The Health 202: Kavanaugh hearing is a teaching moment for teens

THE PROGNOSIS

In the year since the #MeToo movement brought issues of sexual assault to the forefront of the public’s consciousness, interest in a federally funded prevention program has skyrocketed and, say those managing it, it has been impossible to keep up with demand. 

The first version of the Violence Against Women Act, passed in 1994, included funding for a Rape Prevention and Education Program (RPE). Administered by the Centers for Disease Control and Prevention, the money is doled out as grants to health departments in every state and U.S. territory to teach lessons, typically in schools based on real-world examples and evidence on how to prevent sexual misconduct and violence. 

Now, experts in the field say the federal government needs to at least triple current annual funding levels for the program from $50 million to $150 million to meet the sharply growing needs. A 2017 survey by the National Alliance to End Sexual Violence found “nearly 40 percent of programs had a waiting list of a month or more for prevention programming.”

Educating teenagers about sexual misconduct is a timely topic as senators prepare today to hear from Supreme Court nominee Brett Kavanaugh and a woman, Christine Blasey Ford, who has accused him of sexually assaulting her when they were both in high school. Until now, public debate about #MeToo stories has been largely focused on adult interactions, typically in or related to work situations. Ford’s claim that Kavanaugh attacked her when they both were in high school is causing some women to reassess the experiences they had when they were young. 

And, experts say, the allegations against Kavanaugh are a teaching moment for today’s teens. 

“People are reckoning with the fact that it is so prevalent and we can’t pretend it isn’t anymore,” Dr. Emily Rothman, a professor of community health sciences at Boston University, said. “Now is the time to turn to those programs because there is a science to preventing sexual violence.” 

But, Rothman told me, the programs are “woefully underfunded.”

It’s not clear where Congress would come down on recommendations to increase RPE funding because so far there’s been no movement to make changes to VAWA. Instead, lawmakers have extended the law in its current form until Dec. 7 to keep it from expiring on Saturday. 

When the program was first created 25 years ago, it was difficult to find schools that wanted to address allegations of sex and sexual abuse head on. Now, said Terri Poore, the policy director at the National Alliance to End Sexual Violence, parents want their kids to learn about consent and boundaries and what it takes to maintain a healthy relationship. 

“I do think people want a solution to this dismal climate we’re in and we believe this is a solution and we have to start young,” Poore said. “It isn’t a problem that’s gone away.”

“Only a handful of young people are getting exposed to the good levels of prevention work we’ve figured out,” she added. 

Many prevention programs focus on what’s known as “bystander” training, including how to recognize dangerous situations – such as a boy taking an obviously drunk girl upstairs at a party – and how to intervene safely. 

Eileen Recktenwald, executive director of the Kentucky Association of Sexual Assault Programs, manages a school program focused on teaching high schoolers and college students how to recognize a sexual assault may occur and how to intervene if they are a  bystander to such behavior. A 2017 study published in the American Journal of Preventive Medicine surveyed 89,707 students at 26 schools who went through Recktenwald’s program, found the bystander training decreased sexual violence by about 50 percent, including a significant drop in alcohol or drug-facilitated incidents. 

“I didn’t think you could prevent sexual assault, but I am a true believer,” Recktenwald told me. “And we can’t serve as many as would like us to be there.”

In one example, Recktenwald said, a student who had participated in the training might call up to the boy that his car is getting towed to distract him. The goal is for those who take the training, often student leaders, to disseminate what they learn to their friends. Those students are also encouraged to change the culture, to not participate in jokes on Facebook or rumors in the hallways.

Recktenwald said the accusations against Kavanaugh are especially relevant to her work because, according to the women’s accounts, there were other people present who could have intervened. “These scenarios are very familiar scenarios to us in the field,” she said. 

The program also teaches students where to go for help if they or someone they know has been assaulted. Research shows that teenagers typically don’t disclose if something happens to them, she said. 

Rebecca Campbell, a psychology professor at Michigan State University, said she’s interviewed people in their 70s and 80s who never spoke of their abuse and took it to their grave. They carried guilt, shame, depression. “The health impact of this is enormous,” she said. “It is a major public health concern.”

When Ford testifies in the Senate today, she will tell the lawmakers, “Brett’s assault on me drastically altered my life. For a very long time, I was too afraid and ashamed to tell anyone the details,” according to her prepared remarks

Not only is it important to teach children and teens about sexual assault, Campbell said, but it’s also crucial that adults take disclosures seriously. President Trump and Republican lawmakers who have cast doubt on Ford’s recollections could deter young people from coming forward about their experiences, she argued. 

It could also encourage bad actors. A new research study conducted by Harvard and University of Michigan examined how the way people talk about sexual assault can affect real-world behaviors.  In communities where local news reporting about rape downplayed the crime, blamed the victim or expressed sympathy for the accused, there were twice as many reported rapes. 

“The link our research reveals between such ‘rape culture’ attitudes and actual sexual assault suggests that excusing sexually violent behavior or normalizing sexual assault allegations as something all men do may encourage a culture of impunity that increases sexual assault without consequences,” the study’s authors wrote in the Post. 

Campbell told me she worries that teens will see the language being used about Kavanaugh’s accusers and decide it’s not worth telling anyone. 

“I worry for every 15-year-old girl, boy who has been sexually assaulted and is looking to our leadership in D.C. and don’t see the people with power taking this issue seriously,” she said. “I’m worried about what message it’s sending that what happened to them didn’t matter … because it’s critical to prevent this. But when we haven’t been able to prevent it, getting them to treatment or help or support is critical to mitigate these long-term health effects.”

TRUMP TEMPERATURE

— On the eve of Ford and Kavanaugh’s hearing before the Senate, Trump questioned not only the women who have accused his Supreme Court nominee of sexual misconduct but also women who have spoken up about sexual abuse by prominent men.

In wide-ranging comments during a press conference yesterday evening, he called the #MeToo movement “very dangerous,” our colleagues Philip Rucker, Robert Costa, Josh Dawsey and Ashley Parker report.

“When you are guilty until proven innocent, it’s just not supposed to be that way,” Trump told reporters during his long 81-minute presser. “That’s a very dangerous standard for the country.”

When asked whether the assault and harassment allegations brought against him influenced his thinking about Kavanaugh’s accusers, Trump said “absolutely.”

“I’ve had a lot of false charges made against me, really false charges,” he added. “I know friends that have had false charges. People want fame. They want money. They want whatever. So when I see it, I view it differently then somebody sitting home watching television, where they say, ‘Oh, Judge Kavanaugh this or that.’ It’s happened to me many times.”

Meanwhile, our colleagues note the “first cracks in confidence emerged inside the White House on Wednesday… that the nomination might go down” as a third woman came forward alleging misconduct by Kavanaugh.

Trump also said during his news conference that he “can be persuaded” to believe the nominee’s accusers and could withdraw the nomination “if I thought he was guilty.”

A third woman, Julie Swetnick, who is represented by celebrity lawyer Michael Avenatti, said in a sworn declaration that Kavanaugh “was physically abusive toward girls in high school and present at a 1982 house party where she says she was the victim of a ‘gang rape,’” our Post colleagues Sean Sullivan, John Wagner and Gabriel Pogrund report. The Post has not independently verified Swetnick’s allegations. Kavanaugh has dismissed the latest allegations.

Ahead of today’s hearing, Kavanaugh acknowledges in his prepared testimony that he was “not perfect” and that he “said and did things in high school that make me cringe now.”

In her prepared testimony, Ford says the memory of being assaulted by Kavanaugh “have been seared into my memory and have haunted me” into adulthood.

Our colleague Seung Min Kim writes about the trio of Republican senators in the spotlight today during Kavanaugh’s second hearing: Sens. Jeff Flake (Ariz.), Susan Collins (Maine) and Lisa Murkowski (Alaska.)

“In addition to considering weighty legal issues that may come before the Supreme Court, the three senators find themselves dealing with the highly sensitive issue of sexual misconduct in the #MeToo era, just as their party becomes more aggressive in pushing Kavanaugh through to cement a conservative majority on the Supreme Court,” Seung Min writes.

— Will Kavanaugh and Ford’s memories be on trial today? The New York Times’s Benedict Carey and Jan Hoffman explore how trauma and time can change how people recall certain events.

“From the dizzying stream of incoming perceptions, the brain stores, or ‘encodes,’ the sights, sounds, sensations and emotions that it deems important or novel,” they write. “For a trauma victim, this encoding combines mortal fear and heart-racing panic with crystalline fragments of detail… The emotion is so strong that the fragments can become untethered from time and place. They may persist in memory even as other relevant details—the exact date, the conversation just before the attack, who else was in the room — fall out of reach.”

For the accused, meanwhile, experts suggest “there are scenarios in which someone could have committed an assault and yet also have almost no memory of it,” Benedict and Jan write. “If an assailant attaches little significance to an assault—for instance, if he doesn’t consider it an assault — his brain may only weakly encode details of the encounter.”

Meanwhile, our Post colleagues Carolyn Johnson and Joel Achenbach write about how alcohol can play a role and impact memory formation.

“Binge drinking and the imperfection of memory are likely to be discussed during Thursday’s hearing before the Senate Judiciary Committee,” they write. “Alcohol impairs memory formation, but not in a simple or easily anticipated way, researchers say. There’s no clear cutoff point at which memory will be suppressed…[Adolescents] are more vulnerable to the effects of alcohol on memory. Studies suggest that alcohol has a more pronounced negative effect on memory formation in the immature brain. And the kind of drinking teens are likely to engage in at weekend house parties are a particular risk factor for memory impairment.”

Carolyn and Joel add: “Researchers said that whatever the outcome of Thursday’s hearing, the accusations against Kavanaugh bring a critical public health issue into a national spotlight.”

— In his testimony set to be delivered before a Senate panel today, Kavanaugh acknowledges that he was “not perfect” during his high school days, saying that he “drank beer with my friends, usually on weekends. Sometimes I had too many.”

His own characterizations “underscore a key way that the early 1980s were unique in contemporary American history: Long-running federal survey data show that those years were a high-water mark for teenage drinking,” our Post colleague Christopher Ingraham reports.

Three-fourths of male high school seniors drank alcohol monthly in the 1970s and 1980s, Christopher writes, a number that has fallen by more than half to 36 percent in 2015. The 1980s were also marked by a gender gap in drinking habits, he adds. In 1982, male high school seniors were more likely to drink in a month than females by 9 percentage points, a figure that is now basically equal. 

AHH, OOF and OUCH

AHH: Health and Human Services Secretary Alex Azar is set to take a jab today at the “Medicare for all” motto being touted by many Democrats on the campaign trail.

“It’s clear that Medicare for All is a misnomer,” Azar will say during a speech in Nashville, according to prepared remarks reported by Axios’s Sam Baker. “What’s really being proposed is a single government system for every American that won’t resemble Medicare at all … Under Medicare for All, no one’s even promising that you can keep your plan, or keep your doctor. The main thrust of Medicare for All is giving you a new government plan and taking away your other choices.”

Centers for Medicare and Medicaid Services administrator Seema Verma has also already spoken out against a “Medicare for all” system, previously saying such a program would “only serve to hurt and divert focus from seniors.  All the while, expanding the regulatory burden and misaligned and perverse incentives of a government run system.”

As The Health 202 has written, a “Medicare for all” system has become part of a Democratic mantra catching on in congressional races nationwide and shaping part of the health-care debate.

OOF: The rate of suicide among young U.S. veterans increased to 45 per 100,000 in 2016, up from 40.4 in 2015, the Wall Street Journal’s Ben Kesling reports.

The suicide rate for the age group 18-34 increased even while the overall veteran suicide rate declined slightly, according to data from the VA’s National Suicide Data Report.

“According to the report, veterans accounted for 14% of suicides nationwide though they make up only 8% of the U.S. population,” Ben reports. “The suicide rate for female veterans is 1.8 times higher than their civilian counterparts…The overall number of veteran suicides changed little falling to 6,079 in 2016 from 6,281 the year prior, while the overall rate essentially held steady in part because suicides among veterans older than 55 fell while the youngest cohort of veterans saw increased numbers. The oldest age group had the largest number of overall deaths because they make up the largest portion of the veteran population.”

“These findings underscore the fact that suicide is a national public health issue that affects communities everywhere,” the VA says in a news release, Ben reports. “Our goal is to prevent suicide among all Veterans—even those who do not and may never seek care within VA’s system.”

 The House Veterans Affairs Committee is holding a hearing on veteran suicide prevention this morning.

OUCH: The number of opioid-related deaths in New Jersey increased by 24 percent last year, even though doctors wrote markedly fewer prescriptions statewide.

In 2017, there were 2,750 painkiller-related deaths, Bloomberg’s Elise Young reports, with more than half of the deaths attributed to fentanyl and related drugs. At the same time, the state Attorney General Gurbir Grewal said the number of prescriptions written in the state dropped under 5 million for the “first time in recent memory.” There were 5.64 million prescriptions written and filled in 2015, compared with 4.87 million last year, Elise reports.

The number of prescriptions has dropped 26 percent overall since the state adopted a rule in March of 2017 limiting initial opioid prescriptions to five days.

HEALTH ON THE HILL

— The House this week passed bills that will eliminate “gag clauses” that pharmacists argue prevent them from being able to tell consumers if there’s a cheaper way to pay for a prescription medicine at the drugstore, such as when the cash price is cheaper than an insurance co-pay.

The bipartisan bills, sponsored by Sen. Collins as well as Sens. Claire McCaskill (D-Mo.) and Debbie Stabenow (D-Mich.), and Republican Sens. John Barrasso (R-Wyo.) and Bill Cassidy (R-La.) passed the House by a voice vote after previously passing the Senate. The measures are headed to the president’s desk, the Portland Press Herald’s Joe Lawlor reports.  

“I am delighted that our legislation to lower the cost of prescription drugs and save consumers money received overwhelming bipartisan support in both the House and the Senate, and I look forward to it being signed into law,” Collins said in a statement.

STATE SCAN

— Our Post colleague Jenna Portnoy reports on one interesting voice that has been mostly silent amid emerging allegations against Kavanaugh: Rep. Barbara Comstock (R-Va.).

Comstock, who is a longtime friend of Kavanaugh’s and who has been a loud voice in the #MeToo movement on Capitol Hill, has declined to say whether she believes his accusers. She had previously called for Ford and Kavanaugh to testify under oath, but Jenna reports the congresswoman has made no further statement about Ford or about the other women who have come forward with allegations of sexual misconduct against the Supreme Court nominee. Comstock is also in a tough reelection fight. 

“Barbara has talked with many victims and knows the difficulty in bringing forward claims which is why she has fought to reform sexual harassment laws and policies,” her campaign manager, Susan Falconer, said in a Tuesday statement, adding that “each case is unique” and that Comstock “supports any alleged victim having a fair process to be heard.”

Jenna details Comstock’s record supporting women who have made allegations against lawmakers and other men in power: “In November, she said she believed the women who accused Alabama Republican Senate candidate Roy Moore, Fox News head Roger Ailes and movie mogul Harvey Weinstein ‘because they were substantiated and consistent with the stories of how sexual predators operate.’ Around the same time, she called on Democrats John Conyers Jr. and Al Franken and Republican Blake Farenthold to step down in light of what she considered credible accusations. Each has since resigned from Congress.”

After a debate between Comstock and Democratic state Sen. Jennifer T. Wexton on Friday, Comstock was confronted by a group of activists, and one who asked her: ““Do you think the Senate is treating Dr. Ford appropriately?”

The congresswoman hesitated, Jenna reports. She said she was “not sure” and turned away to reporters before finishing the thought.

—  For one 59-year-old U.S. Navy veteran in Kentucky, it was his struggle with health care that turned him against the Republican Party.

At a political event for Democratic congressional candidate Amy McGrath, David Hansen, who voted for Trump in 2016 and a Republican congressman in Kentucky, described losing health coverage after having a stroke last year. “Congress isn’t doing anything,” Hansen said during the event, CNN’s Kyung Lah reports. “They need to fix the health care program because it’s broken. They have to get off their high horse and just do it.”

“Hansen’s struggles illustrate why health care is among the top issues in the midterm elections, dominating political ads, particularly among Democrats, who are attacking Republicans over their efforts to repeal and replace Obamacare,” Kyung writes. “The issue of health care has made Hansen a Democratic voter in the upcoming midterm elections. And in this ruby red area of Kentucky, it seems he is not the only one. Indeed, there are some signs of a blue wave in a corner of the Bluegrass State.

— And here are a few more good reads from The Post and beyond: 

REPRODUCTIVE WARS

AGENCY ALERT

MEDICAL MISSIVES

INDUSTRY RX

DAYBOOK

Today

  • The Senate HELP Committee hosts a hearing on reducing health -costs.
  • The House Energy and Commerce Subcommittee on Health hosts a hearing on reducing maternal mortality in the U.S..
  • Sen. Rob Portman (R-Ohio) speaks at the American Enterprise Institute to discuss combating the international shipment of opioids.

SUGAR RUSH

‘The wheels are off the wagon’: Late-night hosts react to Trump’s rare solo news conference:

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