At times, Watkins, then 30, had to stop on the stairway to catch her breath. Her obstetrician said postpartum depression likely caused the weakness and fatigue. When Watkins, who is Black, complained of a cough, her doctor blamed the flu.

About eight weeks after delivery, Watkins thought she was having a heart attack, and her husband took her to the emergency room. After a 5陆-hour wait in a North Carolina hospital, she returned home to nurse her baby without seeing a doctor.

When a physician finally examined Watkins three days later, he immediately noticed her legs and stomach were swollen, a sign that her body was retaining fluid. After a chest X-ray, the doctor diagnosed her with heart failure, a serious condition in which the heart becomes too weak to adequately pump oxygen-rich blood to organs throughout the body. Watkins spent two weeks in intensive care.

She said a cardiologist later told her, “We almost lost you.”

Watkins is among every year in the U.S.

In a in JAMA Internal Medicine, researchers found that nearly 1 in 4 hospital patients who died or were transferred to intensive care had experienced a diagnostic error. Nearly 18% of misdiagnosed patients were harmed or died.

In all, an estimated 795,000 patients a year die or are permanently disabled because of misdiagnosis, according to a in the BMJ Quality & Safety periodical.

Some patients are at higher risk than others.

Women and racial and ethnic minorities are 20% to 30% more likely than white men to experience a misdiagnosis, said David Newman-Toker, a professor of neurology at Johns Hopkins School of Medicine and the lead author of the BMJ study. “That’s significant and inexcusable,” he said.

Researchers call misdiagnosis an urgent public health problem. The study found that rates of misdiagnosis range from 1.5% of heart attacks to 17.5% of strokes and 22.5% of lung cancers.

Weakening of the heart muscle 鈥� which led to Watkins’ heart failure 鈥� is the one week to one year after delivery, and is .

Heart failure “should have been No. 1 on the list of possible causes” for Watkins’ symptoms, said Ronald Wyatt, chief science and chief medical officer at the Society to Improve Diagnosis in Medicine, a nonprofit research and advocacy group.

Maternal mortality for Black mothers in recent years. The United States has the among developed countries. According to the Centers for Disease Control and Prevention, non-Hispanic Black mothers are as non-Hispanic white moms. More than half of these deaths take place within a year after delivery.

Research shows that Black women with childbirth-related heart failure are typically , said Jennifer Lewey, co-director of the pregnancy and heart disease program at Penn Medicine. That can allow patients to further deteriorate, making Black women less likely to fully recover and more likely to suffer from weakened hearts for the rest of their lives.

Watkins said the diagnosis changed her life. Doctors advised her “not to have another baby, or I might need a heart transplant,” she said. Being deprived of the chance to have another child, she said, “was devastating.”

Racial and gender disparities are widespread.

Women and minority patients suffering from heart attacks are more likely than others to be discharged without diagnosis or treatment.

Black people with depression to be .

Minorities are less likely than whites to be , depriving them of the opportunities to receive treatments that work best in the early stages of the disease.

Misdiagnosis isn’t new. Doctors have to estimate the percentage of patients who died with undiagnosed diseases for more than a century. Although those studies show some improvement over time, life-threatening mistakes remain all too common, despite an array of sophisticated diagnostic tools, said Hardeep Singh, a professor at Baylor College of Medicine who studies ways to improve diagnosis.

“The vast majority of diagnoses can be made by getting to know the patient’s story really well, asking follow-up questions, examining the patient, and ordering basic tests,” said Singh, who is also a researcher at Houston’s Michael E. DeBakey VA Medical Center. When talking to people who’ve been misdiagnosed, “one of the things we hear over and over is, 鈥楾he doctor didn’t listen to me.’”

Racial disparities in misdiagnosis are sometimes explained by noting that minority patients are than white patients and often . But the picture is more complicated, said Monika Goyal, an emergency physician at Children’s National Hospital in Washington, D.C., who has documented racial bias in children’s health care.

In a 2020 study, Goyal and her colleagues found that Black kids with appendicitis were to be correctly diagnosed, even when both groups of patients visited the same hospital.

Although few doctors deliberately discriminate against women or minorities, Goyal said, many are biased without realizing it.

“Racial bias is baked into our culture,” Goyal said. “It’s important for all of us to start recognizing that.”

Demanding schedules, which prevent doctors from spending as much time with patients as they’d like, can contribute to diagnostic errors, said Karen Lutfey Spencer, a professor of health and behavioral sciences at the University of Colorado-Denver. “Doctors are more likely to make biased decisions when they are busy and overworked,” Spencer said. “There are some really smart, well-intentioned providers who are getting chewed up in a system that’s very unforgiving.”

Doctors make better treatment decisions when they’re more confident of a diagnosis, Spencer said.

In researchers asked doctors to view videos of actors pretending to be patients with heart disease or depression, make a diagnosis, and recommend follow-up actions. Doctors felt far more certain diagnosing white men than Black patients or younger women.

“If they were less certain, they were less likely to take action, such as ordering tests,” Spencer said. “If they were less certain, they might just wait to prescribe treatment.”

It’s easy to see why doctors are more confident when diagnosing white men, Spencer said. For more than a century, medical textbooks have of white men. Only 4.5% of images in general medical textbooks .

That may help explain why patients with darker complexions are with conditions that affect the skin, from to , which causes a red or pink rash in the earliest stage of infection. Black patients with Lyme disease are more likely to be diagnosed with more , which can cause arthritis and damage the heart. Black people with melanoma are about within five years.

The covid-19 pandemic helped raise awareness that pulse oximeters 鈥� the fingertip devices used to measure a patient’s 鈥� for people with dark skin. The devices work by ; their failures have delayed critical care for many Black patients.

Seven years after her misdiagnosis, Watkins is an assistant professor of social work at North Carolina Central University in Durham, where she experienced by Black mothers who survive severe childbirth complications.

“Sharing my story is part of my healing,” said Watkins, who speaks to medical groups to help doctors improve their care. “It has helped me reclaim power in my life, just to be able to help others.”

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The bullet shattered the back of his skull, splintering it into 36 pieces. McClain’s heart stopped, and he was technically dead for two minutes and 17 seconds.

Although a hospital team shocked him back to life, McClain never fully recovered. Doctors removed half his skull, replacing it with a gel plate, but shrapnel remains.

The shooting left him in a coma for seven weeks and in a wheelchair for nearly two years. School bullies magnified his pain, laughing at his speech and the helmet he wore to protect his brain. McClain said he repeatedly attempted suicide as a teenager. He remains partly paralyzed on his right side and endures seizures and post-traumatic stress disorder.

“People who die, they get funerals and balloon releases,” said McClain, now 33. “Survivors don’t get anything.”

Yet the ongoing medical needs of gun violence survivors and their families are vast.

In the year after they were shot, child and adolescent survivors were more than twice as likely as other kids to experience a pain disorder, said Zirui Song, an associate professor of health care policy and medicine at Harvard Medical School and the co-author of a The shooting survivors in the study 鈥� age 19 and younger 鈥� were found to be 68% more likely than other kids to have a psychiatric diagnosis and 144% as likely to develop a substance use disorder.

Across the United States, firearm injuries were the leading cause of death for people ages 1 to 19 in 2020 and 2021, according to the Centers for Disease Control and Prevention. More than 48,000 Americans of all ages were in 2022. And an average of about 85,000 Americans every year.

“The public hears about mass shootings and the number of people who died,” Song said. “The population of people affected by firearm violence is much larger than deaths alone.”

Most Americans say they or a family member has experienced gun violence, including witnessing a shooting, being threatened by a person with a gun, or being shot, according to a 麻豆女优 survey.

“We are now a nation of survivors, and we have an unmet obligation to help families and communities heal, both physically and emotionally,” said Megan Ranney, dean of the Yale School of Public Health.

Being shot added an average of $35,000 to the health care costs of each young person studied, compared with the expenses of those who weren’t shot. The more serious the injury, the greater the cost and extent of medical complications, according to the study, based on data from employer-sponsored health insurance plans.

Although McClain’s mother had health insurance through her employer, the plan did not cover the cost of his wheelchair. Insurance didn’t pay for dance or theater classes, which his therapists recommended to improve his speech and movement. Although his grandparents helped pay the medical bills, his family still held fundraisers to cover additional out-of-pocket costs.

The study is one of the first to assess the effects of a child’s shooting on the entire family, said Ranney, who was not involved in the research.

Psychiatric disorders were 30% more common among the parents of the gun-injured children, compared with parents of uninjured kids. Their mothers made 75% more mental health visits than other moms.

Ranney noted that caregivers of shooting survivors often neglect their own needs. In the study, parents and siblings of the injured children made fewer visits for their own routine medical care, lab tests, and procedures.

Doctors can now save most gunshot victims, said Jessica Beard, a trauma surgeon at Temple University Hospital who was not involved in the study.

“We have more experience with bullet wounds than even many battlefield surgeons,” said Beard, who is also director of research for the Philadelphia Center for Gun Violence Reporting. “Surgeons from the military in Philadelphia to learn how to do combat surgery.”

Survivors of gunshot wounds often need continuing care from physical therapists, occupational therapists, makers of prosthetics, and others, which can pose additional hardships for rural residents, who may need to travel long distances multiple times a week for specialized services. Even in major U.S. cities, the hospitals and health systems best equipped to treat shooting survivors may be out of range for families who rely on public transportation.

Using public transportation would have been especially difficult when McClain was in a wheelchair. He said he feels lucky that his grandfather could drive him to the hospital for the first couple of years after his shooting. Later, when McClain could walk, he took two buses and a subway to the hospital. Today, McClain drives himself to get care and receives health insurance through his employer.

The psychological damage from child shootings may be even greater than the study indicates, Ranney said. Negative attitudes surrounding mental illness may have prevented some patients from acknowledging they’re depressed, so their struggles weren’t recorded in doctors’ notes or payment records, she said. Likewise, children afraid of punishment may not have told their doctors about illegal substance use.

McClain said he saw a therapist only once or twice. “I would scream at the doctors,” McClain said. “I said, 鈥楧on’t tell me you know how I feel, because you don’t understand.’”

Yet McClain has found purpose in his experience.

Last year, he co-produced a documentary called “” with the Philadelphia Center for Gun Violence Reporting, where he works. In the film, young survivors talk about wearing hoodies to hide their scars, navigating the world in a wheelchair, and combating infertility caused by their injuries. McClain is now working to of gun violence by creating a directory of shooting survivors willing to share their stories.

“My therapy is helping people,” he said. “I have to wake up and save somebody every day.”

Survivors are the forgotten victims of the nation’s gun violence epidemic, McClain said. Many feel abandoned.

“They push you out of the hospital like you have a normal life,’’ McClain said. “But you will never have a normal life. You are in this club that you don’t want to be in.”

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Somers, who died from complications of breast cancer Oct. 15 at age 76, pioneered the role of celebrity wellness guru, using her sitcom television fame as a springboard to a second career as a self-professed health and beauty expert.

Although younger generations might have never heard of Somers, they still feel her influence, said Timothy Caulfield, a professor at the University of Alberta’s School of Public Health and author of “Is Gwyneth Paltrow Wrong About Everything?”

Somers “created the template that we see over and over again,” Caulfield said.

Somers, a star of the 1970s-’80s show “Three’s Company,” sold millions of ThighMasters to people hoping to achieve the Barbie-like figure for which Somers was famous. Her fans also connected with Somers on a personal level and appreciated the bravery it took to discuss growing up with an alcoholic father or being diagnosed with cancer.

But Somers drew criticism for urging women to defy the medical establishment. She revealed she had skipped chemotherapy against the advice of her doctor. She also championed potentially risky “,” which she touted as a more natural alternative to pharmaceutical treatments for menopause. Somers went on “” to describe an elaborate daily routine, which involved injecting hormones into her vagina and taking 60 pills a day in an effort to remain young-looking and sexy.

“She became an influencer on menopause before being an influencer was even a thing,” obstetrician-gynecologist Jen Gunter on Oct. 17. “Somers almost single-handedly vaulted a fringe, untested medical hypothesis into the mainstream.”

for any menopausal woman, particularly women with a common type of breast cancer fueled by estrogen.

Somers’ advice was dangerous then and remains so today, said Gunter, who noted that internet searches for bioidentical hormones would spike after the release of the actress’s books and television appearances.

Searches surged again after Somers’ death was announced, according to Google Trends.

Oncologist Otis Brawley, a professor at Johns Hopkins Medicine, said he other breast cancer patients from receiving chemotherapy, which increases the odds of survival despite difficult side effects, such as nausea, vomiting, and hair loss.

“I personally know of several women who have died” after rejecting breast cancer treatment “that had a high likelihood of curing them,” Brawley said.

Although Somers cultivated a bright and sunny image, “she was literally scathing if someone suggested something be tested scientifically,” he said.

Somers’ publicist declined to comment for this article.

In her books and media interviews, Somers also championed alternative medical providers, including ones who sell . One of those providers, Stanislaw Burzynski, a Houston oncologist, was for misleading terminal cancer patients and failing to disclose potential risks associated with his treatment.

And while the natural products industry markets its products with photographs of beaches and spring meadows, “underneath that is a lot of fear-mongering and anger and rage,” said Caulfield.

Like Somers, actress and former Playboy model Jenny McCarthy reinvented herself in 2007 as a health advocate, trumpeting the baseless notion that vaccines cause autism and casting doubt on the motives of pediatricians who recommend them. McCarthy famously told Oprah Winfrey that she went to “ for her information about vaccine safety, a phrase echoed by modern-day anti-vaccine activists who eschew expert opinion in favor of doing their own research.

The alternative therapies Somers promoted and the conspiracy theories swirling around the internet today go hand in hand, said Gunter, author of “The Menopause Manifesto.”

“If alternative medicine worked, everyone would be using it,” Gunter said. “So there has to be an excuse for not using it, like a conspiracy.”

Some celebrities “truly believe they have this special ability to suss out the truth about medicine,” Gunter said. “You can only believe that if you have a narcissistic belief in yourself.”

Actress Gwyneth Paltrow also has built a beauty and wellness empire, selling a wide range of dubious products on her website Goop.

Paltrow has endorsed placing jade, or yoni, eggs in the vagina to boost orgasms, for example, and steaming the vagina with mugwort to “balance” female hormones and to cleanse the uterus.

Yet today, people don’t need to be famous to become health influencers; they need only a TikTok account.

Social media contains a cacophony of medical misinformation, some of it dangerous. describe DIY mole removal, ingrown toenail removal, or using nail files to sharpen teeth.

Today’s health influencers speak directly to the camera, “breaking the fourth wall,” a technique Somers used that can create a stronger bond between speaker and viewer, said Jessica Gall Myrick, a professor of media studies at Pennsylvania State University.

“That’s probably why Somers was so influential,” Myrick said. “She talked directly to people through mass media. She was using mass media then the way people use social media today.”

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Como trabajador social en Oakland, California, ha visto la influencia y el poder de las pandillas. Campos apoya a los adolescentes cuando salen del sistema de justicia juvenil, aboga por ellos en la escuela y, si es necesario, los ayuda a encontrar vivienda, servicios de salud mental y tratamiento para adicciones.

Pero nunca se había enfrentado a una fuerza tan formidable como la de las redes sociales, donde pequeñas discusiones y disputas en línea pueden convertirse en violencia mortal en los patios de los colegios y en las calles.

Los adolescentes publican en Facebook, Instagram, Snapchat o TikTok, fotos o videos de sí mismos con armas y montones de dinero, a veces desafiando a sus rivales. Cuando los mensajes se hacen virales, alimentados por los “likes” y los comentarios, el peligro es difícil de contener, dijo Campos.

“Son cientos de personas en las redes sociales, frente a una o dos que intentan guiar a los jóvenes de forma positiva”, afirmó. A veces sus advertencias son tajantes, diciéndoles: “Quiero manteneros con vida”. Pero “no funciona todo el tiempo”, afirmó.

Shamari Martin Jr. era un adolescente de 14 años de Oakland, extrovertido y respetuoso con sus profesores. Mezcladas con videos de amigos sonrientes, en su feed de Instagram aparecían imágenes de Shamari agitando despreocupadamente una pistola o abanicándose la cara con billetes. En marzo de 2022, murió por un impacto de un arma de fuego, cuando el auto en el que iba recibió una lluvia de balas. , y los paramédicos lo declararon muerto en el lugar.

En el barrio de Shamari, los niños se unen a las pandillas cuando tienen 9 o 10 años, y a veces llevan armas a la escuela primaria, contó Tonyia “Nina” Carter, una activista contra la violencia que conocía a Shamari y trabaja con Youth Alive, una organización que trata de prevenir la violencia. Según Carter, Shamari “estaba en cierto modo afiliado a esa cultura” de pandillas y armas.

Los amigos de Shamari volcaron su dolor en Instagram con emojis de corazones rotos y comentarios como “te quiero hermano, me duele el corazón”.

Un post fue más siniestro: “es sangre en el agua, todo lo que queremos es venganza”. Los rivales publicaron videos en los que aparecían pateando flores y velas en el memorial de Shamari.

Según Desmond Patton, profesor de la Universidad de Pennsylvania que estudia las redes sociales y la violencia con armas de fuego, este tipo de manifestaciones de dolor en Internet suelen presagiar más violencia.

Más de un año después, la muerte de Shamari sigue sin resolverse. Pero sigue teniendo consecuencias en Oakland, dijo Bernice Grisby, consejera del East Bay Asian Youth Center, que trabaja con jóvenes involucrados en pandillas.

“Todavía hay mucha violencia pandillera en torno a su nombre”, señaló. “Puede ser tan simple como que alguien diga: 鈥極lvídate de él o F él’, eso puede ser una sentencia de muerte. El mero hecho de estar relacionado con su nombre de cualquier forma puede hacer que te maten”.

El julio, el Cirujano General de Estados Unidos hizo sobre los efectos corrosivos de las redes sociales en la salud mental de niños y adolescentes, advirtiendo del “profundo riesgo de daño” para los jóvenes, que pueden pasar horas en sus teléfonos a diario. El informe, de 25 páginas, destaca los riesgos del ciberacoso y la explotación sexual. Pero no menciona el papel de las redes sociales en la escalada de la violencia armada.

Un papel del que son plenamente conscientes investigadores, líderes comunitarios y policías de todo el país, incluidos los de , , , , , y .

Michel Moore, jefe de policía de Los Angeles, calificó su impacto de “dramático”.

“Lo que antes se comunicaba en la calle o en pintadas, o con rumores de una persona a otra, ahora se distribuye y amplifica en las redes sociales”, afirmó. “El objetivo es avergonzar y humillar”.

Muchas disputas tienen su percibida entre adultos jóvenes inseguros que no pueden controlar sus impulsos y habilidades para gestionar conflictos, según LJ Punch, cirujana traumatóloga y directora de la Bullet-Related Injury Clinic de St. Louis.

“Las redes sociales son una herramienta muy poderosa para propagar la falta de respeto”, afirmó Punch. Y de todas las causas de la violencia armada, los rencores alimentados por las redes sociales son “las más impenetrables”.

Reclamos de regulación

Las empresas de redes sociales están que las por los contenidos publicados en sus plataformas. Sin embargo, la muerte de jóvenes ha provocado reclamos para cambiar esto.

“Cuando permites un video que desemboca en un tiroteo, eres responsable de lo que publicas”, indicó Fred Fogg, director nacional de prevención de la violencia de Youth Advocate Programs, un grupo que ofrece alternativas al encarcelamiento de jóvenes. “Las redes sociales son adictivas, y lo son intencionadamente”.

Se ha señalado que las redes sociales pueden tener un efecto especialmente pernicioso en comunidades con altos índices de violencia con armas de fuego.

“Las compañías de redes sociales deben estar mejor reguladas para asegurarse de no fomentar la violencia en las comunidades afroamericanas”, afirmó Jabari Evans, profesor de raza y medios de comunicación en la Universidad de Carolina del Sur. Pero agregó que estas empresas también deberían ayudar a “desmantelar el racismo estructural” que coloca a muchos jóvenes negros “en circunstancias que los ponen en manos de las pandillas, y no les queda otra que llevar armas a la escuela o adoptar actitudes violentas para llamar la atención”.

Moore, de Los Angeles, describió a las empresas de redes sociales como “reaccionarias. Su único fin es lucrativo. No quieren ningún tipo de control o restricción que suprima la publicidad”.

Las empresas afirman que que infringen sus políticas contra a terceros o . En un comunicado, el vocero de YouTube Jack Malon declaró que la compañía “prohíbe el contenido que se deleite o se burle de la muerte o lesiones graves de un individuo identificable”.

Las empresas de redes sociales enfatizaron que actúan para , especialmente de los niños.

Rachel Hamrick, vocera de Meta, propietaria de Facebook e Instagram, dijo que la empresa ha gastado unos $16,000 millones en los últimos siete años para proteger la seguridad de las personas que publican en sus aplicaciones, y que emplea a 40,000 personas en Facebook que trabajan en seguridad y protección.

“Retiramos contenidos, desactivamos cuentas y colaboramos con las fuerzas de seguridad cuando creemos que existe un riesgo real de daños físicos o amenazas directas a la seguridad pública”, declaró Hamrick. “Como empresa, tenemos todos los incentivos comerciales y morales para intentar ofrecer al máximo número de personas una experiencia lo más positiva posible en Facebook. Por eso tomamos medidas para mantener a salvo a los usuarios, aunque ello repercuta en nuestros beneficios”.

Las plataformas de Meta de más de $116,000 millones en 2022, la mayoría procedentes de la publicidad.

Un portavoz de Snapchat, Pete Boogaard, dijo que la compañía elimina el contenido violento a los pocos minutos de ser notificada. Sin embargo, Fogg señaló que, para cuando se elimina un video, cientos de personas ya pueden haberlo visto.

Incluso los críticos reconocen que el volumen de contenidos en las redes sociales es difícil de controlar. Facebook tiene casi 3,000 millones de usuarios mensuales en todo el mundo; ; Instagram, 2,000 millones. Si una empresa cierra una cuenta, basta con abrir otra nueva, explica Tara Dabney, directora del Institute for Nonviolence Chicago.

“Las cosas pueden ir muy bien en una comunidad”, dijo Fogg, “y luego lo siguiente que sabes es que algo sucede en las redes sociales y comienzan los disparos”.

Jugar con fuego

En una época en la que , muchos tienen acceso a armas de fuego y muchos , hay quien dice que no es sorprendente que la violencia ocupe un lugar tan destacado en sus redes sociales.

Las “páginas de peleas” de las escuelas secundarias son ahora habituales en las redes sociales, y los adolescentes se apresuran a grabar y compartir las peleas en cuanto estallan.

“Las redes sociales magnifican todo”, afirmó el reverendo Cornell Jones, coordinador del grupo de intervención contra la violencia de Pittsburgh.

Al igual que los adultos, muchos jóvenes se sienten validados cuando sus publicaciones gustan y se comparten, dijo Jones.

“Estamos tratando con jóvenes que no tienen una gran autoestima, y este 鈥榓mor’ que están recibiendo en las redes sociales puede llenar parte de ese vacío”, señaló Jones. “Pero puede acabar con ellos recibiendo un disparo o yendo a la cárcel”.

Aunque muchos de los adolescentes de hoy son tecnológicamente sofisticados 鈥攄otados para filmar y editar videos de aspecto profesional鈥�, siguen siendo ingenuos sobre las consecuencias de publicar contenidos violentos, indicó Evans, de la Universidad de Carolina del Sur.

La policía de Los Angeles vigila ahora las redes sociales en busca de indicios de problemas, explicó Moore. También busca en las redes sociales para reunir pruebas contra los implicados en actos violentos.

“Quieren ganar notoriedad”, señaló Moore, “pero claramente y nos dan un camino fácil para llevarlos ante la justicia”.

En febrero, la policía de Nueva Jersey utilizó un video de la feroz paliza que recibió en la escuela una niña de 14 años para contra cuatro adolescentes. La víctima de la agresión, Adriana Kuch, se suicidó dos días después de que el video se hiciera viral.

Prevenir la próxima tragedia

Glen Upshaw, que dirige a los trabajadores de Youth Alive en Oakland, dijo que anima a los adolescentes a expresar su ira con él, en lugar de en las redes sociales. Explicó que ayuda a evitar que los niños hagan alguna tontería.

“Siempre he ofrecido a los jóvenes la oportunidad de llamarme y maldecirme”, añadió Upshaw. “Pueden venir y gritarme, y no me enfadaré con ellos”.

Los trabajadores de Youth Advocate Programs en sus comunidades para desescalar los conflictos. “La idea es intervenir lo antes posible”, explicó Fogg. “No queremos que nadie muera por una publicación en las redes sociales”.

A veces es imposible, aseguró Campos. “No puedes decirles que borren sus cuentas de redes sociales”, dijo. “Ni siquiera un juez les diría eso. Pero puedo decirles: 鈥楽i yo fuera tú, y porque estás en libertad condicional, no publicaría ese tipo de cosas'”.

Cuando trabajó por primera vez con adolescentes en alto riesgo de violencia “dije que si podía salvar 10 vidas de cada 100, sería feliz”, expresó Campos. “Ahora, si puedo salvar una vida de cada 100, soy feliz”.

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As a street outreach worker in Oakland, California, he has seen the pull and power of gangs. And he offers teens support when they’ve emerged from the juvenile justice system, advocates for them in school, and, if needed, helps them find housing, mental health services, and treatment for substance abuse.

But, he said, he’s never confronted a force as formidable as social media, where small boasts and disputes online can escalate into deadly violence in schoolyards and on street corners.

Teens post photos or videos of themselves with guns and stacks of cash, sometimes calling out rivals, on Facebook, Instagram, Snapchat, or TikTok. When messages go viral, fueled by “likes” and comments, the danger is hard to contain, Campos said.

“It’s hundreds of people on social media, versus just one or two people trying to guide youth in a positive way,” he said. Sometimes his warnings are stark, telling kids, “I want to keep you alive.” But, he said, “it doesn’t work all the time.”

Shamari Martin Jr. was an outgoing 14-year-old and respectful to his teachers in Oakland. Mixed in with videos of smiling friends on his Instagram feed were images of Shamari casually waving a gun or with cash fanned across his face. In March 2022, he was shot when the car he was in took a hail of bullets. His body , and emergency medical workers pronounced him dead at the scene.

In Shamari’s neighborhood, kids join gangs when they’re as young as 9 or 10, sometimes carrying guns to elementary school, said Tonyia “Nina” Carter, a violence interrupter who knew Shamari and works with Youth Alive, which tries to prevent violence. Shamari “was somewhat affiliated with that culture” of gangs and guns, Carter said.

Shamari’s friends poured out their grief on Instagram with broken-heart emojis and comments such as “love you brother I’m heart hurt.”

One post was more ominous: “it’s blood inna water all we want is revenge.” Rivals posted videos of themselves kicking over flowers and candles at Shamari’s memorial.

Such online outpourings of grief often presage additional violence, said Desmond Patton, a University of Pennsylvania professor who studies social media and firearm violence.

More than a year later, Shamari’s death remains unsolved. But it’s still a volatile subject in Oakland, said Bernice Grisby, a counselor at the East Bay Asian Youth Center, who works with gang-involved youth.

“There’s still a lot of gang violence going on around his name,” she said. “It could be as simple as someone saying, 鈥楩orget him or F him’ 鈥� that can be a death sentence. Just being affiliated with his name in any sort can get you killed.”

The U.S. surgeon general last month about social media’s corrosive effects on child and adolescent mental health, warning of the “profound risk of harm” to young people, who can spend hours a day on their phones. The 25-page report highlighted the risks of cyberbullying and sexual exploitation. It failed to mention social media’s role in escalating gun violence.

Acutely aware of that role are researchers, community leaders, and police across the country 鈥� including in , , , , , , and They describe social media as a relentless driver of gun violence.

Michel Moore, the Los Angeles police chief, called its impact “dramatic.”

“What used to be communicated on the street or in graffiti or tagging or rumors from one person to another, it’s now being distributed and amplified on social media,” he said. “It’s meant to embarrass and humiliate others.”

Many disputes among insecure young adults who may lack impulse control and conflict-management skills, said LJ Punch, a trauma surgeon and director of the Bullet-Related Injury Clinic in St. Louis.

“Social media is an extremely powerful tool for metastasizing disrespect,” Punch said. And of all the causes of gun violence, social media-fueled grudges are “the most impenetrable.”

Calls for Regulation

Social media companies are that for content posted on their platforms. Yet the deaths of young people have led to calls to change that.

“When you allow a video that leads to a shooting, you bear responsibility for what you put out there,” said Fred Fogg, national director of violence prevention for Youth Advocate Programs, a group that provides alternatives to youth incarceration. “Social media is addictive, and intentionally so.”

People note that social media can have a particularly pernicious effect in communities with high rates of gun violence.

“Social media companies need to be better regulated in order to make sure they aren’t encouraging violence in Black communities,” said Jabari Evans, an assistant professor of race and media at the University of South Carolina. But he said social media companies also should help “dismantle the structural racism” that places many Black youth “in circumstances that resign them to want to join gangs, carry guns to school, or take on violent personas for attention.”

L.A.’s Moore described social media companies as serving “in a reactionary role. They are profit-driven. They don’t want to have any type of control or restrictions that would suppress advertising.”

Social media companies say that violates their policies against or as quickly as possible. In a statement, YouTube spokesperson Jack Malon said the company “prohibits content reveling in or mocking the death or serious injury of an identifiable individual.”

Social media companies said they act to , especially children.

Rachel Hamrick, a spokesperson for Meta, which owns Facebook and Instagram, said the company has spent about $16 billion in the past seven years to protect the safety of people who post on its apps, employing 40,000 people at Facebook who work on safety and security.

“We remove content, disable accounts and work with law enforcement when we believe there is a genuine risk of physical harm or direct threats to public safety,” Hamrick said. “As a company, we have every commercial and moral incentive to try to give the maximum number of people as much of a positive experience as possible on Facebook. That’s why we take steps to keep people safe even if it impacts our bottom line.”

Meta platforms of over $116 billion in 2022, most of which came from advertising.

A spokesperson for Snapchat, Pete Boogaard, said the company deletes violent content within minutes of being notified of it. But, Fogg noted, by the time a video is removed, hundreds of people may have seen it.

Even critics acknowledge that the sheer volume of content on social media is difficult to control. Facebook has nearly 3 billion monthly users worldwide; YouTube has ; Instagram has 2 billion. If a company shuts down one account, a person can simply open a new one, said Tara Dabney, a director at the Institute for Nonviolence Chicago.

“Things could be going great in a community,” Fogg said, “and then the next thing you know, something happens on social media and folks are shooting at each other.”

Playing With Fire

At a time when virtually , many have access to guns, and many are coping with some say it’s not surprising that violence features so heavily in children’s social media feeds.

High school “fight pages” are now common on social media, and teens are quick to record and share fights as soon as they break out.

“Social media puts everything on steroids,” said the Rev. Cornell Jones, the group violence intervention coordinator for Pittsburgh.

Like adults, many young people feel validated when their posts are liked and shared, Jones said.

“We are dealing with young people who don’t have great self-esteem, and this 鈥榣ove’ they are getting on social media can fill some of that void,” Jones said. “But it can end with them getting shot or going to the penitentiary.”

While many of today’s teens are technologically sophisticated 鈥� skilled at filming and editing professional-looking videos 鈥� they remain naive about the consequences of posting violent content, said Evans, of the University of South Carolina.

Police in Los Angeles now monitor social media for early signs of trouble, Moore said. Police also search social media after the fact to gather evidence against those involved in violence.

“People want to gain notoriety,” Moore said, “but they’re clearly and giving us an easy path to bring them to justice.”

In February, New Jersey police used a video of a 14-year-old girl’s vicious school beating to against four teens. The victim of the assault, Adriana Kuch, died by suicide two days after the video went viral.

Preventing the Next Tragedy

Glen Upshaw, who manages outreach workers at Youth Alive in Oakland, said he encourages teens to express their anger with him rather than on social media. He absorbs it, he said, to help prevent kids from doing something foolish.

“I’ve always offered youth the chance to call me and curse me out,” Upshaw said. “They can come and scream and I won’t fuss at them.”

Workers at Youth Advocate Programs in their communities to de-escalate conflicts. “The idea is to get on it as soon as possible,” Fogg said. “We don’t want people to die over a social media post.”

It’s sometimes impossible, Campos said. “You can’t tell them to delete their social media accounts,” he said. “Even a judge won’t tell them that. But I can tell them, 鈥業f I were you, since you’re on probation, I wouldn’t be posting those kinds of things.’”

When he first worked with teens at high risk of violence, “I said if I can save 10 lives out of 100, I’d be happy,” Campos said. “Now, if I can save one life out of 100, I’m happy.”

For an illustrated version of this article, click here.

麻豆女优 Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at 麻豆女优鈥攁n independent source of health policy research, polling, and journalism. Learn more about .

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This illustrated report has been adapted from a 麻豆女优 Health News article, “鈥楢ll We Want Is Revenge’: How Social Media Fuels Gun Violence Among Teens,” by Liz Szabo.

麻豆女优 Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at 麻豆女优鈥攁n independent source of health policy research, polling, and journalism. Learn more about .

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Los menores también pueden tener mareos, perder el conocimiento y sufrir caídas peligrosas de la presión arterial. En el caso más grave que ha visto, los médicos tuvieron que conectar a un niño a un respirador artificial en la unidad de cuidados intensivos porque no podía respirar, dijo Marino, de la Escuela de Medicina de Case Western Reserve University.

Miles de menores al año están de los cigarrillos electrónicos, también conocidos como vapeadores. Para un niño pequeño, incluso unas pocas gotas pueden ser fatales.

Los casos de exposición a nicotina relacionados con el vapeo reportados a los centros de intoxicaciones alcanzaron un en 2022, a pesar de que en 2016 se aprobó la , la cual requiere que los cartuchos de líquido para vapear se vendan en envases a prueba de niños.

Sin embargo, la ley no exige envases protectores para los propios dispositivos de vapeo, algo que los médicos califican como un gran descuido.

Los vapeadores recargables están diseñados para almacenar la nicotina líquida en un depósito central, lo que los vuelve más peligrosos para los niños, dijo Marino.

Aun aquellos que parecen más resistentes a los niños, porque la nicotina está sellada , presentan un riesgo, ya que estos cartuchos pueden abrirse. Y algunos cigarrillos electrónicos descartables, que son el tipo más vendido, permiten a los usuarios inhalar 聽bocanadas o “puffs” y como varios paquetes de cigarrillos.

Muchos cigarrillos electrónicos y líquidos parecen , con envases de colores pastel, nombres como “” y sabores de goma de mascar y frambuesa.

Esto hace que los vaporizadores sean mucho más tentadores y peligrosos que los cigarrillos tradicionales, que contienen una dosis más baja de nicotina y un sabor amargo que suele hacer que los niños los escupan rápidamente, dijo Diane Calello, directora ejecutiva del Sistema de Información y Educación sobre Envenenamiento de Nueva Jersey.

“Las intoxicaciones por líquido de nicotina son sólo una cuestión de tiempo”, dijo Calello. “El líquido huele rico y es muy concentrado”.

El senador Richard Blumenthal (demócrata de Connecticut), quien patrocinó la ley de 2016, dijo que haría lo posible para ampliar el requisito de envasado a prueba de niños. Blumenthal quiere que la ley se aplique a los cigarrillos electrónicos desechables y los tipo “pod”, dispositivos de vapeo de tamaño bolsillo.聽

“Cada día que la Administración de Alimentos y Medicamentos (FDA) permite que los cigarrillos electrónicos saborizados permanezcan en el mercado es otro día en que los niños pueden verse atraídos por estos productos peligrosos y, a veces, mortales”, dijo.

La FDA se negó a dar comentarios para este artículo, pero el 2 de agosto la agencia incluyó un artículo especial sobre la en niños en su boletín “CTP Connect”.

Los casos relacionados con los cigarrillos electrónicos reportados a los centros de toxicología aumentaron más del doble desde 2018, según un análisis de la FDA. Estos centros reportaron más de 7,000 casos de exposición a la nicotina vinculados con el vapeo en personas de todas las edades entre el 1 de abril de 2022 y el 31 de marzo de 2023.

Según la FDA, 43 de estos casos terminaron en hospitalizaciones y 582 requirieron otros tratamientos médicos. Alrededor de la mitad de los informes de los centros de envenenamiento no precisaban si los pacientes necesitaron atención médica.

Casi el 90% de los casos reportados afectaron a niños menores de 5 años. Los autores del informe dicen que es probable que estos números subestimen el problema, dado que no siempre se contacta a los centros de toxicología.聽聽

En 2014, un intoxicado por nicotina de un vapeador. El nuevo informe de la FDA también menciona el aparente suicidio de un adulto por envenenamiento con cigarrillos electrónicos.

Un vocero de la industria del vapeo dijo que las empresas toman en serio la seguridad de los productos.

“Todas las botellas de líquido de nicotina fabricadas en los Estados Unidos cumplen con la ley”, dijo April Meyers, presidenta de la junta directiva y directora ejecutiva de la Smoke-Free Alternatives Trade Association, que representa a la industria del vapeo. “Los envases son a prueba de niños y además, el flujo de líquido está restringido para que solo se puedan dispensar pequeñas cantidades”.

Sin embargo, muchos productos de vapeo se fabrican fuera del país, cuyo mercado se ha visto inundado de cigarrillos electrónicos ilegales en los últimos meses, la mayoría de ellos fabricados en China.

El número creciente de casos de niños expuestos a la nicotina, especialmente los más pequeños que se llevan a la boca casi todo lo que pueden agarrar, probablemente refleje el gran volumen de ventas de cigarrillos electrónicos, dijo Natalie Rine, directora del Centro de Toxicología de Ohio Central del Nationwide Children’s Hospital.

Las ventas de unidades de cigarrillos electrónicos entre enero de 2020 y diciembre de 2022, yendo de 15.5 millones cada cuatro semanas a 22.7 millones, según un informe publicado por los Centros para el Control y la Prevención de Enfermedades.

“Los padres no ven esto como un gran riesgo”, dijo Marino. “Pero si la popularidad de los cigarrillos electrónicos sigue aumentando, el riesgo no va a desaparecer pronto”.

Una estrategia eficaz para reducir las ventas de cigarrillos electrónicos ha sido prohibir los productos saborizados. En California, Massachusetts, Nueva Jersey, Nueva York, Rhode Island y Washington, D.C. , mientras que en Utah y Maryland se han prohibido algunos sabores.

Un estudio demostró que las ventas de cigarrillos electrónicos cayeron en los estados que prohibieron los productos saborizados, en comparación con los estados que no lo hicieron.

Algunos médicos dicen que el país debería hacer más para proteger a los niños.

“Si las cifras están aumentando, entonces la ley no está funcionando”, dijo Carl Baum, profesor de pediatría y medicina de emergencia en la Escuela de Medicina de Yale.

El pediatra Gary Smith dice que la falta de requisitos de seguridad para los cigarrillos electrónicos es un problema serio. Los cigarrillos electrónicos recargables son relativamente fáciles de abrir para los niños.

Aunque la mayoría de los informes de los centros de toxicología no incluyen información sobre las distintas marcas, los cigarrillos electrónicos desechables, como Elfbar, Puff Bar y Pop Vape, estaban entre los productos más mencionados en el análisis de la FDA. (Elfbar se conoce ahora como EB Design.)

Ampliar la ley federal para que aplique a los dispositivos sería “un paso importante”, dijo Smith, presidente de Child Injury Prevention Alliance, un grupo de defensa con sede en Ohio dedicado a proteger a los niños de lesiones y accidentes.

Además, los funcionarios federales deberían limitar la concentración de nicotina en los líquidos de vapeo para que sean menos tóxicos, así como prohibir que los envases muestren sabores y colores similares a los de los dulces, dijo Smith.

“La respuesta de la salud pública debe ser integral”, dijo Smith.

Se sabe que los niños agarran los vapeadores y empiezan a inhalar, imitando a sus padres, dijo Calello.

E incluso si no inhalan el aerosol, chupar el dispositivo expone la piel de los niños a la nicotina, que puede ser absorbida por el torrente sanguíneo, dijo Robert Glatter, profesor asistente de medicina de emergencia de Lenox Hill Hospital en la ciudad de Nueva York.

Glatter agregó que el líquido de los cigarrillos electrónicos contiene , como arsénico y plomo, que son tóxicas en cualquier dosis. También contiene carcinógenos, como acetaldehído y formaldehído, y benceno, un compuesto orgánico volátil que se encuentra en los gases de escape de los autos.

Afortunadamente, los niños que inhalan nicotina reciben una dosis mucho más baja que los que la ingieren, lo que reduce el riesgo de daños graves, dijo Marc Auerbach, profesor de medicina pediátrica de emergencia en la Escuela de Medicina de Yale.

En el estudio de la FDA sólo se registraron efectos moderados o graves en alrededor del 2% de los casos de exposición a la nicotina líquida.

La razón puede ser que los niños pequeños que acceden a líquidos peligrosos, como el de los cigarrillos electrónicos o productos de limpieza o gasolina, generalmente derraman la mayor parte, dijo Baum. “Suelen mancharse la ropa con ellos, no tragárselos”, dijo Baum.

Aunque Stephen Thornton ha atendido a muchos niños por exposición a la nicotina, dijo que el cuerpo humano tiene formas de protegerse de las sustancias tóxicas.

“Afortunadamente, cuando los niños ingieren la nicotina de cigarrillos electrónicos, vomitan, y mucho, y esto mantiene la tasa de mortalidad muy baja, pero estos niños a menudo terminan en las salas de emergencia debido a las náuseas y los vómitos”, dijo Thornton, médico de medicina de emergencia y director médico del Kansas Poison Control Center.

La FDA a mantener los cigarrillos electrónicos y el líquido de vapeo fuera de su alcance y en sus envases originales.

Si necesitas asistencia de emergencia, llama a la línea de ayuda por envenenamiento (800-222-1222) para hablar con un experto, o visita poisonhelp.org para obtener apoyo y recursos.