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What? You’re calling my kid a simp? | CNN

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Editor’s note: After we first published this story in 2021, we received reader feedback about the term’s derivation and use in pop culture. We updated the story to reflect those additional details.

CNN
—

Shannon was used to her socially awkward son being bullied by other boys at the private school he attends.

But when she picked him up from school and he told her he was being called a “simp,” Shannon, who’s only using her first name to protect her son’s identity, didn’t know what to think.

“He’s telling me this and I’m driving and I’m trying to make sense of it,” she said. “I’d never heard the word.”

“He told me, ‘It basically means that I’m just being nice to girls because I like them,’” she said. “I was like, wait, my kid is being picked on for being nice to girls?”

Her son had told her he had recently been put in the “friend zone” by one of the girls, who made it clear she wasn’t interested in dating him. They had continued to be friendly.

“You do all these things as a parent to raise your kid right, to be nice to everyone, especially kids without many friends,” Shannon said. “And you never think that by making your kid the nice one you could be making them a target for bullies.”

Many parents might be unfamiliar with the word “simp,” but chances are your tween or teen has used or at least heard the term.

Simp hashtags are rampant on TikTok. Instagram has more 600,000 posts tagged #simp, and there are Facebook groups devoted to simps and simping. (It can be a verb, too.)

Depending on whom you talk to, there is some debate on the word’s usage and how much (if at all) it has evolved over time. While simp’s origins are connected to the word “simpleton,” its current usage is linked to West Coast American rappers such as Too Short, who first used it in the mid-1980s in a way that denotes the opposite of “pimp” in his song “Pimpology.”

In 1992, Boyz II Men released a song called “Sympin’ Ain’t Easy,” offering a different spelling of the word and evoking frustrated yearning.

Urban Dictionary’s top definition of a simp is “someone who does way too much for a person they like.” Other definitions on the crowdsourced online dictionary include “a guy that is overly desperate for women, especially if she is a bad person, or has expressed her disinterest in him whom which he continues to obsess over.”

“‘Simp’ is slang for a person (typically a man) who is desperate for the attention and affection of someone else (typically a woman),” said Connor Howlett, then a digital strategist in New York City in 2021, in an email to CNN.

“Think the energy of puppy dog eyes but manifested in a romantic, human form,” Howlett said. “It’s used in an insulting manner. Though typically playful, there are definitely undertones of toxic masculinity since it’s related to showing too much emotion.”

Karen McClung first encountered the word in group chats she closely monitors with her daughter and son.

“I saw the word and quickly looked it up,” McClung said. “I asked my kids what they thought it meant and my son said, ‘It’s basically if you had $1,000 and you could do anything with it, you’d use it to get the attention of a girl — then everyone would make fun of you.”

“I blocked the thread,” she said.

McClung said her son wasn’t being called a simp in the thread, but she said she’s “curious to see how it impacts my son because he’s very chivalrous by nature.”

A word that emerged into Generation Z vernacular from social media usage, as simp is thought to have arrived, is bound to get muddled and continue to evolve.

And simp can have different contexts depending on the age group using it, said Laura Capinas, a clinical social worker in Sonoma County, California.

“Depending on if it’s a middle schooler or a high schooler using it, it could be different,” she said, and it’s not just boys talking about simps and simping either.

“Girls in high school sometimes throw out the term to their high school girlfriends,” Capinas said. “Some kids I’ve talked to have said it’s not a derogatory term. It’s sort of like teasing someone, like ‘You’ve left us to go hang out with your friends, you’re simping us.’”

“If you have someone saying it who’s used to being a bully, it will be received as a bully comment,” she said.

She hasn’t heard kids or parents in her practice be overly concerned about the word, but Capinas often hears kids use it in describing their day or their peer groups.

Myra Fortson said she has discussed the word with her daughter and thinks such words often “spread more quickly than their meaning.”

“Kids will also own their language by refusing to go back to its original meaning,” said the mother of three. “They will say things like, ‘Maybe that’s where it comes from, but it doesn’t mean that anymore.’ And they keep using the term the way they want.”

One way to think of a simp, said Sean Davis, a marriage and family therapist in California, is “simply someone who is ahead of their time.”

“Though it hurts in the moment, in the big picture, a boy who is called a ‘simp’ can wear it as a badge of honor,” Davis said.

“Today’s boys are being raised in the middle of the biggest redefinition of male gender roles in recent history,” Davis said. “Should I be kind and sensitive or distant and aloof when trying to win a partner over?”

As with all bullying, teens and tweens should first tell their parents or a trusted adult who may be able to intervene on their behalf, he said. “Otherwise, simply owning it and refusing to be ashamed can help.”

It’s important for parents to remember that there have always been slang terms to navigate for kids and parents alike, Capinas said, and the goal is to “make sure it’s being received in a playful manner and used playfully.”

“I think we are always looking to stop our kids from being hurt,” she said. “We don’t like language that’s slang and has potential for negative connotation.”

One tactic she teaches kids in her therapy sessions, she said, is the “humor tool.”

“It’s comic relief. You practice not putting down the other person, you put down the situation,” she said.

If someone is being called out for always “simping the girls,” Capinas said, “he could turn it around and say, ‘It’s tough being the lone soldier simp nice guy, who wants to join me?’”

“You can turn it and make it into comedy,” she said.

Davis pointed to a similar approach.

“Telling the bully, ‘That’s right,’ while holding your head up high and walking away can help, as bullies usually give up if they don’t succeed in tearing the other person down,” he said. “And you can tell yourself that being bullied is simply the price a revolutionary has to pay for standing up for what’s right.”

Shannon said her son’s therapist advised similar tactics, but the boy said he only comes up with the perfect retort three hours later.

“It’s just been really heartbreaking, especially because I know a lot of these boys bullying him. He’s been at the school since second grade,” Shannon said. “If their moms knew, they’d be horrified. But my son doesn’t want me to tell them because it will just get worse.”

This story was originally published in February 2021 and has been updated.

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No antibiotics worked, so this woman turned to a natural enemy of bacteria to save her husband’s life | CNN

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CNN
—

In February 2016, infectious disease epidemiologist Steffanie Strathdee was holding her dying husband’s hand, watching him lose an exhausting fight against a deadly superbug infection.

After months of ups and downs, doctors had just told her that her husband, Tom Patterson, was too racked with bacteria to live.

“I told him, ‘Honey, we’re running out of time. I need to know if you want to live. I don’t even know if you can hear me, but if you can hear me and you want to live, please squeeze my hand.’

“All of a sudden, he squeezed really hard. And I thought, ‘Oh, great!’ And then I’m thinking, ‘Oh, crap! What am I going to do?’”

What she accomplished next could easily be called miraculous. First, Strathdee found an obscure treatment that offered a glimmer of hope — fighting superbugs with phages, viruses created by nature to eat bacteria.

Then she convinced phage scientists around the country to hunt and peck through molecular haystacks of sewage, bogs, ponds, the bilge of boats and other prime breeding grounds for bacteria and their viral opponents. The impossible goal: quickly find the few, exquisitely unique phages capable of fighting a specific strain of antibiotic-resistant bacteria literally eating her husband alive.

Next, the US Food and Drug Administration had to greenlight this unproven cocktail of hope, and scientists had to purify the mixture so that it wouldn’t be deadly.

Yet just three weeks later, Strathdee watched doctors intravenously inject the mixture into her husband’s body — and save his life.

Their story is one of unrelenting perseverance and unbelievable good fortune. It’s a glowing tribute to the immense kindness of strangers. And it’s a story that just might save countless lives from the growing threat of antibiotic-resistant superbugs — maybe even your own.

“It’s estimated that by 2050, 10 million people per year — that’s one person every three seconds — is going to be dying from a superbug infection,” Strathdee told an audience at Life Itself, a 2022 health and wellness event presented in partnership with CNN.

“I’m here to tell you that the enemy of my enemy can be my friend. Viruses can be medicine.”

How this ‘perfect predator’ saved his life after nine months in the hospital

During a Thanksgiving cruise on the Nile in 2015, Patterson was suddenly felled by severe stomach cramps. When a clinic in Egypt failed to help his worsening symptoms, Patterson was flown to Germany, where doctors discovered a grapefruit-size abdominal abscess filled with Acinetobacter baumannii, a virulent bacterium resistant to nearly all antibiotics.

Found in the sands of the Middle East, the bacteria were blown into the wounds of American troops hit by roadside bombs during the Iraq War, earning the pathogen the nickname “Iraqibacter.”

“Veterans would get shrapnel in their legs and bodies from IED explosions and were medevaced home to convalesce,” Strathdee told CNN, referring to improvised explosive devices. “Unfortunately, they brought their superbug with them. Sadly, many of them survived the bomb blasts but died from this deadly bacterium.”

Today, Acinetobacter baumannii tops the World Health Organization’s list of dangerous pathogens for which new antibiotics are critically needed.

“It’s something of a bacterial kleptomaniac. It’s really good at stealing antimicrobial resistance genes from other bacteria,” Strathdee said. “I started to realize that my husband was a lot sicker than I thought and that modern medicine had run out of antibiotics to treat him.”

With the bacteria growing unchecked inside him, Patterson was soon medevaced to the couple’s hometown of San Diego, where he was a professor of psychiatry and Strathdee was the associate dean of global health sciences at the University of California, San Diego.

“Tom was on a roller coaster — he’d get better for a few days, and then there would be a deterioration, and he would be very ill,” said Dr. Robert “Chip” Schooley, a leading infectious disease specialist at UC San Diego who was a longtime friend and colleague. As weeks turned into months, “Tom began developing multi-organ failure. He was sick enough that we could lose him any day.”

Patterson's body was systemically infected with a virulent drug-resistant bacteria that also infected troops in the Iraq War, earning the pathogen the nickname

After that reassuring hand squeeze from her husband, Strathdee sprang into action. Scouring the internet, she had already stumbled across a study by a Tbilisi, Georgia, researcher on the use of phages for treatment of drug-resistant bacteria.

A phone call later, Strathdee discovered phage treatment was well established in former Soviet bloc countries but had been discounted long ago as “fringe science” in the West.

“Phages are everywhere. There’s 10 million trillion trillion — that’s 10 to the power of 31 — phages that are thought to be on the planet,” Strathdee said. “They’re in soil, they’re in water, in our oceans and in our bodies, where they are the gatekeepers that keep our bacterial numbers in check. But you have to find the right phage to kill the bacterium that is causing the trouble.”

Buoyed by her newfound knowledge, Strathdee began reaching out to scientists who worked with phages: “I wrote cold emails to total strangers, begging them for help,” she said at Life Itself.

One stranger who quickly answered was Texas A&M University biochemist Ryland Young. He’d been working with phages for over 45 years.

“You know the word persuasive? There’s nobody as persuasive as Steffanie,” said Young, a professor of biochemistry and biophysics who runs the lab at the university’s Center for Phage Technology. “We just dropped everything. No exaggeration, people were literally working 24/7, screening 100 different environmental samples to find just a couple of new phages.”

While the Texas lab burned the midnight oil, Schooley tried to obtain FDA approval for the injection of the phage cocktail into Patterson. Because phage therapy has not undergone clinical trials in the United States, each case of “compassionate use” required a good deal of documentation. It’s a process that can consume precious time.

But the woman who answered the phone at the FDA said, “‘No problem. This is what you need, and we can arrange that,’” Schooley recalled. “And then she tells me she has friends in the Navy that might be able to find some phages for us as well.”

In fact, the US Naval Medical Research Center had banks of phages gathered from seaports around the world. Scientists there began to hunt for a match, “and it wasn’t long before they found a few phages that appeared to be active against the bacterium,” Strathdee said.

Back in Texas, Young and his team had also gotten lucky. They found four promising phages that ravaged Patterson’s antibiotic-resistant bacteria in a test tube. Now the hard part began — figuring out how to separate the victorious phages from the soup of bacterial toxins left behind.

“You put one virus particle into a culture, you go home for lunch, and if you’re lucky, you come back to a big shaking, liquid mess of dead bacteria parts among billions and billions of the virus,” Young said. “You want to inject those virus particles into the human bloodstream, but you’re starting with bacterial goo that’s just horrible. You would not want that injected into your body.”

Purifying phage to be given intravenously was a process that no one had yet perfected in the US, Schooley said, “but both the Navy and Texas A&M got busy, and using different approaches figured out how to clean the phages to the point they could be given safely.”

More hurdles: Legal staff at Texas A&M expressed concern about future lawsuits. “I remember the lawyer saying to me, ‘Let me see if I get this straight. You want to send unapproved viruses from this lab to be injected into a person who will probably die.’ And I said, “Yeah, that’s about it,’” Young said.

“But Stephanie literally had speed dial numbers for the chancellor and all the people involved in human experimentation at UC San Diego. After she calls them, they basically called their counterparts at A&M, and suddenly they all began to work together,” Young added.

“It was like the parting of the Red Sea — all the paperwork and hesitation disappeared.”

The purified cocktail from Young’s lab was the first to arrive in San Diego. Strathdee watched as doctors injected the Texas phages into the pus-filled abscesses in Patterson’s abdomen before settling down for the agonizing wait.

“We started with the abscesses because we didn’t know what would happen, and we didn’t want to kill him,” Schooley said. “We didn’t see any negative side effects; in fact, Tom seemed to be stabilizing a bit, so we continued the therapy every two hours.”

Two days later, the Navy cocktail arrived. Those phages were injected into Patterson’s bloodstream to tackle the bacteria that had spread to the rest of his body.

“We believe Tom was the first person to receive intravenous phage therapy to treat a systemic superbug infection in the US,” Strathdee told CNN.

“And three days later, Tom lifted his head off the pillow out of a deep coma and kissed his daughter’s hand. It was just miraculous.”

Patterson awoke from a coma after receiving an intravenous dose of phages tailored to his bacteria.

Today, nearly eight years later, Patterson is happily retired, walking 3 miles a day and gardening. But the long illness took its toll: He was diagnosed with diabetes and is now insulin dependent, with mild heart damage and gastrointestinal issues that affect his diet.

“He isn’t back surfing again, because he can’t feel the bottoms of his feet, and he did get Covid-19 in April that landed him in the hospital because the bottoms of his lungs are essentially dead,” Strathdee said.

“As soon as the infection hit his lungs he couldn’t breathe and I had to rush him to the hospital, so that was scary,” she said. “He remains high risk for Covid but we’re not letting that hold us hostage at home. He says, ‘I want to go back to having as normal life as fast as possible.’”

To prove it, the couple are again traveling the world — they recently returned from a 12-day trip to Argentina.

“We traveled with a friend who is an infectious disease doctor, which gave me peace of mind to know that if anything went sideways, we’d have an expert at hand,” Strathdee said.

“I guess I’m a bit of a helicopter wife in that sense. Still, we’ve traveled to Costa Rica a couple of times, we’ve been to Africa, and we’re planning to go to Chile in January.”

Patterson’s case was published in the journal Antimicrobial Agents and Chemotherapy in 2017, jump-starting new scientific interest in phage therapy.

“There’s been an explosion of clinical trials that are going on now in phage (science) around the world and there’s phage programs in Canada, the UK, Australia, Belgium, Sweden, Switzerland, India and China has a new one, so it’s really catching on,” Strathdee told CNN.

Some of the work is focused on the interplay between phages and antibiotics — as bacteria battle phages they often shed their outer shell to keep the enemy from docking and gaining access for the kill. When that happens, the bacteria may be suddenly vulnerable to antibiotics again.

“We don’t think phages are ever going to entirely replace antibiotics, but they will be a good adjunct to antibiotics. And in fact, they can even make antibiotics work better,” Strathdee said.

In San Diego, Strathdee and Schooley opened the Center for Innovative Phage Applications and Therapeutics, or IPATH, in 2018, where they treat or counsel patients suffering from multidrug-resistant infections. The center’s success rate is high, with 82% of patients undergoing phage therapy experiencing a clinically successful outcome, according to its website.

Schooley is running a clinical trial using phages to treat patients with cystic fibrosis who constantly battle Pseudomonas aeruginosa, a drug-resistant bacteria that was also responsible for the recent illness and deaths connected to contaminated eye drops manufactured in India.

And a memoir the couple published in 2019 — “The Perfect Predator: A Scientist’s Race to Save Her Husband From a Deadly Superbug” — is also spreading the word about these “perfect predators” to what may soon be the next generation of phage hunters.

How naturally occurring viruses could help treat superbug infections

“I am getting increasingly contacted by students, some as young as 12,” Strathdee said. “There’s a girl in San Francisco who begged her mother to read this book and now she’s doing a science project on phage-antibiotic synergy, and she’s in eighth grade. That thrills me.”

Strathdee is quick to acknowledge the many people who helped save her husband’s life. But those who were along for the ride told CNN that she and Patterson made the difference.

“I think it was a historical accident that could have only happened to Steffanie and Tom,” Young said. “They were at UC San Diego, which is one of the premier universities in the country. They worked with a brilliant infectious disease doctor who said, ‘Yes,’ to phage therapy when most physicians would’ve said, ‘Hell, no, I won’t do that.’

“And then there is Steffanie’s passion and energy — it’s hard to explain until she’s focused it on you. It was like a spiderweb; she was in the middle and pulled on strings,” Young added. “It was just meant to be because of her, I think.”

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It’s a myth that women don’t want sex as they age, study finds | CNN

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CNN
—

It’s a myth that women lose interest in sex as they enter midlife and beyond, according to research that followed more than 3,200 women for about 15 years.

“About a quarter of women rate sex as very important, regardless of their age,” said Dr. Holly Thomas, lead author of an abstract presented during the September 2020 virtual annual meeting of the North American Menopause Society.

“The study showed substantial numbers of women still highly value sex, even as they get older, and it’s not abnormal,” said Thomas, an assistant professor of medicine at the University of Pittsburgh.

“If women are able to speak up with their partner and make sure that they’re having sex that’s fulfilling and pleasurable to them, then they’re more likely to rate it as highly important as they get older,” she said.

“That’s actually quite refreshing, that there were a quarter of women for whom sex remains not just on the radar but highly important,” said Dr. Stephanie Faubion, medical director for the North American Menopause Society, who was not involved in the study.

“Studies like these provide valuable insights to health care providers who may otherwise dismiss a woman’s waning sexual desire as a natural part of aging.”

It’s true that past studies have found that women tend to lose interest in sex as they age. But women’s health practitioners say that attitude doesn’t jibe with the reality they see.

“Some of the prior studies had suggested that sex goes downhill and all women lose interest in sex as they get older,” Thomas said. “That really isn’t the type of story that I hear from all my patients.”

One issue, she said, is that past studies took a single snapshot of a woman’s desire at one point in her life and compared it with similar snapshots in later decades of life.

“That type of longitudinal study would just show averages over time,” Thomas said. “And if you look at things on average, it may look like everyone follows one path.”

The study presented in 2020 used a different type of analysis that allowed researchers to follow the trajectory of a woman’s desire over time, Thomas said then.

“We wanted to use this different type of technique to see if there really were these different patterns,” she said. “And when you look for these trajectories, you see there are significant groups of women who follow another path.”

The research, which analyzed data from a national multisite study called SWAN, or the Study of Women’s Health Across the Nation, found three distinct pathways in a woman’s feelings about the importance of sex.

About a fourth of the women (28%) followed traditional thinking on the subject: They valued sex less during midlife years.

However, another fourth of the women in the study said the exact opposite. Some 27% of them said sex remains highly important throughout their 40s, 50s and 60s — a surprising contradiction of the belief that all women lose interest in sex as they age.

“Sex is going to look different,” said Faubion, who is director of the Mayo Clinic’s Center for Women’s Health.

“It’s not going to look the same at 40 as it does at 20; it’s not going to look the same at 60 as it does at 40, and it’s not going to look the same at 80 as it did at 60,” she said. “There may be some modifications that we have to do, but people in general who are healthy and in good relationships remain sexual.”

Women in the study who highly valued sex shared the following characteristics: They were more highly educated, they were less depressed, and they had experienced better sexual satisfaction before entering midlife.

“Women who were having more satisfying sex when they were in their 40s were more likely to continue to highly value sex as they got older,” Thomas said.

There could also be socioeconomic factors at play, she added. For example, more highly educated women may have higher incomes and feel more stable in their lives with less stress.

“Therefore they have more headspace to make sex a priority because they’re not worrying about other things,” Thomas said.

The study found another factor important to both lower-interest and high-interest pathways — race and ethnicity.

African American women were more likely to say sex was important to them for the duration of midlife, while Chinese and Japanese women were more likely to rate sex as having low importance throughout their midlife years.

“I do want to emphasize that it’s much more likely to be due to sociocultural factors than any biological factor,” Thomas said. “Women from different cultural groups have different attitudes … different comfort levels about getting older … and whether it’s ‘normal’ for a woman to continue to value sex as she gets older.”

The majority of women (48%) fell into a third pathway: They valued a healthy sex life as they entered the menopausal years but gradually lost interest throughout their 50s or 60s.

There are a number of emotional, physical and psychological factors that might affect how a woman views sex, experts say. Most can be divided into four categories:

Medical conditions: As women enter perimenopause in their 40s and 50s, they begin to experience hormonal changes that can cause sex to become less satisfying or even painful.

The drop in estrogen causes the vulva and vaginal tissues to become thinner, drier and more easily broken, bruised or irritated. Arousal can become more difficult. Hot flashes and other signs of menopause can affect mood and sleep quality, leading to fatigue, anxiety, irritability, brain fog and depression.

Many medical conditions can arise or worsen during midlife that can also affect libido.

“Do they have medical conditions like hip arthritis that cause pain with sex? Or hand arthritis that can make it more difficult? Or things like diabetes where their sensation is not the same, or do they have heart disease?” Faubion asked.

“But there are modifications that we talk about all the time to help people remain sexual, even for quadriplegics,” she said. “There are ways to stay sexual despite disability.”

Mental and emotional considerations: The psychological component of sex can have a huge influence on a woman’s levels of sexual desire. A history of sexual or physical abuse, struggles with substance abuse and depression, anxiety and stress are major players in this category.

“I can’t tell you enough about the impact of anxiety and stress on sex,” Faubion said. “Think of that fight or flight mechanism — your adrenaline’s pumping so you’re back in caveman days and a lion is chasing you.

“Are you going to lie down on the grassy knoll and have sex when the lion is chasing you? The answer is no. And that’s how women with anxiety are all the time, so anxiety is a huge, huge factor for whether women will be sexual.”

While the study did not look specifically at anxiety, results showed women with more symptoms of depression were much less likely to rate sex as a priority in life. In addition to the emotional impact, a reduced libido is a side effect of many antidepressants prescribed to treat depression.

Partner component: Women in midlife can also face dramatic and disturbing changes in their romantic lives that can take a major toll on their interest in sex.

“Are they losing a romantic partner to divorce or to death? Is a romantic partner developing health issues that make sex more difficult or inconvenient? Are they getting busy in other aspects of their life — their career, caring for grandchildren or even grown children who are moving back in? That makes it hard to prioritize sex,” Thomas said.

Even if they have a partner, relationships may have had ups and downs that can affect how a woman feels about intimacy with a significant other.

“Do you like your partner?” Faubion asked. “Is your communication good? Even logistics can get in the way — are you in the same place at the same time?”

Social mores: Society also affects how a woman feels about sex. Religious, cultural and family values about the topic can play a large role in sexual ease and satisfaction.

“Then there’s what society teaches us about aging women,” Faubion said. “And so for some women being sexual is somehow bad. Women aren’t supposed to like sex.”

“I’ve seen plenty of women in my clinic in the 60-to-65 age group who never got any sex education, their partners never got any sex education, and they don’t really want to know about all that stuff.”

Of course, if a woman isn’t bothered by a lack of sex, then there’s no reason to see a doctor, Faubion and Thomas said. But they both said that past studies have shown that about 10% to 15% of women who do have a lower interest in sex are bothered by it and would like to seek a solution.

There are ways in which physicians can help, including medications and therapies, but first a woman must reach out and talk to her doctor.

“Prior research has shown that women often really do hesitate to reach out to their doctors, perhaps because they’re embarrassed or they see it as part of normal aging and and don’t think it’s worth bringing up,” Thomas said.

Faubion added, “Bottom line: Women should talk to their providers if they’re having concerns about their sexual health. It’s an important part of life, and there are solutions for women who are struggling with that.”

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How the nursing shortage may lead to gaps in sexual assault care | CNN

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Missoula, Montana
KFF Health News
—

Jacqueline Towarnicki got a text as she finished her day shift at a local clinic. She had a new case, a patient covered in bruises who couldn’t remember how the injuries got there.

Towarnicki’s breath caught, a familiar feeling after four years of working night shifts as a sexual assault nurse examiner in this northwestern Montana city.

“You almost want to curse,” Towarnicki, 38, said. “You’re like, ‘Oh, no, it’s happening.’”

These nights on duty are Towarnicki’s second job. She’s on call once a week and a weekend a month. A survivor may need protection against sexually transmitted infections, medicine to avoid getting pregnant, or evidence collected to prosecute their attacker. Or all the above.

When her phone rings, it’s typically in the middle of the night. Towarnicki tiptoes down the stairs of her home to avoid waking her young son, as her half-asleep husband whispers encouragement into the dark.

Her breath is steady by the time she changes into the clothes she laid out close to her back door before going to bed. She grabs her nurse’s badge and drives to First Step Resource Center, a clinic that offers round-the-clock care for people who have been assaulted.

She wants her patients to know they’re out of danger.

“You meet people in some of their most horrifying, darkest, terrifying times,” Towarnicki said. “Being with them and then seeing who they are when they leave, you don’t get that doing any other job in health care.”

A former travel nurse who lived out of a van for years, Towarnicki is OK with the uncertainty that comes with being a sexual assault nurse examiner.

Most examiners work on-call shifts in addition to full-time jobs. They often work alone and at odd hours. They can collect evidence that could be used in court, are trained to recognize and respond to trauma, and provide care to protect their patients’ bodies from lasting effects of sexual assault.

But their numbers are few.

As many as 80% of U.S. hospitals don’t have sexual assault nurse examiners, often because they either can’t find them or can’t afford them. Nurses struggle to find time for shifts, especially when staffing shortages mean covering long hours. Sexual assault survivors may have to leave their town or even their state to see an examiner.

Gaps in sexual assault care can span hundreds of miles in rural areas. A program in Glendive, Montana — a town of nearly 5,000 residents 35 miles from the North Dakota border — stopped taking patients for examinations this spring. It didn’t have enough nurses to respond to cases.

“These are the same nurses working in the ER, where a heart attack patient could come in,” said Teresea Olson, 56, who is the town’s part-time mayor and also picked up on-call shifts. “The staff was exhausted.”

The next closest option is 75 miles away in Miles City, adding at least an hour to the travel time for patients, some of whom already had to travel hours to reach Glendive.

Nationwide, policymakers have been slow to offer training, funding, and support for the work. Some states and health facilities are trying to expand access to sexual assault response programs.

Oklahoma lawmakers are considering a bill to hire a statewide sexual assault coordinator tasked with expanding training and recruiting workers. A Montana law that takes effect July 1 will create a sexual assault response network within the Montana Department of Justice. The new program aims to set standards for that care, provide in-state training, and connect examiners statewide. It will also look at telehealth to fill in gaps, following the example of hospitals in South Dakota and Colorado.

There’s no national tally of where nurses have been trained to respond to sexual assaults, meaning a survivor may not know they have to travel for treatment until they’re sitting in an emergency room or police department.

Sarah Wangerin, a nursing instructor with Montana State University and former examiner, said patients reeling from an attack may instead just go home. For some, leaving town isn’t an option.

This spring, Wangerin called county hospitals and sheriff’s offices to map where sexual assault nurse examiners operate in Montana. She found only 55. More than half of the 45 counties that responded didn’t have any examiners. Just seven counties reported they had nurses trained to respond to cases that involve children.

“We’re failing people,” Wangerin said. “We’re re-traumatizing them by not knowing what to do.”

First Step, in Missoula, is one of the few full-time sexual assault response programs in the state. It’s operated by Providence St. Patrick Hospital but is separate from the main building.

The clinic’s walls are adorned with drawings by kids and mountain landscapes. The staff doesn’t turn on the harsh overhead fluorescent lights, choosing instead to light the space with softer lamps. The lobby includes couches and a rocking chair. There are always heated blankets and snacks on hand.

Kate Harrison turns on her pager at the start of her night shift as a sexual assualt nurse examiner.

First Step stands out for having nurses who stay. Kate Harrison waited roughly a year to join the clinic and is still there three years later, in part because of the staff support.

The specially trained team works together so no one carries too heavy a load. While being on night shift means opening the clinic alone, staffers can debrief tough cases together. They attend group therapy for secondhand trauma.

Harrison is a cardiac hospital nurse during the day, a job that sometimes feels a little too stuck to a clock.

At First Step, she can shift into whatever role her patient needs for as long as they need. Once, that meant sitting for hours on a floor in the lobby of the clinic as a patient cried and talked. Another time, Harrison doubled as a DJ for a nervous patient during an exam, picking music off her cellphone.

“It’s in the middle of the night, she just had this sexual assault happen, and we were just laughing and singing to Shaggy,” Harrison said. “You have this freedom and grace to do that.”

When the solo work is overwhelming or she’s had back-to-back cases and needs a break, she knows a co-worker would be willing to help.

“This work can take you to the undercurrents and the underbelly of society sometimes,” Harrison said. “It takes a team.”

That includes co-workers like Towarnicki, who dropped her work hours at her day job after having her son to keep working as a sexual assault nurse examiner. That meant adding three years to her student loan repayment schedule. Now, pregnant with her second child, the work still feels worth it, she said.

On a recent night, Towarnicki was alone in the clinic, clicking through photos she took of her last patient. The patient opted against filing a police report but asked Towarnicki to log all the evidence just in case.

Towarnicki quietly counted out loud the number of bruises, their sizes and locations, as she took notes. She tells patients who have gaps in their memories that she can’t speculate how each mark got there or give them all the answers they deserve.

But as she sat in the blue light of her computer screen long after her patient left, it was hard to keep from ruminating.

“Totally looks like a hand mark,” Towarnicki said, suddenly loud, as she shook her head.

All the evidence and her patient’s story were sealed and locked away, just feet from a wall of thank-you cards from patients and sticky notes of encouragement among nurses.

On the harder evenings, Towarnicki takes a moment to unwind with a pudding cup from the clinic’s snacks. Most often, she can let go of her patient’s story as she closes the clinic. Part of her healing is “seeing the light returned to people’s eyes, seeing them be able to breathe deeper,” which she said happens 19 out of 20 times.

“There is that one out of 20 where I go home and I am spinning,” Towarnicki said. In those cases, it takes hearing her son’s voice, and time to process, to pull her back. “I feel like if it’s not hard sometimes, maybe you shouldn’t be doing this work.”

It was a little after 11 p.m. as Towarnicki headed home, an early night. She knew her phone could go off again.

Eight more hours on call.

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Fetterman’s hospitalization: What is clinical depression? | CNN

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Editor’s Note: If you or someone you know is struggling with mental health, please call the Suicide & Crisis Lifeline at 988 to connect with a trained counselor or visit 988lifeline.org.

CNN
—

Democratic Sen. John Fetterman of Pennsylvania voluntarily checked himself into a hospital on Thursday “to receive treatment for clinical depression,” according to a statement by Adam Jentleson, his chief of staff.

“While John has experienced depression on and off during his life, it only became severe in recent weeks,” Jentleson wrote.

In May, during his campaign, Fetterman suffered a stroke as he faced off against Republican Mehmet Oz for the Senate seat.

“After what he’s been through in the past year, there’s probably no one who wanted to talk about his own health less than John. I’m so proud of him for asking for help and getting the care he needs,” his wife, Gisele Barreto Fetterman, tweeted.

“I think it’s fantastic that Sen. Fetterman was working with a provider that recommended he get a higher level of care, and that he was able to access services quickly,” said Kristen Carpenter, chief psychologist in the department of psychiatry and behavioral health at Ohio State University College of Medicine.

“Many patients struggle and suffer with these symptoms for a long time before seeking or getting the help they need,” she added. “At a minimum, you can have relief faster when you’re linked for care.”

Depression after a major illness such as stroke is not uncommon, according to the American Stroke Association.

“After a stroke there are biochemical changes within the brain structure which might put him more at risk for depression,” said stress management expert Dr. Cynthia Ackrill, a fellow at the American Institute of Stress.

“After you’ve had a stroke, it takes more work to do what you did before,” Ackrill added. “So you’re more tired and more stressed, and we know that chronic exposure to the cortisol that comes from stress puts you more at risk for depression.”

No one knows the exact cause for depression, and why it is worse in some people than others, according to the US Centers for Disease Control and Prevention.

“It may be caused by a combination of genetic, biological, environmental, and psychological factors,” the CDC noted.

Having a family member with depression raises the risk; so do traumatic experiences such as physical abuse or sexual assault, financial problems and a major life change, such as losing a loved one, the CDC said.

Depression is also more common after having a heart attack or being diagnosed with cancer or chronic pain, and people with anxiety disorders are more likely to suffer from depression, too, the CDC said. Substance abuse, such as alcoholism, is also linked to depressive symptoms.

Feelings of depression can be a side effect of many medications, including common ones such as beta blockers used to treat high blood pressure, some proton pump inhibitors used to treat acid reflux, steroids used for inflammation and pain, hormonal contraceptives and more. A 2018 study found over 37% of US adults used medications that might lead to depression.

Symptoms of depression include an ongoing sad, anxious or vacant mood, along with “feelings of hopelessness, pessimism, guilt, worthlessness or helplessness,” according to the American Stroke Association.

Other symptoms include fatigue and decreased energy; less interest or pleasure in daily activities, including sex; changes in appetite and weight; trouble with memory, concentration, planning and decision-making; sleep changes, such as insomnia or oversleeping; and thoughts of death or suicide.

Depression can be mild, moderate or severe. Clinical depression, also called major depressive disorder, is the more severe form of depression.

To be diagnosed with clinical depression “an individual must have five depression symptoms every day, nearly all day, for at least 2 weeks,” according to the National Institute on Mental Health.

“One of the symptoms must be a depressed mood or a loss of interest or pleasure in almost all activities. Children and adolescents may be irritable rather than sad,” the institute noted.

“We all experience times of sadness, or lack of interest in things we usually enjoy, or other sorts of depressive symptoms,” Ohio State’s Carpenter said. “However, when someone slips into a major depressive episode that means those symptoms are present daily, for most of the day, and they are functionally impairing — meaning they inhibit one’s ability to work, to interface with their families and loved ones, and to engage in the usual activities of living.”

There are a number of treatments for depression, including antidepressant medications, psychological therapy or a combination of both. Antidepressants typically take between four to eight weeks to work, and it’s not uncommon to try a variety of medications before finding the best for that individual, Carpenter said.

“There are higher levels of care like hospitalization, which provides services available all day to help get you on your recovery journey faster.”

If depression fails to respond to first-line treatments, providers may suggest other medications such as esketamine, Carpenter said. Delivered as a nasal spray by doctors, esketamine is a newer US Food and Drug Administration-approved medication for treatment-resistant depression.

“It often acts rapidly — typically within a couple of hours — to relieve depression symptoms,” according to the National Institute on Mental Health.

“If you have what we refer to as a treatment-resistant depression, we may use things like TMS — transcranial magnetic stimulation — and we still use ECT, or electroconvulsive therapy. So there really is a large compendium of therapies available,” Carpenter said.

“The key is getting care. The vast majority of people will have their symptoms remit with proper treatment through psychotherapy and/or medication.”

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Bullying doesn’t look like it used to. Experts share how to fix it | CNN

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Editor’s Note: If you or someone you know is struggling with suicidal thoughts or mental health matters, please call the National Suicide Prevention Lifeline at 988 (or 800-273-8255) to connect with a trained counselor or visit the NSPL site.

CNN
—

Every generation has tales of bullying, but perhaps today’s adults are not as familiar with what it means now for a kid to be bullied.

Physical bullying — like confrontations involving hitting or shoving — actually showed very little association with a risk for mental distress, according to a new study.

“For adults doing this research, you kind of assume that bullying consists of being stuffed in a locker and beaten up on the playground,” said lead study author John Rovers, professor and John R. Ellis Distinguished Chair in Pharmacy Practice at Drake University in Des Moines, Iowa. “We found out that that really has remarkably little effect.”

Researchers took data from the 2018 Iowa Youth Survey of sixth, eighth and 11th graders to see whether there was an association between bullying and mental health and suicidal ideation, according to the study published Wednesday in the journal PLOS ONE.

The results showed different forms of bullying did have an impact on feelings of sadness or hopelessness or thoughts of suicide — but that they did not impact students equally.

Identity bullying, which includes bullying based on sexual orientation or gender identity as well as sexual jokes, was correlated with significant feelings of distress or suicide attempts, the study said.

Cyberbullying and social bullying — leaving someone out or turning peers against them — followed identity bullying on degree of impact.

The study is limited in that the sample did not include a high level of racial and religious diversity, but it does show “a theme very consistent with recent surveys as well as what I’m seeing in my clinical practice,” said child and adolescent psychiatrist Dr. Neha Chaudhary, chief medical officer at BeMe Health who is in the faculty at Massachusetts General Hospital and Harvard Medical School. Chaudhary was not involved in the research.

The teachers and school administrators surveyed were worried most about physical bullying, however, according to the study.

“This is a good learning for schools and families as they think about anti-bullying initiatives and how to talk to young people about the effects of bullying,” Chaudhary said.

It makes sense that identity would be a particularly painful form of bullying.

“Identity is so incredibly important for kids and teens as they develop, and not being able to be themselves without fear of judgement or bullying from others is not only isolating, it can significantly alter their confidence, peace of mind, and ability to see a future for themselves that’s free of pain,” Chaudhary said in an email. “People just want to be themselves, and be loved for who they are.”

The survey data reviewed by the study team revealed a troubling statistic when it came to the state of adolescent mental health.

“About 70,000 students responded to this survey. Five percent of them had attempted suicide in the last year,” Rovers said. “That’s 3,500 kids.”

And this week’s results of the US Centers for Disease Control and Prevention’s biannual Youth Risk Behavior Survey showed mental distress among teens is getting worse.

In rates that “increased dramatically” over the past decade, most high school girls (57%) felt persistently sad or hopeless in 2021, double the rate for teen boys (29%), according to the CDC. Nearly 1 in 3 teen girls seriously considered attempting suicide.

Most LGBTQ students (52%) have also recently experienced poor mental health, and more than 1 in 5 attempted suicide in the past year, the CDC survey showed.

Solutions that address adolescent mental health may come from families and schools working together — not in focusing on what the kids themselves can change, Rovers said.

“Blaming this on some 9-year-old kid is not right,” he added.

When it comes to bullying, there are three types of players: the bully, the victim and the child that is both being bullied and bullying others, Rovers said.

All three need support, said Dr. Hina Talib, adolescent medicine specialist at the Atria Institute in New York and associate professor of clinical pediatrics at the Albert Einstein College of Medicine in New York City.

“Bullying is such a pattern of behavior that causes harm to the victim of the bully, the children that might just be witnessing the bullying happening and even to the bully themselves,” said Talib, who was not involved in the research.

Rarely is a child exerting power over others just for its own sake, Talib added.

While caregivers may have the first reaction to punish their child when they hear they are bullying others, it is important to probe a little deeper into what is going on with them, she said.

“There are likely reasons there that are causing them to act out in this way,” Talib explained. “Underneath that, I think it’s important to see that their child is hurting also.”

She recommended coming to them with the mindset of “this is not acceptable behavior, and this is why, and I’m here to help you through it,” Talib said.

“The bully can and should be helped as well,” she added. “There’s almost always more to it.”

There are many ideas about what motivates bullying behavior, but one could be that kids are emulating how they see the adults in their lives resolve conflict, Rovers said. These adolescents might learn that violence is a way to protect themselves.

For children that are being bullied, they may not always be direct in telling the adults in their lives what is wrong, Talib said.

Instead of hearing about cruel words or isolating actions, families might first see stress, anxiety, depression, stomachaches and avoiding school, she said.

She recommended being attentive to your child and their individual behaviors and stepping in when you see a change. That could mean asking directly, having their pediatrician speak to them about it privately or even coming to them indirectly.

A helpful way in could be to ask about their friends’ experiences.

Say something like: “There was an interesting research report about bullying, and it made me think about bullying. It made me interested in if your friends were bullied or if you ever witnessed a bullying situation,” Talib said.

If you do find that your child is the victim of bullying, Talib said it’s a good idea to get in contact with the school and the other family to develop an action plan together.

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Is your school equipped to save a life? Here’s how you’ll know | CNN

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CNN
—

When 24-year-old Buffalo Bills safety Damar Hamlin collapsed on the field from cardiac arrest during the January 2 game against the Cincinnati Bengals, millions of people witnessed a remarkable resuscitation in real time on live television.

As a trauma neurosurgeon myself, I was in awe of the dozens of medical professionals – athletic trainers, doctors and EMTs – who put their years of training into action within seconds. The immediate recognition that this wasn’t a routine injury and the speedy administration of CPR and defibrillation saved his heart, his brain and his life. Six weeks later, we now hear Dr. Thomas Mayer, the medical director of the NFL Players Association, say “I guarantee you that Damar Hamlin will play professional football again.”

The rescue response was awesome to watch and reflected the remarkable resources and planning that go into every game played in the NFL. As a parent, though, I couldn’t help but wonder what would’ve happened if Hamlin faced this when he was still in high school. What if it would’ve happened to any of my three teenage kids at their school? Would they have been saved as well?

Sudden cardiac deaths are rare in young people, but you may be surprised to know that the US Centers for Disease Control and Prevention estimates that there are about 2,000 such deaths in people under the age of 25 every year.

While the overall number of cardiac arrests has stayed largely consistent, there is no question that school safety efforts – and cardiac arrest survival rates – have improved over the years. Florida was the first state to enact laws requiring automated external defibrillators, or AEDs, in schools in 1999, and there are now 20 states, along with the District of Columbia, with similar mandates, according to the American College of Cardiology. Even in most of the states with no requirement on the books, AEDs are available in the majority of schools.

Most venues with more than 200 people – large businesses, stadiums, casinos and concert halls – are required to have AEDs as well, but there has been a major focus on schools in recent decades, considering that about 20% of the US population is on school grounds at any one time. In the past quarter-century, we went from hardly any AEDs being present in schools to a remarkable awareness of the lifesaving potential they hold. That increased awareness and attention to defibrillators and CPR has directly resulted in more athletes surviving, says Dr. Jonathan Drezner, director of the University of Washington Medicine Center for Sports Cardiology and team physician for the Seattle Seahawks.

He points out that when he began investigating sudden cardiac arrest in young athletes in the early 2000s, survival rates hovered around 11%. A more recent study of young athletes from 2014 to 2018 found that survival rates have climbed to an average of 68%. That’s an improvement of more than 500% in less than two decades.

Still, we can and must do better, especially at the high school level. While there is increased awareness and availability of AEDs, none of that matters if the lifesaving device can’t be accessed within two to three minutes.

As part of a CNN investigation, we wanted a detailed understanding not just of AED availability in schools but of real-life accessibility. Speed matters when someone has suddenly dropped due to cardiac arrest. The best estimates are that every minute without defibrillation reduces survival by up to 10%.

That’s why Dr. Victoria Vetter, a cardiologist with the Cardiac Center at Children’s Hospital of Philadelphia, told us that “just having an AED is not sufficient.”

“You need to make sure that there is an accessible AED that is not locked in the nurse’s office or in some back office,” Vetter said.

The American Heart Association recommends that defibrillators be placed within a two- to three-minute walk. Unfortunately, even in schools that have diligently purchased devices – typically at a cost of $1,000 to $2,000 – too many of them are not readily accessible.

One small study of secondary public schools in Ohio and southeast Michigan found that in more than 70% of the 24 public schools surveyed, the devices simply couldn’t be reached in time. Another study of schools in Oregon found that people in just half of the schools surveyed could access the devices within four minutes of a field or arena. In Vermont, 81% of the state’s 74 schools had defibrillators near athletic fields or arenas; half of the time, the AEDs were kept in the main office, with the nurse or in the lobby.

As part of our investigation, we defined AED access as knowing where the AEDs are in case of emergency. But it is essential to make sure they are always fully charged and that drills are regularly run to ensure people know how to use them.

“We have fire drills in schools generally, every month. We have active shooter drills. But we do not in most schools have sudden cardiac arrest drills,” Vetter said.

Nationally, she said, just a handful of states require schools to practice cardiac emergency plans.

Many people have held up the NFL’s cardiac response as the gold standard: quick action and accessibility. Watching the remarkable 30-person team of professionals who saved Hamlin, many would argue that most high schools don’t have the resources to employ dozens of medical professionals.

But it doesn’t take an army to save a life.

“A single person can save a young athlete’s life if they promptly recognize cardiac arrest, call for help, start CPR and someone gets the AED,” said the Seahawks’ Drezner. “The treatment algorithm really is that simple.”

For many schools, that person would be an athletic trainer, the medical professional on the field.

And yet, in about a third of the nation’s high schools, there is no access to athletic trainers at all.

“You have to ask yourself: When those athletes get injured, who’s addressing those injuries? Who’s there to provide the emergency action plan in case something like this happens?” asked Kathy Dieringer, president of the National Athletic Trainers’ Association.

Drezner’s work has found that the survival rate from cardiac arrest for young athletes nearly doubled to over 80% when an athletic trainer was present or an AED was used. Part of the reason is that schools with athletic trainers were also the ones most likely to have emergency plans and AEDs. As things stand now, schools least likely to have athletic trainers are in urban or rural areas, and the schools most likely to have them are in the suburbs, areas that tend to have higher incomes.

“If I were a parent, I would ask those questions,” Dieringer said. “Where are the AEDs in my school? Are they accessible, and does someone know how to use them if they’re needed?”

Sudden cardiac arrest is a leading cause of death in young competitive athletes, with one study finding as many as one death every three days in youth sports.

One of those deaths was 16-year-old Matthew Mangine Jr., a soccer player at St. Henry District High School in Erlanger, Kentucky. In 2020, Matthew collapsed on the soccer field.

“There were five AEDs at the school that night, and one wasn’t brought to him,” his father, Matthew Mangine Sr., told the local news. “That night, his initial shock came from EMS. They arrived roughly 12 minutes after he was down.” Matthew died an hour later at the hospital.

John and Luann Ellsessar also know that pain well. They lost their 16-year-old son, Michael, on the football field when he went into cardiac arrest during a game in 2010. “There was no ambulance or AED on the field, and it took 15 minutes for the squad to arrive,” John told CNN. “If that ambulance is arriving 15 minutes later, he’s already 150% gone.” John recalls that the doctors at the hospital worked on Michael for 45 minutes before pronouncing him dead.

Many schools have AEDs on campus, but often, they're hard to find quickly.

Fortunately, this wasn’t the story for Peter Laake. In 2021, the star lacrosse player was already on the varsity team as a freshman at Loyola Blakefield in Towson, Maryland. Peter was hit on the left side in what was apparently a normal play, but what followed wasn’t normal at all. Peter told me he blacked out and collapsed on the field.

Jeremy Parr, the school’s athletic trainer, said he immediately went to Peter’s side and checked for a pulse.

“With no pulse, no breathing, we needed to get the AED and EMS activated as soon as possible,” Parr told me when I spoke with him recently.

CPR was started, and in Peter’s case, the AED data showed that his heart was beating again within two to three minutes.

Within three weeks, Peter was back on the field.

It’s an example of how things should work and could work in all schools.

Training in CPR for all staff, athletic and educational. Availability and accessibility of AEDs with regular drills to make sure execution is flawless. An emergency action plan that is posted and reviewed.

As a parent, you can and should ask about all of this yourself. After witnessing what happened to Hamlin, I did just that with the athletic department at my own children’s school.

In a world where we have many complicated problems, saving someone’s life is possible with the knowledge and resources we have right now. With a plan, it is easy. We often prioritize buses, fields and athletic equipment, but cardiac safety must also be at the top of the list.

As Parr told me, when the unthinkable happens, “every athlete deserves the chance to survive.”

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Children’s mental health tops list of parent worries, survey finds | CNN

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CNN
—

Forty percent of US parents are “extremely” or “very” worried that their children will struggle with anxiety or depression at some point, a new survey finds.

The Pew Research Center report said mental health was the greatest concern among parents, followed by bullying, which worries 35% of parents. These concerns trumped fears of kidnapping, dangers of drugs and alcohol, teen pregnancy and getting into trouble with the police.

Concerns varied by race, ethnicity and income level, with roughly 4 in 10 Latino and low-income parents and 3 in 10 Black parents saying they are extremely or very worried that their children could be shot, compared with about 1 in 10 high-income or White parents.

Nearly two-thirds of the respondents said that being a parent has been at least somewhat harder than they expected, about 41% say that being a parent is tiring, and 29% say it is stressful all or most of the time.

The report captured the perceptions of a nationally representative sample of 3,757 US parents whose children were younger than 18 in 2022.

Experts say mental health issues among children and adolescents have skyrocketed in recent years.

“I would say over the last 10 years, since I’ve been practicing as a general pediatrician, I have seen a shift both in the amount of patients and of all ages dealing with anxiety and depression. And their parents being concerned about this is a key issue,” said Dr. Katherine Williamson, a pediatrician and spokesperson for the American Academy of Pediatrics. “Even before the pandemic, we were seeing skyrocketing numbers of kids and adolescents dealing with mental health issues, and that has increased exponentially since the pandemic.”

Suicide became the second leading cause of death among children 10 to 14 during the Covid-19 pandemic, according to the US Centers for Disease Control and Prevention. Mental health-related emergency room visits among adolescents 5 to 11 and 12 to 17 also jumped 24% and 31%, respectively.

Many parents feel helpless when their children have mental health issues because they don’t feel equipped to offer support in this area.

“They are unable to relieve [mental health issues] and address that as they could if they were struggling with their grades or other things that seem more traditional to for kids to struggle with,” said Allen Sabey, a family therapist at the Family Institute at Northwestern University.

Parents trying to “work out and look at and connect with their own feelings will give them important information about what feels off or OK for their kid,” he said.

When it comes to anxiety and depression in children, pediatricians say, parents can watch for signs like decreased interest or pleasure in things they previously enjoyed, poor self-esteem and changes in mood, appetite or sleep.

Experts also say parents should consider the amount and content of social media their child consumes, as research has found that it can have negative effects on their mental health.

But, they say, having more parents recognize the importance of mental health in children is a step in the right direction.

“I have always felt there’s been so much resistance to seeking care for mental health among the population that I serve. And I am actually happy that since the Covid pandemic, at least people now are recognizing this as a very key and important health need,” said Dr. Maggi Smeal, a pediatrician at Stanford Medicine Children’s Health.

Smeal hopes that “all people that are interacting with children can be aware of these issues and feel empowered to identify and advocate for these children, to tell them to go to their primary care provider and have an assessment just like you do if your kid has a cough or a fever or ear infection.”

The number of parents concerned about gun violence reflects the fact that guns are the leading cause of death among children in the US, research has showed. From 2019 to 2020, the rate of firearm-related deaths increased 29.5% – more than twice the increase as in the general population.

“Gun violence is a real risk to our kids today. And that is both being killed by somebody else as well as suicide in the face of the mental health issues that we’re seeing today,” Williamson said.

The survey found that Black, Hispanic and lower-income parents were most likely to be concerned about gun violence, a finding that’s consistent with the communities most affected. Research has shown that from 2018 to 2021, the rate of firearm-related deaths doubled among Black youth and increased 50% among Hispanic youth. Another study found that children living in low-income areas are at higher risk of firearm-related death.

Direct and indirect exposure to gun violence can contribute to mental health problems.

“Even if they hear gunshots in their community, they hear adults talking, there’s all different ways that children are traumatized and victimized by gun violence. And what we see is all the symptoms of anxiety in even the youngest of children. We see children with somatic complaints – stomachaches, headaches. They have post-traumatic stress disorder,” Smeal said.

Most of the parents in the survey said parenting is harder than they expected, and that they feel judgment from various sources.

“The findings of this of this report were, as a pediatrician and a parent, just exactly what you would expect. Parenting is the hardest thing you’ll ever do, and there are very high levels of stress and fatigue, especially in the parents of young children,” Smeal said.

One of the best things parents can do is lean on fellow parents, experts say.

“The main challenge for parents is our siloed independent nature sometimes, and so we want to find people who we trust and kind of work towards being more vulnerable and open with,” Sabey said. “To where it’s like not just you and your kid, but it’s a kind of a group of people caring and working together.”

Pediatricians emphasize that no parent is perfect and that the most important thing you can do is to just be there for your child.

“We know that the best chance for a child to be successful and happy is for them to have at least one person in their life who believes in them and advocates for them. So I think it’s important for parents to know that there’s no such thing as a perfect parent, because we are all human, and humans are imperfect by nature, but that is OK,” Williamson said.

A parent’s job is to “really make sure that they know how important they are and they have a voice in this world,” she said. “Every child will have their own unique struggles, whether it is academically, emotionally, physically. Our job is to help them with the areas [where] they struggle, but even more, help them recognize their strengths.”

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How to be prepared in case of a shooting without living in fear | CNN

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CNN
—

At first, Brandon Tsay froze when a gunman aimed a firearm at him, he said. He was sure those would be his last moments.

But then something came over Tsay, who was working the ticket counter in the lobby of his family’s Lai Lai Ballroom & Studio, a dance hall in Alhambra, California.

He lunged toward the armed man and struggled through being hit several times in order to wrestle the gun away, he told CNN’s Anderson Cooper Monday evening.

The gunman had already killed 11 people and injured 10 others before arriving at Tsay’s workplace.

Tsay’s courage saved his life that day, but probably also saved countless more, said Ronald Tunkel, a former special agent with the US Bureau of Alcohol, Tobacco, Firearms and Explosives, who was trained as a criminal profiler.

While Tsay’s actions show heroism and bravery, what he did is more possible than people think, said Dr. Ragy Girgis, associate professor of clinical psychiatry at Columbia University in New York City.

“People have a great capacity for responding to tragedies like these. People wouldn’t realize how heroically they could respond,” he said.

Fortunately, most people will not find themselves in a situation in which they will have to respond to a mass shooter, Girgis said. But incidents like these are all too common and on the rise in the US, according to the Gun Violence Archive.

There is not much research on intervention in mass shootings by civilians, Girgis said.

Still, as the US sees mass shootings on a regular basis, companies, nonprofits and schools are training people about how to respond. Tunkel and Jon Pascal, an instructor for both Krav Maga Worldwide and the Force Training Institute, say they are seeing more training and protocols around active shooting situations for everyday people.

A word of warning: If your awareness around safety starts to contribute to anxiety or interfere with life in a meaningful way, it may be time to consult a mental health expert, said psychiatrist Dr. Keith Stowell, chief medical officer of behavioral health and addictions for Rutgers Health and RWJBarnabas Health.

Tunkel said being able to respond effectively to emergency situations takes two things: awareness and preparation.

Create “a habit of safety,” Pascal recommended. That means that people should routinely make note of the mood of crowds they are in, the exits and entrances, and what tools are available around them in case they need to respond to a scary event.

“We don’t want to walk around paranoid and not live our lives, but I think if we make personal safety a habit, it becomes something normal,” he said.

Your worst-case scenario is probably never going to happen, but being prepared means you have ways to take care of yourself and those around you if it does, Pascal added.

In addition to implementing awareness of your surroundings, Pascal recommends making a plan for how you will respond in case of medical, fire or violent emergencies.

It is always important to look for two ways of exiting a building in case danger or an obstacle is blocking one, he said. And at home or in workplaces, he recommended taking note of doors that can be locked and things that can be used to barricade.

Once you have the plan, practice it, he added. That bookcase might look like the perfect barricade in your head, but then be impossible to move in an emergency, Pascal said. And you want to be sure your escape routes don’t have locked doors you can’t open.

But preparation can also take the form of training — and it doesn’t have to be long-term, intensive and specific to the situation, Tunkel said.

Self-defense or active shooter training can help give you knowledge and strategies to use quickly if ever they are needed, Pascal said. But even more general training can help give you the mental and physical responses needed in case of emergency, Tunkel said.

Weight lifting and team sports can show you that you are physically capable of responding, he said. Yoga and meditation can train your breath and brain to stay calm and make good decisions in crisis, he said.

And in a dangerous situation, acting quickly and decisively is often safest, Pascal said.

It’s hard to be decisive when bullets are flying. Many victims of mass shootings have reported that the events were confusing and that it was hard to tell what was happening, Girgis said.

And if people don’t know what is happening, they often rely on their instincts to make decisions on what to do next, which can be scary, Pascal said.

The human brain likes categories to make things simpler, so it will often default to relating new things to those we have been exposed to before, Stowell said. When a person hears a popping noise, they might be likely to assume the sound is something familiar like a firecracker, he added.

Instead, Pascal advised people — whether they think they hear balloons popping or gunshots — to stop, look around to gather as much information as they can about what is going on around them, listen to see if they can learn anything from the sound, and smell the air.

Because where there are gunshots, there is often gunpowder, Pascal said.

Once someone has gathered what information they can, it is important to trust your perception of danger, Tunkel said.

Knowing there is danger activates a fight-or-flight response, which humans have honed over thousands of years to respond to predators, Stowell said.

But when a person is in a dangerous situation that is so far from anything they’ve experienced before, it is not uncommon for them to freeze, he added.

That is where training of any kind comes in. Even if it doesn’t teach you every detail of how to respond, it gives your brain a set of knowledge to fall back on in a terrifying situation, Stowell said.

Wrestling a gun away isn’t the only way to act when there is a mass shooter, Pascal said.

The US Department of Homeland Security developed a protocol called “Run, hide, fight.”

“Run” refers to the first line of defense — to get yourself away from a dangerous situation as quickly as possible, Pascal said. You can encourage others to run away too, but don’t stay back if they won’t leave with you.

If it isn’t possible to run, the next best option is to hide, making it more difficult in some way for the perpetrator to get to you, he said.

If none of those are an option, you can fight.

“You don’t have to be the biggest, strongest person in the room,” Pascal said. “You just have to have that mindset that no one is going to do this to me and I’m going home safe.”

Even though most people are capable of responding to danger in some way, it is important not to judge how much or how little a bystander or victim acts, Tunkel said.

“What may be reasonable for one person in one situation is not for someone else in another situation,” Pascal said.

No matter how well a person has been trained, mass shootings are “beyond the scope of anything we’ve had to experience in our everyday lives,” Stowell said. “There’s no real expectation of a right response, despite training.”

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Pediatricians are giving out free gun locks to approach the gun violence epidemic as a public health crisis | CNN

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CNN
—

In a triage waiting room of St. Louis Children’s Hospital in Missouri, a clear basket filled with gun locks sits near the walkway, just noticeable enough to those passing by.

The hospital staff calls it the “No Questions Asked” basket, to encourage gun safety without having to confront gun owners about what can be a sensitive and divisive topic. It holds an assortment of cable gun locks free of charge, available to those who need them, alongside pamphlets explaining how to properly and safely store firearms.

The initiative, aimed at reducing the stigma of addressing gun safety, is part of a growing effort by medical professionals who are treating the country’s gun violence epidemic as a public health crisis.

“It takes standing at the bedside of one child who has been shot to realize that we all have to do more and as the leading cause of death for children in this country, pediatricians need to be front and center of the solution, of all the solutions,” said Dr. Annie Andrews, a professor of pediatrics at the Medical University of South Carolina and an expert on gun violence prevention.

Over the course of two years, thousands of gun locks have been taken from the basket, according to Dr. Lindsay Clukies, a pediatric emergency medicine physician at the hospital.

In the coming weeks, baskets filled with free gun locks will be available at more than 17 locations operated by BJC HealthCare, an organization serving metro St. Louis, mid-Missouri and Southern Illinois, Clukies said. It’s a low-cost and effective way to easily distribute firearm safety devices.

“We’ve had employees as well as patients take our locks, also their families and even a grandmother who took one for her grandson. It’s for anyone who needs them,” Clukies told CNN. In recent years, a rising number of pediatricians across the country have been engaging with the topic of gun safety in medical settings by focusing on safety and prevention, already a natural aspect of their work.

During patient visits, it’s increasingly common for pediatricians to ask the patient’s parents if there are guns at home, and if so, how they are stored. Some hospitals then offer free gun locks, often sourced from donations or police departments and paired with safe storage education.

Some pediatricians, who bear witness to the effects of gun violence on children in their workplace every day, told CNN they see it as their obligation as medical professionals to be part of the solution to the epidemic.

In 2022, 1,672 children and teenagers under 17 were killed by gun violence and 4,476 were injured, according to the Gun Violence Archive, a nonprofit organization tracking injuries and deaths by gunfire since 2014.

“We have just as an important voice in this conversation as anyone else because we’re the ones who have invested our entire careers to protecting children and ensuring that children can grow up to be the safest healthiest version of themselves,” said Andrews.

“It is only natural that we see these things that we understand that they’re preventable, and we want to get involved in finding the solutions,” she added.

So far in 2023, high-profile incidents of children accessing firearms have heeded calls for stronger, more consistent laws nationwide, requiring adults to safely secure their guns out of the reach of children and others unauthorized to use them. They have also highlighted a lack of public education on the responsibility of gun owners to store their guns unloaded, locked and away from ammunition, CNN previously reported.

In early January, a 6-year-old boy was taken into police custody after he took a gun purchased by his mother from his home, brought it to school and shot his teacher at Richneck Elementary School in Newport News, Virginia, police said. Just over a week later, a man was arrested in Beech Grove, Indiana, after video was shown on live TV of a toddler, reportedly the man’s son, waving and pulling the trigger of a handgun, CNN previously reported.

Hundreds of children in the US every year gain access to firearms and unintentionally shoot themselves or someone else, according to research by Everytown for Gun Safety, a leading non-profit organization focusing on gun violence prevention. In 2022, there were 301 unintentional shootings by children, resulting in 133 deaths and 180 injuries nationally, Everytown data showed.

Firearm injuries are now the leading cause of death among people younger than 24 in the United States, according to the Centers for Disease Control and Prevention. The American Academy of Pediatrics released an updated policy statement in October 2022, stating firearms are now the leading cause of death in children under the age of 24 in the US.

The Academy’s statement urged a “multipronged approach with layers of protection focused on harm reduction, which has been successful in decreasing motor vehicle-related injuries, is essential to decrease firearm injuries and deaths in children and youth.”

The Academy has free educational modules for pediatricians to guide them on how to have what can be challenging or uncomfortable conversations about firearms with families, according to Dr. Lois Kaye Lee, a pediatrician and the chair of the Academy’s Council on Injury, Violence and Poison Prevention.

“This shouldn’t be considered as something extra; it should be considered as part of the work that we do every day around injury prevention, be it around firearms, child passenger safety and suicide prevention,” Lee said.

Dr. Georges Benjamin, executive director of the American Public Health Association, told CNN the public health approach to addressing gun violence removes the politics from the issue and “puts it into a scientific evidence-based framework.”

“Physicians have a unique opportunity to engage their patients, the parents of kids or the parents themselves as individuals to make their homes safer,” Benjamin said. “We already do this for toxins under our kitchen cabinets, razor blades and outlets in the wall.”

In the emergency department at St. Louis Children’s Hospital, all patients are screened for access to firearms and offered free gun locks, as well as safe storage education, Clukies said. Gun locks can also be mailed to families, free of cost, through the hospital’s website.

“Every patient that comes into our emergency department, whether it’s for a fever or a cold or a broken arm, is asked about access to firearms,” said Clukies, adding 5,000 locks have been given out since the initiatives were started in 2021.

In a collaborative effort between trauma nurses, physicians, social workers, violence intervention experts and family partners, the hospital created a “nonjudgmental” script for doctors to follow as they ask patients about access to firearms, Clukies said.

During the screening process, pediatricians will ask parents or caretakers questions such as: Do you have access to a firearm where your child lives or plays? How is it stored? Is it stored unloaded or loaded?

“When I first started doing this, I would say, ‘Are there any guns in the home? Yes, or no?’ But I have found and learned from other experts that if you just say, ‘If there are any guns in the home, do you mind telling me how they’re secured?’ it takes away the judgment,” said Andrews, a pediatrician whose hospital, the Medical University of South Carolina, also offers free gun locks to patients.

An assortment of cable gun locks offered free of charge by the Medical University of South Carolina.

Families are asked about firearms in the “social history” phase of a patient visit, during which pediatricians will ask who lives in the home, what grade the child is in, what activities they engage in and where the child goes to school, according to Andrews. When parents indicate their firearms are not safely stored, like on the top of a shelf or in a nightstand drawer, Andrews said those are important opportunities for intervention and education about storage devices such as keypad lockboxes, fingerprint biometric safes and other types of lock systems.

It’s also important for pediatricians to understand the parents’ or caretakers’ motivation for owning a firearm to “inform the conversation about where they’re willing to meet you as far as storage goes,” she added.

Andrews and Clukies said they were pleasantly surprised by the willingness of families to discuss firearm safety, most of whom recognize it is an effort to protect their children.

“I expected more pushback than we received, which is attributed to us really focusing on how we properly word these questions,” Clukies said. “I think it’s because we turn it into a neutral conversation, and we focus on safety and prevention.”

Andrews added it is uncommon for medical schools or residencies to discuss gun violence prevention, which she says is due to the “politics around the issue.”

“Thankfully, that has evolved, and more and more pediatricians are realizing that we have to be an integral part of the solution to this problem,” Andrews said.

At the St. Louis Children’s Hospital, pediatricians followed up with patients who received a free gun lock in a research study roughly two months after they launched the initiative in the fall of 2021 to see if their storage practices changed.

The study found two-thirds of families reported using the gun lock provided to them by the hospital and there was a “statistically significant decrease” in those who didn’t store their firearms safely, as well as an increase in those who stored their firearms unloaded, according to Clukies.

But there is still much more work to be done in the medical community to fight the gun violence epidemic and scientific research on the issue is “woefully underfunded,” Andrews contended.

According to the American Public Health Association’s Benjamin, a multidisciplinary approach by policymakers, law enforcement and the medical community is essential to fostering a safer environment for children.

“Injury prevention is a core part of every physician’s job,” Benjamin said. “It’s clearly in our lane.”

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