Current Events in May 2019

Most recent mothers are flooded with articles and information about postpartum depression, but a new study links depressive symptoms with mothers own personal histories.

According to researchers from University College London, women who have struggled with body image issues or eating disorders before pregnancy -- even as far back as childhood -- are at a greater risk of developing depression during pregnancy and after having children.

“We found that women who have had an eating disorder at any point before childbirth, even if it was years earlier during adolescence, were more likely to experience depressive symptoms during pregnancy and up to 18 years after the birth of their child,” said researcher Dr. Francesca Solmi. “This finding suggests that many people with eating disorders might not fully recover since we know that eating disorders and depression often happen at the same time.”

Finding the link

To see how an eating disorder could affect later depression, the researchers looked at data from over 9,200 women who participated in the Avon Longitudinal Study of  Parents and Children, monitoring the women from their 18th week of pregnancy until their child was 18 years old.

According to Dr. Solmi, it’s important to uncover the links and gain a better understanding of the risk factors, as “depressive symptoms in mothers have been shown to be associated with a number of negative outcomes for their children.”

“It is therefore important to identify and treat eating disorders early, as these could be one potential cause of the depressive symptoms,” Dr. Solmi said.

Compared with those who had no history of an eating disorder, the women who had experienced either anorexia, bulimia, or both were more likely to have depressive symptoms both during pregnancy and after childbirth. At the 18-year follow-up, the depression symptoms were still prevalent in the women who had had eating disorders.

The study also revealed that the women who struggled with body image or their diet during pregnancy -- regardless of past experience with eating disorders -- were more likely to have depressive symptoms.

The researchers hope that medical professionals get the training and the tools required to not only detect eating disorders during pregnancy, but also help women who may be struggling with their mental health both during pregnancy and after they give birth.

“There’s a lot of stigma around both depression and eating disorders, so many people might not feel comfortable talking about it or seeking help,” said researcher Yu Wei Chua. “Assessment of mental illness in pregnancy, as standard practice, could help health professionals pick up on signs of depression and/or eating disorders at this crucial stage of life.”

Knowing the risks

While most studies don’t delve deeper to look at how mothers’ own history can affect their mental health, there are several risks associated with postpartum depression that are important for new mothers to be aware of.

Researchers have found that mothers who have fussy babies or who aren’t getting enough natural light could be at an increased risk of postpartum depression.

However, researchers have discovered a fruit-based supplement regimen that could help combat feelings of depression in the first days after giving birth.

While opioids -- even for medical use -- are controversial for many consumers, a new report found that many physicians may be inadvertently harming patients by going out of their way to not prescribe opioids.

In 2016, the Centers for Disease Control and Prevention (CDC) released guidelines for medical professionals to follow in an effort to reduce the number of opioid prescriptions; however, the agency is now saying that many doctors may be misapplying these guidelines, to the detriment of patients.

“There are some people suffering from chronic pain who can and do benefit from taking opioids,” said Dr. Kurt Kroenke. “Doctors and clinicians need to be discussing treatment options with their patients and making the decision that is best for those individual patients in the context of safety and pain relief.”

Focusing on patient needs

Following an uptick in opioid overdoses, the CDC released guidelines to help regulate the use of opioids for medical purposes.

Though not applicable to cancer patients or those in end-of-life or palliative care, the guidelines are broken down into three categories:

• Determining when to initiate or continue opioids for chronic pain

• Opioid selection, dosage, duration, follow-up, and discontinuation

• Assessing risk and addressing harms of opioid use

“The intent of the CDC guidelines was to individualize treatment, but the overly restrictive prescribing policies created by legislatures and payers have led to unintended harm for some patients,” Dr. Kroenke said. “In addition, burdens, fears, and stigma related to opioid prescribing have been instilled in many clinicians, and that will be even more difficult to reverse.”

Despite being designed to help prevent overdoses, Dr. Kroenke discovered that many physicians have become too restrictive in their opioid prescriptions and too rigid in following the guidelines, even when the drugs can be helpful to patients.

He noted instances of doctors quickly terminating a prescription, which can be detrimental to patients’ overall health, or placing strict limits on cancer patients, who the guidelines specifically don’t cover.

Dr. Kroenke and his fellow American Academy of Pain Medicine Foundation panelists agree with the basis of the CDC’s guidelines, but they want policymakers to ensure all patients are given the care that is most beneficial to their individual needs going forward. To see their recommendations for healthcare professionals, click here.

Using discretion

Earlier this year, the American Society of Anesthesiologists (ASA) conducted a survey and found that the majority of parents are in favor of doctors prescribing their kids opioids for pain relief -- despite the risks and the rate at which children are exposed to opioid poisoning.

“Opioids may not always be the best option. It really depends on the type of surgery and how long they are required,” Dr. Linda J. Mason said. “It is, however, important for parents to know that there are many alternatives available that are as -- or more -- safe and effective for pain management. But only about a third of parents whose children were prescribed opioids even asked their doctor about pain management alternatives.”

In a shot fired across Amazon’s bow, Walmart has announced the launch of one-day delivery on a wide range of general merchandise from Walmart.com, with a minimum purchase.

The service is rolling out first to consumers in Phoenix and Las Vegas, with plans to expand it to  Southern California next. Marc Lore, CEO of Walmart eCommerce U.S., says NextDay delivery will roll out gradually over the coming months, with a plan to reach approximately 75 percent of the U.S. population by the end of the year. Lore says that will include 40 of the top 50 major U.S. metro areas.

“Walmart’s NextDay delivery offers a stand-alone, curated shopping experience where customers can browse up to 220,000 of the items most frequently purchased, ranging from diapers and laundry detergent to toys and electronics, with more assortment to be added,” Lore said in a statement. “It is available on eligible orders of $35 or more, with the specific assortment varying by customer location.”

Keeping up with Amazon

The move follows Amazon’s announcement in late April that it intends to make one-day delivery the default for Prime members, who currently pay $119 a year for free two-day shipping, along with other perks.

Amazon said it had already planned to invest $800 million in the second quarter to make the change, but it didn’t provide a time frame for the launch of the shortened shipping plan.

“It will take us a significant amount of time to achieve,” said Amazon’s CFO Brian Olsavsky on a conference call with analysts. “We want to ensure we have good delivery experience for our customers as we evolve this offer.”

No membership fee

In announcing its plans, Walmart underscored the fact that its new shipping service will be available to all consumers and will not require a membership fee. The company said a customer need only go to Walmart.com and click the NextDay delivery tab to view items that are available for one-day delivery.

“After adding items to their cart, the customer proceeds to checkout,” Lore said. “Everything in the cart must be eligible for NextDay delivery to qualify. Cut-off times vary by location.”

Lore said the company will benefit along with customers. He said delivering items in one day will actually save money because the eligible items will come from a single fulfillment center located in close proximity to the customer. The order is more likely to come in one box and travel the shortest distance, two factors that contribute to shipping costs.

Mercedes-Benz USA (MBUSA) is recalling 1,051 model year 2019 A220s and A220 4MATICs.

Due to improper welding, the pedal plate may bend, impairing the operation of the brake pedal.

Impaired operation of the brake pedal may increase the risk of crash.

What to do

MBUSA will notify owners, and dealers will inspect the welding of the brake pedal, replacing it as necessary free of charge.

The recall is expected to begin June 19, 2019.

Owners may contact MBUSA customer service at 1-800-367-6372.

American Fastbacks (EHGUSA-AF) is recalling 94 model year 2018 Jeep Wranglers sold with a roof top tent installed.

The top cover of the roof top tent may crack or break, possibly resulting in the cover detaching from the vehicle while it is moving.

This can create a road hazard, increasing the risk of a crash.

What to do

The remedy for this recall is still under development.

The recall is expected to begin in May 2019.

Owners may contact American Fastbacks customer service at 1-844-533-7997 extension 301.

It’s on.

Now that the U.S. has increased tariffs and applied them to $200 million in Chinese goods, that country is retaliating against the U.S., and a prolonged trade dispute appears to be on the verge of becoming an all-out trade war.

“At no time will China forfeit the country’s respect, and no one should expect China to swallow bitter fruit that harms its core interests,” wrote the People’s Daily, a newspaper that reflects the views of the Chinese government.

In retaliation, China will raise tariffs on $60 billion worth of U.S. goods imported to that country, starting June 1. As expected, China is targeting mostly agricultural products since U.S. farmers and other food producers are viewed as an important constituency for President Trump.

In a tweet, Trump urged China not to retaliate for the U.S. hike in tariffs, saying a prolonged trade dispute does not serve the interests of either country. On that point, there is no disagreement.

So why the impasse?

Sticking point

The main sticking point revolves around how any trade agreement between the two countries would be enforced. The U.S. is demanding that reforms in Chinese trade policy be written into Chinese law. Specifically, the U.S. wants China to pledge not to steal U.S. intellectual property. The Chinese government has refused to put that into its laws.

On “Fox News Sunday,” Larry Kudlow, chairman of the president’s Council of Economic Advisors, made the argument for “very strong” enforcement provisions in any agreement and said the tariffs would remain in place as negotiations continue.

Kudlow also seemed to contradict his boss when he acknowledged that the tariffs placed on Chinese imports aren’t really paid by China, but by U.S. importers, who almost always pass the extra cost on to consumers. Tariffs hurt China only because U.S. consumers may buy fewer Chinese imports than in the past because of their higher cost.

Market reaction

Predictably, the markets don’t like what’s happening in trade talks between the world’s two largest economic powers. The Dow Jones Industrial Average opened the week about 500 points lower after another big loss on Friday. Japan’s Nikkei 225 index declined 0.7 percent Monday, while the Shanghai Composite plunged 1.2 percent.

Economic analysts say the longer the standoff between the U.S. and China lasts, the greater the chances the U.S. eventually slips into a recession. But Kudlow says both countries have a lot to lose.

“Both sides will pay,” Kudlow said during the Fox interview. “Both sides will suffer on this.”

The Supreme Court ruled by a vote of 5-4 on Monday that a group of iPhone owners can proceed with their class action lawsuit against Apple over the pricing on its App Store.

In 2011, the group of iPhone users accused Apple of violating antitrust rules by unfairly taking a 30 percent commission on sales in its app marketplace. The suit claimed that consumers have been harmed by Apple’s practice of taking a cut of sales because the company doesn’t allow users to download apps from any platform other than its official App Store.

"Our cases have consistently stated that direct purchasers from alleged antitrust violators may maintain a suit against the antitrust violaters," wrote Justice Brett Kavanaugh, who sided with the court’s four liberal justices in the decision.

"Ever since Congress overwhelmingly passed and President Benjamin Harrison signed the Sherman Act in 1890, protecting consumers from monopoly prices has been the central concern of antitrust," he said. "That is why we have antitrust law."

Right to sue

The nation’s highest court didn’t accuse Apple of violating antitrust laws, but it ruled that consumers are within their rights to sue the company for engaging in monopolistic practices since they have a “direct purchaser” relationship with Apple.

Apple argued that only app developers should be able to file a suit of this nature since they can set their own prices on the platform. Apple contended that it’s merely an intermediary since customers technically buy their apps from developers.

“We disagree. The plaintiffs purchased apps directly from Apple and therefore are direct purchasers,” Justice Kavanaugh wrote. “Apple’s line-drawing does not make a lot of sense, other than as a way to gerrymander Apple out of this and similar lawsuits.”  

The court noted that the group’s suit against Apple is still in an “early stage,” so there’s yet to be a definitive ruling on whether the tech giant unlawfully engaged in monopolistic practices.

Major discrepancies are present between the prices paid to hospitals for privately insured patients and what the federal Medicare program pays, according to a RAND analysis of hospital prices in 25 states.

Overall, hospitals treating patients with private health insurance were paid 2.4 times the Medicare rates in 2017. RAND researchers found that the difference was most significant for outpatient care. In those cases, private prices were nearly triple what Medicare would have paid.

"The widely varying prices among hospitals suggests that employers have opportunities to redesign their health plans to better align hospital prices with the value of care provided," said lead author Chapin White in a statement. "Employers can exert pressure on their health plans and hospitals to shift from current pricing system to one that is based on a multiple of Medicare or another similar benchmark."

Suggested interventions

The researchers say changes are needed to drive down hospital prices in the private sector, whether they be in the form of federal intervention or a shift in industry behavior.

The study authors recommend that private insurers switch from discounted charge contracts for hospital services and to contracts “based on a percent of Medicare or another similar fixed-price arrangement.”

"Employers can also encourage expanded price transparency by participating in existing state-based all payer claims databases and promoting the development of such tools," White said. "Transparency by itself is likely to be insufficient to control costs so employers may need state or federal policy changes to rebalance negotiating leverage between hospitals and their health plans."

Legislative interventions might include placing limits on payments for out-of-network hospital care or allowing employers to buy into Medicare or another public option that pays providers based on Medicare rates.

Hospitals raise concerns

After the study was published, the American Hospital Association said it had a “number of concerns” about the results of the analysis.

In addition to pointing out the limitations of the small sample size, the group argued that paying hospitals at Medicare rates would have a huge impact on the industry and could cause many hospitals to close.

“Medicare payment rates, which reimburse below the cost of care, should not be held as a standard benchmark for hospital prices,” the AHA said in a statement. “In 2017, hospitals received payment of only 87 cents for every dollar spent caring for Medicare patients.”  

“Simply shifting to prices based on artificially low Medicare payment rates would strip vital resources from already strapped communities, seriously impeding access to care. Hospitals would not have the resources needed to keep our doors open, innovate to adapt to a rapidly changing field and maintain the services communities need and expect,” the AHA said.

Technology companies have had mixed results in becoming publicly traded companies. In recent weeks, Lyft’s initial public offering (IPO) soared out of the gate, only to fall significantly days later.

On Friday, Uber went public amid red hot hype but failed to impress investors. In the future, the path may be a little easier for technology companies offering IPOs.

The Securities and Exchange Commission (SEC) has approved an application for a new stock exchange to be based in Silicon Valley. It’s called the Long-Term Stock Exchange (LTSE), with an approach designed to give high-growth startups more time to grow, without the pressure of having to report increases in profits every quarter.

Part of the problem with the launch of both Lyft and Uber is neither company has turned a profit. They generate significant revenue but the money is put back into the company to launch and expand other business lines.

Doing it the hard way

Other tech companies -- now giants -- have done it the hard way, competing for investors on well-established markets. When Facebook went public just a few short years ago, it really hadn’t worked out a way to monetize the platform. Now it’s a virtual money-printing machine.

Even Amazon, which went public in 1997, still doesn’t always produce a quarterly profit, preferring to spend its massive revenue on expanding its business. Investors value its stock in the belief that one day Amazon will control not just retail, but many other aspects of business and will be able to charge whatever it wants.

Promoters of the LTSE say other tech startups shouldn’t have to go through that. Investors who buy LTSE-listed companies will understand from the start that the companies are losing money and that the payoff could be years down the road.

Initially skeptical

The SEC was initially skeptical of the idea but gave it the green light on Friday after objectionable areas of the proposal were revised. Eric Ries, who came up with the idea and raised $19 million to launch it, said the New York-based stock exchanges are hostile territory for new tech companies and often stifle innovation.

Ries says the new stock exchange will have rules that will encourage listed companies to focus on the long-term, not the next quarter. The exchange may ask listed companies to limit the bonuses they pay executives who achieve short-term goals. It would also increase the payout to investors the longer they hold the stock.

Delta Airlines on Monday kicked off a two-week trial of free Wi-Fi to all passengers on 55 of its flights. The airline says its goal is to eventually offer complimentary Wi-Fi on all domestic flights.

At the end of its initial trial on select flights, Delta hopes to have gleaned insight into how well its system can support Wi-Fi and the way passengers use it. The carrier is aware that offering Wi-Fi free of charge will lead to a significant increase in the number of customers who use it.

“Customers are accustomed to having access to free Wi-Fi during nearly every other aspect of their journey, and Delta believes it should be free when flying, too,” said Ekrem Dimbiloglu, Director of Onboard Product in a statement.

“Testing will be key to getting this highly complex program right – this takes a lot more creativity, investment and planning to bring to life than a simple flip of a switch,” Dimbiloglu said.

Travelers will be notified of availability

Delta says customer feedback will be crucial as it strives to roll out free Wi-Fi on a larger scale.

“As with any test in uncharted territory, Delta will rely heavily on customer and employee feedback to navigate how to best make free in-flight Wi-Fi a reality,” Dimbiloglu said, adding that several more test phases will likely be necessary before free Wi-Fi touches down in all cabins.

Passengers will be notified via email and a Fly Delta app push notification if their flight is among those involved in the two-week trial. Delta says passengers will be able to  “browse, email, shop, message, engage with social media and more” while using its free Wi-Fi, but they won’t be able to stream video.

While some students can find it difficult to balance extracurricular activities with school requirements, a new study conducted by researchers from Michigan State University found that engaging in sports could positively benefit college students in the classroom.

According to the researchers, recreational sports were found to not only help college students’ performance in the classroom, but it also pushed them to continue their studies.

“At the end of the year, students who played sports dropped or failed a total average of six credits compared to 7.7 credits among non-playing students,” said researcher Kerri Valsod.

Reaping the rewards

To see just how pivotal playing sports was for college students, the researchers evaluated nearly 1,800 freshman at Michigan State University who enrolled in intramural sports.

The researchers accounted for outside factors, such as first generation college students, high school GPA, living on campus versus living off campus, race, gender, and socioeconomic status.

“The only thing that was different between these students was whether they played or not,” said researcher Jim Pivarnik. “You can’t just say one person was smarter in high school than the other or his or her socioeconomic status was better. We addressed all that, with all things being equal.”

The study revealed that intramural sports considerably affected students’ academic performance -- in a positive way. Students who played sports not only had higher GPAs -- 3.25 for athletes compared to 3.07 for non-athletes -- but they were also nearly three times as likely to return to school at the end of the year.

Additionally, these students were also less likely to fail or drop classes during their freshman year compared with students who didn’t play sports. They were also 40 percent more likely to earn sophomore standing at the university at year’s end.

The researchers do warn that students don’t need to go overboard with joining teams and activities, as that can get overwhelming. However, finding what works for them personally can be incredibly effective.

“Don’t go crazy,” Pivarnik said. “Don’t join 20 teams. Grab some friends, find a moderate number of activities, and get involved in something different. The four-to-seven range seems to be effective and is linked to a higher GPA.”

Keeping a good mindset

While this study focuses strictly on how playing sports can affect college students academically, previous studies have shown how staying physically active can be beneficial for those coping with mental health issues, which a large number of college students are.

Researchers from Binghamton University recently found that college students can end up in bouts of bad behavior after just one poor decision, which can ultimately affect everything from their grades to their social lives and mental and physical health.

These findings emphasize just how important having a team or other forms of social support can be to college students’ overall wellbeing. According to Pivarnik, this is part of the beauty of intramural sports, as students “don’t have to be… all-star basketball player[s] or have played ultimate frisbee before.”

“It’s an inclusive environment and helps students do better and creates a new home,” Pivarnik added.”

Though the growing arena of digital health comes with some concerns for healthcare officials, researchers from Penn State University have discovered an interesting trend among consumers who might consider using digital doctors.

According to their study, the researchers found that consumers are more likely to trust digital healthcare if they also trust technology more broadly, and their own ability to utilize technology.

“Doctors are limited by their human bandwidth, by their experience, knowledge, and even state of mind from minute to minute,” said researcher S. Shyam Sundar. “In contrast, machines can be programmed to ‘think’ of all the possible conditions that a patient’s symptoms could point to, and they never get tired. Some level of automation is clearly needed.”

Incorporating more technology

In this study, the researchers sought to gauge consumers’ acceptance and trust of various digital healthcare providers, including “robot receptionists” and virtual nurses and doctors.

Before exposing participants to digital healthcare services, the researchers first collected their opinions about machines completing tasks typically done by humans, as well as the participants’ reliance on machines and how comfortable they feel using technology.

The second part of the study involved having participants interact with digital healthcare in various forms.

Using various combinations of receptionists, doctors, nurses, avatars, machines, and humans, the participants were exposed to several different options of digital healthcare. They were then required to report back on how they felt about the interactions and how likely they’d be to use the service again.

The researchers found that those who had a positive outlook towards digital healthcare, and advanced forms of technology in general, were more likely to accept the various avatars and robots in medical settings.

“We found that if you’re high on machine heuristic and you’re high on power usage, you have the most positive attitude towards automated healthcare providers,” said Sundar. “This combination seems to make people more accepting of these technologies.”

Sundar and his team suggest that these findings can be useful as digital healthcare continues to evolve.

“Our results suggest that the key to implementing automation in healthcare facilities may be to design the interface so that it appeals to expert users who have a high belief in machine abilities,” said Sundar. “Designers can direct resources toward improving features such as chat functionality instead of anthropomorphizing healthcare robots. In addition, increasing the number of power users and the general belief that machines are trustworthy may increase the adoption of automated services.”

Expanding the field

The digital healthcare field has shown no signs of slowing down, as companies like Walgreens and CVS are making it easier for customers to access healthcare.

Moreover, a recent study from Massachusetts General Hospital found that digital doctor’s visits were not only more convenient for many patients, but their quality of care wasn’t compromised by skipping an office visit.

These results were particularly promising, as many doctors revealed that they think virtual appointments will become the norm in just a few short years.  

"Physicians' increased willingness to see patients over video, in addition to the increasing physician shortage, high burnout rates and a more favorable reimbursement landscape, signals a boom in virtual visits over the next several years,” said Dr. Sylvia Romm.

This year’s college graduates are entering the best job market in years. That’s the good news.

But here’s the bad news: finding an affordable place to live as you start your career is getting harder to do.

A new study by HotPads, a rental marketplace, found the median rent in the U.S. is $1,535 per month, up almost 30 percent over the last decade. When you break it down for renters early in their careers, rent has grown nearly 15 percent. Now, factor in the amount of student loan debt most college grads carry. You’ll quickly see that putting a roof over their heads can be a daunting task.

Students coming out of college with less marketable majors are having an especially tough time. HotPads examined 45 majors  – including U.S. history, music, biology, and early childhood education – and found the rent burden for grads with those degrees has grown faster than for renters without a four-year college degree.

Graduates with history degrees have seen one of the largest changes in rent affordability in the past 10 years. Their rent burden has soared by 22 percent as their early-career median annual income dropped 14.5 percent.

Recent grads with music, biology, and early childhood education degrees have seen a less than 10 percent increase in their incomes over the past 10 years, and their rent burden grew 10 percent during that time.

30 percent of annual income

Personal finance experts usually suggest spending no more than 30 percent of annual income on housing, but that is becoming increasingly rare for people fresh out of college. On a national basis, only early-career graduates with one of 17 majors analyzed – including computer science and various engineering degrees – have a rent burden of 30 percent or less.

"As rent prices and student debts rise, affordability concerns for recent college graduates have garnered attention on the national stage," said Joshua Clark, an economist at HotPads. “Graduating from college still typically pays off in the long run, but slower wage growth for college graduates and rising costs have dampened the immediate financial benefits associated with a four-year degree.”

As a result, what students specialize in while in college, and where they live afterward, has a bigger impact on their finances than ever before.

Living with mom and dad

An unrelated study by real estate marketplace Zillow shows how this is affecting many recent graduates. It found that nearly 22 percent of millennials -- those between the ages of 23 and 37 -- are living with a parent.

While it was very common for recent graduates to be living in their parents’ basement in the wake of the financial crisis a decade ago, the Zillow study found the number of people moving back home is at its highest level since 2000.

And it’s not because they can’t find a job. Only 10 percent of millennials living at home are unemployed. It was nearly 20 percent in 2010.

DOM International Limited is recalling Dom Reserve brand Atlantic Salmon Strips (Hot Smoked) Cracked Black Pepper.

The product may be contaminated with Listeria monocytogenes.

There have been no reported illnesses associated with the consumption of this product.

Dom Reserve, sold in retail stores in Ontario, Canada, is being recalled:

• Common Name: Atlantic Salmon Strips (Hot Smoked) Cracked Black Pepper
• Size: 150 g
• Code(s) on Product: 002451
• UPC: 7 72945 11150 8

What to do

Customers who purchased the recalled product should not consume it, but discard or returned it to the store where purchased.

Consumers with questions may contact the company at (416) 265-3993 extension 223, 247 or 249 or by email at dom.info@dominternational.com.

Planning on going out of the U.S. this summer? Then, taking five minutes to read this story is a must.

Let’s start with a quick quiz: which of these countries do you think the U.S. Department of State lists as destinations travelers should “exercise increased caution” in going to?

• A. United Kingdom
• B. France
• C. Belize
• D. Netherlands
• E. All of the above

Did you say E -- All of the above? If so, then you get an extra pack of honey roasted peanuts on your next flight. (If only...)

There are many places that Americans like to travel to and have always considered safe -- like France, the United Kingdom, and the Bahamas. But the fact is that the world isn’t the arms-opened-wide place it used to be, and travelers can’t be footloose and fancy free like they once were.

With heightened alerts on every aspect of a vacation, from a leisurely stroll on the beach at sunset to possible terror attacks at cultural events, there are 57 countries on the U.S. Department of State’s list that are considered to be level 2 -- exercise increased caution; level 3 -- reconsider travel; or level 4 -- do not travel.

Keep in mind that the Department of State isn’t asking travelers to completely ditch their vacation plans, but rather be cautious and aware. And in trying to have the traveler’s back, the agency leaves no stone unturned in its assessments.

Advisories vary by country

For example, its advisory for Italy details how terrorism is something consumers should be wary of if they plan to visit.

“Exercise increased caution in Italy due to terrorism.Terrorist groups continue plotting possible attacks in Italy. Terrorists may attack with little or no warning, targeting tourist locations, transportation hubs, markets/shopping malls, local government facilities, hotels, clubs, restaurants, places of worship, parks, major sporting and cultural events, educational institutions, airports, and other public areas,” the advisory reads.

Every country poses different sets of circumstance. In China, for example, travelers may be detained and/or deported for sending private electronic messages critical of the Chinese government. Unfortunately, most of those detentions don’t manifest themselves until a traveler is exiting the country and without access to U.S. consular services..

“Chinese authorities have asserted broad authority to prohibit U.S. citizens from leaving China by using ‘exit bans,’ sometimes keeping U.S. citizens in China for years. China uses exit bans coercively,” writes the Department of State in its travel advisory for China.

What countries are flagged?

Here’s an alphabetical list of countries the Department of State considers level 2, 3, and 4. Clicking on the link for the advisory will take you straight to that particular country’s warning.

Don’t wing it -- be prepared in advance

The Department of State offers some basic advice for all travelers, whether they’re headed to a place with no restrictions or one that causes concern.

• At the top of that list is STEP (Smart Traveler Enrollment Program), which sends travelers alerts and makes it easier for the local U.S. embassy or other U.S.-friendly agencies to locate travelers in an emergency.

• Follow the Department of State on Facebook and Twitter.

• Review the Crime and Safety reports for the countries you plan on visiting.

• Have a contingency plan for emergency situations. The Traveler’s Checklist.is a good place to start.

• Some U.S. citizens with special considerations – such as students, women, and LGBTI travelers – may face additional challenges when abroad. Take time to know what those are and what accommodations may have to be made.

• Some countries have restrictions on electronic communications. For example, if your life revolves around all things Google (like YouTube and G-Mail), you’ll probably be out of luck in most Arab countries. There are ways to get around that issue, like using a VPN (Virtual Proxy Network); however, doing so requires some technical knowledge and skill.

In the Department of State’s way of thinking, the bottom line is this: if you do decide to travel, make a plan for what to do if something goes wrong overseas.

Best to leave that sea turtle where you found it

One last thing…

There are products countries don’t want travelers either bringing in or taking out. Those items range from food to medications. Many are wildlife-oriented, like feather products from wild birds and products made from sea turtles. There’s also a ban on bringing in any shape, size, or form of coral back into the U.S.

The risk? Simple -- confiscation and a potential fine. For a complete list of what not to bring back into the U.S., check out both the U.S. Customs and the U.S. Fish and Wildlife’s site. For details on what items can’t be brought into specific countries, it’s best to check each country’s particular restrictions.

Amazon has promised to discontinue sales of children’s school supplies and jewelry that contain high levels of toxic metals -- specifically, cadmium and lead.

The move follows an investigation by the Washington Attorney General's Office, which revealed that Amazon had listings for dozens of products marketed for children that exceeded the legal limits of these heavy metals.

The investigation also determined that Amazon sold more than 15,000 items that contained high levels of toxic metals. After being alerted to the issue by the Attorney General’s office, Amazon contacted users that had purchased the items earlier this year and encouraged them to toss the products. Those consumers also received refunds amounting to a collective $200,000.

Cracking down on items with toxins

The e-commerce giant also paid the Washington Attorney General $700,000, which will be used to “fund future environmental protection efforts, including future investigations into toxic children’s products.”

"As a parent, when I buy products for my kids, I expect them to be safe," Washington Attorney General Bob Ferguson said in a statement announcing the agreement. "All retailers must ensure that their products do not pose a threat to Washington children. If they don't, they will hear from my office."

From now on, Amazon said it will no longer allow third-party sellers to list school supplies and jewelry geared towards children without providing lab reports or documents from an accredited lab showing that the products meet safety standards. Additionally, the company must remove listings for products found to have high levels of toxic metals within two days of being advised to do so by either the Washington Attorney General or the Department of Ecology.

The issue of toxins in school supplies isn’t new. In 2018, a study by the U.S. Public Interest Research Group (U.S. PIRG), a consumer advocacy group, found traces of lead, asbestos, and other harmful chemicals in several popular school supplies, including Playskool crayons and one brand of dry-erase markers.  

Beginning July 1, consumers looking to purchase tobacco or e-cigarette products at Walmart or Sam’s Club will have to be at least 21 years old.

The retailer announced this week that it’s raising the minimum age to buy tobacco products as part of a larger effort being made by regulators to reduce teen nicotine addiction. In addition to raising the minimum age to buy tobacco products, Walmart will stop selling e-cigarettes in sweet flavors, which have been found to appeal to teen users.

Walmart said the new policy is intended to improve its less-than-perfect track record regarding sales of tobacco products to minors. In a letter recently sent to Walmart, the FDA said it conducted 13,000 compliance checks since 2010 and Walmart passed only 93 percent of them.

"While we have implemented a robust compliance program, we are not satisfied with falling short of our company-wide goal of 100% compliance," the company wrote. "Even a single sale to a minor is one too many, and we take seriously our responsibilities in this regard."

Increasing the minimum buying age

The FDA, which has described the dramatic rise in e-cigarette use among teens as an “epidemic,” threatened earlier this year to fine Walmart, Kroger, and several convenience store chains for illegally selling tobacco products to minors.

In response to the warning, Walgreens announced in April that it will increase the minimum age to buy tobacco products to 21 starting September 1.

Lawmakers in several states have also sought to address the issue by raising the minimum tobacco-buying age to 21 under a new policy dubbed “Tobacco 21.” The initiative aims, in part, to prevent the tobacco industry from “recruiting young adults as replacement smokers” in an effort to sustain their business.

As more and more consumers across the country continue to be affected by measles, researchers have done their homework to try and protect more people from becoming infected.

Researchers from Johns Hopkins University conducted a study that predicted which counties in the United States were at the greatest risk for a measles outbreak.

“There has been a resurgence in measles cases, among other vaccine preventable diseases, in the U.S. and other countries in recent years,” said researcher Lauren Gardner. “Measles, in particular, poses a serious public health threat due to the highly contagious nature of the disease. It is therefore critical that we proactively identify areas most likely to experience outbreaks to strategically target for surveillance and control.”

Where the risk lies

To help consumers stay ahead of this highly contagious disease, the researchers worked to compile a list of the twenty-five counties in the country at the highest risk of experiencing a measles outbreak.

In order to do so, they completed a risk-analysis by looking at several important factors:

• Location of global measles outbreaks

• Non-medical exemption rates

• Population

• Anonymous passenger travel data from international airports

Based on their work, the researchers found that the top five counties in the United States that are most at risk are:

• Cook County, Ill.

• Los Angeles County, Calif.

• Miami-Dade, Fla.

• Queens, N.Y.

• King County, Wash.

Consumers should feel confident in these findings, as the analysis was able to identify areas that have already seen severe cases of measles.

“Our prediction is aligned with multiple counties that have experienced measles outbreaks this year,” Gardner said. “Critically, we recommend that public health officials and policymakers prioritize monitoring the counties we identify to be at high risk that have not yet reported cases, especially those that lie adjacent to counties with ongoing outbreaks and those that house large international airports.”

The researchers cite international airports as a major contributor to this recent measles outbreak, as travelers are coming through from countries with measles outbreaks. Moreover, they stress the importance of the measles vaccine in helping prevent future outbreaks.

“Anti-vaxxers are denying the best and very successful medical science we have and choosing instead to rely on fraudulent claims, such as purported link to autism, that have been uniformly debunked by evidence and analysis over the last two decades,” said researcher Sahotra Sarkar. “The New York borough of Brooklyn is a perfect example with a large number of unvaccinated members of an orthodox Jewish community even though the overall vaccination rate is not low.”

To see the researchers’ analysis in an interactive map, click here.

Staying informed

With over 550 cases of measles confirmed in the United States this year, the disease has increased rapidly as of late, and health experts warn that we could see the highest numbers of measles cases in nearly two decades.

The Centers for Disease Control and Prevention (CDC) has been keeping consumers updated on the current trends regarding these recent measles outbreaks, including keeping a running tally of affected areas and offering tips and advice for parents and travelers to help prevent the disease.