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A new survey finds significant anxiety and fear among teenagers who identify as lesbian, gay, bisexual, transgender or queer.

The survey findings, released Tuesday, are based on the answers of roughly 12,000 youth ages 13 to 17 who responded to an online solicitation by the Human Rights Campaign Foundation and other advocacy groups. Researchers say they reveal the depth of challenges that LGBTQ teens face.

At home, at school, in social circles and communities, these teens are experiencing high levels of anxiety, feelings of rejection and fears for their safety, according to a report on the survey findings.

“Despite the change in social attitudes, they’re still struggling,” said Ryan Watson, an assistant professor in human development and family studies at the University of Connecticut who is one of the researchers. “We still see alarming disparities and experiences, disheartening mental health problems and self-esteem issues.”

The report notes that nearly three-quarters of the teens responding to the survey said they have been threatened verbally because of their sexual identity. Ninety-five percent reported having trouble sleeping.

Problems associated with being transgender were particularly pernicious. About half of transgender teens surveyed said they were unable to use school restrooms or locker rooms that match their gender identity, with most of this group citing safety as the reason.

Yet teens generally shared similar concerns about school overall: Just 26 percent of those surveyed said they felt safe in their classroom.

The report comes at a particularly challenging time for LGBTQ individuals, with the federal administration scaling back protections across several agencies. The Justice Department announced last July that civil rights laws do not include workplace protection against sexual orientation discrimination for lesbian and gay individuals. The Department of Education has reversed a directive mandating schools protect and accommodate transgender students.

“Anecdotally, we have seen the decision to rescind critical guidance [for schools] has caused fear and worry for transgender students and their families,” said Rebecca Kling, education program director at the National Center for Transgender Equality. “We’ve seen many cases where schools feel like they can roll back protections.”

The survey, conducted online between April and December 2017 by the Human Rights Campaign Foundation and the University of Connecticut, asked about behavioral health, peer relationships, exercise and fitness, participation in sports, tobacco use and other elements of the teens’ lives.

“We wanted to know about a range of things, everyday lived experience, not isolating one aspect,” said Ellen Kahn, the foundation’s director of the Children, Youth and Families program.

To solicit subjects, the researchers advertised for LGBTQ teens on social media — Twitter, Instagram, Facebook and Snapchat. Among the advocacy and nonprofit groups that helped publicize the survey were Planned Parenthood and the Trevor Project, which focuses on suicide prevention among LGBTQ youth. The gay activist Tyler Oakley, whose videos on YouTube have reached more than 650 million people, also took part in spreading the word about the survey.

The results cannot be considered representative nationally because participants were not selected through a random sampling method.

Of the LGBTQ teens responding, 77 percent said they felt down or depressed in the prior week. Of those LGBTQ teens whose families did not know of their sexual orientation, 78 percent said they heard negative comments from their families.

Comments included in the report reflect their worries:

• “I’m not out to my parents for safety reasons.”
• “At school I have been bullied and called slurs by other students.”
• “My town is very tiny, racist, and homophobic. I don’t trust anyone to talk about LGBTQ issues.”

Ma’ayan Anafi, policy counsel at the National Center for Transgender Equality, was not surprised by the results of the survey.

“It’s consistent with what we’ve seen,” Anafi said. “Trans students face immense harassment and discrimination.”

One of the biggest surprises to researchers was the obvious interest in the survey by so many LGBTQ teens.

“It shows that youth are really excited about being asked about their experiences,” Watson said. “They care about being heard.”

Read more on WashingtonPost.com.

For decades, addiction recovery was focused on helping people get clean and stay sober. There was lots of talk of willpower and surrendering, but not much discussion of mental health, past trauma and adverse childhood experiences. Today, that has changed dramatically, says Hanna LeBaron, the clinical director at Maple Mountain Recovery, a trauma-informed addiction treatment center outside Salt Lake City.

“We all agree there are underlying issues to substance abuse and addiction,” LeBaron says. “We’re actually looking into them now and starting to treat underlying issue.”

LeBaron says that in her 18 years of working in the treatment industry, providers have begun paying more attention to the root cause of addiction. For many people with substance use disorder, that is mental illness. In fact, the National Institute on Drug Abuse estimates that 60 percent of people with substance use disorder also have a diagnosable mental health disorder.

Understanding this can help practitioners treat substance use disorder more effectively, equip people with tools to stay in recovery long term, and help people without addiction empathize with those who are struggling.

“What we’re looking at is this [addictive] behavior as an adaptation,” LeBaron says. “It’s a strategy, a way to cope.”

Understanding the root cause of addiction can also help the person with substance use disorder understand their own actions, LeBaron says.

“A lot of time people who are using don’t understand why they are doing it,” she explains. “When you think about it logically, everybody knows it’s super dangerous to abuse drugs and alcohol. People die from using drugs, alcohol and tobacco even. So why do we put ourselves in danger? It’s because at that moment it gives us relief.”

Once the brain has experienced that feeling of self-medication it is hard to give up.

“The brain quickly learns this is an easy way to cope,” LeBaron says. “At that point, when we get that quick dopamine release, we’re not thinking about the longer term consequences.”

Viewing addiction as a maladaptive coping strategy has changed the way that substance use disorder is treated. Old methods — like tough love and confrontation — are now seen as dangerous, since they can further isolate or harm people who are already vulnerable.

“Those just don’t help because in the end they shame the client more,” LeBaron explains.

Still, many treatment centers don’t understand trauma, which requires a specialized and thorough approach, particularly when it is being treated alongside substance use disorder.

“At Maple Mountain Recovery, we have the understanding and the know-how,” LeBaron says. “We know it is important for our clients to do their trauma work while in treatment in order for them to have long-term recovery.”

At Maple Mountain, the program involves treatment professionals taking a more gentle approach. The first step, LeBaron says, is teaching clients healthy coping mechanisms that can replace their use of drugs or alcohol.

“Before we go and deal with the trauma they have to have some ways to cope,” she says. Exercise, meditation and therapy all provide healthy ways for clients to handle the discomfort that they’ll be facing during treatment.

It’s important that these new coping strategies be introduced before more in-depth trauma and mental health work starts, so that the client is able to process their feelings during their recovery.

“They have to have coping skills first and have to learn to relax,” LeBaron explains. “Often, clients have so much toxic stress that their brain isn’t even capable of relaxing: they’re always in fight, flight or freeze. We have to get them out of survival mode by helping them learn to relax.”

In addition, clients need to learn to be able to tolerate positive feelings. Many have spent years completely numbed by drugs and alcohol. Coming out of that, even positive feelings of joy, hope and contentment can be deeply uncomfortable, LeBaron explains. Here again, activities like yoga, time in the sauna or deep meditation can all be helpful.

“These activities may sound luxurious, but there is a reason behind all of them: We’re trying to reset the brain and get the brain to function in a more normal way,” LeBaron says.

Read more on TheFix.com.

A barbershop may not be the first place you would think to house a health care center, but Aaron Perry believes it’s the perfect place because it can bridge the deep-rooted gulf between the health care system and the black community.

Perry, a former University of Wisconsin (UW)–Madison police officer who is living with diabetes, has spent years unraveling the complex relationship between black men and the world-class health care system in Dane County. He founded the non-profit Rebalanced-Life Wellness Association in 2007 to help other black men with diabetes and reduce health disparities in his community.

His breakthrough came as he was getting a haircut at JP Hair Design in Madison and listening to the clientele and barbers talk about health. He realized that, instead of trying to draw black men into the health care system – a process which so far had proven largely unsuccessful – the health care system should be brought to meet black men in a place they trust and where they feel loved and respected.

“The men here were actually talking about their concerns, their health challenges. And I’m thinking, ‘This old myth that black men don’t talk about their health issues – they talk about it in the barbershop.’’’

The trouble was, he said, the men would talk about their health challenges – like having gout, feeling faint or having heart palpitations – but would leave the shop with these concerns unresolved.

Two years ago, with funding from SSM Health and support from barbershop owner Jeff “JP” Patterson, Perry knocked down the back wall of JP Hair Design and built the Men’s Health and Education Center.

Patterson liked the idea immediately when Perry pitched it to him over breakfast and says the reason it works comes down to the strong relationships between barbers and clientele.

“The clients trust us … they believe in us, have faith in what we say,” Patterson said. “We can easily persuade them. The good part is, as barbers, we are able to encourage them to go into the Men’s Health and Education Center, to get information, to get their blood pressure checked, to talk to one of the student nurses about issues.”

Although the 120 square foot room is small, the space is utilized to its full potential. One wall is lined with pamphlets on cancer, heart disease, high blood pressure, influenza, pneumonia, diabetes, and many other ailments. Above two computers preloaded with Harvard Medical School and the Mayo Clinic information is an eye test. Clientele can also have their body mass index calculated and their blood pressure checked. In April, 84 men had their blood pressure screened – 68 percent had high blood pressure.

The center also offers referrals for mental health concerns and substance abuse – although Perry hopes to one day be able to offer these services under the roof of the barbershop –  and brings in health care professionals, like a dental hygienist who does free oral screenings. They’ve learned that a large number of men struggle with mouth and tooth pain but grit through it.

Some live with pain for years. Dewayne Conklin came into the center in early May with high blood pressure and significant pain in the back of his jaw. Perry, using partnerships with Madison Public Health Dane County, got him an appointment at Access Community Health within four days. Doctors learned he had been enduring the pain from two decaying teeth for four and a half years. After the two teeth were removed, Perry said Conklin was practically doing backflips he was so happy and relieved.

“I’ll never forget what he said to me when he got out of the car,” Perry said. “He looked and me and said, ‘Man, who are you?’ And I said, ‘This is what we do at this men’s health center. This is what we do for this community.’”

“I wasn’t expecting anything more than a haircut,” Conklin said. “I’m very impressed.”

Perry was recently awarded a Community Collaboration grant from the Wisconsin Partnership Program at the UW School of Medicine and Public Health to expand his efforts reducing health disparities among black men and boys in Dane County. Perry will use the $300,000 in funding over a four-year period to start the Black Men’s Wellness Sustainable Initiative.

The grant, designed in response to feedback from nonprofit organizations across the state who sought more involvement from UW, also provides training and support from the university.

“What we heard loud and clear was that in addition to funding, organizations want to build their capacity to be more effective in their communities – and that the resources of the university can support that,” said Courtney Saxler, program officer for the Wisconsin Partnership Program.

The grants focus on health equity and are community-driven. Saxler said Perry fit the bill perfectly.  With the new funding, Perry said the center can now roll out what the men in the barbershop have been requesting.

He is most excited about the establishment of the Barbershop Health Advisory Committee, a collaboration between all eight black barbershops in Dane County. Of the 15,600 black men in Dane County, these barbershops have the potential of reaching upwards of 5,700 of them, he said. The committee will meet once a month to strategize on how to make their clientele healthier and develop a unified voice for healthy living across the county. If the advisory committee decides diabetes is the issue of the month, for instance, all the owners and barbers across Dane County will share a unified message about diabetes with their clientele.

Perry also plans to expand Black Men Run, a running group he started two and a half years ago, into a new group including black boys called Black Men Run, Brown Boys Read. The group will run for the first time next month and afterwards will sit in a park and read chapters from books written by black authors. A group of black men have also agreed to mentor the young boys.

“For these young men that don’t have fathers in their lives, we’re hoping that this has a great impact,” Perry said.

Perry said the barriers between the black community and the health care system are multi-faceted. Some people mistrust the medical community because of the experiences passed down by their elders. Many men have little awareness or interaction with the system, which can lead to frustration when they try to schedule an appointment and there are no available times that work.

Above all, some black people feel that this community doesn’t care about them and their well-being. The challenge is to change that narrative, Perry said, and many fathers have started to accomplish this by bringing their young sons into the center to teach them about their health and how to take care of their bodies.

By returning to the template of the early 1900s barbershops, which were social and cultural centers where men could see their doctor, fill prescriptions, and socialize, Perry believes he’s found a model for reducing disparities not just for the black community in Dane County, but for communities nationwide.

“I believe we can literally pick this 120 square foot room and put it in any barbershop nationwide and I think it would start to yield the same dividends and would have the same outcomes,” Perry said.

“We are reaching the men and that is real simple,” he added. “We’re doing the work that many have said could not be done.”

Read more on News.Wisc.edu.

The term “Asian American” appears innocuous today. It’s in the name of film festivals, professional organizations, college clubs and an officially recognized heritage month.

But that wasn’t always so.

When the phrase Asian American was created — in 1968, according to activists and academics — it was a radical label of self-determination that indicated a political agenda of equality, anti-racism and anti-imperialism. Asian American was an identity that was chosen, not one that was given.

Over the last 50 years, however, as people of Asian ancestry in the United States have grown in number and diversity, the term has evolved — raising new questions of who is included in Asian America, what it stands for and if it’s still relevant.

“If you were to ask most people who are Asian American, ‘Describe your race or ethnicity,’ they would say, ‘I’m Japanese American,’ ‘I’m Thai, Cambodian, Filipino.’ Very few of us would start out by saying, ‘I’m Asian American,’” Daryl Maeda, a professor of Asian-American studies at the University of Colorado, Boulder and author of the book, “Rethinking the Asian American Movement,” said.

“Instead, ‘Asian American’ — rather than describing our personally felt identities or describing our family histories — expresses an idea. And that idea is that as Asian Americans, we have to work together to fight for social justice and equality, not only for ourselves, but for all of the people around us.”

Activists and academics trace the origins of the term back to 1968 and University of California, Berkeley students Yuji Ichioka and Emma Gee, who, inspired by the Black Power Movement and the protests against the Vietnam War, founded the Asian American Political Alliance as way to unite Japanese, Chinese and Filipino American students on campus.

But Ronald Quidachay, who co-founded the Philippine American Collegiate Endeavor (PACE) at the then-San Francisco State College in 1967, said the term “Asian American” took time to catch on.

“Nobody was referring to themselves as ‘Asian,’” he said of the Third World Liberation Front strikes in 1968 and 1969, when Ichioka and Gee’s Asian American Political Alliance joined with PACE, the Intercollegiate Chinese for Social Action, as well as black, Latino and Native American students at San Francisco State to demand ethnic studies and more faculty and students of color.

“It was very interesting,” Quidachay, who is now a Superior Court judge in San Francisco, said of first hearing the term. “My step-dad from Guam, his father was decapitated in World War II by the Japanese… I didn’t have this animosity, but I was certainly familiar with these sorts of concerns that people from Guam, and even the Philippines, had.”

A Fractured History

This pan-Asian identity wasn’t necessarily an obvious one. Before this, people of Asian ancestry identified with their ethnic group and didn’t see commonalities with each other.

For instance, when the Chinese Exclusion Act was up for renewal in 1902, Maeda said, Japanese immigrants didn’t protest it, and when people of Japanese descent were forced into incarceration camps during World War II, Chinese and Korean Americans often wore buttons stating their ethnicity so that they wouldn’t be mistaken for being Japanese.

“In other words, the injustice here isn’t that you’re incarcerating Japanese Americans, the injustice is that you’re lumping us in with them unfairly,” Maeda said.

The term Asian American, however, signaled a shared and interconnected history of immigration, labor exploitation and racism, as well as a common political agenda. It was also a pushback against the pejorative word “Oriental.”

“There was a recognition that the term Oriental was a Eurocentric term that geographically referenced the East relative to Europe,” said Karen Umemoto, director of UCLA’s Asian American Studies Center, which was co-founded by Ichioka in 1969. “Many of the stereotypes of Orientals and Orientalism was part of the project of imperialist conquest — British, and later, American — in Asia, with the exoticization of the Oriental as well as the creation of threat and fear, as evidenced in the yellow peril movement.”

The U.S. Census first used the term Asian American in 1980, according to Paul Ong, a professor of Asian American Studies at UCLA who has also served as an advisor to the U.S. Bureau of the Census. It was only in 2016 that the U.S. government formally banned the word Oriental in federal law, instead requiring the use of the term Asian American.

Creating a Community

While the term Asian American was used in activist and academic circles, it took decades for the term to become popularized across the country.

The turning point, said Helen Zia, a journalist and author of the book, “Asian American Dreams: The Emergence of an American People,” was the 1982 murder of Vincent Chin, a Chinese American who was mistaken for being Japanese at a time when auto workers in Detroit were being laid off in part because of competition with Japanese manufacturers.

“The nature of the killing of Vincent Chin compelled people to see what there was in common,” said Zia, referring to different Asian ethnicities. “So whether people wanted to feel like there was anything in common or not, they could not deny that if they looked that way, they could be killed, whether they were Japanese ethnically or not.”Zia, who helped organize the community in response to Chin’s murder, said the national movement that followed helped bring together Asian Americans of all different backgrounds at a time when they made up only about 3.5 million, or less than 2 percent of the total population, according to the U.S. Census.

“The fact that they could come together and multiply their presence in the American democracy was huge,” she said. “It really was an empowering recognition… It raised the stakes in terms of no—you can’t ignore this population.”

In addition, Chin’s case also introduced the Asian Americans to white Americans.“To the rest of America at the time, Asian people didn’t exist in the popular consciousness,” said Zia. “They were like, ‘Oh, where did these people come from? What — they’re organizing, they have a voice, they’re talking about racism? What — they speak English?’ These were all the reactions we got… It was a teaching process.”

But just as Asian America took shape, it expanded and evolved.

The 1965 Immigration and Nationality Act — which changed immigration quotas for non-European countries — and the conflicts in Southeast Asia resulted in new populations from countries such as Vietnam, Laos, Cambodia, India, Pakistan, Bangladesh and Sri Lanka. In addition, the U.S. Supreme Court’s overturning of anti-miscegenation laws in 1967’s Loving v. Virginia led to a boom in the number of multiracial Asian Americans.

Even as Asian American remained a strategic political label, this diversity also meant that recognizing each ethnicity on its own terms became a critical tool for advancement.For instance, Kathy Ko Chin, president of the Asian and Pacific Islander American Health Forum, explained that when viewed as a single group, Asian Americans and Pacific Islanders had the highest rates of health insurance coverage in the country in 2013. But by disaggregating the data, she found that not all groups fared equally well — for example, more than 20 percent of Korean Americans were uninsured in her analysis, a higher rate than any other racial category. Knowing this, the APIAHF was able to address the disparity.

“Because we see the challenges of having only aggregated data,” said Chin, “the only way to address those challenges is through disaggregated data. It’s using a powerful tool to zero in on how to best achieve equity for our communities.”

‘That Never Felt Like Us’

There are approximately 21.4 million people of Asian descent living in the United States, according to a 2016 U.S. Census estimate. They come from more than 20 countries and are now the fastest growing major racial or ethnic group in the United States, according to the Pew Research Center.

With this growth and diversification of the community come new questions about what it means to be Asian American, who belongs, and which issues to advocate for.

Sarath Suong, executive director of the Providence Youth Student Movement, which organizes Southeast Asian youth in Rhode Island, said that as a Cambodian refugee, he often feels like he doesn’t fit into Asian America.

“Growing up during the 1980s and 1990s, the Asians we saw were East Asian, and often images of the model minority,” he said. “And that never felt like us. We were failing out of schools, we were being harassed and profiled by the police, and there was a really fast school to prison pipeline — and now, a school to deportation pipeline.”

“When I wanted to join Asian-American groups, I always felt like I was othered by my skin color, my class or my refugee experience,” Suong added. “I’ve always felt, personally and as a community, rejected by Asian America.”

Deepa Iyer, author of the book “We Too Sing America: South Asian, Arab, Muslim, and Sikh Immigrants Shape Our Multiracial Future,” said South Asians grapple with similar questions of who — and which issues — belong under the umbrella of Asian America.

“In the wake of 9/11, South Asians would bring up the need to address national security and that be something that Asian Americans look at broadly, but oftentimes they felt that those issues were not part and parcel of the policy agenda of Asian-American organizations,” she said, citing Islamophobia as another such issue.

“Questions from those who find themselves on the margins of the Asian-American community — who are mainly South Asian and Southeast Asian — can be really helpful in refining an analysis of what it means to be Asian in this country.”

For others, the future of Asian American is about reconnecting with the term’s roots.

“Today when a community of immigrants and the descendants of immigrants from Asia is more diverse than ever, the term Asian American is more essential than ever before,” Maeda said. “People of Asian ancestry continue to face discrimination, harassment and prejudice, and just as it’s been over the past century-and-a-half, we exist in a society that sees us all as one, as all looking the same, as all being the same.”

“And given that that’s the case,” he added, “it’s even more incumbent upon us to come together to fight for social justice.”

Read more on NBCNews.com.

The National Indian Health Board (NIHB) invites MSPI/DVPI grantees, Tribal behavioral health experts, public health professionals, advocates, researchers, community-based providers, and others to submit proposals to highlight the accomplishments of their programs at the American Indian and Alaska Native National Behavioral Health Conference, in Washington, DC from July 25-27, 2018. This year’s conference theme, “Promoting Connections Between Culture and Purpose” will provide evidenced-based, best, wise, or promising behavioral health practices developed in and for American Indian and Alaska Native (AI/AN) communities.

The Poster Session is a great way for success stories to be heard by a large audience of Tribal leaders, Tribal behavioral health professionals, health experts, public health professionals, federal employees, advocates, researchers and community-based providers as well as share program ideas with others.

Those interested should submit contact information and a brief description of the program within the application.

The deadline for proposals is Friday, June 15 at 11:59 p.m. EST.

Presenters will be notified within one week of their submission.

Poster Guidelines: Posters should contain information about your program and should be visually appealing. Presenters may choose to highlight specific program activities, programs, or data, based on the story they want to tell. All posters must be 36″ x 48″ (3ft by 4ft) to fit on the easels available at the conference. NIHB will provide additional guidelines upon selection.

Learn more and submit your poster proposal with NIHB!

Working-age Americans in 21 states faced a higher probability of premature death from 1990 to 2016, according to the most extensive state-by-state US health study ever conducted.

The likelihood of early death for men and women age 20 to 55 is highest in West Virginia, Mississippi, and Alabama. In contrast, same-age residents of Minnesota, California, New York, and several northeastern states have a lower probability of premature mortality.

“We are seeing dangerous disparities among states,” said Dr. Christopher Murray, director of the Institute for Health Metrics and Evaluation (IHME) at the University of Washington, whose organization coordinated the study. “Unless and until leaders of our health care system work together to mitigate risks, such as tobacco, alcohol, and diet, more Americans will die prematurely, and in many cases, unnecessarily.”

The study, published recently in JAMA, covers 1990 to 2016; it is part of the Global Burden of Disease (GBD) study, a comprehensive effort to quantify health internationally, covering 333 diseases and injuries and 84 risk factors. It is the most comprehensive state-by-state health assessment ever undertaken and includes estimates of prevalence, incidence, death, life expectancy, and several other summary health metrics for all 50 states, the District of Columbia, and the nation overall..

In 2016, key factors driving the increased likelihood of early death for those aged 20 to 55 included substance abuse, suicide, and alcohol-related conditions. For these diseases, the states with the “worst” and “best” age-standardized rates of years of life lost (YLLs) per 100,000 people were the following (with national rates shown for comparison):

• Drug use disorders: West Virginia (982), North Dakota (161), US (451)
• Alcohol-related conditions: New Mexico (328), Utah (110), US (156)
• Suicide: Utah (979), District of Columbia (306), US (564) 

Opioid use disorders rose from the 11th leading cause of disability-adjusted life years (DALYs) in 1990 to the seventh leading cause in 2016.

“The US has witnessed some improvements among youth under 20 and seniors over 55, but overall the nation and some of our states are falling behind other, less developed countries,” said Dr. Ali Mokdad, who, with Murray, wrote the study. “The strain on America’s health resources is getting worse, and the need for prevention services and greater access to and quality of medical care is increasing.”

In addition, the burden of mental health disorders is increasing in the United States with DALYs; major depression increased over 27% nationwide between 1990 and 2016. Similarly, the burden due to anxiety disorders increased by about 31% and totaled 1.76 million DALYs in 2016.

“These findings serve as compelling evidence of the need to increase mental health care and screening, as well as programs seeking to prevent mental disorders and to promote mental health,” Murray said.

Murray also noted that high body mass index (BMI), smoking, and high fasting plasma glucose (FPG) were the three largest health risks in 2016. Both high BMI and FPG are linked to diabetes. In addition, high BMI, commonly referred to as overweight or obesity, is associated with an increased risk of cardiovascular diseases, some types of cancer, and poor health generally.

“To an increasing degree, overweight, obesity, and sugary diets are driving up health care costs and are costing Americans years of healthy life,” Murray said. “They are undermining progress toward better health.”

Among the study’s findings:

• The three leading causes of years of life lost in the US in 2016 were: ischemic heart disease, lung cancer, and COPD, a change from 1990 when the third leading cause of YLLs was motor vehicle injuries.
• While smoking is declining, it remained the top risk factor for DALYs in 34 states in 2016.
• There also were increases between 1990 and 2016 nationally in Alzheimer’s disease, which moved from the seventh leading cause of YLLs to the fourth; diabetes rose from 12th to eighth.  

Mokdad said increasing access to primary care, such as general practitioners and physician assistants, would help identify patients’ early warning signs of poor health.  

“Primary care is our health system’s front line of defense, detection, and treatment,” he said. “Local, state, and federal dollars need to be targeted more effectively for primary care, especially for those millions of Americans not on Medicare.”

Top 10 Risk Factors in 2016 as a percentage of disability-adjusted life years:

• Tobacco
• Overweight/obesity (high BMI)
• Dietary risks
• Alcohol and drug use
• High fasting plasma glucose
• High systolic blood pressure
• High cholesterol
• Impaired kidney function
• Occupational risks
• Air pollution

“Top and Bottom” 10 States for Probability of Premature Death Among 20 to 55-Year-Olds Between 1990 and 2016:

• Ten states with lowest probability of premature death: Minnesota, California, New York, Connecticut, New Jersey, Washington, Massachusetts, Vermont, New Hampshire, and Hawaii
• Ten states with highest probability of premature death: West Virginia, Mississippi, Alabama, Oklahoma, Kentucky, Arkansas, New Mexico, Louisiana, Tennessee, and South Carolina

Read more on HealthData.org.