We Asked. You Answered.

At HealthyWomen, it’s our mission to educate and empower women so they can make informed decisions about their health care. Our everyday mission aligns with the rest of the world each year in May during National Women’s Health Month.

This year, we took the opportunity to ask our readers some questions to make sure we’re giving our audience what they want — and that we continue to do so.

What do you want to know?

We learned that our audience is most interested in learning more about mental health. And is anyone surprised that sexual health came in second? Following closely were chronic pain and menopause.


We’re so happy to find out that 65% of our audience considers themselves healthy.

Time and money: Barriers to care

When asked what your biggest health challenge is, almost 40% of you indicated that it’s finding time to care for yourself. It’s like the age-old oxygen mask analogy. You have to take care of yourself so you can properly take care of everyone else. Don’t forget that self-care isn’t a luxury — it’s a necessity.

The second biggest challenge was being able to afford health care. This is a big problem, and it’s why we work so hard to expose disparities in health care. No one should have to sacrifice their health because of financial concerns.

You guys are smart

30% of you knew that you should start thinking about your brain health in your twenties. It’s never too late — but it’s never too early, either!

A trusted resource

When it comes to health concerns, 42% of you are turning to the internet even before your healthcare providers (35%). While we always recommend that you consult a healthcare provider about health issues, we recognize that turning to online sources is also a huge part of the process.

That’s why it’s so important that you can find reliable information you can count on — and that’s why all of our content at HealthyWomen is credible, unbiased and fact-based.

Thank you!

We really appreciate you taking the time to let us know what’s on your mind. Now that we’ve got the scoop, we’ll use all this great info to keep creating content that’s relevant and useful. Until we meet again …

Enough to Wreck Their Rest: $10,322 for a Sleep Study

By Michelle Andrews, Kaiser Health News

José Mendoza’s snoring was bad — but the silence when he stopped breathing was even worse for his wife, Nancy. The sudden quiet would wake her and she waited anxiously for him to take another breath. If too many seconds ticked by, she pushed him hard so that he moved and started breathing again. This happened several times a week.

This story also ran on NPR. It can be republished for free.

Diagnosed with severe sleep apnea 15 years ago, Mendoza was prescribed a continuous positive airway pressure (CPAP) device to help him breathe easier. But the machine was noisy and uncomfortable. After a month, he stopped using it.

Late in 2019, Mendoza, 61, went to an emergency department near the family’s Miami home with an excruciating headache. He thought it was related to his high blood pressure, a condition sometimes linked to obstructive sleep apnea. But after a battery of tests, clinicians concluded his obstructive sleep apnea itself was likely causing his headache and cardiac problems. He needed a new CPAP machine, they said.

But first, he had an at-home sleep test. Mendoza’s pulmonologist said it was not detailed enough and ordered a visit to an overnight sleep lab to get extensive data.

Mendoza arrived at the sleep center about 8 p.m. one night in early February and was shown into a spacious room with a sofa, a TV and a bed. After he got into his pajamas, a technician attached electrodes to his head and chest to track his brain, heart, lung and muscle activity while he slept. The technician fitted him with a CPAP with two small cannulas for his nose. Despite the unfamiliar setting and awkward equipment, Mendoza slept that night.

After the study, Mendoza started using the same, more comfortable CPAP model he’d used during the study.

“Now I’m not snoring. I feel more energetic. I’m not as tired as I was before,” he said.

The new CPAP was helping both Mendozas get a better night’s sleep — until the bill came.

The Patient: José Mendoza, 61, has a Humana HMO plan through the construction company where he works as a truck driver. It has a $5,000 deductible and an out-of-pocket maximum of $6,500 for covered care by in-network providers. Once his deductible is satisfied, he owes 50% in coinsurance for other billed charges. (Nancy Mendoza, who works as a social worker, and their two teenage children are covered under her employer plan.)

Medical Service: An overnight sleep study at a hospital sleep center to determine the type of mask and the proper levels of airflow and oxygen needed in Mendoza’s CPAP to treat his severe obstructive sleep apnea.

Total Bill: $10,322, including a $9,853 outpatient charge for the sleep study and a $469 charge for the sleep specialist who interpreted the results. Humana’s negotiated rate for the total was $5,419. Mendoza owed the bulk of that: $5,157, including $262 in coinsurance and $4,895 to satisfy his deductible. Humana paid $262.

Service Provider: University of Miami Health System’s sleep medicine facility at Bascom Palmer Eye Institute in Miami.

What Gives: Sleep studies are somewhat controversial and have been flagged in the past as being overused. Not everyone who snores needs this evaluation. But with Mendoza’s pauses in breathing and hypertension, he likely did.

According to Dr. Vikas Saini, president of the Lown Institute, a think tank that analyzes low-value health care, sleep studies fall into a gray zone.

Josu00e9 Mendoza

“They are incredibly useful and necessary in certain clinical circumstances,” he said. “But it’s known to be one that can be overused.”

But how much should it cost to be monitored at home or in a hospital sleep lab? That’s the question. The Office of Inspector General at the federal Department of Health and Human Services has identified billing problems for the type of sleep study Mendoza had that led to Medicare overpayments.

The University of Miami Health System’s total charge was high by nearly every measure, but so was the allowed amount that Humana agreed to pay the health system for the study. And because Mendoza’s skimpy health plan has a deductible of $5,000, he’s on the hook for paying almost all of that hefty bill.

Mendoza’s Humana plan agreed to pay the hospital $5,419 for the sleep study he had. That’s nearly six times what Medicare would pay for the same service nationally — $920 — according to the Centers for Medicare & Medicaid Services.

Private insurers typically pay higher rates than Medicare for care, but that multiple is “much higher than what other insurers would pay,” said Jordan Weintraub, vice president of claims at WellRithms, a company that analyzes medical bills for self-funded companies and other clients.

Consider the total facility charge of $9,853. The average charge in the United States for a sleep study of the same type is just over half that amount at $5,384, according to Fair Health, a national independent nonprofit that tracks insurance charges.

Charges in the Miami area are on the high end of the national range. The average billed charges for similar hospital sleep studies in Miami range from $2,646 to $19,334, Weintraub said. So Mendoza’s bill is not as high as the highest in the area, and is just under the average in Miami.

“Billed charges are just completely fictitious,” said Weintraub. “There’s really no grounds for charging it other than that they can.”

More telling than what other Miami hospitals are charging for sleep studies is what the University of Miami Health System reports it actually costs the hospital to do the procedure. And that figure was just $1,154 on average in 2019, according to WellRithms’ analysis of publicly available cost report data filed with CMS. That year, the hospital’s average charge for the type of sleep study Mendoza had was $7,886, according to WellRithms.

Mendoza doesn’t pay premiums for his health plan, but his “free” coverage has a cost. The $5,000 deductible and high coinsurance leaves him woefully exposed financially if he needs medical care, as the family discovered. Nancy Mendoza’s plan has a lower deductible of $1,350, but her employer charges extra to cover spouses who have coverage available to them at their own jobs.

Obstructive sleep apnea is often undiagnosed, sleep medicine experts agree, and sleep studies can result in a diagnosis that leads to necessary treatment to help prevent serious problems like heart attacks and diabetes.

“From that perspective, sleep testing is actually underprescribed,” said Dr. Douglas Kirsch, medical director of sleep medicine at Atrium Health in Charlotte, North Carolina, who is past president of the American Academy of Sleep Medicine, a professional group.

After strong growth by independent and hospital-affiliated lab-based sleep centers over several years, there’s been a shift toward home-based sleep tests recently, said Charlie Whelan, vice president of consulting for health care at Frost & Sullivan, a research and consulting firm.

“The entire sleep medicine field is deeply worried about a future where more testing is done at home since it means less money to be made for in-center test providers,” Whelan said.

Josu00e9 Mendoza

Resolution: When the bill arrived, Nancy Mendoza thought it must be a mistake. José’s home sleep test hadn’t cost them a penny, and no one had mentioned their financial responsibility for the overnight test in the lab.

She called the billing office and asked for an itemized bill. There were no complications, no anesthesia, not even a doctor present. Why was it so expensive? But what they received wasn’t any more enlightening than the summary bill.

She got a clear impression that if they didn’t pay they’d be sent to collections. To avoid ruining their credit, they agreed to a two-year payment plan and got their first installment bill, for $214.87, in April. Nancy thinks the overall charge is too high: “It’s not fair [for] people who are in the low end of the middle class.”

Lisa Worley, associate vice president for media relations at the University of Miami Health System, said in a statement that Mendoza “does not qualify for financial assistance because he has health insurance.”

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But the health system’s posted financial assistance policy clearly states that financial assistance is available to “underinsured individuals with a balance remaining after third party liability of $1000 or more, whose family income for the preceding 12 months is equal to or less than 300%” of the federal poverty guidelines.

Under a less detailed version of the hospital policy included in one of their bills, the Mendozas meet the income threshold for “assistance provided on a sliding scale.”

In her statement, Worley referred to Mendoza’s sleep test as an “elective service.” The health system website says it “provides financial assistance for emergency and other medically necessary (non-elective) care.”

Mendoza’s sleep study was medically necessary. The emergency department staff evaluated him and determined he needed a new CPAP to deal with serious medical problems caused by his obstructive sleep apnea. His pulmonologist concurred, as did his insurer, which preauthorized the sleep study.

In a statement, Humana wrote: “With sleep studies, there can be a wide range of costs, depending on the complexity of the case and the setting.”

The insurer refused to comment on Mendoza’s case specifically, even though the Mendozas had given permission to discuss it.

The Takeaway: The Mendozas followed the rules: They used an in-network provider and got prior authorization from their insurance company for the test.

Unfortunately, they are caught between two financial traps of the U.S. health care system: high-deductible health plans, which are increasingly common, and sky-high billing.

With a high-deductible plan, it’s crucial to try to learn what you’ll owe before receiving nonemergency medical care. Ask for an estimate in writing; if you can’t get one, try to shop for a different provider who will give you an estimate.

Be aware that insurance plans that have zero or low premium costs may not be your best option for coverage.

Once you are stuck with a high bill that hits a high deductible, remember you can still negotiate with the hospital. Find out what a more reasonable charge would be and ask for your bill to be adjusted. Also inquire about payment assistance from the hospital — most hospitals must offer this option by law (though they often do not make it easy to apply for it).

If a doctor suggests a sleep study, ask if you can do one at home, and whether it’s really needed. And remember: Not every snore is sleep apnea.

Dan Weissmann, host of An Arm and a Leg podcast, contributed to the audio version of this story.

Bill of the Month is a crowdsourced investigation by KHN and NPR that dissects and explains medical bills. Do you have an interesting medical bill you want to share with us? Tell us about it!

Subscribe to KHN’s free Morning Briefing.

KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism about health issues. Together with Policy Analysis and Polling, KHN is one of the three major operating programs at KFF (Kaiser Family Foundation). KFF is an endowed nonprofit organization providing information on health issues to the nation.

April Policy Roundup

1. HealthyWomen Advocates for New Pain Treatments at the FDA

Monica Mallampalli, Ph.D., HealthyWomen’s senior scientific advisor, provided testimony at the FDA’s joint meeting of the Arthritis Advisory Committee and the Drug Safety and Risk Management Advisory Committee Meeting in late March 2021. The meeting was to review a potential osteoarthritis drug that could provide the first new osteoarthritis treatment in more than a decade. HealthyWomen supports expanding access to nonaddictive treatment for chronic pain, which affects more than 20% of women in the United States. Osteoarthritis is one cause of chronic pain. Though it affects Black and Chinese women at higher rates than white women, women of color are less likely to receive adequate pain treatment, if they get any at all. Though the FDA panel voted 19 to one against approving the drug, citing rare side effects and questions about long-term safety, HealthyWomen will continue to stand up for the health needs of women and advocate for nonaddictive pain treatments.

2. A New Study Confirms That Women’s Pain Is Underestimated

A new study published in the Journal of Pain confirmed what many already know: Women’s pain is underestimated. Research participants rated the pain of male and female subjects on video clips. Participants consistently underestimated women’s pain and judged women more likely to benefit from psychotherapy over pain medicine. The problem is worse for women of color.

3. Maternal Health Disparities Take Center Stage During Black Maternal Health Week

HealthyWomen was proud to support Black Maternal Health Week (BMHW) this April 11 through 17 to help bring national attention to racial disparities in maternal health. In the U.S., Black women are three times more likely to die as a result of pregnancy-related causes than white women, according to the CDC. On April 13, President Biden also formally recognized BMHW, the first-ever presidential recognition. As a senator, Vice President Kamala Harris co-sponsored the first BMHW resolution in 2018.

4. More Women Are Vaccinated Against Covid-19 Than Men

On April 14, 2021, the U.S. Census Bureau reported that 50% of adult women had gotten at least one dose of a Covid-19 vaccine compared with 44% of men. Vaccine hesitancy does not explain the difference, as just under 16% of men and women reported vaccine hesitation. Relevant factors may include access to the vaccine — which is higher for healthcare workers (three-quarters of whom are women) and older people (disproportionately women). Women, more often in caregiving roles, may also have a greater inclination to seek preventive care.

5. New Data Show Covid-19 Vaccines Are Safe for Pregnant Women

The mRNA Covid-19 vaccines from Pfizer-BioNTech and Moderna are safe and effective for pregnant women, according to a study published this month. Covid-19 antibodies were found in umbilical cord blood and breast milk, indicating that babies born to vaccinated mothers can also benefit from the vaccines. Earlier this year, Pfizer and BioNTech launched a large clinical trial with approximately 4,000 healthy pregnant women ages 18 and older to study the safety, tolerability and efficacy of the vaccine.

6. President Biden’s $2 Trillion Infrastructure Plan Could Bolster Telehealth Access

On March 31, 2021, President Biden announced a $2.3 trillion infrastructure plan, called the American Jobs Plan. The proposal allocates $100 billion to expanding high-speed internet and ensuring broadband access in underserved urban and rural areas. One-third of people living in rural areas don’t have access to broadband internet, which limits their access to video telehealth visits. Before this investment can be made, though, the bill has to pass both houses of Congress.

7. Marketplace Insurance Enrollments Continue to Climb

Healthcare.gov is open for business thanks to a presidential executive order signed earlier this year. By the end of March, 528,000 people had enrolled in health insurance through the marketplace. Millions of Americans may qualify for new or expanded subsidies to reduce the cost of coverage. To spread the word about affordable insurance options, the U.S. Department of Health and Human services launched a $50 million ad campaign, on top of $50 million that The Centers for Medicare & Medicaid Service (CMS) had previously committed. The health insurance marketplace will stay open through August 15, 2021. If you need health insurance or to check if you qualify for subsidies, visit Healthcare.gov.

8. Illinois Is Set to Expand Postpartum Insurance Coverage for Women With Low Incomes

Starting April 11, 2021 — the first day of Black Maternal Health Week — Illinois women with Medicaid can keep their health insurance coverage continuously, for up to a year after they give birth. Illinois is the first state to expand postpartum coverage enabled by the recently enacted American Rescue Plan. In announcing CMS’s approval of this coverage expansion, Health and Human Services Secretary Xavier Becerra noted that 52% of pregnancy-related deaths in the U.S. take place up to one year postpartum, and more than half of pregnant women on Medicaid had a gap in insurance coverage within six months of giving birth.

9. New Data Show That Sexually Transmitted Diseases Have Reached an All-Time High

According to newly released data from the CDC, sexually transmitted diseases (STDs) reached an all-time high in 2019 for the sixth year in a row. In 2019, 2.5 million cases of chlamydia, gonorrhea and syphilis were reported — a nearly 30% increase since 2015. Untreated STDs can cause health problems, raise other infection risks, and lead to pregnancy complications and infant mortality. People of color were more likely to have an STD than white people. Telehealth or express clinics could help close testing and treatment gaps that have worsened during the Covid-19 pandemic.

10. Biden Requests Nearly $11 Billion to End the Opioid Epidemic

President Biden released his first budget request to Congress, highlighting his healthcare priorities. The proposed budget includes $10.7 billion to help end the opioid epidemic, including funds for research, prevention and treatment and recovery services.

Lady Gaga and J.Lo Sell ‘Well’ Building Seal, but It’s a Payday, Not a PSA

By Michael McAuliff, Kaiser Health News

Viewers could be excused for thinking Robert De Niro was just being a good fella in an ad promoting safe buildings amid the covid pandemic, along with the likes of Jennifer Lopez, Lady Gaga and Michael B. Jordan.

This story also ran on The Daily Beast. It can be republished for free.

They would be wrong.

De Niro and the other A-list celebs are backing something called the Well Health-Safety seal, offered by the International Well Building Institute. The organization, a for-profit subsidiary of a decade-old real estate service company called Delos, is piggybacking on post-pandemic anxiety to profit by popularizing its healthy building certification program.

“Feeling safe should be a right for all, not a privilege for some,” De Niro says in one spot.

What the ad doesn’t tell viewers, though, is that the seal itself is something of a privilege that must be bought. Companies pay — sometimes a lot — to be judged on a range of categories. Some relate directly to covid (such as air quality), but others are less easily measured and have little obvious link to the pandemic (community “connectivities”).

And De Niro, plus Venus Williams, Wolfgang Puck and even New Age guru Deepak Chopra, is being well paid to endorse the Well seal in a carefully planned and executed campaign.

“We compensated them for their time,” IWBI President and CEO Rachel Hodgdon confirmed in an interview, explaining that the effort was modeled on a green schools campaign she ran several years ago at the U.S. Green Building Council. She declined to specify how much it cost to harness all that star power, or how much the company is spending to air the ads.

A spokeswoman said the spots have run nationally since late January on more than 30 networks, including Bravo, MTV, TBS, FX, Paramount, CNBC and CNN, but said the dollars spent “are confidential.”

The cost is certainly substantial. Data from the ad-tracking firm iSpot.tv shows that the institute has spent nearly $500,000 to air six ads.

“What I wanted to do with this campaign was make it very much in the style of a public service announcement,” Tony Antolino, the chief marketing officer at Delos, told Ad Age.

But the effort very much services the bottom line of Delos.

Not to be confused with the diabolical corporation of the same name in the HBO series Westworld, Delos was founded in 2009 by former Goldman Sachs partner Paul Scialla with the aim of linking real estate to the health and wellness industry.

The company has raised $237 million from investors, including Bill Gates, according to Forbes.

In interviews, Scialla describes himself as an “altruistic capitalist.” He told the Los Angeles luxury lifestyle publication Dreams that he saw “a unique opportunity to merge the world’s largest asset class — the $180 trillion worth of real estate — with the world’s fastest growing industry — wellness.”

Putting together an all-star cast for a for-profit venture took some doing.

“It wasn’t a fast process, because each of these celebrities and influencers has a rigorous process through which they filter any opportunity,” said Hodgdon, who also got director Spike Lee to ask questions of the famous “ambassadors.”

“We went through a pretty intensive process of educating the celebrities and the teams that work with them on why there was heft and legitimacy behind what we were putting out there,” she said.

She recalled Lady Gaga saying in one interview, “Look, I really believe in what you all are doing. I said yes to this because I think that this is really important.”

Having clean, healthy buildings is undoubtedly important for many. It’s especially so for the International Well Building Institute, which is using its seal as a gateway into its broader building certification services.

“What’s been exciting for us is that a lot of our customers who are entering in through the Well Health-Safety Rating are now beginning to upsize their commitment to achieve a full-on wellness certification, which is so important,” Hodgdon said.

The price for the health seal starts at $2,730 and rises to $12,600. Getting seals for multiple locations or franchises can run up to $166,000. Starter costs are cheaper if a property owner already buys the broader certification service. That starts at about $9,000 and rises to just over $100,000. Additional testing services start at $6,500.

Delos launched the certification standard in 2014 after what the institute says was a rigorous peer-reviewed process. The program is modeled on the U.S. Green Building Council’s LEED program, and uses the Green Building Council to verify its work. Hodgdon worked there for a decade before moving to the IWBI, along with the Green Building Council’s founder, Rick Fedrizzi.

The certification covers 10 categories, including such easily measured things as air and water quality, sound and temperature, and harder-to-pin-down items such as mental health, community “connectivities,” movement and nourishment — all backed, Hodgdon said, by science and study.

Whether meeting all the standards in those categories will also lead to a building’s occupants becoming healthier and fulfilled probably will take a long time to prove. The company points to case studies — some done by its own workers and clients — that suggest the holistic approach pays off.

Independent experts — scientists, doctors, engineers, mental and physical health experts, and others — who helped evaluate the initial standard described the concepts as sound.

“They asked provocative questions. They were interested in what experts had to say. I thought it was a pretty good process,” said Ellen Tohn, an assistant professor of epidemiology at Brown University who runs an environmental engineering firm and is listed as a peer reviewer.

Still there’s no guarantee it actually works. Even the well-regarded LEED program often doesn’t live up to its hope and hype.

“It seems rather obvious: Skepticism is in order,” said John Scofield, a physics professor at Oberlin College in Ohio who has extensively studied the LEED program.

Scofield noted that there is very little empirical data that can be used to verify the effects of certification programs, since landlords often refuse access to researchers.

“Owners have little to gain by allowing someone to study the performance of their building. They have already garnered the green publicity and marketing that goes with the label,” he said.

“In the end, all of these programs, no matter how well-intentioned, turn into marketing and money.”

While Delos’ program appears to be the most ambitious attempt to create an independent arbiter of building health, there are others, including some run by nonprofits.

Another option for builders less focused on the mind-body connection and more on just air quality is the Environmental Protection Agency’s Indoor airPlus certification program.

It’s free.

Subscribe to KHN’s free Morning Briefing.

KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism about health issues. Together with Policy Analysis and Polling, KHN is one of the three major operating programs at KFF (Kaiser Family Foundation). KFF is an endowed nonprofit organization providing information on health issues to the nation.

Can the Covid-19 Vaccine Disrupt Our Menstrual Cycle? Maybe — But It’s Likely Nothing to Worry About

When I got the alert that COVID-19 vaccines were available to people 16 and over in Los Angeles, I booked the soonest available appointment. This was in late March, and by then I well understood that it’s normal for the vaccine (specifically the second dose, as required with Pfizer-BioNTech and Moderna) to trigger flu-like symptoms and other temporary ailments.

A few days of feeling achy and tired is nothing compared to the risk of getting infected with and spreading COVID-19, so I wasn’t at all worried. Months after my vaccination, I’m still not worried — but there is something I wish I’d known beforehand: The vaccine might (big emphasis on the word “might”) disrupt one’s menstrual cycle.

Women are taking to social media to share their stories

I got wind of the Covid-19 vax potentially affecting
menstruation on Twitter, where droves of women have been sharing stories about irregular menstruation after being fully vaccinated against Covid-19.

By the time I stumbled upon these tweets, I’d already received my second shot. Coincidentally, I got it on the first day of my period that month.

Typically, I have a very heavy first day and then a more regular to light flow in the days following. But after that second jab, my period was different. The next three days were heavier and more painful than usual. Then, on day four, the bleeding abruptly ended, whereas normally it would taper off. It returned a couple days later, heavy as ever, and then disappeared again.

The sudden change in my cycle alarmed me, not only because I’m always regular but because I’m trying to get pregnant. I diligently track my periods and an irregularity, though usually no cause for concern, could signal an underlying problem with my fertility. Not to mention it could throw off my whole ovulation schedule.

Is it mere chance or could the vaccine be causing disruptions to our menstrual cycles?

I brought this question to a few OB-GYNs, all of whom were grateful to explore this topic with me as it continues to generate conversation on social media.

“My 16-year-old daughter told me that these stories and questions are blowing up on Instagram,” said Dr. Frank Tu, a clinical associate professor at the University of Chicago who specializes in obstetrics and gynecology at NorthShore University. “It’s huge right now.”

We face a lack of scientific evidence — for now 

Though Tu and other OB-GYNs I consulted think there could be some correlation between the second vaccine and altered menstruation in some women, there’s no substantial scientific research yet available on the subject, so we’re still very much in the realm of anecdotal evidence.

“We don’t have good scientific research yet to know yet if the vaccine is directly affecting menstruation,” said Dr. Nora Doyle, OB-GYN specialist and the Kirk Kerkorian School of Medicine at UNLV’s assistant dean of student affairs.

Dr. Michael Tahery, an OB-GYN, urogynecologist and assistant professor of OB-GYN at the UCLA Geffen School of Medicine, concurred with Doyle, adding that we likely won’t know how much — or if at all — the Covid-19 vaccine affects menstruation for another few years. But so far “no studies in any of the OB-GYN literature indicate that there could be a problem,” Tahery said.

It could be our immune system hard at work

Dr. Tu hypothesized that the reason women may experience an unusual or skipped period after the second vaccine is because of the vaccine’s potency.

“Any vaccine so powerful that it triggers such a strong immune response has enormous effects on the body,” Tu said. “People talk about how, after the vaccine, they have fatigue and flu-like symptoms. If the vaccine causes that strong an effect, it should be able to affect uterine lining and endocrine levels, too.”

Dr. Doyle sees how the tremendous immune response, particularly spurred by the second vaccine, could disrupt a woman’s cycle — noting the complex relationship between a woman’s immune system and her menstrual cycle — but reasoned that there could be other causes for a weird or missed period after the Covid-19 vaccine.

Stress and other benign factors can play a role, too

“Certainly, a number of physical and mental stressors associated with the Covid-19 pandemic have affected everyone this past year, including women,” Doyle said. “To say that the vaccine alone is the sole perpetrator of menstrual irregularities is perhaps a pedestrian explanation of this multipart cause.”

And there are many other reasons for menstrual irregularity including, “weight gain, weight loss, diet, travel and even exercise,” Tahery said.

One wonky cycle is normal — but only one

There could be other serious reasons behind a funky cycle including uterine fibroids, endometriosis and polycystic ovary syndrome (PCOS), to name but a few. It’s important to know when to be concerned and when to let it go.

If you have one weird cycle after the vaccine, you can likely chalk it up to being no big deal — regardless of how slight our scientific understanding is at this point. If the irregularities continue past one cycle, or if you find yourself in extreme pain and/or losing a lot of blood, it’s time to consult your healthcare provider. But in any event, it’s too soon to point a finger at the vaccine, and even if the vaccine is to blame, its effects on menstruation appear to be temporary and harmless.

If you haven’t yet gotten the vaccine and have a history of heavy periods and intense discomfort while menstruating, Dr. Tu recommends scheduling your vaccine appointment so that the second jab happens right after your period ends.

“There’s so much vaccine available now that if you already have uncomfortable periods, try to schedule it,” Tu said. “Of course, don’t wait months and months but, if possible, do that. If you’re not having any menstrual problems, just get the vaccine as fast as you can.”

Find Covid-19 Vaccines Near You

Giving Food Pantry Clients Choices – and Gently Nudging Them Toward Nutritious Foods – Can Lead to Healthier Diets

By Caitlin Caspi, University of Connecticut and Marlene B. Schwartz, University of Connecticut

Food banks and pantries across the U.S. were forced in the pandemic to dispense with something that is central to most people’s grocery experience: choice.

Faced with social-distancing rules and a large uptick in need – by one estimate these nonprofits served 55% more people – for the most part, clients were offered prepacked bags or boxes of food rather than allowed to pick from shelves themselves, as was increasingly common before the pandemic.

It was one of a number of adaptations that food banks and pantries made in 2020, which also included drive-thru services and expanded meal delivery options.

The content of these prepacked bags differed from venue to venue and also by who was assembling them. As a result, there was tremendous variability in the quality of produce being offered and whether they contained the kind of food that people were seeking.

As experts on food policy and obesity, we are aware of both the important role of choice to clients of food pantries, and also the need to encourage healthier options. People who rely on food pantries are disproportionately at risk for diet-related diseases such as diabetes and hypertension, yet most would like to eat more fresh fruit and vegetables.

We are currently conducting work on the charitable food system and its potential to promote a healthy lifestyle through measures including behavioral economics, which uses “nudges” to promote behavior change.

Our prior research suggests that people want healthy food that can be used to put together balanced meals when they visit food pantries. In a 2019 study of over 200 food pantries and more than 5,000 of their clients in Minnesota, the top requested food categories were all healthy items that form the basis of the American diet, including meat, fresh fruits and vegetables, dairy products, eggs, and common ingredients like flour and spices. In fact, over 90% of clients said they would like to get more fresh fruits and vegetables.

At the same time, only about half of the people surveyed said that fresh fruits and vegetables were available at their local food pantry during every visit. Demand for healthy food has been consistently demonstrated in studies in other U.S. areas as well.

Another key finding from the Minnesota survey was that people who visit food pantries place a very high value on choosing their own food. They said that this is even more important than having reasonable wait times and being welcomed by volunteers.

Because clients really want healthy food, it makes sense for food pantries to make it easier for them to make healthier choices. This requires making sure that food pantries stock a consistent supply of healthy and fresh food. It also requires displaying food so that it is appealing and accessible to people.

This is where behavioral economics can be helpful in guiding food pantry clients to healthier food options.

Changing behaviors

Behavioral economics builds on the way that people make decisions by restructuring environments to encourage certain choices. For example, grocery carts have gotten bigger over the years to nudge people to buy more food. The idea behind the bigger carts is that fewer people will head to the checkout aisle with a cart that feels empty, so they will buy more stuff.

Behavioral economics strategies are used commonly in grocery stores, but they are a good match for food pantries for several reasons. Many behavioral economics strategies are compatible with the way food pantries already operate. And food pantries have leeway in setting the default options for clients. This might mean offering bags of produce by default, but providing day-old birthday cakes by request, rather than displaying them by the front door.

And unlike many food retailers, as nonprofits, food pantries do not rely on advertising from food distributors for revenue. That means food pantries are under no obligation, for example, to display soda prominently as is the case in many supermarkets. They are also at liberty to alter their layout and what’s on the shelves to nudge clients toward healthier options.

Food pantries that have started to use behavioral economics to promote healthier choices are seeing results. Studies in Utah, Minnesota and New York have shown that people are more likely to take healthy foods in food pantries when they are nudged.

New tools are making it easier to use behavioral economics. In March of 2020, Healthy Eating Research, a national program that supports research on strategies to promote healthy eating among children, published new guidelines for the healthfulness of food bank and pantry offerings. These guidelines have been supported by Feeding America, the largest network of food banks in the U.S.

The new guidelines offer a system for ranking individual food items in a three-tiered system using a “stoplight system” of green, yellow and red, based on their nutritional value. Stoplight systems like this have long been used in other countries to encourage people to buy healthier food in grocery stores.

Perhaps the most common food-ranking system in the charitable food system is Supporting Wellness at Pantries. SWAP, which was introduced in 2016 and has been updated to meet the new charitable food guidelines, can be used to nudge both food pantry staff to procure healthier food and clients to select it. Research has shown that SWAP has resulted in healthier food at the pantry being ordered by staff and offered to clients. In our most recent study we found that after a pantry implemented SWAP, clients selected significantly more “green” foods and fewer “red” foods.

[You’re smart and curious about the world. So are The Conversation’s authors and editors. You can read us daily by subscribing to our newsletter.]

A post-pandemic model

The pandemic has accelerated the emergence of a number of innovations in food banks and pantries and encouraged client-centered practices like trauma-informed services, new mobile and delivery options and opportunities to preserve client anonymity. New models are also being considered to address not just the immediate need of clients, but also the root causes of food insecurity.

As food pantries pivot to a post-pandemic model, we believe putting choice at the center and helping guide decisions through nudges toward healthier, nutritious food would serve food pantry clients well.The Conversation

Caitlin Caspi, Associate Professor of Allied Health Sciences, University of Connecticut and Marlene B. Schwartz, Professor of Human Development and Family Sciences, University of Connecticut

This article is republished from The Conversation under a Creative Commons license. Read the original article.

คนที่หลงตัวเองไม่ได้เป็นเพียงแค่ตัวเองเท่านั้น – การวิจัยใหม่พบว่าพวกเขามีแนวโน้มที่จะก้าวร้าวและรุนแรงมากขึ้น

โดย แบรดบุชแมน, มหาวิทยาลัยแห่งรัฐโอไฮโอ และ Sophie kjaervik, มหาวิทยาลัยแห่งรัฐโอไฮโอ

บทสรุปการวิจัย เป็นเนื้อหาสั้น ๆ เกี่ยวกับงานวิชาการที่น่าสนใจ


เมื่อเร็ว ๆ นี้เราได้ตรวจสอบการศึกษาเกี่ยวกับการหลงตัวเองและความก้าวร้าว 437 ที่เกี่ยวข้องกับผู้เข้าร่วมทั้งหมดกว่า 123,000 คนและพบว่าการหลงตัวเองนั้นเกี่ยวข้องกับ ความก้าวร้าวเพิ่มขึ้น 21% และความรุนแรงเพิ่มขึ้น 18%.

การหลงตัวเองถูกกำหนดให้เป็น“สิทธิความสำคัญในตนเอง. “คำว่าหลงตัวเองมาจากตำนาน ตัวละครกรีกนาร์ซิสซัสซึ่งตกหลุมรักภาพของตัวเองที่สะท้อนในน้ำนิ่ง มีการกำหนดความก้าวร้าว เป็นพฤติกรรมที่ตั้งใจจะทำร้ายบุคคลอื่นที่ไม่ต้องการได้รับอันตรายในขณะที่ มีการกำหนดความรุนแรง เป็นความก้าวร้าวที่เกี่ยวข้องกับการทำร้ายร่างกายอย่างรุนแรงเช่นการบาดเจ็บหรือเสียชีวิต

การตรวจสอบของเราพบว่าบุคคลที่หลงตัวเองในระดับสูงมักมีความก้าวร้าวเป็นพิเศษเมื่อถูกยั่วยุ แต่ก็มีความก้าวร้าวเช่นกันเมื่อพวกเขาไม่ถูกยั่วยุ ผู้เข้าร่วมการศึกษาที่มีความหลงตัวเองในระดับสูงแสดงให้เห็นถึงความก้าวร้าวทางร่างกายในระดับสูงความก้าวร้าวทางวาจาการแพร่กระจายการนินทาการกลั่นแกล้งผู้อื่นและแม้กระทั่งการแทนที่ความก้าวร้าวต่อผู้ที่ไม่รู้อิโหน่อิเหน่ พวกเขาโจมตีทั้งในลักษณะเลือดร้อนและเลือดเย็น การหลงตัวเองเกี่ยวข้องกับความก้าวร้าวในเพศชายและเพศหญิงทุกวัยจากทั้งประเทศตะวันตกและตะวันออก



สายงานที่สำคัญอย่างหนึ่งคือการตรวจสอบว่าผู้คนหลงตัวเองตั้งแต่แรกได้อย่างไร ตัวอย่างเช่น, การศึกษาหนึ่ง พบว่าเมื่อพ่อแม่ประเมินค่าสูงเกินไปและยกย่องคุณสมบัติของลูกมากเกินไปลูกก็มีแนวโน้มที่จะหลงตัวเองมากขึ้นเมื่อเวลาผ่านไป พ่อแม่เช่นนี้คิดว่าลูกของตนมีความพิเศษและมีสิทธิมากกว่าเด็กคนอื่น ๆ การศึกษานี้ยังพบว่าหากพ่อแม่ต้องการให้ลูกมีความภาคภูมิใจในตนเองที่ดีต่อสุขภาพแทนการหลงตัวเองที่ไม่ดีต่อสุขภาพพวกเขาควรให้ความอบอุ่นและความรักแก่ลูกอย่างไม่มีเงื่อนไข

การทบทวนของเราดูความเชื่อมโยงระหว่างการหลงตัวเองและความก้าวร้าวในระดับบุคคล แต่ลิงก์ยังมีอยู่ในระดับกลุ่ม การวิจัยพบว่า“ การหลงตัวเองโดยรวม” – หรือ“ กลุ่มของฉันเหนือกว่ากลุ่มของคุณ” – เกี่ยวข้องกับการรุกรานระหว่างกลุ่มโดยเฉพาะอย่างยิ่งเมื่อคนในกลุ่ม (“ พวกเรา”) ถูกคุกคามจากคนนอกกลุ่ม (“ พวกเขา”)

Sending Science Majors Into Elementary Schools Helps Latino and Black Students Realize Scientists Can Look Like Them

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By Dieuwertje J. Kast, University of Southern California

The Research Brief is a short take about interesting academic work.

The big idea

After taking part in hands-on STEM lab experiments as part of a youth science program I coordinate, Latino and Black students were more likely to picture scientists as people who look like them – and not stereotypical white men in lab coats.

The Young Scientists Program at the Joint Educational Project of the University of Southern California offers specialized science, technology, engineering and math instruction in local elementary schools that have mostly Latino and Black students – two groups long underrepresented in STEM fields. My colleagues and I recruit undergrad and graduate STEM majors to teach lab experiments at seven schools in Los Angeles. About 2,400 students in grades two to five receive 20 hours of instruction each year. Over 80% of the students are Latino, and about 13% are African American.

We wanted to get a sense of whether the program increases the kids’ interest in science, as well as whether it changes how they view scientists. To do so, we used an evaluation tool based on the Draw-A-Scientist-Test created by educational researcher David Wade Chambers in 1983 which assessed kids’ preconceived notions of what scientists look like. Researchers later developed a checklist for the drawings that includes certain characteristics like gender, age, race and being in a laboratory.

When our program began collecting drawings of scientists from its participating students in 2015, 90% of the pictures were of white men in lab coats, often looking like Albert Einstein. About 10% of the students did not know what a scientist is or does. This was demonstrated by students who wrote “I don’t know” or drew question marks on their drawings.

The drawings have become more diverse over time, which we attribute to a gamut of reasons including hiring more diverse teaching staff and incorporating more examples of scientists of color into our programming.

In fall of 2019, before beginning the yearlong program, we asked the kids to draw a picture of a scientist. Just under 40% drew white female scientists, 6% drew scientists of color – either men or women – and 6% drew themselves as a scientist. Almost half of them, 48%, depicted scientists as either white men or cartoon characters. After completing the program, the kids were asked to draw a picture of a scientist again. This time, 37% of them drew white women, 10% drew scientists of color and 9% drew themselves. Only 44% drew white men or cartoon characters.

These increases in students who drew themselves or scientists of color, though perhaps seemingly small, are significant. They demonstrate that the students are developing and internalizing an identity of becoming a scientist.

Why it matters

Black workers make up only 9% of the STEM workforce, and Latino workers represent 8%, though they are roughly 13% and 19% of the U.S. population, respectively. Similarly, Black and Latino undergrad and graduate students are less likely to earn STEM degrees than white and Asian students.

Without diversity in the STEM fields, it’s harder for students of color to see themselves as future scientists. Research shows a more diverse scientific community would likely lead to more innovation, better health care, more supportive academic spaces and a greater trust in science, just to name a few benefits.

What still isn’t known

We hope that students who finish the Young Scientists Program continue to pursue STEM and go on to become scientists themselves. However, that data is not available, and we are unable to track the graduates. We do have one former participant and four other community students who are STEM majors who are now on staff and teaching science in the community where they grew up. This epitomizes the goal of our program.

What’s next

To change students’ preconceived notions of scientists as being white and male, it’s important they experience diverse science teachers, are taught about scientists of color in history and see diverse characters in science-related children’s books. Its our hope to see more of the students in our program drawing scientists of color or themselves as scientists in future drawings.The Conversation

Dieuwertje J. Kast, Director of STEM Education Programs of the Joint Educational Project, University of Southern California

This article is republished from The Conversation under a Creative Commons license. Read the original article.

No-Cancel Culture: How Telehealth Is Making It Easier to Keep That Therapy Session

By Eric Berger, Kaiser Health News

When the covid-19 pandemic forced behavioral health providers to stop seeing patients in person and instead hold therapy sessions remotely, the switch produced an unintended, positive consequence: Fewer patients skipped appointments.

This story also ran on NBC News. It can be republished for free.

That had long been a problem in mental health care. Some outpatient programs previously had no-show rates as high as 60%, according to several studies.

Only 9% of psychiatrists reported that all patients kept their appointments before the pandemic, according to an American Psychiatric Association report. Once providers switched to telepsychiatry, that number increased to 32%.

Not only that, but providers and patients say teletherapy has largely been an effective lifeline for people struggling with anxiety, depression and other psychological issues during an extraordinarily difficult time, even though it created a new set of challenges.

Many providers say they plan to continue offering teletherapy after the pandemic. Some states are making permanent the temporary pandemic rules that allow providers to be reimbursed at the same rates as for in-person visits, which is welcome news to practitioners who take patients’ insurance.

“We are in a mental health crisis right now, so more people are struggling and may be more open to accessing services,” said psychologist Allison Dempsey, associate professor at University of Colorado School of Medicine in Aurora. “It’s much easier to connect from your living room.”

The problem for patients who didn’t show up was often as simple as a canceled ride, said Jody Long, a clinical social worker who studied the 60% rate of no-shows or late cancellations at the University of Tennessee Health Science Center psychiatric clinic.

But sometimes it was the health problem itself. Long remembers seeing a first-time patient drive around the parking lot and then exit. The patient later called and told Long, “I just could not get out of the car; please forgive me and reschedule me.”

Long, now an assistant professor at Jacksonville State University in Alabama, said that incident changed his perspective. “I realized when you’re having panic attacks or anxiety attacks or suffering from major depressive disorder, it’s hard,” he said. “It’s like you have built up these walls for protection and then all of a sudden you’re having to let these walls down.”

Absences strain providers whose bosses set billing and productivity expectations and those in private practice who lose billable hours, said Dempsey, who directs a program to provide mental health care for families of babies with serious medical complications. Psychotherapists often overbooked patients with the expectation that some would not show up, she said.

Now Dempsey and her colleagues no longer need to overbook. When patients don’t show up, staffers can sometimes contact a patient right away and hold the session. Other times, they can reschedule them for later that day or a different day.

And telepsychiatry performs as well as, if not better than, face-to-face delivery of mental health services, according to a World Journal of Psychiatry review of 452 studies.

Virtual visits can also save patients money, because they might not need to travel, take time off work or pay for child care, said Dr. Jay Shore, chairperson of the American Psychiatric Association’s telepsychiatry committee and a psychiatrist at the University of Colorado medical school.

Shore started examining the potential of video conferencing to reach rural patients in the late ’90s and concluded that patients and providers can virtually build rapport, which he said is fundamental for effective therapy and medicine management.

But before the pandemic, almost 64% of psychiatrists had never used telehealth, according to the psychiatric association. Amid widespread skepticism, providers then had to do “10 years of implementations in 10 days,” said Shore, who has consulted with Dempsey and other providers.

Dempsey and her colleagues faced a steep learning curve. She said she recently held a video therapy session with a mother who “seemed very out of it” before disappearing from the screen while her baby was crying.

She wondered if the patient’s exit was related to the stress of new motherhood or “something more concerning,” like addiction, she said. She thinks she might have better understood the woman’s condition had they been in the same room. The patient called Dempsey’s team that night and told them she had relapsed into drug use and been taken to the emergency room. The mental health providers directed her to a treatment program, Dempsey said.

“We spent a lot of time reviewing what happened with that case and thinking about what we need to do differently,” Dempsey said.

Providers now routinely ask for the name of someone to call if they lose a connection and can no longer reach the patient.

In another session, Dempsey noticed that a patient seemed guarded and saw her partner hovering in the background. She said she worried about the possibility of domestic violence or “some other form of controlling behavior.”

In such cases, Dempsey called after the appointments or sent the patients secure messages to their online health portal. She asked if they felt safe and suggested they talk in person.

Such inability to maintain privacy remains a concern.

In a Walmart parking lot recently, Western Illinois University psychologist Kristy Keefe heard a patient talking with her therapist from her car. Keefe said she wondered if the patient “had no other safe place to go to.”

To avoid that scenario, Keefe does 30-minute consultations with patients before their first telehealth appointment. She asks if they have space to talk where no one can overhear them and makes sure they have sufficient internet access and know how to use video conferencing.

To ensure that she, too, was prepared, Keefe upgraded her Wi-Fi router, purchased two white noise machines to drown out her conversations and placed a stop sign on her door during appointments so her 5-year-old son knew she was seeing patients.

Keefe concluded that audio alone sometimes works better than video, which often lags. Over the phone, she and her psychology students “got really sensitive to tone fluctuations” in a patient’s voice and were better able to “pick up the emotion” than with video conferencing, she said.

With those telehealth visits, her 20% no-show rate evaporated.

Kate Barnes, a 29-year-old middle school teacher in Fayetteville, Arkansas, who struggles with anxiety and depression, also has found visits easier by phone than by Zoom, because she doesn’t feel like a spotlight is on her.

“I can focus more on what I want to say,” she said.

In one of Keefe’s video sessions, though, a patient reached out, touched the camera and started to cry as she said how appreciative she was that someone was there, Keefe recalled.

“I am so very thankful that they had something in this terrible time of loss and trauma and isolation,” said Keefe.

Demand for mental health services will likely continue even after the lifting of all covid restrictions. About 41% of adults were suffering from anxiety or depression in January, compared with about 11% two years before, according to data from the U.S. Census Bureau and the National Health Interview Survey.

“That is not going to go away with snapping our fingers,” Dempsey said.

After the pandemic, Shore said, providers should review data from the past year and determine when virtual care or in-person care is more effective. He also said the health care industry needs to work to bridge the digital divide that exists because of lack of access to devices and broadband internet.

Even though Barnes, the teacher, said she did not see teletherapy as less effective than in-person therapy, she would like to return to seeing her therapist in person.

“When you are in person with someone, you can pick up on their body language better,” she said. “It’s a lot harder over a video call to do that.”

KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism about health issues. Together with Policy Analysis and Polling, KHN is one of the three major operating programs at KFF (Kaiser Family Foundation). KFF is an endowed nonprofit organization providing information on health issues to the nation.


This story can be republished for free (details).

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My Parents Dismissed My Anxiety. Now I’m Helping My Daughter Work Through Hers

As told to Nicole Audrey Spector

May is Mental Health Awareness Month.

I can’t remember a time during my childhood when I didn’t feel worried.

Even in first grade, there was always this sense of unease in my stomach, a tangled knot of dread. My mind was constantly churning out terrifying “what ifs.” What if my parents die? What if my mom never picks me up from school? What if, after the lights go off for bedtime, they never come back on? The thoughts just wouldn’t stop, and the more I tried to quiet them, the louder they became.

My anxiety got so intense that at playdates and sleepovers, I’d sometimes make myself throw up just to appear sick so my mom would come get me early.

To my knowledge, my incessant anxiety wasn’t prompted by any specific event. Perhaps if there had been some known trauma or tragedy beforehand, my family would have taken my anxiety seriously. Instead, nobody around me gave much thought to my being literally worried sick all the time. My sisters teased me about it. My parents shrugged it off as normal kid stuff that I’d grow out of. The idea of getting me a therapist or any other type of help was never considered.

Over time, I learned to lock my anxiety away like my worst secret.

In my teen years, my fear and dread shifted onto my studies. I believed that if I did not achieve academic perfection at every opportunity, something horrific would happen. My anxiety persisted through college, when one day, my heart began palpitating and I fainted.

I went to see my doctor, who, after running tests on my heart (all clear), suggested I see a therapist, suspecting I suffered from an anxiety disorder. I was shocked. I knew I was different, but I never thought there was any sort of disorder at hand.

I began seeing a therapist and a psychiatrist. I was diagnosed with generalized anxiety and prescribed an SSRI, which is a type of medication that can help treat depression and anxiety by increasing levels of serotonin in the brain. The treatment was life-changing. The fear lifted off my chest. It felt like I was finally myself.

Some years later, still doing well and in therapy, I got married. A few years after that, I became pregnant. At that time, I chose to go off my medication, thinking an SSRI could affect my baby. I was in between therapists and just hadn’t gotten around to finding a new one.

Immediately, I fell back into the clutches of anxiety — which felt worse than ever. I loved being pregnant, but after my first of two children, Kelly*, was born, my postpartum depression was unbearable. Sleep deprivation triggered all my old anxiety symptoms times 10 — with a heaping side of depression. At times I was so sad and anxious I considered suicide, though fortunately never made any attempts. In retrospect, I don’t even know how I survived it.

It’s all kind of a blur to me now, but I was eventually able to understand that if I was going to care for my daughter (and keep my marriage intact), I would need to return to therapy and get back on my meds. And so I did. I got back on track and had my second child, this time with proper mental health care and very little anxiety or depression.

Around the time our second child was born, Kelly was just over 2 years old. I started noticing that she was a lot like I was at her age. She didn’t seem anxious per se, but she was extremely sensitive and quick to take on the pain of others. In preschool, she made sure everyone had their snack before she ate. If I was ever upset about anything, she rushed to console me, giving me her favorite stuffed animal for comfort.

Kelly didn’t seem worried, just deeply empathetic, so I wasn’t concerned — until the night terrors began. And the sudden social shutdowns. And the obsessing over “what if” scenarios.

One day when Kelly was 4, she couldn’t stop sobbing and turned to me with wide, worried eyes and said, “Mommy, I’m scared.” My heart just broke. Seeing Kelly so small with the weight of the world on her little shoulders, I thought, “That was me.”

My husband and I met with a pediatrician who referred Kelly to a child therapist. Within weeks of beginning therapy, we noticed a huge difference: Kelly was more confident, more engaged with others, and less prone to panic.

Around this time, I met with my mother for lunch. I’d been hesitant to tell her that Kelly was receiving mental health treatment (I hadn’t wanted to open myself up to possible criticism), but I decided it was best that she knew. So, I explained all the anguish Kelly had gone through and how much better she was doing now. As I spoke, my mother remained very quiet.

“Kristi,” she said, a sadness welling in her eyes. “That’s exactly how you were.”

Then she asked me if my feeling like that — worried all the time — had made it hard for me growing up.

I admitted that it had been.

“I am so sorry,” she said. “I didn’t know. I thought it was just a phase.”

She told me how proud she was of me for not letting my daughter go through what I went through. At that moment, whatever remnants of resentment I’d carried in my heart sloughed off like dead skin. The inner anxious child in me felt finally heard, seen and calmed.

I thought of all the other parents out there who, like my mother, love their children so much but may not know what to do when their child is anxious or even what signs to look for. And I thought of the parents out there like me, who have learned how to cope with their own anxiety but are at a loss with their child’s. The common denominator between people like me and people like my mother is, in part, a lack of accessible resources to understand and address a child’s anxiety. So I came up with Wondergrade, a company and app that teaches parents tools to help their young kids self-regulate and calm down when anxious.

Every once in a while, Kelly will approach me with a worried “what if?” In return, I ask her, “What is most likely to happen?” She works out that, most likely, whatever dreaded scenario she’s imagining won’t occur because it hasn’t thus far. She self-regulates and her fear flies away.

Sometimes a “what if” creeps up on me, too. But now I know how to shoot it down, just like Kelly does. And I know how to do what used to be impossible for me: I go about my day, moment by moment, feeling — fearlessly — every beautiful second.

*Kelly is not her real name.


Anxiety & Depression Association of America

National Alliance on Mental Health

National Institute of Mental Health