Black people in the U.S. were far more likely to report harmfully low sleep in the months after a killing compared with white people surveyed during that time.Black people in the United States are more likely than white people to report that they do not sleep much, research shows. On average, they live in louder neighborhoods, work longer hours and pick up more late-night shifts — concerning to public health experts, since sleep deprivation is linked to chronic health issues and early death.But a group of public-health researchers from multiple universities and the National Institutes of Health wondered whether unequal exposure to police violence could also be contributing to racial sleep disparities, since those events are known to increase hypervigilance, worry and post-traumatic stress. They designed a pair of complex studies to measure how police killings of unarmed Black people affected sleep among Black and white people over time. The results were published Monday in the journal JAMA Internal Medicine.Black people were consistently more likely to report harmfully low levels of sleep after such a killing than they did before it occurred, the researchers found, regardless of whether the killing was a nearby event or a high-profile incident captured in media. The researchers did not find substantial impacts on sleep among white people in either case.Dr. Atheendar Venkataramani, an associate professor of medical ethics and health policy at the University of Pennsylvania’s Perelman School of Medicine, was a co-author of the studies. He said the findings reflected “the general human tendency to interpret events — and disparities in events — in ways that apply to you, and your future, and your family’s future.”Dr. Venkataramani’s lab, the Opportunity for Health Lab, uses statistical data to investigate the relationship between economic opportunity and health outcomes. He said that standard health questionnaires and clinicians, including himself, tended to ask patients about behavioral risk factors but that “we don’t really collect data with these kinds of timely social exposures in mind.”“We’re never really asking, ‘Hey, did you see something on the news that made you kind of rethink your position in society or how you feel about your future?’” he said.We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe.

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The gunshots rang out at 8:13 a.m., echoing across the high school football field and middle school garden. They continued for 49 minutes without interruption: an AR-15-style rifle, with .223-caliber bullets, ripping at 94 decibels through a community that did not even pause to wonder if a disaster was unfolding at the schools.Listen to This ArticleOpen this article in the New York Times Audio app on iOS.It was just a typical morning in Cranston, R.I., where more than 2,000 children attend school within 500 yards of a police shooting range. There, local police officers sharpen their gun skills, sometimes until 8:30 at night.Some days they shoot Glock pistols, like the weapons used in the mass shootings at Virginia Tech, the Charleston church and Thousand Oaks, Calif. Other days, they use AR-15-style semiautomatic rifles, similar to the ones used in the killings in Newtown, Conn.; Las Vegas; Parkland, Fla.; Buffalo and Uvalde, Texas.Many parents have tried in vain to have the range moved to a more remote area or enclosed to block out the upsetting sounds. They have written letters in support of a bill in the state legislature that would prohibit outdoor shooting ranges within a mile of schools. But the police opposed the legislation, and the bill is now being “held for further study.”“This facility is necessary to train and qualify all department members with the weapons they carry to fulfill the mission of protecting the public,” said Col. Michael Winquist, the chief of police.Sherry IzziExcessive noise — even generally — is disruptive to the health and well-being of children, research shows, and medical experts say the sound of gunfire, which could elicit a fight-or-flight response, may be even worse.But while many students say they recall being deeply disturbed by the gunfire at first — freezing, diving under desks — they now exhibit what public health experts say could be a potentially more dangerous reaction: desensitization.“I remember thinking, ‘We shouldn’t be getting used to this,’” said Valentina Pasquariello, who graduated in June. “But it was at the point where you have to get used to it — you don’t have a choice.”Sara Johnson, a professor of pediatrics at Johns Hopkins University School of Medicine, who has studied how firearms and other chronic stressors affect child development, said the students are “doing mental gymnastics to feel safe in that type of environment, and make peace with it.” Though the situation in Cranston is unique, Dr. Johnson and others said it is reflective of a country where the threat of gun violence has encroached upon the everyday lives of schoolchildren.“Whether or not you go to school across from a gun range,” Dr. Johnson said, “you’re being asked to accommodate the challenges of growing up in an environment that has guns baked in.”Morning: Psychology ClassCarmen Carline, whose two daughters, ages 17 and 10, attend Cranston, R.I., schools near the shooting range.Maansi Srivastava/The New York TimesMaranda Carline, 17. “Nobody has that healthy kind of fear that drives you to find safety — that’s what I’m afraid of,” said her mother, Carmen.Maansi Srivastava/The New York TimesOne morning last month, the first blasts of the day came as Maranda Carline, 17, a high school junior, was in first-period psychology class, snacking on Skittles and learning about how childhood trauma can affect a person’s long-term development. The sound of 50 rounds barraged Miranda again as she walked outside to her next class at 9:01 a.m.; another 50 came at 10:56 a.m., as she rushed to finish an essay on prohibition for her history midterm.Maranda has long memorized the steps from active shooter training, as rote as solving an algebra equation: Barricade the door. Hide in the corner. If necessary, wield scissors and throw trash bins, or chairs, or whatever else you can find.But her mother, Carmen Carline, was not confident Maranda would follow these steps in a real-life situation, for the simple reason that she wouldn’t know it was real. “When a gunman shows up at my kid’s school, and they hear the bullets, and nobody even looks up — nobody has that healthy kind of fear that drives you to find safety — that’s what I’m afraid of,” she said, breaking down in tears.Asked whether she found the gunfire distracting, Miranda paused, then said: “It’s kind of reassuring, I guess, because it means that there are police close by,”Her mother interjected: “That’s how they sell it to the kids.”Midday: Lunch BlockSherry IzziBetween the blasts that day, Cranston, a city of about 80,000, embodied the euphony of a New England autumn: leaves tumbling across driveways, basketballs drumming the pavement of cul-de-sacs; engines humming in a Dunkin’ drive-through line. Decades ago, residents said, the gunfire from the range was sporadic and quieter, like popcorn popping in the distance, as local officers learned to use handguns. But police departments grew, and so did the number of federal agencies and other groups using the range. So, too, did the types of weapons — and with them, the noise.During the Covid pandemic, adults who had commuted to jobs stayed home all day and could not believe what they heard. By 2021, the range became a source of tension. A petition for “peace and quiet” circulated.In September 2022, residents went to the City Council with stories: the new art teacher crouching down and calling for a lockdown; visiting athletes at a track invitational “hitting the turf”; one resident stepping on a spent 9-millimeter casing in front of the high school.A homework assignment for Camryn Carline, Maranda’s younger sister.Maansi Srivastava/The New York TimesWestern Hills Middle School, which is across the street from the Cranston Police Academy and its gun range.Maansi Srivastava/The New York TimesOne council member, Jessica Marino, said tradition should take precedence: “I do believe the range is in the right location, because it has been there for a long time,” she said.Another council member at the time, Matthew Reilly, an alum of the middle and high schools, said: “It was never a traumatic situation. Me and my friends, and I can only speak from personal experience, it never really affected us.”The police department’s training academy applied for $1.6 million through the American Rescue Plan to enclose the range, but the grant was denied.The department said it reduced the number of outside groups using the range — ending agreements with the airport police and federal agencies like the F.B.I. — and had replaced sound-absorbing panels and added berms and shrubbery to dampen the noise.“These are our last efforts,” the department’s second-in-command, Maj. Todd Patalano, wrote to the mayor and the chief of police in a February 2023 email obtained by The Times. “At this point, we will not be making any further accommodations.”Afternoon: Football PracticeAntonella Pasquariello. “You start to wonder if you’re the crazy one for worrying,” she said.Maansi Srivastava/The New York TimesMeshanticut State Park, where Ms. Pasquariello strolls around a lake and onto school grounds, just to scan the premises for her peace of mind.Maansi Srivastava/The New York TimesFor Antonella Pasquariello, a mother of three, one memory of school pickup time plays like a slow-motion movie in her head: She pulled up in her car, rolled down her window and watched as “cute little kids are strolling out of the school, not flinching, as the sound of artillery whacked up against the building.”She glanced at the bus lines and tennis courts to “make sure bodies weren’t falling.”Haunted by the experience, she wrote to the superintendent asking why the shooting couldn’t be banned during school hours. She was referred to the mayor, who replied that it would “take time and financing.”Ms. Pasquariello was leashing her goldendoodle, Cleo, for a walk when shooting resumed at 12:03 p.m. She listened for sirens: No sirens, no school shooting, she said. They cracked again at 2:47 p.m., as the junior varsity Falcons took to the football field for practice, and then at 3:21 p.m., as elementary school children climbed off their buses.When Ms. Pasquariello’s youngest son, August, got home from school, she asked him about the gunshots. He said he didn’t hear any.Evening: Bedtime RoutineJose GiustiAt dusk, Jose Giusti watched his 6-year-old, Gianna, practice cartwheels under a cacophony of bullets.Mr. Giusti works for the city of Providence’s licensing department, which enforces noise ordinances. He and his wife, Alyssa, know that, in research studies, children living in noisy environments have higher blood pressure, increased levels of cortisol, and hyperactivity. So far, Gianna seems OK.At bedtime, Gianna shuffled around in her cheetah pajamas and unicorn earphones. Then her parents put her to sleep with a white noise machine to block out the sound of the gunfire.Audio produced by

Gun suicides increased from prepandemic rates in all racial and ethnic groups, but the degree of change differed drastically.The rate of suicides involving guns in the United States has reached the highest level since officials began tracking it more than 50 years ago, according to a new report from the Centers for Disease Control and Prevention.The rate increased by more than 10 percent in 2022 compared with 2019, and in some racial and ethnic groups, the rise was significantly steeper, especially among Native Americans. Overall, about 27,000 of 50,000 suicides were carried out by gun in 2022.Federal researchers involved in the analysis suggested that the coronavirus pandemic might have exacerbated many of the known risk factors for suicide generally, which include social isolation, strained relationships, and drug and alcohol disorders. At the same time, outside experts noted, the increased rates also correlated with another trend seen during the acute phase of the pandemic: rising gun sales.“When there are more firearms, there are more firearm suicides,” said Michael Anestis, the executive director of the New Jersey Gun Violence Research Center.The rate of suicide by any method has increased by one-third in the past two decades, according to federal data. More than half of those now involve firearms, the report said, a figure that translates to about one every 20 minutes.On the flip side, more than half of all gun deaths in the United States are suicides.To examine recent trends, federal researchers at the C.D.C.’s National Center for Injury Prevention and Control compiled and analyzed demographic and mortality data from the National Vital Statistics System and the Census Bureau. (Statistics from 2022, the most recent available data, are still considered preliminary.)They found that the firearm suicide rate in 2022 (8.1 per 100,000) was the highest level since at least 1968, the earliest year on record in the Centers for Disease Control and Prevention data.Suicide rates have increased across all racial and ethnic groups since 2019, but the degree of change differed drastically. American Indian and Alaska Native people, for example, saw the sharpest spike: a 66 percent increase in the rate of firearm suicides from 2019 to 2022 (to 10.6 from 6.4 per 100,000). The rate among Black people increased by 42 percent (to 5.3 from 3.8), and among Hispanic and Latino people by 28 percent (to 3.3 from 2.5). Asian and Pacific Island people saw firearm suicide rates increase by about 10 percent (to 1.9 from 1.7).White people experienced the smallest bump — a 9 percent increase since 2019 — but maintained the highest overall rate of firearm suicides (11.1 per 100,000 in 2022).Sarah Burd-Sharps, the senior director of research at Everytown for Gun Safety, a nonprofit group that aims to prevent gun violence, said the unparalleled increase in the rate among American Indian and Alaska Native communities could be caused by disparities in access to mental health care. She said the high levels of job loss and financial strains in Black and Latino communities during the pandemic could have contributed to the rise in those groups.Dr. Anestis of the New Jersey Gun Violence Research Center said he was “sadly not surprised,” since the demographic groups driving the surge in firearm sales did not match the stereotype of “older, white, male gun owners.” Research showed that about half of first-time buyers during the pandemic were female, and an increasing proportion were Black and Hispanic.Research shows that gun owners are no more likely than others to have suicidal thoughts, but surveys have showed that people who planned to purchase firearms during the pandemic were more likely to have thought recently about suicide than people without plans to purchase.“When firearms are going into new types of communities, and into homes where people have had the propensity to think about suicide, they are suddenly gaining access to the single most lethal method,” Dr. Anestis said.Researchers at the C.D.C. called for stronger efforts to reduce such suicides by addressing underlying inequities. Some states are working to develop safe options for storing guns away from a person’s home during times of distress.Dr. Anestis is planning a project that could train barbers, faith leaders, bartenders and even divorce lawyers on how to help promote those options to people who are discouraged, “much like knowing who’s going to hold your car keys when you’ve had too much to drink,” he said.“The goal is not to infringe upon their autonomy as an owner,” he said. “It’s to make sure that, in their worst moment, it’s not right there at their fingertips.”If you are having thoughts of suicide, call or text 988 to reach the 988 Suicide and Crisis Lifeline or go to SpeakingOfSuicide.com/resources for a list of additional resources. Go here for resources outside the United States.

A new analysis also found wide disparities in age and race, with Black and young people receiving treatments at far lower rates than white and middle-aged people.More than half a million Medicaid recipients diagnosed with opioid use disorder did not receive medication to treat it in 2021, according to a new report released Friday by the inspector general of the Department of Health and Human Services.The report, which examined the use of addiction treatments that almost all Medicaid programs are now required to cover, also found major disparities in medication rates across states, ages and racial groups. It said the Centers for Medicare & Medicaid Services, an agency of the Health and Human Services Department, should work to close the gaps.“Medicaid is uniquely positioned to achieve these goals given that the program is estimated to cover almost 40 percent of nonelderly adults with opioid use disorder,” the report said.The half-million people who did not receive treatment amounted to about one-third of all Medicaid recipients with opioid use disorder. The authors of the report expressed concern that, when a five-year mandatory coverage period issued by the federal government ends in September 2025, some states could again start restricting access.Dr. Bradley Stein, the director of the RAND Opioid Policy Center and a senior physician policy researcher at the RAND Corporation, who was not involved in the report, said he had expected even lower overall treatment rates. Still, he said, for certain groups, “things are not where they need to be, and I’m asking: Are the successes things we’re going to be able to sustain or not?”More than 80,000 people died from opioid overdoses in 2021 — about 17 percent more than the prior year. Research shows that medications including methadone, buprenorphine and naltrexone are effective in blunting cravings, and can help prevent deaths.But people seeking medication treatment often struggle to find providers willing to prescribe the medications — and they often face stigma surrounding their use. Some patients might also be unaware that they can obtain treatment under Medicaid, since state Medicaid programs were not required to cover the treatments until October 2020.Investigators used enrollment, eligibility and claim data to understand the extent to which people with opioid use disorder received medication.The rate of medication uptake varied widely across states, from less than 40 percent of Medicaid patients with the disorder in Illinois and Mississippi to almost 90 percent in Rhode Island and Vermont. Medicaid expansion in some states most likely plays a role, said Dr. Stein, as well as “tremendous variation” in state policies around the provision of medication, such as reimbursement for telehealth expenses and the ability of nurse practitioners and physician assistants to independently prescribe.In 10 states, including New York and Texas, more than half of Medicaid enrollees with opioid use disorder did not receive any medication — enough people to account for a quarter of all Medicaid patients with the disorder across the country.Only 15 states kept comprehensive data on participants’ race and ethnicity. But among them, officials found that more than 70 percent of white patients with opioid use disorder received medication, compared to about 53 percent of Black patients — a worrisome inequity, they said, considering that overdose deaths have increased more dramatically among Black people.The young and the old are also at a disadvantage: For Medicaid enrollees under age 19, only about 11 percent of those with the disorder received medication treatment, compared with 70 percent among those 19 to 44. (Research has shown that pediatric treatment programs that involve medication are sparse.) Less than half of Medicaid patients 65 and older with the disorder used the treatment.The inspector general’s office outlined specific steps for the Centers for Medicare & Medicaid Services to take to encourage states to reduce barriers and reach marginalized groups, including creating a social media campaign and fact sheets to disseminate information.For Dr. Ayana Jordan, an associate professor of psychiatry at N.Y.U. Grossman School of Medicine, who studies race and addiction, the recommendations were “infuriating” because they failed to include policy moves, like giving incentives to health care providers to work in settings that have few prescribers, partnering with churches and other community organizations, or dealing with medication shortages in pharmacies that serve communities of color.“They ‘encourage, encourage, encourage’ action — what does that mean? Nothing. It is not enough,” she said. “How can the federal government be involved in actually holding states accountable?”Dr. Jordan, who treats mostly Medicaid patients in marginalized groups, said she “is tired of seeing so many of them die.”“I’m over it,” she said. “There is intense sorrow in trying to address a crisis when you are very much handicapped by a lack of legislation.”

The agency outlined “core elements” needed to detect and treat the condition, a factor in 1.7 million hospitalizations in the U.S. each year.On a Wednesday afternoon in 2012, 12-year-old Rory Staunton got a scrape during a middle-school basketball game. His gym teacher applied two Band-Aids to the cuts on his arm.By Thursday, Rory had a 104-degree fever, vomiting and leg pain, but the emergency room staff at NYU Langone Health suspected dehydration and gave him fluids and anti-nausea medicine.By Friday, the boy was critically ill. By Sunday, he was dead. Hospital records show the cause was severe septic shock.More than a decade later, Rory’s mother, Orlaith Staunton, believes that change may finally be coming, that there may fewer tragedies like this one in the future. The Centers for Disease Control and Prevention on Thursday released new guidelines to help hospitals quickly detect and treat cases of sepsis.The road map, a 35-page document outlining the “core elements” of a hospital sepsis program, is meant to help administrators bring together experts from various medical disciplines to detect and treat sepsis faster.Dr. Raymund Dantes, a C.D.C. medical adviser and one of the experts who designed the new guidelines, said they were intended to “complement clinical guidelines” by detailing the infrastructure needed to equip health care workers on the front lines.An interdepartmental sepsis group should “look something like hospitals’ other code teams,” said Dr. Chris DeRienzo, the chief physician at the American Hospital Association, at a news briefing on Thursday.He likened the teams to a “well-oiled NASCAR pit crew,” coordinated to act quickly at the first signs of sepsis.Sepsis is an extreme immune response to an infection, which sends a chain reaction through the body that can result in tissue damage, organ failure and death. About one in three people who die in a hospital had sepsis during their time there, according to the C.D.C. About 1.7 million adults in the United States develop sepsis each year, and about 350,000 of them die or are moved to hospice.Despite its prevalence, hospitals often misdiagnose the illness because it is masked by common symptoms, such as fevers and shivering, clamminess and shortness of breath, according to Dr. Hallie Prescott, a sepsis expert at the University of Michigan who helped develop the C.D.C. guidelines.Sepsis detection and care also require coordination across departments and disciplines, a weak point in many health care settings.A new survey of over 5,000 hospitals found that about 73 percent had sepsis teams, but only 55 percent had a leader with time allocated to manage the program. Only about half of hospitals integrate their sepsis programs with antibiotic stewardship initiatives, despite the fact that these drugs are the key to recovery.The C.D.C.’s guidance explores the best practices for sepsis programs in both large hospital systems and small rural facilities, including how to allocate personnel and financial resources, institute processes to improve case identification, and train staff members to look for symptoms.The agency now says that sepsis programs should include experts from the hospital’s antimicrobial stewardship, the emergency room, infectious disease department and even the pharmacy — and should be led by both a doctor and a nurse.Every hospital should have a well-rehearsed “code sepsis” protocol and a live dashboard for tracking various metrics in case management and outcomes.Dr. DeRienzo said hospital administrators should think of the C.D.C.’s road map not as a prescriptive plan but as “scaffolding” upon which to build a program that fits the local context.The C.D.C. also offered a detailed assessment tool to help apply the guidance to the local setting, as well as a list of first steps for the 1,400 hospitals in the United States that, according to the survey, must begin from scratch.Rory’s mother, Ms. Staunton, who started a foundation to combat sepsis with her husband, Ciaran Staunton, acknowledged the federal guidance didn’t go as far as the state regulations they championed the year after Rory died. (In 2013, New York became the first state to mandate that all hospitals adopt sepsis protocols, known as “Rory’s regulations.”)Still, after years of pleading with C.D.C. officials to take action, she is hopeful that the new guidance won’t slide to the bottom of the pile among hospital administrators’ tasks.“It’s too late for Rory,” but not for the three million others who are predicted to die of sepsis in the next decade, Ms. Staunton said in an interview. “He never got to graduate high school, or college, or have a girlfriend,” she said. “If the C.D.C. guidelines had been in place 11 years ago, when our son died at a major New York City hospital, maybe he would have.”

The number of procedures rose to roughly 13,000 in 2019 from about 4,550 in 2016 as access broadened, researchers estimated.The NewsThe number of gender-affirming surgeries, intended to align patients’ physical appearance with their gender identity, nearly tripled in the United States between 2016 and 2019, according to a new analysis published in JAMA Network Open on Wednesday.The number of procedures rose from about 4,550 in 2016 to about 13,000 in 2019, and then dipped slightly in 2020, according to the study’s estimates. Because of various data limitations, the researchers behind the study believe the true figures are higher.Surgeons performing a bilateral mastectomy on a transgender patient at a hospital in Boston in 2016.Christine Hochkeppel/Worcester Telegram & Gazette, via Associated PressThe Context: Transition care has become a political issue.Gender-affirming care has become a key political issue for conservatives in the run-up to the presidential election. At least 20 states led by Republicans have restricted or banned such care for minors.Gender-affirming surgery is endorsed by a wide array of medical groups. Yet surprisingly little has been known about how often these operations are performed.“There’s been a sense that more patients are asking about it, and ultimately pursuing it, but there wasn’t good data,” said Dr. Jason D. Wright, the chief of gynecologic oncology at Columbia University Vagelos College of Physicians and Surgeons, who led the research.“Ours is one of the first studies to quantify the age groups and the procedures they’re undergoing.”Past analyses have shown that such surgeries have been increasing. Health experts anticipated a sharper increase in recent years, in part because of changes in federal and state laws that often require coverage of transition-related care.The Numbers: What kinds of procedures do patients opt for?Dr. Wright and his colleagues drew patient counts from two databases maintained by the federal Agency for Healthcare Research and Quality in order to account for both inpatient and outpatient procedures, and weighted the figures to produce estimates for the entire country.According to the analysis, about 48,000 patients underwent surgeries from 2016 through 2020. Breast and chest surgeries were the most common: There were about 27,187, or 56.6 percent of all gender-affirming surgeries.Researchers estimated there were about 16,872 genital surgeries (35.1 percent of the total) during the period, and about 6,669 facial and cosmetic surgeries (13.9 percent).Just over half of all patients were ages 19 to 30; about 22 percent were ages 31 to 40; and almost 8 percent were ages 12 to 18. The number of genital surgeries in particular increased with age, which researchers attributed to the higher complexity and “definitive nature” of the procedure.The number of procedures overall rose from 2016 to 2019 but declined slightly in 2020, which the researchers said might have resulted from the onset of the Covid pandemic.The data accounted only for surgeries in inpatient and ambulatory settings, and did not include cases in which surgeons omitted certain gender-related diagnosis codes. As a result, the study’s findings are “almost certainly under-captures” of the real figures, Dr. Wright said.Background: Recent developments in gender-affirming care.Much of the national discussion has centered on treatment for adolescents. Earlier this month, the American Academy of Pediatrics reaffirmed its guidelines regarding the gender-affirming treatment but also commissioned a fresh review of the research, after European health authorities found uncertain evidence for its effectiveness.Here are articles to better understand the topic:Medical Group Backs Youth Gender Treatments, but Calls for Research ReviewEngland Limits Use of Puberty-Blocking Drugs to Research OnlyReport Reveals Sharp Rise in Transgender Young People in the U.S.

A new analysis of older people who have never had a heart attack or stroke suggests limited protective power of daily low-dose aspirin, and worrisome side effects.A new analysis of data from a large clinical trial of healthy older adults found higher rates of brain bleeding among those who took daily low-dose aspirin, and no significant protection against stroke.The analysis, published Wednesday in the medical journal JAMA, is the latest evidence that low-dose aspirin, which slows the clotting action of platelets, may not be appropriate for people who do not have any history of heart conditions or warning signs of stroke. Older people prone to falls, which can cause brain bleeds, should be particularly cautious about taking aspirin, the findings suggest.The new data supports the recommendation of the U.S. Preventive Services Task Force, finalized last year, that low-dose aspirin should not be prescribed for preventing a first heart attack or stroke in healthy older adults.“We can be very emphatic that healthy people who are not on aspirin and do not have multiple risk factors should not be starting it now,” said Dr. Randall Stafford, a medical professor and epidemiologist at Stanford University who was not involved in the study.He acknowledged, however, that the decision was less clear-cut for people who did not fit that description.“The longer you’ve been on aspirin and the more risk factors you have for heart attacks and strokes, the murkier it gets,” he said.For most people who have already had a heart attack or stroke, daily aspirin should remain an important part of their care, a number of cardiac and stroke experts said in interviews.The new analysis used data from Aspirin in Reducing Events in the Elderly, or ASPREE, a randomized control trial of daily low-dose aspirin among people living in Australia and the United States. The 19,114 participants were adults over 70 who were free of any symptomatic cardiovascular disease. (Any person with a history of stroke or heart attack was excluded from the study.)It aimed to reveal nuances in the data to address the difficult balance that doctors face in preventing clots and bleeds in older patients. The rationale was that the balance of risk and benefits of aspirin might shift as people age. Strokes become more frequent from clots as well as from small blood vessels that become more fragile over time, and older people can experience an increased likelihood of head trauma from falls.The study randomly assigned 9,525 people to take 100 milligram daily doses of aspirin and 9,589 people to take matching placebo pills. Neither of the groups nor the researchers knew who was taking each type of pill. The study followed participants for a median of 4.7 years.Aspirin appeared to reduce the occurrence of ischemic stroke, or a clot in a vessel supplying blood to the brain, though not significantly. Researchers found a significant increase — 38 percent — of intracranial bleeding among the people who took daily aspirin compared with those who took a daily placebo pill.Cardiologists who were not involved in the study lauded its size and rigorous design, in which specialists reviewed medical records and characterized the events manually, rather than relying on outcomes reported by the patients. But they noted that the rate of strokes was low in both groups, making the results difficult to extrapolate. The paper did not include an analysis on heart attacks.They also questioned how the findings would apply to the diverse population of the United States, since a majority of participants were in Australia, and 91 percent of them were white.In the past, some doctors regarded aspirin as something of a wonder drug, capable of protecting healthy patients against a future heart attack or stroke. But recent studies have shown that the powerful drug has limited protective power among people who have not yet had such an event, and it comes with dangerous side effects.The U.S. Preventive Services Task Force recommended last year that most people who have never had a heart attack or stroke not begin taking low-dose aspirin because of the risk of internal bleeding. The American College of Cardiology quickly released a follow-up statement, reiterating that the recommendation “does not apply to patients with a prior history of heart attack, stroke, bypass surgery, or recent stent procedure.”Still, some stroke patients seemed to misinterpret the guidance. In interviews, multiple cardiologists said that patients who clearly needed aspirin had abruptly stopped taking it, only to end up in the emergency room with a second stroke.No one should ever stop taking aspirin without consulting a doctor, they said.“When a study comes out, you have to ask yourself, how well do I fit into this study’s population?” said Dr. Shlee S. Song, the director of the Comprehensive Stroke and Telestroke Programs at Cedars-Sinai. “If you’ve ever had a heart attack or stroke event, this study’s findings do not apply to you.”In an interview last year, Dr. Song, who oversees stroke programs at four hospitals in Los Angeles, urged patients not to abandon the drug. She said this study had not changed her opinion.“There is a lot of noise out there,” she said. “At the end of the day, these things will need to be discussed with a doctor who knows your specific story.”Dr. Joshua Willey, an associate professor of neurology and a stroke specialist at the Columbia University Vagelos College of Physicians and Surgeons, said the risk-benefit calculation would also differ for each patient, depending on how long they had been on aspirin and why their doctor recommended the pill in the first place. For a patient at high risk of another condition, like colorectal cancer, a doctor might conclude that aspirin offers protective power that offsets the patient’s risk of bleeding.For patients who need to remain on aspirin, he said, the study findings have a different significance for doctors: “Check their balance, get them physical therapy, make sure the house is set up properly. Do everything you can in that Medicare age group to mitigate the risk of a fall.”

Thirty years of progress in decreasing drowning deaths in the United States appears to have plateaued, and disparities in deaths among some racial groups have worsened.Yadira Salcedo was born in Mexico to parents who did not know how to swim. As a child, she nearly drowned when she waded too deep in a backyard pool.Now a mother of two in Santa Ana, Calif., Ms. Salcedo is “breaking the cycle,” she said, making sure Ezra, 3, and Ian, 1, never experience such terror. The family has qualified for Red Cross scholarships to a new program that teaches children who might not have other chances to learn how to swim.On a recent day, Ms. Salcedo and her children climbed together into the Salgado Community Center pool, using kickboards and blowing bubbles with an instructor, Josue, who uses a mix of English and Spanish.Drowning is the leading cause of death for children ages 1 to 4, according to the Centers for Disease Control and Prevention. Deaths are likely to surge this month, as they do every July, with children drowning just feet from their parents without a scream, struggle or splash. A 4-year-old at a Texas hotel pool, a 5-year-old in a California river, a 6-year-old at a Missouri lake and a 10-year-old at an Indiana public pool all drowned just this past week.And yet, despite calls from the United Nations, the United States is one of the only developed countries without a federal plan to address the crisis. Thirty years of progress in decreasing the number of drowning deaths in the country appears to have plateaued, and disparities in deaths among some racial groups have worsened.“It’s hard to imagine a more preventable cause of death. No one is going to say, ‘Oh, well, some people just drown,’” said William Ramos, an associate professor at Indiana University School of Public Health-Bloomington and the director of the school’s Aquatics Institute.“It’s time to go deeper than the sad statistics and answer the ‘why’ and the ‘how,’” he said.A parent who has never learned to swim yields an 87 percent chance that a child won’t, either, said Dr. Sadiqa A.I. Kendi, the division chief of pediatric emergency medicine at Boston Medical Center, who studies the cyclical nature of injury and inequity.“This is anthropology,” said Mr. Ramos. “To start a new narrative around water is not an easy task.”From left, Berenice Gonzalez, with her daughter Luna Romero, 1, and Yadira Salcedo with her son Ian, 1, in the Salgado Community Center pool during a Parent and Me class.Gabriella Angotti-Jones for The New York TimesKendra Lubin, 16, an instructor in the Splash Camp swim program, helped guide Daymian Espinoza, 9, to the pool wall.Gabriella Angotti-Jones for The New York TimesThe National Institutes of Health recently published a call for research proposals to examine drowning prevention, writing that “little is known” about what intervention strategies work. The C.D.C. said it planned to do an in-depth analysis of childhood drownings in several states to better understand the contributing factors.But epidemiologists point to an array of factors that could make it increasingly difficult to close the gap, including shrinking recreation department budgets, a national lifeguard shortage and an era of distraction on pool decks, as parents juggle child supervision with laptops and cellphones when they work from home.In the longer term, the figures are likely to be exacerbated by climate change, said Deborah Girasek, a drownings researcher at the Uniformed Services University of the Health Sciences. More children are likely to drown in hurricane floodwater in Florida, fall through thin ice in Wisconsin or climb into restricted reservoirs in Yosemite for a reprieve from the increasing heat. (Research shows that drownings rise with every degree on a thermometer.)Though overall drowning deaths have decreased by one-third since 1990, they have risen by 16.8 percent in 2020 alone, according to the C.D.C. There are still over 4,000 of them in the United States annually, and about a quarter of the deaths are of children. An analysis by the C.D.C. shows that Black children between ages 5 and 9 are 2.6 times more likely to drown in swimming pools than white children, and those between ages 10 and 14 are 3.6 times more likely to drown. Disparities are also present in most age groups for Asian and Pacific Islander, Hispanic, and Native American and Alaska Native children.Socioeconomic factors are at play as well. A study of drownings in Harris County, Texas, for example, showed that they were almost three times more likely for a child in a multifamily home than in a single-family residence, and that drownings in multifamily swimming pools — like the one at the Salcedos’ apartment — were 28 times more likely than in single-family pools.Ms. Salcedo said she often saw children swimming in the pool of her apartment complex unsupervised, the gate propped ajar with a water bottle or a shoe.Apropos Parent and Me class signage at the Salgado Community Center.Gabriella Angotti-Jones for The New York TimesKendra learned to swim in her school principal’s backyard in Phoenix, where she grew up. Santa Ana paid for her training to become a lifeguard this summer.Gabriella Angotti-Jones for The New York TimesThe leading theory to explain the inequities traces back half a century to the proliferation of municipal pools after World War II. When those gave way to suburban swim clubs and middle-class backyard pools, the historian Jeff Wiltse wrote in his book on pool history, white children began learning to swim in private lessons, while children in minority families saw public pools become dilapidated and aquatics budgets be slashed. Many of the facilities and education programs have never recovered.Black adults in particular report having had negative experiences around water, with familial anecdotes of being banned from public beaches during Jim Crow-era segregation and brutalized during the integration of public pools.A U.N. resolution issued in 2021 and a World Health Assembly decision this year to accelerate action urged every member nation to prioritize the fight against childhood drownings. Both the W.H.O. and the American Academy of Pediatrics have implored the United States government to catch up.“Canada, U.K., Australia, New Zealand, South Africa — they all have a plan. We don’t,” said Mr. Ramos. “The message to Congress is: We need to fix this, and we can. But look at seatbelts, fire safety, smoking cessation. Legislation is what’s going to move the needle.”Officials could add aquatics to gym class curriculums or mandate four-sided pool fences in backyards (since many victims still wander into pools from the exposed side facing the house). Ms. Girasek said she was eager to see legislation because “we see very clearly that it works.”After former Secretary of State James Baker’s 7-year-old granddaughter Virginia Graeme Baker was trapped by the suction of a hot tub drain and drowned, a federal law was named in her honor that required public pools and spas to be equipped with drain covers that meet certain standards. It seemed to all but eradicate such deaths.The U.S. National Water Safety Action Plan, launched by a group of nonprofits last week, is the country’s first-ever attempt to construct a road map to address the crisis. Its 99 recommendations for the next decade serve as a sobering guide through the country’s various gaps in research, funding, surveillance and parental education, compiled by earnest advocacy groups on shoestring budgets that aren’t equipped to fill them alone.Though overall drowning deaths have decreased by one-third since 1990, there remain over 4,000 in the United States annually.Gabriella Angotti-Jones for The New York TimesMs. Gonzalez, blowing bubbles for Luna.Gabriella Angotti-Jones for The New York TimesConnie Harvey, the director of the Aquatics Centennial Campaign at the American Red Cross, held a Capitol Hill briefing recently alongside other experts, she said, “to let our leaders know that there is a plan — that this plan exists.”Representative Debbie Wasserman Schultz, Democrat of Florida and a longtime advocate for drowning prevention, was the only member of Congress to attend.In the meantime, some local governments have adopted their own interventions. This summer, Seattle is piloting a new initiative based on the nonprofit No More Under, which connects hundreds of low-income and foster children with swim lessons. Broward County, Fla., which has some of the highest drowning rates in the state, is offering free vouchers. And Santa Ana plans to pull more than $800,000 from its Cannabis Public Benefit Fund this year to bring its aquatics program back under its domain.The city, with a population that is nearly 80 percent Hispanic nestled between wealthier Orange County suburbs, has historically epitomized racial and economic health disparities. One of its public pools is 63 years old. But its Parks and Recreation Department recently hired an aquatics supervisor and 36 new life guards — several of whom the supervisor needed to first teach to swim.Under the new Santa Ana program, Ms. Salcedo, a waitress, and her husband, a post office employee, who live in a three-generation household, secured scholarships that brought the cost of swim lessons down to $15 per child every two weeks. They plan to attend all summer.Ezra, who is 3, cried on the first day of lessons. Now he shares facts about hammerheads between strokes during the “Baby Shark” singalong. Ian, the 1-year-old, has not yet mastered walking on land. Still, he paddled after an orange rubber duck, with his mother — now a proficient swimmer — keeping him afloat.

The international vaccine aid group agreed to provide developing countries with a new shot to prevent a global resurgence of the paralyzing virus.The NewsThe governing board of Gavi, the international organization that provides vaccines to developing countries, added a new shot to its roster this week that could help to eradicate polio worldwide and prevent its resurgence.The new vaccine does not contain the live viruses that are in the polio vaccines currently used in some low- and middle-income countries. It adds what’s known as an inactivated polio component into a multifaceted shot that is already being used to protect young children against five other dangerous infections. A similar shot is already available in the United States and some European countries. A child was marked after receiving the polio vaccine in Kabul, Afghanistan, in May.Samiullah Popal/EPA, via ShutterstockWhy It Matters: Combining vaccines could offer longevity.Oral polio vaccines, administered in droplet form, have driven down polio cases by more than 99 percent in recent decades. But because the drops contain live viruses — detectable in the excrement of children who get the vaccine — the virus can spread and cause new infections in countries with poor sanitation. The new vaccine won’t have this problem.“More children today, in 2023, are paralyzed from circulating vaccine-derived polio than wild polio,” said Dr. James Campbell, a pediatric infectious disease expert at the University of Maryland School of Medicine who studies vaccine development. He called the Gavi approval an “important step” in quelling the virus globally because it will give children in low- and middle-income countries access to a product that pediatricians in the United States and Europe have long offered.The shot is also expected to help prevent infections because of its logistical ease. Since the polio vaccine will be wrapped into a combination product that is already being distributed to children, scientists say countries who use it will be less likely to see a resurgence of polio once the oral vaccines are scaled back.Background: Polio has remaining strongholds in Afghanistan and Pakistan.Polio, officially known as poliomyelitis, is a highly infectious viral disease transmitted mainly through feces in places with poor sanitation. The virus multiplies in the intestine and invades the nervous system, causing paralysis. Even a single existing case is problematic, experts say, because it could lead to a global resurgence.The United States has long used an inactivated polio vaccine, or IPV, instead of the oral drops, and Gavi has been helping lower income countries buy it for the past 10 years. But the new six-in-one vaccine, called a hexavalent, will also protect children against hepatitis B, Haemophilus influenzae, tetanus, diphtheria and pertussis.Adding polio protection to the existing five-component vaccine will raise its cost, but public health officials say the move is still economically advantageous. Fewer vaccine doses overall will help to decrease small expenses that add up, including syringes, serum refrigerators and appointments with health workers.What’s Next: A global rollout is on the horizon.Countries that Gavi serves will now be able to apply for funding for the vaccine, which could become available as soon as 2024. It is administered in three doses within the first months of life — plus a subsequent booster shot before age 2 — and UNICEF has estimated that the global market for the new vaccine could reach 100 million annual doses by 2030.