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GMA Photo Illustration/Getty(NEW YORK) -- Helicopter parents may hover and tiger moms may roar, but make room for the lawnmower parent whose approach to child-rearing is generating buzz.

In an essay recently published on the site, an anonymous educator calls the parenting style a "troubling trend."

"Lawnmower parents go to whatever lengths necessary to prevent their child from having to face adversity, struggle, or failure," the teacher wrote.

The post, titled "Lawnmower Parents Are the New Helicopter Parents & We Are Not Here for It," has been shared 12,000 times on the brand's Facebook page. The teacher, who wrote it, told a story of a seemingly reluctant father who dropped off a water bottle for his child at her school.

"'Hi, sorry,' the parent said sheepishly. He was in a suit, clearly headed to work (or something work-like)," the teacher recalled. “Remy kept texting me that she needed it. I texted back, 'Don’t they have water fountains at your school?' But I guess she just had to have it out of the bottle. He laughed, as if to say, 'Teenagers, am I right?'"

The teacher went on describing her reaction to the alleged encounter she had with the parent.

"I took a deep breath through my nose. 'Oh, I have one of those -- I love mine, too,' I said. But I’m pretty sure my eyes were saying, 'WHAT ON THIS ACTUAL EARTH,'" she wrote.

Named after the device used for cutting grass, a lawnmower parent will intervene or "mow down" any person or obstacle that stands in the way of them saving their child from any "inconvenience, problem or discomfort," according to a college professor who wrote a blog on the subject.

In that same blog, the professor notes how helicopter parenting is widely known for parents who hover or swoop in to "rescue" their kids whenever they're in trouble. Lawnmower parents, however, are geared more towards parents of older children where hovering "may be limited," she wrote.

"If you say, 'Oh, I took care of this for you,' it inadvertently gives that message of 'you can't do this yourself, you can't succeed,'" said Stephanie Samar, a clinical psychologist at the Mood Disorders Center of the Child Mind Institute. "That can lead to other problematic things -- may be increased anxiety, low distressed tolerance -- [a] discomfort that comes with having conflict helplessness about heir situation."

She went on, "This [lawnmower] parenting style really focuses on short-time goals for parents and their kids. Their question is, 'if I could make this easier for my child, why wouldn't I do that?'"

Samar told Good Morning America that focusing on short-term parenting goals will take away from the practice of important, long-term goals that kids can benefit from like resilency, grit, problem-solving, conflict resolution and coping skills.

One example: A parent connecting with a teacher on behalf of their child because he or she disagrees with a grade they received on an assignment.

Instead, the child, if capable, should learn to advocate for themselves, Samar noted.

"When parents are removing obstacles for their child they are really taking away that opportunity for kids to learn those problem-solving techniques," she said.

But Samar also points out that the anonymous teacher who wrote the piece on lawnmower parenting also addresses that children who may suffer from anxiety, depression or other forms of mental illness, may need assistance from their parents to tackle common life dilemmas.

"The parents of these students may, understandably, try to remove struggles and challenges from their child’s life because they’ve seen the way their child has responded to other struggles and challenges in the past," the teacher explained.

Samar said since every child isn't at the same level make sure you know, as the parent, when and how to step in.

Elisabeth Fairfield Stokes, a mother of two, told GMA that she has heard of a parenting style like lawnmower, but it was referred to as "snowplow" parenting.

“Lawnmower sounds like an even more aggressive version," she said in a statement. "I heard someone proudly describe themselves as such, how they clear any obstacles out of their child’s path so they can just do their thing."

In 2014, Stokes, 46, a professor at Colby College in Waterville, Maine, wrote a buzzed-about piece for Time magazine titled, "I Am a Helicopter Parent -- And I Don't Apologize."

Stokes said she first heard the term helicoptering (think involved, protective) while teaching. Later, her perspective changed after her daughter had turned 8 years old.

"She was in the situation that she was not able to advocate herself," Stokes recalled to "GMA" in April. "We were aware of the phenomenon of helicopter parents, so we held back a bit and we hesitated in terms of getting involved."

Although she said she faces criticism, Stokes doesn't mind the label of "helicopter mom."

"I believe in being involved, in being aware in what's going on and I don't mind if that's perceived as hovering," Stokes said.

As for advice to lawnmower parents who may face criticism, Stokes said it's better, rather, to focus on yours and your children's mental health as you raise them -- especially in teens, which she calls "extremely important."

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WCPO-TV(CINCINNATI) -- After one family said their baby was sent home with two months to live, neighbors and friends around the world have banded together to create early Christmas for the boy.

"We decided to make every day that he has left as amazing as it can be," Brody’s sister McKenzie Allen, 21, told ABC News. "We try to think of every fun thing that he would like to do to just bring a smile to his face."

Last year, the family took 2-year-old Brody to see Christmas lights displays and his face lit up with joy and excitement.

"He loves Christmas lights," Allen said. "So we decided to do Christmas early."

In May, Brody's family realized there may be something more serious wrong with him after he appeared dizzy, vomited and had difficulty walking.

"We got really worried because he just laid down on the floor and threw up and then was just drooling. It was terrible,” Allen said.

The family said they took Brody to a hospital where they were told the boy may have an inner ear infection. But when they took him to the children's hospital for treatment, Allen said doctors found four brain tumors.

Brody was in the hospital for treatment for the aggressive cancer for almost 100 days, the family said, but on Aug. 4, the doctors found another tumor and that the main tumor had grown significantly.

"That's when we had found out that the chemo treatment wasn't working," Allen said. "That moment was even worse than finding out he had cancer in the first place."

The doctors told the family that there is nothing more they could do for Brody and that he might have only two more months. He was released to go home.

"It’s was unimaginable. I really don’t have any word, but the best I can describe is my heart just instantly drops to the bottom of my stomach," Allen said. "I felt hopeless and scared. I was a little angry too, I mean he’s so young."

The family decided making the time that Brody has left the best life he could live. Three weeks ago, the family had a "birthday" party for him.

"We had an early birthday for him and just let him open presents and had a birthday cake and all sorts of fun stuff," Allen said.

On the family's Facebook page, which they said they set up a week after they found out Brody had cancer and now has 6,000 followers, they posted about throwing the early Christmas party for him and asked for decorations.

"He has no idea how sick he is," the boy’s father, Todd Allen wrote on the post. "He doesn't care. He just wants to have fun and enjoy every minute."

The family received an outpouring of support from neighbors and strangers in the community who brought them Christmas items, according to Allen. A week ago, their town of Colerain Township in northern Cincinnati started to decorate for Christmas too.

Some friends and neighbors have also set up early Christmas decorations at their homes to join the family.

"It's amazing," Allen said about the people who have joined "Team Brody." "We have people in New York that have decorations up and all across the United States.”

She said the family has also been contacted by people in Japan, the Philippines, Australia, Germany, Russia, Belgium, and Italy who want to send Brody Christmas cards.

Back at home, people in the community have organized a Christmas parade for him.

"Everybody is sending their personal Merry Christmas wishes to Brody," she said, adding some said they even put pictures of Brody on their Christmas trees.

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iStock/Thinkstock(NEW YORK) -- Addiction has taken an immeasurable toll on millions of American families. Over the past several years, there has been a sharp increase in drug overdoses deaths in the midst of a growing opioid epidemic. Experts and public officials have tried to determine who is responsible and what can be done.

The Trump administration declared the crisis a "national public health emergency" in 2017.

A number of states have passed bills to fight the epidemic in their own states. Florida Gov. Rick Scott did just that this past spring, in a state that has seen over a dozen people killed each day by opioids alone.

Other organizations are creatively trying to combat the crisis and the disease of addiction in different ways.

Paul Pellinger is the co-founder and chief strategy officer of Recovery Unplugged, an addiction treatment center in Florida that has several locations around the US. He recently spoke to ABC News about how the center employs music to help those combatting addiction.

Pellinger is a certified counselor and has been working to fight addiction since 1989. He believes many professionals experience difficulty helping their clients understand their own emotions and the underlying issues that may have led to their addiction. He has found music helps create a safe space for clients to identify with others and discover their emotions. The hope is this personal discovery will help them develop empathy for themselves and their journeys as they work to combat their disease.

Since the center opened six years ago, Recovery Unplugged has used music to help engage clients with "existing evidence-based [mental health treatment] models."

Pellinger discussed one client, who he picked up shortly after the person completed a prison sentence. He was not comfortable opening up to Pellinger, but once he heard Marshall Tucker Band's Can't You See started playing on the radio in their car, his demeanor changed:

"This was one of the last songs I remember hearing before I went to prison," he told me.... Then he broke down crying. ‘This song became a catalyst for emotion with him,’ I remember thinking. I could have spent hours with this guy, asking good, open-ended questions like I was taught to do as a clinician and never got him to emote like a three minute song could. So I realized then, 'There's got to be a way to harness this."

Pellinger now incorporates music and song lyrics into sessions with clients. Recovery Unplugged will introduce clients to positive songs about recovery or addiction, with the goal of creating a sense of empathy and understanding to show their clients they are not alone in their recovery and there is hope.

“My goal was to establish a rapport with the clients, break down their defenses, help them learn new perceptions... and I realized that's what music can do,” says Pellinger.

Long term, Recovery Unplugged hopes to "break the cycle of addiction for decades to come." Pellinger believes, in the short term, the center will "save lives through the power of this new music approach."

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iStock/Thinkstock(NEW YORK) -- As Hurricane Florence pummels towards the Carolinas and neighboring states, many residents are bracing for what officials are calling "the storm of a lifetime," and its anticipated catastrophic flooding, storm surge and damaging winds.

The impending storm -- which is expected to make landfall Friday morning -- has prompted mass evacuations in coastal areas and is forecast to be one of the strongest hurricanes to hit the area in years.

"This will likely be the storm of a lifetime for portions of the Carolina coast," the National Weather Service spokesperson in Wilmington, North Carolina, said late Tuesday night. "I can't emphasize enough the potential for unbelievable damage from wind, storm surge, and inland flooding with this storm."

For those out of the path of the storm looking to help those impacted, it can be difficult to navigate the slew of humanitarian organizations and charity networks out there that are promising relief and aid for those impacted by the storm. Below is a roundup of all of the organizations that have been approved by the nonprofit group Charity Navigator as highly-rated organizations that are currently responding to areas affected by Florence.

The American Red Cross

The American Red Cross has already mobilized more than 1,500 disaster workers to aid in the relief efforts as residents hunker down or flee ahead of Florence. The American Red Cross is currently taking donations to aid in their response efforts -- specifically for those affected by Florence -- here.


The health-focused disaster relief organization, Americares has already deployed a response team to North Carolina ahead of Florence.

“The storm is on track to make a direct hit on the East Coast and impact much of the southern United States in the coming days,” Americares Director of Emergency Response Brian Scheel said in a statement Monday. “Our response team has been activated and is ready to meet the immediate health needs in affected communities.”

They are currently collecting donations for emergency medicine and other supplies specifically for those impacted by Florence here.

North Carolina Community Foundation

The North Carolina Community Foundation (NCCF) is a local humanitarian organization based in North Carolina that partners with local charities that support the community -- and is still ranked as a highly-rated charity currently providing aid to the Carolinas ahead of Florence.

You can learn more about how to support their relief efforts on the ground on their website.


The nonprofit crowdfunding organization GlobalGiving, which supports grassroots charity projects on the ground in areas affected, has launched a Hurricane Florence relief fund.

The fund will support immediate relief efforts such as food, water, and medicine but also invest in longer-term recovery projects to help residents rebuild their community after the storm recedes.

For animals: American Humane and the Charleston Animal Society

When these storms hit, animals -- especially those in a shelter -- are often extremely vulnerable as residents evacuate. If you are looking to help with the relief efforts for pet shelters, the national nonprofit organization American Human and the local Charleston Animal Society are both highly-rated organizations aiding in the Florence relief efforts specifically for four-legged residents of Virginia and the Carolinas.

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Courtesy Sam Williams(NEW YORK) -- The father of an American woman who was attacked by a giraffe on a wildlife reserve in South Africa last week has told ABC News that both his daughter, Katy Williams, and her 3-year-old son, Finn, are recovering well.

Jack Standish said he is relieved that Finn could be taken off a ventilator on Thursday, as it indicates the boy’s condition is improving. The boy is still being sedated.

Dr. Steve Ponde, Finn’s pediatric pulmonologist, said Katy Williams is being kept updated on her son’s condition, and was visibly relieved by the news of his recovery.

Dr. Coceka Mfundisi, the neurosurgeon involved in both the mother and son’s treatment, said Finn will have to undergo further surgeries later in his life, but they will only be cosmetic in nature to repair the damage to the boy’s head. Mfundisi said the child sustained a brain injury during the attack, but she doesn’t expect any long-term effects from that injury.

"I'm pleasantly surprised on how well they have both done, considering their injuries," Dr. Mfundisi told ABC News.

Standish was full of praise for the medical team treating his daughter and grandson, saying he is grateful that they saved his family. He also praised his son-in-law, Dr. Sam Williams, who witnessed the attack and drove off the giraffe.

"While they were under sedation, I sat by their side holding their hands, reading their favorite books and talking to them for hours," Sam Williams told ABC News. "Since family and friends arrived, we have been taking turns to be at their bedsides. I was so happy when Katy regained consciousness, and I could tell her how well she and Finn were doing under circumstances."

Standish said neither he nor Sam would want anything to happen to the animal, as the giraffe did what any wild animal would do when fearing their offspring are in danger. The female giraffe, which was with a 2-month-old calf, is believed to have attacked the young mom and her son because she felt threatened when they surprised her.

The Williams couple are both nature scientists, and Standish said that even though his daughter cannot speak yet, he has no doubt she would be distraught if anything happened to the animal as a result of the attack.

Standish also thanked thousands of well-wishers across the world, who he said have been praying and sending messages of support. He has requested that anyone who wants to contribute to the family’s mounting expenses donate to the family’s GoFundMe campaign.

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iStock/Thinkstock (WASHINGTON) -- The use of e-cigarettes has become an "epidemic” among children, according to the U.S. Food and Drug Administration, which said it is taking the most aggressive steps in the history of the agency to slow the rate at which young people become addicted to the product.

Fines and warning letters have been issued to e-cigarette retailers after the FDA found them unlawfully selling e-cigarette products to minors, including the popular brand Juul, the FDA announced Wednesday.

FDA Commissioner Scott Gottlieb said the agency recently received data confirming that more and more young people, even high school students, are using and becoming addicted to nicotine through e-cigarettes. The rate at which teenagers have become addicted to nicotine from e-cigarettes is alarming, he added.

"We're seeing an acceleration in the use of the cigarettes to levels that simply aren't tolerable,” Gottlieb told ABC News.

“We have access to data that tells us that the growth in youth use of the cigarettes has reached what I'm calling epidemic proportions and we need to step in and take action to try to stem that use to try to bring the rates of use among young people down, particularly high school students.”

The government targeted the retailers as a result of an "undercover blitz" of both physical stores and online retailers, the FDA said, adding that more than 1,100 warning letters and 131 fines were issued.

The agency is worried an entire generation of young people will be addicted to nicotine from using e-cigarette products, Gottlieb said.

Many e-cigarette products like Juul are intended to help adults move from traditional cigarettes to e-cigarettes that don't have some of the health risks like lung cancer that come with burning tobacco. But nicotine is not a benign substance and can have detrimental effects on a developing brain, Gottlieb said, adding that young people addicted to nicotine can also transition to smoking traditional cigarettes.

Because of that public health risk, Gottlieb said, the FDA is willing to take aggressive action such as pulling flavored liquid tobacco off the market or requiring manufacturers to limit the amount of nicotine to make it less addictive, even if that means fewer products are available for adults.

"We think these cigarettes can offer a potentially less harmful alternative for adult smokers so we don't want to see these products eliminated from the market,” he said. “But the availability of these products for the adults cannot come at the expense of hooking a whole generation of young people on e-cigarettes.

“And if we have to narrow the off-ramp for adults in order to close the on-ramps for kids, that's a step we're prepared to take.”

Health and Human Services Secretary Alex Azar Wednesday released a statement in support of the decision.

"No child should be using any tobacco or nicotine-containing product," Azar said in a statement.

"We commend the FDA for the critical, immediate and historic action to address the sale and marketing of these products to kids, while it examines additional aggressive steps to stem the troubling trend of their use among youth," the statement reads.

Gottlieb said he has been warning e-cigarette companies for more than a year that the government had become concerned that too many young people were using their products but that the industry's response has not done enough to discourage the trend.

"Regardless of what steps they've been taking, the fact remains that the use is continuing to rise,” he said. “It's reached proportions that we are calling an epidemic among teenagers. And so whatever steps they've taken to date hasn't been sufficient to try to stem that growth.”

Juul, one of the most popular manufacturers of liquid tobacco, said in a statement it is committed to working with FDA to prevent teens from using its product, including looking at restricting the available flavors.

"Our mission is to improve the lives of adult smokers by providing them with a true alternative to combustible cigarettes. Appropriate flavors play an important role in helping adult smokers switch. By working together, we believe we can help adult smokers while preventing access to minors, and we will continue to engage with the FDA to fulfill our mission," Juul Chief Executive Officer Kevin Burns said in the statement.

In addition to taking actions to enforce laws about selling tobacco to minors and pursuing new regulations on e-cigarettes, the FDA is launching a campaign to educate young people about the risks associated with nicotine.

It will be the first time the FDA launches a campaign specifically targeted at teenagers, Gottlieb said, including placing information in school bathrooms.

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iStock/Thinkstock(LONDON) -- A British runner is adding a level to what it means to be a supermom after she stopped during a 106-mile race to breastfeed her baby.

Sophie Power of London recently ran the Ultra-Trail Mont Blanc event in the Alps between France, Italy and Switzerland. Sixteen hours in, the 36-year-old mom of two stopped to nurse her 3-month-old son, Cormac. The moment was caught in a much-discussed photo.

"It was very much a picture of me juggling everything that mothers do and I didn't think anything of it," Power told "Good Morning America" about the image of her breastfeeding.

Power said she stopped at Courmayeur, a town in northern Italy, to feed her child where he was waiting with her husband. Since her body is attuned to Cormac's schedule of eating every three hours, Power said she started by hand-extracting her breastmilk during the ultramarathon.

Later in the event, Power's husband gave her a breast pump and he would bring the milk back to Cormac.

Power, who finished the race in 43 hours and 33 minutes, said she is thrilled the photo of her breastfeeding is inspiring mothers across the globe.

"Now that it's gone viral, for me, it's fantastic that there's a platform for women to speak about the struggles they have of breastfeeding and being a new mom because it's really hard," she explained. "I've had thousands of positive comments."

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iStock/ThinkstockBY: DR. ITALO M. BROWN

(NEW YORK) -- A new study reveals that within the last year, 14 percent of teenagers have attempted suicide at least once. But while that statistic alone is alarming, the research shows there’s an even larger risk if the teen identifies as another gender.

Transgender and nonbinary teens face a higher risk of suicide when compared to others, but it's trans male teens who face the highest risk, reporting, on average, at least one suicide attempt in the last year, according to the study published in Pediatrics.

“There is an urgent need to understand why transgender, female-to-male and nonbinary adolescents report engaging in suicide behavior at higher levels,” says co-author Russell B. Toomey, PhD, in the article.

The new data comes from researchers at the University of Arizona, who analyzed responses to the Profiles of Student Life: Attitudes and Behaviors survey, a 160-item questionnaire from the Search Institute that gauges the development of US children from 11 to 19 years old. The survey, given to middle and high school students, asks students a range of questions, including some about suicidal thoughts ("Have you ever tried to kill yourself?"). Other questions gather information about race, gender, parents’ education level and the kind of environment the teens live in.

Previous studies on adults indicate that gender discrimination has a great effect on transgender men and women, but there has been little information about teens. For teens, stigmatization and feeling isolated from others might have an even greater impact, considering that students in this age group often want to fit in with and be valued by their peers more.

Between 2012 and 2015, over 120,000 teens filled out the survey. Until now, no other study has directly asked about suicide risk and gender identity. There were six categories: “male,” “female,” “male-to-female transgender,” “female-to-male transgender,” “not exclusively male or female” and “unsure,” which they called “questioning."

Only 202 teens identified themselves as transgender — less than 1 percent. However, one of every two female-to-male transgender teens in the study reported a suicide attempt in the past year. The next greatest risk was seen in those who identified as nonbinary, or not identifying as either male or female — about 42 percent reported some kind of self-harm within the past year. Male-to-female transgender adolescents (30 percent of the 202) and “questioning” adolescents (27.9 percent) also reported suicidal behaviors at an elevated rate.

By comparison, fewer than one in 10 cisgender males reported suicidal behaviors within that same year, while about 17 percent of cisgender females reported the same. That’s far fewer than in transgender teens, marking a clear difference in suicide risk.

This study adds to a growing mental health dialogue surrounding gender identity and suicidality in young adults and calls for further research to be done, especially on transgender adolescents. Based on the findings, suicide prevention and intervention efforts should consider transgender teens and develop strategies to help them.

Dr. Italo M. Brown is an Emergency Medicine Physician and writer with the ABC News Medical Unit.

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FDA(NEW YORK) -- Large, cage-free eggs from an Alabama farm are being recalled due to a potential contamination of salmonella after at least 14 people reported feeling ill in a multistate outbreak, according to U.S. officials.

"Reported illnesses were confirmed at locations using Gravel Ridge Farm Eggs," the U.S. Food and Drug Administration (FDA) said in a release Saturday. "We are voluntarily recalling out of an abundance of caution."

Gravel Ridge Farms, located in Cullman, Alabama, learned of the salmonella risk on Thursday, the FDA said.

The affected products are large, cage-free eggs either in single dozen cardboard containers or 2.5 dozen flat containers with a UPC of 7-06970-38444-6 and use-by dates of July 25, 2018, through Oct. 3, 2018, the agency said.

The eggs were sold primarily in restaurants and retail stores in Alabama and Georgia as well as restaurants in Tennessee, according to Gravel Ridge Farms co-owner Dustin Smith.

The Cullman farm was a small operation and had just sold eggs, Smith told ABC News on Tuesday.

"Consumers who have purchased these products can return to [the] store for [a] refund or discard the product immediately," the FDA said. "If any consumers have Gravel Ridge Farms eggs in their refrigerator, they should be discarded, regardless of the date stamped on the package."

The company stopped the production and distribution of the eggs as an investigation continued into what had caused the problem, Smith said.

“We may very well be out of business,” he said Tuesday.

Illnesses started on dates ranging from July 10 to Aug. 7, the U.S. Centers for Disease Control and Prevention (CDC) said, and sick people ranged in age from 1 to 94.

Two people were hospitalized but no deaths had been reported, according to the CDC.

Click here for an FDA list of stores that carry the product.

The 14 people had been infected with salmonella in two states since Friday and the agency also stated that evidence indicated shell eggs from Gravel Ridge Farms were likely the source of the outbreak, the CDC said.

"In interviews, ill people answered questions about the foods they ate and other exposures in the week before they became ill," the CDC said. "Thirteen of 14 people interviewed reported eating restaurant dishes made with eggs. ... These restaurants reported using shell eggs in the dishes eaten by ill people."

The FDA and state partners traced the source of the shell eggs supplied to these restaurants to Gravel Ridge Farms.

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iStock/Thinkstock(MANCHESTER, N.H.) -- While New Hampshire voters are traditionally animated and vocal during campaign season, one issue this year leaves many of them virtually speechless: the opioid crisis.

The state is one of the nation's hardest hit by a spiraling American epidemic of narcotic addiction.

In recent ABC News interviews with potential voters in New Hampshire's 1st Congressional District, they appeared to be passionate about wanting candidates who would be aggressive in dealing with the student loan issue, health care and would work to ensure that small business owners benefit from the booming economy.

But while the opioid crisis was not the first -- or second -- topic that many of those interviewed volunteered as being a top priority, each time a potential voter was asked about the pervasive problem, his or her face grew visibly somber, a seeming combination of resignation and heartbreak.

“It’s a tragic state of affairs in New Hampshire right now,” Nick Gray, a small-business worker said. “I don’t think you can go anywhere in New Hampshire or spend any amount of time here without knowing someone that’s been impacted by the opioid crisis.”

The opioid crisis is a “perfect storm of a number of factors that have made New Hampshire and some of the other New England states really ground zero in a way,” said Tym Rourke of the New Hampshire Charitable Foundation.

Those interviewed were also largely uniform in the belief that combating the opioid crisis must be a bipartisan effort with one common goal: to save fellow Americans from this often fatal addiction.

“It’s a real problem and I think it needs to be addressed by both parties,” Saint Anselm College senior Karoline Leavitt told ABC News. “I think it should absolutely be a bipartisan effort.”

Nick Gray has seen three friends he grew up with die from opioid overdoses, all within the last five years. Leavitt said she knew at least six people who overdosed and died. She said her two older brothers knew even more.

“They were people you would not necessarily believe to be predisposed to that kind of addiction,” Gray added.

Gray believes it is both an immigration and cultural problem. Nevertheless, he said no set amount of money will fix the issue.

“The reality is that when we have underprivileged illegal immigrants flowing across our border, there’s also going to be drugs coming with them,” he said.

Culturally, Gray says it is about having more awareness in the local communities and having a “value set” in children.

Leavitt said the crisis is far from an immigration problem.

“The fact of the matter is, it’s available, it’s around, and it’s cheap,” she said. “And that’s why people are doing it -- because they’re addicted to drugs. They just want to get high, and they are broke because they’re in college.”

Dean Lemire has been sober for six years. His addiction began when he was just 14. He struggled with alcohol and later tried to quit by booze by using heroin. Every day for two years, he injected heroin. In his late 20s, he reached out to a relative for help and thought about suicide.

Lemire ended up in a total abstinence treatment center, got clean and sober, and entered the world of advocacy. He and some of his fellow recovering addicts created a peer-driven organization and sought state funds for recovery programs.

There is a dire need, Lemire said, for a multiplicity of harm reduction programs because for many addicts, traditional, 12-step treatment programs that focus on abstinence and a spiritual path to overcoming addiction is no longer enough.

“There’s a need for a shift in understanding around how best to care for people who have addictions and how fast do you approach them and what kind of implications that approach has for the services that we have to invest in New Hampshire,” he said.

“The opportunity right now and the need for those contemplating office is to keep the long game in mind,” Rourke told ABC. He was firm in his stance that there has to be an understanding that temporary resources will not solve the long-term problem.

“There is an imperative to do better for people who are looking for recovery,” he said. “The recovery community has a voice that they’ve never had before.”

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Courtesy Jeff Flynn(NEW YORK) -- Jeff Flynn had no idea men could get breast cancer, so “I ignored the symptoms,” he said of a disease commonly associated with women.

But the “dreaded” diagnosis came in 2011, 10 years after the then-strategic account manager for EMC Corp., a data storage company, had worked recovering business accounts for his company in the wake of the Sept. 11, 2001, World Trade Center attacks.

“That required me to be on site,” Flynn, 65, told ABC News, adding that he toiled in lower Manhattan for six months.

“The pile burned for 99 days. For 99 days there was still soot, ash and that burning smell in the air. I certainly breathed toxic air and fumes, dust and smoke in the downtown area.”

Flynn is now among at least 20 men, all represented by the New York law firm of Barasch & McGarry, who say they are struggling with this relatively rare form of cancer as a result of their proximity to Ground Zero.

While there is no proven medical link between incidences of male breast cancer and 9/11 fallout, a surgeon told ABC News, there is “potentially a link to environmental factors.”

“Were there higher levels of radiation during that time period or was there something more pronounced in the air?” Dr. Roshni Rao, chief of the breast surgery program at New York-Presbyterian/Columbia University Medical Center in New York City, told ABC News. “I don’t think they’ve gotten to the bottom of that. From the data I have seen, it’s well within the realm of possibility but not definitely linked.”

Of the 20 male breast cancer victims represented by Barasch & McGarry, more than half have received financial awards from the September 11th Victim Compensation Fund, according to the firm.

That federal program was established by the James Zadroga 9/11 Health and Compensation Act of 2010 to provide medical monitoring and treatment for WTC responders. To qualify, a patient has to certify a link between their cancer and 9/11 before an award is granted.

“Buildings [that] were insulated with asbestos were on fire for 99 days,” attorney Michael Barasch said. “The concrete dust alone had the same pH level [toxicity] as Drano, so it’s no surprise we’re seeing these incredibly rare cancers.”

Risk is smaller than mortality rates

Dr. Jennifer Ashton, ABC News' chief health and medical correspondent, emphasized that “we need to remember men have breasts too and, as such, they also get breast cancer. While it is much less common in men, it does occur and often carries a difficult stigma for men that they are battling a ‘woman’s disease.’

“It serves as a reminder for all of us to not gender-stereotype diseases or conditions in medicine.”

An estimated 400,000 first responders, residents, workers and others were exposed to the caustic dust and toxic pollutants in the dust and debris cloud from the collapse of the WTC buildings in 2001, according to the Centers for Disease Control and Prevention (CDC). They were responders and those who lived, worked and studied nearby.

All told, 15 to 23 men with breast cancer had been certified by the WTC Health Program as of July 31, 2018, according to the CDC.

Dr. Kristi Funk, who was Angelina Jolie’s breast cancer surgeon, said in general, “male breast cancer accounts for approximately 0.8 percent of all breast cancer cases; about 2,470 men annually.”

“In American men, the lifetime risk of breast cancer approaches 1.3 in 100,000. This means women are 120 times more likely to get this disease.”

But because men like Flynn don’t even recognize male breast cancer as a possibility, “their diagnoses usually come at later stages, increasing overall mortality rates,” she added.

Flynn, who first spoke to the New York Post, told ABC News he was 48 in 2001 when he agreed to work downtown because “we were told the air was safe by the environmental protection agency. [Then-Environmental Protection Administrator] Christine Todd Whitman had put out a public notification that the air downtown was safe to breathe and my company put a notification, email out that the air was safe to breathe.”

“[His employer] EMC didn’t have anyone monitoring the air; they took that from the government,” the East Meadow, Long Island, man said. “So, I trusted them.”

Some of his colleagues did not and refused to go downtown. “At least one employee told me, ‘I’ll go down if you buy me a mask.’ I did but he still refused to go downtown. In hindsight, he was smarter than I was. At the time I didn’t appreciate it,” he said softly.

Flynn was diagnosed with breast cancer in September of 2011. That was a year after his first symptom, which he noticed while lifting up his dog, who bumped into his chest and triggered pain.

He felt a bump, he said, but thought it was a gland or cyst. “I didn’t know that a male could get breast cancer. So, I ignored the symptoms,” he said, adding that the pain subsided and the lump flattened out a little.

A lump that doesn't hurt

Dr. Rao, the chief of breast surgery at New York-Presbyterian/Columbia University Medical Center, said the first sign of breast cancer in men is, typically, “a lump that doesn’t hurt.”

A few months later, Flynn said, he and his wife took a beach trip to Florida, where she noticed that his left nipple was inverting. A sunken nipple that is getting flatter or inverting (retracting inward) is one of the breast cancer signs men should watch out for, according to Dr. Funk, Jolie’s surgeon.

Flynn underwent a needle biopsy and, three days later, received the “dreaded call” from his doctor that the cells tested positive for breast cancer.

He was diagnosed with Stage 3C breast cancer, which ultimately spread through his lymph nodes to reach Stage 4 metastatic breast cancer.

“It was devastating. The testing for this is brutal,” he recalled. “Right now, I’m cancer free but have to stay on drugs for the rest of my life.”

With his soaring medical bills, he was advised to apply to the Victim Compensation Fund (VCF). “I did not know how to apply and deal with all the questions and so, since the law firms are only allowed to take 10 percent of the fee, I contacted Michael Barasch” at the advice of a friend, he said of the lawyer. There is no lawsuit involved.

In February 2018, Flynn said, he got a “six-figure award” from the VCF. “Getting that award and the coverage for my medical bills is life-changing,” he said. “I swore if I survived this, I would help others by raising awareness and supporting other men.”

He did the right thing

Michael Guedes, 65, is another breast cancer victim and Barasch client.

He was an NYPD sergeant out of the 40th Precinct detective squad in the Bronx when the planes hit. He and fellow officers deployed downtown in school buses.

Close to a year after the attack, Guedes spent his time either at a nearby landfill where the debris was dumped or the temporary morgue at Ground Zero.

“The debris and everything that came from Ground Zero was taken to Staten Island landfill. We would take the debris and spread it,” he said. “If we recovered body parts or personal possessions, we would hand them in for identification.”

Guedes retired in January 2003 after 20 years of service and moved to Florida. In late-April 2015, his girlfriend, Maria Rodriguez, felt a lump on his right breast.

She had just checked herself and decided to examine him. Guedes followed his girlfriend’s advice and went to his primary-care physician, who referred him to a surgeon. His biopsy came back positive for breast cancer.

He had his breast removed and was put on chemo for six months, followed by radiation. He is now on the drug Tamoxifen, an estrogen receptor modulator, which he has to take daily for five to 10 years.

“Right now, I’m in remission. You’re not cancer free until you hit the five-year mark. I’m under 3.5 years,” he said. “I’m hoping for the best. I have no history of breast cancer in my family.”

Guedes did exactly what Dr. Rao recommends when they feel or see a lump. “Because the incidence of breast cancer is so low,” she said, “we are not routinely recommending that men get mammograms. But if they feel something it is important; they should be evaluated by their physician. Don’t ignore it.”

Guedes also took someone’s advice and signed up for the World Trade Center Health Program when he was still on the force.

The federal government set up the program to help people with health problems related to the attacks and to pay for the cost of their care.

Only 80,000 people have registered with the program for screening and care out of the 400,000 who were exposed.

Dr. Gaetane Michaud, who is the chief of interventional pulmonology at NYU Langone’s Perlmutter Cancer Center, says some “people don’t know they are eligible and some people have left the state,” adding that “people were very young at the time and may not have had any risks manifest and are unaware of their potential risk.”

Guedes, with the help of attorney Barasch, also filed with the Victim Compensation Fund for medical coverage and was compensated in 2016.

As of August 31, the Victim compensation Fund had 20,874 claimants eligible for compensation. The VCF has made initial award determinations on 19,204 of those claims and has issued revised awards on 5,011 claims because of an amendment or appeal. The total amount awarded to date is more than $4.3 billion.

'We’re the forgotten people'

John Mormando was 34 when the towers came down. “I was home with my son because my wife was on a trip,” he recalled. “I was working at the New York Mercantile Exchange. I was home for a week in the aftermath but the next week they decided to open up the exchange. We came back with much fanfare. We were the first business to open in the Ground Zero area.

“We had Mayor [Rudy] Giuliani, Senator Hilary Clinton, Governor [George] Pataki and EPA Administrator Christine Todd Whitman.”

Mormando, like others, was told it was OK to go return. “They handed us little surgical masks like that was going to help anything,” he recalled. “They called us all heroes. We ate it up and went back to work.

The New Jersey resident did not exhibit any symptoms for years. He became an endurance athlete. He ran the Iron Man triathlon in September 2017 followed by the NYC Marathon in November.

But then he felt a painless bump in his chest in March of 2018. His went to his doctor and got a biopsy on March 19. Four days later, he learned he has an invasive ductal carcinoma, a form of breast cancer.

He had surgery at NYU Langone where his breast surgeon removed his right breast.

His surgeon also did a breast reduction on the left side just to balance things out visually. That’s when he was diagnosed with an undetected cancer tumor in his left breast.

“Not only is it rare for a man to get breast cancer, it is even more rare for a man to get bilateral breast cancer,” he said.

They also found cancer in six of his lymph nodes, which resulted in his doing chemotherapy and radiation at Memorial Sloan-Kettering Cancer Center (MSK Bergen), which is close to his home in New Jersey.

When Mormando found out he had cancer, he confided in a friend who told him that he had an autoimmune disease that he contracted from 9/11 toxin exposure. His friend connected Mormando with lawyer Barasch.

“I was unaware that this exposure affected people other than the first responders,” he said. “We’re the forgotten people. There are people who worked down there. There are students who studied there. I have not been compensated as of yet.”

He added: “The compensation that they’re giving out is not life-changing money at all. When you look at what we’ve gone through, the compensation is really nothing,” he said.

“I’m speaking out because I want people to be aware that men can get breast cancer. If you feel a lump on your chest, don’t blow it off. Go get yourself checked out. The quicker you find out, the easier it is to save your life. If you worked or lived near Ground Zero, you are more at risk.”

If you believe you may be at risk from exposure after the Sept. 11 attacks, go to to apply for free screening.

Copyright © 2018, ABC Radio. All rights reserved.


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K. Levis(NEW YORK) -- When Kristina Wong’s mother told her if anyone finds out she went to therapy she would never be able to get a job, it became crystal clear just how taboo discussions of mental health were in her family.

“That made it clear that my joy had a monetary value, and it was that shameful to go about seeking help or even talking to someone about your problems,” Wong, a third-generation Chinese-American, told GMA.

That mentality reflects a broader sentiment within the Asian American community.

While Asian-Americans have a lower reported rate of psychiatric disorders and suicide compared to Caucasians within the U.S., they are three times less likely to seek mental health help, according to the data collected by the National Latino and Asian American Study.

There are a number of reasons why, according to experts. Discussing mental health concerns is “taboo” in a variety of Asian-American communities where seeking help is stigmatized, explained Koko Nishi, a licensed psychologist on the counseling staff at San Diego State University. As a result, many Asian Americans often dismiss, deny or neglect their symptoms.

The idea that a person can be hampered by something that can’t be seen by the naked eye is unacceptable in some Asian cultures, Nishi said.

“There’s a lot of shame involved,” especially among elderly Asian-Americans who are afraid of losing face, said Wesley Mukoyama, a clinical social worker and former director for Yu Ai Kai, a senior center for Japanese-Americans.

Even though Asian-Americans, who came as immigrants and refugees and are at higher risk of depression and suicide due to trauma from their past, when they do seek help, they often report the physical symptoms that are results of psychological problems, according to Nishi.

That’s why organizations like Yu Ai Kai focus on less traditional treatments, ones that don’t require residents to directly address their feelings, Mukoyama said.

With 59 percent of all Asian-Americans born in a different country, according to Pew, language barriers, cultural stigma and lack of understanding of mental health resources are factors that contribute to the issue as well.

Many come from countries without accessible mental health care and in certain cultures some of the terms for mental health don’t even exist in the language, said Nishi.

There is a word, however, for shame in the Filipino language called “hiya.”

It’s a “particular kind of shame” when one has failed to live a “happy and harmonious life” that is in conjunction with society’s norms and expectations, Tess Paras, a Filipino-American actress and writer, told “Good Morning America.”

3 Asian-American women share their stories to combat stigma

Years ago, Paras said she was in an emotionally and physically abusive relationship and was sexually assaulted, leading to depression and symptoms of post-traumatic stress disorder. Paras said she felt more comfortable calling friends, or a crisis hotline, than she did approaching her own parents, who emigrated from the Philippines.

“I remember my parents saying, ‘We know you need to go to therapy. We will pay for it, but we’re not comfortable talking about it at home,’” Paras recalled.

There is a deafening silence in her family surrounding the subject of mental health.

It’s a silence Emily Wu Truong also knew all too well.

Growing up, Truong, a Taiwanese-American, started to experience feelings of depression and isolation when her family moved from Arkansas to California. She wasn’t able to articulate her feelings as she was taught sharing problems will bring shame to oneself and one’s family.

Throughout the years, she continued to keep her struggles and emotions bottled up well into adulthood.

At one point, Truong said she told her family she wanted to end her life, but her family told her that she “was selfish for thinking that way.”

Truong was eventually diagnosed with depression and anxiety, and in 2013 she had a mental breakdown. After finally finding a center offering affordable therapy options, she began to work with organizations like the National Alliance on Mental Illness, Recovery International and Each Mind Matters as a public speaker to raise awareness.

For Wong, she first started feeling depressed when she was pressured to excel in Chinese school and carried guilt because she couldn’t communicate with her grandparents.

Her grandparents, who supported her family, spent all their time working in a butcher shop and raised the family to deal with things “by not talking about it,” she said.

She hid her feelings from her family for years before seeking out a therapist, all the while isolating herself from her Chinese-American community because people shunned talk about anything that might be perceived as weakness.

Shining a light on mental health in their own ways

Now as a comedian and performance artist, Wong decided to take mental health right to the stage.

In her one woman comedy show, “Wong Flew over the Cuckoo’s Nest,” which she toured for eight years, Wong explored the high rates of depression and suicide among Asian-American women.

In the show, Wong used the “dramatic arc of fiction” to point out the danger in the fictional narrative Asian American women are fed about what their lives are supposed to look like. After her character failed to save these women, she has a mental breakdown on stage.

Paras also dove into her experience with mental health, but through a different comedic vehicle - music.

After Paras ended a relationship with someone who was also going through depression, one of her writing partners from Quick and Funny Musicals suggested using her breakup as inspiration for their new music video, which had to be “Frozen”-themed.

In the video, they said they tried to make fun of certain aspects of depression “in order to have a laugh” and open up a conversation, Paras said.

“It really means a lot when I post this video then I get some Filipina teens who are experiencing this and saying ‘I needed this’ I’m not able to talk about this at home either,’” Paras recalled.

Wong recounted similar responses to her show when people who have also struggled with depression and attempts at suicide reached out to her.

“I was just like, 'where were you when I was in high school?' Where were any of us? Why do we have to sit on our pain and try to save face?” Wong exclaimed.

A reason why many Asian-Americans feel the need to “save face” and avoid confronting their mental illness is possibly due in part to the misperception that Asian-Americans do not have such needs, Nishi told “Good Morning America” -- a fallacy fueled by the model minority myth.

It’s a myth that perpetuates the image that Asian-Americans represent the positive qualities that all immigrants or minorities should have in order to assimilate.

Having lived the unrealistic social and familial expectations, Paras is well aware of the stereotype.

“Asian America is not a monolithic thing -- it’s filled with all kinds of nuanced experiences and stories that are not widely represented, and mental health is a huge part of that.”

And that’s why Truong, who often dresses head-to-toe in lime green, a color for mental health awareness, works hard to dismantle those myths.

Over the past five years, Truong has spoken in numerous venues and at events, helped facilitate mental health programs and last year pushed to establish May 10 as as Asian Pacific American Mental Health Day in Los Angeles County.

She saw this being done in other cities and by asking for recognition in her own community she hoped to shine a light on people’s struggles but more importantly their resilience.

“I want to share my story and let people know they’re not alone,” Truong said.

Through her experience working at various colleges, Nishi has seen a shift towards awareness of mental health resources among young Asian-Americans. She also noticed many students “are going against the grain of what they were taught growing up about mental wellness” and are focusing more on self-care.

Being able to talk about these issues is the first step, Paras said, as she and others like Wong and Truong continue to incorporate their stories in their creative work to bring awareness and combat stigma surrounding mental health.

“The more we talk about this issue the more we can normalize this topic the more we talk about it then it’s not such a scary topic to talk about,” Truong said.

Copyright © 2018, ABC Radio. All rights reserved.


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(NEW YORK) -- Can a blood test tell what time it is in your body? Scientists at Northwestern University think so.

In a study published Monday in the medical journal PNAS, researchers reveal that they have invented a new computer algorithm called “TimeSignature” that uses blood sample data to predict someone’s circadian rhythm.

Circadian rhythms are a major area of research in the medical field. Scientists believe someone’s internal clock is a key to figuring out how their body works. The clock can direct hormone release, dictate when someone will feel fatigue, and help control daily changes in body temperature. Disruption of a normal rhythm may be a factor in many diseases: insomnia, heart disease, and even neurological disorders like dementia have all been linked to a misaligned circadian rhythm.

“Before we didn’t have a clinically feasible way of assessing the clock in healthy people and people with disease. Now we can see if a disrupted clock correlates with various diseases and, more importantly, if it can predict who is going to get sick,” said the study’s coauthor Ravi Allada, a professor of neurobiology at Northwestern University, in a statement.

TimeSignature was created using machine learning-based methods that looked at real-world data from hundreds of blood samples from about 25 people. Artificial intelligence software took that data and found patterns to identify internal markers that best corresponded to a person’s physiological time.

Physicians currently have no way of measuring a patient’s internal clock. Models have been proposed, but none currently could be used in a doctor’s office or hospital, and some models have only been tested on animals. Bioclock, for example, a program that incorporates machine learning to predict internal time, has only been applied to data from mice. Molecular Timetable, another algorithm, demonstrated poor results in humans. Others are impractical, requiring frequent blood tests throughout the day.

TimeSignature was tested exclusively in humans, and would only require two blood tests spaced 10 to 12 hours apart. In order to get a fix on a person’s circadian rhythm, the algorithm first studied an array of over 7,000 genes, looking at their peak expressions at different times of the day. From these genes, TimeSignature found 40 that best went along with a person’s circadian rhythm. It was able to predict the time of day based on how strongly those genes were expressed, comparing it with the actual time the patient's blood sample was taken. In tests of about 50 more patients, TimeSignature outperformed all other internal clock models. After taking the blood test, the artificial intelligence program could predict what the patient's personal circadian time was to within two hours.

If TimeSignature works as well as they believe, physicians could know “what time it is” within someone’s circadian rhythm, and use it to examine the impact of a disrupted "clock" on various diseases. The algorithm could also be used to guide when medications should be taken – they may be more effective at certain times.

“Knowing what time it is in your body is crucial to getting the most effective benefits. The best time for you to take the blood pressure drug or the chemotherapy or radiation may be different from somebody else,” Dr. Phyllis Zee, coauthor of the study and chief of sleep medicine in neurology at Northwestern, said in a statement.

TimeSignature won’t be used in the doctors’ offices anytime soon, but the algorithm marks an important step in the field. The software is available for researchers to use for free, and Northwestern has filed for a patent on the blood test itself, which measures the genes expressed at the time of the blood draw.

In the future, if doctors can schedule their treatment around a patient’s internal clock, medical care might improve.

Dr. Jonathan Steinman is a radiology physician and writer with the ABC News Medical Unit.

Copyright © 2018, ABC Radio. All rights reserved.


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(NEW YORK) -- Talking to children when they're tiny doesn't just teach them speech -- early conversation is linked to better language skills and higher IQ scores when they get to school, according to a new study published today in the Journal of Pediatrics.

“By showing that parent-child verbal interactions in early childhood predict critically important outcomes ... the authors of this study have made a major contribution to this topic,” said pediatricians Dr. Alan Mendelsohn and Dr. Perri Klass -- who were not involved in the study -- in an attached commentary.

The team of researchers began with children 18-months-old to two-years-old, recording -- both the words the children heard from adults, and their adult-child conversations -- once a month, for a total of six months. Researchers then brought children back for language and cognitive testing when they were nine to 14-years-old.

The children who had taken more "turns" speaking when talking back and forth with adults had an average of 14 to 27 percent higher performance on IQ tests, verbal comprehension, and receptive and expressive vocabulary scores, according to the study, which controlled for socioeconomic factors.

“Programs seeking to foster language skills in young children should pay careful attention...promotion of language-rich and emotionally positive interactions should be the goal, with play and reading aloud offering contexts for parents to provide not only enriched vocabulary, but also...enriched interactions,” Mendelsohn and Klass said in the commentary.

Both the quantity and quality of language are known to affect the future language and mental development of children.

In a recent short term study, children who took more turns in back-and-forth conversation with their parents had stronger connections between the brain regions responsible for comprehension and production of speech, and also scored higher on verbal skills tests.

In a well-known 1990 study, researchers showed that by the time children from higher socioeconomic backgrounds reach school age, they are exposed to -- on average -- 30 million more words than children growing up in poorer families. This became known in the medical community as the “word gap,” and since then, many policies and interventions have been focused on the quantity of words a child hears.

But the word gap might be too simple an explanation for vocabulary differences, said Dr. Rachel Romeo, a postdoctoral research fellow in translational neurodevelopment at Massachusetts Institute of Technology and Boston's Children's Hospital, who was not involved in the study. In a recent interview with ABC News, she said her team and others are part of a movement to emphasize the importance of word quality -- not just quantity.

“When you engage children in conversation, you can target language for their appropriate level of development," she said. "They’re getting that optimal feedback,” Romeo said.

Copyright © 2018, ABC Radio. All rights reserved.


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iStock/ThinkstockBy DR. NICKY MEHTANI

(NEW YORK) -- The Trump administration early this year started allowing states to require that their Medicaid beneficiaries work and, to date, 11 states have applied for waivers to set such work rules.

Medicaid work requirements could promote “better mental, physical and emotional health” and “help individuals and families rise out of poverty and attain independence,” Brian Neale, a top Medicaid official for the administration who has since left his post, wrote in a letter to state directors of the health program.

But two new studies published today in JAMA Internal Medicine question the effectiveness of and rationale for such work requirements, finding that the vast majority of Medicaid recipients already work or would be exempt for reasons such as pregnancy or disability. Because only a small number of beneficiaries would be affected, budgetary savings through any reduction in the rolls would be minimal.

"Medicaid work requirements are out of step with the lived experiences of low-income people ... [and] represent a case of policymaking gone astray, causing more harm than good," wrote Dave Chokshi, a professor of population health at New York University, and Mitchell Katz, deputy editor of JAMA Internal Medicine, in a commentary accompanying the two studies.

One of the studies, led by David M. Silvestri of the Yale School of Medicine, used data on household income, employment and utilization of government assistance programs from the U.S. Census to determine the number of people who would be subject to the new work requirements in each of the 11 states that applied for federal waivers. They found that only between 0.3 percent and 5.4 percent of people who were eligible for Medicaid in these states would be affected -- in large part because so many in the program already work.

The second study, led by Anna L. Goldman of the Cambridge Health Alliance and Harvard’s School of Public Health, estimated changes in Medicaid enrollment and expenditures if the work requirements and the exemptions common to all of the approved state waivers to date (those from Kentucky, Indiana, Arkansas, and New Hampshire) were applied on a national scale.

Kentucky's plan was blocked last month by a federal judge, who called its policies "arbitrary and capricious" and noted that the federal Medicaid office "never adequately considered" whether Kentucky's plan, "would, in fact, help the state furnish medical assistance to its citizens, a central objective of Medicaid." However, this has not seemed to deter the Trump administration in moving ahead with allowing Medicaid work rules around the country.

The Goldman study found that 2.1 million current beneficiaries would be at risk of losing their coverage nationally. This amounts to only 2.8 percent of all people in the program, spending on whom accounts for just 0.7 percent of current Medicaid expenses.

The study's authors cautioned, however, that there could be a substantial "spillover" effect: Medicaid enrollees who fulfill the work requirement or should be legally exempt may lose their coverage due to trouble meeting new documentation rules. This is because in states instituting the work requirements, all Medicaid recipients — even those who already work or qualify for exemptions — will be required to regularly report their work hours or reasons for exemption, sometimes as often as monthly.

"Procedural hurdles to qualifying for health insurance run counter to [the federal Medicaid programs'] stated goal of putting 'Patients Over Paperwork,' with deleterious health effects," Chokshi and Katz wrote in their accompanying commentary.

Chokshi and Katz's commentary also stressed that having health coverage makes it easier for people to find jobs. "Medicaid work requirements largely ignore the effects of expanded health coverage on employment and other determinants of health such as financial protection," they wrote.

"Implementing Medicaid work requirements will likely result in greater administrative expenses, eligible persons losing coverage for failure to complete paperwork, and loss of benefits that support employment," they concluded. "Sound social policy should not seek to draw distinctions among the poor, but rather should seek to lift up all to their highest state of health and well-being."

Dr. Nicky Mehtani is an internal medicine physician at Johns Hopkins Hospital and part of the ABC News Medical Unit

Copyright © 2018, ABC Radio. All rights reserved.


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