TIME public health

Here’s Where You’re Most Likely to Own a Gun in the U.S.

U.S. citizens own more than 270 million guns

Americans love their guns. U.S. citizens own more than 270 million of them, nearly 9 for every 10 Americans. No other country even comes close to matching that rate.

Now, a new study in the journal Injury Prevention shows just how much gun culture varies within the U.S. In Alaska, the state with the highest rate of gun ownership, more than 60% of residents own a gun. In Delaware, the state with the lowest rate, 5% of residents own a gun. Overall, one-third of American adults own a gun. Public health researchers say this information could help inform how to reduce gun violence.

“When you look at different states, you see a wide variation in these rates, and it mirrors the gun death rate,” said Bindu Balesan, an assistant professor at Columbia University’s public health school.

Idaho, West Virginia, Wyoming and Montana round out the list of states with top gun ownership, following Alaska. Delaware, Rhode Island, New York, New Jersey and New Hampshire are the only states where fewer than 15% of residents own guns, according to the research.

Read More: Gun Fatality Rates Vary Wildly By State, Study Finds

The study also found a strong correlation between gun ownership and living in a so-called social gun culture. In such gun cultures, friends and family tend to own firearms and community members may attend gun-themed social events. Nearly 8% of respondents even said that their social life with family members involves guns. The correlation may suggest a way to reduce gun deaths and injuries outside of federal government lawmaking, which has proven ineffective, Balesan says. Instead of focusing on big policy changes, public health advocates may want to focus on changing gun culture.

“We need to think about strategies for social change like we did with tobacco,” she said.

Gun violence remains a leading cause of death and injury in the U.S. More than 30,000 people are killed in a firearm-related incident each year, according to the CDC. And while a third of those deaths are the result of homicide, many more are a result of suicide and accidents. More than 200,000 people are injured each year.

But treating gun violence as a public health issue is going to be an uphill battle, even without relying on the federal government for new laws. Research dollars, for instance, are nearly impossible to come by, Balesan said. The Centers for Disease Control and Prevention (CDC), a huge source of money for health research, hasn’t given out funding for gun violence studies and others are similarly reluctant to touch such a controversial issue.

TIME vaccines

Jerry Brown Must Sign the California Vaccine Bill

Bad choice: Anti-vaxxers protesting the California vaccine bill
Rich Pedroncelli—AP Bad choice: Anti-vaxxers protesting the California vaccine bill

Jeffrey Kluger is Editor at Large for TIME.

The governor has a chance to protect thousands of children. This should not be a close call

California does not often make common cause with Mississippi and West Virginia. America’s blue-red divide doesn’t come any wider than it does between the liberal laboratory of the Pacific West and the conservative cornerstones of the old south. But with a single signature on a single bill, California Gov. Jerry Brown could ensure that the largest state in the nation joins the two far smaller ones in what ought to be a simple, primal mission: keeping children healthy.

The pending bill, which passed the California legislature with bipartisan majorities and now rests on Brown’s desk, is known simply as SB277 and it does a straightforward job—removing the religious and personal belief exemptions that allow parents to refuse to vaccinate their children. The legislation leaves standing the medical exemption—the waiver families receive when a child has a manifest medical condition like a compromised immune system that would make vaccines dangerous. If the new law is signed, families without the medical waiver will face a choice: get your kids the shots or prepare to home-school them, which would ensure they get an education but would protect other children from whatever pathogens they may be carrying.

Mississippi and West Virginia are the only two states in the country that currently have such no-nonsense rules and they’ve got the stellar vaccination rates to prove it: fully 99.9% of the states’ kids are up to date on all their shots. California could use some of those southern-fried smarts. Only 90.4% of the Golden State’s kindergarteners had their full complement of vaccinations in the 2014-2015 school year. The worst offenders are the parents in the too-rich, too-famous, too-smart by half provinces of Silicon Valley, where vaccination rates in some day care centers struggle to crack the 50% mark.

That matters—a lot. When vaccine coverage falls below 95%, communities begin to lose what’s known as herd immunity, the protection a fully inoculated population provides to the relative handful of its members who can’t be vaccinated. California has suffered the consequences of that, with outbreaks of whooping cough and mumps across the state. Earlier this year, more than 100 cases of measles in California and Mexico were traced to a single unvaccinated visitor to Disneyland. That outbreak, at one of the state’s most iconic destinations, at last got Sacramento’s attention, and SB277, though hotly debated, passed.

Brown, for now, has been coy about whether he will sign it. He did approve an earlier bill that preserved the personal belief exemption but at least made it harder for families to claim one. No longer could parents simply check a box on a form—an awfully easy thing to do without giving the matter much thought. Now, they must visit a health care provider who must sign a statement confirming that the parents have been informed of the benefits (too many to enumerate) and the risks (vanishingly small) of vaccination. Once they’re in the doctor’s office, plenty of parents come around. But Brown, a one-time Jesuit seminarian who has made no secret of his spiritual side over the years, carved out an exception in that law for religious beliefs.

He shouldn’t make the same mistake again. There was a time when religious exemptions were no cause for worry. The share of Americans whose faith forbids vaccinations is exceedingly small, and as long as the herd remained intact, those kids would remain safe. But that was before the nonsense factory of the anti-vaccine community went into operation, churning out all manner of misinformation about autism and brain damage and big pharma conspiring with big government to inject unsuspecting children with toxins. The result: Vaccine rates have plummeted nationwide, and children have paid the price.

The tension between religious liberty and civic responsibility is hardly a new issue in the American system. If your religion does no harm to anyone else—least of all kids—you ought to be free to practice it in peace. But if that faith requires prayer to treat pediatric cancer or laying on of hands as a cure for severe pneumonia, the state ought to be able to intervene and provide proper care if you won’t and prosecute you if your child is injured or killed. In some states that’s indeed possible but in others it’s not, and a complex patchwork governs the level of care each state will or won’t mandate.

Mandatory testing for lead levels in blood? OK in most places, but not if you live in Delaware, Maine, Kansas, Illinois, Massachusetts, New Jersey and Rhode Island, where religious exemptions are available. Mandatory eyedrops to help prevent blindness in newborns? An important preventive for kids born to mothers with certain kinds of STDs—but they may be out of luck if they’re born in Colorado, Delaware, Florida, Idaho, Iowa, Maine, Michigan, Minnesota, Nevada, or Pennsylvania.

The kids, it’s worth noting, did not choose to be born in states with weak protections. And they don’t choose either to be born to parents who look at vaccines and see in them something sinister or dangerous or strangely unholy.

Anti-vax parents came into a world of medically rational adults who had seen the wages of polio or diphtheria or smallpox or whooping cough and were grateful for a preventive that could eliminate those horrors. Jerry Brown himself came into that world too. Contemporary children deserve the same kind of wisdom and the same kind of care the grown-up around them enjoyed. And California children deserve a governor who will see to it that that they get it.

Brown should sign the bill.

TIME Ideas hosts the world's leading voices, providing commentary and expertise on the most compelling events in news, society, and culture. We welcome outside contributions. To submit a piece, email ideas@time.com.

TIME medicine

How This Common Drug Can Have Lasting Effects on Kids

Antibiotics are prescribed for a range of childhood ailments, from ear to throat infections. But the drugs may be changing kids’ health in potentially unwelcome ways

In a study published in Nature Communications, scientists document the possible long-term effects of antibiotics when they’re used early in life. Their study involved mice, but the team used the drugs in doses and treatment regimens that mimic those frequently administered in young children.

Dr. Martin Blaser, professor of medicine and microbiology at New York University Langone Medical Center, and his colleagues tested three different antibiotic regimens: one involving amoxicillin, another involving macrolides and a final one that combined the two. They compared these animals to mice that received a placebo. The mice got antibiotics 10 to 15 days after birth, then again 27 days later and finally after day 39. They lived for 160 days, at which point they were sacrificed and their gut bacteria were studied.

MORE: Here’s What Eating Nothing But McDonalds for 10 Days Does to Your Gut Bacteria

Compared to the mice taking the placebo, the antibiotic-treated animals had less diverse communities of bacteria, and the proportions of the bugs living in their guts were also different. The macrolides seemed to have the biggest effect on reducing microbial richness, while amoxicillin led to abnormally large bones. The changes in the microbiome persisted even to the animals’ death, nearly four months after their last antibiotic dose.

“There are really long-term, probably permanent effects on the microbiome from antibiotics,” says Blaser. “We showed changes in the richness and the community structure, and also the genes present in the bacteria.”

MORE: Antibiotics Before Age 2 Increase Risk of Childhood Obesity

What this means for humans still isn’t clear from this study, but the findings do provide hints. Other studies that have analyzed the potential effects of antibiotics found that children receiving more rounds of the drugs because of early infections tend to be heavier and are more likely to be obese as adolescents and adults. And the earlier children are exposed to the drugs, the more likely their metabolism is to be affected.

Blaser notes that antibiotics are a necessary and potentially life-saving treatment for some, but for many infections, their risks might be greater than their benefits. “If what we found in mice is true for human children, then this is yet another reason to be cautious in using antibiotics,” he says. “We know there are kids who are severely ill who must have antibiotics. But there is a larger number of kids who are only mildly ill. The question is, what proportion of them really need antibiotics?” Based on the animal data, he says, the first two to three years of life are particularly important for development, and doctors and parents should be judicious about prescribing antibiotics during this sensitive time.

TIME Healthcare

This Vitamin May Be Behind Your Acne Problems

It can be found in your burgers and cheese

Vitamin B12 is notably found in beef, dairy, and some fish. It’s been used to improve memory and combat anemia. Now, according to a study just published in Science Translational Medicine and as reported on the Verge, it may be linked to acne. It’s still early, so researchers don’t want everyone freaking out and nixing burgers and cheese from their diet, but it’s important to note that B12 changes how the genes of facial bacteria behave, a shift that aids in inflammation. The vitamin has been connected to acne in studies since the 50’s, but the researchers say that was mostly anecdotal.

“It has been reported several times that people who take B12 develop acne,” Huiying Li, a molecular pharmacologist at the University of California-Los Angeles and a co-author of the study, told the Verge. “So it’s exciting that we found that the potential link between B12 and acne is through the skin bacteria.”

Acne is still largely a mystery to researchers, even though 80 percent of teens and young adults have to deal with the pesky skin condition. Oily secretion known as sebum and faulty cells that line hair follicles play a role, but Li and her team wanted to see where bacteria factors into acne development.

The study found in a small group of people that humans who take B12 develop high levels of vitamin in their skin (which sounds like a good thing), but that skin bacteria known as Propionibacterium acnes then lowers its own production of B12 causing an imbalance. More porphyrins (naturally occurring chemicals in the body and a related molecule) are produced, which have been known to induce inflammation, AKA where acne begins.

Li says that the “main message is that skin bacteria are important. But until other researchers confirm the link between B12 and acne in a larger number of people, dermatologists won’t really be able to make any clinical recommendations one way or the other. I don’t want people to misinterpret the results by not taking B12.”

Let’s just drink more water and eat more berries until we know for sure what’s going on.

This article originally appeared on MIMI

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TIME Music

Avril Lavigne Is ‘Excited for Life After’ Lyme Disease

Avril Lavigne Celebrates 30th Birthday
Denise Truscello—WireImage/Getty Images Avril Levigne arrives at her 30th birthday celebration at the Bank nightclub in the Bellagio Hotel and Casino on September 28, 2014 in Las Vegas, Nev.

"It’s like a second shot at life”

Avril Lavigne has been candid about her struggle with Lyme disease, and the singer opened up even more about her illness in a new ABC News interview, in which she criticized doctors who didn’t take her health as seriously as they perhaps should have.

“I was seeing every specialist and literally the top doctors, and … they would pull up their computer and be like, ‘Chronic fatigue syndrome?’” a teary Lavigne said. “Or, ‘Why don’t you try to get out of bed, Avril, and just go play the piano?’ … This is what they do to a lot of people who have Lyme disease. They don’t have an answer for them so they tell them, ‘You’re crazy.’”

Lavigne was bedridden for multiple months, but is about halfway through her treatment now and says she is doing much better.

“I think for me it’s like a second shot at life,” she said. “I want to go out there and truly do what I love, so I’m excited for life after this.”

Watch the interview here.

This article first appeared on EW.com

TIME Infectious Disease

California Lawmakers Pass Strict School Vaccine Bill

The bill ends vaccine exemptions for personal beliefs

The California senate has passed a bill that requires most children in public schools to get vaccinations and ends exemptions from vaccinations for personal beliefs.

The bill only allows for kids with serious health problems to not get vaccinated.

The bill is now heading to California Governor Jerry Brown, who has not said whether he will sign the bill. It would be one of the strictest vaccination laws in the country.

California recently experienced an outbreak of measles that was tied to a Disneyland amusement park. Many of the people infected were not vaccinated.

TIME Diet/Nutrition

New York City Restaurants Are Cleaner Than Ever

18% fewer eateries have been cited for evidence of mice

It’s been five years since New York City instituted a strict grading policy assessing restaurants for cleanliness, food safety and handling—an attempt to address its somewhat unsavory reputation as a mecca for unsanitary eating establishments.

Now, in the latest report, city health officials have some good news: 95% of restaurants now earn A grades, and violations that can contribute to foodborne illnesses have dropped by 11%, giving New York its cleanest report card since the program began.

The requirements and methods of the health inspections are not without critics; even high-end establishments with Michelin-star honored chefs like Per Se were notoriously cited for not maintaining hot foods at high enough temperatures or cold foods at cold enough temperatures, despite commonly used practices of “resting” dishes after they come out of the oven or refrigerator to balance flavor and temperature. But the system works, say health officials. The report says that 37% more new restaurants in the city earn A grades in their first year compared to five years ago, and 18% fewer eateries have been cited for evidence of mice.

The program allows eating establishments one do-over; if they don’t meet criteria for earning an A grade, they have up to 30 days to fix their violations and receive a second inspection before getting the final grade that gets posted on their window. That posting, says Dan Kass, deputy commissioner for environmental health at the New York City Department of Health and Mental Hygiene, is key to the program’s success. “You need transparency in governmental inspection programs,” he says. “It’s the best way to inform the public and encourage them to vote with their feet and the best way to motivate restaurants—especially those that lag behind others in hygiene and food safety practices—to feel motivated to comply [with health regulations.]”

When the letter grading and public posting of the grades began five years ago, says Kass, officials expected about a 5% improvement in grades every year. “We have seen much more rapid change than that,” he says, “and it truly influences the practice of food safety in restaurants.”

The department now plans to launch a food safety workshop for restaurant workers—not just owners—to help them better understand the value and importance of proper handling and storing of food. But the public and prominent posting of letter grades will remain, so diners will still have a quick and easy way of knowing where the restaurant stands with respect to food safety and sanitation. “Inspections and education alone are insufficient to drive restaurants to improve,” Kass says. “Threats of fines may help, but those too are insufficient to move some restaurants to really change practices and put the public’s health first. There is no question that public transparency and making the information available to public at the point of sale is probably the most important driver—at least for the improvements we see.”

In fact, the system is gaining in popularity; Yelp reviews now include the grades or number scores for restaurants in cities that provide them.

TIME medicine

Minnesota Takes Half Step Toward Legalizing Marijuana

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Getty Images

Pills and oils are approved, but smoking marijuana remains prohibited

Minnesota eased a statewide ban on medical marijuana products Wednesday, approving the use of pills and oils for seriously ill patients, while upholding a ban on products that can be smoked.

Under the new law, users will be able to use liquid and pill extracts of marijuana plants, provided they are suffering from serious conditions such as epilepsy, HIV and cancer, the Associated Press reports. The law also restricts sales to only eight dispensaries within the state.

While legalization advocates hailed the new rules as a step forward, they argued that Minnesota’s approach was unusually restrictive, potentially excluding patients living in rural areas or on tight budgets from obtaining the drugs.

[AP]

TIME Diet/Nutrition

The Strange Link Between Junk Food and Depression

TIME.com stock photos Food Snacks Candy Chocolate
Elizabeth Renstrom for TIME

Some—but not all—sugars were associated with depressive disorders

Of our many modern diseases, one of the biggest burdens on society is an unexpected one: depression, according to the World Health Organization. And what we eat may be contributing, finds a new study published in the American Journal of Clinical Nutrition.

James E. Gangwisch, PhD, assistant professor at Columbia University in the department of psychiatry, wanted to find out whether foods with a higher glycemic index (GI)—a scale that ranks carbohydrate-containing foods by how much they raise your blood sugar—would be associated with greater odds of depression. “When I was a kid, I was almost like a candy junkie,” Gangwisch says. “I noticed for myself, if I eat a lot of sugar, it makes me feel down the next day.” Gangwisch says he stopped eating added sugar years ago but remained curious about whether a junk food diet could make people depressed.

He and a team of researchers looked at data from food questionnaires and a scale that measures symptoms of depressive disorders from postmenopausal women in the Women’s Health Initiative Observational Study. The data came from roughly 70,000 women, none of whom suffered from depression at the study’s start, who had baseline measurements taken between 1994 and 1998, and then again after a three-year follow-up.

Diets higher on the glycemic index, including those rich in refined grains and added sugar, were associated with greater odds of depression, the researchers found. But some aspects of diet had protective effects against developing depression, including fiber, whole grains, whole fruits, vegetables and lactose, a sugar that comes from dairy products and milk that sits low on the glycemic index.

Added sugars—but not total sugars or total carbohydrates—were strongly associated with depression.

Though the authors couldn’t pinpoint a mechanism from this study—it was associative—they note that one possibility is that the overconsumption of sugars and refined starches is a risk factor for inflammation and cardiovascular disease, both of which have been linked to the development of depression.This kind of diet could also lead insulin resistance, which has been linked to cognitive deficits similar to those found in people with major depression.

Further research is needed, Gangwisch says, and it’s not yet known whether the results would translate to a broader group of people, including men and younger women. But even now, diet may be worth discussing with people who suffer from depression, Gangwisch says—even though doing so may be difficult. “It’s hard enough to get the general public to avoid those kinds of foods, but it’s even harder to get someone who suffers from depression to avoid them and give them up,” he says. “You don’t want people to feel guilty either…to say, ‘Your diet’s bad and you should change it,’ would take kind of a soft sell approach.” Still, he believes the effort is worth it. “I think it’s important and I think it has a big effect on your mood and how you feel and your energy level,” he says. “If it’s something that people can change, they really would benefit from it.”

TIME Infectious Disease

California Lawmakers to Vote on Tougher Vaccine Measures

The bill would end exemptions from vaccinations for personal beliefs

California lawmakers are expected to vote Monday on a measure that would require most children in public schools to get vaccinations.

The bill, which is headed for a final vote in the California state Senate, would end exemptions from vaccinations for personal belief, and would excuse only children with serious health issues from vaccines, reports the Associated Press. Other unvaccinated children would need to be homeschooled.

An outbreak of measles at Disneyland in December infected over 100 people in the U.S. and Mexico, largely due to pockets of unvaccinated Californians.

Gov. Jerry Brown has not said whether he would sign the bill. If it becomes law, California, Mississippi and West Virginia would be the only states with such strict vaccination requirements.

[AP]

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