1-s800-c85.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2019/07/20190627_npr_telemedicine_029_a-copy_custom-f3228875c407b98325b47961a319f0152f6037f1-s800-c85-160x106.jpg 160w\" sizes=\"auto, (max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Coordinator Brandy Hartsgrove demonstrates how the telehealth connection works at The Chapa-de Indian Health Clinic in Grass Valley, Calif. Via this video screen, patients can consult doctors hundreds of miles away. \u003ccite>(Salgu Wissmath for NPR)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Hill is one of a growing number of Americans turning to telehealth appointments with medical providers in the wake of widespread hospital closings in remote communities, and a shortage of local primary care doctors, specialists and other providers.\u003c/p>\n\u003cp>Long-distance doctor-to-doctor consultations via video also fall under the “telehealth” or “telemedicine” rubric.\u003c/p>\n\u003cp>A recent NPR poll of rural Americans found that nearly a quarter have used some kind of telehealth service within the past few years; 14% say they received a diagnosis or treatment from a doctor or other health care professional using email, text messaging, live text chat, a mobile app, or a live video like FaceTime or Skype. And 15% say they have received a diagnosis or treatment from a doctor or other health professional over the phone.\u003c/p>\n\u003cp>\u003ca href=\"https://apps.npr.org/dailygraphics/graphics/rural-telehealth-20190517?mode=childlink&utm_source=nprnews&utm_medium=app&utm_campaign=storyredirect\">\u003cem>\u003cstrong>Don’t see the graphic above? Click here.\u003c/strong>\u003c/em>\u003c/a>\u003c/p>\n\u003cp>Those survey findings are part of the second of \u003ca href=\"https://media.npr.org/documents/2019/may/NPR-RWJF-HARVARD_Rural_Poll_Part_2.pdf\" target=\"_blank\" rel=\"noopener\">two recent polls on rural life and health\u003c/a> conducted by NPR, the Robert Wood Johnson Foundation and the Harvard T.H. Chan School of Public Health.\u003c/p>\n\u003cp>The Chapa-de clinic offers telehealth services not only for consultations in behavioral health and psychiatry, but also in cardiology, nephrology, dermatology, endocrinology, gastroenterology and more.\u003c/p>\n\u003cfigure id=\"attachment_11759543\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-11759543\" src=\"https://ww2.kqed.org/news/wp-content/uploads/sites/10/2019/07/20190627_npr_telemedicine_085_a-copy_custom-1a637914e39a25b065a49562157a54ac7fdeb747-s800-c85-800x532.jpg\" alt=\"The Chapa-de Indian Health Clinic building.\" width=\"800\" height=\"532\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2019/07/20190627_npr_telemedicine_085_a-copy_custom-1a637914e39a25b065a49562157a54ac7fdeb747-s800-c85.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2019/07/20190627_npr_telemedicine_085_a-copy_custom-1a637914e39a25b065a49562157a54ac7fdeb747-s800-c85-160x106.jpg 160w\" sizes=\"auto, (max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">The Chapa-de Indian Health Clinic in Grass Valley, Calif., offers telehealth services for various specialties, including dermatology, gastroenterology and psychiatry. \u003ccite>(Salgu Wissmath for NPR)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Hill feels fortunate; she knows most rural health facilities don’t include telehealth services, which means most patients living in remote areas would need their own broadband internet access at home to get therapy online.\u003c/p>\n\u003cp>And that’s out of reach for many, says \u003ca href=\"https://www.hsph.harvard.edu/robert-blendon/\" target=\"_blank\" rel=\"noopener\">Robert J. Blendon\u003c/a>, co-director of NPR’s poll and professor of health policy and political analysis at the Harvard Chan School.\u003c/p>\n\u003cp>The poll found that one in five rural Americans say getting access to high-speed internet is a problem for their families.\u003c/p>\n\u003cp>Blendon says advances in online technology have brought a “revolution” in healthcare that has left many rural patients behind.\u003c/p>\n\u003cp>“They lose the ability to contact their physicians, fill prescriptions and get follow-up information without having to go see a health professional,” he says.\u003c/p>\n\u003cp>Critical care pediatrician \u003ca href=\"https://health.ucdavis.edu/publish/providerbio/children/516\" target=\"_blank\" rel=\"noopener\">James Marcin\u003c/a> at UC Davis Children’s Hospital, directs the University of California, Davis, Center for Health and Technology and regularly consults via a telehealth monitor with primary care doctors in remote hospitals in rural areas.\u003c/p>\n\u003cp>“We’re able to put the telemedicine cart [virtually] at the patient’s bedside,” Marcin says, “and within minutes our physicians are able to see the child and talk with the family members and help assist in the care that way.”\u003c/p>\n\u003cp>If not for telehealth, Marcin says, the costs of getting what should be routine care “are significant barriers for those living in rural communities.”\u003c/p>\n\u003cp>“We have patients that drive to our Sacramento offices and they have to drive the night before,” he says, “and spend the night in a hotel because it’s a five-hour trip each way.” And there are additional costs for many patients, he says, such as childcare services, and missed days of work.\u003c/p>\n\u003cp>With telehealth, “a video is truly worth a thousand words,” he says; it can mean patients don’t have to make costly time-consuming trips to see a specialist.\u003c/p>\n\u003cp>Though Hill initially had reservations about meeting with a therapist online, she says she’s been amazed by how helpful the sessions have been.\u003c/p>\n\u003cp>“She gives me assignments and works me really hard,” Hill says, “and I have grown so much — especially just in the last few months.”\u003c/p>\n\u003cp>Her latest assignment in therapy: writing down positive characteristics of herself. Initially, she could only come up with three: loyalty, compassion and resilience. But the therapist questioned that, and encouraged Hill to consider that there might be more.\u003c/p>\n\u003cfigure id=\"attachment_11759544\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-11759544\" src=\"https://ww2.kqed.org/news/wp-content/uploads/sites/10/2019/07/20190627_npr_telemedicine_220_a_custom-38c1aa4ffa8a0888af2fd48aee63e1b05914c810-s800-c85-800x532.jpg\" alt=\"Jill Hill in a harden is touching tall pink flowers.\" width=\"800\" height=\"532\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2019/07/20190627_npr_telemedicine_220_a_custom-38c1aa4ffa8a0888af2fd48aee63e1b05914c810-s800-c85.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2019/07/20190627_npr_telemedicine_220_a_custom-38c1aa4ffa8a0888af2fd48aee63e1b05914c810-s800-c85-160x106.jpg 160w\" sizes=\"auto, (max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Hill says she’s in a ‘super growth” mode these days psychologically, and says the support she’s received in therapy has been key to that. She speaks with a clinical psychologist via a telehealth session twice a week for 30 minutes, and completes assigned homework in between those appointments. \u003ccite>(Salgu Wissmath for NPR)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>“She wanted 10,” says Hill, who proceeded to work through some other issues and talk more with therapist. “Now I’ve got like 15 at least,” Hill says, “and I keep adding to the list; once I started writing things down, I started really seeing that I have a lot of strengths I didn’t even know I had.”\u003c/p>\n\u003cp>Attorney \u003ca href=\"https://www.telehealthpolicy.us/about/staff\" target=\"_blank\" rel=\"noopener\">Mei Kwong\u003c/a>, executive director of the Center for Connected Health Policy in Sacramento, says telehealth services have the potential to remove many barriers to good health care in rural America.\u003c/p>\n\u003cp>But policies that regulate which telehealth services get paid for “lag way behind the technology,” Kwong says. Many policies are 10 to 15 years behind what the technology is able to do, she says.\u003c/p>\n\u003cp>For example, high-resolution photos can now be taken – and sent anywhere digitally — of skin conditions that many doctors say are better than “the naked eye looking at the condition,” she says. But the policies on the books of what Medicare, Medicaid and private insurers will pay for often means these services are not fully covered.\u003c/p>\n\u003cp>That’s unfortunate, Kwong says, especially for underserved communities where there is a shortage of specialists.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Changes are starting to be made in state, federal and private insurance policies, Kwong says. But it’s “slow going.”\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2019 NPR. To see more, visit https://www.npr.org.\u003cimg decoding=\"async\" src=\"https://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=With+Rural+Health+Care+Stretched+Thin%2C+More+Patients+Turn+To+Telehealth+&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n\u003c/div>\u003c/p>",
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"title": "California Pays $60 Million in Student Loan Debt of Doctors Who Agree to Treat Poorer Patients",
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"content": "\u003cp>It’s a trade aimed at getting more doctors to treat poorer patients: California this week said it will help repay the student loans of 247 selected doctors in exchange for their promise that at least 30% of their caseload will be people enrolled in Medi-Cal.\u003c/p>\n\u003cp>The $60 million student loan repayment, \u003ca href=\"http://www.calhealthcares.org/\" target=\"_blank\" rel=\"noopener\">CalHealthCares\u003c/a>, is funded by the state tobacco tax that voters increased three years ago.\u003c/p>\n\u003cp>It’s all part of California’s effort to try to increase the number of doctors who accept Medi-Cal, the state’s Medicaid health insurer of low-income residents, which has been plagued by shortages — due both to the state’s paltry rates for doctors in its provider network and to the substantial increase in the number of residents on Medi-Cal. California has one of the \u003ca href=\"https://www.pewtrusts.org/en/research-and-analysis/blogs/stateline/2017/09/22/are-medicaids-payment-rates-so-low-theyre-discriminatory\" target=\"_blank\" rel=\"noopener\">lowest\u003c/a> Medicaid reimbursement rates in the country, and patients wait months, or longer, to see specialists.\u003c/p>\n\u003cp>[pullquote]The $60 million student loan repayment, CalHealthCares, is funded by the state tobacco tax that voters increased three years ago.[/pullquote]\u003c/p>\n\u003cp>“I wouldn’t say that with a loan repayment you’re necessarily earning as much as you would if you’re working for Kaiser or Sutter,” \u003ca href=\"https://profiles.ucsf.edu/janet.coffman\" target=\"_self\" rel=\"noopener\">Janet Coffman\u003c/a>, a professor in the \u003ca href=\"https://healthpolicy.ucsf.edu/philip-r-lee-institute-health-policy-studies\" target=\"_self\" rel=\"noopener\">Philip R. Lee Institute for Health Policy Studies\u003c/a> at UCSF, told the \u003ca href=\"https://www.sacbee.com/news/local/health-and-medicine/article232264972.html\" target=\"_blank\" rel=\"noopener\">Sacramento Bee\u003c/a>. “But it can be the difference that enables folks to say, ‘OK, if I get this loan repayment in addition to salary, I can see my way to work in an urban or rural underserved community.’ ”\u003c/p>\n\u003cp>More than 1,300 doctors and medical residents applied for the benefit, which provides up to $300,000 over five years (the time of the commitment), and those selected were chosen based on their commitment to treat the underserved, their geographic location and their specialties.\u003c/p>\n\u003cp>Selected doctors included pediatricians, psychiatrists and obstetricians/gynecologists, and work in settings from community clinics to private practices.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>“By removing the burden of student loan debt, this program will encourage more providers to make different choices when entering the health care market and be able to provide care for the Medi-Cal population,” said Jennifer Kent, director of the state Department of Health Care Services, which is administering the program.\u003c/p>\n\u003cp>[aside tag='medi-cal' label='More Coverage of Medi-Cal']\u003c/p>\n\u003cp>Research indicates that debt is a major concern for physicians nationwide: A 2017 survey by an affiliate of the American Medical Association found that half owed $200,000 or more in medical school loans.\u003c/p>\n\u003cp>In California, the passage of the federal Affordable Care Act and the expansion of Medi-Cal eligibility brought more than 4 million new enrollees to the program. Three years ago, California opened the program to undocumented children, adding more than 200,000 to the benefit, and is now poised to add nearly 100,000 undocumented adults ages 19 to 25 under the new budget enacted by Gov. Gavin Newsom and the Legislature. This year, 1 in 3 Californians are on Medi-Cal. It pays for half of all births in the state, and 58% of all long-term care stays.\u003c/p>\n\u003cp>This is the first doctor group to receive funding from the $340 million fund created by Proposition 56 tobacco tax revenue. The state expects there will be at least five more rounds of awards.\u003c/p>\n\u003cp>Later this summer, the state will announce awards for dentists who applied to participate in the loan repayment program for serving Denti-Cal patients.\u003c/p>\n\u003cp>\u003c/p>\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>It’s a trade aimed at getting more doctors to treat poorer patients: California this week said it will help repay the student loans of 247 selected doctors in exchange for their promise that at least 30% of their caseload will be people enrolled in Medi-Cal.\u003c/p>\n\u003cp>The $60 million student loan repayment, \u003ca href=\"http://www.calhealthcares.org/\" target=\"_blank\" rel=\"noopener\">CalHealthCares\u003c/a>, is funded by the state tobacco tax that voters increased three years ago.\u003c/p>\n\u003cp>It’s all part of California’s effort to try to increase the number of doctors who accept Medi-Cal, the state’s Medicaid health insurer of low-income residents, which has been plagued by shortages — due both to the state’s paltry rates for doctors in its provider network and to the substantial increase in the number of residents on Medi-Cal. California has one of the \u003ca href=\"https://www.pewtrusts.org/en/research-and-analysis/blogs/stateline/2017/09/22/are-medicaids-payment-rates-so-low-theyre-discriminatory\" target=\"_blank\" rel=\"noopener\">lowest\u003c/a> Medicaid reimbursement rates in the country, and patients wait months, or longer, to see specialists.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>“I wouldn’t say that with a loan repayment you’re necessarily earning as much as you would if you’re working for Kaiser or Sutter,” \u003ca href=\"https://profiles.ucsf.edu/janet.coffman\" target=\"_self\" rel=\"noopener\">Janet Coffman\u003c/a>, a professor in the \u003ca href=\"https://healthpolicy.ucsf.edu/philip-r-lee-institute-health-policy-studies\" target=\"_self\" rel=\"noopener\">Philip R. Lee Institute for Health Policy Studies\u003c/a> at UCSF, told the \u003ca href=\"https://www.sacbee.com/news/local/health-and-medicine/article232264972.html\" target=\"_blank\" rel=\"noopener\">Sacramento Bee\u003c/a>. “But it can be the difference that enables folks to say, ‘OK, if I get this loan repayment in addition to salary, I can see my way to work in an urban or rural underserved community.’ ”\u003c/p>\n\u003cp>More than 1,300 doctors and medical residents applied for the benefit, which provides up to $300,000 over five years (the time of the commitment), and those selected were chosen based on their commitment to treat the underserved, their geographic location and their specialties.\u003c/p>\n\u003cp>Selected doctors included pediatricians, psychiatrists and obstetricians/gynecologists, and work in settings from community clinics to private practices.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Research indicates that debt is a major concern for physicians nationwide: A 2017 survey by an affiliate of the American Medical Association found that half owed $200,000 or more in medical school loans.\u003c/p>\n\u003cp>In California, the passage of the federal Affordable Care Act and the expansion of Medi-Cal eligibility brought more than 4 million new enrollees to the program. Three years ago, California opened the program to undocumented children, adding more than 200,000 to the benefit, and is now poised to add nearly 100,000 undocumented adults ages 19 to 25 under the new budget enacted by Gov. Gavin Newsom and the Legislature. This year, 1 in 3 Californians are on Medi-Cal. It pays for half of all births in the state, and 58% of all long-term care stays.\u003c/p>\n\u003cp>This is the first doctor group to receive funding from the $340 million fund created by Proposition 56 tobacco tax revenue. The state expects there will be at least five more rounds of awards.\u003c/p>\n\u003cp>Later this summer, the state will announce awards for dentists who applied to participate in the loan repayment program for serving Denti-Cal patients.\u003c/p>\n\u003cp>\u003c/p>\n\u003c/div>\u003c/p>",
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"content": "\u003cp>Alzheimer’s disease begins altering the brain long before it affects memory and thinking.\u003c/p>\n\u003cp>So scientists are developing a range of tests to detect these changes in the brain, which include an increase in toxic proteins, inflammation and damage to the connections between brain cells.\u003c/p>\n\u003cp>The tests \u003ca href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3078627/\">rely on biomarkers\u003c/a>, shorthand for biological markers, that signal steps along the progression of disease. These new tests are already making Alzheimer’s diagnosis more accurate and helping pharmaceutical companies test new drugs.\u003c/p>\n\u003cp>“For the future, we hope that we might be able to use these biomarkers in order to stop or delay the memory changes from ever happening,” says \u003ca href=\"https://www.alz.org/press/spokespeople/maria_c_carrillo_ph_d\">Maria Carrillo\u003c/a>, chief science officer of the Alzheimer’s Association. (The association is a recent NPR sponsor.)\u003c/p>\n\u003cp>The first Alzheimer’s biomarker test was approved by the Food and Drug Administration in 2012.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>It’s a dye called \u003ca href=\"https://www.accessdata.fda.gov/drugsatfda_docs/nda/2012/202008_Florbetapir_Orig1s000TOC.cfm\">Amyvid\u003c/a> that reveals clumps of a protein called amyloid. These amyloid plaques are a hallmark of Alzheimer’s.\u003c/p>\n\u003cp>Before Amyvid came along, diagnosing the disease involved a lot of guesswork, says \u003ca href=\"https://www.alzdiscovery.org/about-addf/staff\">Dr. Howard Fillit\u003c/a>, founding executive director and chief science officer at the Alzheimer’s Drug Discovery Foundation.\u003c/p>\n\u003cp>“I can now send a patient down the block to the radiology office and within 24 hours with 98% certainty I can tell people if they have Alzheimer’s disease,” Fillit says.\u003c/p>\n\u003cp>The test costs thousands of dollars, though, in part because it requires a \u003ca href=\"https://www.cancer.gov/publications/dictionaries/cancer-terms/def/pet-scan\">PET scan\u003c/a> of the brain. Also, Amyvid reveals only amyloid plaques, which are just one of the brain changes associated with Alzheimer’s.\u003c/p>\n\u003cp>So the Alzheimer’s Drug Discovery Foundation has launched an \u003ca href=\"https://www.alzdiscovery.org/research-and-grants/diagnostics-accelerator\">effort\u003c/a> to speed up the development of biomarkers that are cheaper and detect a wider range of brain changes.\u003c/p>\n\u003cp>One promising test detects the protein tau, which causes toxic tangles to form inside brain cells.\u003c/p>\n\u003cp>“The tangles represent the dying neurons,” Fillit says, which means a biomarker for tau could make diagnosing Alzheimer’s even more accurate. It could also help pharmaceutical companies assess experimental drugs meant to remove tau from the brain.\u003c/p>\n\u003cp>Several drug companies appear close to receiving FDA approval for injected dyes that reveal tau in patients who get PET scans.\u003c/p>\n\u003cp>[aside postID='news_11758552,news_11758605,news_11757925' label='Further Health Coverage']\u003c/p>\n\u003cp>And eventually, scientists hope to use biomarkers in spinal fluid and blood to assess levels of both amyloid and tau in the brain. Those tests promise to be easier for patients, and less expensive to administer.\u003c/p>\n\u003cp>But even detecting amyloid and tau in the brain won’t be enough, Fillit says. People can have high levels of both and still do pretty well until something else shows up in the brain: inflammation.\u003c/p>\n\u003cp>“It’s like having the highest sensitivity computer up there and throwing coffee on it,” explains Fillit.\u003c/p>\n\u003cp>So researchers are working to identify biomarkers for inflammation.\u003c/p>\n\u003cp>They’re also working on a biomarker that indicates the health of synapses, the connections between brain cells.\u003c/p>\n\u003cp>Weakening synapses are one of the surest signs of Alzheimer’s, Fillit says. “So we’re funding a clinical trial at a company that is going to use this biomarker as a measure of how well their drug is preserving synapses in the hippocampus of people with Alzheimer’s disease.”\u003c/p>\n\u003cp>Biomarkers for Alzheimer’s are still a work in progress. For example, they will have to be tested in many different populations.\u003c/p>\n\u003cp>“What may represent as a biomarker in one population may not actually hold true in another, and we’ve seen this in other diseases,” says the Alzheimer Association’s Carrillo.\u003c/p>\n\u003cp>Also, biomarkers still don’t offer a reliable way to measure a person’s mental function. They only reveal the brain changes that are associated with loss of memory and difficulty thinking.\u003c/p>\n\u003cp>Even so, over time the arrival of new markers should make treating Alzheimer’s more like treating other diseases, Carrillo says.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>“We treat high cholesterol to reduce the risk of that heart attack,” she says. And someday it may be possible to reduce the risk of dementia by treating high levels of amyloid, tau or inflammation in the brain.\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2019 NPR. To see more, visit https://www.npr.org.\u003cimg decoding=\"async\" src=\"https://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=New+Markers+For+Alzheimer%27s+Disease+Could+Aid+Diagnosis+And+Speed+Up+Drug+Development&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Alzheimer’s disease begins altering the brain long before it affects memory and thinking.\u003c/p>\n\u003cp>So scientists are developing a range of tests to detect these changes in the brain, which include an increase in toxic proteins, inflammation and damage to the connections between brain cells.\u003c/p>\n\u003cp>The tests \u003ca href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3078627/\">rely on biomarkers\u003c/a>, shorthand for biological markers, that signal steps along the progression of disease. These new tests are already making Alzheimer’s diagnosis more accurate and helping pharmaceutical companies test new drugs.\u003c/p>\n\u003cp>“For the future, we hope that we might be able to use these biomarkers in order to stop or delay the memory changes from ever happening,” says \u003ca href=\"https://www.alz.org/press/spokespeople/maria_c_carrillo_ph_d\">Maria Carrillo\u003c/a>, chief science officer of the Alzheimer’s Association. (The association is a recent NPR sponsor.)\u003c/p>\n\u003cp>The first Alzheimer’s biomarker test was approved by the Food and Drug Administration in 2012.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>It’s a dye called \u003ca href=\"https://www.accessdata.fda.gov/drugsatfda_docs/nda/2012/202008_Florbetapir_Orig1s000TOC.cfm\">Amyvid\u003c/a> that reveals clumps of a protein called amyloid. These amyloid plaques are a hallmark of Alzheimer’s.\u003c/p>\n\u003cp>Before Amyvid came along, diagnosing the disease involved a lot of guesswork, says \u003ca href=\"https://www.alzdiscovery.org/about-addf/staff\">Dr. Howard Fillit\u003c/a>, founding executive director and chief science officer at the Alzheimer’s Drug Discovery Foundation.\u003c/p>\n\u003cp>“I can now send a patient down the block to the radiology office and within 24 hours with 98% certainty I can tell people if they have Alzheimer’s disease,” Fillit says.\u003c/p>\n\u003cp>The test costs thousands of dollars, though, in part because it requires a \u003ca href=\"https://www.cancer.gov/publications/dictionaries/cancer-terms/def/pet-scan\">PET scan\u003c/a> of the brain. Also, Amyvid reveals only amyloid plaques, which are just one of the brain changes associated with Alzheimer’s.\u003c/p>\n\u003cp>So the Alzheimer’s Drug Discovery Foundation has launched an \u003ca href=\"https://www.alzdiscovery.org/research-and-grants/diagnostics-accelerator\">effort\u003c/a> to speed up the development of biomarkers that are cheaper and detect a wider range of brain changes.\u003c/p>\n\u003cp>One promising test detects the protein tau, which causes toxic tangles to form inside brain cells.\u003c/p>\n\u003cp>“The tangles represent the dying neurons,” Fillit says, which means a biomarker for tau could make diagnosing Alzheimer’s even more accurate. It could also help pharmaceutical companies assess experimental drugs meant to remove tau from the brain.\u003c/p>\n\u003cp>Several drug companies appear close to receiving FDA approval for injected dyes that reveal tau in patients who get PET scans.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>And eventually, scientists hope to use biomarkers in spinal fluid and blood to assess levels of both amyloid and tau in the brain. Those tests promise to be easier for patients, and less expensive to administer.\u003c/p>\n\u003cp>But even detecting amyloid and tau in the brain won’t be enough, Fillit says. People can have high levels of both and still do pretty well until something else shows up in the brain: inflammation.\u003c/p>\n\u003cp>“It’s like having the highest sensitivity computer up there and throwing coffee on it,” explains Fillit.\u003c/p>\n\u003cp>So researchers are working to identify biomarkers for inflammation.\u003c/p>\n\u003cp>They’re also working on a biomarker that indicates the health of synapses, the connections between brain cells.\u003c/p>\n\u003cp>Weakening synapses are one of the surest signs of Alzheimer’s, Fillit says. “So we’re funding a clinical trial at a company that is going to use this biomarker as a measure of how well their drug is preserving synapses in the hippocampus of people with Alzheimer’s disease.”\u003c/p>\n\u003cp>Biomarkers for Alzheimer’s are still a work in progress. For example, they will have to be tested in many different populations.\u003c/p>\n\u003cp>“What may represent as a biomarker in one population may not actually hold true in another, and we’ve seen this in other diseases,” says the Alzheimer Association’s Carrillo.\u003c/p>\n\u003cp>Also, biomarkers still don’t offer a reliable way to measure a person’s mental function. They only reveal the brain changes that are associated with loss of memory and difficulty thinking.\u003c/p>\n\u003cp>Even so, over time the arrival of new markers should make treating Alzheimer’s more like treating other diseases, Carrillo says.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>“We treat high cholesterol to reduce the risk of that heart attack,” she says. And someday it may be possible to reduce the risk of dementia by treating high levels of amyloid, tau or inflammation in the brain.\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2019 NPR. To see more, visit https://www.npr.org.\u003cimg decoding=\"async\" src=\"https://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=New+Markers+For+Alzheimer%27s+Disease+Could+Aid+Diagnosis+And+Speed+Up+Drug+Development&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n\u003c/div>\u003c/p>",
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"title": "California's First Surgeon General Spotlights Health Risks of Childhood Adversity",
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"content": "\u003cp>Not long after she finished her medical residency at Stanford University about a decade ago, Nadine Burke Harris got to work as a pediatrician in the \u003ca href=\"https://www.youtube.com/watch?time_continue=336&v=ozflNOVzd6w\" target=\"_blank\" rel=\"noopener\">Bayview-Hunters Point\u003c/a> neighborhood of San Francisco. She \u003ca href=\"https://centerforyouthwellness.org/about-us/\" target=\"_blank\" rel=\"noopener\">founded and became CEO of a clinic\u003c/a> there, focused on addressing health disparities in the community.\u003c/p>\n\u003cp>It was in talking with those children and their families, she says, that she first realized how many of her patients experiencing the worst health outcomes — those with the highest levels of chronic asthma, for example — were also living with significant adversity, such as growing up in a household where a parent was mentally ill, abusive or substance dependent.\u003c/p>\n\u003cp>[aside postID='news_11687798,news_11703271' label='Related Coverage']\u003c/p>\n\u003cp>Eventually, those conversations led her to the expanding research on \u003ca href=\"https://www.cdc.gov/violenceprevention/childabuseandneglect/acestudy/index.html\" target=\"_blank\" rel=\"noopener\">adverse childhood experiences\u003c/a>, or ACEs, and their \u003ca href=\"https://www.npr.org/sections/health-shots/2018/09/17/648710859/childhood-trauma-and-its-lifelong-health-effects-more-prevalent-among-minorities\" target=\"_blank\" rel=\"noopener\">profound, lifelong health effects\u003c/a>. The term “ACEs” has been used since the 1990s to describe the abuse, neglect and other potentially traumatic experiences estimated to afflict more than 34 million U.S. children under 18.\u003c/p>\n\u003cp>Burke Harris has dedicated much of her career to spreading the word to fellow doctors and the public about ACEs and the dangers of this toxic stress to children. She champions a multidisciplinary approach to helping these kids and teens.\u003c/p>\n\u003cp>In an \u003ca href=\"https://www.npr.org/sections/ed/2018/01/23/578280721/what-do-asthma-heart-disease-and-cancer-have-in-common-maybe-childhood-trauma\" target=\"_blank\" rel=\"noopener\">interview \u003c/a>last year, after \u003ca href=\"https://www.npr.org/books/titles/578679908/the-deepest-well-healing-the-long-term-effects-of-childhood-adversity\" target=\"_blank\" rel=\"noopener\">her book\u003c/a>, \u003cem>The Deepest Well: Healing the Long-Term Effects of Childhood Adversity, \u003c/em>was published,\u003cem> \u003c/em>Burke Harris told NPR’s Cory Turner, “We all need to be part of the solution. If we each take … our little piece, it’s nuts how far we’ll be able to go, together as a society, in terms of solving this problem.”\u003c/p>\n\u003cp>California Gov. Gavin Newsom took Burke Harris up on her challenge, appointing her the first-ever surgeon general of California. Newsom cites the toxic stress of childhood trauma as among the root causes “of many of the most harmful and persistent health challenges facing Californians.”\u003c/p>\n\u003cp>[aside label='Take the ACE Quiz' link1='https://www.npr.org/sections/health-shots/2015/03/02/387007941/take-the-ace-quiz-and-learn-what-it-does-and-doesnt-mean,Take The ACE Quiz and Learn What It Does And Does Not Mean']\u003c/p>\n\u003cp>NPR’s Erika Stallings recently spoke with Burke Harris about her work and about what it means to her, particularly as a black woman, to serve as her state’s first surgeon general — one of only three such positions in the United States.\u003c/p>\n\u003chr>\n\u003cp>\u003cstrong>Interview Highlights\u003c/strong>\u003c/p>\n\u003cp>\u003cstrong>On the role of racism and discrimination in high maternal mortality, particularly among black women, who are \u003c/strong>\u003ca href=\"https://www.cdc.gov/reproductivehealth/maternalinfanthealth/pregnancy-mortality-surveillance-system.htm?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Freproductivehealth%2Fmaternalinfanthealth%2Fpmss.html\" target=\"_blank\" rel=\"noopener\">\u003cstrong>three to four times more likely to die\u003c/strong>\u003c/a>\u003cstrong> in childbirth than white women. \u003c/strong>\u003c/p>\n\u003cp>Health equity is one of the priority areas for my role. I’m currently working to understand better what the California Department of Public Health’s approach has been on addressing this issue. I also want to get a better understanding of what the drivers are behind what we’re seeing in maternal mortality and to see [to] what extent we can understand the impact of toxic stress and cumulative adversity.\u003c/p>\n\u003cp>My strong suspicion is that there is a connection, but right now I am working on pulling together the resources to be able to take a deeper look at questions like that and how [my office] might work together with other offices to support the statewide response.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\u003cstrong>On the possible links between childhood adversity and homelessness\u003c/strong>\u003c/p>\n\u003cp>When you look at the biggest drivers of homelessness in California, domestic violence is a major driver, as well as mental health and substance dependence issues. When you look at the impact of childhood adversity on all three of those issues, it’s massive.\u003c/p>\n\u003cp>What I’ve been hearing over and over again on my listening tour around the state is that childhood adversity is a “root cause issue.” So I think we have a tremendous opportunity to get at the root of the root and make some changes in the way our systems work. For example, beginning with \u003ca href=\"https://pediatrics.aappublications.org/content/142/1_MeetingAbstract/349\" target=\"_blank\" rel=\"noopener\">universal screening for ACEs\u003c/a> and figuring out how we are developing a coordinated response, so children and families can get the support that they need in a two-generation fashion.\u003c/p>\n\u003cp>\u003cstrong>On Newsom’s allocation of $45 million to implement the screening of all Medi-Cal recipients for adverse childhood experiences and her role in expanding such screening beyond California\u003c/strong>\u003c/p>\n\u003cp>Even though I’m the surgeon general for California, I believe we should be doing early identification and early intervention globally. That was the work I did \u003ca href=\"https://centerforyouthwellness.org/building-a-movement/\" target=\"_blank\" rel=\"noopener\">in my previous role\u003c/a>, and I feel in my current role I have an opportunity to be a champion of that. [Recently] I was in Virginia meeting with the first lady of Virginia and the secretary for health and human services in Virginia about the importance of ACEs screening and early identification.\u003c/p>\n\u003cp>Let’s go back to the maternal mortality issue. One of the biggest drivers of maternal mortality is increased risk of chronic conditions, such as heart diseases, diabetes, etc. We know that childhood adversity dramatically increases the risk of [those kinds of chronic conditions]. What would it be like if every OB-GYN in the country were able to do some type of assessment of cumulative adversity of the patients they were caring for, assessing their risk and being able to proactively do interventions to support and protect the health of their patients?\u003c/p>\n\u003cp>\u003cstrong>On what it means to be the state’s first surgeon general — especially as a woman of\u003c/strong> \u003cstrong>color\u003c/strong>\u003c/p>\n\u003cp>When I was in high school, my aunt, who is a physician in Chicago, took me to a “black women in medicine” conference. I remember looking around the room and being like, “Holy moly!” Because, I mean, it was a whole ballroom filled with black women in medicine. And that really had a lasting effect for me. I do believe that if we can see it, we can be it. And growing up as a black girl in the United States, I certainly faced my share of obstacles on the way. So it’s very, very meaningful to me to be able to stand in this role as an immigrant. My family came from Jamaica to the U.S. As a woman and as a woman of color, it’s something that I’m very proud of.\u003c/p>\n\u003cp>\u003cstrong>On inspiring the next generation\u003c/strong>\u003c/p>\n\u003cp>When I first came into the role, my first week on the job, one of my first speaking events was one put on by the black caucus in the California legislature. And as I was getting up to set up my slides and preparing — I had arrived early — there was a young boy who came up to me. And he was maybe 9 years old. And he came up to shake my hand and say hello. He said, “I just wanted to meet you. My mom took me out of school today so that I could meet the first black surgeon general of California.” It’s memorable. It makes me proud to be in this role. And I know that it was meaningful for that child and meaningful for his mom.\u003c/p>\n\u003cp>\u003cem>Erika Stallings is an attorney and freelance writer based in New York City. Her work focuses on health care disparities, with a focus on breast cancer and genetics. Her work has appeared in HuffPost, \u003c/em>New York \u003cem>magazine, Jezebel and \u003c/em>O, The Oprah Magazine\u003cem>. Find her on Twitter: \u003c/em>\u003ca href=\"http://twitter.com/quidditch424\">@quidditch424\u003c/a>. \u003c/p>\n\u003cp>Copyright 2019 NPR. To see more, visit https://www.npr.org.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Not long after she finished her medical residency at Stanford University about a decade ago, Nadine Burke Harris got to work as a pediatrician in the \u003ca href=\"https://www.youtube.com/watch?time_continue=336&v=ozflNOVzd6w\" target=\"_blank\" rel=\"noopener\">Bayview-Hunters Point\u003c/a> neighborhood of San Francisco. She \u003ca href=\"https://centerforyouthwellness.org/about-us/\" target=\"_blank\" rel=\"noopener\">founded and became CEO of a clinic\u003c/a> there, focused on addressing health disparities in the community.\u003c/p>\n\u003cp>It was in talking with those children and their families, she says, that she first realized how many of her patients experiencing the worst health outcomes — those with the highest levels of chronic asthma, for example — were also living with significant adversity, such as growing up in a household where a parent was mentally ill, abusive or substance dependent.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Eventually, those conversations led her to the expanding research on \u003ca href=\"https://www.cdc.gov/violenceprevention/childabuseandneglect/acestudy/index.html\" target=\"_blank\" rel=\"noopener\">adverse childhood experiences\u003c/a>, or ACEs, and their \u003ca href=\"https://www.npr.org/sections/health-shots/2018/09/17/648710859/childhood-trauma-and-its-lifelong-health-effects-more-prevalent-among-minorities\" target=\"_blank\" rel=\"noopener\">profound, lifelong health effects\u003c/a>. The term “ACEs” has been used since the 1990s to describe the abuse, neglect and other potentially traumatic experiences estimated to afflict more than 34 million U.S. children under 18.\u003c/p>\n\u003cp>Burke Harris has dedicated much of her career to spreading the word to fellow doctors and the public about ACEs and the dangers of this toxic stress to children. She champions a multidisciplinary approach to helping these kids and teens.\u003c/p>\n\u003cp>In an \u003ca href=\"https://www.npr.org/sections/ed/2018/01/23/578280721/what-do-asthma-heart-disease-and-cancer-have-in-common-maybe-childhood-trauma\" target=\"_blank\" rel=\"noopener\">interview \u003c/a>last year, after \u003ca href=\"https://www.npr.org/books/titles/578679908/the-deepest-well-healing-the-long-term-effects-of-childhood-adversity\" target=\"_blank\" rel=\"noopener\">her book\u003c/a>, \u003cem>The Deepest Well: Healing the Long-Term Effects of Childhood Adversity, \u003c/em>was published,\u003cem> \u003c/em>Burke Harris told NPR’s Cory Turner, “We all need to be part of the solution. If we each take … our little piece, it’s nuts how far we’ll be able to go, together as a society, in terms of solving this problem.”\u003c/p>\n\u003cp>California Gov. Gavin Newsom took Burke Harris up on her challenge, appointing her the first-ever surgeon general of California. Newsom cites the toxic stress of childhood trauma as among the root causes “of many of the most harmful and persistent health challenges facing Californians.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>NPR’s Erika Stallings recently spoke with Burke Harris about her work and about what it means to her, particularly as a black woman, to serve as her state’s first surgeon general — one of only three such positions in the United States.\u003c/p>\n\u003chr>\n\u003cp>\u003cstrong>Interview Highlights\u003c/strong>\u003c/p>\n\u003cp>\u003cstrong>On the role of racism and discrimination in high maternal mortality, particularly among black women, who are \u003c/strong>\u003ca href=\"https://www.cdc.gov/reproductivehealth/maternalinfanthealth/pregnancy-mortality-surveillance-system.htm?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Freproductivehealth%2Fmaternalinfanthealth%2Fpmss.html\" target=\"_blank\" rel=\"noopener\">\u003cstrong>three to four times more likely to die\u003c/strong>\u003c/a>\u003cstrong> in childbirth than white women. \u003c/strong>\u003c/p>\n\u003cp>Health equity is one of the priority areas for my role. I’m currently working to understand better what the California Department of Public Health’s approach has been on addressing this issue. I also want to get a better understanding of what the drivers are behind what we’re seeing in maternal mortality and to see [to] what extent we can understand the impact of toxic stress and cumulative adversity.\u003c/p>\n\u003cp>My strong suspicion is that there is a connection, but right now I am working on pulling together the resources to be able to take a deeper look at questions like that and how [my office] might work together with other offices to support the statewide response.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cstrong>On the possible links between childhood adversity and homelessness\u003c/strong>\u003c/p>\n\u003cp>When you look at the biggest drivers of homelessness in California, domestic violence is a major driver, as well as mental health and substance dependence issues. When you look at the impact of childhood adversity on all three of those issues, it’s massive.\u003c/p>\n\u003cp>What I’ve been hearing over and over again on my listening tour around the state is that childhood adversity is a “root cause issue.” So I think we have a tremendous opportunity to get at the root of the root and make some changes in the way our systems work. For example, beginning with \u003ca href=\"https://pediatrics.aappublications.org/content/142/1_MeetingAbstract/349\" target=\"_blank\" rel=\"noopener\">universal screening for ACEs\u003c/a> and figuring out how we are developing a coordinated response, so children and families can get the support that they need in a two-generation fashion.\u003c/p>\n\u003cp>\u003cstrong>On Newsom’s allocation of $45 million to implement the screening of all Medi-Cal recipients for adverse childhood experiences and her role in expanding such screening beyond California\u003c/strong>\u003c/p>\n\u003cp>Even though I’m the surgeon general for California, I believe we should be doing early identification and early intervention globally. That was the work I did \u003ca href=\"https://centerforyouthwellness.org/building-a-movement/\" target=\"_blank\" rel=\"noopener\">in my previous role\u003c/a>, and I feel in my current role I have an opportunity to be a champion of that. [Recently] I was in Virginia meeting with the first lady of Virginia and the secretary for health and human services in Virginia about the importance of ACEs screening and early identification.\u003c/p>\n\u003cp>Let’s go back to the maternal mortality issue. One of the biggest drivers of maternal mortality is increased risk of chronic conditions, such as heart diseases, diabetes, etc. We know that childhood adversity dramatically increases the risk of [those kinds of chronic conditions]. What would it be like if every OB-GYN in the country were able to do some type of assessment of cumulative adversity of the patients they were caring for, assessing their risk and being able to proactively do interventions to support and protect the health of their patients?\u003c/p>\n\u003cp>\u003cstrong>On what it means to be the state’s first surgeon general — especially as a woman of\u003c/strong> \u003cstrong>color\u003c/strong>\u003c/p>\n\u003cp>When I was in high school, my aunt, who is a physician in Chicago, took me to a “black women in medicine” conference. I remember looking around the room and being like, “Holy moly!” Because, I mean, it was a whole ballroom filled with black women in medicine. And that really had a lasting effect for me. I do believe that if we can see it, we can be it. And growing up as a black girl in the United States, I certainly faced my share of obstacles on the way. So it’s very, very meaningful to me to be able to stand in this role as an immigrant. My family came from Jamaica to the U.S. As a woman and as a woman of color, it’s something that I’m very proud of.\u003c/p>\n\u003cp>\u003cstrong>On inspiring the next generation\u003c/strong>\u003c/p>\n\u003cp>When I first came into the role, my first week on the job, one of my first speaking events was one put on by the black caucus in the California legislature. And as I was getting up to set up my slides and preparing — I had arrived early — there was a young boy who came up to me. And he was maybe 9 years old. And he came up to shake my hand and say hello. He said, “I just wanted to meet you. My mom took me out of school today so that I could meet the first black surgeon general of California.” It’s memorable. It makes me proud to be in this role. And I know that it was meaningful for that child and meaningful for his mom.\u003c/p>\n\u003cp>\u003cem>Erika Stallings is an attorney and freelance writer based in New York City. Her work focuses on health care disparities, with a focus on breast cancer and genetics. Her work has appeared in HuffPost, \u003c/em>New York \u003cem>magazine, Jezebel and \u003c/em>O, The Oprah Magazine\u003cem>. Find her on Twitter: \u003c/em>\u003ca href=\"http://twitter.com/quidditch424\">@quidditch424\u003c/a>. \u003c/p>\n\u003cp>Copyright 2019 NPR. To see more, visit https://www.npr.org.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cp>San Francisco’s Board of Supervisors unanimously voted to ban the sale and distribution of e-cigarettes in the city on Tuesday. The city is the corporate home of \u003ca href=\"https://www.juul.com/\" target=\"_blank\" rel=\"noopener\">Juul Labs\u003c/a>, the biggest producer of e-cigarettes in the country.\u003c/p>\n\u003cp>The ordinance would make the sale of e-cigarettes \u003ca href=\"https://sfgov.legistar.com/View.ashx?M=F&ID=7111897&GUID=7C3912E3-BB56-420D-896E-6FEA1391287D\" target=\"_blank\" rel=\"noopener\">illegal in brick-and-mortar stores\u003c/a>. It would also prohibit online sales when shipping to San Francisco addresses. The ban is accompanied by \u003ca href=\"https://sfgov.legistar.com/View.ashx?M=F&ID=7111894&GUID=6F15F287-1053-42A8-86C1-EF7694EF1041\" target=\"_blank\" rel=\"noopener\">another ordinance\u003c/a> that prevents the manufacture, distribution and sale of e-cigarettes on San Francisco property.\u003c/p>\n\u003cp>[pullquote citation=\"Dennis Herrera, San Francisco's City Attorney\"]‘This is a decisive step to help prevent another generation of San Francisco children from becoming addicted to nicotine.’[/pullquote]\u003c/p>\n\u003cp>City Attorney Dennis Herrera co-authored the ordinance, and celebrated the final vote. \u003c/p>\n\u003cp>“This is a decisive step to help prevent another generation of San Francisco children from becoming addicted to nicotine,” he said. “This temporary moratorium wouldn’t be necessary if the federal government had done its job. E-cigarettes are a product that, by law, are not allowed on the market without FDA review. For some reason, the FDA has so far refused to follow the law. If the federal government is not going to act, San Francisco will.”\u003c/p>\n\u003cp>[pullquote align=\"left\" citation=\"Ted Kwong, spokesman for Juul\"]‘This full prohibition will drive former adult smokers who successfully switched to vapor products back to deadly cigarettes.’[/pullquote]\u003c/p>\n\u003cp>San Francisco Mayor London Breed has ten days to sign the legislation, which she has said she will do. The laws will take effect seven months from that date, in early 2020.\u003c/p>\n\u003cp>Juul responded to the final vote in a written statement to media, saying the ban will cause new challenges for the city. \u003c/p>\n\u003cp>“This full prohibition will drive former adult smokers who successfully switched to vapor products back to deadly cigarettes, deny the opportunity to switch for current adult smokers, and create a thriving black market instead of addressing the actual causes of underage access and use,” wrote Juul spokesman Ted Kwong.\u003c/p>\n\u003cp>Under federal law, the minimum age to buy tobacco products is 18 years old. In California, however, that age is 21. Despite this, use of e-cigarettes, or “vaping,” has skyrocketed among teenagers nationally.\u003c/p>\n\u003cp>Last year, \u003ca href=\"http://www.monitoringthefuture.org//pubs/monographs/mtf-vol1_2018.pdf\" target=\"_blank\" rel=\"noopener\">one in five high school seniors\u003c/a> reported vaping in the past month. That’s almost double the number who reported vaping\u003ca href=\"https://www.drugabuse.gov/news-events/news-releases/2018/12/teens-using-vaping-devices-in-record-numbers\" target=\"_blank\" rel=\"noopener\"> the year before\u003c/a>. Even eighth graders are vaping in record numbers.\u003c/p>\n\u003cp>These increases come after \u003ca href=\"https://www.hhs.gov/ash/oah/adolescent-development/substance-use/drugs/tobacco/trends/index.html\" target=\"_blank\" rel=\"noopener\">years of declines\u003c/a> in teenagers smoking traditional cigarettes.\u003c/p>\n\u003cp>Public health officials are concerned about the rising number of teenagers using e-cigarettes, as nicotine can \u003ca href=\"https://e-cigarettes.surgeongeneral.gov/\" target=\"_blank\" rel=\"noopener\">harm a young person’s developing brain\u003c/a>. The Centers for Disease Control and Prevention warn that young people who vape may be \u003ca href=\"https://www.cdc.gov/tobacco/basic_information/e-cigarettes/Quick-Facts-on-the-Risks-of-E-cigarettes-for-Kids-Teens-and-Young-Adults.html\" target=\"_blank\" rel=\"noopener\">more likely to start smoking traditional cigarettes\u003c/a>.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>San Francisco Supervisor Shamann Walton, who co-wrote the city’s ordinance, said he’s disgusted with Juul and similar companies, who he said are “putting profits before the health of young people, and people in general.”\u003c/p>\n\u003cp>“We spent a few decades fighting big tobacco in the form of cigarettes,” Walton said. “Now we have to do it again in the form of e-cigarettes.”\u003c/p>\n\u003cp>Walton said even with the tobacco age limit, vaping devices are commonly confiscated from students in the city’s middle and high schools.\u003c/p>\n\u003cp>The second ordinance, which prevents the manufacture, distribution and sale of e-cigarettes on City property, takes direct aim at Juul Labs, which leases space from the city on San Francisco’s Pier 70. The ordinance is not retroactive, so it would not remove Juul from the company’s current space, but it would prevent other e-cigarette makers from renting city property in the future. In a statement, Kwong, the Juul spokesperson, wrote that regardless, the company does not “manufacture, distribute or sell our product from this space.”\u003c/p>\n\u003cp>[pullquote citation=\"Shamann Walton, San Francisco Supervisor\"]‘We spent a few decades fighting big tobacco in the form of cigarettes. Now we have to do it again in the form of e-cigarettes.’[/pullquote]\u003c/p>\n\u003cp>Juul’s vaping device was introduced in 2015. It’s small, sleek and discrete, looking similar to a flash drive. The company now controls 70 percent of the vaping market.\u003c/p>\n\u003cp>In a statement, Juul Labs said they share the city’s goal of keeping e-cigarettes away from young people. They said they’ve made \u003ca href=\"https://newsroom.juul.com/2019/02/18/action-plan-update/\" target=\"_blank\" rel=\"noopener\">it harder for underage buyers to purchase Juul off their website\u003c/a>, and have shut down Juul accounts on Facebook and Instagram.\u003c/p>\n\u003cp>The company also argues, the prohibition “of vapor products for all adults in San Francisco will not effectively address underage use and will leave cigarettes on shelves as the only choice for adult smokers, even though they kill 40,000 Californians every year.”\u003c/p>\n\u003cp>Walton doesn’t buy that argument, however. He said it’s simply, “trading one nicotine addiction for another.” What’s more, he’s concerned that for every adult that might benefit, dozens of young people could become addicted.\u003c/p>\n\u003cp>San Francisco resident Jay Friedman thinks the complete e-cigarette ban goes too far. The software engineer smoked a pack of cigarettes a day for twenty years, and smoking e-cigarettes has reduced his regular cigarette habit to two to three a day. He said he feels better physically.\u003c/p>\n\u003cp>Friedman supported a ban on flavored tobacco that \u003ca href=\"https://www.kqed.org/futureofyou/441395/sf-voters-may-ban-vape-flavors-menthol-cigarettes\" target=\"_blank\" rel=\"noopener\">city voters passed last year\u003c/a>.\u003c/p>\n\u003cp>“I feel like it was good to get rid of the fruit flavors for kids,” he said, “but this feels like maybe a step too far.”\u003c/p>\n\u003cp>Friedman said if e-cigarettes are banned, he would try to quit nicotine altogether. But, “there would be a point in a moment of weakness where I’d just end up buying a pack of smokes again and then it’s just a slippery slope from there.”\u003c/p>\n\u003cfigure id=\"attachment_11757142\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-11757142\" src=\"https://ww2.kqed.org/news/wp-content/uploads/sites/10/2019/06/IMG_2145-800x600.jpg\" alt=\"Ted's Market is a convenience store in the South of Market neighborhood in San Francisco. Miriam Zouzounis is a third-generation owner of the store. She said the e-cigarette ban will hurt the market's bottom line.\" width=\"800\" height=\"600\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2019/06/IMG_2145-800x600.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2019/06/IMG_2145-160x120.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2019/06/IMG_2145-1020x765.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2019/06/IMG_2145-1200x900.jpg 1200w, https://cdn.kqed.org/wp-content/uploads/sites/10/2019/06/IMG_2145-1920x1440.jpg 1920w, https://cdn.kqed.org/wp-content/uploads/sites/10/2019/06/IMG_2145-1832x1374.jpg 1832w, https://cdn.kqed.org/wp-content/uploads/sites/10/2019/06/IMG_2145-1376x1032.jpg 1376w, https://cdn.kqed.org/wp-content/uploads/sites/10/2019/06/IMG_2145-1044x783.jpg 1044w, https://cdn.kqed.org/wp-content/uploads/sites/10/2019/06/IMG_2145-632x474.jpg 632w, https://cdn.kqed.org/wp-content/uploads/sites/10/2019/06/IMG_2145-536x402.jpg 536w, https://cdn.kqed.org/wp-content/uploads/sites/10/2019/06/IMG_2145.jpg 2048w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Ted’s Market is a convenience store in the South of Market neighborhood in San Francisco. Miriam Zouzounis is a third-generation owner of the store. She said the e-cigarette ban will hurt the market’s bottom line. \u003ccite>(Laura Klivans/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Small businesses in San Francisco are concerned the ban will hurt their bottom line.\u003c/p>\n\u003cp>Miriam Zouzounis and her family own convenience store Ted’s Market near downtown San Francisco. She said e-cigarettes are an “anchor” product, meaning they draw people into the store.\u003c/p>\n\u003cp>“When people come and want to purchase something at the store and we don’t have that exact item that they want, they’re not going to buy the rest of the items that they might on that trip: a drink or a sandwich,” Zouzounis said.\u003c/p>\n\u003cp>[pullquote align=\"left\" citation=\"Jay Friedman, San Francisco resident\"]‘I feel like it was good to get rid of the fruit flavors for kids, but this feels like maybe a step too far.’[/pullquote]\u003c/p>\n\u003cp>She said sales from e-cigarettes account for at least $200 to $300 a day. As a board member of the Arab American Grocers Association, she believes laws like this mostly affect immigrant-owned businesses.\u003c/p>\n\u003cp>Abbey Chaitin, 15, is a San Francisco resident. She isn’t drawn to using e-cigarettes, she said, because she has seen peers her become addicted to them.\u003c/p>\n\u003cp>“I’ll see them in class fidgeting,” Chaitin said, “they need it to focus, to function.”\u003c/p>\n\u003cp>Chaitin thinks regardless of a ban, young people will still get their hands on e-cigarettes, “People my age can find a way around that if they really need to.”\u003c/p>\n\u003cp>Meanwhile, Juul is collecting signatures for a \u003ca href=\"https://sfelections.sfgov.org/sites/default/files/Documents/candidates/20190529_VaporProducts_title-summary.pdf\" target=\"_blank\" rel=\"noopener\">November ballot initiative\u003c/a> to override the ban.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n",
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"excerpt": "If signed by Mayor London Breed, the ordinance, which makes the sale of e-cigarettes illegal in brick and mortar stores, will go into effect early 2020. E-cigarette maker Juul is proposing a ballot initiative to override the ban.",
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"title": "San Francisco Passes Ban on E-Cigarette Sales, Distribution | KQED",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>San Francisco’s Board of Supervisors unanimously voted to ban the sale and distribution of e-cigarettes in the city on Tuesday. The city is the corporate home of \u003ca href=\"https://www.juul.com/\" target=\"_blank\" rel=\"noopener\">Juul Labs\u003c/a>, the biggest producer of e-cigarettes in the country.\u003c/p>\n\u003cp>The ordinance would make the sale of e-cigarettes \u003ca href=\"https://sfgov.legistar.com/View.ashx?M=F&ID=7111897&GUID=7C3912E3-BB56-420D-896E-6FEA1391287D\" target=\"_blank\" rel=\"noopener\">illegal in brick-and-mortar stores\u003c/a>. It would also prohibit online sales when shipping to San Francisco addresses. The ban is accompanied by \u003ca href=\"https://sfgov.legistar.com/View.ashx?M=F&ID=7111894&GUID=6F15F287-1053-42A8-86C1-EF7694EF1041\" target=\"_blank\" rel=\"noopener\">another ordinance\u003c/a> that prevents the manufacture, distribution and sale of e-cigarettes on San Francisco property.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>City Attorney Dennis Herrera co-authored the ordinance, and celebrated the final vote. \u003c/p>\n\u003cp>“This is a decisive step to help prevent another generation of San Francisco children from becoming addicted to nicotine,” he said. “This temporary moratorium wouldn’t be necessary if the federal government had done its job. E-cigarettes are a product that, by law, are not allowed on the market without FDA review. For some reason, the FDA has so far refused to follow the law. If the federal government is not going to act, San Francisco will.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>San Francisco Mayor London Breed has ten days to sign the legislation, which she has said she will do. The laws will take effect seven months from that date, in early 2020.\u003c/p>\n\u003cp>Juul responded to the final vote in a written statement to media, saying the ban will cause new challenges for the city. \u003c/p>\n\u003cp>“This full prohibition will drive former adult smokers who successfully switched to vapor products back to deadly cigarettes, deny the opportunity to switch for current adult smokers, and create a thriving black market instead of addressing the actual causes of underage access and use,” wrote Juul spokesman Ted Kwong.\u003c/p>\n\u003cp>Under federal law, the minimum age to buy tobacco products is 18 years old. In California, however, that age is 21. Despite this, use of e-cigarettes, or “vaping,” has skyrocketed among teenagers nationally.\u003c/p>\n\u003cp>Last year, \u003ca href=\"http://www.monitoringthefuture.org//pubs/monographs/mtf-vol1_2018.pdf\" target=\"_blank\" rel=\"noopener\">one in five high school seniors\u003c/a> reported vaping in the past month. That’s almost double the number who reported vaping\u003ca href=\"https://www.drugabuse.gov/news-events/news-releases/2018/12/teens-using-vaping-devices-in-record-numbers\" target=\"_blank\" rel=\"noopener\"> the year before\u003c/a>. Even eighth graders are vaping in record numbers.\u003c/p>\n\u003cp>These increases come after \u003ca href=\"https://www.hhs.gov/ash/oah/adolescent-development/substance-use/drugs/tobacco/trends/index.html\" target=\"_blank\" rel=\"noopener\">years of declines\u003c/a> in teenagers smoking traditional cigarettes.\u003c/p>\n\u003cp>Public health officials are concerned about the rising number of teenagers using e-cigarettes, as nicotine can \u003ca href=\"https://e-cigarettes.surgeongeneral.gov/\" target=\"_blank\" rel=\"noopener\">harm a young person’s developing brain\u003c/a>. The Centers for Disease Control and Prevention warn that young people who vape may be \u003ca href=\"https://www.cdc.gov/tobacco/basic_information/e-cigarettes/Quick-Facts-on-the-Risks-of-E-cigarettes-for-Kids-Teens-and-Young-Adults.html\" target=\"_blank\" rel=\"noopener\">more likely to start smoking traditional cigarettes\u003c/a>.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>San Francisco Supervisor Shamann Walton, who co-wrote the city’s ordinance, said he’s disgusted with Juul and similar companies, who he said are “putting profits before the health of young people, and people in general.”\u003c/p>\n\u003cp>“We spent a few decades fighting big tobacco in the form of cigarettes,” Walton said. “Now we have to do it again in the form of e-cigarettes.”\u003c/p>\n\u003cp>Walton said even with the tobacco age limit, vaping devices are commonly confiscated from students in the city’s middle and high schools.\u003c/p>\n\u003cp>The second ordinance, which prevents the manufacture, distribution and sale of e-cigarettes on City property, takes direct aim at Juul Labs, which leases space from the city on San Francisco’s Pier 70. The ordinance is not retroactive, so it would not remove Juul from the company’s current space, but it would prevent other e-cigarette makers from renting city property in the future. In a statement, Kwong, the Juul spokesperson, wrote that regardless, the company does not “manufacture, distribute or sell our product from this space.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Juul’s vaping device was introduced in 2015. It’s small, sleek and discrete, looking similar to a flash drive. The company now controls 70 percent of the vaping market.\u003c/p>\n\u003cp>In a statement, Juul Labs said they share the city’s goal of keeping e-cigarettes away from young people. They said they’ve made \u003ca href=\"https://newsroom.juul.com/2019/02/18/action-plan-update/\" target=\"_blank\" rel=\"noopener\">it harder for underage buyers to purchase Juul off their website\u003c/a>, and have shut down Juul accounts on Facebook and Instagram.\u003c/p>\n\u003cp>The company also argues, the prohibition “of vapor products for all adults in San Francisco will not effectively address underage use and will leave cigarettes on shelves as the only choice for adult smokers, even though they kill 40,000 Californians every year.”\u003c/p>\n\u003cp>Walton doesn’t buy that argument, however. He said it’s simply, “trading one nicotine addiction for another.” What’s more, he’s concerned that for every adult that might benefit, dozens of young people could become addicted.\u003c/p>\n\u003cp>San Francisco resident Jay Friedman thinks the complete e-cigarette ban goes too far. The software engineer smoked a pack of cigarettes a day for twenty years, and smoking e-cigarettes has reduced his regular cigarette habit to two to three a day. He said he feels better physically.\u003c/p>\n\u003cp>Friedman supported a ban on flavored tobacco that \u003ca href=\"https://www.kqed.org/futureofyou/441395/sf-voters-may-ban-vape-flavors-menthol-cigarettes\" target=\"_blank\" rel=\"noopener\">city voters passed last year\u003c/a>.\u003c/p>\n\u003cp>“I feel like it was good to get rid of the fruit flavors for kids,” he said, “but this feels like maybe a step too far.”\u003c/p>\n\u003cp>Friedman said if e-cigarettes are banned, he would try to quit nicotine altogether. But, “there would be a point in a moment of weakness where I’d just end up buying a pack of smokes again and then it’s just a slippery slope from there.”\u003c/p>\n\u003cfigure id=\"attachment_11757142\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-11757142\" src=\"https://ww2.kqed.org/news/wp-content/uploads/sites/10/2019/06/IMG_2145-800x600.jpg\" alt=\"Ted's Market is a convenience store in the South of Market neighborhood in San Francisco. Miriam Zouzounis is a third-generation owner of the store. She said the e-cigarette ban will hurt the market's bottom line.\" width=\"800\" height=\"600\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2019/06/IMG_2145-800x600.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2019/06/IMG_2145-160x120.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2019/06/IMG_2145-1020x765.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2019/06/IMG_2145-1200x900.jpg 1200w, https://cdn.kqed.org/wp-content/uploads/sites/10/2019/06/IMG_2145-1920x1440.jpg 1920w, https://cdn.kqed.org/wp-content/uploads/sites/10/2019/06/IMG_2145-1832x1374.jpg 1832w, https://cdn.kqed.org/wp-content/uploads/sites/10/2019/06/IMG_2145-1376x1032.jpg 1376w, https://cdn.kqed.org/wp-content/uploads/sites/10/2019/06/IMG_2145-1044x783.jpg 1044w, https://cdn.kqed.org/wp-content/uploads/sites/10/2019/06/IMG_2145-632x474.jpg 632w, https://cdn.kqed.org/wp-content/uploads/sites/10/2019/06/IMG_2145-536x402.jpg 536w, https://cdn.kqed.org/wp-content/uploads/sites/10/2019/06/IMG_2145.jpg 2048w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Ted’s Market is a convenience store in the South of Market neighborhood in San Francisco. Miriam Zouzounis is a third-generation owner of the store. She said the e-cigarette ban will hurt the market’s bottom line. \u003ccite>(Laura Klivans/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>Small businesses in San Francisco are concerned the ban will hurt their bottom line.\u003c/p>\n\u003cp>Miriam Zouzounis and her family own convenience store Ted’s Market near downtown San Francisco. She said e-cigarettes are an “anchor” product, meaning they draw people into the store.\u003c/p>\n\u003cp>“When people come and want to purchase something at the store and we don’t have that exact item that they want, they’re not going to buy the rest of the items that they might on that trip: a drink or a sandwich,” Zouzounis said.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>She said sales from e-cigarettes account for at least $200 to $300 a day. As a board member of the Arab American Grocers Association, she believes laws like this mostly affect immigrant-owned businesses.\u003c/p>\n\u003cp>Abbey Chaitin, 15, is a San Francisco resident. She isn’t drawn to using e-cigarettes, she said, because she has seen peers her become addicted to them.\u003c/p>\n\u003cp>“I’ll see them in class fidgeting,” Chaitin said, “they need it to focus, to function.”\u003c/p>\n\u003cp>Chaitin thinks regardless of a ban, young people will still get their hands on e-cigarettes, “People my age can find a way around that if they really need to.”\u003c/p>\n\u003cp>Meanwhile, Juul is collecting signatures for a \u003ca href=\"https://sfelections.sfgov.org/sites/default/files/Documents/candidates/20190529_VaporProducts_title-summary.pdf\" target=\"_blank\" rel=\"noopener\">November ballot initiative\u003c/a> to override the ban.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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