TIME Health Care

Many Teens Are Still Not Getting The HPV Vaccine

Even though the HPV vaccine prevents cancer, the number of teens who get vaccinated is still lower than desired

New federal data shows that despite public health efforts, the number of teen boys and girls receiving the human papillomavirus (HPV) vaccine only increased slightly in 2014.

The new numbers from the U.S. Centers for Disease Control and Prevention (CDC) released on Thursday show that four out of 10 adolescent girls and six out of 10 adolescent boys have not started the HPV vaccination series. Without vaccination, young people are at a greater risk of developing HPV-related cancers down the line.

Overall, 60% of girls in the age group and 42% of boys have received one or more doses of the vaccine which the CDC reports is 3% higher for girls and 8% higher for boys compared to data from 2013.

Currently it is recommended by the CDC that girls and boys ages 11 to 12 get the HPV vaccine. While the new numbers are an improvement from prior years, medical experts would like to see greater HPV vaccine use, especially since the vaccine prevents cancer.

HPV is not an uncommon infection. Other data from the CDC shows sexually active men and women will get at least one type of the virus at some point during their lives. Each year around 27,000 people in the U.S. are diagnosed with HPV-caused cancer.

We are missing crucial opportunities to protect the next generation from cancers caused by HPV,” said Dr. Anne Schuchat, assistant surgeon general and director of CDC’s National Center for Immunization and Respiratory Diseases in a statement.

TIME China

New Study Blames Chinese Grandparents For Obese Kids

Weight-Loss Summer Camp For Students In Shenyang
ChinaFotoPress—Getty Images Overweight students attend military training during a weight-loss summer camp on July 30, 2009 in Shenyang of Liaoning Province, China.

China is already the second fattest country in the world

Chinese children raised by their grandparents are twice as likely to be overweight or obese, according to a study published this month in the International Journal of Behavioral Nutrition and Physical Activity.

China is already the second fattest country in the world, with more than a quarter of its adults overweight, or obese, in 2014.

The new study’s researchers set out to determine the factors leading to China’s high obesity rate, and they discovered that grandparents often work at cross-purposes with parents and schoolteachers when it comes to child nutrition.

Chinese grandparents, the study found, tend to overfeed the kids under their care: “Fat means wealthy,” some grandparents in the study told the researchers, believing that obesity indicates that children are well cared for. For many grandparents in China, who came of age during a famine that killed as many as 45 million people, high-calorie foods are viewed as healthier.

According to the study, children who live with their grandparents eat two more servings of junk food each week.

The widespread obesity among Chinese youth — with 23% of boys and 14% of girls considered overweight or obese, according to NPR — is creating problems for the rising country. Those figures have already surpassed other wealthy countries like Japan and South Korea. It’s posing problems for the Chinese military, since some soldiers are too fat to fit into their tanks. Last year, the People’s Liberation Army relaxed its weight standards slightly to allow “more portly young men” to join the ranks. Meanwhile, the prevalence of diabetes across China increased by 56% over the past two decades.

So don’t blame McDonald’s for China’s rapidly growing waistlines. Blame the grandparents.

TIME Diet/Nutrition

Should I Eat Pretzels?

Runners, yogis and dieters love them — but are they good for you?

4/5 experts say no.

You might think pretzels are the best nutritional choice from the vending machine, since they’re typically free of (or low in) fat. But here’s a twist: pretzels aren’t a healthy pick, according to most of our experts.

“Pretzels are a snack food made from enriched flour which provides very little fiber and overall very little nutritional benefit,” says Kate Patton, a registered dietitian in the preventive cardiology nutrition program at the Cleveland Clinic. They might be low in fat, but they’re also low in protein, low in fiber and high in sodium—a typical one-ounce serving has 352 mg of sodium, almost 15% of the total daily limit recommended by the Food and Drug Administration. For snacks that are more nutrient-dense, Patton says, nuts, seeds, roasted edamame or popcorn would be better choices.

Another thing pretzels have in abundance are carbohydrates and they’re high on the glycemic index, says David Katz, director of the Yale University Prevention Research Center. High-glycemic index foods spike blood sugar levels more quickly than foods sitting lower on the glycemic index. Moul Dey, PhD, associate professor in health and nutritional sciences at South Dakota State University and a researcher of flour, agrees that eaters can do better than pretzels. “Pretzels are not in my preferred list of snacks,” she says.

But Kristi King, senior clinical dietitian at Texas Children’s Hospital, says it’s all relative, and if the options are pretzels or certain other salty snacks, then pretzels would be the healthier pick. “Pretzels are a great alternative to full-fat chips”—though you should watch the sodium.

And if you really love pretzels, there are some people are on a mission to make the snack healthier. “We have developed a ‘nutritional’ soft pretzel as a functional food,” says Yael Vodovotz, PhD, professor at the Ohio State University department of food science and technology. It’s a high-soy pretzel with a lower glycemic index and a higher amount of protein derived from plants, and Vodovotz hopes it will help people manage their weight. “We are comparing these functional pretzels to ordinary ones and preliminary data looks very promising,” she says.

But since the kind you’re most likely to buy is still far from a health food, for now, it’s best to limit the twists.

Pretzels
Illustration by Lon Tweeten for TIME

Read Next: Should I Eat Corn?

TIME Diet/Nutrition

5 Foods That Taste Better Now Than They Will All Year

Here's what should be on your grocery list this month

Want to know what’s growing now? Let’s take it one month at a time, with TIME‘s Foods That Taste Better Now Than They Will All Year.

August is one of the best months for produce, according to Chris Romano, an associate produce coordinator at Whole Foods. “In summer there are a lot of good choices out there,” he says. Based on where you live in the U.S., your produce offerings can vary, but in August there are several fruits and veggies that are in-season and tasty nationwide.

Pluots: Summer is the season for stone fruit like plums, peaches cherries and pluots—which look like deep red or nearly forest green plums—are especially flavorful this month. “August is by far their peak,” says Romano. “They really sharpen in flavor and are very dramatic in color.”

Tomatoes: These need long, hot days to really develop in flavor, Romano says. “Heirlooms have gotten so popular in the last few years,” he says. To find the perfect tomato, our friends at Cooking Light recommend looking for one with bright, shiny, firm skin that has a little give when gently squeezed.

Grapes: Grapes need a many hours of sun and heat to develop their flavors, and they concentrate all their sugars in August, says Romano. “We will see all sorts of varieties from champagne to cotton-candy grapes.” A good way to select grapes is to pay attention to the color of the stem. If the stems are brittle it means they likely won’t last very long once you bring them home. Grapes with a flexible green stem are a good bet.

Melons: Though you can get a decent melon in the fall or even winter, summer is really their peak. “Whether it’s a melon with a white, deep orange, or a salmon flesh, there’s nothing better,” says Romano. To pick a good melon, look for symmetry, a heavy weight, and no bruising.

Okra: August is a good month to keep an eye out for okra. Look for small green pods and steer clear of bruising. In the United States, okra has become a Southern cuisine staple, but people living in other U.S. regions can enjoy it too. When okra is overcooked it can have a slimy texture, so be sure to look up a couple recipes before diving in.

TIME Cancer

Black Men are Twice as Likely to Die of Prostate Cancer as White Men

White man's risk of getting prostate cancer is approximately 1 in 8, whereas for black men the risk was 1 in 4

Black men are twice as likely to be diagnosed with and die from prostate cancer as white men, according to a new study.

The study, published online in BMC Medicine, looked at incidence and mortality data from Public Health England and found that in the U.K., a white man’s lifetime risk of being diagnosed with prostate cancer was approximately 1 in 8, whereas for black men the risk was 1 in 4. Asian men fared the best, with a 1 in 13 risk for diagnosis.

Each group was equally likely to die from the disease once they were diagnosed, so proportionally more black men die from prostate cancer than white or Asian men.

The research does not determine why there are these differences in ethnic groups, but Alison Cooper of Prostate Cancer UK, the lead author of the study, told the Guardian, “The study also provides important absolute-risk figures to help black men better understand their risk of developing prostate cancer. These figures can be used for targeted awareness-raising and to help them make an informed decision about whether or not to have a prostate specific antigen test.”

Prostate cancer is the most common form of cancer in the UK.

TIME politics

How Medicare Came Into Existence

Aug. 6, 1965
Cover Credit: BORIS CHALIAPIN The Aug. 6, 1965, cover of TIME

TIME said the bill—signed on July 30, 1965—created a "welfare state beyond Roosevelt's wildest dreams"

It was 50 years ago Thursday, on July 30, 1965, that President Lyndon Johnson signed the Medicare bill, turning the national social security healthcare program for older Americans into law. But, despite Johnson’s legendary powers of legislative persuasion, the celebratory signing event—complete with the enrollment of the first Medicare beneficiary, former President Harry S. Truman—could have looked very different.

After all, the idea of helping American seniors afford health care took time to gain traction: The idea came up not long after Franklin Roosevelt initiated the modern social-security system in the 1930s. When the coinage “Medicare” first came on the American scene, the program it described was not the one we think of today. In 1960, the term referred to an opposing program proposed by the Eisenhower administration. The big fear at the time was that tying any kind of health aid to social security would quickly deplete the funds available for that then-30-year-old system; Eisenhower’s version, overseen by then-Vice President Richard Nixon, would have been both voluntary and state-funded.

In that year’s Presidential campaign, however, Nixon lost to challenger John F. Kennedy—who, as TIME put it a few years later, “vowed without qualification that his Administration would persuade a Democratic Congress to pass a medicare bill, to be financed under the social security system.” Kennedy died, however, before he could make good on that promise—which is where Johnson comes in. Benefiting from his 1964 election victory, Johnson made it happen. But what exactly it would look like remained to be settled.

By April of 1965, as TIME reported, there were three options in the running: Johnson’s social-security-linked compulsory program; an Eisenhower-esque voluntary program with no link to social security; or an American Medical Association-backed plan called “eldercare,” which prioritized patient choice and was need-based. The solution came, surprisingly, in the form of House Ways and Mean Committee chair Wilbur Mills, who had been a staunch opponent of Medicare. He combined elements of the three plans into one that would succeed. The basics of the plan were compulsory and funded by increasing social-security taxes, while extras were voluntary. The program we now know as Medicaid, for those in need, would also be expanded.

“The medicare bill will not solve all the problems of growing old—but it will certainly make the process much less costly to the elderly,” TIME noted. And that wasn’t all it did, the magazine continued. The medicare bill represented a fundamental change to American political norms:

Almost 30 years ago, Franklin Delano Roosevelt signed into law the Social Security Act. At the moment of signing, he issued a statement that, in retrospect, sounds almost apologetic: “We have tried to frame a law which will give some measure of protection to the average citizen and his family against the loss of a job and against poverty-ridden old age. This law, too, represents a cornerstone in a structure which is being built but is by no means complete. It is a structure intended to lessen the force of possible future depressions.”

Social security was mostly an emergency act in a nation still struggling out of the depths of a depression in which, in F.D.R.’s famed phrase, more than one-third of the nation was “ill-housed, ill-clad, ill-nourished.” The change since then in American life has never been more apparent than last week, when Congress acted on two bills that projected a new sort of welfare state beyond Roosevelt’s wildest dreams. First, the House of Representatives passed and sent to the Senate, where it faces certain swift approval, the Johnson Administration’s $6 billion-a-year medicare bill…

Action on both bills came not in time of depression but in the midst of the most prosperous year that the affluent society has ever known. There were a few squawks about presidential pressure, but it was widely accepted that both measures would achieve great good in making the U.S. even more affluent without turning it into a socialistic society. It was generally conceded that both bills, despite the vastness of their scope, were aimed not at increasing the power of the Federal Government, but at eradicating some remaining blemishes in the Great Society.

Read the full story, here in the TIME Vault: The New Welfare State

TIME medicine

Boy Who Received Double Hand Transplant Says He Can’t Wait to Hold His Little Sister

Zion Harvey had the world's first bilateral hand transplant

Eight-year-old Zion Harvey could hardly be more thankful for the incredible double-hand transplant he recently received.

In an interview with Today, the boy said he is eager to do one thing: hold his little sister.

“My favorite thing [will be to] wait for her to run into my hands as I pick her up and spin her around,” he said.

After losing his hands and feet to a life-threatening bacterial infection as a toddler, Harvey, who is from Baltimore, recently became the first kid in the world to receive a double hand transplant.

Doctors at The Children’s Hospital of Philadelphia disclosed the nearly 11-hour operation this week. Harvey said it is a dream come true.

“I hoped and I hoped for somebody to ask me, ‘do I want a hand transplant?’ and it came true,” he said.

It was a 40-member team led by Dr. L. Scott Levin that helped the boy to realize his dream. Levin told NBC News that in the face of such a risky operation, Harvey never shed a tear.

“I’ve never seen a tear, never an untoward face, never a complaint,” he said. “He’s always positive. And that, in and of itself, is remarkable.”

Harvey’s mother, Pattie Ray, said she was happy and overcome with emotion when she saw her son leaving the operating room.

“When I saw Zion’s hands for the first time after the operation, I just felt like he was being reborn,” she told the Today. “I see my son in the light I haven’t seen him in five years.

“It was like having a newborn. It was a very joyous moment for me.”

Through the years, Harvey adapted to life without his hands, mastering writing, eating and playing video games. He said he hopes to add swinging from monkey bars to the list.

He unveiled his new hands at a hospital press conference on Tuesday where he thanked his family.

“I want to say to you guys thank you for helping me do this,” he said.

The 8-year-old will spend the next several weeks going through hand therapy at an inpatient rehabilitation center at Children’s Hospital.

This article first appeared on People.com

TIME medicine

Meet the Heroes and Villains of Vaccine History

A California legislator who faces a recall campaign for his support of a law mandating vaccinations is just one of the heroes in the history of vaccines. Alas, there are villains too

  • Edward Jenner

    Edward Jenner Vaccines
    Popperfoto/Getty Images Edward Jenner

    No one knows the name of the dairy maid 13-year old Edward Jenner overheard speaking in Sodbury, England in 1762, but everyone knows what she said: “I shall never have smallpox for I have had cowpox. I shall never have an ugly pockmarked face.” Jenner was already a student of medicine at the time, apprenticed to a country surgeon, and the remark stayed with him. But it was not until 34 years later, in 1796, that he first tried to act on the dairy maid’s wisdom, vaccinating an 8-year-old boy with a small sample from another dairy maid’s cowpox lesion, and two months later exposing the same boy to smallpox. The experiment was unethical by almost any standard—except perhaps the standards of its time—but it worked. Jenner became the creator of the world’s first vaccine, and 184 years later, in 1980, smallpox became the first—and so far only—disease to have been vaccinated out of existence.

  • Jonas Salk and Albert Sabin

    Albert Sabin Jonas Salk Vaccines
    Mondadori/Getty Images; PhotoQuest/Getty Images Left: Albert Sabin in his laboratory in 1960; Right: Jonas Salk

    Jonas Salk and Albert Sabin didn’t much care for each other. The older, arid Sabin and the younger, eager Salk would never have been good matches no matter what, but their differences in temperament were nothing compared to a disagreement they had over science. Both researchers were part of the National Foundation for Infantile Paralysis—later dubbed the March of Dimes—and both were trying to develop a polio vaccine. Sabin was convinced that only a live, weakened virus could do the trick; Salk was convinced a newer approach—using the remains of a killed virus—would be better and safer. Both men turned out to be right. Salk’s vaccine was proven successful in 1955; Sabin’s—which was easier to administer, especially in the developing world, but can cause the rare case of vaccine-induced polio due to viral mutations—followed in 1962. Both vaccines have pushed polio to the brink of eradication. It is now endemic in only three countries—Afghanistan, Pakistan and Nigeria—and appears, at last, destined to follow smallpox over the extinction cliff.

  • Dr. Maurice Hilleman

    Dr. Maurice Hilleman Vaccines
    Ed Clark—Time & Life Pictures/Getty Image Dr. Maurice Hilleman (center) talks with his research team as they study the flu virus in a lab at Walter Reed Army Institute of Research, Silver Springs, Md. in 1957.

    Around the world, untold numbers of children owe their health to a single girl who woke up sick with mumps in the early morning hours of March 21, 1963. The girl was Jeryl Lynne Hilleman, who was then only 5; her father was a Merck pharmaceuticals scientist with an enduring interest in vaccines. Dr. Maurice Hilleman did what he could to comfort his daughter, knowing the disease would run its course; but he also bristled at the fact that a virus could have its way with his child. So he collected a saliva sample from the back of her throat, stored it in his office, and used it to begin his work on a mumps vaccine. He succeeded at that—and a whole lot more. Over the course of the next 15 years, Hilleman worked not only on protecting children against mumps, but also on refining existing measles and rubella vaccines and combining them into the three-in-one MMR shot that now routinely immunizes children against a trio of illnesses in one go. In the 21st century alone, the MMR has been administered to 1 billion children worldwide—not a bad outcome from a single case of a sickly girl.

  • Pearl Kendrick and Grace Eldering

    Pearl Kendrick Vaccines
    University of Michigan School of Public Health Pearl Kendrick

    It was not easy to be a woman in the sciences in the 1930s, something that Pearl Kendrick and Grace Eldering knew well. Specialists in public health—one of the only scientific fields open to women at the time—they were employed by the Michigan Department of Health, working on the routine business of sampling milk and water supplies for safety. But in their free time they worried about pertussis—or whooping cough. The disease was, at the time, killing 6,000 children per year and sickening many, many more. The poor were the most susceptible—and in 1932, the third year of the Great Depression, there were plenty of poor people to go around. A pertussis vaccine did exist, but it was not a terribly effective one. Kendrick and Eldering set out to develop a better one, collecting pertussis samples from patients on “cough plates,” and researching how to incorporate the virus into a vaccine that would provide more robust immunity. They tested their vaccine first on mice, then on themselves and finally, in 1934, on 734 children. Of those, only four contracted whooping cough that year. Of the 880 unvaccinated children in a control group, 45 got sick. Within 15 years of the development of Kendrick and Eldering’s vaccine, the pertussis rate in the U.S. dropped by 75%. By 1960 it was 95%—and has continued to fall.

  • Dr. Richard Pan

    Sacramento California News - June 30, 2015
    Madeline Lear—Sacramento Bee/ZUMA Wire June 30, 2015 - Sacramento, California - Senator Richard Pan (right) speaks during a press conference at William Land Park Elementary School in Sacramento on June 30, 2015, where vaccination advocates thanked the legislature and Gov. Brown for passing Senate Bill 277, which eliminates personal and religious belief exemptions for vaccines.

    The work that’s done at the lab bench is not the only thing that makes vaccines possible; the work that’s done by policymakers matters a lot too. That is especially true in the case of California State Senator Richard Pan, a pediatrician by training who represents Sacramento and the surrounding communities. Pan was the lead sponsor of the recently enacted Senate Bill 277, designed to raise California’s falling vaccine rate by eliminating the religious and personal belief exemptions that many parents use to sidestep the responsibility for vaccinating their children. For Pan’s troubles, he now faces a possible recall election, with anti-vaccine activists trying to collect a needed 35,926 signatures by Dec. 31 to put the matter before the district’s voters. Pan is taking the danger of losing his Senate seat with equanimity—and counting on the people who elected him in the first place to keep him on the job. “I ran to be sure we keep our communities safe and healthy,” he told the Sacramento Bee. That is, at once, both a very simple and very ambitious goal, made all the harder by parents who ought to know better.

  • Dr. Andrew Wakefield

    Dr. Andrew Wakefield Vaccines Autism
    Shaun Curry—AFP/Getty Images From right: Dr. Andrew Wakefield and his wife, Carmel arrive at the General Medical Council (GMC) in central London on Jan.28, 2010.

    Not every conspiracy theory has a bad guy. No one knows the name of the founding kooks who got the rumor started that the moon landings were faked or President Obama was born on a distant planet. But when it comes to the know-nothing tales that vaccines are dangerous, there’s one big bad guy—Andrew Wakefield, the U.K. doctor who in 1998 published a fraudulent study in The Lancet alleging that the MMR vaccine causes autism. The reaction from frightened parents was predictable, and vaccination rates began to fall, even as scientific authorities insisted that Wakefield was just plain wrong. In 2010, the Lancet retracted the study and Wakefield was stripped of his privilege to practice medicine in the U.K. But the damage was done and the rumors go on—and Wakefield, alas, remains unapologetic.

  • Jenny McCarthy and Jim Carrey

    Jenny McCarthy Jim Carrey Vaccines Autism
    Brendan Hoffman—Getty Images Jim Carrey (center) carries Evan McCarthy, son of actress Jenny McCarthy (left) during a march calling for healthier vaccines on June 4, 2008 in Washington.

    If you’re looking for solid medical advice, you probably want to avoid getting it from a former Playboy model and talk show host, and a man who, in 1994’s Ace Ventura: Pet Detective, introduced the world to the comic stylings of his talking buttocks. But all the same, Jenny McCarthy and Jim Carrey are best known these days as the anti-vaccine community’s most high-profile scaremongers, doing even the disgraced Andrew Wakefield one better by alleging that vaccines cause a whole range of other ills beyond just autism. None of this is true, all of it is shameful, and unlike Wakefield, who was stripped of his medical privileges, Carry and McCarthy can’t have their megaphones revoked.

  • Rob Schneider

    Rob Schneider Vaccines
    Richard Shotwell—Invision/AP Rob Schneider in 2014.

    What’s that you say? Need one more expert beyond Jenny McCarthy and Jim Carrey to weigh in on vaccines? How about Rob Schneider, the Saturday Night Live alum and star of the Deuce Bigalow, Male Gigolo films? Schneider has claimed that the effectiveness of vaccines has “not been proven,” that “We’re having more and more autism” as a result of vaccinations, and that mandating vaccines for kids attending public schools is “against the Nuremberg laws.” So, um, that’s all wrong. A vocal opponent of the new California law eliminating the religious and personal belief exemptions that allowed parents to opt out of vaccinating their kids, Schneider called the office of state legislator Lorena Gonzalez and left what Gonzalez described as a “disturbing message” with her staff, threatening to raise money against her in the coming election because of her support of the law. Gonzalez called him back and conceded that he was much more polite in person. Still, she wrote on her Facebook page, “that is 20 mins of my life I’ll never get back arguing that vaccines don’t cause autism with Deuce Bigalow, male gigolo.#vaccinateyourkids.”

  • Robert F. Kennedy, Jr.

    Robert Kennedy, Jr. Vaccines
    Rich Pedroncelli—AP Robert F. Kennedy, Jr. speaks against a measure requiring California schoolchildren to get vaccinated during a rally at the Capitol in Sacramento, Calif., on April 8, 2015.

    If you’re looking for proof that smarts can skip a generation, look no further that Robert F. Kennedy, Jr., son of the late Bobby Kennedy. RFK Jr. has made something of a cottage industry out of warning people of the imagined dangers of thimerosal in vaccines. An organomercury compound, thimerosal is used as a preservative, and has been removed from all but the flu vaccine—principally because of the entirely untrue rumors that it causes brain damage. But facts haven’t silenced Kennedy who, as a child of the 1950s and ‘60s, surely got all of the vaccines his family doctor recommended. Children of parents who listen to what he has to say now will not be so fortunate.

TIME Exercise/Fitness

13 Fun Ways to Work Out With Your Dog

woman-running-with-dog
Getty Images

The versatile furry friends can do anything from running to yoga to boot camp with you

Dogs make the best workout buddies. They never complain about hills or cancel on you last-minute. And they’re always stoked to follow you out the door. That energy can be contagious: research from Michigan State University found that canine owners were 34% more likely to get the recommended 150 minutes of exercise a week than folks who didn’t have a dog. Even if you’re just taking your pup for a walk, that counts. (Move at a brisk clip and you can burn as many as 170 calories in half an hour.) But there are lots of other activities you and Fido can do together—all while strengthening your bond.

Check out these fun ways to get fit with your furry pal.

Running

Because dogs are creatures of habit, they can help you keep up your weekly mileage: Once your pup gets into the routine of a morning run, she won’t let you wimp out if it’s drizzling, or you’re just feeling bleh, explains J.T. Clough, author of 5K Training Guide: Running with Dogs($8; amazon.com). “She’ll wait by your sneakers, tongue out, tail wagging,” says Clough, who runs a dog-training business on Maui. “Her excitement can be enough to change your attitude.”Concerned your little pooch won’t keep up? No need to worry, says Clough: “The truth is most small dogs have more energy than the big breeds.” Just be careful in the heat and humidity, since dogs don’t sweat like we do. And if you have a flat-faced breed (think pugs and Boston terriers), keep your runs under five miles, Clough suggests, since these dogs have a harder time taking in air.

Stand-up paddleboarding

It’s almost as if stand-up paddleboards were designed for canine co-pilots: Dogs of all sizes can ride on the nose (while you get a killer ab workout). Pick an ultra-calm day on a lake or bay for your first excursion together, so your pup can develop his sea legs. If you’re struggling to balance the board, try paddling on your knees, which lowers your center of gravity, until your dog is comfortable. Still, odds are you’ll both take a dip, which is why Clough recommends outfitting your dog with a life preserver. It’ll make it easier for you to lift him back onto the board, too: Most doggie vests have an easy-to-grab handle, like the NRS CFD (from $35; amazon.com).

Is your dog a born swimmer? Bring a stick or throw toy and play fetch once you’ve paddled out.

Kayaking

You can also take your dog out for a spin in a sit-on-top kayak. Smaller breeds may perch up front, while larger dogs might feel safer closer to your feet. Teach your buddy to get in and out of the kayak on land first; then practice in the shallow water close to shore. (If he seems nervous about sliding around, you could lay down a small mat or piece of carpet so his paws can get some traction.) The trick is to keep the first few outings relaxed and fun (read: brings treats!). Stick to inlets and slow-moving rivers without too much boat traffic. You can let your dog paddle alongside you if he wants to swim. If not, that’s okay too: “He’s getting lots of stimulation just by riding in the boat,” says Clough—all while you ton your arms and core and burn hundreds of calories.

Cycling

Is your dog so exuberant on walks you worry she might one day pull your arm off? If so, try letting her keep up with you as you pedal: “Biking is perfect for dogs with tons of energy,” says Clough. “They are totally psyched to flat-out run.” Meanwhile, you’re getting a great workout (cycling can torch 500-plus calories per hour) and building your leg muscles.

If your girl likes chasing squirrels and skateboards, consider using a device called the Springer. It attaches the leash to your bike’s frame or seat stem and absorbs much of the force of sudden tugs ($130; amazon.com).

Biking with your dog may actually help with any behavioral issues she has, Clough adds. “The biggest problem I see with dogs is that they’re not getting enough exercise.” Indeed, veterinarians at Tufts University’s Animal Behavior Clinic say aerobic exercise stimulates the brain to make serotonin, a hormone that helps dogs, especially those who are anxious or aggressive, to relax.

Rollerblading

This is another great way to burn off a dog’s excess energy—as long as you’re an expert inline skater, that is. If not, “it can be disastrous,” warns Clough. “Your dog will be like ‘Woohoo!’ and you’ll be like, ‘Where’s the break?!” But even if you’re super confident on wheels, she suggest rollerblading in an area free of traffic, like a park or boardwalk, so you can enjoy the excursion as much as your pal. Chances are, you’ll have so much fun you’ll forget you’re seriously working your core.

Dog-friendly boot camp

Fitness classes designed for people and pups—like Leash Your Fitness in San Diego and K9 Fit Club in Chicago —are becoming more and more popular. In a typical class, you’ll run through high-intensity moves for strength, balance and cardio while your four-legged companion practices obedience drills. “I recommend that people at least try out a class,” says Clough, who helped launch Leash Your Fitness. “The focus is more on the person’s workout than the dog’s,” she explains, but your dog is learning to feel comfortable in a distracting environment—and that will make it easier to take him along on other fitness adventures.

Dog yoga

Yep, “doga” is a thing, and it turns out pooches are naturals at this ancient practice. Can’t picture it? Think about your girl’s morning stretches: She probably does a perfect cobra, right? In a doga class, you’ll help her try more poses—and she’ll (hopefully) act as a prop for your own poses. But really doga is all about the pet-human bond. There’s often some doggy massage and acupressure involved. And while you’re in such close contact, you’ll have the opportunity to do a regular health check, feeling for any lumps beneath her fur.

Active fetch

You throw the ball and your pup goes bounding after it. But who says you have to just stand there? While he’s retrieving, bust out some muscle-building moves like crunches, lunges, squats, and more—until you’re both panting and worn out. Better yet, race him for the ball and squeeze in some sprints. Fetch can be a game you play, too.

Soccer

Believe it or not, some dogs love soccer—especially herding breeds like Border Collies and Australian Shepherds. Pet brands sell soccer-style balls (resistant to sharp teeth) in different sizes, like the 5-inch Orbee-Tuff ball from Planet Dog ($20; amazon.com). Once your boy learns to “kick” or “dribble” with his nose or paws, get your heart rates up with keep-away, or by punting the ball and racing for it.

Not a soccer fan? Try engaging him with other toys (like rope tugs) and activities (such as hide-and-seek). “Put yourself into kid mood, come up with a game, and show him,” Clough suggests. “He’ll most likely play it with you.”

Snowshoeing and cross-country skiing

Cold weather doesn’t mean you have to leave your dog cooped up. Some breeds—like Huskies and St. Bernards—have snow in their DNA, but many dogs enjoy a good romp in the white stuff. And whether you’re on snowshoes or skis, you’ll get in a low-impact, total-body workout. But the best part comes later, when you both curl up for a snooze by the fire.

If your dog gets chronic snow build-up between the pads on her paws, you can outfit her with booties. Brands like Ultra Paws (from $32; amazon.com). and Ruffwear ($90; amazon.com) make rugged footwear for winter walks.

Stair-running

Thanks to the vertical element, climbing stairs (or bleachers) makes your quads, hamstrings, and glutes work extra hard. You’ll tighten up your lower half, while Spot burns off the biscuits.

Join a canine charity race

You have the perfect training buddy. Why not work toward the goal of finishing a dog-friendly race? Events for four-pawed runners and their owners—such as the Fast and the Furry 8K in St. Paul, Minn. and the Rescue Me 5K9 in Irvine, Calif. —are held all over the country.

Don’t have a dog?

You can still work out with one. Call a local animal shelter and volunteer to take dogs out for walks or runs. Pound puppies are often desperate for exercise and attention, and your commitment to your new furry pal is great motivation to stick with a fitness routine. Best of all, as an anxious or unruly dog learns to walk on a leash and behave in public, you’ll be improving his chances of finding a forever home.

This article originally appeared on Health.com

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TIME Research

Millennials Now Have Jobs But Still Live With Their Parents

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A Pew study finds the perplexing pattern has affected the housing industry

Halfway through this decade and nearly seven years after the Great Recession, Millennials are bouncing back—sort of.

In a new study released by Pew, researchers find that while Millennials—people who were born after 1981—are back to the pre-recession era unemployment levels of 7.7%, they haven’t been able to establish themselves as adults in other ways, like owning a home or getting married.

Richard Fry, an economist and lead author of the study, describes the situation as Millennials’ “failure to launch.” “I think the core is a bit of a puzzle with one clear consequence,” Fry told TIME. “There’s good news: the group that was hit the hardest—young adults—are now getting full-time jobs and earnings are tracking upwards. But the surprise is that with the recovery in the labor market, there are fewer young adults living independently.” (Living independently here is defined as heading a household; in other words, owning a home.)

When the recession hit, young people moved back into their parents’ house in droves, unemployed and without much hope for any future work. The thought process was that once the economy improved and Millennials returned to work, they’d scoot out of their parents lair.

But that hasn’t been the case, and economists aren’t sure why.

“Is it a good thing or a bad thing? I don’t know,” Fry said. He was also the author of a study three years ago that explored Millennials living and work situations using 2012 data, and he thought then that the explanation was clear. “My thought was, ‘Yeah, that’s true, the job market is crummy,'” he said. “My expectation was that as the labor market improves, more young people will strike out on their own, but that’s not the case.”

About 42.2 million 18-to-34 year olds are living away from home this year; 2007 numbers were just above 2015’s independent young adult population at 42.7 million. There are a few common characteristics of these Millennial householders; they are more likely to be women (72% compared to their male counterparts) and college-educated (86% of those with bachelors degrees were living independently compared to 75% of the same peer group holding only a high school education). Fry points to women getting in permanent romantic relationships earlier that either lead to marriage or cohabitation as the cause of this gender difference.

The consequences of Millennials still living at home go far beyond the household dynamics of adult children being at home with parents. Consider the housing sector, which has not recovered from the 2008 economic tumble. If more young adults had decided to take on home ownership, the economy may have improved more.

So how are Millennials most likely living if they’re not living at home? Probably with a roommate, or doubled up with a fellow adult who is not their spouse or partner, data suggests.

But having a roommate or living at home have real demographic effects for the future, Fry says. He goes back to two key facts: that people living independently tend to be better educated and that college educated people tend to delay marriage or not marry at all (though even Millennials with a high school education are not getting married as much as they used to.) That means that less educated Millennials are facing consequences in not just the job market, but beyond.

“There’s less sorting—that when the less educated do marry, they marry others who are also less educated,” he said. “That’s going to impact household income and economic wellbeing. That’s going to affect economic outcomes.”

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