LISTEN: Distracted. Reckless. Drunk. Americans’ driving has gotten since the covid pandemic. Chaseedaw Giles appeared on WAMU’s “Health Hub” on Nov. 26 to share her reporting on that deadly trend.

Traffic deaths have climbed nationwide over the past decade. In some major cities, traffic deaths have . But this year, Washington, D.C., has recorded a in these kinds of deaths. Chaseedaw Giles, audience engagement editor with Ñî¹óåú´«Ã½Ò•îl Health News, appeared on WAMU’s “Health Hub” on Nov. 26 to share her reporting on the ways design and better enforcement can contribute to safer streets.

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LOS ANGELES — Kris Edwards waited at home with friends for his wife, Erika “Tilly” Edwards, to go out to dinner, but she never made it back to the house they had purchased only four days earlier. Around 9 p.m. on June 29, a hit-and-run driver killed Tilly as she walked to her car after a fundraiser performance in Hollywood.

“I’ve just got to figure out how to keep living. And the hard part with that is not knowing why,” Edwards said of his wife’s death.

Despite local, state, and federal safety campaigns, such as the global initiative to eliminate traffic fatalities, such deaths are up 20% in the U.S. from a decade ago, from 32,744 in 2014 to an estimated , according to data from the Department of Transportation’s National Highway Traffic Safety Administration. Although traffic deaths have declined since peaking at 43,230 in 2021, the number of deaths remains higher than a decade ago.

Since the covid-19 pandemic, the Pew Research Center found, Americans’ driving habits have worsened across multiple measures, from , which road safety advocates call a public health failure. They say technology could dramatically reduce traffic deaths, but proposals often run up against industry resistance, and the Trump administration is focusing on driverless cars to both innovate and improve public safety.

“Every day, 20 people go out for a walk, and they don’t return home,” said Adam Snider, a spokesperson for the Governors Highway Safety Association, which represents state road safety offices.

American roads have become more dangerous than violent crimes in some cities: Los Angeles, San Francisco, and Houston are among the major cities that now report more traffic fatalities than homicides. In 2024, the Los Angeles Police Department reported an estimated 268 homicides and 302 traffic deaths, the that the number of people killed in collisions exceeded the number of homicide victims, according to Crosstown LA, a nonprofit community news outlet.

San Francisco reported and in 2024. In Houston, approximately died in crashes and .

“Simply put, the United States is in the middle of a road safety emergency,” David Harkey, president of the Insurance Institute for Highway Safety, testified during a House Energy and Commerce subcommittee hearing . Out of 29 high-income countries, America ranks at the bottom in road safety, Harkey said. “This spike is not — I repeat, is not — a global trend. The U.S. is an outlier.”

In January 2017, then-Mayor Eric Garcetti joined 13 other L.A. city leaders in pledging to implement the and eliminate traffic deaths in the city by 2025.

Instead, deaths .

released in April that was commissioned by the city’s administrative officer found that the level of enthusiasm for the program at City Hall has diminished and that it suffered because of “the pandemic, conflicts of personality, lack of total buy-in for implementation, disagreements over how the program should be administered, and scaling issues.” The report also cited competing interests among city departments and inconsistent investment in the city’s most dangerous traffic corridors.

Mayor Karen Bass’ office did not immediately respond to requests for comment.

Last year, California state Sen. Scott Wiener proposed that would have required new cars sold in the state to include “intelligent speed assistance,” software that could prevent vehicles from exceeding the speed limit by more than 10 mph. But the bill was following pushback from the auto industry and opposition from some legislators who called it government overreach. It was by Democratic Gov. Gavin Newsom, who said a state mandate would disrupt ongoing federal safety assessments.

Meanwhile, the Alliance for Automotive Innovation, an influential automotive lobby, this year over an automatic emergency braking rule adopted during the Biden administration. The lawsuit is pending in federal court while the Department of Transportation completes a review. Even before Donald Trump was sworn in for his second term, the alliance appealed to the president-elect to support consumer choice.

Under Trump, Transportation Secretary Sean Duffy is prioritizing the development of autonomous vehicles by proposing sweeping regulatory changes to test and deploy driverless cars. “Federal Motor Vehicle Safety Standards were written for vehicles with human drivers and need to be updated for autonomous vehicles,” NHTSA Chief Counsel Peter Simshauser said in September in announcing the , which includes repealing some safety rules. “Removing these requirements will reduce costs and enhance safety.”

Some Democratic lawmakers, however, have criticized the administration’s repeal of safety rules as misguided since new rules can be implemented without undoing existing safeguards. NHTSA officials did not respond to requests for comment about Democrats’ concerns.

Advocates worry that without continued adoption of road safety regulations for conventional vehicles, factors such as excessive speed and human error will continue to drive fatalities despite the push for driverless cars.

“We need to continue to have strong collaboration from the federal, state, local sectors, public sector, private sector, the everyday public,” Snider, of the Governors Highway Safety Association, said. “We need everyday drivers to get involved.”

It took nearly a month for police to track down the driver of a Mercedes-Benz G-Wagen allegedly involved in Tilly’s death. Authorities have charged Davontay Robins with vehicular manslaughter with gross negligence, felony hit-and-run driving, and driving with a suspended license due to a previous DUI. He has pleaded not guilty to all charges and is out on bail.

Kris Edwards now tends to the couple’s backyard garden by himself. Since his wife’s death, he has experienced sleep deprivation, fatigue, and trouble eating, and he relies on a cane to walk. His doctors attribute his ailments to the brain’s response to grief.

“I’m not alone,” he said. “But I am lonely, in this big, empty house without my partner.”

Edwards hopes for justice for his wife, though he said he’s unsure if prosecutors will get a conviction. He wants her death to mean something: safer streets, slower driving, and for pedestrians to be cautious when getting in and out of cars parked on busy streets.

“I want my wife’s death to be a warning to others who get too comfortable and let their guard down even for a moment,” he said. “That moment is all it takes.”

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She saw people running from Exclusive Barbershop next door. She heard a voice telling a 911 operator that someone had been shot in the head. Her hands shook as she ventured outside. Then she saw 20-year-old Elijah Clunie slumped in a barber’s chair, haircut unfinished.

In the chaos, a 7-year-old boy stood in shock, eyes bulging at Clunie’s body. Sowers-Hassell asked the boy to come with her and sheltered him at the salon until his father arrived. “He kept going, ‘I can’t breathe. I can’t breathe,’” she said, and he later told her he never wanted to get his hair cut again.

Barbershops and salons are regarded in the Black community as safe, sacred spaces, where men and women gather to laugh, debate, and see their unofficial therapists: the barbers and stylists. When those refuges are violated by gun violence, an unspoken bond is broken.

Clunie’s killing cost Dorchester more than his own young life. Shootings send ripples of trauma through communities that can carry across generations. A found that exposure to gun killings was linked to higher levels of depression, suicidal ideation, and other mental health difficulties. Children and young adults were the most susceptible, and Black youth were disproportionately affected.

When economists calculate the societal costs of gun violence, “what they find is that much bigger than hospital treatment or criminal justice response or anything, is the fear and trauma and how it affects individuals and businesses,” said Daniel Webster, a professor and distinguished scholar with the Johns Hopkins Center for Gun Violence Solutions.

Four Corners — home largely to African American, Caribbean, and Puerto Rican families — is not a destination neighborhood. A historic Methodist church is one of the few attractions. There aren’t any major supermarkets, fine dining restaurants, or hospitals. Of the businesses that do exist, many cover their doors and windows in plexiglass and metal bars.

“We talk about these food deserts of good, healthy food; the truth of the matter is, it’s a desert for everything,” Webster said. “Businesses generally don’t want to be there.”

The owner of Salvaged Roots, Shanita Clarke, said she intended her salon to stand out as an oasis in the community.

Clarke was planning to take her then-13-year-old son to the salon to get his hair done when she got a phone call about the shooting. She rushed to work to check on her stylists. Clarke, her staff, and clients spent the next three hours waiting while officers collected evidence. In the weeks that followed, calls came in to push back appointments. Clarke said she could sense her clients’ anxiety and understood it. Even though she wasn’t in the shop when Clunie was shot, she experienced the incident vicariously through the sound of gunshots captured on the salon’s security footage and accounts from her employees.

A from the commonwealth of Massachusetts alleges the suspect in Clunie’s killing, Diamond Jose Brito, entered Exclusive Barbershop wearing all black clothing and a ski mask. Brito walked to the back of the shop, where Clunie was seated, and asked his barber how long the wait was for a haircut. About 45 minutes later, the statement alleges, Brito returned, walked to Clunie’s chair, shot him in the back of the head with a small silver revolver, then shot another victim multiple times.

Brito, of Canton, Massachusetts, was in October and is being held without bail. He to all the charges against him, including murder.

“Mr. Brito maintains his innocence and we are looking forward to presenting his defense at trial,” Brito’s attorney, David Leon, said in a statement to Ñî¹óåú´«Ã½Ò•îl Health News.

Boston City Councilor Brian Worrell’s office is around the corner from Salvaged Roots and Exclusive Barbershop. The neighborhood requires investment and initiatives by elected officials and policymakers, he said. Residents have to feel that homeownership and stable careers are possible.

“That can’t be some far-off thinking,” said Worrell, who represents District 4, which includes that part of Dorchester. “They have to be able to see it, and it has to show up in their lives, in a real, tangible way.”

Clunie had been a student at TechBoston Academy and a basketball player who was named player of the game after a big win his senior year, in 2022. But in a uploaded to the presentation site Prezi in June of that year, a user presumed to be Clunie wrote: “When I first moved to the Dorchester area I thought I was going to die,” noting “the killings on the news” every day.

Moments after the shooting, an unknown person walked into the barbershop and recorded a graphic video of Clunie’s body, which was then uploaded to social media platforms. It spread on Facebook and X, leading users to find Clunie’s personal accounts, on which some commenters made light of his death. He would have turned 21 the Saturday following his killing.

Worrell called the video especially inappropriate and callous. But apathy in the face of violence, he said, isn’t hard to imagine in a community suffering food and housing insecurity, struggling schools, and a persistent lack of opportunity.

Clarke said she’s torn on how to move forward. Loud noises and being alone trigger anxiety, and she now sometimes locks the salon doors once clients are in for their appointments. She’s felt anger and isolation, she said.

Recovering from the trauma of witnessing gun violence is often more difficult for onlookers when they still live and work where the shootings happened.

“We want to address the mental health trauma from gun violence, but let’s not kid ourselves,” Webster said. “If we don’t actually address gun violence, we’re swimming against a really strong tide.”

Since she opened her salon almost six years ago, Clarke has been active in community efforts to make the neighborhood safer, attending civic association and neighborhood meetings and speaking with police and local politicians.

Clarke believes efforts to clean up moved more drug users into Dorchester. Salvaged Roots is next to a commuter rail station, which Clarke said attracts transients who set up camps and leave behind trash and sometimes drug paraphernalia. Only a week before Clunie’s killing, there was a across the street from the salon.

In 2024, there were about 20 shootings in the police district that includes Four Corners, five of them fatal. Most of the victims were Black men, according to a Ñî¹óåú´«Ã½Ò•îl Health News analysis of data.

Though gun violence overall is at a record low in Boston and the city has in investigative resources — including , management, and oversight — a disproportionate amount occurs in Boston’s historically Black communities.

Since Clarke opened Salvaged Roots, she feels Four Corners has gotten both better and worse. “If other businesses leave, then where do people that live in the community — where are the nice places that they get to go to?” she asked.

Residents of neighborhoods with frequent gun violence and crime can mistakenly be perceived as being desensitized, but “we can never accept the violence as normal,” Boston City Council President Ruthzee Louijeune said. She’s volunteered and worked in Four Corners and said tackling the violence takes a multipronged approach, including getting guns off the street and providing access to affordable housing, secure jobs, and good health care.

In communities of color, she said, intergenerational trauma from racism and poverty must also be addressed.

In Dorchester, Louijeune said, a high number of residents resort to visiting emergency rooms for mental health issues. The neighborhood needs more access to health care, she said, especially for young people. Across Boston, Black residents were nearly twice as likely to go to the ER for mental health care than white residents, according to the Boston Public Health Commission’s .

Months later, attention and curiosity over the shooting had died down, but the trauma remained. Sowers-Hassell continues to work at Salvaged Roots, and though the city sent a trauma team to meet with the stylists after the shooting, she still has flashbacks. She said the influx of resources was helpful and that Four Corners has been a little quieter. But she’s skeptical the reprieve will last.

“Everybody talks a good game,” she said, “but when it’s time to get something done, what’s going to happen?”

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“It’s like this negative connotation,” said the 37-year-old actress, singer, and stand-up comedian, who said she is often asked to audition for villainous roles such as a bully, drug dealer, or pimp.

Her quest for more equitable representation on the big screen isn’t just professionally exhausting. Thompson says anxiety about her skin complexion has affected her health.

“It definitely had a negative impact on my self-esteem,” she said. She recalls being called “charcoal” in kindergarten. “It was big, like, your skin is dark and that’s a problem.”

The term colorism — a form of prejudice and discrimination in which lighter skin is favored over darker skin — was popularized by author Alice Walker in her 1983 book “In Search of Our Mothers’ Gardens: Womanist Prose.”

Clinicians from various ethnic groups have recently begun to draw a direct line between colorism and poor health. A 2023 found that, among Black and Hispanic adults, those with self-described darker skin tones reported more experiences with discrimination in daily life compared with those who have lighter skin tones. People who feel they experience daily discrimination can be at higher risk for depression, loneliness, increased alcohol and drug use, and anxiety, data shows.

And colorism can also lead to . Hair straighteners and skin lighteners commonly used by women of color, sometimes to conform to , increase their exposure to toxic chemicals, research shows.

Because of the potential health implications, the health care system should pay more attention to colorism, said Regina James, a child and adolescent psychiatrist who heads the American Psychiatric Association’s Division of Diversity and Health Equity.

“Skin color discrimination is so insidious it can literally get under your skin,” she said. “And consciously or subconsciously, it can contribute to low self-esteem and self-confidence, and even be detrimental to one’s mental health.”

Conversations about skin complexion can remain overlooked by mental health professionals who do not have expertise about or awareness of a person’s cultural context, if the conversations happen at all, said Usha Tummala-Narra, a clinical psychologist and professor in the Department of Counseling, Developmental, and Educational Psychology at Boston College.

“There’s no specific training on colorism. Many people are unaware that it exists,” Tummala-Narra said.

But the experience can negatively affect a person’s self-worth, relationships, sense of belonging, and dignity. “These are all really critically important things as human beings that we all need to secure to have good health, both physically and mentally,” she said.

The issue can emerge in childhood for Black and Indigenous people and other people of color, who must navigate fair skin often being seen as superior, a ramification of colonialization. Black children with the darkest complexions experience higher levels of depressive symptoms, found a in the journal Society and Mental Health.

Shannon Brown, 34, a former college counselor from the Bronx, New York, who is Black, remembers being called “midnight” by classmates and having family members joke about his skin being difficult to light in family photos. “I’ve just kind of accepted it and try to find the humor in it,” he said. “I feel like most folks aren’t intentionally trying to hurt me, but the jokes get tiresome.”

Shakun Kaushal, a 26-year-old digital communications specialist at the Johns Hopkins Center for Gun Violence Solutions, is Indian American and has a “darker complexion.” She said that in Indian culture one might hear comments like, “Oh, she’s so light and beautiful.”

“I sometimes feel dismissed by people,” said Kaushal, who has searched for an Indian or Black therapist in hopes they might better relate to her lived experience. She believes conversations about colorism should be intergenerational, start early, and get introduced with great care.

“What you say to a child does affect them. They will remember, and it will impact how they feel about themselves and in their skin,” Kaushal said. “We must talk about it.”

The feeling of shame and embarrassment colorism produces in people is palpable and needs to be acknowledged in health care settings, said Roopal Kundu, a dermatologist who founded and directs the Northwestern Medicine Center for Ethnic Skin and Hair in Chicago. Kundu, who is of South Asian heritage, opened the center in 2005 and notes that some cases of diseases like psoriasis, skin cancer, and eczema get diagnosed later, or misdiagnosed, because they present differently on diverse skin tones.

“How can we really make sure, as a field, that we’re taking care of everybody?” she said. “Healthy skin is beautiful skin. And beauty is across every single skin tone that there is.”

Therapists, doctors, and other clinicians from diverse backgrounds say that, in addition to clinical approaches that incorporate cultural competence, more efforts are needed to diversify the pool of mental health practitioners and to collaborate between disciplines.

Without cultural awareness and sensitivity, “you’re not going to get all the information that you need to appropriately diagnose and treat someone,” James said.

Black people are more likely to report difficulty finding mental health providers who understand their background and experiences, a found. At the same time, programs that bolster diversity, equity, and inclusion in medical schools are faltering in the wake of the 2023 Supreme Court decision outlawing affirmative action in higher education.

According to the Association of American Medical Colleges, in 2022, about 5% of active psychiatric physicians identified as Black, 16% as Asian, 6% as Hispanic, and fewer than 1% as American Indian or Alaska Native.

Thompson, Brown, and Kaushal all said they had never been treated by a therapist who looks like them.

Thompson, the L.A. comedian, said she drank bleach when she was 10 years old, thinking it would lighten her skin. Fortunately, it caused only nausea.

If she could speak to her younger self, she would say: “You’re beautiful. You’re brilliant.”

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Oldways Ambassadors Brenda Atchison and Glorya Fernandez walked a KHN reporter through two cooking demonstrations to showcase modern takes on cultural classics — like a cold black-eyed pea salad just in time for the new year, and a garlicky dill mojo sauce served over spinach salad.

Last year, Kelly LeBlanc, director of nutrition at Oldways, shared the organization’s heritage-based food guide pyramids with KHN for a report on USDA food guidelines. It’s the 10-year anniversary of Oldways’ A Taste of African Heritage nutrition curriculum, and this year, the curriculum became part of the Department of Agriculture’s , a collection of interventions from the Supplemental Nutrition Assistance Program educational effort focused on helping low-income households make healthier food choices and reinforce healthy eating habits.

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People have been styling their teeth for centuries across the globe throughout North and South America, Africa, and Asia. But social media — particularly TikTok, where everything old and new is nip/tucked into short videos with trendy sounds and served up fresh to young eyes — has breathed life into trends like tooth gems. Drake, Rihanna, and Bella Hadid wore them years ago. Now, some TikTok influencers are selling DIY gem kits.

But it doesn’t stop there. There are DIY tooth replacement kits and bedazzled grills available online for under $25, and recipes for homemade toothpaste and whitening treatments. The TikTok hashtag #DIYdentist has 2.6 million views. It’s enough to make any licensed dentist or orthodontist cringe.

The professionals wholeheartedly agree that DIY dentistry is a very bad idea. Dental care can be expensive, and orthodontic treatment is usually considered cosmetic and not covered by dental insurance — which 65 million Americans don’t have. And, according to the , people who are low-income, uninsured, members of racial minority groups, immigrants, or living in rural areas are more likely to have poor oral health.

So, is the high cost of dental treatment driving these viral trends among young people, or is it the lure of supposedly painless, instantly changed smiles?

, a Fremont, California, dentist and spokesperson for the American Dental Association, said she can understand why patients want to try DIY dentistry at home. “I just don’t know how [they] could do it safely,” she said, especially altering the shape of their teeth. While filing teeth is something a dentist might do to smooth out imperfections or create space between teeth during treatment for braces, for instance, some people are doing it themselves to smooth away chips in teeth or create vampire-like fangs for aesthetic reasons. “When we practice dentistry, we do it with the background information of years of training, X-rays, and the experience that helps us decide when and how to do the treatment,” Sahota said.

Even tooth gems applied correctly with oral bonding materials are troublesome, she said, because they “are adding something to your teeth that will also attract bacteria. You’re increasing your risk of cavities, of gum infections. And you’re increasing your risk of chipped teeth, of inflammation inside your mouth.”

DIY prices are certainly part of the allure. On Amazon, a was selling for $12.99 from Tondiamo, a brand that also sells children’s earwax removal tools, waterproof adhesive bandages, and chainsaw chains. The kit comes with 10 rhinestones, a mini-LED keychain to cure the adhesive, four wooden sticks, five disposable applicator brushes, and five cotton rolls.

But no instructions.

Reviews on Amazon complained of the gems not sticking. Some suggested using nail glue — which is toxic and can damage tooth enamel. But among Amazon’s “frequently bought together” suggestions: a bottle of epoxy resin glue.

A for $7.98 from TCOTBE and a set of for $10.99 from OOCC both advertised that “one size fits most,” but reviewers said otherwise. “Save your money and use foil (old school way) if you want a grill lol,” one buyer warned. Bleeding gums were a common complaint among the reviewers.

Perhaps the most bizarre DIY find was a temporary tooth repair kit for under $25 from CZsy. It came with plastic “veneers” in different shapes for missing teeth, and moldable plastic beads for repairs.

It also did not come with printed instructions, but these were buried in the product description on Amazon’s site:

1. Drop into hot water above 130 degrees for about two minutes.
2. Shape the size what you want.

No company information or websites could be found for some of these brands, but the products had one thing in common: a bar code sticker reading “Made in China.” Instead of responding to a request by KHN for an explanation of its policies, Amazon . The other items were still available to order at publication time.

It’s not just DIY dentistry giving licensed professionals a toothache. Vendors touting certificates to apply composite veneers and partials — dentures that replace missing teeth when someone still has multiple natural teeth in place — are sprouting up on social media. Vendors like in Philadelphia will apply composite veneers over less-than-perfect smiles — in this case, starting at with a $499 deposit — as a lower-cost alternative to porcelain veneers, which require shaving down the natural teeth. The merchant advertises for $5,999. Marie’s Beauty Bar did not respond to emails or voice messages seeking comment.

DIY dentistry isn’t just a phenomenon of young people on social media. “There are teens, adolescents, even adults that are trying these things,” said , a dentist in Marietta, Georgia, and a state director for , a Boston company. “A major contributing factor is lack of access to dental care.”

DIY can appear a viable alternative, especially since a person with severely damaged teeth, in severe pain, or with mounting dental bills from repairing DIY damage rarely displays the disappointing results on TikTok. Social media users, for the most part, display carefully curated highlights, not adverse reactions.

“The ‘cool thing’ right now is all these hacks to make things supposedly easier or more accessible,” she said. Caveat emptor, or let the buyer beware, she cautioned. Reviews from influencers who often receive free services in exchange for promotional posts may be biased. Bonnaig warned that complications could occur many days, weeks, or months after treatment.

Even when people aren’t daring to drill their own teeth, they can do damage with other social trends like drinking a concoction of balsamic vinegar — which has a higher acid content than the actual soft drink — and flavored carbonated water. It’s a recipe for severe erosion of tooth enamel.

Sahota has seen what these viral trends can do. “Patients have been drinking or swishing with lemon water, or maybe apple cider vinegar, and that has caused acid or erosions on their teeth,” she said. “The patients will say, ‘Oh, yeah, you know, I saw online that, you know, this will be better for my health. And so I’ve been doing it every night.’ That’s when I’ll bring a mirror and show them exactly what the effect of that trend has made on your teeth.”

Such low-cost hacks may end up costing patients far more in the long run. Sahota suggested that consumers looking for safe ways to enhance their smiles can scour the products on the site that sports the . Bonnaig and Sahota both implore patients to discuss their oral and cosmetic concerns with a dentist.

Every tooth and every mouth is unique, and there is no safe one-size-fits-all DIY hack. “You can have a beautiful smile,” Sahota said, “even if it’s not perfect.”

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So it gnawed at me, a Black woman, when I recently walked into a supermarket in a lower-income L.A. neighborhood and was greeted instead by an array of processed, high-sugar, high-sodium foods — often offered with a nice discount: Coca-Cola products, five 2-liter bottles for $5; sugary cereals, two for $4; boxed brownie and cake mixes, four for $5.

The pandemic had underlined long-standing health disparities of Black and brown communities. Covid had resulted in a for Black Americans, compared with 1.2 years for white Americans. Research had consistently shown that among the underlying factors giving rise to those poor health statistics — high rates of diabetes and heart disease, for example — is poor diet, fueled by a lack of healthy food options in their neighborhoods.

“I could go into a supermarket, and I can tell everything about the people who live [in the area] based on what’s in their carts, based on what’s at eye level, what’s not at eye level,” said Phil Lempert, also known as the “.”

In retail, specific product placement — not just a store’s inventory — heavily influences a shopper’s experience. So shouldn’t responsible markets encourage shoppers to make better choices?

“There’s a lot of racism, to be honest, I think, behind these decisions, whether it’s unconscious or implicit,” said Andrea Richardson, a policy researcher focused on nutrition epidemiology at the Rand Corp. and professor at the Pardee Rand Graduate School. The presence of a supermarket in your neighborhood should signal that you aren’t living in a food desert, but, I wondered, if the supermarket isn’t guiding you toward more healthful food choices, you might as well be.

So when I flew home for Thanksgiving, I enlisted my mother, Lilie — who always cared about her kids’ diets — to help with more research. I have vivid childhood memories of her scouring multiple grocery stores — often traveling to different parts of town — for the freshest ingredients when none were available close by. We set out one Sunday last fall to buy 12 items on a simple “healthy eating” shopping list at five locations of Stop & Shop, a supermarket chain with stores in a cross section of Boston neighborhoods.

First the good news: We were able to find every item we wanted at each store. But, just as I’d experienced in L.A., healthy foods were easier to find in higher-income neighborhoods. In lower-income areas, junk food was more likely to be front and center.

At the Stop & Shop I recall from my childhood in Jamaica Plain, the food choices had become much more balanced, with a plentiful organic food section in the front of the store. My mom can now buy fresher greens locally.

But that likely in part reflects the gentrification that has taken place since I was a kid. Jamaica Plain now has a of almost $77,000 — though the poverty rate is 18.3% and the aroma of Dominican and Haitian patties still scented the air as we approached the entrance.

Our next two stops were in even fancier areas, Brookline (median income over ) and Somerville — both green oases compared with many of Boston’s grittier neighborhoods.

At the Brookline location, each aisle started with low-fat, low-sugar choices like Crystal Light and V8, and the candy section was minuscule. In Somerville, the produce section was spacious, leaving plenty of room to browse the bins of guava and dragon fruit.

Our next Stop & Shop was in South Boston — a working-class, Irish Catholic community. It was strikingly different than our first three stops. The organic section consisted mostly of breakfast bars and cereals. The produce section positioned caramels, candied apples, and pumpkin-spice doughnuts in a bin alongside regular apples — at the bargain price of two packages for $3. The “International Foods” aisle sold everything you need for a very American Taco Tuesday, while a big part of this section was dedicated to Italian and Irish foods.

In the Grove Hall neighborhood in Dorchester — a predominantly Black neighborhood with a — the offerings were downright dispiriting.

Soda was displayed prominently near one entrance. And as we walked the aisles it seemed that many of the “sale” items were sugary soda products, chips, or cookies. This store had a dizzying array of snack food options, including 20 kinds of Oreos. And there wasn’t an organic food section at all.

The chain has been “doing a lot of work” to make sure that stores are “culturally relevant and [reflect] the demographics of the neighborhood,” said Jennifer Brogan, director of Stop & Shop’s corporate external communications and community relations.

How a store is stocked depends on size, product movement, shelf size, and a mixture of customer feedback and data. That data comes from companies like , that provides consumer, shopper, and retail market intelligence and analyses.

Lempert, the “supermarket guru,” further explained that companies and brands pay retailers “promotional dollars” to put their goods “at eye level” or on sale, or make them available for consumers to sample.

But in making these largely commercial decisions, markets make it more difficult for people in low-income areas to eat healthfully, encouraging those with poor diets to continue the habits that landed them with diet-related illnesses.

“It has been well documented that junk-food companies spend significantly more money advertising in certain communities,” said Kelly LeBlanc, director of nutrition , a Boston-based food and nutrition nonprofit. A , for instance, found that junk-food advertising disproportionately targeted Black and Hispanic youth.

Stop & Shop has started to try to redress the inequity, with changes coming first to its Dorchester location, including an in-store dietitian. The Grove Hall store also sends out an ad circular that features promotional pricing on better-for-you items, which may include fish, vegetables, and fruit. It has joined the food prescription program that allows participating doctors to prescribe to patients a prepaid Visa card that can be used to purchase fruits and vegetables.

Still, why not simply cut down on the soda and bewildering number of Oreos, I wondered. “I think our job is to give customers a choice,” Brogan said. “I also think we have a responsibility to help them make healthier choices.”

I’m glad my mom taught me how to make those choices early on.

Another thing I learned: There’s a whole science behind how supermarkets are organized, and depending on where you live, that could say a lot about the surrounding area. So the next time I think about moving, the first place I’m heading to is the local supermarket because, as Lempert told me, “going to that community grocery store is going to tell you about the neighborhood.”

This <a target="_blank" href="/public-health/food-inequities-supermarket-shopping-list/">article</a&gt; first appeared on <a target="_blank" href="">KFF Health News</a> and is republished here under a <a target="_blank" href=" Commons Attribution-NonCommercial-NoDerivatives 4.0 International License</a>.<img src="/wp-content/uploads/sites/8/2023/04/kffhealthnews-icon.png?w=150&quot; style="width:1em;height:1em;margin-left:10px;">

“If you ain’t rapping about being on no drugs, or you out here in the streets selling some drugs,” he said of his chosen profession, “you ain’t got some of that going on — like, don’t nobody wanna hear what you talking about.”

This snapshot of Williams’ hip-hop life doesn’t seem all that different from that of musicians of other genres for whom the mix of drugs and addiction is a recurring storyline, claiming the lives of artists like Janis Joplin, found dead of a heroin overdose in 1970, and rapper DMX, who died last .

But drug use in the hip-hop community has an ever increasing presence that is intertwined with the music – and one with dire consequences. The catchy lyrics suggest that opioid misuse is part and parcel with fame and wealth, just a normal, and innocuous, component of that life.  

Coverage on the abuse of hard drugs in the community usually focuses on tragedy surrounding certain popular rappers rather than the lyrics and the culture they create. And while public health experts take great pains, for example, to criticize and curtail the promotion of vaping to young people, little attention is paid to the dangerous effects that hip-hop is having on vulnerable listeners by normalizing popping Percocets or drinking cough syrup.

From big cities like Los Angeles to rural towns like Gibsland — population 878 — opioid misuse among some young, hopeful listeners is about emulating their favorite rap star’s enviable image. For others, it is not all about the high life. It’s self-medication.

“Let’s talk about pain,” said Mikiel Muhammad, 38, aka King Kong Gotcha, a member of the rap trio in Virginia. “The pain is so deep. They ain’t got money to go see a psychiatrist, but they got money to go get a Perc-10. They got $10, $15 for that,” Gotcha said, referencing the street value of a 10-milligram Percocet tablet.

According to a , anxiety, depression and thoughts of suicide have increased for young adults in the past year.

Artists like Young Nyke sometimes confront neighborhood and family violence, as well as a general lack of opportunities and resources in their communities — circumstances amplified by the covid pandemic. The poetic detailing the rappers’ experience offer some support. But these phrases can also be fraught.

It’s not just the drug use that is worrisome, said , an associate professor of public health at William Paterson University in Wayne, New Jersey. Often these songs promote using opioids while engaging in high-risk activities like unprotected sex or speeding and, while she is a hip-hop fan, “from a public health perspective, it’s just dangerous,” she said.

That toxicity reaches into populations already plagued by perpetual cycles of poverty, poor health and . There is a need for “culturally relevant interventions” to educate and raise awareness within the hip-hop music audience, which Tettey’s categorizes as primarily composed of youth from “vulnerable and socially disadvantaged” groups.

It is time to turn a critical eye to how opioid misuse permeates hip-hop’s lyrics, creating an entryway for Black young adults into the American opioid epidemic, said Tettey.

In 2017 that epidemic was declared a national public health emergency, with over 47,000 opioid-related overdose deaths reported. Researchers at the Centers for Disease Control and Prevention say fatal drug overdoses nationwide have surged roughly 20% during the covid pandemic, killing more than 83,000 people in 2020. Within this grim statistic the Substance Abuse and Mental Health Services Administration has found inequities.

According to a 2020 from the Department of Health and Human Services’ Office of Behavioral Health Equity and SAMHSA, attention to this crisis has focused more on white suburban and rural communities, even though Black communities are experiencing similar dramatic increases in opioid misuse and death. The report also found that synthetic opioids, like fentanyl, are affecting opioid death rates among Black people more severely than other populations.

A 2020 SAGE journal research found a large increase in prescription opioid overdose deaths among Black people. The paper also found the rate of death almost tripling between 1999 and 2017. In February 2018 the U.S. surgeon general a warning that trends in opioid misuse “may be a precursor to even more opioid overdose fatalities in the black community in coming years.”

“The music industry, all it does is perpetuate whatever’s going on outside,” said Jarrell Gilliard, 40, explaining the pharmaceutical drug presence he’s encountered and how it’s reflected in popular lyrics. “How they pump these pills and all these prescribed medicines through the streets. Once the streets got ’em …” said Gilliard, whose hip-hop alias is Grunge Gallardo.

Grunge is also a member of The Opioid Era, named for their gritty, raw imagery and lyrics. Songs such as “Suboxones,” “Sackler Oath” and “Overdose,” which opens with a haunting 911 of a woman frantically pleading for help with one, contrast sharply with the pill-laced tunes of hip-hop’s mainstream.

“I think that’s the most dangerous thing about it,” said Richard Buskey, 42, who completes The Opioid Era trio as Ambassador Rick. “It’s a disconnect between the youth and them realizing that they’re in the same category as what they would consider a junkie or a fiend.”

Tettey said that’s partly because mainstream artists represent a lifestyle many young adults want for themselves, which can translate into modeling behaviors like opioid misuse.

Feeling the ‘Lean’

Patrick Williams, 26, an independent rapper from Orange, Texas, with the stage name , is no stranger to addiction.

He was 21 when he first sipped “” — a drink made from mixing prescription cough syrup containing the antihistamine promethazine and the opioid codeine with soda, Jolly Rancher candies and ice, served in doubled-up Styrofoam cups. “It’s a variety of colors that you have,” PatvFoo said, referencing the various formulations of codeine cough syrups. Purple syrup ranks as most potent. PatvFoo learned about lean through the Texas rap scene and artists like and then became a user.

“At first, there’s a mellowing high,” said Stevie Jones, 23, also known as Prophet J, an independent rapper in Louisville, Kentucky. He has similar recollections from his first time misusing codeine syrups. He and his friends drizzled some on a blunt — the slang term for a hollowed-out cigar filled with pot. “It just makes it burn slower — like, get you a little bit higher, I guess,” said.

Things can take a bad turn quickly. Although lean is one of the weaker opioids, experts say it is . “The day you go without it you get bad, bad stomach cramps. You feel like you got to just throw up all the time. You sweating. It’s like you got a bad flu,” PatvFoo said.

That flu-like feeling is opioid withdrawal, said Dr. Edwin C. Chapman, a Howard University College of Medicine alum who has practiced internal and addiction medicine in Washington, D.C., for more than 40 years. The symptoms range from runny nose and eyes to diarrhea and usually can be stopped with a gulp of cough syrup or lean, he said.

And there’s a harsh reality in that. Whether it’s Percocet pills or lean, “it’s all in the same class as heroin and fentanyl,” Chapman said.

But learning that opioid use is promoted in popular music came as a revelation to Chapman. “That’s not the music that I listened to,” said the 75-year-old doctor. The medical community, he said, has been focused on curbing the overprescribing of pain medication. “But it’s never talked about … that it’s being advertised overtly to young folks through music or through the media.”

Indeed, abuse of lean, also known as “” and “,” has managed to evade the regulatory spotlight while remaining popular and recognizable — so much so that vaping companies distributed nicotine-containing e-liquids resembling the drink and even mimicked the slang term “double cup” in their labeling. These products triggered a 2019 on the vaping juices. The drugs themselves, however, still pump through the streets, just like the hip-hop lyrics.

And it has altered the market, moving it beyond the street options of heroin and opioids, said hip-hop artist Buskey. “We living in the times where they’re getting it out of the medicine cabinet.”

Phillip Coleman, 34, a rapper in Rochester, New York, who goes by the name , started using at age 15 after being prescribed 5-milligram tablets of Percocet following wisdom tooth extraction. That set him on a path to misusing prescription painkillers, which led to cocaine and then a heroin addiction that eventually landed him in .

Fortunately, Coleman was able to overcome his addictions in rehab and refocus on family and . He cautions that people buying Percocet or other prescription pills on the street have no way of knowing if they are legitimate or “just pressed fentanyl.” He said the reward for opioid addiction isn’t the lifestyles of the rich and famous you see portrayed by some hip-hop artists. “You don’t get to trade in your empty bags like the box tops and get, like, a bike or whatever. Like, you don’t get no hat; you don’t get no fentanyl swag,” he chuckled. “Like, you just die.”

This <a target="_blank" href="/public-health/opioids-like-lean-permeate-hip-hop-culture-but-dangers-are-downplayed/">article</a&gt; first appeared on <a target="_blank" href="">KFF Health News</a> and is republished here under a <a target="_blank" href=" Commons Attribution-NonCommercial-NoDerivatives 4.0 International License</a>.<img src="/wp-content/uploads/sites/8/2023/04/kffhealthnews-icon.png?w=150&quot; style="width:1em;height:1em;margin-left:10px;">

A full-time artist, Bond, 44, made a living through a patchwork of vocal gigs — performing live at weddings, bars and theaters, recording jingles, teaching vocal lessons and hosting events.

But the coronavirus pandemic found her burning through her savings and struggling to make ends meet in a tiny rental accessory dwelling unit above the tree-lined garage of a home in Hyattsville, Maryland. According to a 2020 report from the , artists were more likely than others to have lost their main source of income — music-related or not — due to the pandemic.

So with few other obvious options, and the world at a standstill for the foreseeable future, she set out to write her first solo album in the small rental she fondly referred to as her “treehouse.”

But cut off from family, friends and other nearby musicians, she devised a way to bring together out-of-work musicians from around the world, people who felt just as abandoned and stuck as she did. What resulted is an extraordinary transnational album — “,” released March 5 — that connected her with a far broader musical community and buoyed their collective spirits during a year of isolation.

The new album is a pandemic-fueled collaboration of musicians such as , PhD. a violinist and acting chair of the strings department at Berklee College of Music in Boston; two-time Grammy-nominated drummer in Nashville; and a percussionist from the British acid jazz band , who sent in his recordings from London. “Everyone jumped on board from wherever they were,” Bond said. And most, she said, “didn’t even stress me for money. We all wanted to create.” She was even able to work with , a songwriter who has written for several artists from Beyoncé to Anita Baker and likely would not have been accessible to her or available pre-pandemic.

They were up against the challenges of not just a pandemic, but also a music industry that has come to rely heavily on curated playlists like Apple Music’s “New Music” or “From Our Editors” to promote new releases. Mainstream artists who have released music during the pandemic have teams of industry professionals ensuring their tunes end up on the most highly trafficked playlists.

Some music- like Apple Music don’t allow third-party playlist curation. So, without a direct connection to their editorial team or partners, landing a spot on these lists isn’t likely. Without being able to perform live at clubs and events this past year, Bond says, some independent artists may feel financial pressure to focus less on the quality of their music and more on finding ways to go viral on social media to tip the scales.

How does an independent artist find new listeners at a time when performing for a crowd isn’t allowed, and they’re battling against more than already on Spotify and Apple Music, respectively?

Bond was not naïve about how the music world works, having been a performer for decades. She and her band, Third Logic, had been performing together since they were in their early 20s, but as time passed and adulthood — marriage, children, increased work responsibilities — set in, finding the time to write music together became nearly impossible. They hadn’t released a new album since “Madam Palindrome” in 2011. Time and distance from her bandmates meant that gigs were few. So, in 2019, she decided to embark on a solo career. Then covid hit.

At first, she despaired about how she would be able to pay for things like rent and food without the hope of recurring live gigs. “The pandemic relief money was really helpful,” she said, because independent artists can sometimes go weeks without making any money even without a global pandemic. Between her stimulus check and unemployment, Bond budgeted $600 a week to live on. She had affordable health insurance through Kaiser Permanente, “thanks to Obamacare,” she said. She cut expenses, stuck to her budget and received modest payments from booking a few covid-friendly, livestreamed events for Washington, D.C.’s Kennedy Center and the Music Center at Strathmore in North Bethesda, Maryland.

She was able to improvise a home-recording studio with mics, speakers, her MacBook and ProTools software and the help of music engineering friends over video conferences. Bond writes song lyrics and performs but doesn’t herself compose music. So, she put out a call to the musicians in her network and found many of them were also at home tinkering with new tunes and willing to share. Bond would “wait until late at night, turn on colored bulbs, blast things through my monitors and write,” she said.

After a rough draft of the album was completed in September, she and independent producer Brandon Lane put out a broader call for help for more live instrumentation. Their pleas circulated and produced a village of talent, as musicians from all over the world sent the singer their high-quality home recordings. “It showed me how many musicians were in the same boat,” Bond said.

Lane, who lived nearby and became part of Bond’s pandemic bubble, would come to her home studio — fully masked-up — as technical support and to co-produce the album. The title “” reflects an appreciation of the importance of trusting your own internal compass, she explained. The project showed Bond “who has my back,” she said, and that in a time of global crisis musicians — many of whom Bond considers friends — would come together to co-create with her.

Bond, who describes herself as having an eclectic Bohemian style and devil-may-care attitude, said she doesn’t want to change herself to jockey for a spot on the Billboard charts or playlists — even in the post-pandemic world.

The music industry is notoriously and male-dominated, she said. The third annual report on the industry, “” from professor and the found that in evaluating gender across eight years of Grammy nominations for Record of the Year, Album of the Year, Song of the Year, Producer of the Year and Best New Artist, 21.7% — or about 1 in 5 artists — were women.

“This is who the f*** I am,” she said. “I’m not 18, but I’m not ‘old’ either.” She wants listeners to have the chance to discover diverse musical options for female entertainers, at different ages, with different sounds and styles to match. By dint of necessity, the pandemic opened new types of doors for performers like her — through which she hopes new types of music will continue to be heard.

“You have to be smart,” she said. “It’s not hard to find new music.” Manually searching streaming apps like SoundCloud and Spotify take no more effort than scrolling through Instagram, she said. Bond hopes that listeners will take a break from the algorithms that sneakily sway our musical interests toward those artists pushed to the top of the charts and follow their own compass.

This <a target="_blank" href="/mental-health/an-indie-artists-plea-to-look-beyond-algorithms-and-curated-playlists/">article</a&gt; first appeared on <a target="_blank" href="">KFF Health News</a> and is republished here under a <a target="_blank" href=" Commons Attribution-NonCommercial-NoDerivatives 4.0 International License</a>.<img src="/wp-content/uploads/sites/8/2023/04/kffhealthnews-icon.png?w=150&quot; style="width:1em;height:1em;margin-left:10px;">

It might engender envy, even outrage, especially if the person posting seems to have cut the line. But what if the intention was to encourage others to also get the shot? Does that make it OK?

Since the pandemic began, people around the world are increasingly living out significant portions of their lives online. But with using some type of social media, according to the Pew Research Center, who sets the rules for proper social media etiquette?

“This is a totally new type of world to have a pandemic in,” said Catherine Newman, the etiquette columnist at and author of the book “.” One advantage of using social media, she said, is that people can create waves of public opinion from which everyone can benefit. Newman, who also volunteers at a hospice, was vaccinated and posted a selfie. She said the selfies can help address some of the public health mistrust issues that have contributed to vaccine hesitancy.

“I don’t want to see a picture of your yacht on social media,” she said. She’d rather see covid vaccine selfies but cautions users to be mindful of the caption they choose.

After all, nearly 500,000 American lives have been lost in the pandemic and stark disparities have emerged in vaccination rates — especially among communities of color and older adults who are in the highest risk categories.

It raises the question: Is posting a vaccine selfie on your social media account a faux pas or still par for the course?

, a lifestyle and etiquette expert, a certified mediator in the state of California and the founder of the Swann School of Protocol in Carlsbad, California, echoed those precautions. “RNs and front-line workers have a very different story to tell than a 20-something-year-old who got vaccinated for some obscure reason,” she said.

At the same time, she said, it’s not necessarily clear how someone came to be eligible for the vaccine. A person could present young and healthy at first glance but could have a health condition or other qualifying criteria. “We don’t know,” she said. She advises that posters follow what she calls the three core values of manners: respect, honesty and consideration.

And the same goes for people reacting to the posts.

George Francois, 35, a center director at Children’s National Hospital in Washington, D.C., chronicled his covid vaccination on Facebook. Looking at the overall death and infection rates in the African American community, he considered his post a public service. “I could inspire others to get it without having to talk to them directly,” he said.

It’s a sentiment shared by J. Shawn Durham, 44, an actor in Washington, D.C., and an unintentional He got a call from a friend of a friend to get vaccinated after a scheduled patient missed their appointment — leaving a critical dose that otherwise might have gone to waste. “I am healthy. I am Black. I am scholastic, so I know about our history and the ,” he said. And, given that history, Durham posted his selfies to “lead by example,” he added. “The white and the wealthy are getting vaccinated. I want Black people to want to get vaccinated too.”

Francois didn’t receive any backlash from his post and didn’t think it was a big deal. “A lot of people post their HIV and covid test results,” he said.

Bottom line: It’s common among younger adults to publicly share things some older adults may consider to be far too personal.

“It’s kind of tacky sometimes, I think, but there’s a lot of misinformation out there,” said Emilio Delgado, 31, who was born in Puerto Rico and now lives in D.C. He posted in part to foster confidence in the vaccine — to let his connections “see that someone they knew has taken it and didn’t grow a third eyeball,” he said of his hesitant followers. For that reason, he added, it was worth it.

Delgado, a local actor and patient instructor at the George Washington University School of Medicine and Health Sciences, had access to the vaccine because in this role of “standardized patient” he is often called in to role-play ultrasounds with fourth-year medical students. He makes the bulk of his income through such patient instruction and is frequently at the hospital — a place generally considered high-risk — so he’d rather be vaccinated.

For Signe Hawley, 34, a researcher and volunteer firefighter in the foothills of northwestern Boulder, Colorado, getting the vaccine — and posting about it — was an emotional experience.

Earlier in the pandemic, she made the difficult decision to pull back from her volunteer duties to protect her wife and 2-year-old daughter. But because she had been a first responder in her community, she became eligible for the vaccine sooner than expected. “I wouldn’t cut the line,” said Hawley. “But when given the opportunity, I wouldn’t pass it up either.”

For Hawley, the hardest side effect she faced after getting the vaccine was the depth of grief and sadness that surfaced surrounding the loss of her father, along with thoughts of all of the other lives lost “in the mismanagement of this,” she said.

Her father, Joe Hawley Sr., 67, died in early April from complications of covid-19 at Norwalk Hospital in southwestern Connecticut. His family was not allowed into the intensive care unit at any time during his bout with covid. And her interest in volunteerism and service is something she inherited from her father, a “humanitarian at heart,” who was involved and committed to the New England community where he lived.

“To be vaccinated for something that my father died from is so surreal,” she said, her voice breaking. Sharing her story and the vaccine photo was a way to honor her father. “This is one step to lessening the impact of death and severe health complications with covid, but it’s not the end of it,” she said.

Ultimately, she said, the more people vaccinated the better off we all are.

“We’re all posting this hoping to get buy-in,” said national etiquette expert , an author and founder of the Protocol School of Texas, a company specializing in corporate etiquette training based in San Antonio. Know your audience, she advised. And another important reminder: Follow , which advise against posting vaccination cards containing identifying information that could expose you to identity theft.

This <a target="_blank" href="/public-health/the-dos-and-donts-on-social-media-for-vaccine-haves-and-have-nots/">article</a&gt; first appeared on <a target="_blank" href="">KFF Health News</a> and is republished here under a <a target="_blank" href=" Commons Attribution-NonCommercial-NoDerivatives 4.0 International License</a>.<img src="/wp-content/uploads/sites/8/2023/04/kffhealthnews-icon.png?w=150&quot; style="width:1em;height:1em;margin-left:10px;">

LISTEN: Distracted. Reckless. Drunk. Americans’ driving has gotten since the covid pandemic. Chaseedaw Giles appeared on WAMU’s “Health Hub” on Nov. 26 to share her reporting on that deadly trend.

Traffic deaths have climbed nationwide over the past decade. In some major cities, traffic deaths have . But this year, Washington, D.C., has recorded a in these kinds of deaths. Chaseedaw Giles, audience engagement editor with Ñî¹óåú´«Ã½Ò•îl Health News, appeared on WAMU’s “Health Hub” on Nov. 26 to share her reporting on the ways design and better enforcement can contribute to safer streets.

This <a target="_blank" href="/news/listen-wamu-health-hub-washington-dc-traffic-deaths-safety-vision-zero/">article</a&gt; first appeared on <a target="_blank" href="">KFF Health News</a> and is republished here under a <a target="_blank" href=" Commons Attribution-NonCommercial-NoDerivatives 4.0 International License</a>.<img src="/wp-content/uploads/sites/8/2023/04/kffhealthnews-icon.png?w=150&quot; style="width:1em;height:1em;margin-left:10px;">

LOS ANGELES — Kris Edwards waited at home with friends for his wife, Erika “Tilly” Edwards, to go out to dinner, but she never made it back to the house they had purchased only four days earlier. Around 9 p.m. on June 29, a hit-and-run driver killed Tilly as she walked to her car after a fundraiser performance in Hollywood.

“I’ve just got to figure out how to keep living. And the hard part with that is not knowing why,” Edwards said of his wife’s death.

Despite local, state, and federal safety campaigns, such as the global initiative to eliminate traffic fatalities, such deaths are up 20% in the U.S. from a decade ago, from 32,744 in 2014 to an estimated , according to data from the Department of Transportation’s National Highway Traffic Safety Administration. Although traffic deaths have declined since peaking at 43,230 in 2021, the number of deaths remains higher than a decade ago.

Since the covid-19 pandemic, the Pew Research Center found, Americans’ driving habits have worsened across multiple measures, from , which road safety advocates call a public health failure. They say technology could dramatically reduce traffic deaths, but proposals often run up against industry resistance, and the Trump administration is focusing on driverless cars to both innovate and improve public safety.

“Every day, 20 people go out for a walk, and they don’t return home,” said Adam Snider, a spokesperson for the Governors Highway Safety Association, which represents state road safety offices.

American roads have become more dangerous than violent crimes in some cities: Los Angeles, San Francisco, and Houston are among the major cities that now report more traffic fatalities than homicides. In 2024, the Los Angeles Police Department reported an estimated 268 homicides and 302 traffic deaths, the that the number of people killed in collisions exceeded the number of homicide victims, according to Crosstown LA, a nonprofit community news outlet.

San Francisco reported and in 2024. In Houston, approximately died in crashes and .

“Simply put, the United States is in the middle of a road safety emergency,” David Harkey, president of the Insurance Institute for Highway Safety, testified during a House Energy and Commerce subcommittee hearing . Out of 29 high-income countries, America ranks at the bottom in road safety, Harkey said. “This spike is not — I repeat, is not — a global trend. The U.S. is an outlier.”

In January 2017, then-Mayor Eric Garcetti joined 13 other L.A. city leaders in pledging to implement the and eliminate traffic deaths in the city by 2025.

Instead, deaths .

released in April that was commissioned by the city’s administrative officer found that the level of enthusiasm for the program at City Hall has diminished and that it suffered because of “the pandemic, conflicts of personality, lack of total buy-in for implementation, disagreements over how the program should be administered, and scaling issues.” The report also cited competing interests among city departments and inconsistent investment in the city’s most dangerous traffic corridors.

Mayor Karen Bass’ office did not immediately respond to requests for comment.

Last year, California state Sen. Scott Wiener proposed that would have required new cars sold in the state to include “intelligent speed assistance,” software that could prevent vehicles from exceeding the speed limit by more than 10 mph. But the bill was following pushback from the auto industry and opposition from some legislators who called it government overreach. It was by Democratic Gov. Gavin Newsom, who said a state mandate would disrupt ongoing federal safety assessments.

Meanwhile, the Alliance for Automotive Innovation, an influential automotive lobby, this year over an automatic emergency braking rule adopted during the Biden administration. The lawsuit is pending in federal court while the Department of Transportation completes a review. Even before Donald Trump was sworn in for his second term, the alliance appealed to the president-elect to support consumer choice.

Under Trump, Transportation Secretary Sean Duffy is prioritizing the development of autonomous vehicles by proposing sweeping regulatory changes to test and deploy driverless cars. “Federal Motor Vehicle Safety Standards were written for vehicles with human drivers and need to be updated for autonomous vehicles,” NHTSA Chief Counsel Peter Simshauser said in September in announcing the , which includes repealing some safety rules. “Removing these requirements will reduce costs and enhance safety.”

Some Democratic lawmakers, however, have criticized the administration’s repeal of safety rules as misguided since new rules can be implemented without undoing existing safeguards. NHTSA officials did not respond to requests for comment about Democrats’ concerns.

Advocates worry that without continued adoption of road safety regulations for conventional vehicles, factors such as excessive speed and human error will continue to drive fatalities despite the push for driverless cars.

“We need to continue to have strong collaboration from the federal, state, local sectors, public sector, private sector, the everyday public,” Snider, of the Governors Highway Safety Association, said. “We need everyday drivers to get involved.”

It took nearly a month for police to track down the driver of a Mercedes-Benz G-Wagen allegedly involved in Tilly’s death. Authorities have charged Davontay Robins with vehicular manslaughter with gross negligence, felony hit-and-run driving, and driving with a suspended license due to a previous DUI. He has pleaded not guilty to all charges and is out on bail.

Kris Edwards now tends to the couple’s backyard garden by himself. Since his wife’s death, he has experienced sleep deprivation, fatigue, and trouble eating, and he relies on a cane to walk. His doctors attribute his ailments to the brain’s response to grief.

“I’m not alone,” he said. “But I am lonely, in this big, empty house without my partner.”

Edwards hopes for justice for his wife, though he said he’s unsure if prosecutors will get a conviction. He wants her death to mean something: safer streets, slower driving, and for pedestrians to be cautious when getting in and out of cars parked on busy streets.

“I want my wife’s death to be a warning to others who get too comfortable and let their guard down even for a moment,” he said. “That moment is all it takes.”

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She saw people running from Exclusive Barbershop next door. She heard a voice telling a 911 operator that someone had been shot in the head. Her hands shook as she ventured outside. Then she saw 20-year-old Elijah Clunie slumped in a barber’s chair, haircut unfinished.

In the chaos, a 7-year-old boy stood in shock, eyes bulging at Clunie’s body. Sowers-Hassell asked the boy to come with her and sheltered him at the salon until his father arrived. “He kept going, ‘I can’t breathe. I can’t breathe,’” she said, and he later told her he never wanted to get his hair cut again.

Barbershops and salons are regarded in the Black community as safe, sacred spaces, where men and women gather to laugh, debate, and see their unofficial therapists: the barbers and stylists. When those refuges are violated by gun violence, an unspoken bond is broken.

Clunie’s killing cost Dorchester more than his own young life. Shootings send ripples of trauma through communities that can carry across generations. A found that exposure to gun killings was linked to higher levels of depression, suicidal ideation, and other mental health difficulties. Children and young adults were the most susceptible, and Black youth were disproportionately affected.

When economists calculate the societal costs of gun violence, “what they find is that much bigger than hospital treatment or criminal justice response or anything, is the fear and trauma and how it affects individuals and businesses,” said Daniel Webster, a professor and distinguished scholar with the Johns Hopkins Center for Gun Violence Solutions.

Four Corners — home largely to African American, Caribbean, and Puerto Rican families — is not a destination neighborhood. A historic Methodist church is one of the few attractions. There aren’t any major supermarkets, fine dining restaurants, or hospitals. Of the businesses that do exist, many cover their doors and windows in plexiglass and metal bars.

“We talk about these food deserts of good, healthy food; the truth of the matter is, it’s a desert for everything,” Webster said. “Businesses generally don’t want to be there.”

The owner of Salvaged Roots, Shanita Clarke, said she intended her salon to stand out as an oasis in the community.

Clarke was planning to take her then-13-year-old son to the salon to get his hair done when she got a phone call about the shooting. She rushed to work to check on her stylists. Clarke, her staff, and clients spent the next three hours waiting while officers collected evidence. In the weeks that followed, calls came in to push back appointments. Clarke said she could sense her clients’ anxiety and understood it. Even though she wasn’t in the shop when Clunie was shot, she experienced the incident vicariously through the sound of gunshots captured on the salon’s security footage and accounts from her employees.

A from the commonwealth of Massachusetts alleges the suspect in Clunie’s killing, Diamond Jose Brito, entered Exclusive Barbershop wearing all black clothing and a ski mask. Brito walked to the back of the shop, where Clunie was seated, and asked his barber how long the wait was for a haircut. About 45 minutes later, the statement alleges, Brito returned, walked to Clunie’s chair, shot him in the back of the head with a small silver revolver, then shot another victim multiple times.

Brito, of Canton, Massachusetts, was in October and is being held without bail. He to all the charges against him, including murder.

“Mr. Brito maintains his innocence and we are looking forward to presenting his defense at trial,” Brito’s attorney, David Leon, said in a statement to Ñî¹óåú´«Ã½Ò•îl Health News.

Boston City Councilor Brian Worrell’s office is around the corner from Salvaged Roots and Exclusive Barbershop. The neighborhood requires investment and initiatives by elected officials and policymakers, he said. Residents have to feel that homeownership and stable careers are possible.

“That can’t be some far-off thinking,” said Worrell, who represents District 4, which includes that part of Dorchester. “They have to be able to see it, and it has to show up in their lives, in a real, tangible way.”

Clunie had been a student at TechBoston Academy and a basketball player who was named player of the game after a big win his senior year, in 2022. But in a uploaded to the presentation site Prezi in June of that year, a user presumed to be Clunie wrote: “When I first moved to the Dorchester area I thought I was going to die,” noting “the killings on the news” every day.

Moments after the shooting, an unknown person walked into the barbershop and recorded a graphic video of Clunie’s body, which was then uploaded to social media platforms. It spread on Facebook and X, leading users to find Clunie’s personal accounts, on which some commenters made light of his death. He would have turned 21 the Saturday following his killing.

Worrell called the video especially inappropriate and callous. But apathy in the face of violence, he said, isn’t hard to imagine in a community suffering food and housing insecurity, struggling schools, and a persistent lack of opportunity.

Clarke said she’s torn on how to move forward. Loud noises and being alone trigger anxiety, and she now sometimes locks the salon doors once clients are in for their appointments. She’s felt anger and isolation, she said.

Recovering from the trauma of witnessing gun violence is often more difficult for onlookers when they still live and work where the shootings happened.

“We want to address the mental health trauma from gun violence, but let’s not kid ourselves,” Webster said. “If we don’t actually address gun violence, we’re swimming against a really strong tide.”

Since she opened her salon almost six years ago, Clarke has been active in community efforts to make the neighborhood safer, attending civic association and neighborhood meetings and speaking with police and local politicians.

Clarke believes efforts to clean up moved more drug users into Dorchester. Salvaged Roots is next to a commuter rail station, which Clarke said attracts transients who set up camps and leave behind trash and sometimes drug paraphernalia. Only a week before Clunie’s killing, there was a across the street from the salon.

In 2024, there were about 20 shootings in the police district that includes Four Corners, five of them fatal. Most of the victims were Black men, according to a Ñî¹óåú´«Ã½Ò•îl Health News analysis of data.

Though gun violence overall is at a record low in Boston and the city has in investigative resources — including , management, and oversight — a disproportionate amount occurs in Boston’s historically Black communities.

Since Clarke opened Salvaged Roots, she feels Four Corners has gotten both better and worse. “If other businesses leave, then where do people that live in the community — where are the nice places that they get to go to?” she asked.

Residents of neighborhoods with frequent gun violence and crime can mistakenly be perceived as being desensitized, but “we can never accept the violence as normal,” Boston City Council President Ruthzee Louijeune said. She’s volunteered and worked in Four Corners and said tackling the violence takes a multipronged approach, including getting guns off the street and providing access to affordable housing, secure jobs, and good health care.

In communities of color, she said, intergenerational trauma from racism and poverty must also be addressed.

In Dorchester, Louijeune said, a high number of residents resort to visiting emergency rooms for mental health issues. The neighborhood needs more access to health care, she said, especially for young people. Across Boston, Black residents were nearly twice as likely to go to the ER for mental health care than white residents, according to the Boston Public Health Commission’s .

Months later, attention and curiosity over the shooting had died down, but the trauma remained. Sowers-Hassell continues to work at Salvaged Roots, and though the city sent a trauma team to meet with the stylists after the shooting, she still has flashbacks. She said the influx of resources was helpful and that Four Corners has been a little quieter. But she’s skeptical the reprieve will last.

“Everybody talks a good game,” she said, “but when it’s time to get something done, what’s going to happen?”

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“It’s like this negative connotation,” said the 37-year-old actress, singer, and stand-up comedian, who said she is often asked to audition for villainous roles such as a bully, drug dealer, or pimp.

Her quest for more equitable representation on the big screen isn’t just professionally exhausting. Thompson says anxiety about her skin complexion has affected her health.

“It definitely had a negative impact on my self-esteem,” she said. She recalls being called “charcoal” in kindergarten. “It was big, like, your skin is dark and that’s a problem.”

The term colorism — a form of prejudice and discrimination in which lighter skin is favored over darker skin — was popularized by author Alice Walker in her 1983 book “In Search of Our Mothers’ Gardens: Womanist Prose.”

Clinicians from various ethnic groups have recently begun to draw a direct line between colorism and poor health. A 2023 found that, among Black and Hispanic adults, those with self-described darker skin tones reported more experiences with discrimination in daily life compared with those who have lighter skin tones. People who feel they experience daily discrimination can be at higher risk for depression, loneliness, increased alcohol and drug use, and anxiety, data shows.

And colorism can also lead to . Hair straighteners and skin lighteners commonly used by women of color, sometimes to conform to , increase their exposure to toxic chemicals, research shows.

Because of the potential health implications, the health care system should pay more attention to colorism, said Regina James, a child and adolescent psychiatrist who heads the American Psychiatric Association’s Division of Diversity and Health Equity.

“Skin color discrimination is so insidious it can literally get under your skin,” she said. “And consciously or subconsciously, it can contribute to low self-esteem and self-confidence, and even be detrimental to one’s mental health.”

Conversations about skin complexion can remain overlooked by mental health professionals who do not have expertise about or awareness of a person’s cultural context, if the conversations happen at all, said Usha Tummala-Narra, a clinical psychologist and professor in the Department of Counseling, Developmental, and Educational Psychology at Boston College.

“There’s no specific training on colorism. Many people are unaware that it exists,” Tummala-Narra said.

But the experience can negatively affect a person’s self-worth, relationships, sense of belonging, and dignity. “These are all really critically important things as human beings that we all need to secure to have good health, both physically and mentally,” she said.

The issue can emerge in childhood for Black and Indigenous people and other people of color, who must navigate fair skin often being seen as superior, a ramification of colonialization. Black children with the darkest complexions experience higher levels of depressive symptoms, found a in the journal Society and Mental Health.

Shannon Brown, 34, a former college counselor from the Bronx, New York, who is Black, remembers being called “midnight” by classmates and having family members joke about his skin being difficult to light in family photos. “I’ve just kind of accepted it and try to find the humor in it,” he said. “I feel like most folks aren’t intentionally trying to hurt me, but the jokes get tiresome.”

Shakun Kaushal, a 26-year-old digital communications specialist at the Johns Hopkins Center for Gun Violence Solutions, is Indian American and has a “darker complexion.” She said that in Indian culture one might hear comments like, “Oh, she’s so light and beautiful.”

“I sometimes feel dismissed by people,” said Kaushal, who has searched for an Indian or Black therapist in hopes they might better relate to her lived experience. She believes conversations about colorism should be intergenerational, start early, and get introduced with great care.

“What you say to a child does affect them. They will remember, and it will impact how they feel about themselves and in their skin,” Kaushal said. “We must talk about it.”

The feeling of shame and embarrassment colorism produces in people is palpable and needs to be acknowledged in health care settings, said Roopal Kundu, a dermatologist who founded and directs the Northwestern Medicine Center for Ethnic Skin and Hair in Chicago. Kundu, who is of South Asian heritage, opened the center in 2005 and notes that some cases of diseases like psoriasis, skin cancer, and eczema get diagnosed later, or misdiagnosed, because they present differently on diverse skin tones.

“How can we really make sure, as a field, that we’re taking care of everybody?” she said. “Healthy skin is beautiful skin. And beauty is across every single skin tone that there is.”

Therapists, doctors, and other clinicians from diverse backgrounds say that, in addition to clinical approaches that incorporate cultural competence, more efforts are needed to diversify the pool of mental health practitioners and to collaborate between disciplines.

Without cultural awareness and sensitivity, “you’re not going to get all the information that you need to appropriately diagnose and treat someone,” James said.

Black people are more likely to report difficulty finding mental health providers who understand their background and experiences, a found. At the same time, programs that bolster diversity, equity, and inclusion in medical schools are faltering in the wake of the 2023 Supreme Court decision outlawing affirmative action in higher education.

According to the Association of American Medical Colleges, in 2022, about 5% of active psychiatric physicians identified as Black, 16% as Asian, 6% as Hispanic, and fewer than 1% as American Indian or Alaska Native.

Thompson, Brown, and Kaushal all said they had never been treated by a therapist who looks like them.

Thompson, the L.A. comedian, said she drank bleach when she was 10 years old, thinking it would lighten her skin. Fortunately, it caused only nausea.

If she could speak to her younger self, she would say: “You’re beautiful. You’re brilliant.”

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Oldways Ambassadors Brenda Atchison and Glorya Fernandez walked a KHN reporter through two cooking demonstrations to showcase modern takes on cultural classics — like a cold black-eyed pea salad just in time for the new year, and a garlicky dill mojo sauce served over spinach salad.

Last year, Kelly LeBlanc, director of nutrition at Oldways, shared the organization’s heritage-based food guide pyramids with KHN for a report on USDA food guidelines. It’s the 10-year anniversary of Oldways’ A Taste of African Heritage nutrition curriculum, and this year, the curriculum became part of the Department of Agriculture’s , a collection of interventions from the Supplemental Nutrition Assistance Program educational effort focused on helping low-income households make healthier food choices and reinforce healthy eating habits.

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People have been styling their teeth for centuries across the globe throughout North and South America, Africa, and Asia. But social media — particularly TikTok, where everything old and new is nip/tucked into short videos with trendy sounds and served up fresh to young eyes — has breathed life into trends like tooth gems. Drake, Rihanna, and Bella Hadid wore them years ago. Now, some TikTok influencers are selling DIY gem kits.

But it doesn’t stop there. There are DIY tooth replacement kits and bedazzled grills available online for under $25, and recipes for homemade toothpaste and whitening treatments. The TikTok hashtag #DIYdentist has 2.6 million views. It’s enough to make any licensed dentist or orthodontist cringe.

The professionals wholeheartedly agree that DIY dentistry is a very bad idea. Dental care can be expensive, and orthodontic treatment is usually considered cosmetic and not covered by dental insurance — which 65 million Americans don’t have. And, according to the , people who are low-income, uninsured, members of racial minority groups, immigrants, or living in rural areas are more likely to have poor oral health.

So, is the high cost of dental treatment driving these viral trends among young people, or is it the lure of supposedly painless, instantly changed smiles?

, a Fremont, California, dentist and spokesperson for the American Dental Association, said she can understand why patients want to try DIY dentistry at home. “I just don’t know how [they] could do it safely,” she said, especially altering the shape of their teeth. While filing teeth is something a dentist might do to smooth out imperfections or create space between teeth during treatment for braces, for instance, some people are doing it themselves to smooth away chips in teeth or create vampire-like fangs for aesthetic reasons. “When we practice dentistry, we do it with the background information of years of training, X-rays, and the experience that helps us decide when and how to do the treatment,” Sahota said.

Even tooth gems applied correctly with oral bonding materials are troublesome, she said, because they “are adding something to your teeth that will also attract bacteria. You’re increasing your risk of cavities, of gum infections. And you’re increasing your risk of chipped teeth, of inflammation inside your mouth.”

DIY prices are certainly part of the allure. On Amazon, a was selling for $12.99 from Tondiamo, a brand that also sells children’s earwax removal tools, waterproof adhesive bandages, and chainsaw chains. The kit comes with 10 rhinestones, a mini-LED keychain to cure the adhesive, four wooden sticks, five disposable applicator brushes, and five cotton rolls.

But no instructions.

Reviews on Amazon complained of the gems not sticking. Some suggested using nail glue — which is toxic and can damage tooth enamel. But among Amazon’s “frequently bought together” suggestions: a bottle of epoxy resin glue.

A for $7.98 from TCOTBE and a set of for $10.99 from OOCC both advertised that “one size fits most,” but reviewers said otherwise. “Save your money and use foil (old school way) if you want a grill lol,” one buyer warned. Bleeding gums were a common complaint among the reviewers.

Perhaps the most bizarre DIY find was a temporary tooth repair kit for under $25 from CZsy. It came with plastic “veneers” in different shapes for missing teeth, and moldable plastic beads for repairs.

It also did not come with printed instructions, but these were buried in the product description on Amazon’s site:

1. Drop into hot water above 130 degrees for about two minutes.
2. Shape the size what you want.

No company information or websites could be found for some of these brands, but the products had one thing in common: a bar code sticker reading “Made in China.” Instead of responding to a request by KHN for an explanation of its policies, Amazon . The other items were still available to order at publication time.

It’s not just DIY dentistry giving licensed professionals a toothache. Vendors touting certificates to apply composite veneers and partials — dentures that replace missing teeth when someone still has multiple natural teeth in place — are sprouting up on social media. Vendors like in Philadelphia will apply composite veneers over less-than-perfect smiles — in this case, starting at with a $499 deposit — as a lower-cost alternative to porcelain veneers, which require shaving down the natural teeth. The merchant advertises for $5,999. Marie’s Beauty Bar did not respond to emails or voice messages seeking comment.

DIY dentistry isn’t just a phenomenon of young people on social media. “There are teens, adolescents, even adults that are trying these things,” said , a dentist in Marietta, Georgia, and a state director for , a Boston company. “A major contributing factor is lack of access to dental care.”

DIY can appear a viable alternative, especially since a person with severely damaged teeth, in severe pain, or with mounting dental bills from repairing DIY damage rarely displays the disappointing results on TikTok. Social media users, for the most part, display carefully curated highlights, not adverse reactions.

“The ‘cool thing’ right now is all these hacks to make things supposedly easier or more accessible,” she said. Caveat emptor, or let the buyer beware, she cautioned. Reviews from influencers who often receive free services in exchange for promotional posts may be biased. Bonnaig warned that complications could occur many days, weeks, or months after treatment.

Even when people aren’t daring to drill their own teeth, they can do damage with other social trends like drinking a concoction of balsamic vinegar — which has a higher acid content than the actual soft drink — and flavored carbonated water. It’s a recipe for severe erosion of tooth enamel.

Sahota has seen what these viral trends can do. “Patients have been drinking or swishing with lemon water, or maybe apple cider vinegar, and that has caused acid or erosions on their teeth,” she said. “The patients will say, ‘Oh, yeah, you know, I saw online that, you know, this will be better for my health. And so I’ve been doing it every night.’ That’s when I’ll bring a mirror and show them exactly what the effect of that trend has made on your teeth.”

Such low-cost hacks may end up costing patients far more in the long run. Sahota suggested that consumers looking for safe ways to enhance their smiles can scour the products on the site that sports the . Bonnaig and Sahota both implore patients to discuss their oral and cosmetic concerns with a dentist.

Every tooth and every mouth is unique, and there is no safe one-size-fits-all DIY hack. “You can have a beautiful smile,” Sahota said, “even if it’s not perfect.”

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So it gnawed at me, a Black woman, when I recently walked into a supermarket in a lower-income L.A. neighborhood and was greeted instead by an array of processed, high-sugar, high-sodium foods — often offered with a nice discount: Coca-Cola products, five 2-liter bottles for $5; sugary cereals, two for $4; boxed brownie and cake mixes, four for $5.

The pandemic had underlined long-standing health disparities of Black and brown communities. Covid had resulted in a for Black Americans, compared with 1.2 years for white Americans. Research had consistently shown that among the underlying factors giving rise to those poor health statistics — high rates of diabetes and heart disease, for example — is poor diet, fueled by a lack of healthy food options in their neighborhoods.

“I could go into a supermarket, and I can tell everything about the people who live [in the area] based on what’s in their carts, based on what’s at eye level, what’s not at eye level,” said Phil Lempert, also known as the “.”

In retail, specific product placement — not just a store’s inventory — heavily influences a shopper’s experience. So shouldn’t responsible markets encourage shoppers to make better choices?

“There’s a lot of racism, to be honest, I think, behind these decisions, whether it’s unconscious or implicit,” said Andrea Richardson, a policy researcher focused on nutrition epidemiology at the Rand Corp. and professor at the Pardee Rand Graduate School. The presence of a supermarket in your neighborhood should signal that you aren’t living in a food desert, but, I wondered, if the supermarket isn’t guiding you toward more healthful food choices, you might as well be.

So when I flew home for Thanksgiving, I enlisted my mother, Lilie — who always cared about her kids’ diets — to help with more research. I have vivid childhood memories of her scouring multiple grocery stores — often traveling to different parts of town — for the freshest ingredients when none were available close by. We set out one Sunday last fall to buy 12 items on a simple “healthy eating” shopping list at five locations of Stop & Shop, a supermarket chain with stores in a cross section of Boston neighborhoods.

First the good news: We were able to find every item we wanted at each store. But, just as I’d experienced in L.A., healthy foods were easier to find in higher-income neighborhoods. In lower-income areas, junk food was more likely to be front and center.

At the Stop & Shop I recall from my childhood in Jamaica Plain, the food choices had become much more balanced, with a plentiful organic food section in the front of the store. My mom can now buy fresher greens locally.

But that likely in part reflects the gentrification that has taken place since I was a kid. Jamaica Plain now has a of almost $77,000 — though the poverty rate is 18.3% and the aroma of Dominican and Haitian patties still scented the air as we approached the entrance.

Our next two stops were in even fancier areas, Brookline (median income over ) and Somerville — both green oases compared with many of Boston’s grittier neighborhoods.

At the Brookline location, each aisle started with low-fat, low-sugar choices like Crystal Light and V8, and the candy section was minuscule. In Somerville, the produce section was spacious, leaving plenty of room to browse the bins of guava and dragon fruit.

Our next Stop & Shop was in South Boston — a working-class, Irish Catholic community. It was strikingly different than our first three stops. The organic section consisted mostly of breakfast bars and cereals. The produce section positioned caramels, candied apples, and pumpkin-spice doughnuts in a bin alongside regular apples — at the bargain price of two packages for $3. The “International Foods” aisle sold everything you need for a very American Taco Tuesday, while a big part of this section was dedicated to Italian and Irish foods.

In the Grove Hall neighborhood in Dorchester — a predominantly Black neighborhood with a — the offerings were downright dispiriting.

Soda was displayed prominently near one entrance. And as we walked the aisles it seemed that many of the “sale” items were sugary soda products, chips, or cookies. This store had a dizzying array of snack food options, including 20 kinds of Oreos. And there wasn’t an organic food section at all.

The chain has been “doing a lot of work” to make sure that stores are “culturally relevant and [reflect] the demographics of the neighborhood,” said Jennifer Brogan, director of Stop & Shop’s corporate external communications and community relations.

How a store is stocked depends on size, product movement, shelf size, and a mixture of customer feedback and data. That data comes from companies like , that provides consumer, shopper, and retail market intelligence and analyses.

Lempert, the “supermarket guru,” further explained that companies and brands pay retailers “promotional dollars” to put their goods “at eye level” or on sale, or make them available for consumers to sample.

But in making these largely commercial decisions, markets make it more difficult for people in low-income areas to eat healthfully, encouraging those with poor diets to continue the habits that landed them with diet-related illnesses.

“It has been well documented that junk-food companies spend significantly more money advertising in certain communities,” said Kelly LeBlanc, director of nutrition , a Boston-based food and nutrition nonprofit. A , for instance, found that junk-food advertising disproportionately targeted Black and Hispanic youth.

Stop & Shop has started to try to redress the inequity, with changes coming first to its Dorchester location, including an in-store dietitian. The Grove Hall store also sends out an ad circular that features promotional pricing on better-for-you items, which may include fish, vegetables, and fruit. It has joined the food prescription program that allows participating doctors to prescribe to patients a prepaid Visa card that can be used to purchase fruits and vegetables.

Still, why not simply cut down on the soda and bewildering number of Oreos, I wondered. “I think our job is to give customers a choice,” Brogan said. “I also think we have a responsibility to help them make healthier choices.”

I’m glad my mom taught me how to make those choices early on.

Another thing I learned: There’s a whole science behind how supermarkets are organized, and depending on where you live, that could say a lot about the surrounding area. So the next time I think about moving, the first place I’m heading to is the local supermarket because, as Lempert told me, “going to that community grocery store is going to tell you about the neighborhood.”

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“If you ain’t rapping about being on no drugs, or you out here in the streets selling some drugs,” he said of his chosen profession, “you ain’t got some of that going on — like, don’t nobody wanna hear what you talking about.”

This snapshot of Williams’ hip-hop life doesn’t seem all that different from that of musicians of other genres for whom the mix of drugs and addiction is a recurring storyline, claiming the lives of artists like Janis Joplin, found dead of a heroin overdose in 1970, and rapper DMX, who died last .

But drug use in the hip-hop community has an ever increasing presence that is intertwined with the music – and one with dire consequences. The catchy lyrics suggest that opioid misuse is part and parcel with fame and wealth, just a normal, and innocuous, component of that life.  

Coverage on the abuse of hard drugs in the community usually focuses on tragedy surrounding certain popular rappers rather than the lyrics and the culture they create. And while public health experts take great pains, for example, to criticize and curtail the promotion of vaping to young people, little attention is paid to the dangerous effects that hip-hop is having on vulnerable listeners by normalizing popping Percocets or drinking cough syrup.

From big cities like Los Angeles to rural towns like Gibsland — population 878 — opioid misuse among some young, hopeful listeners is about emulating their favorite rap star’s enviable image. For others, it is not all about the high life. It’s self-medication.

“Let’s talk about pain,” said Mikiel Muhammad, 38, aka King Kong Gotcha, a member of the rap trio in Virginia. “The pain is so deep. They ain’t got money to go see a psychiatrist, but they got money to go get a Perc-10. They got $10, $15 for that,” Gotcha said, referencing the street value of a 10-milligram Percocet tablet.

According to a , anxiety, depression and thoughts of suicide have increased for young adults in the past year.

Artists like Young Nyke sometimes confront neighborhood and family violence, as well as a general lack of opportunities and resources in their communities — circumstances amplified by the covid pandemic. The poetic detailing the rappers’ experience offer some support. But these phrases can also be fraught.

It’s not just the drug use that is worrisome, said , an associate professor of public health at William Paterson University in Wayne, New Jersey. Often these songs promote using opioids while engaging in high-risk activities like unprotected sex or speeding and, while she is a hip-hop fan, “from a public health perspective, it’s just dangerous,” she said.

That toxicity reaches into populations already plagued by perpetual cycles of poverty, poor health and . There is a need for “culturally relevant interventions” to educate and raise awareness within the hip-hop music audience, which Tettey’s categorizes as primarily composed of youth from “vulnerable and socially disadvantaged” groups.

It is time to turn a critical eye to how opioid misuse permeates hip-hop’s lyrics, creating an entryway for Black young adults into the American opioid epidemic, said Tettey.

In 2017 that epidemic was declared a national public health emergency, with over 47,000 opioid-related overdose deaths reported. Researchers at the Centers for Disease Control and Prevention say fatal drug overdoses nationwide have surged roughly 20% during the covid pandemic, killing more than 83,000 people in 2020. Within this grim statistic the Substance Abuse and Mental Health Services Administration has found inequities.

According to a 2020 from the Department of Health and Human Services’ Office of Behavioral Health Equity and SAMHSA, attention to this crisis has focused more on white suburban and rural communities, even though Black communities are experiencing similar dramatic increases in opioid misuse and death. The report also found that synthetic opioids, like fentanyl, are affecting opioid death rates among Black people more severely than other populations.

A 2020 SAGE journal research found a large increase in prescription opioid overdose deaths among Black people. The paper also found the rate of death almost tripling between 1999 and 2017. In February 2018 the U.S. surgeon general a warning that trends in opioid misuse “may be a precursor to even more opioid overdose fatalities in the black community in coming years.”

“The music industry, all it does is perpetuate whatever’s going on outside,” said Jarrell Gilliard, 40, explaining the pharmaceutical drug presence he’s encountered and how it’s reflected in popular lyrics. “How they pump these pills and all these prescribed medicines through the streets. Once the streets got ’em …” said Gilliard, whose hip-hop alias is Grunge Gallardo.

Grunge is also a member of The Opioid Era, named for their gritty, raw imagery and lyrics. Songs such as “Suboxones,” “Sackler Oath” and “Overdose,” which opens with a haunting 911 of a woman frantically pleading for help with one, contrast sharply with the pill-laced tunes of hip-hop’s mainstream.

“I think that’s the most dangerous thing about it,” said Richard Buskey, 42, who completes The Opioid Era trio as Ambassador Rick. “It’s a disconnect between the youth and them realizing that they’re in the same category as what they would consider a junkie or a fiend.”

Tettey said that’s partly because mainstream artists represent a lifestyle many young adults want for themselves, which can translate into modeling behaviors like opioid misuse.

Feeling the ‘Lean’

Patrick Williams, 26, an independent rapper from Orange, Texas, with the stage name , is no stranger to addiction.

He was 21 when he first sipped “” — a drink made from mixing prescription cough syrup containing the antihistamine promethazine and the opioid codeine with soda, Jolly Rancher candies and ice, served in doubled-up Styrofoam cups. “It’s a variety of colors that you have,” PatvFoo said, referencing the various formulations of codeine cough syrups. Purple syrup ranks as most potent. PatvFoo learned about lean through the Texas rap scene and artists like and then became a user.

“At first, there’s a mellowing high,” said Stevie Jones, 23, also known as Prophet J, an independent rapper in Louisville, Kentucky. He has similar recollections from his first time misusing codeine syrups. He and his friends drizzled some on a blunt — the slang term for a hollowed-out cigar filled with pot. “It just makes it burn slower — like, get you a little bit higher, I guess,” said.

Things can take a bad turn quickly. Although lean is one of the weaker opioids, experts say it is . “The day you go without it you get bad, bad stomach cramps. You feel like you got to just throw up all the time. You sweating. It’s like you got a bad flu,” PatvFoo said.

That flu-like feeling is opioid withdrawal, said Dr. Edwin C. Chapman, a Howard University College of Medicine alum who has practiced internal and addiction medicine in Washington, D.C., for more than 40 years. The symptoms range from runny nose and eyes to diarrhea and usually can be stopped with a gulp of cough syrup or lean, he said.

And there’s a harsh reality in that. Whether it’s Percocet pills or lean, “it’s all in the same class as heroin and fentanyl,” Chapman said.

But learning that opioid use is promoted in popular music came as a revelation to Chapman. “That’s not the music that I listened to,” said the 75-year-old doctor. The medical community, he said, has been focused on curbing the overprescribing of pain medication. “But it’s never talked about … that it’s being advertised overtly to young folks through music or through the media.”

Indeed, abuse of lean, also known as “” and “,” has managed to evade the regulatory spotlight while remaining popular and recognizable — so much so that vaping companies distributed nicotine-containing e-liquids resembling the drink and even mimicked the slang term “double cup” in their labeling. These products triggered a 2019 on the vaping juices. The drugs themselves, however, still pump through the streets, just like the hip-hop lyrics.

And it has altered the market, moving it beyond the street options of heroin and opioids, said hip-hop artist Buskey. “We living in the times where they’re getting it out of the medicine cabinet.”

Phillip Coleman, 34, a rapper in Rochester, New York, who goes by the name , started using at age 15 after being prescribed 5-milligram tablets of Percocet following wisdom tooth extraction. That set him on a path to misusing prescription painkillers, which led to cocaine and then a heroin addiction that eventually landed him in .

Fortunately, Coleman was able to overcome his addictions in rehab and refocus on family and . He cautions that people buying Percocet or other prescription pills on the street have no way of knowing if they are legitimate or “just pressed fentanyl.” He said the reward for opioid addiction isn’t the lifestyles of the rich and famous you see portrayed by some hip-hop artists. “You don’t get to trade in your empty bags like the box tops and get, like, a bike or whatever. Like, you don’t get no hat; you don’t get no fentanyl swag,” he chuckled. “Like, you just die.”

This <a target="_blank" href="/public-health/opioids-like-lean-permeate-hip-hop-culture-but-dangers-are-downplayed/">article</a&gt; first appeared on <a target="_blank" href="">KFF Health News</a> and is republished here under a <a target="_blank" href=" Commons Attribution-NonCommercial-NoDerivatives 4.0 International License</a>.<img src="/wp-content/uploads/sites/8/2023/04/kffhealthnews-icon.png?w=150&quot; style="width:1em;height:1em;margin-left:10px;">

A full-time artist, Bond, 44, made a living through a patchwork of vocal gigs — performing live at weddings, bars and theaters, recording jingles, teaching vocal lessons and hosting events.

But the coronavirus pandemic found her burning through her savings and struggling to make ends meet in a tiny rental accessory dwelling unit above the tree-lined garage of a home in Hyattsville, Maryland. According to a 2020 report from the , artists were more likely than others to have lost their main source of income — music-related or not — due to the pandemic.

So with few other obvious options, and the world at a standstill for the foreseeable future, she set out to write her first solo album in the small rental she fondly referred to as her “treehouse.”

But cut off from family, friends and other nearby musicians, she devised a way to bring together out-of-work musicians from around the world, people who felt just as abandoned and stuck as she did. What resulted is an extraordinary transnational album — “,” released March 5 — that connected her with a far broader musical community and buoyed their collective spirits during a year of isolation.

The new album is a pandemic-fueled collaboration of musicians such as , PhD. a violinist and acting chair of the strings department at Berklee College of Music in Boston; two-time Grammy-nominated drummer in Nashville; and a percussionist from the British acid jazz band , who sent in his recordings from London. “Everyone jumped on board from wherever they were,” Bond said. And most, she said, “didn’t even stress me for money. We all wanted to create.” She was even able to work with , a songwriter who has written for several artists from Beyoncé to Anita Baker and likely would not have been accessible to her or available pre-pandemic.

They were up against the challenges of not just a pandemic, but also a music industry that has come to rely heavily on curated playlists like Apple Music’s “New Music” or “From Our Editors” to promote new releases. Mainstream artists who have released music during the pandemic have teams of industry professionals ensuring their tunes end up on the most highly trafficked playlists.

Some music- like Apple Music don’t allow third-party playlist curation. So, without a direct connection to their editorial team or partners, landing a spot on these lists isn’t likely. Without being able to perform live at clubs and events this past year, Bond says, some independent artists may feel financial pressure to focus less on the quality of their music and more on finding ways to go viral on social media to tip the scales.

How does an independent artist find new listeners at a time when performing for a crowd isn’t allowed, and they’re battling against more than already on Spotify and Apple Music, respectively?

Bond was not naïve about how the music world works, having been a performer for decades. She and her band, Third Logic, had been performing together since they were in their early 20s, but as time passed and adulthood — marriage, children, increased work responsibilities — set in, finding the time to write music together became nearly impossible. They hadn’t released a new album since “Madam Palindrome” in 2011. Time and distance from her bandmates meant that gigs were few. So, in 2019, she decided to embark on a solo career. Then covid hit.

At first, she despaired about how she would be able to pay for things like rent and food without the hope of recurring live gigs. “The pandemic relief money was really helpful,” she said, because independent artists can sometimes go weeks without making any money even without a global pandemic. Between her stimulus check and unemployment, Bond budgeted $600 a week to live on. She had affordable health insurance through Kaiser Permanente, “thanks to Obamacare,” she said. She cut expenses, stuck to her budget and received modest payments from booking a few covid-friendly, livestreamed events for Washington, D.C.’s Kennedy Center and the Music Center at Strathmore in North Bethesda, Maryland.

She was able to improvise a home-recording studio with mics, speakers, her MacBook and ProTools software and the help of music engineering friends over video conferences. Bond writes song lyrics and performs but doesn’t herself compose music. So, she put out a call to the musicians in her network and found many of them were also at home tinkering with new tunes and willing to share. Bond would “wait until late at night, turn on colored bulbs, blast things through my monitors and write,” she said.

After a rough draft of the album was completed in September, she and independent producer Brandon Lane put out a broader call for help for more live instrumentation. Their pleas circulated and produced a village of talent, as musicians from all over the world sent the singer their high-quality home recordings. “It showed me how many musicians were in the same boat,” Bond said.

Lane, who lived nearby and became part of Bond’s pandemic bubble, would come to her home studio — fully masked-up — as technical support and to co-produce the album. The title “” reflects an appreciation of the importance of trusting your own internal compass, she explained. The project showed Bond “who has my back,” she said, and that in a time of global crisis musicians — many of whom Bond considers friends — would come together to co-create with her.

Bond, who describes herself as having an eclectic Bohemian style and devil-may-care attitude, said she doesn’t want to change herself to jockey for a spot on the Billboard charts or playlists — even in the post-pandemic world.

The music industry is notoriously and male-dominated, she said. The third annual report on the industry, “” from professor and the found that in evaluating gender across eight years of Grammy nominations for Record of the Year, Album of the Year, Song of the Year, Producer of the Year and Best New Artist, 21.7% — or about 1 in 5 artists — were women.

“This is who the f*** I am,” she said. “I’m not 18, but I’m not ‘old’ either.” She wants listeners to have the chance to discover diverse musical options for female entertainers, at different ages, with different sounds and styles to match. By dint of necessity, the pandemic opened new types of doors for performers like her — through which she hopes new types of music will continue to be heard.

“You have to be smart,” she said. “It’s not hard to find new music.” Manually searching streaming apps like SoundCloud and Spotify take no more effort than scrolling through Instagram, she said. Bond hopes that listeners will take a break from the algorithms that sneakily sway our musical interests toward those artists pushed to the top of the charts and follow their own compass.

This <a target="_blank" href="/mental-health/an-indie-artists-plea-to-look-beyond-algorithms-and-curated-playlists/">article</a&gt; first appeared on <a target="_blank" href="">KFF Health News</a> and is republished here under a <a target="_blank" href=" Commons Attribution-NonCommercial-NoDerivatives 4.0 International License</a>.<img src="/wp-content/uploads/sites/8/2023/04/kffhealthnews-icon.png?w=150&quot; style="width:1em;height:1em;margin-left:10px;">

It might engender envy, even outrage, especially if the person posting seems to have cut the line. But what if the intention was to encourage others to also get the shot? Does that make it OK?

Since the pandemic began, people around the world are increasingly living out significant portions of their lives online. But with using some type of social media, according to the Pew Research Center, who sets the rules for proper social media etiquette?

“This is a totally new type of world to have a pandemic in,” said Catherine Newman, the etiquette columnist at and author of the book “.” One advantage of using social media, she said, is that people can create waves of public opinion from which everyone can benefit. Newman, who also volunteers at a hospice, was vaccinated and posted a selfie. She said the selfies can help address some of the public health mistrust issues that have contributed to vaccine hesitancy.

“I don’t want to see a picture of your yacht on social media,” she said. She’d rather see covid vaccine selfies but cautions users to be mindful of the caption they choose.

After all, nearly 500,000 American lives have been lost in the pandemic and stark disparities have emerged in vaccination rates — especially among communities of color and older adults who are in the highest risk categories.

It raises the question: Is posting a vaccine selfie on your social media account a faux pas or still par for the course?

, a lifestyle and etiquette expert, a certified mediator in the state of California and the founder of the Swann School of Protocol in Carlsbad, California, echoed those precautions. “RNs and front-line workers have a very different story to tell than a 20-something-year-old who got vaccinated for some obscure reason,” she said.

At the same time, she said, it’s not necessarily clear how someone came to be eligible for the vaccine. A person could present young and healthy at first glance but could have a health condition or other qualifying criteria. “We don’t know,” she said. She advises that posters follow what she calls the three core values of manners: respect, honesty and consideration.

And the same goes for people reacting to the posts.

George Francois, 35, a center director at Children’s National Hospital in Washington, D.C., chronicled his covid vaccination on Facebook. Looking at the overall death and infection rates in the African American community, he considered his post a public service. “I could inspire others to get it without having to talk to them directly,” he said.

It’s a sentiment shared by J. Shawn Durham, 44, an actor in Washington, D.C., and an unintentional He got a call from a friend of a friend to get vaccinated after a scheduled patient missed their appointment — leaving a critical dose that otherwise might have gone to waste. “I am healthy. I am Black. I am scholastic, so I know about our history and the ,” he said. And, given that history, Durham posted his selfies to “lead by example,” he added. “The white and the wealthy are getting vaccinated. I want Black people to want to get vaccinated too.”

Francois didn’t receive any backlash from his post and didn’t think it was a big deal. “A lot of people post their HIV and covid test results,” he said.

Bottom line: It’s common among younger adults to publicly share things some older adults may consider to be far too personal.

“It’s kind of tacky sometimes, I think, but there’s a lot of misinformation out there,” said Emilio Delgado, 31, who was born in Puerto Rico and now lives in D.C. He posted in part to foster confidence in the vaccine — to let his connections “see that someone they knew has taken it and didn’t grow a third eyeball,” he said of his hesitant followers. For that reason, he added, it was worth it.

Delgado, a local actor and patient instructor at the George Washington University School of Medicine and Health Sciences, had access to the vaccine because in this role of “standardized patient” he is often called in to role-play ultrasounds with fourth-year medical students. He makes the bulk of his income through such patient instruction and is frequently at the hospital — a place generally considered high-risk — so he’d rather be vaccinated.

For Signe Hawley, 34, a researcher and volunteer firefighter in the foothills of northwestern Boulder, Colorado, getting the vaccine — and posting about it — was an emotional experience.

Earlier in the pandemic, she made the difficult decision to pull back from her volunteer duties to protect her wife and 2-year-old daughter. But because she had been a first responder in her community, she became eligible for the vaccine sooner than expected. “I wouldn’t cut the line,” said Hawley. “But when given the opportunity, I wouldn’t pass it up either.”

For Hawley, the hardest side effect she faced after getting the vaccine was the depth of grief and sadness that surfaced surrounding the loss of her father, along with thoughts of all of the other lives lost “in the mismanagement of this,” she said.

Her father, Joe Hawley Sr., 67, died in early April from complications of covid-19 at Norwalk Hospital in southwestern Connecticut. His family was not allowed into the intensive care unit at any time during his bout with covid. And her interest in volunteerism and service is something she inherited from her father, a “humanitarian at heart,” who was involved and committed to the New England community where he lived.

“To be vaccinated for something that my father died from is so surreal,” she said, her voice breaking. Sharing her story and the vaccine photo was a way to honor her father. “This is one step to lessening the impact of death and severe health complications with covid, but it’s not the end of it,” she said.

Ultimately, she said, the more people vaccinated the better off we all are.

“We’re all posting this hoping to get buy-in,” said national etiquette expert , an author and founder of the Protocol School of Texas, a company specializing in corporate etiquette training based in San Antonio. Know your audience, she advised. And another important reminder: Follow , which advise against posting vaccination cards containing identifying information that could expose you to identity theft.

This <a target="_blank" href="/public-health/the-dos-and-donts-on-social-media-for-vaccine-haves-and-have-nots/">article</a&gt; first appeared on <a target="_blank" href="">KFF Health News</a> and is republished here under a <a target="_blank" href=" Commons Attribution-NonCommercial-NoDerivatives 4.0 International License</a>.<img src="/wp-content/uploads/sites/8/2023/04/kffhealthnews-icon.png?w=150&quot; style="width:1em;height:1em;margin-left:10px;">