Report: 'Deaths of despair' decrease across the country, but Appalachia still sees the highest mortality rates

Opioids are one of the biggest drivers of deaths of despair
in Appalachia. (Photo by S. Pollio, Unsplash) 

The U.S. mortality rate from "deaths of despair" has declined by 5%, according to a report by researchers at the University of Chicago and East Tennessee State University. The decrease means such deaths, which are commonly linked to drug overdoses, alcohol and suicide, are hovering near pre-pandemic levels, reports Liz Carey of The Daily Yonder. 

Despite the encouraging news, deaths of despair remain disproportionately high in Appalachia, where drug overdoses are considered the "primary factor driving the difference."

Michael Meit, the director of the Center for Rural Health and Research at ETSU and a co-author of the report, believes the reasons for the higher rate of deaths of despair in Appalachia aren't fully known. He told Carey, "I think there are a lot of complexities to it, and I don’t know if we know all of the answers."

The new report is the "latest update to research started in 2017," Carey explains. "At that time, Appalachian mortality from overdose, alcohol, and suicide was 44% higher than it was in the rest of the country." Despite a decreasing mortality rate since 2017, the number of Appalachian deaths of despair remains stubbornly higher than the rest of the U.S.

The decrease in the number of deaths by despair isn't happening evenly across all age groups. Millennials are a generation that has lost thousands of lives to deaths of despair. Carey reports, "According to a report by Trust for America’s Health, the largest number of deaths from overdoses, alcohol, and suicide in the 25- to 44-year-old demographic has steadily increased since 2017." 

The report singled out opioid addictions and overdoses as the biggest driver of Millennial deaths of despair. As a result of those findings, the Appalachian Regional Commission awarded "nearly $11.5 million in 2023 to nearly 40 projects across the region to address the impact of substance use disorder," Carey writes.

But regional progress is slow. Meit told the Yonder, "You don’t necessarily see a region-wide impact, but you see really strong community-based efforts that impact those communities. And as you reduce numbers in any given community, that has a broader impact across the region.”

Study: More Americans ages 18-54 are dying from severe first heart attacks

Even some 35-year-olds are at risk for severe heart
attacks. (Photo by E. Akurt, Unsplash)

Death by heart attack used to be a worry for only older Americans, but a new study revealed an alarming increase in heart attack deaths among younger Americans. The results are particularly worrisome for younger rural Americans who tend to have less access to preventative medical treatment, are more likely to smoke cigarettes and often face longer drives to reach emergency care. 

"The proportion of adults ages 18 to 54 who died in a hospital of a severe first heart attack rose 57% between 2011 and 2022, according to the study published in the Journal of the American Heart Association," reports Betsy McKay of The Wall Street Journal. The study data showed that more than 75% of severe heart attack deaths were men, and 71% were between the ages of 45 and 54 years.

The increase in heart attacks deaths is yet another indicator younger Americans aren't as healthy as previous generations. McKay writes, "Poorer health among younger adults is one reason heart disease remains the leading cause of death in the U.S."

Americans who died after a heart attack often had other underlying chronic health issues or smoked. "About 60% had high blood pressure, while more than half also had high cholesterol and smoked. About a quarter had diabetes."

Younger adults need to be warned that the risk of heart attacks can begin "as early as age 35," McKay adds. "Younger people could use a risk calculator on the AHA’s website." Experts recommend using the 30-year estimate rather than a 10-year one for greater accuracy.

Opinion: Understanding how fentanyl 'saturated the U.S. drug supply' could help address the addiction crisis

Naloxone can prevent overdose deaths, but it's expensive.
(Adobe Stock photo)

The current U.S. opioid crisis started with painkiller prescriptions in the early 2000s, but once medical providers started nixing those medicines, heroin's popularity surged, and then fentanyl and its "tsunami" of death entered the market, reports Maia Szalavitz of The New York Times. "Understanding how fentanyl saturated the drug supply, moving from the East Coast of the U.S. to the West, is critical to ending the worst drug crisis in American history."

Drug cartels' greed drove the creation and use of fentanyl. "By 2013, cartels had realized that they could slash their labor, manufacturing and transit costs by replacing heroin derived from farm-grown opium with a powder made in a lab — fentanyl," Szalavitz writes. "Before 2018, 80% of all deaths associated with fentanyl occurred east of the Mississippi. . . . Since 2021, at least two-thirds of America’s 100,000 annual overdose deaths involved a synthetic opioid like fentanyl."

While heroin was considered a more urban drug, "increased opioid prescriptions — followed by sharp reductions — resulted in new heroin users in rural areas," Szalavitz explains. "Illegally manufactured fentanyl began appearing in both urban and rural drug markets. . . . Rural West Virginia and other Appalachian regions were the center of the earliest prescription opioid wave of the crisis, which led to the establishment of new heroin markets in places facing job loss."

Combating opioid addiction and overdose deaths liked to fentanyl is tough because the drug's supply chain and use is now deeply embedded across the country. The drug is cheap to make and buy, and provides an exceedingly potent high for the user. "So, what can be done? The answer is to focus on the drivers of demand, not supply. This means addressing the roots of addiction and treating it compassionately," Szalavitz writes. "We have a great generic opioid overdose antidote, naloxone. . . . And two medications — methadone and buprenorphine — have proved to cut the risk of death among people with opioid addictions by 50% or more when used long-term."

Szalavitz adds that people often start doing drugs because their lives feel hopeless. "Addiction is most often an attempt to escape despair. The condition itself is defined by compulsive drug use despite negative consequences, which is why threats of punishment or even death rarely yield recovery. . . . It’s not coincidental that the exponential rise in overdose deaths has occurred in tandem with a profound increase in income inequality."

As seasons change, mosquitoes will still be busy spreading deadly diseases. Awareness and precautions can help.

Aedes aegypti, aka  'tiger mosquitos' bite
during the daytime. (Wikipedia photo)

During an average day, many people never think about mosquitoes, but perhaps the tiny arthropod deserves more consideration. Weighing in at a mere 2.5 milligrams (about 180,000 mosquitoes equal a pound), a female mosquito is considered the most deadly animal on earth. Lacking venom or any toxin, mosquitos kill by spreading diseases with alarming effectiveness -- around a million people die a year from illnesses caused by mosquito bites.

"Mosquitoes carry malaria, dengue, yellow fever, chikungunya, West Nile virus and eastern equine encephalitis," reports Alice Park of Time magazine. "Different species of mosquitoes are adept at spreading different viruses." This summer, mosquitoes along the East Coast have been making news. "Towns in Massachusetts are shutting down public parks and other outdoor areas after officials learned that mosquitoes in the region are carrying eastern equine encephalitis, a rare but deadly virus."

Mosquito-borne illnesses will keep increasing as climate change continues to warm the planet. Jonathan Oliver, associate professor at the University of Minnesota, told Park, "With climate change, we see the [habitat] ranges for concerning species like Aedes (which transmits most of the world’s malaria, dengue, yellow fever, West Nile and Zika) spreading northward. . . all predictions indicate that they are going to spread throughout the Southeast and up the Eastern Seaboard, and fairly high north in the Midwest." The more mosquitoes there are, the more bites and ranges of diseases they spread.

While working or playing outdoors is more often associated with mosquito encounters, urban populations are more at risk. "Growing urbanization and densely packed cities — with less-than-ideal sewage and sanitation systems — also provide more and fertile environments for mosquitoes to lay eggs and proliferate."

No matter where humans live, respecting mosquitoes and avoiding bites is key to disease prevention. "That means wearing long-sleeved clothing when outdoors and spraying yourself with insect repellent. You can also eliminate mosquito-breeding grounds by getting rid of any standing water around your home, since mosquitoes just need a little bit of water in which to lay their eggs."

Meanwhile, scientists are trying to depopulate mosquitoes with varied approaches. "Another strategy that appears encouraging is infecting mosquitoes with a bacterium that kills the viruses they may carry," Park adds. "This approach has been used in Southeast Asia and Australia to lower the rates of dengue transmission."

Quick hits: Canned bread nostalgia; loneliness primer; python teeth inspire improved shoulder repair; fall skies

B&M introduced canned bread to America in 1928.
(Photo by Kaleigh Brown, The Takeout)

Canned bread might fit nicely on a list of non-perishables that are nostalgic and still worth making or buying. "Canned bread's legacy is tied to the survival instincts of early New Englanders," writes Kaleigh Brown for The Takeout. "When the first settlers arrived in Massachusetts, they hoped to grow wheat, but the local climate made it difficult. Instead, they turned to more affordable and resilient grains like rye and corn. . . .Lacking ovens, they steamed their bread over open fires, often using cans as makeshift molds."

Loneliness is a common experience across the United States, but some Americans are more susceptible to the harm long bouts with the emotion can cause. "Loneliness is more than just isolation: It’s the subjective experience of craving more social interaction than you currently have. It isn’t binary, either, and no one is immune," reports Allie Volpe of Vox. "Chronic loneliness has severe negative physical and mental effects. . . . Rather than point to certain populations as explicitly lonely, understanding what increases someone’s risk for loneliness can help address it on a population level."

Python teeth are uniquely curved and sharp, which helps
them grip their prey without tearing. (A.S. photo)

Picking fruit, baling hay and moving or handling food animals can all end in a farmer or farm worker tearing their rotator cuff, which hurts like heck and normally requires shoulder surgery to repair. The surgery is tricky and often fails, which is why a "python-like surgical implant" could help, reports Eric Niiler of The Wall Street Journal. "Medical researchers at Columbia University designed and built a python-tooth-inspired implant to better mend rotator cuff tear. . . . [The snake's] prey-grabbing method was the inspiration for the device."

Failing to have end-of-life discussions can leave important decisions to a time when there is no time. "Morbidity, mortality, and the many grey zones in between are ever-present in healthcare, writes Nidhi Bhaskar for MedPage Today. "I believe it is crucial to equip future physicians with the skills to navigate these conversations, especially in acute situations where time is limited and patient capacity for decision-making can quickly change. . . . Multiple studies have highlighted the positive impact that early exposure to palliative care and end-of-life goals can have on patient satisfaction at the end of life."

Remember to star gaze this fall; there's going to be a lot to marvel at. Mars and Jupiter will be easily visible on Aug. 27 and "will be accompanied by the crescent moon, creating a dazzling pack in the sky, according to NASA," reports Juliana Kim of NPR. If you missed August's super 'blue' moon, don't despair, "next month’s supermoon will be on Sept. 18. It will be a super harvest moon. It’s called a harvest moon because of its proximity to the autumnal equinox: An equinox is when the Earth’s equator is most directly in line with the sun. This supermoon will also undergo a partial lunar eclipse, reports Mansee Khurana of NPR. "The next two supermoons will occur on Oct. 17 and Nov. 15."

Series of columns, "What I learned from dying," by rural weekly journalist Dave Taylor is now a book

Taylor’s book is available on Amazon.com.

In spring 2021, Dave Taylor found out he had Stage 4 esophageal cancer. The veteran journalist and editor of the weekly Hancock Clarion in Hawesville, Kentucky, began writing about the experience the week afterward in a column series called "What I Learned From Dying."

"If things go well this will be a long-term column that could serve as catharsis for me or a peek behind the gown for those who are curious," Taylor wrote in the first column. "If things don’t go as well, then maybe it’s just a long, rambling goodbye."

Taylor's columns weren't destined to remain a rambling goodbye. Instead, his widow Jamie D. Taylor re-released the entire collection as a softcover book available on Amazon.

Taylor told Jennifer Wimmer of the Clarion, "I believe what Dave achieved with his columns every week was amazing. . . . I saw how hard it was for him, physically and emotionally, to write those columns. . . . For him to go from being so very black and white to putting his heart in these columns and being completely vulnerable. . . I was just so proud of him. . . . He always wanted to publish a book, and I just feel like this was my way of making sure that his dream came true."

The book's cover also has a story. Dave commissioned the artist just 10 hours before his death. "Dave had texted Aaron Kizer, the artist who created his portrait," Wimmer writes, "asking him about painting it for him. That text is included in the book. Aaron also kindly accepted a commission to complete Jamie’s portrait, which was completed with Dave’s ashes."

As Dave faced cancer, he leaned on his faith in God, and Jamie Taylor hopes these shared details might help others. She told the Clarion: "I just hope that people who have cancer or love someone with cancer can pick it up and relate to it, and just understand that you can live a good life while you’re going through these things. . . . If there are any book clubs or churches that would like me to come and talk about the book, our prayers and our experience with cancer, I’m willing to do that. I want to share how faith can get you through these really hard times."

You can contact Jamie Taylor with any questions, or to schedule a speaking engagement at: davetaylorproject@gmail.com

Working-age rural residents are dying at 'wildly higher rates' than their urban counterparts; cause is undetermined

Photo by M. Vistocco

U.S. mortality rates can fall into two very different camps -- rural working-age death rates and everyone else's death rate. "Rural Americans age 25 to 54 — considered the prime working-age population — are dying of natural causes such as chronic diseases and cancer at wildly higher rates than their age-group peers in urban areas, according to a new report from the Agriculture Department's Economic Research Service," reports Jazmin Orozco Rodriguez of KFF Health News.

To compare the two groups, "USDA researchers analyzed mortality data from the Centers for Disease Control and Prevention from two three-year periods — 1999 through 2001, and 2017 through 2019," Rodriguez explains. "In 1999, the natural-cause mortality rate for rural working-age adults was only 6 percent higher than that of their city-dwelling peers. By 2019, the gap had widened to 43 percent." 

In reviewing demographic differences, Native American women fared the worst, but overall, a link between younger rural deaths and a lack of Medicaid expansion could be part of the cause. "USDA researchers and other experts noted that states in the South that have declined to expand Medicaid under the Affordable Care Act had some of the highest natural-cause mortality rates for rural areas," Rodriguez reports. "But the researchers didn’t pinpoint the causes of the overall disparity."

Another possible connection could be the lack of rural health care options and rural hospital closures. "Alan Morgan, CEO of the National Rural Health Association, and other health experts have maintained for years that rural America needs more attention and investment in its health care systems by national leaders and lawmakers," Rodriguez adds. "It’s unlikely that things have improved for rural Americans since 2019, the last year in the periods the USDA researchers examined. The coronavirus pandemic was particularly devastating in rural parts of the country."

California prosecutors charge fentanyl suppliers with murder. The legally unsettled approach is catching on.

Prosecutors in California are forging a path to make fentanyl dealers accountable for their part in overdose deaths by filing homicide charges against them. In Riverside County, California, county district attorney Mike Hestrin "has charged 34 suspected fentanyl suppliers with murder and is said to be the first prosecutor in California to achieve a guilty verdict from a jury in a fentanyl-related homicide trial," reports Michael Corkery of The New York Times. Some critics fault the prosecution of street dealers "as a misguided return to the aggressive approaches of the 1990s, which failed to curb drug use and swelled state prison populations."

But even in boldly liberal parts of the state, murder investigations of fentanyl overdoses are being used to discourage fentanyl sales and provide some level of justice for families. Corkery writes, "Some other counties — like San Diego and Placer, near Sacramento — that have also brought murder charges against fentanyl suppliers have sizable numbers of conservative-minded voters who tend to favor more punitive approaches to crime." Even in San Francisco, the district attorney's office is planning to prosecute fentanyl dealers for overdose deaths.

While prosecutors pursue murder charges against fentanyl dealers, their cases are on murky legal ground. "Prosecutors have been working around the fact that California does not have a law that specifically allows fentanyl deaths to be charged as murders," Corkery explains. 

Defense attorneys have responded to the prosecutions as "overbroad and unconstitutional," Corkery reports. But their complaints are being drowned out. "Parents whose children died from fentanyl are a driving force behind new laws and stepped-up prosecutions just as the parents of drunken-driving victims swayed the nation to crack down on alcohol-fueled traffic deaths decades ago."

To read more on how California prosecutors are using the Watson murder rule to prosecute fentanyl suppliers, click here. 

Drug Enforcement Administration statistics draw a startling picture of fentanyl's lethal power: It is the leading cause of death for Americans ages 18 to 45, and it's responsible for nearly 70 percent of the United States' 107,000+ drug overdose deaths in the past year. A educational warning video is shared below.

Opinion: The number of U.S. suicides is unacceptable, so we need a new approach to address the problem

Suicide rates are at an 80-year high.
(MedPage Today photo)

In April, the Centers for Disease Control and Prevention shared this grim data: "In the past two decades, suicide rates have been consistently higher in rural America than in urban America." National suicide statistics are even more dire: Last week, the CDC reported that U.S. suicide deaths reached an 80-year high. While there was a "modest" improvement in youth data, the report pointed to a national suicide crisis. With that backdrop, Russell Copelan, a retired emergency department psychiatrist, suggests a new approach in his opinion for MedPage Today.

"Consider the American Foundation for Suicide Prevention's aspirational goal launched in 2016, to reduce the annual U.S. suicide toll by 20% by 2025. Since the initiative began, there has instead been a 10% increase in suicide deaths. We should be nothing short of appalled and dismayed by these numbers.

"Perhaps it is now best to consider the advice of Davy Crockett to young hunters: 'Whenever a fellow gets bad lost, the way home is just the way he don't think it is.' The field of suicidology is indeed 'bad lost.' We are in urgent need of a new 'way home.' So let's get out our compasses and make directions based on where we are standing, our present state.

"Here is a starting point. Saving life is difficult. If it were easy, everyone would be doing it. Well, in suicide prevention and research, everyone is trying to do it. And yet, the escalating press of self-directed death marches on. For foundations, alliances, and associations, the definitional issues, fragmentary data, ubiquitous risk training. . . and entrenched leadership make it difficult to determine a true North Star. . . . It is currently equivalent to the blind leading the blind -- and falling in a ditch.

"Ideation-centric assessments have continued to be promoted as 'best practices.' Under mounting evidence of insensitivity to risk, statistical inefficiencies, unreliable patient recruitment. . . confirmatory bias, should these assessments continue to serve as surrogates or the 'gold standard' in suicide risk evaluation? None of these instruments have been sufficiently accurate.

"Where is the proactive management to identify the root causes of our current and miserable predicament? Where is the preparatory understanding of the basic elements of the 'map' that could have empowered the field of suicidology to stay found?

"Let me ask again: Is conventional suicide prevention practice good enough? No. Unequivocally, no! What medical specialty would tolerate such a recurring -- indeed '80-year high' -- disaster?

"The topic of suicide is complex, complicated, and dark, and attempting to systemize and communicate improved risk probability stratification is considered by many either too difficult or a lost proposition.

"But you must fight with implacable doggedness, challenge old laws, and test new hypotheses. Demonstrate the miracles of good sense, connected observations, and strong convictions. Maximize your cause and seize your direction."

To read the theory and practice of Copelan's "new way home," click here.

Drug overdose deaths don't just happen to adults; dozens of teens die each month, and boys are especially vulnerable

The U.S. continues to see overwhelming numbers of drug overdose deaths, but one of the most jarring statistics is the number of adolescents dying from overdoses every month, reports Ty Schepis for The Conversation, a journalistic platform for academics. "Drug overdoses are killing young Americans in unprecedented numbers: The monthly total rose from 31 in July 2019 to 87 in May 2021, the period with the most recent data. As a scholar of substance use who focuses on patterns that vary between age groups, I’m struck by how adolescents’ overdose deaths differ from adults’ in terms of gender, race and ethnicity and the drugs causing these fatalities."

The Conversation graph, from CDC data

Who is dying? "When the Centers for Disease Control and Prevention examined data for Americans 10 to 19 years old, it found that, as is the case for adults, most adolescents dying from drug overdoses are male. However, the share of girls among these fatalities is larger than the share of women," Schepis writes. "More than twice as many boys who are tweens or teens are dying of a drug overdose for every girl in that age group."

Which drug is most involved in teen overdose deaths? Fentanyl. "For teens, 84% of fatal overdoses involved fentanyl, and 56% of all overdoses involved only fentanyl," Schepis explains. "Many adolescents accidentally take fentanyl when they ingest counterfeit pills that they believe are prescription opioids or stimulants, or other illicit drugs that are laced with the drug. . . .In 67% of adolescent overdose deaths, a bystander was present who could have intervened. Naloxone was administered in less than half of cases where a bystander was present."

Is there a common thread among adolescent overdose deaths? Schepis reports, "Little or no prior drug use. Only 1 in 10 teens and tweens who died from a drug overdose had a history of treatment for a substance use problem, and only 1 in 7 had ever experienced a prior nonfatal overdose. . . . This pattern underscores the importance that all parents proactively talk with their children about substance use by the time they are 12 years old."

What can parents and extended family do to help change this pattern? "Having naloxone available can also be important. It prevents fentanyl and other opioids from causing an overdose by blocking access to opioid receptors in the brain," Schepis writes. "Think of naloxone like car insurance: You don’t want to use it, but it’s important to have in case something goes wrong. . . . There’s also a strong link between mental health conditions and drug overdoses among adults. . . . I recommend that all adults – whether caregivers or other people in an adolescent’s life – check in on their mental health regularly and recommend or seek treatment for any concerns as early as possible."

Rural trauma deaths would decline if ambulances could bill insurance companies for delivering blood on way to hospital

A fire-district ambulance on a dirt road after a training exercise near Fruita, Colo., last April. The West and parts of the South pose big challenges for rural emergency medical services. (Photo by Smiley Pool, Dallas Morning News)

In 2020, a traumatic injury killed an American every 31½ minutes, and such injuries are the top killer of children and adults under 45. Those statistics could be better if more ambulances carried blood and could bill insurance companies for administrering it, Lauren Caruba of the Dallas Morning News reports in a package with the San Antonio Express-News focused on rural America.

The problem is worst in the sparsely populated West, but "parts of the South performed worse compared with the coasts," Caruba reports. The package focuses on western Colorado and has an interactive map showing how far every location in the 48 contiguous states is from a trauma center.

"The vast majority of emergency medical providers . . . are unequipped and underfunded, leaving them unprepared to fully treat patients with severe internal bleeding," Caruba writes. "Across the country, bleeding patients receive drastically different care depending on where they are injured and the emergency providers who treat them." Awareness of the issue "has been mostly confined to medical journals and discussions within the medical community, leaving the general public largely uninformed about the extent of the epidemic."

"The solution is straightforward: If paramedics widely carried blood, as military medics have done for years, tens of thousands of lives could be spared annually. But the country’s fragmented health-care system does not allow for an easy fix. . . . Despite repeated pleas from specialists, the federal government has not prioritized or properly invested in the plight of injured Americans."

With each minute that passes after a potentially fatal injury, the possibility of death increases, "especially within the first half-hour, when severe bleeding deaths peak," Caruba notes, citing research. "An estimated quarter of all Americans live further than a 30-minute drive from Level I or II trauma centers, which provide the highest level of care to injured patients."

The Defense Department has greatly improved combat death rates with faster evacuation, "increased tourniquet use and administered blood on the way to the hospital," Caruba notes. "No such overhaul has happened in U.S. health care, and efforts have not been made to broadly adopt the military’s best practices, particularly before patients reach a hospital."

In 2019, fewer that 1% of trauma patients "received blood products of any kind on the way to the hospital, even when they displayed clear warning signs of bleeding out," Caruba reports, citing research by the University of Alabama-Birmingham. She notes that there is relatively little research into trauma deaths, and that the federal government doesn't even track them. But a federal report in 2016 estimated that 20,000 to 30,000 trauma deaths a year were potentially avoidable.

The U.S. has more than 23,000 emergency medical services, but only about 100 ground services have blood, "trauma advocates have found in recent surveys. While most air ambulance companies carry blood products, they treat only a small fraction of injured patients," Caruba reports. "Blood is a costly, limited resource, and most emergency medical providers lack relationships with blood banks. They also face regulatory and logistical hurdles, like maintaining blood refrigeration temperatures in the field and creating a system where unused units do not go to waste."

The Prehospital Blood Transfusion Initiative Coalition is focusing on the servcies' "inability to bill insurers for the cost of the blood and the rules in some states that prevent paramedics from starting transfusions," Caruba reports. "The group hopes to present recommendations to Congress and the National Association of State EMS Officials next year. Their goal is that every patient with major bleeding — including the injured and those hemorrhaging from medical complications — will receive blood if they need it."

Maine gun owner opinion: 'The only people capable of shifting the gun conversation are the people who buy them'

Smith & Wesson rifles civilian versions of the AR-15 for sale
at a gun show. (Photo by Luke Sharrett, The New York Times)

The Second Amendment of the U.S. Constitution gives all Americans "the right to keep and bear arms," but the amendment's scope did not envision the AR-15 or a society that would tolerate hundreds of mass shootings. In his opinion for The Atlantic, Mainer and gun owner Tyler Austin Harper writes about why many American love their guns and asks, "How Much Blood Is Your Fun Worth?"

"During my first semester of teaching while in grad school, I made a habit of showing up to my classroom half an hour early. . . . The second week of classes, coffee in hand, I arrived to find an undergrad crouched in front of a half-open window. He was taking a photo with his phone, and when he saw me, he jumped. . . .When I asked if everything was all right, he said he was making sure the windows opened. 'My mom told me to always check to make sure they work, just in case, you know.' . . . . I must have looked confused because he continued: 'In case some gun nut with an AR-15 tries to shoot up the place. When a new semester starts, my mother makes me send her a photo of the open windows in each of my classrooms.' I tried to come up with something to say and found I could not.

"Last night, as I sat on my couch watching CNN anchors discuss a mass shooting that left 18 dead and 13 injured in Lewiston, Maine — the little city where I teach at Bates College and where I lived until recently — I thought about my terrified students who were sheltering in place. About my colleagues who live in town who could have been at the bar or bowling alley where the violence unfolded. . . . I thought about the hospital workers who were in the middle of the worst night of their life, I thought about all the people waiting for news, or getting news.

"As the night wore on and surreality gave way to cold reality, my grief also slowly gave way to guilt. I felt guilty and complicit. . . . I felt guilty because gun nuts are, whether I like it or not, my people: I grew up in gun country. I spent my teenage years working at a Pennsylvania gun club. I’ve been a gun owner nearly my entire life. . . . I am embarrassed to say that this is what it took — a place I love to become somewhere that a uniquely American tragedy has taken place — for me to fully understand our country’s mass-shooting problem.

"I am filled with nothing so much as rage. Rage at my gun-nut friends from home who will see this tragedy as a reason for less gun control, rather than more of it. . . . Rage at the politicians here and beyond who have refused to solve a problem for which solutions readily exist. Rage at myself for being so blind. . . . But it is only now that gun violence has visited my little corner of the world that I have been forced to confront reality, a truth that has been there all along but that I have refused to admit: I own guns because I like them and because I am an American and I’m allowed to and no one stops me.

"The inescapable fact is that the only people capable of shifting the gun conversation in this country are the people who buy them. . . . Yesterday’s events haven’t made me change my mind about being a gun owner. . . . . The shooting in Lewiston changed my mind about being a quiet gun owner. I have spent years of my life making apologies on behalf of my gun-nut acquaintances. Staying silent when friends bring up the National Rifle Association despite my fierce opposition to that organization. Not pushing back when they call minor reforms such as mandatory waiting periods 'totalitarian.' Changing the subject rather than asking 'Why do you need a military-style rifle?'

Read Harper's full essay here.

Mass shooting survivors face physicial and mental trauma, but perhaps worst of all, their sense of security is 'shattered'

The plaques are part of a memorial to the seven victims in
Highland Park, Illinois. (Photo by Roger Schneider, AP)

Mass shootings have stripped away much of what Americans always felt were public safety zones. Shooting survivors say the loss, fear and trauma never leave them, reports Claire Savage of The Associated Press. "Since 2016, thousands of Americans have been wounded in mass shootings, and tens of thousands by gun violence, with that number continuing to grow, according to the Gun Violence Archive. Beyond the colossal medical bills and the weight of trauma and grief, mass shooting survivors and family members contend with scores of other changes that upend their lives."

In speaking with individuals and families, Savage explores the aftermath of mass shootings. She writes, "Survivors talked about the mental and physical wounds that endure in the aftermath of shootings in Uvalde; Las Vegas; Colorado Springs, Colorado; and the Chicago suburb of Highland Park, Illinois, during a July Fourth parade last year."

The Zamora family, whose 11-year-old daughter Maya was airlifted out of Uvalde, Texas, after being critically injured in the Robb Elementary school shooting, shared a glimpse of how much the shooting changed their lives forever. Savage reports, "Mayah suffered wounds to her chest, back, both hands, face and ear, and needed so many surgeries her parents said they stopped counting. The family relocated to San Antonio, where Mayah spent 66 days in the hospital and still needs care. A year later, Christina and Mayah's father, Ruben, said they didn't know what bills would be covered by insurance. When Mayah was discharged, they realized one parent needed to stay home to care for her." Mayah's mother, Christina, told Savage: "Her hospital bill is insane. It reaches close to $1,000,000, maybe over." 

Leah Sundheim, 29, was a night manager at a hotel in Las Vegas when "she got 'the worst phone call you can ever receive," Savage writes."Her mother, Jacquelyn Sundheim, had been killed at a shooting during Highland Park's 2022 Fourth of July parade, along with six other people. . . . Mass shootings cause a variety of trauma, she said. Her experience is different from that of her aunt and cousins, who were sitting next to Jacquelyn Sundheim when she died." Sundheim told Savage: "That flight home broke me. . . . [trauma] shatters the sense of security that you have in the world."

From Las Vegas to Highland Park, shooting survivors impart unique losses and a common fear that nowhere is safe. "So far in 2023, nearly 400 people in the U.S. have been wounded in mass shootings, according to the Gun Violence Archive," Savage reports. "And 140 people have died in mass killings this year, which is on track to surpass 2019, the deadliest year on record for mass killings since 2006," according to a database maintained by The Associated Press and USA Today in a partnership with Northeastern University.

Many rural counties are poorly equipped to deal with rising gun homicides; some of the worst rates are in the South

From 2016 to 2020, Phillips County had the country’s highest per capita
rate of gun homicides. (Photo by Renuka Rayasam, KFF Health News)

Homicides involving guns are often considered an urban problem, but rural America has its own firearm traumas that few communities have the resources to address effectively. "Nationwide, rural gun homicides have risen, and, in some areas, outpaced their urban counterparts. From 2016 to 2020, 13 of the 20 counties with the highest gun homicide rates were in the rural South, according to the Center for American Progress, a policy research institute, reports Renuka Rayasam for The Daily Yonder.

Elaine, Arkansas, pop. 500, is a dramatic example, "Phillips County, where Elaine is located, is home to about 15,000 people spread across 690 square miles. Data shows they're at high risk of gun violence. From 2016 to 2020, the Phillips County had the country's highest per capita rate of gun homicides, according to an analysis last year by the CAP," Rayasam writes. "During three days in July, police responded to reports of four homicides in Helena-West Helena, the Phillips County seat. That might be a small number for a major city, but it has an outsize impact in a rural town," said Nick Wilson, senior director for gun violence prevention at the Center for American Progress. The sheer number of deaths can devastate communities that often lack resources to stem gun violence or mental health services to help traumatized residents. Also, the nearest medical centers to treat victims are often miles away.

Segregated communities, racism and poverty add to social tensions that can lead to violent outcomes. Phillips County has "a harrowing history of racism," Rayasam reports. "In 1919, Elaine was the site of one of the worst racial massacres in U.S. history. At least 200 Black residents were murdered by white residents and soldiers over a couple of days after a group of Black farmers met one late September evening to demand better payments for their cotton crops." Daniel Webster, a distinguished scholar at the Johns Hopkins Center for Gun Violence Solutions, told Rayasam: "These disadvantages are structural and driven by policy rather than naturally occurring. The conditions that lead to structural racism also lead to higher rates of gun violence. . . . These places have lacked investment, where poverty is rampant, unemployment is high, schools are failing, and buildings are crumbling."

"Under those conditions, even small stressors, like a fight over a cigarette, can lead to a shooting, researchers say. Most homicides in Phillips County, as in urban areas, stem from interpersonal or domestic disputes," Rayasam adds. "A few years ago, a man in Helena shot a man who allegedly stole butter beans from his garden."

Hicks Gilbert, who became Elaine's first Black and female mayor, is working on changing "'the mindset of what is possible,'" Rayasam reports. "She is requiring public housing operators to keep properties up to code, bringing in dumpsters to encourage residents to clean up trash, tearing down dilapidated houses, hiring young people to work in city government and at the community center, and starting a tutoring program." But progress can be slow and "persistent poverty and violence take an emotional toll, said Steven Cannon, a pastor who also runs an after-school community center in West Helena." Cannon told Rayasam, "What you see can be depressing at times, especially on a young generation."

Newly released data reveals a 'virtual opioid belt' developed over about 15 years in West Virginia, Virginia and Kentucky

Average number of pills distributed per person per year, ranked by county from 2006 to 2019. White is equal to zero pills and scarlet is 120+ pills; shades of pink are ranges between those two. (Post via Openmap, with DEA Automation report data)

America's battle with pain-pill prescriptions might be tapering off, but deaths spawned by its spin-offs, heroin and fentanyl, have increased, and deeply affected regions are still clawing toward a recovery.

A database maintained by the Drug Enforcement Administration shows how the use of pain pills increased dramatically, particularly in Appalachian counties. The database "tracks every single pain pill sold in the United States, tracing the path from manufacturers and distributors to pharmacies in every town and city," reports Steven Rich, Paige Moody and Kevin Schaul of The Washington Post. "These records provide an unprecedented look at the surge of legal pain pills. . . which resulted in more than 210,000 overdose deaths during the 14-year time frame ending in 2019. It also sparked waves of an ongoing and raging opioid crisis first fueled by heroin and then illicit fentanyl."

The information can help people "understand the impact of years of prescription pill shipments on their communities," the Post reports. "A county-level analysis shows where the most oxycodone and hydrocodone pills were distributed across the country over that time — more than 145 billion in all."

The DEA's database, known as ARCHOs, was not willingly shared with the public. The Post and HD Media, which publishes the Charleston Gazette-Mail in West Virginia, "waged a year-long legal battle for access to the database, which the government and the drug industry had sought to keep secret," Rich, Moody and Shaw add. "The initial release of data covered 2006 to 2012, and was later updated through 2014. . . . The Post analysis shows that the volumes of the pills handled by the companies climbed as the epidemic surged, increasing by 52 percent from 8.4 billion in 2006 to 12.8 billion in 2011."

Appalachian counties have maintained that their regions were targeted by pharmaceutical companies' greed. The maps show how those areas suffered more than other areas of the country. The Post reports, "Comparing county-level maps of prescription opioid overdose deaths and pill shipments reveal a virtual opioid belt of more than 90 counties stretching southwest from Webster County, W.Va., through southern Virginia and ending in Monroe County, Ky. This swath includes 18 of the top 20 counties ranked by per-capita prescription opioid deaths nationwide and 15 of the top 20 counties for opioid pills distributed per capita."

The maps show a 'virtual opioid belt' through Appalachia. (Post map, from DEA and CDC data)

Opinion: The case for the death penalty's 'nearly perfect method of execution'

Kenneth Smith's Alabama execution failed in 2022.
(Alabama Dept. of Corrections photo via Newsweek)

While the death penalty is a contentious topic, it's a fact that some executions have been botched by methods that promise to render the convicted unconscious and then induce death, only to have the person still living in extreme pain at the end of a failed termination. Stuart A. Creque explores Kenneth Eugene Smith's case in Alabama and the death penalty's new "painless drug" in his opinion for The Wall Street Journal.

Kenneth Eugene Smith was convicted and sentenced to death for the murder-for-hire slaying of 45-year-old Elizabeth Sennett, whom Smith and another man, John Forrest Parker, beat to death with the promise of payment from her husband of $1,000 apiece. Parker was also convicted in the killing and was executed in 2010.

On Aug. 25, Alabama Attorney General Steve Marshall "filed a request with the state Supreme Court for a date to execute Mr. Smith. If the state does so, it may mark a fundamental shift in the method of capital punishment in the U.S.

"In 2007, Smith amended his 2006 appeal of his capital sentence to object to lethal injection as his method of execution, alleging that it could subject him to substantial pain. As if to prove his point, Smith’s scheduled execution on Nov. 17, 2022, had to be cancelled after technicians failed to place intravenous needles into his veins before his death warrant expired.

"Smith’s lawsuit demanded that the state use a different method: nitrogen anoxia. . . .The 2018, Alabama law approved this method. . . . Nitrogen anoxia is painless. It requires no drugs, poisons or medical procedures, and its effects are well-understood, consistent and reliable. Its first symptom is loss of consciousness.

"The electric chair, the gas chamber and lethal injection were all invented with the goal of making executions more humane by instantly inducing unconsciousness. The hope was that the condemned wouldn’t feel pain. But none of those methods reliably cause unconsciousness as an initial effect.

"Marshall has stated in his Supreme Court filing that Alabama intends to execute Smith by nitrogen anoxia. Smith’s lawyers have already filed an appeal based on their argument that using this method is 'human experimentation.' . . . Inevitably, there will be delays due to this and other litigation, but the method’s first use may come as early as 2024.

"Society doesn’t view it as morally acceptable to inflict the same suffering on a murderer that he inflicted on his victim. Nitrogen anoxia will inflict no physical pain; a murderer such as Smith will merely forfeit the balance of his natural life span." 

Final resting choices include green burials, water cremation and human composting -- in addition to traditional options

The Forest Conservation Burial Ground in Ashland, Oregon, is a
green burial site. (Green Burial Council photo via Herald-Leader)

Ash and casket burials aren't the only final resting choices. Depending on state laws, water cremation, green burials and even human composting are options, reports Bill Estep of the Lexington Herald-Leader.

Nationally, cremation has become more popular. The process "uses flame and heat to reduce a body to ash and bone fragments. The brittle bone fragments are then put in a machine to pulverize them into pieces, usually no bigger than an eighth of an inch," Estep writes. "The deceased person is placed in the cremator in a flammable container such as wood, wicker or rigid cardboard. The process of cremation typically takes two to two and a half hours. The average weight of the remains of a cremated adult is four to six pounds."

Other alternatives include green burials where the deceased is put "into the ground in a shroud or other biodegradable container — or no container — without being embalmed. Supporters see green burial as better for the environment," Estep reports. "Another method of disposition is called alkaline hydrolysis, or water cremation. As the name indicates, the deceased person is placed in a watertight container with water and alkaline chemicals that are heated. The process breaks down the body into a sterile solution that can be put down a drain, and the bones are pulverized as in flame cremation."

Natural organic reduction, or human composting, is legal in a few states. Estep explains, "In that process, a person’s body is put in a container with materials such as hay, straw and wood ships that help turn the body into soil, according to a document explaining the law in Oregon. The process takes about about four to six weeks, with additional time needed to dry the soil."

And finally, is it legal to be buried in your own backyard? It depends. Sidney Fogle, executive director of the Funeral Directors Association of Kentucky, told Estep, “People bury on private property all the time." Estep reports, ". . . there may be city or county ordinances that prevent it, but in the absence of those prohibitions, it is legal for people to be buried on their own property, Fogle said. . . . It would be best for a funeral home to handle the burial, however. One reason is that the state and other agencies, such as the Social Security Administration, are supposed to be notified of deaths, and funeral homes know how to complete that process."

Health investigation finds startling gap in funding to prevent maternal deaths, new grant award aims for change

USA Facts map, from CDC data

National maternal mortality rates have been on a steady incline, with far more minority women dying while pregnant or within 42 days of the end of pregnancy than white women, reports Sarah Jane Tribble of KFF Health News. Despite the rate difference, a federal program designed to "combat the alarming rates of rural women dying from pregnancy complications. . . . hadn't sent a grant to serve mothers in majority-Black rural communities."

A KFF Health News investigation discovered the possible funding-bias and criticized the program for neglecting some of the most marginalized women. The program has addressed that problem by "supporting an organization that serves predominantly Black counties in the Deep South," Tribble writes.

The Institute for the Advancement of Minority Health in Madison, Mississippi, was "one of two winners in the latest round of an initiative administered by Health Resource and Services Administration," Tribble writes. Mississippi has the highest rate of maternal mortality in the U.S. and the highest proportion of Black births in the U.S. "In June, KFF Health News found that HRSA's Rural Maternity and Obstetrics Management Strategies Program had failed to fund any sites in the Southeast . . . . despite a White House declaration to make Black maternal health a priority, and despite statistics showing America's maternal mortality rate rising sharply in recent years."

Peiyin Hung, deputy director of the University of South Carolina's Rural and Minority Health Research Center, is a member of the health equity advisory group for the maternal grant program. Hung said "the Mississippi nonprofit is an unusual awardee because it is not part of a larger health system." Tribble reports: "The grant application process skewed toward large health systems because they 'have much higher capacity to form a statewide network', Hung said. That's, in part, because grant winners were required to create a network of specific health care clinics, hospitals, and the state Medicaid office. In recent years, the agency has 'become much more flexible,' Hung said."

Tribble adds: "The success of the Mississippi application is a 'promising signal' for states that don't have large rural health systems focusing on maternal care, said Hung, who hopes a South Carolina applicant receives a grant in the future."

Suicide isn't just a cause of death for teenagers and adults; younger children also commit suicide

Children ages 5-11 also commit suicide.
(Photo by Lukas Metz, Unsplash)

As children enter their new classrooms and routines this fall, it's an excellent time to remember to monitor their mental health. And while many people might not realize it, young children are also at risk to commit suicide. "Suicide ranks as either the seventh- or eighth-leading cause of death among children ages 5 to 11, according to the Centers for Disease Control and Prevention and recent studies," reports Cheryl Platzman Weinstock of CBS News. "And numbers show the rates among younger kids appear to have increased in the past decade, especially among Black boys."

Paul Lipkin, a pediatrician at the Kennedy Krieger Institute, told Weinstock, "Historically, we thought that suicide is a problem of teens and adults, but younger children are expressing similar thoughts that may have been ignored before." Weinstock reports, "This has many experts calling for lowering the screening age for suicide ideation in children and moving to develop more effective early suicide risk detection and targeted prevention strategies. The broad approach includes pediatricians, teachers, and parents working with children at a young age to build their resilience and identify and manage their stress."

Weinstock writes, "Studies have found that young children gain an understanding about death and killing oneself from TV or other media, discussions with other children, or exposure to death from a family or community loss. . . . It is quite likely the 136 reported suicides from 2001 to 2021 among 5- to 9-year-olds were an undercount." Margaret Warner, a CDC epidemiologist, told Weinstock: "If we are missing deaths or don't have all the information leading to them, we can't properly develop programs to prevent future deaths." Weinstock adds, "That's why there's also an ongoing national effort by coroners and medical examiners to improve the quality and consistency of pediatric death investigations."

What parents can do now is be aware and observant. Lisa Horowitz, a pediatric psychologist and staff scientist at the National Institute of Mental Health, told Weinstock: "It's never too early to start a conversation with kids about recognizing mental health distress and doing what we can do to help them have better coping strategies and foster resilience. . . . I don't want people to panic but just want them to be vigilant about their children."

Flooding can cause caskets to float away and headstones to disappear as climate change hits cemeteries

A coffin juts out of a riverbank.
(Courtsey photo by Judy Blair Berry)

Climate change can mean prolonged or repeated flooding in some areas unprepared for submersion; graveyards and cemeteries are experiencing unearthed remains and floating caskets, reports Dinah Voyles Pulver of USA Today. "Thousands of graves have been disturbed in cemeteries nationwide in the past 30 years. Flooding, erosion and other climate-related weather disasters have been reported in at least 21 states and 15 countries over the past three decades. Coffins have washed away, and bones have been exposed in big cities and tiny hamlets."

Cemeteries have long struggled with neglect and upkeep expenses, but extreme weather has amplified the problem. Judy Blair Berry and her husband told Pulver of a prime example. The couple was "motoring along the Pearl River in Copiah County, Mississippi, when she looked up from the boat to see a casket jutting out of the bank above the river. Pieces of gravestones lay scattered on the shore. . . . Mississippi, and its neighbors to the north are among the states in the eastern half of the United States experiencing more rainfall extremes since the 1990s, including increases in the number of days with more than an inch of rain."

Families have had to rebury loved ones, and state and local governments, the Federal Emergency Management Agency and cemetery associations "are already spending millions to preserve cemeteries and build seawalls, and relocate or rebury remains," Pulver reports. "Perhaps nowhere have the effects of climate change had more impact on cemeteries than in Louisiana. At least 11 hurricanes have pummeled the Bayou State since 2002, disturbing thousands of graves and washing away hundreds of vaults and caskets. . . . At least a dozen cemeteries in southern Louisiana parishes have succumbed to rising seas and sinking land, The Associated Press has reported."

Pulver explains, "Water can infiltrate a burial site in several ways, and each type of casket, whether it's sealed, unsealed or inside a vault, can develop issues. . . . Options are available to help protect cemeteries and have been used at some locations in the U.S., including adding seawalls and stabilizing shorelines. A more complex and expensive step also has been needed in some cemeteries: moving the graves to safer locations."