High Fives from Health Advocates

unduhan-50“My guess would be that there will be an explosion of cities…across the county that will pursue a soda tax,” said Howard Wolfson, Senior Adviser to Michael Bloomberg, during a press conference on Friday. “This is an issue whose time has come. We couldn’t be more excited to support local efforts.”

Still, the soda industry did not go down without a fight, mounting ad campaigns in cities like San Francisco to oppose the tax. All told the the American Beverage Association (ABA) spent $20 million to fight the issue. “It was unprecedented in terms of how the soda industry kicked it off in terms of spending,” said Dan Newman of the consulting firm SCN Strategies during the press conference. “They were absolutely flooding mailboxes and TV. We really risked drowning in soda propaganda.”

Ads funded by the ABA urged people to vote “no” on a grocery tax, even though the tax was solely targeting soda.

Soda-tax supporters also kicked in a fair amount of cash to fund the fight. Former New York City Mayor Michael Bloomberg, for instance, donated over $18 million to support the measures in Oakland and San Francisco, an billionaires John and Laura Arnold also reportedly donated $3.3 million in support of the soda taxes.

“Americans are saying to the beverage industry: ‘Enough is enough,’” says Dr. Dean Schillinger, a professor of medicine at the University of California, San Francisco. “These election results show that there is a new and real grassroots movement in America to put an end to the misleading messages about ‘drinking happiness.’”

Schillinger recently published a study in the journal Annals of Internal Medicine showing that when studies are funded by the beverage industry, they much less likely to report a link between sugary drinks and obesity and type 2 diabetes. “I believe that with the recent outcomes, we are finally seeing the war against diabetes as something we might actually win,” says Schillinger.

It’s still too early to determine the effect soda taxes have on chronic diseases like obesity and type 2 diabetes, but research has shown that since Berkeley, California, passed a soda tax in 2014, sugary drink consumption dropped 20%. A year after Mexico passed a soda tax in 2014, early researchreported an average 6% decline in purchases of sugar-sweetened beverages and a 4% average increase in untaxed beverages. Yet, some evidence suggests soda sales are back on the rise after the drop.

The Reason of Moms Are Spanking Their Kids

unduhan-51In many developed nations, the corporal punishment of children—that is, spanking, whipping, caning and so on—is illegal. America, where it’s even legal to spank a child at school in some states, has been something of a holdout, but a new study suggests that fewer mothers approve of using spanking as a disciplinary technique.

Georgetown University researchers analyzed data from the University of Chicago’s General Social Survey and found that the percentage of mothers in middle-income families who reported spanking their kids dropped from 46% to 21% over a 23-year period.

The study, published Nov. 14 in the journal Pediatrics, also found that, across all socioeconomic groups, the number of moms with kids under 5 who reported using spanking was shrinking while the number of moms who approved of various forms of nonphysical punishment was growing. For example, the percentage of moms who endorsed time-outs—removing kids from the environments in which the bad behavior took place—increased to 81% in 2011 from 41% in 1988.

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For many experts this lessening of physical punishment has been a long time coming. The American Academy of Pediatrics warned parents to avoid physically disciplining their children as far back 1998. That message has slowly been trickling through. And while it has long been the case that low income parents use spanking and other physical punishment more often than wealthier parents, that gap is narrowing, says the study, as the message about more effective disciplinary techniques seeps out.

The authors of the study believe the drop in spankings is part of a longer trend that started in the 1980s. “It may be in response to social science research that suggests spanking is linked to negative outcomes for children like delinquency, antisocial behavior, psychological problems and substance abuse,” says Rebecca Ryan, Associate Psychology Professor at the D.C.-based university and lead author of the study. “There is also little evidence that spanking or other forms of physical discipline are effective in the long term at reducing unwanted child behaviors or encouraging children to internalize, to really believe in, parents’ rules.”

To replace physical punishment parents have started using gentler techniques, including timeouts and what are known as “token economies,” such as sticker charts, for good behavior. The AAP, pediatricians and the rise of the parenting genre in books have also probably played a role in phasing out spanking.

READ MORE: The Discipline Wars Among American Parents

Of course there are still plenty of parents who think that when they spare the rod, they spoil the child. The Georgetown study suggests that low income mothers are more likely to spank than other income levels, and indeed a quarter of them reported hitting their kid in the previous week. But as recently as 2013, a Harris Poll of more than 2000 parents found that the majority of parents of any wealth, gender or ethnicity—except Pacific Islander or Asian— agreed with the statement that it is sometimes necessary to give a kid “a good hard spanking.”

There is also a slight gender difference. Men are more likely to believe it’s OK to spank kids than women are, but the current study doesn’t look at fathers’ attitudes. But researchers think women are changing their parenting habits more swiftly. “Data from the GSS suggests that the decline in support for corporal punishment of children since the 1980s has been more pronounced among women than men,” says Ryan. “So, it stands to reason that the trends we found might be similar—but weaker—for fathers. It’s hard to know.”

It’s also plausible that mothers have realized that many experts frown on spanking and so these moms decline to share their true views on the subject, or are ashamed of using it and thus are not candid. Ryan says that she would tell those who still think that spanking is an important parental tool what the AAP said in 1998: “There are many nonphysical discipline strategies, like time outs, positive reinforcement of good behavior, and selective inattention, that have been shown to be more effective at curbing unwanted behavior and encouraging the internalization of parents’ values than spanking.”

Unhealthy Diet For Women

unduhan-49Losing 10 pounds now and then and gaining it back may be bad for your heart, according to research presented at the American Heart Association’s Scientific Sessions.

Particularly if you’re a normal-weight woman: “We found that those with normal weight were the highest at risk for both sudden cardiac death and coronary heart disease death,” says Dr. Somwail Rasla, study lead author and internal medicine resident at Memorial Hospital of Rhode Island at Brown University.

In the study, Rasla and his colleagues looked at data from 158,000 women over age 50, who had self-reported their weight history and were categorized as normal weight, overweight or obese. During an 11-year followup, they were tracked for sudden cardiac death and coronary heart disease death.

Women who were normal weight at the study’s start but who reported a history of weight cycling—dropping more than 10 pounds and regaining it while not sick or pregnant, more than four times—had a 3.5 times greater risk for sudden cardiac death than those with stable weights. They also had a 66% increased risk of dying from coronary heart disease. However, weight cycling didn’t increase these risks for overweight or obese people.

That weight fluctuations are linked to such dire consequences makes some sense, and there are several different theories as to why. One is that every time weight is gained and lost, risk variables like heart rate, blood pressure, cholesterol and blood glucose fluctuate; repeat this cycle enough, and they’ll be less likely to return to baseline levels, Rasla says. Gaining and losing weight repeatedly may also cause insulin resistance, which increases the risk for coronary heart disease death, he says.

Why do these health problems appear to disproportionately affect women of healthy weight? Other research has shown that normal-weight women are more likely to die from with heart failure than obese women, Rasla says. “Obese people have higher blood pressure, high diabetes but over a long period of time, and it’s been found that their bodies develop a compensatory adaptive mechanism to different diseases,” he says. Thinner women, though they don’t get sick as often, may therefore be more vulnerable.

The preliminary research needs to be replicated in men and different age groups before researchers can make conclusions and recommendations. It’s also important to keep in mind that self-reports are sometimes inaccurate and that the study was merely observational, so the link could be due to a number of factors.

Alcohol Does to Your Heart

Having a drink or two a day can be a good thing, at least as far as the heart is concerned. There are nearly 100 studies of large populations that support this — they show consistently that people who drink moderately tend to have fewer heart events and are less likely to die of heart disease.

The key is moderation. Alcohol can be both tonic and toxin, since excessive drinking can lead to liver problems and other psychological and behavioral issues that impair health. In the latest study presented at the American Heart Association meeting in New Orleans, researchers pinpoint one way that alcohol can benefit the heart — by keeping good cholesterol levels high.

The study involved more than 80,000 healthy Chinese adults, who answered questions about their drinking habits and who gave blood for analysis four times during the six year study so researchers could measure their HDL as well as liver function and inflammatory markers. Those who reported drinking moderate amounts of alcohol — about one serving a day for women and two for men — had the lowest drop in HDL levels. With age, good cholesterol levels tend to decline, but these people seemed to slow that decline with their drinking. Those who abstained or drank more heavily didn’t show the same benefit.

Dr. Eric Rimm, director of cardiovascular epidemiology at the T. H. Chan Harvard School of Public Health, says the findings support other studies that have found that at any age, people who drink moderately tend to have higher HDL levels than those who don’t. HDL is important for heart health since it can mop up excess LDL, which can build up within blood vessel walls and contribute to plaques that can trigger heart attacks.

In fact, research suggests that having one or two drinks a day can lower risk of heart events about the same as losing around 30 pounds through diet and exercise. However, he says, “I’m hesitant to make that comparison, since weight loss is much more beneficial for other health reasons, such as reducing risk of cancer, diabetes and other chronic diseases.” Drinking and driving is also a leading cause of health problems and death.

The author, Shue Huang at Pennsylvania State University, reports that the Chinese population mostly drank beer or spirits, so the study doesn’t shed light on the effects of wine, although previous work shows that the ethanol in different alcoholic beverages generally has the same health effects. “Almost without exception if you look at fatal and non fatal heart disease, people who drink in moderation have substantially lower rates than people who abstain,” he says. All the more reason to raise a glass — but probably not more than that.

Let’s Safe As You Think

Over-the-counter and prescription drugs that control inflammation, like Advil, Aleve and Motrin, are among the most popular drugs people take. Without a prescription, they can relieve short-term pain from backaches and headaches, and at higher doses can reduce the inflammation behind chronic conditions like osteoarthritis or rheumatoid arthritis. But recent studies have questioned their safety, enough so that in 2015, the Food and Drug Administration (FDA) strengthened warnings on the drugs’ labels about their risk of heart attack and stroke.

But most concerning were the heart risks linked to a new class of these so-called nonsteroidal anti-inflammatory drugs (NSAIDs), the COX-2 inhibitors. These drugs were supposed to be kinder to the stomach and intestines, since NSAIDS typically activated chemicals that compromised the protective lining of these organs, leading to bleeding and pain. It turned out that the benefit for the intestines, however, came at a price to the heart. Two of the COX-2 inhibitors were removed from the market because studies showed they were linked to higher risk of heart attack and stroke.

That left one—celecoxib, or Celebrex—on the market, but the heart concerns led the FDA to require its maker, Pfizer, to pay for additional studies to ensure that celecoxib did not put people at increased risk of heart trouble. Now the results of the study show that contrary to what doctors and regulators expected, celecoxib does not lead to any higher rates of heart events than ibuprofen or naproxen. In fact, celecoxib may even cause fewer kidney problems than the other two NSAIDs.

“I would never have guessed these results,” says the study’s lead author, Dr. Steven Nissen, chair of cardiovascular medicine at the Cleveland Clinic. “The whole world has been saying for a decade now that if you must take an NSAID, you probably ought take naproxen because it’s the safest. We just don’t see that in these results. In almost every measure, ibuprofen looks worse, naproxen is intermediate and celecoxib is the best.”

The study, which is published in the New England Journal of Medicineand which Nissen will present at the American Heart Association annual meeting in New Orleans, involved more than 24,000 people with heart problems who needed to take an NSAID to treat conditions like arthritis and rheumatoid arthritis. They were randomly assigned to take one of the three drugs for nearly two years and followed for another three years for heart attacks, stroke or death. The people assigned to celecoxib did not show any higher rates of these events than those taking ibuprofen or naproxen. When Nissen and his team looked at kidney problems, they found lower risk among those taking celecoxib than among people taking ibuprofen.

“These results negate the preconceived notion—the present thinking—that COX-2 inhibitors are associated with increased heart risk,” says Dr. Nitin Damle, president of the American College of Physicians. “I think people may be more willing to start COX-2 inhibitors a little earlier because they see that heart risk is not increased.”

The previous concerns about COX-2 inhibitors and heart problems led many internists to prescribe NSAIDs like ibuprofen and naproxen as their first-choice therapies for people with osteoarthritis and rheumatoid arthritis, he says. They would only turn to celecoxib if people had stomach issues. Now that may change.

For people who take NSAIDs only occasionally, however, and for short periods of time, the findings shouldn’t make them worry that they’re putting their heart at risk. The study did not include healthy people who didn’t have a history of heart problems, and short-term use is not likely to have the same effect as longer term use typical of patients in chronic pain.

Nissen also notes that nearly 70% of the participants in the study stopped taking their assigned medication; that’s typical in a study of chronic pain in which people get frustrated when their symptoms aren’t relieved and switch from treatment to treatment. But the proportion who stopped their treatment in each group was about the same, meaning that the results were unlikely to have been drastically different if they had continued.

Drugs May Work Better Together Than Apart

In a new study of a class of cholesterol lowering drugs called PCSK9 inhibitors—which received much fanfare recently for lowering cholesterol to unprecedented levels —doctors wanted to know how they would work if taken along with statins, the gold standard for treating high LDL cholesterol. Do the drugs, which both work on cholesterol receptors in the liver but in slightly different ways, combine forces to lower LDL even further than either alone? Or do they negate each other’s effects, only producing as much reduction as either one alone?

Dr. Steven Nissen, chair of cardiovascular medicine at Cleveland Clinic, and his colleagues report the answer to those questions in a report in JAMA and in a presentation at the American Heart Association annual meeting. Among nearly 1,000 people with heart disease in six countries, they found that the combined effect of the PCSK9 inhibitor evolocumab and a statin lowered LDL dramatically — more than either drug alone. And that reduction came with a possible heart benefit — the drug combination also shrunk plaques that had been building up in the heart vessel walls of these people.

“The question was, could we do better than giving a statin alone, by giving the combination,” says Nissen. “And at the end of 18 months, we found [among the people taking the combination], there was less plaque than what the patients started with.”

All of the people in the study had at least one partially blocked major heart vessel, as well as other heart disease risk factors including a previous heart attack, unstable angina, type 2 diabetes, hypertension or were smokers. All were being treated with a statin to lower their cholesterol. For 18 months, they continued with their statin but about half were randomly assigned to receive evolobumab, a PCSK9 inhibitor, while the remaining people took a placebo. All also had ultrasound images taken of their heart at the start of the study and again toward the end to measure if and how much their plaque changed.

About 64% of people taking the combination of cholesterol-lowering drugs had their heart plaques shrink during the study, compared to 47% of those taking placebo. That suggests that the two-drug regimen might reverse atherosclerosis and potentially even avert some heart events by dissolving the fatty buildup that causes them.

“This study shows that for people with difficult-to-control cholesterol, we are beginning to accumulate evidence that there are drug options for them to not only lower cholesterol but to improve the health of their arteries,” says Nissen. “That’s new information.”

Survive the Holidays With a Narcissist

Your mother wants to tell you how wrong you are for, well, everythinginvolving your kids. Or your aunt wants to pry into your love life—and insult you about your single status. Maybe it’s a friend who needs to one-up you about everything (you just went away for the weekend? She’s planning on taking a luxurious tropical vacation. And flying first class). Or, your sister needs all the attention on her and throws a fit when she doesn’t get it.

Welcome to the holidays, the time of year when you’re forced to spend quality time with all the narcissists in your life.

While only 6% of the US population is thought to actually have narcissistic personality disorder, narcissism is really on a spectrum. “I think all of us have people in our family that meet some of the criteria for being a narcissist,” says Karyl McBride, PhD, licensed marriage and family therapist and author of Will I Ever Be Good Enough? Healing the Daughters of Narcissistic Mothers. (Learn the signs someone you know—or even you!—might be a narcissist.)

When you’re heading out to all the holiday parties and gatherings this year, you don’t have to run away from your narcissistic mother, uncle, or family friend. Here’s how to face them head on:

Don’t fight back

As hard as it can be, you shouldn’t try to compete with a narcissist. “Remember that they’re usually driven by an unconscious sense of shame or inferiority,” says Joseph Burgo, PhD, author of The Narcissist You Know: Defending Yourself Against Extreme Narcissists in an All-About-Me Age. For that reason, if you fight back, you’ll lose—and may make an enemy, he says. You can’t choose your family members, so it’s best to listen politely, then excuse yourself and join another conversation. But a friend? “You might want to look for different friends who take an interest in you, too,” Burgo says. Now that’s honesty. (Here are the two routes to a friend breakup.)

Remember this one word

Narcissists have a way of surprising you with their meanness. “They’re not in touch with their own feelings, so if they’re having a bad day, they’ll project that onto other people,” explains McBride. Whether they give you a backhanded compliment or deliver an outright insult, don’t get sucked in. Instead, shrug your shoulders and say this one word: “Interesting.” That’s McBride’s favorite go-to response when something comes at you out of the blue and you need time to think without reacting. It shows them that, nope, you’re not taking the bait and they can’t get to you.

Death With Dignity

The D.C. Council overwhelmingly approved a “Death With Dignity” bill Tuesday that allows terminally ill patients the ability to obtain medication to end their own lives.

The council passed the measure 11-2 after approving the bill by the same margin in an initial vote two weeks ago. The bill will now go to Mayor Muriel Bowser, who has pledged not to veto the legislation, which would make D.C. the first jurisdiction with a predominantly African-American population to approve a so-called right to die.

Read more: Why One Doctor is Fighting for the Right to Die

The bill is modeled after the nation’s first “Death With Dignity Act” in Oregon and would let terminally ill patients 18 years or older and with six months or less to live the ability to obtain life-ending, physician-prescribed medicine. Two witnesses have to verify that the patient’s decision is voluntary, and the medication must be self-administered.

Some African-Americans in D.C. opposed the bill claiming it could be used to target elderly black residents. Other groups like disability rights advocates and medical associations have historically opposed a so-called right-to-die, saying it unnecessarily devalues life and violates doctors’ Hippocratic Oath to do no harm.

And California’s largest school district, Los Angeles Unified, tallied more than 5,000 incidents of suicidal behavior last year. That’s huge increase since they began tracking these issues in the 2010-2011 school year, when just 255 incidents were reported. These incidents ranged from expressions of openness to suicide and self-harm, and acts of self-harm. Specific incidents of self-harm, like superficial cutting and burning the skin are usually not attempts at suicide, but the behavior does correlate with a higher risk of suicidal behavior. Studies of self harm are consistent in showing that people who injure themselves do so to cope with anxiety or depression.

Increase in Major Depression Among Teens

Describing teens as moody and angsty is an old cliche. That stage of life is loaded with drama and intense feelings. And it was ever thus—just go back read your high school diary for evidence. But while anxiety and sadness aren’t new phenomena among adolescents, there’s been a significant increase in the percentage of young people aged 12-20 who have reported having a major depressive episode (MDE).

A study of national trends in depression among adolescents and young adults published in the journal Pediatrics on November 14 found that the prevalence of teens who reported an MDE in the previous 12 months jumped from 8.7% in 2005 to 11.5% in 2014. That’s a 37 percent increase. (An MDE is defined as a period of at least two weeks of low mood that is present in most situations. Symptoms include low self-esteem, loss of interest in normally enjoyable activities, and problems with sleep, energy and concentration.)

Despite the rise in teen depression, the study, which analyzed data from the National Surveys on Drug Use and Health, reported that there hasn’t a corresponding increase in mental health treatment for adolescents and young adults. Researchers said this is an indication that there is a growing number of young people who are under-treated or not treated at all for their symptoms. Meanwhile, among those who did get help, treatment tended to be more intense, often involving specialized care by in-patient and outpatient providers and including prescription medications. (This may be due in part to increased mental health coverage in the wake of new health care parity laws.)

This information won’t come as a surprise to school counselors and clinicians who’ve seen a rise in depression, anxiety and related incidents of self-harm first hand, as reported in TIME’s Nov. 7th cover story “The Kids Are Not All Right.” The number of kids who are struggling with these issues is staggering. According to the Department of Health and Human Services, more than three million adolescents aged 12-17 reported at least one major depressive episode in the past year, and more than two million reported severe depression that impeded their daily functioning.

Ellen Chance, co-president of the Palm Beach School Counselor Association, says that in her region “anxiety and depression are affecting kids’ behavior and their ability to learn which can lead to dropping out or home school.” Getting resources to these students is essential for them to function in school. She’s working with the National Alliance for Mental Illness to get more counselors trained to identify mental health disorders, but it’s not easy. Counselors are often responsible for more than 500 kids and have other duties as well, often including administering state tests.

In Montana, where major depressive episodes have also spiked, there’s a dearth of trained counselors that can get to all the schools in the sparsely populated state so officials are trying implement tele-counselling programs.

And California’s largest school district, Los Angeles Unified, tallied more than 5,000 incidents of suicidal behavior last year. That’s huge increase since they began tracking these issues in the 2010-2011 school year, when just 255 incidents were reported. These incidents ranged from expressions of openness to suicide and self-harm, and acts of self-harm. Specific incidents of self-harm, like superficial cutting and burning the skin are usually not attempts at suicide, but the behavior does correlate with a higher risk of suicidal behavior. Studies of self harm are consistent in showing that people who injure themselves do so to cope with anxiety or depression.

Some of the increase in depression in Los Angeles schools may be due to more awareness and improved data collection, but with more than 30 percent of high school students there reporting prolonged feelings of hopelessness and sadness lasting more than two weeks, and 9.1% of middle schoolers and 8.4% of high schoolers in the district actually attempting suicide, the data highlights the need for more mental health resources for young people.

Improve Your Mental Health

Although French fries and ice cream often make it on the list of grub to dig into when we’re down, true comfort food comes from a healthier crowd. What you eat actually plays an important role in how you feel mentally; Spanish researchers who followed 15,000 young adults over the course of nine years found that those who ate more nuts, fruit, vegetables and fish had a 30 percent lower incidence of depression than those who gorged on sweets or processed foods. That’s not all. The UK-based Mental Health Foundation reports that fewer than half of patients who suffer from mental health problems eat fresh fruit and vegetables. Nearly two-thirds of those free from daily mental health problems eat fresh produce regularly.

Ensuring your diet is full of adequate amounts of healthy nutrients can enhance your mental clarity, provide a more balanced mood, and protect your mind from early mental decline. Discover all the ways that eating better can help improve your mental health.

1. You’ll save money

Think about all that cash you blow on soda, grabbing takeout at restaurants, picking out a snack every couple of hours and ordering dessert after every meal. But it’s not just food you’ll save money on when you start to eat better. Those who clock in at a healthy weight spend an astounding 42 percent less cash on medical bills and health expenses than their overweight peers, according to a Health Affairs report. And get this: you’ll not only be less stressed financially, but a study published in The Journals of Gerontology: Psychological Sciences and Social Sciences says that financial strain is a strong risk factor for and predictor of worsening mental health.

Eat This, Not That!: The 20 Ultimate Tips for Finally Understanding Nutritional Labels

2. Fueling up properly means you won’t get hangry as much

Whether you’re constantly muttering under your breath about coworkers’ minute errors or snapping at drivers during rush hour, you go about life with a short fuse. Rather than looking to poor anger management or mood disorders, look to your rumbling stomach. You could actually be hangry! One of the reasons why you’re always hungry, and thus, always hangry, is perhaps because of an inefficient diet that subsists on empty carbs. This food burns up in your body quickly, which causes your body to crave substance more quickly.

When you deprive yourself of food while your body screams at you to eat, your body goes into a state of distress. The result is low dopamine levels, which means less control over your emotions and more irritability, anxiety, mental confusion and slowness in thought. If you choose to fuel up with slow-burning sources of energy like complex carbs, protein, and healthy fats, you’ll start to see your anger subside in no time.

3. Combatting nutritional deficiencies can improve your mood

Studies show that a number of nutrients are associated with brain health, and deficiencies of these nutrients have countlessly been linked to depression. It should be no surprise that many of these micronutrients are abundant in “healthy” foods and M.I.A. in junk foods. Some of which include omega-3s (salmon, flax and chia seeds, walnuts), folate (asparagus, chickpeas, lentils), vitamin B12 (tuna, shrimp, milk), choline (egg yolks, broccoli, brussels sprouts), magnesium (spinach, yogurt, black beans), vitamin D (fatty fish, eggs). Always check with your doctor before going off any anti-depressants, but you may want to get blood work done to see if the reason your mood has tanked is because you’re experiencing some nutritional deficiencies.

4. Eating antioxidants can help you feel more optimistic about the future

Whether you’re a recent college grad or just attended your last child’s college graduation, the future can certainly seem daunting at times—and that can cause some serious anxiety. That’s even more so the case if you’re not eating enough carrots. Why? A study published in the journal Psychosomatic Medicine found that individuals with higher levels of carotenoids (a type of antioxidant) tended to be more optimistic about the future, an indicator of positive health. Unless you’re always ordering sweet potato fries when you eat out, you’re likely missing out on these beneficial antioxidants. On the other hand, a healthy diet easily incorporates many of its top sources: carrots, tomatoes, sweet potatoes, and kale.