Health

(NEW YORK) — When Kat, a 23-year-old living in Central Texas, discovered they were pregnant, it was five days before a law that bans nearly all abortions after six weeks was to go into effect.

“I was stuck with this reality that I was pregnant days before one of the worst abortion bans that I’ve seen in my life gets implemented in Texas,” Kat, whose gender pronouns are they/them and who asked that their last name not be used, told Good Morning America. I was scared.”

Kat said that after estimating they were likely between four and six weeks pregnant, they feared not having access to an abortion after Sept. 1, the day the law, Senate Bill 8, went into effect. They also learned the two abortion providers in town were “completely booked” due to the pending deadline.

“I thought I can’t be pregnant right now. I don’t want to be pregnant. I don’t have the time or money to travel out of state [for an abortion],” said Kat. “I knew I had to do what was best for me and my best option was to have an abortion at home.”

Kat said they went through with a self-managed abortion at home and while medically safe, the experience felt terrifying.

A self-managed abortion is one that occurs outside of a clinical setting. It is typically done by taking medication that induces a miscarriage.

“The reality is that I was at home alone having an abortion,” they said. “I was worried about going to the hospital, worried about complications and didn’t have anyone there with me because of COVID.”

Kat’s experience is one that abortion rights advocates worry will become all too common across Texas, the nation’s second most populous state with now the most restrictive abortion law in the nation.

The law, enforced after the U.S. Supreme Court failed to intervene, does not make exceptions for pregnancies resulting from incest or rape. It allows anyone to sue a person they believe is providing an abortion or assisting someone in getting an abortion after six weeks.

When a person is six weeks pregnant, it typically means the embryo started developing about four weeks prior, based on the formula used to figure out when a person will give birth. People don’t often realize they are pregnant until after the six-week mark.

Cardiac activity is typically first detected five to six weeks into pregnancy, or three-four weeks after the embryo starts developing.

“A lot of people don’t think about abortion access until they need an abortion,” said Joan Lamunyon Sanford, executive director of the New Mexico Religious Coalition for Reproductive Choice, which provides financial and logistical support for people who travel to New Mexico for abortions. “There are likely people in Texas that don’t know they’re pregnant yet today but will find out they’re pregnant next week or the week after and will call their local clinic and find out that they can’t be seen.”

Lamunyon Sanford’s organization and others that help cover the costs of travel for people to seek abortions say they are already seeing an increase in services needed, and bracing for more.

“We anticipate it’s going to really start increasing next week or the week after, but we’re ready,” said Lamunyon Sanford. “Instead of the shame or stigma that people may have faced in Texas, we’ll make sure that they are able to follow through and get the health care that they need.”

There are currently less than two dozen abortion clinics in Texas, home to more than 6 million people of childbearing age, as of 2019. As the clinics in Texas have stopped scheduling abortion-related visits for people more than six weeks pregnant, the lengths people have to go in order to access abortions has multiplied exponentially.

The new law has increased the average miles a Texan must drive one-way to seek an abortion from 12 miles to 248, according to the Guttmacher Institute, a reproductive rights organization.

A trip from Texas to Wichita, Kansas, for someone seeking an abortion is, on average, 650 miles roundtrip. People have been making that trip with increasing frequency already this week, according to Ashley Brink, clinic director of Wichita’s Trust Women clinic.

“Yesterday I felt like our phones were constant. Multiple phone lines lit up and ringing,” said Brink. “We have already seen an increase.”

Brink said she has been preparing for the influx for weeks, making sure the clinic has enough supplies and trying to get more physicians in the clinic, a difficult task in Kansas, where she says over 90% of counties don’t have an abortion provider.

In Oklahoma City — more than 460 miles from South Texas — the Trust Women clinic there typically receives calls from three to five people from Texas per day. On Tuesday and Wednesday, as the law went into effect, the clinic scheduled 80 appointments, and of those, as many as 55 were patients from Texas.

“That’s just going to increase as people from farther away start to look to see where they can get access,” said Zack Gingrich-Gaylord, communications manager for Trust Women Clinics. “Throughout the Gulf [Coast] and the I-35 corridor, the center of the country and the Southwest, that’s all going to radiate and start to have a lot of strain put on those clinics and people are going to have to travel farther and farther.”

“If you had to travel overnight to go see a dentist, you would think that’s ludicrous,” he said. “But it’s expected of people seeking abortion care, that they are going to have to significantly disrupt their own lives.”

Adding to the difficulty of seeking abortion care outside of their home state is the fact that abortion is difficult emotionally and physically, and time sensitive, according to Dr. Iman Alsaden, an OBGYN in Missouri and Kansas and medical director for Planned Parenthood Great Plains, which provides care in Arkansas, Kansas, Oklahoma and Missouri.

“It’s absolutely devastating that people are being forced to leave their communities to seek safe, essential health care outside of the state,” said Alsaden, also a fellow with Physicians for Reproductive Health. “It’s heartbreaking to think of all of the people who may not be able to make it to a desired appointment to receive abortion care.”

Alsaden said her clinics have seen an “influx of patients” from Texas over the last few weeks, noting, “We have adjusted our schedules to ensure that we can take care of as many patients as possible, no matter where they’re coming to us from.”

Lori Williams, a nurse practitioner and the clinic director at Little Rock Family Planning Services in Little Rock, Arkansas, described the patients her clinic is seeing from Texas as “frantic.”

“Many didn’t realize that this was coming or didn’t know that they were suddenly not going to be able to obtain care,” said Williams, also chair of the National Abortion Federation Board, a membership association of abortion providers. “I had patients today driving seven hours to see us and Arkansas has a [72-hour] waiting period so that means these patients will have to travel twice.”

Williams said she worries that as many patients from Texas as the clinic expects to see over the coming weeks and months, she knows there will be just as many, or more, who cannot access care.

“We know there are patients that tell us, ‘I don’t have a car that can make it that far,’ ‘I can’t get off work that many times,’ and these are the challenges we’re trying to have our patients navigate,” she said. “It’s the time off work, the child care, the expense, all the things that go along with this, which makes this an economic crisis for women, in addition to an access to care crisis.”

The rates of unintended pregnancy in the U.S. are highest among low-income women, women aged 18 to 24 and women of color, according to the Guttmacher Institute.

Meanwhile, people denied an abortion are more likely to experience long-term economic hardship and insecurity than people who received an abortion, according to a 2018 study published in the American Journal of Public Health (AJPH).

“The women who have the means will obtain the care, but the women who were already struggling financially, who are socioeconomically disadvantaged are the ones who are going to be impacted the most,” said Williams. “There are going to be women out there who are forced to carry a pregnancy than they don’t want to.”

“This is really going to have an impact more so than the abortion providers are going to see,” she said.

Maleeha Aziz, a community organizer with the Texas Equal Access Fund, one of Texas’ nearly one dozen abortion funds that provide support to women seeking abortions, said it cost her about $1,500 to travel from Texas to Colorado for an abortion eight years ago.

Her organization and other abortion funds in the state are now working to raise additional funds and figure out the logistics needed for people in Texas to travel farther distances for care.

“While it’s a lot harder, we’re going to do whatever we can legally, even if that means flying someone out of state,” said Aziz. “We are going to need so much more money because the cost [is high].”

Adding to the financial and logistical challenges is the fact that Texas is surrounded by states that have also have laws limiting abortion access. Those laws, called targeted restrictions on abortion providers, or TRAP laws, by abortion rights advocates, have been implemented in mainly conservative states to avoid being overturned in court and still limit abortion access in a variety of ways.

In the four states with which Texas shares a border, Arkansas, Louisiana, Oklahoma and New Mexico, there were just 21 facilities providing abortions combined as of 2017, according to the Guttmacher Institute.

Robin Marty, operations director at the West Alabama Women’s Center, said the clinic is bracing for a trickle-down effect of patients from Texas making their way to Alabama because of a lack of access in other states.

“I believe that for people who are pregnant in Texas, I believe that a lot of them, if they were in early pregnancy, probably thought that they could just hold on for a while and see how everything’s sorted out,” she said. “So I expect next week to be the point at which things are really going to become clear what this does to the landscape, because people are going to start first calling Louisiana, where they’re probably going to find out that there is a very long wait, because there already is, and then they’re going to try to go next to Mississippi and will find mostly the same thing. And by that point, we’re talking, when you come to Alabama, that’s an eight-and-a-half hour drive.”

Adrienne Mansanares, chief experience officer for Planned Parenthood of the Rocky Mountains, which provides health care in Colorado, New Mexico, and Las Vegas, said that while their clinics are already seeing the immediate impact of Texas’s law, they are also planning for the long road ahead.

“That last bit of hope that there would be a solution, that there would be a backstop, that there would be protections for this procedure, that being gone has really shook a lot of us,” Mansaneres said of the Supreme Court’s 5-4 decision to not block the ban.

“With that, we are absolutely prepared for and doing the really dark, hearty work of trying to figure out what does this look like for years to come, and if it’s not just this law in Texas, what other laws can it be and what other states across the country are going to be this emboldened to continue with these really hostile bans,” she said. “Unfortunately, it’s looking very dark.”

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(CARLOS, Minn.) — A Minnesota father is celebrating a new chance at life thanks to his daughter, who donated part of her liver to save his.

“Now I can take all of Molly’s positive traits because they’re in me,” said Mike Maudal, of Carlos, Minnesota, referring to his daughter, Molly Maudal. “I certainly have a tremendous appreciation for Molly.”

Mike Maudal, 62, was preparing to retire from his job as a loan officer nearly six years ago when he went to his doctor for a routine checkup before his medical benefits ran out.

The doctor noticed something unusual in his blood work and sent him to the Mayo Clinic in Rochester, Minnesota, about four hours from the family’s home.

It was at the Mayo Clinic that Mike Maudal was diagnosed with non-alcoholic steatohepatitis (NASH), an aggressive form of fatty liver disease, which can progress to cirrhosis and liver failure, according to the Mayo Clinic.

Mike Maudal said he was “very surprised” by the diagnosis, which doctors initially treated with diet changes and medication.

He was even more surprised when two years later, in 2018, doctors told him he would ultimately need a liver transplant.

“I pretty much went into denial. I really didn’t think I was that sick or that I’d need a transplant,” said Mike Maudal. “I thought I was going to beat the odds.”

At home, Molly Maudal, 23, and her mother, Cindy Maudal, watched as their dad and husband, respectively, began to quickly decline both physically and mentally.

“It was really hard. He just got sicker and weaker and was struggling with everyday tasks,” said Cindy Maudal. “And then the fear of what does this mean every time he had some new issue develop … and the [fear of] what if he didn’t make it, what would life be like? What would that be like for me and Molly? And then trying to hold down the house at home, trying to work full-time, take care of his medications, it was stressful.”

Molly Maudal, an only child, said she struggled most with seeing her father’s mental decline, which occurs in people with NASH because the liver is unable to remove toxins from the blood.

“When I was growing up, he was so sharp and to see him lose that to the disease was really hard,” she said. “He was always really jovial and would joke around and people loved him for his humor. It was like his personality changed.”

Mike Maudal was placed on the liver transplant waiting list but doctors, and his family, worried that he would not be strong enough physically to undergo a transplant by the time he was eligible for a liver from a deceased donor.

The Maudals then began to consider a living-donor liver transplant, in which a portion of the liver from a healthy, living person is removed and placed into someone in need of a working liver, according to the Mayo Clinic.

A living donor is able to donate just a part of their liver because the remaining liver regrows to its normal size and capacity within a few months, and the donated portion of the liver also grows and restores normal liver function in the recipient.

“It’s amazing the amount of people who have told us, ‘Oh, I thought I could only donate when I was deceased. I didn’t know I could do this when I was alive,'” said Mike Maudal. “It was news to us too when we started down this path years ago.”

When Cindy Maudal did not qualify as a donor for her husband, the family quietly began to ask loved ones and close friends about the possibility of donating, but fell short of finding a match.

The Maudals all also knew that Molly Maudal, with the same blood type as her dad, could possibly match as a donor, but neither of her parents wanted to put that pressure on her.

“Molly was in college and we wanted her to finish her education,” said Cindy Maudal. “She was young and as a parent, you don’t want to ask for something like that.”

Molly Maudal though said she had been preparing to step up if she was needed, explaining, “In the back of my mind, for several years through it all, I was thinking about being a donor and in several ways wanted to arrange my life so that just in case he needed an emergency transplant, I could be there.”

That moment came in late 2020, when doctors at Mayo Clinic told Mike Maudal that his only chance at surviving liver disease was to find a living donor.

“It hit home in a whole new way hearing that,” said Molly Maudal. “My mom knew I had been thinking about [donating] and she said, ‘Hey Mol, if you’re thinking about this, now is probably a good time to get tested.’ I was totally in agreement.”

Molly Maudal then began the process of being evaluated as a potential donor for her dad, undergoing bloodwork and physical exams and meeting with doctors as well as a psychiatrist and social worker.

She learned she was eligible to save her dad’s life during a phone call with the Mayo Clinic nurse at the end of April.

“It was such a relief to know that we had a match and the wait and the uncertainty of finding a donor was over, just to know that he had a chance now,” she said. “I just had this sense of calm about my decision to move forward. It just felt right.”

Just two months later, on June 11, the Maudal father-daughter duo underwent a living-donor liver transplant at Mayo Clinic.

The approximately four-hour transplant surgery involved a team of three surgeons led by Dr. Julie Heimbach, director of the Mayo Clinic Transplant Center in Rochester.

“I’ve been taking care of Mr. Maudal for several years before transplant and every time I saw him, he was doing worse, so I was very worried about him,” said Heimbach. “He’s an amazing guy and I’m just so happy it worked out.”

“That we can take one side of a healthy person’s liver and give it to somebody else who is really struggling and have them both leave doing great is unbelievable,” she said of living-donor procedure.

The Maudals recovered in hospital rooms near each other and were discharged within one day of each other, Molly on June 17 and Mike on June 18.

“I remember Dr. Heimbach and another surgeon came up and told me, ‘Your liver was perfect for your dad.’ That was a fantastic feeling,” said Molly Maudal. “And I remember visiting dad in his room and we could visibly see him improving. His eyes weren’t as sunken and his color was improving. His sense of humor and personality came back so fast. It was amazing to see firsthand.”

The Maudals, who are both recovering well and returning to their normal daily activities, including work as an occupational therapist for Molly, say they want to share their story to encourage more people to become living liver donors.

The need for living liver donors is great because the demand so far overwhelms the number of livers available from deceased donors.

Of the 8,000 liver transplants performed in the United States in 2017, only about 360 involved living donors. But more than 11,000 people were registered on the waiting list for a liver transplant, according to the Mayo Clinic.

In addition, living-donor liver transplants can help save the lives of children, for whom suitable deceased-donor organs can be hard to find.

In order to be a living liver donor, a person typically needs to just have a matching blood type and meet the health requirements for a transplant, according to Heimbach.

“The liver is more forgiving from an immunology standpoint,” she said. “With a kidney, we are looking at a match pretty closely but with a liver, we’re just looking at having a compatible blood type.”

Cindy Maudal, who watched her two closest family members undergo surgery at the same time, said the family feels likes “one of the lucky ones” in finding a living liver donor.

“I’m not sure Mike would still be here if Molly hadn’t been a match to be a donor for her dad,” she said. “I’m so grateful that the two people I love the most are still with me.”

It was also not lost on the family that June 11, the day their transplant took place, was the same day 24 years ago that Cindy and Mike Maudal found out they were pregnant with their only child.

“That’s the day we found out we were giving Molly life, and it ended up being the same day years later that she gave her dad new life,” said Cindy Maudal.

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(NEW YORK) — In a stunningly short period of time, the delta variant has changed the course of the COVID-19 pandemic by evolving to become more transmissible than previous versions of the virus.

Compared to the alpha variant, which is estimated to be 50% more transmissible than the original virus strain identified in Wuhan, China, scientists believe the delta variant, now dominant worldwide, is 40% to 60% more transmissible than alpha.

But how exactly did the delta variant evolve into the highly infectious strain that the world is now struggling to contain? Scientists have a few theories.

“This is a new virus for humans,” explained Adolfo Garcia-Sastre, director of the Global Health and Emerging Pathogens Institute of Icahn School of Medicine at Mount Sinai. “You can think about like a baby. The virus came to humans for the first time. He has not learned still everything.”

The so-called variants of concern — alpha, beta, gamma and delta — show the virus is evolving. “What we are seeing is that there are mutations that are being selected that make the virus even better at transmission,” Garcia-Sastre said. For now, scientists don’t know whether the delta variant, the most transmissible of the four, has reached its full potential for transmissibility. But the more the variant circulates, the more chances it has to evolve and reach full potential to infect humans at maximum scale.

“That’s what makes a winner if you’re a virus — more replication,” he added.

How viruses evolve to be more transmissible

“Every time the virus replicates, or makes a copy of itself, it tries to make a copy that’s identical,” Garcia-Sastre said. But like human cell replication, which can sometimes result in cells with new mutations, viruses make mistakes when they copy themselves. In most cases, those mistakes make the virus weaker. But if a single mutation makes the virus stronger and also manages to infect a new host, “it will start to propagate and start to dominate,” he said. While stronger mutations are the exception to the rule, widespread transmission of the virus means more chances for mutations that could include less common, but stronger variants.

In general, there are a few pathways by which this could happen. High community transmission, as was seen in the United Kingdom and India before the alpha and delta variants were detected there, is one pathway. Another is in people with so-called chronic infections, meaning they are infectious for longer than the typical duration of COVID-19 (not to be confused with long-haul cases), which could occur if someone has a weakened immune system or is taking immunosuppressant drugs.

“Some individuals have a persistent or a prolonged or a chronic infection. Then you have accelerated evolution inside that individual,” said Dr. Richard Lessells, an infectious disease expert at Kwazulu-Natal Research Innovation and Sequencing Platform in Durban, South Africa, where he researches beta, the virus variant first identified in the country.

“If that virus is then transmitted and has some evolutionary advantage in the population, it can spread from there,” Lessells said.

Nevan Krogan, a molecular biologist at the University of California, San Francisco, has collaborated on papers with Garcia-Sastre during the pandemic.

“It’s like the mother of all selections in the world. It’s the biggest experiment that’s ever happened,” Krogan said. “We’re forcing the virus to mutate, which it loves to do.”

In addition to mutations, there is another way that viruses can acquire new changes that may make them more transmissible, according to Garcia-Sastre, although it’s a pathway that’s difficult to study and not well understood. Viral recombination happens when two different parent strains of the virus enter the same cell. They then can combine and make new mixtures when they replicate.

“Someone can get, for example, an alpha and a beta together,” Garcia-Sastre explained. That could explain why the delta variant has 20 mutations, a high number for a virus that has not evolved very quickly.

Still, Garcia-Sastre cautioned of the recombination theory — “it is very difficult to prove.”

While the vaccines are holding up well against the variants in terms of protecting against hospitalization and death, the delta variant is a bit more likely to infect fully vaccinated people — so-called breakthrough cases — than past variants.

“It shows the possible beginning of a trajectory and that’s what worries me,” Aris Katzourakis, an evolutionary biologist at the University of Oxford, told Science magazine in August.
Changes to the virus’s spike protein could make it more transmissible

All four variants of concern have mutations in the virus’s spike protein, the protein that protrudes from the surface and makes it look like it’s wearing a crown.

“The thing that is happening with all of these variants is that they bind better to the receptor,” Garcia-Sastre said. “It finds the cells faster because it binds better to the receptor. If the virus has acquired the ability to bind better, then it has a better chance to start infections.”

While alpha, beta, gamma and delta all have mutations on their spike proteins, they are all different mutations, Garcia-Sastre explained. “That’s what’s interesting. They gain a better ability to process the spike and then a better ability to enter and replicate.”

Beyond spike

“Everyone is focused on spike. Yes, spike is playing a role, no question about it, but there are other mutations that could be equally as important as spike,” said Krogan.

Krogan’s research, which has not yet been published in a scientific journal, suggests that once the alpha variant gets inside a cell, it suppresses the immune response compared to other variants. A suppressed immune response allows the virus to replicate more, resulting in increased transmissibility and ultimately increased mortality, he explained.

It could also explain why the alpha variant spreads so rapidly. Now Krogan’s team is doing tests on the delta variant to see if it has similar immune response suppression causing it to be even more transmissible than the alpha variant. “We are investigating if a similar mechanism exists with delta and other variants of concern.”

Importantly, as far as scientists can tell, the alpha variant did not evolve into the delta variant. Instead, the two variants developed independently of one another in countries where high community transmission was occurring.

“The alpha variant came from England and the delta variant came from India, it just kind of got to the same place,” Krogan said. “Different mutations could have the same results.”

A glimmer of hope

As vaccinations ramp up in wealthier and well-connected countries, it puts selection pressure on the virus to mutate so it’s able to continue to infect hosts. The only way out is to vaccinate faster or adapt vaccinations to beat out newer versions of the virus as they crop up.

“We’re in this battle with the virus,” Krogan said. “Are we going to use the tools we have right now? Or will those tools become obsolete very quickly?”

Garcia-Sastre struck a more optimistic note on the role of vaccines.

“If you can bring this virus from killing 5 million per year to 500,000 per year, this virus will have the same consequences as an influenza,” Garcia-Sastre said of the power of vaccinations. “If we can reduce the mortality of this virus 10 times by vaccination, the problem is still is there, but now it’s a different problem.”

While having dueling infectious disease threats of the flu and COVID-19 each year would certainly burden the health care system, it would be a significant improvement over the overwhelming crisis that many countries have faced over the past 18 months. “We are not going to be completely able to prevent death — that’s clear — but if we can reduce it at least 20 times, then I think we can say that the pandemic is over,” Garcia-Sastre said.

In his mind, the goal was never getting to COVID zero. “It was quite clear for me that it was going to be very difficult to eradicate this virus,” he said. “But we can make it manageable. Then it will be a nuisance. It’s unfortunate for the people who get severe disease — the same thing as with flu — but at least it is not impacting all the sectors of the society like it is right now.”

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(NEW YORK) — As students return for a third school year affected by the coronavirus pandemic, trauma and grief support are top of mind among educators addressing the wide-reaching impacts of the crisis.

For many students, loss due to the pandemic hits close to home. More than 140,000 children in the U.S. lost a primary or secondary caregiver, such as a live-in grandparent or another family member, in a COVID-19-associated death, according to provisional data from the Centers for Disease Control and Prevention obtained by ABC News in late July. More than 640,000 Americans have died from COVID-19.

Most, if not all, students may have experienced loss in other ways, from financial or housing instability to a prolonged disruption to their sense of normalcy or routine.

In Georgia, Atlanta Public Schools plan to screen over 30,000 pre-K to 12th grade students on their social-emotional behavior this fall.

“Many of our students had been at home and participating virtually since March of 2020,” Shannon Hervey, director of student support and interventions for Atlanta Public Schools, told ABC News. “We don’t know what our students may have faced, and so we wanted to take a proactive approach and say, ‘Let’s get to know our students more so that we can determine what their needs are and help to provide for that.'”

The district will be screening for external behaviors like hyperactivity or aggression, and internalized risks like depression and anxiety. From there, they hope to determine what students’ needs are and how the school can support them. The district also added 25 new school social workers and plans to train employees in trauma-informed practices this year, among other measures, to address the mental health needs of its students this year.

Other school districts are also looking to bolster support around trauma and grief due to the pandemic. Chicago Public Schools had previously announced a $24 million, multiyear plan to invest in mental health and trauma support programs for students and staff. Miami-Dade County Public Schools has provided staff with social-emotional learning and mental health awareness trainings as they welcomed students back, as well as hiring 45 mental health coordinators.

Identifying and accommodating students impacted by trauma and grief are key, as those who have experienced significant loss may need long-term support in the classroom, said Maria Collins, the head of New York Life Foundation’s Grief-Sensitive Schools Initiative, a program that provides resources and tools for school communities to support grieving students.

“Grief can have a serious impact on learning, academic performance, social withdrawal, behavioral issues, if not supported,” Collins told ABC News. “It’s really understanding and acknowledging that the loss exists, and this impacts how they learn and also how present they are in the classroom.”

While educators largely recognize the importance of supporting students’ emotional needs, most don’t feel they have the training to do so. A 2020 survey by the New York Life Foundation and American Federation of Teachers found that only 15% of educators said they feel comfortable addressing the grief or trauma tied to the pandemic.

The Grief-Sensitive Schools Initiative has seen an “increasing need” for support during the pandemic, Collins said, with nearly 100 schools and school districts reaching out in the past year. The organization has also partnered with the National Parent Teacher Association to help provide similar resources and support for parents.

“We’re educating new generations; we’re educating educators, parents and children about grief and grief support,” Collins said.

Dr. David Schonfeld has also seen an increase in interest from schools for grief support during the pandemic, particularly for younger students. As the director of the National Center for School Crisis and Bereavement, which provides schools with crisis, trauma and grief support, he’s done over 200 trainings, workshops and presentations since the pandemic started. Much of the center’s work focuses on grades K-12, though they have seen “lots of demand” at the preschool level, Schonfeld said.

The National Center for School Crisis and Bereavement has shifted most of its training to focus on how to support students during the pandemic, which has “heightened” grief, he said.

The pandemic has “raised people’s interests and importance” of grief and trauma support, he said, “but also made it very challenging for them to find the time and have the capacity to schedule the training. Schools are frankly overwhelmed by everything they need to do. Opening the door is now a big challenge.”

Educators have also often questioned how to best support students when they themselves may be struggling with grief or trauma, Schonfeld said.

“A lot of people say, ‘What are we supposed to do? We’re grieving or we’re struggling or we’re exhausted,'” he said. “What I try and tell them is we’re really not asking classroom teachers to counsel children over the death of their parents. We’re not asking them to do therapy. We’re asking them to show sympathy and be present for the child and show concern and then maybe make accommodations to help them learn.”

Collins advocates for schools to become “grief-sensitive” and have a specific bereavement plan that can help connect families with local resources.

“We’re not saying that educators need to be grief specialists,” she said. “They just have to have the awareness and know where to refer and have the resources to give to the parents.”

For Schonfeld, the impacts of the pandemic are so wide-reaching that staff may need to support all students on some level.

“We need to figure out how to help everyone and still keep our eyes open for those who need more,” he said. “If educators know how to provide universal support, they will be better prepared to know when someone needs more than that.”

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(NEW YORK) — Sleeping too much or too little each night can harm adults’ brain performance, increase symptoms of depression and weight and raise the risk of Alzheimer’s disease, according to a new study.

The study, published in the journal JAMA Neurology, found that sleeping six hours or less per night or nine hours or more per night negatively impacted adults’ health.

“There appears to be a real sweet spot,” said Dr. Jennifer Ashton, ABC News chief medical correspondent and a board-certified OBGYN. “People who got less than six hours of sleep on PET scan brain imaging had a higher rate of these brain plaques that we’ve found in association with Alzheimer’s disease.”

“However, too much, just as bad. Nine or more hours associated with poor cognitive performance,” added Ashton, who was not involved in the study.

The ideal amount of sleep per night is seven to eight hours, the study found.

“This really speaks to the fact that more is not better,” said Ashton. “Your brain needs a certain amount of sleep, but too much actually kind of puts your brain to sleep in some ways.”

The findings of the study — which looked at data from more than 4,000 adults in United States, Canada, Australia and Japan — reemphasize the important role sleep plays in achieving optimal health, according to Ashton.

She noted that not getting enough sleep each night affects your immune system and has been associated with everything from increased risk of heart attacks and stroke to depression and obesity.

“I always say sleep has a [public relations] problem. We look at it like a luxury. In fact, it is a medical necessity,” she said. “We need to prioritize this on par with our nutrition and our fitness for optimum health.”

Ashton added, “I always tell people, ‘If you are not feeling right, look at your sleep first.’”

Here are Ashton’s four tips for achieving a good night’s sleep, in her own words:

1. Follow a consistent sleep schedule: That means, if possible, every day go to sleep and wake up around the same time. You can’t make up for this on the weekend.

2. Avoid heavy meals, alcohol and caffeine in the couple of hours before bedtime.

3. The environment is really important. You want to keep your bedroom cold, dark and quiet, without something with a screen.

4. Meditation and exercise during the day have been shown to increase sleep at night.

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(NEW YORK) — The most restrictive abortion law in the nation took effect in Texas early Wednesday, effectively barring the procedure across the state, as the U.S. Supreme Court remained silent on an emergency request from women’s health groups to block the measure while legal challenges continue.

Texas becomes the first and only state in the country to outlaw abortions after about six weeks of pregnancy. Twelve other states have passed similar laws that have not yet taken effect due to legal challenges.

Abortion providers across Texas had said the measure would “immediately and catastrophically” prevent care for “at least 85%” of Texas abortion patients. Several clinics reported full waiting rooms up until the midnight deadline.

“Our clinic staff saw patients until 11:56 last night, just 3 minutes before the 6 week abortion ban went into effect in Texas,” Whole Women’s Health, a top abortion provider in Texas, posted to Twitter.

Most of the abortions performed nationwide are after 6 weeks of pregnancy; staff at several Texas clinics have said they plan to start turning away patients Wednesday.

“Our clinics are providing abortions in accordance with the law,” the group added Wednesday. “Our work is not over.”

The law, Senate Bill 8, says “a physician may not knowingly perform or induce an abortion … if the physician detects a fetal hearbeat,” including embryonic cardiac activity, that can be observed as early as six weeks into a pregnancy.

In an unusual twist, the law expressly prohibits the state from enforcing the ban, instead authorizing private citizens to bring civil suits against anyone who “aids or abets” an abortion — but not the patient herself.

“It actively encourages private individuals to act as bounty hunters by awarding them at least $10,000 if they are successful,” the American Civil Liberties Union said in a statement.

The enforcement mechanism has complicated the legal dispute before the Supreme Court, because it is not clear who might bring a lawsuit and how widespread private legal action might be.

The abortion providers “have not shown they’ll be harmed by a bill that may never be enforced against them by anyone, much less the government,” a group of Texas state officials defending the law wrote in a filing with the Supreme Court late Tuesday.

The court has only been asked at this stage to decide whether or not to issue a temporary injunction on S.B. 8 while lower-level court proceedings continue. Whatever the decision, legal experts cautioned that it will not have direct bearing on the precedent in Roe v Wade or abortion rights more broadly across the country.

The justices are likely to weigh in on the matter but do not operate on a fixed timeline.

“The abortion industry is using their last, desperate option in an attempt to block the life-saving Texas Heartbeat Act,” said John Seago, legislative director of Texas Right to Life, an anti-abortion rights group.

“This anti-Life lawsuit is invalid. We are hopeful that Justice Alito will examine the compelling arguments raised explaining why the case should be ultimately dismissed,” he said.

Women’s rights groups planned protests against S.B. 8 across Texas on Wednesday afternoon. Meanwhile, advocates said women seeking abortion services now faced expensive and time-consuming options to obtain care.

“Patients will have to travel out of state – in the middle of a pandemic – to receive constitutionally guaranteed healthcare,” said Nancy Northup, president and CEO of the Center for Reproductive Rights, which is leading the challenges to Texas’ law. “And many will not have the means to do so. It’s cruel, unconscionable, and unlawful.”

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(WASHINGTON) — The U.S. is poised to begin rolling out booster shots in a matter of weeks, with still one major sticking point to resolve: It’s not entirely clear yet that third shots are needed.

President Joe Biden recently vowed to begin deploying boosters the week of Sept. 20, pending a green light from federal regulators.

But health experts advising the government on that decision say the August announcement by Biden’s political appointees came as somewhat of a surprise. It also was unclear, they said, why that date was chosen at all.

Evidence for boosters is still mixed, and announcing a timetable — while likely popular with much of the public — put independent government regulators in a corner by suggesting they would sign off no matter what.

“That doesn’t mean you can’t get out (of the decision), but I think the public expectation is that boosters are needed now,” said Dr. Henry Bernstein, a pediatrician at Northwell Health Cohen’s Children Medical Center in New York who has advised the Centers for Disease Control and Prevention on vaccines.

“There’s a lot more data to be reviewed and work to be done in evaluating whether boosters are needed in various populations,” Bernstein added.

The question of whether America’s immunity is waning has become an urgent question in recent months with the rise of the delta variant and large pockets of the country still unvaccinated.

The latest analysis, released Monday by the CDC, found troubling signals on the ability of vaccines to prevent infections and to keep older people out of the hospital.

Whereas the vaccines were 90% effective in June at preventing hospitalization in people ages 75-plus, that number fell to around 80% in July.

But even with such a drop, the data still suggests extraordinary protection against becoming seriously ill with COVID-19. It also raises more questions than it answers: Is immunity waning with time? Is the delta variant making people sicker? Is this a problem mostly for older Americans, whose immune systems are less robust to begin with?

Young adults under age 49 are still 24 times more likely to end up hospitalized if unvaccinated. And the vast majority of people in the hospital are unvaccinated, suggesting the vaccines are holding up in real world scenarios.

“We don’t have a lot of evidence of reduced vaccine effectiveness against important outcomes in most of the population based on our current data,” said Dr. Beth Bell, a professor at the University of Washington and independent adviser to the CDC who will help decide whether to recommend boosters to Americans.

Dr. Yvonne Maldonado, who works with the CDC advisory panel on behalf of the American Academy of Pediatrics, was among those who said the Sept. 20 date was a surprise and that it’s unclear why it was chosen.

During a meeting of CDC advisers, Maldonado said she was fielding text messages from colleagues asking: “Why are we rolling out detailed plans for this when it sounds like we still don’t know?”

Typically, the Food and Drug Administration reviews data before announcing any decision on whether a vaccine can be administered. Then a CDC advisory group of experts weighs in, and the CDC director signs off on whether to recommend the vaccine to the public.

In this case, Biden’s political appointees involved in the pandemic response — including acting FDA chief, Dr. Janet Woodcock — agreed on the Sept. 20 date before that process played out. And with the crisis in Afghanistan still unfolding, the president switched gears to the pandemic, publicly unveiling his commitment to every American getting a booster shot eight months after their immunization.

Pfizer and BioNTech, which partnered to develop the nation’s first vaccine, have said they have early data suggesting that a booster dose anywhere from six to 12 months after the initial vaccination will help maintain a high level of protection. That data has not yet been shared publicly.

“The frustration too comes in part due to the sense of urgency here as well, because of the public pressure to get the booster. Everyone would like data that are still evolving,” Maldonado said.

On Tuesday, the FDA confirmed two longtime vaccine officials were planning to depart the agency. Their exit, addressed in a memo to staff, followed news reports citing the officials’ frustration with the process. Woodcock told colleagues she was confident in the leadership of the FDA’s vaccine chief Peter Marks, who planned to remain in his position.

“We have put together a plan that will allow us to continue prioritizing science, while meeting timelines that are important to ensuring the end of this devastating pandemic,” she wrote in the staff email.

Other top political appointees also defended the Sept. 20 date on Tuesday. CDC Director Rochelle Walensky told reporters during a White House press briefing that there was international data that will be presented and likely play a role in the regulatory decision on boosters.

Jeff Zients, Biden’s COVID coordinator, noted that the FDA and CDC had signed on to the plan for a Sept. 20 rollout.

“The bottom line, this virus has proven to be unpredictable, and we want to stay ahead of it, and plan for every scenario, and that’s been our approach from day one and will continue to be our approach,” he said.

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(NEW YORK) — Thousands of Americans were finally persuaded to get their first shot in the week following the Food and Drug Administration’s full approval of the Pfizer-BioNtech coronavirus vaccine, new data reveals.

A new ABC News analysis found that initial data, stemming from the last seven days, indicates that since the FDA’s announcement of the approval, the U.S. has indeed seen a slight uptick in the average number of Americans getting their first COVID-19 vaccine dose.

Just prior to the announcement, the U.S. rate of first doses had stagnated. Although the country experienced an increase in people initiating vaccination in July as new coronavirus cases surged across the country, the average number of Americans getting their first dose had then declined.

However, following Pfizer’s full approval, the U.S. saw a 17% increase in the number of Americans getting vaccinated with their first dose.

In the week prior to the full approval, an average of about 404,000 Americans were initiating vaccination each day. As of Monday, approximately 473,000 Americans were getting their first shot each day.

“As expected, full approval was enough to convince at least some to finally get immunized,” said Dr. John Brownstein, an epidemiologist at Boston Children’s Hospital and an ABC News contributor.

Although there does not appear to have been a mad rush of people getting vaccinated in the days immediately following approval, the uptick was significant enough to shift the country’s vaccination trend upward.

“While surveys initially had estimated a far greater segment of the population who pegged full approval as their reason for holding off, we have yet to see a large wave of newly convinced people to roll up their sleeves,” Brownstein added.

Experts caution that although the uptick is encouraging, there is still much work to do in convincing millions more hesitant Americans to get the shot.

However, according to a newly released Axios-Ipsos poll, vaccine hesitancy among Americans has hit a record low, with only 2 in 10 Americans saying they are unlikely to get the COVID-19 vaccine, and 14% saying they are not likely at all.

The poll, which was conducted prior to full FDA approval, found that about a third of unvaccinated Americans said they would be likely to get vaccinated if it was formally approved for use by the FDA. However, about 6 in 10 said they would still not get vaccinated even if it were approved by the FDA.

In another move that officials hope will encourage Americans to get the shot, the Advisory Committee on Immunization Practices, the Centers for Disease Control and Prevention independent advisory panel, took the approval a step further on Monday, unanimously endorsing Pfizer’s vaccine for use in people 16 years of age and older

“We now have a fully approved COVID-19 vaccine and ACIP has added its recommendation. If you have been waiting for this approval before getting the vaccine, now is the time to get vaccinated and join the more than 173 million Americans who are already fully vaccinated,” CDC Director Dr. Rochelle Walensky said in a statement Monday.

It is difficult to know for sure if this increasing trend will continue. On Tuesday, for example, the U.S. reported a single-day total of approximately 283,000 first shots administered, well below the current seven-day average.

Vaccination trends also remain unsteady, and highly susceptible to mandates imposed by jurisdiction.

“While FDA approval has many positive implications for the vaccine rollout, this is not a replacement for the constant need for basic education on the individual and community benefits of immunization,” Brownstein said.

Full approval has rendered it easier for employers to mandate vaccines, which could also be one of the drivers of rising vaccination rates, experts have suggested. In the last week alone, an increasing number of companies and government entities have moved to require proof of vaccination or risk termination.

Just hours after the full approval was announced, for example, the Pentagon announced that they would begin preparations to make the vaccine mandatory.

“I’m calling on more companies in the private sector to step up with vaccine requirements that will reach millions more people,” President Joe Biden said in remarks at the White House last week. “If you’re a business leader, a nonprofit leader, a state or local leader, who has been waiting for full FDA approval to require vaccinations, I call on you now to do that — require it. It only makes sense to require a vaccine to stop the spread of COVID-19.”

The push for more companies to require employees to get vaccinated comes as the U.S. continues to struggle through its latest surge in COVID-19 infections.

With more than 101,000 patients now hospitalized across the country with COVID-19, the U.S. is steadily approaching its hospitalization peak from early January, when more than 125,000 patients were hospitalized at one time. A little over two months ago, there were under 12,000 patients receiving care.

And nationally, nearly 94% of U.S. counties are now reporting high community transmission.

“With only 53% of the population fully vaccinated, we are going to need a much more significant increase in vaccinations if we are going to limit the impact of a fall surge and get to the other side of this pandemic,” Brownstein said.

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(NEW YORK) — In yet another setback in the decadeslong scientific quest for an HIV vaccine, a Johnson & Johnson HIV vaccine candidate failed to reduce the risk of infection in a clinical trial among women in southern Africa. The would-be vaccine uses the same underlying technology used successfully for COVID-19 and Ebola viruses, but this recent high-profile failure is another example of immense challenge of creating a vaccine against HIV.

The trial, called Imbokodo, was co-sponsored by the Bill & Melinda Gates Foundation and the U.S. National Institutes of Health. It included more than 2,600 women living in five African countries where women and girls have a high risk of HIV infection.

The vaccine was safe, researchers said, but ultimately, efficacy was only 25% — meaning people who received the vaccine had a slightly smaller risk of developing HIV, but the difference was so slight that the result might be chalked up to random chance.

Prominent scientists, including Dr. Anthony Fauci, have been searching for an effective HIV vaccine since the virus, which attacks the immune system and leads to a disease called AIDS if left untreated, was first identified in the 1980s. Today, nearly 38 million people are living with HIV worldwide. Although effective treatments can now help people infected with HIV live long and healthy lives, there is still no vaccine that can prevent infection.

Still, scientists say they aren’t giving up.

“The development of a safe and effective vaccine to prevent HIV infection has proven to be a formidable scientific challenge,” Fauci said in prepared remarks. “Although this is certainly not the study outcome for which we had hoped, we must apply the knowledge learned from the Imbokodo trial and continue our efforts to find a vaccine that will be protective against HIV.”

“The challenges associated with the development of an HIV vaccine are unprecedented in the history of vaccinology. After 40 years of global efforts, we still do not have an HIV vaccine,” said Dr. Dan Barouch, director of the Center for Virology and Vaccine Research at Beth Israel Deaconess Medical Center.

“This trial was not a home run but hopefully will guide the HIV field moving forward,” said Barouch, whose laboratory contributed significantly to the initial development of the investigational vaccine.

Despite the setback, the Imbokodo trial showed the vaccine was safe among people who received it — a hopeful sign. Imbokodo means “rock” in the South African language isiZulu, referring to a proverb about women’s strength and community.

“We are extremely grateful to the women who volunteered for the Imbokodo study, and to our partners, including the people on the front lines, all of whom are contributing every day to this enduring quest to make HIV history.” Dr. Paul Stoffels, vice chairman of the executive committee and chief scientific officer at Johnson & Johnson, said in prepared remarks.

The Johnson & Johnson HIV vaccine uses the same underlying “viral vector” technology used in its current COVID-19 vaccine. Scientists say the recent failure has no bearing on the technology itself, which has been used successfully for other viruses, including Ebola and SARS-CoV-2, the virus that causes COVID-19. Rather, HIV itself is a unique virus. It evades the body’s immune system, making it very difficult to create a vaccine that generates immunity against infection.

HIV activists and scientists alike say this result shouldn’t slow down other efforts to find an effective HIV vaccine.

“It is very disappointing that this particular vaccine candidate did not work in this trial, but the trial was well-conducted and got an answer quickly. HIV remains a global threat, and a safe, efficacious and accessible HIV vaccine is still needed to contribute towards curbing new infections and providing a durable end to the pandemic,” Mitchell Warren, executive director of HIV prevention advocacy organization AVAC, said in prepared remarks.

Another late-stage trial called Mosaico, which uses a slightly different vaccine approach and is being tested among men who have sex with men and transgender people in Europe and North America, will continue. Another study called PrEPVacc is combining HIV vaccine candidates with a once-daily pill called PrEP, which reduces the risk of HIV infection. Meanwhile, Moderna has said it will begin early-stage clinical trials of its own HIV vaccine candidate, which uses its mRNA technology, this year.

“This is in no way the end of the search for an HIV vaccine,” Warren said.

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(NEW YORK) — From popular sayings like mommy juice, wine down, rose all day and happy hour to T-shirts that read “Mama needs wine,” the marketing of alcohol towards women in America is omnipresent.

And while women have historically consumed less alcohol than men, that trend is changing, increasingly to the detriment of women’s health, data shows.

The increases in alcohol consumption, binge drinking, and alcohol-related health issues are largely driven by women in their 30s and 40s. Over the past 20 years, as alcohol consumption among women has increased, the rates of death involving alcohol increased 85% among women, according to the National Institute on Alcohol Abuse and Alcoholism (NIAAA).

And this spring, amid the coronavirus pandemic, doctors across the country warned of anecdotal evidence showing increases in the number of hospitalizations and deaths caused by alcohol-related liver disease over the past year, particularly among young women.

Women have increased their consumption of alcohol during the coronavirus pandemic, data shows.

The increase in drinking among women comes as research shows that even one alcoholic drink per day can contribute to an increased risk of breast cancer for women. Women are also, research shows, at greater risk than men for health risks like alcohol-related cardiovascular diseases, liver disease and alcohol use disorder.

While the impacts of marketing and societal pressures have combined to make alcohol a common topic among women, talking honestly about how much they may be drinking and how it is affecting their bodies is still taboo, according to Dr. Jennifer Ashton, ABC News chief medical correspondent and a board-certified OBGYN.

“This is something that is really, really ripe with questions, emotions, myths, misconceptions, and unfortunately, stigma and taboo,” said Ashton. “There is a taboo about alcohol for women that is oftentimes not spoken about at all, or if it is spoken about, it’s whispered about.”

“Alcohol is, in fact, a type of drug, and yet, it is socially acceptable in our country, in our society, in our culture,” she added. “That can set up a potentially precarious situation, or relationship, for anyone.”

Here are six things women should know and talk about with their friends when it comes to alcohol, according to Ashton.

1. Serving size matters.

For women, a moderate alcohol intake per week is defined as seven servings of alcohol or less, according to the Centers for Disease Control and Prevention.

One serving of alcohol is defined as five ounces for wine and just one-and-a-half ounces for hard alcohol, far less than what is typically served in bars, restaurants and at home.

“You can do this experiment for yourself at home with water or wine, but let’s start with water,” explained Ashton. “You can take water, pour it into your wine glass to the amount that you think that you would serve yourself.”

“If you were having a glass of rose, for example, and then pour that water into a measuring cup, chances are it is going to be significantly more than five ounces. It might even be twice that amount,” she said. “So what you think is one drink, i.e., one serving, could actually be one-and-a-half or even two servings.”

Ashton continued, “It doesn’t matter whether it is one [alcoholic drink] a day or all on the weekends or spread out over a couple of days. If you’re drinking let’s say a margarita that’s made with three ounces of tequila, because it’s served in a giant, supersize, pretty glass, your seven drinks might actually be 21 drinks, 21 servings, and that qualifies as heavy alcohol consumption for a woman.”

For women, even eight or more drinks qualify as heavy alcohol consumption.
The National Institute on Alcohol Abuse and Alcoholism shares this graphic on how much alcohol a drink contains.

Ashton said that participating in Dry January — not consuming any alcohol for the month of January — for several years herself has taught her to keep a “mental tally” of the servings of alcohol she has per week.

“Now I kind of keep a mental tally of my servings per week so that I’m under that seven number that’s recommended, or acceptable, in the medical literature for alcohol consumption for women,” she said. “I just am aware of it very much like I would be aware of spending habits or my cardio exercise.”

2. Drinking alcohol can cause cancer.

Drinking alcohol is listed by the Department of Health and Human Services as a known human carcinogen.

“That means it’s known to be a contributing agent in the formation or development of various types of cancers,” said Ashton, noting that those cancers include cancer of the esophagus, liver cancer, colon cancer and breast cancer.

Women who consume about one alcoholic drink per day have a 5 to 9% higher chance of developing breast cancer than women who do not drink at all, and that risk increases for every additional drink a woman has per day, according to NIAAA.

3. Alcohol affects women differently than men.

Men can drink double the servings of alcohol each week and still stay within the moderate alcohol intake limits because their bodies metabolize alcohol differently than women, according to Ashton.

“Generally, women are smaller, the body fat distribution in a woman is different and their metabolism is different,” Ashton said. “So in general, two drinks for a woman could give you the blood alcohol level equivalent of one drink for a man.”

“That’s [why] it’s important to take a gender-specific approach to this issue and not lump men and women together,” she said.

4. The health effects of alcohol are worse than a hangover.

While women may talk or joke about the hangovers they have after drinking too much alcohol, what often goes unsaid, or even unknown, is what alcohol is doing inside their bodies.

“When you look at the possible effects of excessive alcohol consumption or heavy alcohol consumption for women, it ranges from head to toe,” said Ashton, citing health consequences including brain atrophy, cognitive issues, weight gain, negative effects on the heart and cardiovascular system, increased risk of alcoholic liver disease and fatty liver, increased risk of cancers and increased risks of accidents based on alcohol intoxication.

And just as women metabolize alcohol differently than men, they also face more serious health consequences, research shows.

Women are more susceptible to alcohol-related heart disease than men; alcohol misuse produces brain damage more quickly in women than in men; women may be more susceptible than men to alcohol-related blackouts, or gaps in memory; and women who regularly misuse alcohol are more likely than men who drink the same amount to develop alcoholic hepatitis, a potentially deadly condition, according to the NIAAA.

“We have to remember that almost anything, if done to excess, has the potential to be bad for us,” said Ashton.

5. Not all women may safely consume alcohol.

For women especially, there are times in their lives when it is not medically safe to consume alcohol.

Women who should completely avoid alcohol are those who are under age 21, the legal drinking age, those who are pregnant and those taking medications that can interact negatively with alcohol.

When it comes to pregnancy, research has proven that any amount of alcohol intake at any point in pregnancy can be harmful, according to the CDC. Still, CDC data shows that as many as one in nine women report drinking while pregnant.

Doctors advise against drinking while pregnant because alcohol in the mom’s blood passes through the umbilical cord to the baby and can cause everything from miscarriage and stillbirth and can increase the risk of fetal alcohol spectrum disorders which can cause physical, cognitive, and behavioral problems in children, according to the CDC.

Drinking during pregnancy is also associated with an increased risk of premature, or early, birth.

6. There are flags women can look for to know when drinking is too much.

“At this point, it’s pretty well known that it was a strategic marketing campaign on the part of the alcohol industry to target women, in particular moms, to make alcohol consumption cooler, more hip, more current,” said Ashton. “In terms of the medical, physical, psychological and societal implications of that, I think it’s really up to women that we have to be able to look in the mirror and ask ourselves, ‘Why am I reaching for this glass? Why am I reaching for this drink?'”

As a physician, Ashton said a red flag for her would be if a woman is answering that question all the time, “I feel so tense. I feel so stressed. I need it to help calm me down.”

Another “glaring red flag” for Ashton is if women find themselves drinking alone, looking to drink in more covert or hidden or cryptic environments or in situations where they’re hiding it from people.

For both of those red flag cases, Ashton suggests seeking medical help.

A “pink flag” for Ashton as a physician is if a woman answered the question of why she reached for an alcoholic drink by saying, “‘Because I feel like I deserve it. Because it’s been a tough year-and-a-half. Because it’s just the low-hanging fruit for me, and it’s better than doing something else.”

“That may be a time to say, ‘Is there something else going on emotionally, psychologically, in your environment, behaviorally, that could be targeted so that there are less potentially negative behaviors involved,” she said.

The good news for women is that help is available, and it starts by talking about their drinking, be it with a doctor, with a friend, with a loved one or with a mental health professional, according to Ashton.

“I can’t encourage women enough to speak up and seek help,” she said. “It takes massive courage. It can be incredibly scary. But the health consequences will sneak up on someone who is consuming too much alcohol.”

Describing the dangers of waiting too long to get help for drinking, Ashton continued, “Ultimately, it’s like a marble rolling off the edge of a table. Once it gets to that edge, it’s much harder to stop it.”

If you or someone close to you needs help for a substance use disorder, call the Substance Abuse and Mental Health Services Administration (SAMHSA) National Helpline at 1-800-662-HELP (4357) or visit FindTreatment.gov, SAMHSA’s Behavioral Health Treatment Services Locator.

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