Category: Diseases, Injuries, and Dying

Fighting the Crisis of Firearm Injury in Children

In this post I share the White House’s MAHA report which aims to address the childhood chronic disease crisis but omits gun violence. Guns are a leading cause of death among children. Recent studies show that permissive gun laws correlate with increased firearm deaths,. This suggests we need better policies and community interventions to protect youth from this public health emergency.

The objective of the Make America Healthy Again (MAHA) report from the White House is to “turn the tide and better protect our children”. The report goes on to state that it will

“study the scope of the childhood chronic disease crisis and any potential contributing causes, including the American diet, absorption of toxic material, medical treatments, lifestyle, environmental factors, Government policies, food production techniques, electromagnetic radiation, and corporate influence or cronyism;”

President Trump and Secretary Kennedy at the MAHA commission meeting

I have not read the entire report, but by reviewing the table of contents, I see no mention of violence, especially gun violence. Unless it’s implied under “environmental factors”, “Government policies”, or “corporate influence.”

Violence may not technically be a “chronic disease,” but it certainly is chronic in frequency, so I wonder why it’s not mentioned in the MAHA report. The physicians quoted in this story from Oklahoma Voice think it should be, and I agree.

Guns kill more US children than other causes, but state policies can help, study finds

by Nada Hassanein, Oklahoma Voice
June 17, 2025

(reprinted under Creative Commons license)

More American children and teens die from firearms than any other cause, but there are more deaths — and wider racial disparities — in states with more permissive gun policies, according to a new study.

The study, published in the medical journal JAMA Pediatrics last week, analyzes trends in state firearm policies and kids’ deaths since 2010. That’s the time of a landmark U.S. Supreme Court decision in McDonald v. City of Chicago. The ruling struck down the city’s handgun ban, clearing the way for many states to make it easier for people to buy and carry guns.

The study authors split states into three groups: “most permissive,” “permissive” and “strict,” based on the stringency of their firearm policies. Those policies include safe storage laws, background checks and so-called Stand Your Ground laws. The researchers analyzed homicide and suicide rates and the children’s race.

Using statistical methods, the researchers calculated 6,029 excess deaths in the most permissive states between 2011 and 2023, compared with the number of deaths that would have been expected under the states’ pre-McDonald rules. There were 1,424 excess deaths in the states in the middle category.

In total, about 17,000 deaths were expected in the post-decision period, but 23,000 occurred, said lead author Dr. Jeremy Faust, an emergency physician at Brigham and Women’s Hospital in Boston, in an interview.

Among the eight states with the strictest laws, four — California, Maryland, New York and Rhode Island — saw statistically significant decreases in their pediatric firearm death rates.

Illinois, which was directly affected by the court’s decision in the McDonald case, and Connecticut saw increases in their rates. In Massachusetts and New Jersey, the changes were not statistically significant.

The rate increased in all but four (Alaska, Arizona, Nebraska and South Dakota) of the 41 states in the two permissive categories. (Hawaii was not included in the study due its low rates of firearm deaths.)

Non-Hispanic Black children and teens saw the largest increase in firearm deaths in the 41 states with looser gun laws. Those youths’ mortality rates increased, but by a much smaller amount, in the states with strict laws.

Photo by Photo By: Kaboompics.com on Pexels.com

The Power of Gun Violence Policy

Experts say the study underscores the power of policy to help prevent firearm deaths among children and teens. The analysis comes less than a month after the release of a federal report on children’s health.

This report highlighted the drivers of poor health in America’s children but failed to include anything on firearm injuries — the leading cause of death for children and teens in 2020 and 2021, according to the federal Centers for Disease Control and Prevention.

Trauma surgeon Dr. Marie Crandall, chair of surgery at MetroHealth Medical Center and a professor at Case Western Reserve University School of Medicine in Cleveland, researches gun violence. She previously practiced at a Jacksonville, Florida, urban trauma unit, where she frequently saw children and teens caught in gun violence.

“When I see children come in with 10 holes in them that I can’t save — that is a loss. That is a completely preventable death, and it is deeply emotionally scarring to have to have those conversations with families when we know, as a society, there are things we could do to de-escalate,”

Dr. Marie Crandall, trauma surgeon

In her state of Ohio, firearm death rates among children and teens increased from 1.6 per 100,000 kids in the decade before the McDonald decision to 2.8 after it, according to the study. Ohio was categorized in the group with the most permissive laws.

The study adds to previous research that shows state laws around child access to firearms, such as safe storage and background checks, tend to be associated with fewer child firearm deaths.

“We know that child access prevention decreases unintentional injuries and suicides of children. So having your firearms locked, unloaded, stored separately from ammunition, decreases the likelihood of childhood injuries,” Crandall said. “More stringent regulation of those things also decreases childhood injuries.”

But she said it’s hard to be optimistic about more stringent regulation when the current administration dismisses gun violence as a public health emergency. The Trump administration earlier this year took down an advisory from the former U.S. Surgeon General, issued last year, that emphasized gun violence as a public health crisis.

Photo by Anna Shvets on Pexels.com

Gun Violence is a Public Health Issue

Faust, the lead author of the new study, stressed that firearm injuries and deaths were notably missing from the Make America Healthy Again Commission report on children’s health. He said the failure to include them illustrates the politicization of a major public health emergency for America’s kids.

“It’s hard to take them seriously if they’re omitting the leading cause of death,” Faust said. “They’re whiffing, they’re shanking. They’re deciding on a political basis not to do it. I would say by omitting it, they’re politicizing it.”

Dr. Jeremy Faust, Emergency Medicine physician

Faust and pediatric trauma surgeon Dr. Chethan Sathya, who directs the Center for Gun Violence Prevention at the Northwell Health system in New York, each pointed to car seat laws and public health education, as examples of preventive strategies that helped reduce childhood fatalities. They support a similar approach to curbing youth gun deaths.

“We really have to apply a public health framework to this issue, not a political one, and we’ve done that with other issues in the past,” said Sathya, who wasn’t involved in the study and oversees his hospital’s firearm injury prevention programs. “There’s no question that this is a public health issue.”

Politics and Gun Violence

In Louisiana, categorized as one of the 30 most permissive states, the child firearm mortality rate increased from 4.1 per 100,000 kids in the pre-McDonald period to 5.7 after it — the nation’s highest rate. The study period only goes to 2023, but the state last year enacted a permitless carry law, allowing people to carry guns in public without undergoing background checks. And just last month, Louisiana legislators defeated a bill that would have created the crime of improper firearm storage.

Louisiana Democratic state Rep. Matthew Willard, who sponsored the safe storage legislation, said during the floor debate that its purpose was to protect children. Louisiana had the highest rate of unintentional shootings by children between 2015 to 2022, according to the research arm of Everytown for Gun Safety, which advocates for stricter gun access. Willard cited that statistic on the floor.

But Republican opponents said Willard’s proposal would infringe on residents’ gun rights and make it more difficult for them to use guns in self-defense.

“Nobody needs to come in our houses and tell us what to do with our guns. I think this is ridiculous,” Republican Rep. R. Dewith Carrier said during the debate.

Another Republican opponent, state Rep. Troy Romero, said he was concerned that having a firearm locked away would make it harder for an adult to quickly access it.

“If it’s behind a locked drawer, how in the world are you going, at 2 or 3 in the morning, going to be able to protect your family if somebody intrudes or comes into your home?” Romero said.

Gun violence researcher Julia Fleckman, an assistant professor, and her team at Tulane University in New Orleans have started to collect data on the impact of the state’s permitless carry law.

“It places a disproportionate impact on really vulnerable people, really, our most vulnerable people,” Fleckman said, noting kids bear the brunt of legislators’ decisions. “They don’t have a lot of control over this or the decisions we’re making.”

In South Carolina, another of the most permissive states, the mortality rate increased from 2.3 to 3.9 per 100,000 kids in the time before and after the McDonald decision.

South Carolina Democratic state Rep. JA Moore, who lost his adult sister in the 2015 racist shooting that killed nine at a Charleston church, said state policy alone isn’t enough. He implored his colleagues to also examine their perception of guns.

“We have a culture here in South Carolina that doesn’t lend itself to a more safe South Carolina,” said Moore, who advocates for background checks and stricter carry laws. “There is a need for a culture change in our state, in our country, when it comes to guns and our relationships with guns as Americans, realizing that these are deadly weapons.”

And investing in safer neighborhoods is crucial, he said.

“People are hurt by guns in places that they’re more comfortable, like their homes in their own neighborhoods,” he said.

“There is a need for a culture change in our state, in our country, when it comes to guns and our relationships with guns as Americans, realizing that these are deadly weapons.”

State Representative JA Moore

Community Gun Control Efforts

Community-based interventions are important to stemming violence, experts said. Dr. Crandall, Cleveland surgeon, said there’s emerging evidence that hospital-based and community-based violence prevention programs decrease the likelihood of violent and firearm-related injury.

Such programs aim to break cycles of violence by connecting injured patients with community engagement services. After New York City implemented its hospital-based violence interruption program, two-thirds of 3,500 violent trauma patients treated at five hospitals received community prevention services.

After her 33-year-old son was killed in her neighborhood in 2019, Michelle Bell started M-PAC Cleveland — “More Prayer, Activity & Conversation” — a nonprofit collaborative of people who’ve lost loved ones to violent crime. She’s encountered many grieving parents who lost their children to gunfire. The group advocates and educates for safe storage laws and holds peer grief support groups.

She also partners with the school district in a program that shares stories of gun violence’s long-lasting impact on surviving children, families, and communities and non-violent interpersonal conflict resolution.

“Oftentimes, the family that has lost the child, the child’s life has been taken by gun violence, there are other children in the home,” she said.

“It’s so devastating. It’s just so tragic that the No. 1 cause of death for children 18 and under is gun violence,” Bell continued.

The decision to “pull a trigger,” she said, changes a “lifetime of not only yours, but so many other people.”

This story is republished under Creative Commons license CC BY-NC-ND 4.0.

“Oklahoma Voice provides independent, nonpartisan reporting that holds officials accountable and elevates the voices of those too often sidelined by the political process. We’re part of States Newsroom, the nation’s largest state-focused nonprofit news organization.”

Personal Gun Ownership-Right and Responsibility

You may be thinking, what about the Second Amendment to the Constitution, the right to “keep and bear arms”?

I don’t think anyone suggests repealing that amendment, although some may want to. The “arms” and guns available today are far more powerful than those in 1791. Would the authors of the Constitution think citizens need to own and use assault rifles?

If you own or use guns, use them wisely and safely, especially if there is any chance children or teens might have access to them.

Even the NRA, National Rifle Association, has NRA Gun Safety Rules.

At the NRA, firearm education and safety is paramount—that’s why we offer a variety of programs and services to promote the safe handling, use and storage of firearms. Whether you’re a parent in search of information about firearm safety in the home, a first-time gun owner, or an old pro looking to brush up on your firearm handling skills, the NRA is here to keep you and your family safe.

Exploring the HEART of Health

for your consideration
  • How has gun violence touched you and your family?
    • How safe do you feel from the risk of injury from firearms?
  • How does this article change what you already know about gun violence?
  • What else would you like to know about how guns affect the health of our communities?

I’d love for you to follow this blog. I share information and inspiration to help you turn health challenges into health opportunities.

Add your name to the subscribe box to be notified of new posts by email. Click the link to read the post and browse other content. It’s that simple. No spam.

I enjoy seeing who is new to Watercress Words. When you subscribe, I will visit your blog or website. Thanks and see you next time.

You can find other posts about guns and violence by searching in this box.

Dr. Aletha

Understanding Seasonal Affective Disorder (SAD): Symptoms and Treatments

This new post shares information about Seasonal Affective Disorder (SAD) affecting many individuals as daylight hours decrease, causing depressive symptoms that vary between winter and summer patterns. Treatment options include light therapy, psychotherapy, antidepressants, and vitamin D supplements. It’s essential to seek help from healthcare providers if experiencing signs of SAD, which can impact mood and behavior.

If you or someone you know is struggling or having thoughts of suicide, call or text the 988 Suicide and Crisis Lifeline at 988 or chat at 988lifeline.org . In life-threatening situations, call 911.

This information is current as of the date of original publication or update. It may have changed by the time you read this. I invite you to fact-check what you read here.

This information is not intended for diagnosis or treatment. Before making health decisions, discuss with your physician or other qualified healthcare provider to decide what is right for you.

Photo by Katie Harp on Pexels.com

Many of us turned our clocks back one hour this month (if they didn’t change automatically) as Daylight Saving Time ended. Daylight hours are fewer now and will be until the first day of winter, December 21, when they will get progressively longer until next spring.

Many people feel “down” or have the “winter blues” when the days get shorter in the fall and winter and feel better in the spring when longer daylight hours return. (That pattern will be reversed if you live in the southern hemisphere.)

Sometimes, these mood changes can affect how a person feels, thinks, and behaves. If you notice significant changes in your mood and behavior when the seasons change, you may be experiencing seasonal affective disorder (SAD).

Characteristics of SAD

SAD is a type of depression having a recurrent seasonal pattern, lasting about 4−5 months out of the year. The signs and symptoms of SAD include those associated with depression as well as other symptoms that differ for winter-pattern versus summer-pattern SAD.

Not every person with SAD experiences all the symptoms listed below. Learn about signs and symptoms of depression.

Symptoms of depression can include:

  • Persistent sad, anxious, or “empty” mood most of the day, nearly every day, for at least 2 weeks
  • Feelings of hopelessness or pessimism
  • Feelings of irritability, frustration, or restlessness
  • Feelings of guilt, worthlessness, or helplessness
  • Loss of interest or pleasure in hobbies and activities
  • Decreased energy, fatigue, or feeling slowed down
  • Difficulty concentrating, remembering, or making decisions
  • Changes in sleep or appetite or unplanned weight changes
  • Physical aches or pains, headaches, cramps, or digestive problems that do not have a clear physical cause and do not go away with treatment
  • Thoughts of death or suicide or suicide attempts

For winter-pattern SAD, additional symptoms can include:

  • Oversleeping (hypersomnia)
  • Overeating, particularly with a craving for carbohydrates, which can cause weight gain
  • Social withdrawal ( “hibernating”)

For summer-pattern SAD, additional symptoms can include:

  • Trouble sleeping (insomnia)
  • Poor appetite, leading to weight loss
  • Restlessness and agitation
  • Anxiety
  • Violent or aggressive behavior

The depression associated with SAD is related to changes in daylight hours, not the calendar, so stresses associated with the holidays or predictable seasonal changes in work or school schedules, family visits, and so forth are not the same as SAD.

Learn about ways to get help and find a healthcare provider or access treatment.

The Substance Abuse and Mental Health Services Administration has an online treatment locator to help you find mental health services in your area.

Diagnosis of SAD

If you or someone you know is showing symptoms of SAD, talk to a healthcare provider or a mental health specialist about your concerns. They may have you fill out a questionnaire to determine if your symptoms meet the criteria for SAD.

To be diagnosed with SAD, a person must meet the following criteria:

  • They have the symptoms of depression or the more specific symptoms of winter- or summer-pattern SAD listed above.
  • Their depressive episodes occur during specific seasons (winter or summer) for at least 2 consecutive years. However, not all people with SAD experience symptoms every year.
  • Their depressive episodes during the specific season are more frequent than depressive episodes experienced at other times of the year.

Who develops SAD?

It is estimated that millions of Americans experience SAD, although they may not know they have this disorder. In most cases, SAD begins in young adulthood.SAD occurs more often in women than in men.

Winter-pattern SAD occurs more often than summer-pattern SAD and is more common in people living farther north, with shorter daylight hours in the winter. For example, people in Alaska or New England are more likely to develop SAD than people in Texas or Florida.

SAD is more common in people with depression or bipolar disorder, especially bipolar II disorder, which involves repeated depressive episodes and hypomanic episodes (less severe than the typical manic episodes of bipolar I disorder). They may have other mental disorders, such as attention-deficit/hyperactivity disorder, eating disorder, anxiety disorder, or panic disorder. Learn more about these disorders.

SAD sometimes runs in families and may be more common in people who have relatives with other mental illnesses, such as depression or schizophrenia.

What causes SAD?

The cause of SAD is still unknown but is being studied. Most research to date has investigated potential causes of winter-pattern SAD because it is more common and easier to study. As a result, less is known about summer-pattern SAD, and more research is needed.

Serotonin

Studies indicate that people with SAD, especially winter-pattern SAD, have reduced levels of the brain chemical serotonin, which helps regulate mood. Sunlight may affect levels of molecules that help maintain normal serotonin levels. Shorter daylight hours may prevent these molecules from functioning properly, causing lower serotonin levels in the winter.

Vitamin D

Vitamin D deficiency may exacerbate these problems in people with winter-pattern SAD because vitamin D is believed to promote serotonin activity. Our bodies produce vitamin D when exposed to sunlight on the skin. With less daylight in the winter, people with SAD may have lower vitamin D levels, further reducing serotonin activity.

Melatonin

Other studies suggest that both forms of SAD relate to altered levels of melatonin—a hormone important for maintaining the normal sleep−wake cycle. People with winter-pattern SAD produce too much melatonin, which can increase sleepiness and lead to oversleeping.

In contrast, people with summer-pattern SAD may have reduced melatonin levels, consistent with long, hot days worsening sleep quality and leading to depression symptoms. Longer daylight hours, shorter nights, and high temperatures can cause sleep disruptions. However, these theories have not been fully tested.

Both serotonin and melatonin help maintain the body’s daily rhythm tied to the seasonal night−day cycle. In people with SAD, changes in serotonin and melatonin disrupt normal daily rhythms so they can no longer adjust to seasonal changes in day length, leading to sleep, mood, and behavior changes.

Negative thoughts and feelings about the winter or summer and its associated limitations and stresses are also common among people with SAD (as well as others). It is unclear, however, whether these thoughts are causes or effects of the mood disorder, but they can be a useful focus of treatment.

Treatments for Seasonal Affective Disorder

Treatments are available to help people with SAD. They fall into four main categories that can be used alone or in combination:

  • Light therapy
  • Psychotherapy
  • Antidepressant medication
  • Vitamin D

Light therapy and vitamin D are treatments for winter-pattern SAD, whereas psychotherapy and antidepressants are used to treat depression in general, including winter- and summer-pattern SAD. There are no treatments specific to summer-pattern SAD.

Talk to a health care provider about the potential benefits and risks of different treatment options and which treatment is best for you. Find tips for talking with a health care provider to improve your care and get the most out of your visit.

Light therapy

Since the 1980s, light therapy has been a mainstay for treating winter-pattern SAD. It aims to expose people with SAD to a bright light to make up for the diminished natural sunlight in darker months.

For this treatment, the person sits in front of a very bright lightbox (10,000 lux) every day for about 30−45 minutes, usually first thing in the morning, from fall to spring. The light box, which is about 20 times brighter than ordinary indoor light, filters out the potentially damaging UV light, making this a safe treatment for most.

However, people with certain eye diseases or people taking certain medications that increase sensitivity to sunlight may need to use alternative treatments or use light therapy under medical supervision.

Light therapy lamp 10000 lux

Psychotherapy

Psychotherapy (also called talk therapy or counseling) can help people with SAD by teaching them new ways of thinking and behaving and changing habits that contribute to depression.

Cognitive behavioral therapy (CBT) is a type of psychotherapy aimed at helping people learn to challenge and change unhelpful thoughts and behaviors to improve their depressive and anxious feelings. CBT has been adapted for people with SAD (known as CBT-SAD).

CBT-SAD is typically conducted in two weekly group sessions for 6 weeks that focus on replacing negative thoughts related to the season, such as thoughts about the darkness of winter or the heat of summer, with more positive thoughts.

CBT-SAD also uses behavioral activation, which helps people identify and schedule pleasant, engaging indoor or outdoor activities to offset the loss of interest they typically experience in the winter or summer.

Photo by Photo By: Kaboompics.com on Pexels.com

When researchers directly compared CBT-SAD with light therapy, both treatments were equally effective in improving SAD symptoms—although some symptoms got better slightly faster with light therapy than CBT. However, a long-term study that followed SAD patients for two winters found that the positive effects of CBT seemed to last longer.

Learn more about psychotherapy.

Antidepressant medication

Medications used to treat depression (antidepressants) can be effective for SAD when used alone or in combination with talk therapy. Antidepressants work by changing how the brain produces or uses certain chemicals involved in mood or stress.

Antidepressants take time—usually 4−8 weeks—to work. Problems with sleep, appetite, and concentration often improve before mood lifts. You may need to try more than one medication to find the one that works best.

Because SAD, like other types of depression, is associated with disturbances in serotonin activity, antidepressant medications called selective serotonin reuptake inhibitors are sometimes used to treat symptoms. These medications can significantly enhance a person’s mood.

The U.S. Food and Drug Administration (FDA) has approved an antidepressant called bupropion in an extended-release form designed to last longer in the body. For many people, bupropion can prevent the recurrence of seasonal depressive episodes when taken daily from the fall through early spring.

All medications can have side effects. Talk to a healthcare provider before starting or stopping any medication. Learn more about antidepressants. Learn about specific medications like bupropion, including the latest approvals, side effects, warnings, and patient information, on the FDA website .

Ordinarily Well: The Case for Antidepressants

by Peter D. Kramer

“Dr. Kramer never loses sight of patients. He writes with empathy about his clinical encounters over decades as he weighed treatments, analyzed trial results, and observed medications’ influence on his patients’ symptoms, behavior, careers, families, and quality of life. He shows how antidepressants act in practice: less often as miracle cures than as useful, and welcome, tools for helping troubled people achieve an underrated goal—becoming ordinarily well.” (Amazon affiliate link)

Vitamin D

Because many people with winter-pattern SAD have vitamin D deficiency, vitamin D supplements may help improve symptoms. However, studies testing vitamin D as a treatment for SAD have produced mixed results, in some it is as effective as light therapy and others found no effect.

Talk to a healthcare provider about any dietary supplements and prescription or over-the-counter medications you are taking. Vitamin D can interact with some medications.

Prevention of SAD

Because the onset of SAD is so predictable, people with a history of the disorder might benefit from starting the treatments mentioned above before the fall (for winter-pattern SAD) or spring (for summer-pattern SAD) to help prevent or reduce depression symptoms. So far, few studies have investigated whether SAD can be prevented.

Discuss a personalized treatment plan with a healthcare provider. A provider can help you decide not only the best treatment option but also the best timing to help prevent SAD depressive episodes.

What are clinical trials and why are they important?

Clinical trials are research studies that look at new ways to prevent, detect, or treat diseases and conditions. These studies help researchers determine if a new treatment is safe and effective in people. The main purpose of a clinical trial is to gain new scientific knowledge so that others may be better helped in the future.

People volunteer for clinical trials for many reasons. Some people join clinical trials to help doctors and researchers learn more about a disease and improve health care. Other people, such as those with health conditions, join to try new or advanced treatments that aren’t widely available.

NIMH supports clinical trials at the National Institutes of Health campus in Bethesda, Maryland, and across the United States. Talk to a healthcare provider about clinical trials, their benefits and risks, and whether one is right for you. Learn more about participating in clinical trials.

I adapted this public domain content, from the National Institutes of Mental Health, National Institutes of Health, Department of Health and Human Services

Exploring the HEART of Health

I’d love for you to follow this blog. I share information and inspiration to help you turn health challenges into health opportunities.

Add your name to the subscribe box to be notified of new posts by email. Click the link to read the post and browse other content. It’s that simple. No spam.

I enjoy seeing who is new to Watercress Words. When you subscribe, I will visit your blog or website. Thanks and see you next time.

Dr. Aletha