- Why Fewer Moms Are Spanking Their Kids
- Two Cholesterol Drugs May Work Better Together Than Apart
- Donald Trump’s Victory Could Jeopardize Roe v. Wade Abortion Ruling
Posted: 15 Nov 2016 09:26 AM PST
In many developed nations, the corporal punishment of children—that is, spanking, whipping, caning and so on—is illegal. America, where it’s even legal to spank a child at school in some states, has been something of a holdout, but a new study suggests that fewer mothers approve of using spanking as a disciplinary technique.
Georgetown University researchers analyzed data from the University of Chicago’s General Social Survey and found that the percentage of mothers in middle-income families who reported spanking their kids dropped from 46% to 21% over a 23-year period.
The study, published Nov. 14 in the journal Pediatrics, also found that, across all socioeconomic groups, the number of moms with kids under 5 who reported using spanking was shrinking while the number of moms who approved of various forms of nonphysical punishment was growing. For example, the percentage of moms who endorsed time-outs—removing kids from the environments in which the bad behavior took place—increased to 81% in 2011 from 41% in 1988.
For many experts this lessening of physical punishment has been a long time coming. The American Academy of Pediatrics warned parents to avoid physically disciplining their children as far back 1998. That message has slowly been trickling through. And while it has long been the case that low income parents use spanking and other physical punishment more often than wealthier parents, that gap is narrowing, says the study, as the message about more effective disciplinary techniques seeps out.
The authors of the study believe the drop in spankings is part of a longer trend that started in the 1980s. “It may be in response to social science research that suggests spanking is linked to negative outcomes for children like delinquency, antisocial behavior, psychological problems and substance abuse,” says Rebecca Ryan, Associate Psychology Professor at the D.C.-based university and lead author of the study. “There is also little evidence that spanking or other forms of physical discipline are effective in the long term at reducing unwanted child behaviors or encouraging children to internalize, to really believe in, parents’ rules.”
To replace physical punishment parents have started using gentler techniques, including timeouts and what are known as “token economies,” such as sticker charts, for good behavior. The AAP, pediatricians and the rise of the parenting genre in books have also probably played a role in phasing out spanking.
READ MORE: The Discipline Wars Among American Parents
Of course there are still plenty of parents who think that when they spare the rod, they spoil the child. The Georgetown study suggests that low income mothers are more likely to spank than other income levels, and indeed a quarter of them reported hitting their kid in the previous week. But as recently as 2013, a Harris Poll of more than 2000 parents found that the majority of parents of any wealth, gender or ethnicity—except Pacific Islander or Asian— agreed with the statement that it is sometimes necessary to give a kid “a good hard spanking.”
There is also a slight gender difference. Men are more likely to believe it’s OK to spank kids than women are, but the current study doesn’t look at fathers’ attitudes. But researchers think women are changing their parenting habits more swiftly. “Data from the GSS suggests that the decline in support for corporal punishment of children since the 1980s has been more pronounced among women than men,” says Ryan. “So, it stands to reason that the trends we found might be similar—but weaker—for fathers. It’s hard to know.”
It’s also plausible that mothers have realized that many experts frown on spanking and so these moms decline to share their true views on the subject, or are ashamed of using it and thus are not candid. Ryan says that she would tell those who still think that spanking is an important parental tool what the AAP said in 1998: “There are many nonphysical discipline strategies, like time outs, positive reinforcement of good behavior, and selective inattention, that have been shown to be more effective at curbing unwanted behavior and encouraging the internalization of parents’ values than spanking.”
Posted: 15 Nov 2016 08:45 AM PST
In a new study of a class of cholesterol lowering drugs called PCSK9 inhibitors—which received much fanfare recently for lowering cholesterol to unprecedented levels —doctors wanted to know how they would work if taken along with statins, the gold standard for treating high LDL cholesterol. Do the drugs, which both work on cholesterol receptors in the liver but in slightly different ways, combine forces to lower LDL even further than either alone? Or do they negate each other’s effects, only producing as much reduction as either one alone?
Dr. Steven Nissen, chair of cardiovascular medicine at Cleveland Clinic, and his colleagues report the answer to those questions in a report in JAMA and in a presentation at the American Heart Association annual meeting. Among nearly 1,000 people with heart disease in six countries, they found that the combined effect of the PCSK9 inhibitor evolocumab and a statin lowered LDL dramatically — more than either drug alone. And that reduction came with a possible heart benefit — the drug combination also shrunk plaques that had been building up in the heart vessel walls of these people.
“The question was, could we do better than giving a statin alone, by giving the combination,” says Nissen. “And at the end of 18 months, we found [among the people taking the combination], there was less plaque than what the patients started with.”
All of the people in the study had at least one partially blocked major heart vessel, as well as other heart disease risk factors including a previous heart attack, unstable angina, type 2 diabetes, hypertension or were smokers. All were being treated with a statin to lower their cholesterol. For 18 months, they continued with their statin but about half were randomly assigned to receive evolobumab, a PCSK9 inhibitor, while the remaining people took a placebo. All also had ultrasound images taken of their heart at the start of the study and again toward the end to measure if and how much their plaque changed.
About 64% of people taking the combination of cholesterol-lowering drugs had their heart plaques shrink during the study, compared to 47% of those taking placebo. That suggests that the two-drug regimen might reverse atherosclerosis and potentially even avert some heart events by dissolving the fatty buildup that causes them.
“This study shows that for people with difficult-to-control cholesterol, we are beginning to accumulate evidence that there are drug options for them to not only lower cholesterol but to improve the health of their arteries,” says Nissen. “That’s new information.”
The study didn’t answer whether the cleaner vessels can actually lead to fewer heart attacks or heart deaths, but that would be the logical result. PCSK9 inhibitors like evolocumab were discovered after researchers found that some people had mutations in the PCSK9 gene and enjoyed astonishingly low LDL levels, around 20mg/dL (doctors recommend average adults aim for levels around 100mg/dL). Those people didn’t seem to have any health issues because of their mutation, but enjoyed lower than average risk of heart disease.
So the results raise the more complicated question of how low LDL levels should go, and whether current guidelines are set too high. Would more lives be saved, and more heart attacks averted, if LDL targets were set lower? The findings make a strong case that may be the case. The study found that for people with the lowest levels of LDL, the benefit from the paired drugs in reducing plaque in the arteries nearly doubled, suggesting that not only people with advanced disease but even those with lower amounts of plaque might benefit.
But for now, the combination isn’t accessible enough to be used widely. The study only looked at people with a history of heart problems; it says nothing yet about whether the combination of medications could be used to prevent first heart attacks in high risk people. Evolocumab isn’t a pill but has to be injected, and it’s expensive, costing about $1200 per month. So as effective as it may be, either alone or in combination with a statin, it’s likely out of reach for most people who might benefit.
Still, doctors now have another option for treating people who may have stubbornly high cholesterol levels that don’t drop with statins, diet and exercise alone. And reason to take a closer look at how low LDL should be set. “The science here is what is really interesting,” says Nissen, noting that the low levels of LDL achieved in the study by combining the drugs are found in nature among wild animals with low heart disease rates. “There seems to be a really big benefit to going really low.” The results of next year’s studies on how people on PCSK9 inhibitors fared on heart events will provide more evidence on whether that’s true.
Posted: 15 Nov 2016 01:46 AM PST
NEW YORK — Roe v. Wade, the 1973 Supreme Court decision legalizing abortion nationwide, could be in jeopardy under Donald Trump’s presidency. If a reconfigured high court did overturn it, the likely outcome would be a patchwork map: some states protecting abortion access, others enacting tough bans, and many struggling over what new limits they might impose.
Trump, who will have at least one Supreme Court vacancy to fill, has pledged to appoint “pro-life” justices who potentially would be open to weakening or reversing Roe. With one seat vacant, the high court now has a 5-3 majority supporting abortion rights, and thus one of those five would need to vacate his or her seat to give the court an anti-abortion majority.
Trump broached that possibility in an interview aired Sunday night on CBS’ “60 Minutes,” suggesting that a reversal of Roe would return the matter to the states, leaving it up to their legislatures to decide the future of abortion access.
Asked about the likelihood that some women would face abortion bans in their states, Trump replied, “Well, they’ll perhaps have to go, they’ll have to go to another state.”
Supporters of abortion rights concurred with that analysis.
“If Roe were overturned, we would likely return to a patchwork quilt of laws, which would force women onto the road even more than at present,” said Dr. David Grimes, a North Carolina obstetrician-gynecologist.
Grimes was alluding to the fact that many states under Republican control already have forced closure of some abortion clinics, confronting some women with the need for long-distance travel in order to obtain an abortion. While affluent women might be able to afford such travel, it can be an insurmountable burden for some low-income women.
“Is that the world we want, where women’s ability to get the care she needs depends on her ability to go to another state?” asked Jennifer Dalven, director of the American Civil Liberties Union’s Reproductive Freedom Project.
Anti-abortion leader Clark Forsythe, acting president and senior counsel for Americans United For Life, predicted that the states would break into three basic categories if Roe were overturned: Perhaps a dozen states would continue to make abortion widely accessible, another dozen or so would ban virtually all abortions unless the mother’s life were at stake, and roughly two-dozen more states would thrash out their response with debate among the public and in the legislatures. Forsythe suggested that some of those states might allow abortions in the first trimester of pregnancy, while restricting or banning later abortions.
Among the states likely to maintain full access to abortion are those on the Pacific Coast and in the Northeast. South-central and southeastern states would be among those likely to impose bans, potentially leaving women in a huge, contiguous chunk of the United States with no nearby access to abortion providers.
“For many women, it’s not possible to traverse across multiple state lines,” said Nancy Northup, president of the Center for Reproductive Rights. “This could have tragic consequences.”
She said one consequence might be an increase in the number of women seeking to self-induce an abortion.
Florida, compared to other Southern states, has a large number of abortion clinics — more than 70, according to the most recent count by the Guttmacher Institute, a research group which supports abortion rights.
Laura Goodhue, executive director of the Florida Alliance of Planned Parenthood Affiliates, said the state legislature has been increasingly hostile to abortion rights, yet she was uncertain what would happen if Roe were overturned.
“A majority of Floridians support access to abortion, and don’t want to see it go away,” she said.
In the decades since the Roe decision, several states have kept or added anti-abortion laws that could take effect immediately if the ruling were overturned.
Among them is Wisconsin. Nicole Safar, director of government relations for the state’s Planned Parenthood affiliate, said a statute has been on the books since 1849 making it a felony for a doctor to perform an abortion in Wisconsin. Abortion is likely to remain legal in neighboring Illinois, but Safar said even that trip might be out of reach for many low-income women in Wisconsin.
“Illinois is and should remain an oasis for abortion care, but we can’t be complacent about that,” said Brigid Leahy, director of public policy for Planned Parenthood in Illinois. “I don’t think our legislature is poised to pass a ban should Roe be overturned. But things can always change.”
Vicki Saporta, president of the National Abortion Federation, said a reconfigured Supreme Court might address an abortion case by leaving some aspects of Roe in place, but chipping away at it to allow a broader range of restrictions.
“It’s not so easy to overturn Roe,” she said. “Women in this country would not stand for it.”
Anti-abortion leader Marjorie Dannenfelser of the Susan B. Anthony List also predicted that a “chipping away” of Roe might be more likely than its total reversal. She said Congress was likely to pass a ban on most abortions after 20 weeks of pregnancy, and states would feel more emboldened in passing tough anti-abortion laws.
“Roe is already in shambles,” she said.
Carol Tobias, president of the National Right to Life Committee, said Roe’s eventual demise would mean even brighter prospects for state anti-abortion legislation.
“Our state affiliates have been working to pass laws, but they run up against Roe,” she said. “If Roe were overturned, it would allow us to fight in each state.”
Professor Michael New, an abortion opponent who teaches economics at Ave Maria University in Florida, said he would welcome a reversal of Roe even if abortion policy in many states remained unchanged.
“It would restart a serious debate about sanctity of life issues in the United States,” he wrote in an email. “This is a debate that pro-lifers welcome.”
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