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Increase in rattlesnake attack on dogs, Texas vets report

Veterinarians in some parts of Texas have reported an increase in the number of dogs bitten by rattlesnakes this year, according to media reports. 

“The snakes are coming out of hibernation, they’re cranky and are more likely to strike when other times they might try to avoid that,” Jim Holcomb of Hill Country Animal Hospital in Austin told KVUE.

>> Read more trending news

The story does not offer any specific figures to back the claim.

If you live in an area that is especially populated by rattlesnakes, some veterinarians recommend the Red Rock Rattlesnake vaccine, which helps dogs develop antibodies that can neutralize rattlesnake venom. 

Dogs need to be 16 weeks old to receive the vaccine. Although it can help slow the effects of the venom, it is still important to get your dog to the vet immediately if you suspect a rattlesnake bite.

Related: Texas family’s toilet snake surprise leads to discovery of dozens more

The Houston Chronicle is reporting that recent hotter-than-usual weather has at least one upside: rattlesnakes rattle more when its warmer, serving as the perfect warning for you and your best friend.

A growing debate: Is vaping hazardous?

U.S. health officials say the rapidly expanding industry of e-cigarettes and vaping caters to children with a new unhealthy habit, tantalizing them with flavors such as Strawberry Shortcake Ice Cream and brands like Devil’s Juice.

>> Read more trending news

But those who vape say health officials are just carrying water for the tobacco and pharmaceutical companies, which make money from selling cigarettes and products that help people quit smoking.

Representatives of the vaping industry -- a phenomena in its own right estimated to be worth $10 billion -- said it has been unfairly disparaged and that their nicotine delivery system is far safer than traditional tobacco, pointing to studies in England.

“This is a revolution,” Ryna Schalk of Wellington, Florida, told The Palm Beach Post. “There are people giving out misinformation about vaping because of Big Government, Big Tobacco and Big Pharma. Vaping is taking money out of their pocket.”

Read more about the growing vaping debate at the Palm Beach Post.

Justice Department Joins Lawsuit Alleging Massive Medicare Fraud By UnitedHealth

The Justice Department has joined a California whistleblower’s lawsuit that accuses insurance giant UnitedHealth Group of fraud in its popular Medicare Advantage health plans.

Justice officials filed legal papers to intervene in the suit, first brought by whistleblower James Swoben in 2009, on Friday in federal court in Los Angeles. On Monday, they sought a court order to combine Swoben’s case with that of another whistleblower.

Swoben has accused the insurer of “gaming” the Medicare Advantage payment system by “making patients look sicker than they are,” said his attorney, William K. Hanagami. Hanagami said the combined cases could prove to be among the “larger frauds” ever against Medicare, with damages that he speculates could top $1 billion.

UnitedHealth spokesman Matt Burns denied any wrongdoing by the company. “We are honored to serve millions of seniors through Medicare Advantage, proud of the access to quality health care we provided, and confident we complied with program rules,” he wrote in an email.

Burns also said that “litigating against Medicare Advantage plans to create new rules through the courts will not fix widely acknowledged government policy shortcomings or help Medicare Advantage members and is wrong.”

Medicare Advantage is a popular alternative to traditional Medicare. The privately run health plans have enrolled more than 18 million elderly and people with disabilities — about a third of those eligible for Medicare — at a cost to taxpayers of more than $150 billion a year.

Although the plans generally enjoy strong support in Congress, they have been the target of at least a half-dozen whistleblower lawsuits alleging patterns of overbilling and fraud. In most of the prior cases, Justice Department officials have decided not to intervene, which often limits the financial recovery by the government and also by whistleblowers, who can be awarded a portion of recovered funds. A decision to intervene means that the Justice Department is taking over investigating the case, greatly raising the stakes.

“This is a very big development and sends a strong signal that the Trump administration is very serious when it comes to fighting fraud in the health care arena,” said Patrick Burns, associate director of Taxpayers Against Fraud in Washington, a nonprofit supported by whistleblowers and their lawyers. Burns said the “winners here are going to be American taxpayers.”

Burns also contends that the cases against UnitedHealth could potentially exceed $1 billion in damages, which would place them among the top two or three whistleblower-prompted cases on record.

“This is not one company engaged in episodic bad behavior, but a lucrative business plan that appears to be national in scope,” Burns said.

On Monday, the government said it wants to consolidate the Swoben case with another whistleblower action filed in 2011 by former UnitedHealth executive Benjamin Poehling and unsealed in March by a federal judge. Poehling also has alleged that the insurer generated hundreds of millions of dollars or more in overpayments.

When Congress created the current Medicare Advantage program in 2003, it expected to pay higher rates for sicker patients than for people in good health using a formula called a risk score.

But overspending tied to inflated risk scores has repeatedly been cited by government auditors, including the Government Accountability Office. A series of articles published in 2014 by the Center for Public Integrity found that these improper payments have cost taxpayers tens of billions of dollars.

“If the goal of fraud is to artificially increase risk scores and you do that wholesale, that results in some rather significant dollars,” Hanagami said.

David Lipschutz, senior policy attorney for the Center for Medicare Advocacy, a nonprofit offering legal assistance and other resources for those eligible for Medicare, said his group is “deeply concerned by ongoing improper payments” to Medicare Advantage health plans.

These overpayments “undermine the finances of the overall Medicare program,” he said in an emailed statement. He said his group supports “more rigorous oversight” of payments made to the health plans.

The two whistleblower complaints allege that UnitedHealth has had a practice of asking the government to reimburse it for underpayments, but did not report claims for which it had received too much money, despite knowing some these claims had inflated risk scores.

The federal Centers for Medicare & Medicaid Services said in draft regulations issued in January 2014 that it would begin requiring that Medicare Advantage plans report any improper payment — either too much or too little.

These reviews “cannot be designed only to identify diagnoses that would trigger additional payments,” the proposal stated.

But CMS backed off the regulation’s reporting requirements in the face of opposition from the insurance industry. The agency didn’t say why it did so.

The Justice Department said in an April 2016 amicus brief in the Swoben case that the CMS decision not to move ahead with the reporting regulation “does not relieve defendants of the broad obligation to exercise due diligence in ensuring the accuracy” of claims submitted for payment.

The Justice Department concluded in the brief that the insurers “chose not to connect the dots,” even though they knew of both overpayments and underpayments. Instead, the insurers “acted in a deliberately ignorant or reckless manner in falsely certifying the accuracy, completeness and truthfulness of submitted data,” the 2016 brief states.

The Justice Department has said it also is investigating risk-score payments to other Medicare Advantage insurers, but has not said whether it plans to take action against any of them.

Lead Poisoning’s Lifelong Toll Includes Lowering Social Mobility, Researchers Find

Cynthia Brownfield was lucky. When her daughter, then 2 years old, tested for high levels of lead in her blood, she could do something.

Brownfield, a pediatrician in St. Joseph, Miss., got her home inspected and found lead in the windows. She got them replaced and had her pipes fixed, too. Her daughter, now 12, was probably affected, says Brownfield. But quick action minimized the exposure. Her daughter is now a healthy, fully-functioning preteen.

“We were in the financial position where we could hire a plumber and change the windows,” she said. But others — even her own patients — may not be so fortunate. This reality may have implications even more far-reaching than generally accepted.

Findings published Tuesday in JAMA break new ground by suggesting the effects of childhood lead exposure continue to play out until adulthood, not only harming an individual’s lifelong cognitive development, but also potentially limiting socioeconomic advancement. Specifically, Duke University researchers tracked a generation of kids based on data collected through a nearly 30-year, New Zealand-based investigation known as the Dunedin Multidisciplinary Health and Development Study.

They studied the development of more than 1,000 New Zealanders born between April 1972 and March 1973. Because at that time gasoline still contained lead, exposure was common, creating a sizeable sample that included people across class and gender. More than half in that data set had been tested for lead-exposure at age 11, and the study tracked brain development and socio-economic status over the years — making for “a natural time” to use them to study lead’s health effects, said Aaron Reuben, a PhD candidate in neuropsychology at Duke University, and the study’s first author.

By the time study participants reached age 38, a pattern emerged: Children who were exposed to lead early in life had worse cognitive abilities, based on how their exposure level. The difference was statistically significant. They were also more likely to be worse off, socioeconomically, than those who had not been exposed to lead. The study found that no matter what the child’s IQ, the mother’s IQ, or the family’s social status, lead poisoning resulted in downward social mobility. That was largely thanks to cognitive decline, according to the research.

“Regardless of where you start out in life, exposure to lead in childhood exerts a downward pull to your trajectory,” Reuben said.

Though this research was set in New Zealand, it offers insight into a problem experts said is fairly ubiquitous in the United States and across the globe. The CDC estimates that as many as half a million children between ages 1 and 5 had blood lead levels high enough to cause concern: 5 micrograms per deciliter and up. At least 4 million households across the country have children experiencing significant lead exposure.

Last year’s water crisis in Flint, Mich., brought lead exposure front and center as a public health concern. Meanwhile, a Reuters investigation published this winter found elevated lead levels in almost 3,000 communities around the country. The Centers of Disease Control and Prevention recently changed its guidelines to suggest that any childhood exposure to the chemical is harmful, and is pushing to get rid of lead poisoning in kids by 2020.

In the U.S., children at risk are typically poorer and racial minorities — in part because they more often live in older houses with lead paint. This is a stark difference from the research population, which tended to be white. However, because the study spanned a period of time in which lead was still used in gasoline, the lead exposure measured in the study spanned a wider class spectrum.

That adds greater consequence to these findings, many said.

“Kids who are poor, or who have some of these other social determinants of health that are negative — they end up with a double whammy. Whatever health consequences they have from being poor, those are added to the additional consequences of being exposed to lead,” said Jerome Paulson, an emeritus professor and pediatrician at George Washington University. Paulson has researched lead’s effects on children, although he wasn’t involved with this study.

“If you want to talk about ‘breaking out of poverty,’ kids who have lead exposure are probably going to have more difficulties,” he added.

That said, these conclusions aren’t perfect. For instance, the research doesn’t account any variation in how the children who were tested may have been previously exposed to lead, or how their continued lead exposure through adulthood may have differed. Those who worked in jobs like construction, for instance, may have had greater lead exposure than those in white-collar jobs, Paulson noted. But on the whole, he said, it makes a strong case for the long-term impact of childhood lead exposure.

Pennsylvania, Maryland and Massachusetts, which all have cities with concentrated areas of older housing, have identified lead poisoning as a major child health hazard. The CDC has also embraced “primary prevention” — testing homes for lead and removing it before people move in and risk exposure. But securing resources for lead testing, screening and abatement poses its own set of challenges.

The JAMA study illustrates, in part, one such difficulty. Lead poisoning happens over years, not overnight. So illustrating the impact, even if it’s ultimately significant, is hard to do.

“Prevention doesn’t have a lot of pizzazz. If you prevent something from happening, it’s a wonderful thing, but it’s hard to measure and take credit for,” said David Bellinger, a neurology professor at Harvard Medical School and a professor in the environmental health department of the university’s public health school, who wrote a commentary that ran alongside the JAMA paper.

And funding for such programs is often unreliable, said Donna Cooper, the executive director of Public Citizens for Children and Youth, a Pennsylvania-based nonprofit that advocates on behalf of young people. For instance, the White House’s initial budget plans would boost some lead abatement funds but slash other grants used for similar purposes. And for many states, she said, even what’s long been available isn’t enough to meet the scope of the concern.

“We have very clear CDC guidance on what should be done, and no money to back it up,” Cooper said. “It ebbs and flows with the headlines.”

Woman, 94, celebrates 44 years of work at McDonald’s

An Indiana woman who has been caring for hungry customers for more than four decades is celebrating a milestone.

Miss Loraine, as she’s known to customers and staff, has been an employee at McDonald’s since 1973.

“I didn’t come to stay,” Miss Loraine told WEHT. “I just needed something to do after my husband had to retire.”

Now at age 94, she’s celebrating 44 years with the restaurant.

>> Need something to lift your spirits? Read more uplifting news

“She’s more like the sunshine of this place,” said customer Andrea Feller. “You come in, she’s always smiling, always doing her best.”

Her customers said they can always count on her for amazing service.

“Loraine knows her customers so well that sometimes she even has their order prepared for them before they even walk through the door,” said another customer.

WTF Is Jackfruit? (Plus 7 Recipes That Use It)

If you’ve never heard of jackfruit before, you're not totally out of the loop (yet). This starchy member of the fig family is a staple in South and Southeast Asian cuisine, but has become more popular, and readily available in canned form, in the Western Hemisphere in recent years. And it's time we all get well-acquainted.

Packed with potassium, fiber, and anti-inflammatory benefits, it’s not only a nutritional powerhouse, but when cooked and shredded, it has a freakishly similar texture and flavor to pulled pork—how great is that? While there are many ways to enjoy the versatile ingredient, start with these seven easy jackfruit recipes.

1. Jackfruit Sweet Potato Curry With Spinach Photo: Blueberry Vegan Canned, unripe jackfruit gives this curry a meaty texture while keeping it entirely plant based. Given its roots in the tropical climates of Southeast Asia, the fruit is also a natural fit with the coconut milk in this recipe.  2. Spicy Chipotle Garlic Jackfruit Tacos Photo: Vegan Richa If you’re sick of tofu or mushroom fillings but still need your vegetarian taco fix, use jackfruit instead. Shredded and then flavored up with all the usual spicy seasonings, it’s a great alternative to soy but still helps you stick to a meatless menu.  3. Vegan "No Tuna" Sandwich Photo: Nutritional Foodie Jackfruit is known for tasting like pulled pork once cooked, but combine it with mustard, mayo, and relish, and it could pass for tuna too. Stuff between two thick slices of bread for a simple five-minute sandwich.    4. Pulled Jackfruit Enchiladas Verdes Photo: One Ingredient Chef Spiced with cumin and chili powder, jackfruit, black beans, and corn make for a hearty filling in these vegan enchiladas. Drizzled with that addictive green sauce, they’ll make you completely forget that there’s no dairy or meat involved.   5. BBQ Pulled Jackfruit Bowls With Asian Peanut Slaw Photo: Euphoric Vegan It looks and tastes just like pulled pork, but the BBQ-soaked stuff here is actually shredded jackfruit. Pile it on top of white rice and pair with a nutty cabbage slaw for a bowl that’s perfectly balanced in taste, nutrition, and texture.    6. Jackfruit and Black Bean Wraps Photo: Quite Good Food Spicy black beans give the smoky and sweet jackfruit filling some extra protein in this easy twist on tacos. Even if you don’t have tortillas, the mixture tastes just as good in sandwich buns or even lettuce wraps. 7. Jackfruit Pilaf Photo: Veggie Zest Jackfruit’s a super-popular ingredient in Indian dishes, like this fragrant basmati pilaf, where it’s combined with ghee and spices such as garam masala and cardamom. While this blogger cooks it in a clay pot, it isn’t a requirement—the dish comes together just as well in a regular skillet.  

 

How to Quit Being Indecisive About Life Decisions

“Start knowing. Try saying those two words to yourself in a very calm, very wise, very ancient, very adamant voice—the next time you panic. Just say it and then breathe. Then get quiet and see what comes up. I promise you that your very next thought will be the truth.” - Elizabeth Gilbert

“Um, I just knew I had to.”

That's the answer I'm given (in some form or another) by every successful entrepreneur I’ve ever coached, when I’ve posed the question, “What made you start your business?”

In fact, this answer applies to most significant things. Having a baby. Writing a book. Deciding to take a six-month sabbatical and travel. Saying yes to curiosity and accepting that first date. Yes to that (scary!) promotion. Yes to that unlikely opportunity to move to a new city, start blogging, buy a puppy. 

When something is stirring within you, stop saying, “I don’t know!” Because you do. Here’s why:

1. Logic is limited.

Logic has a place in the world, yes. We can do the numbers. We can consider the options and the outcomes. We can weigh the pros and cons until the cows come home. But the most important decisions in life are seized by instinct. We feel them. That’s why confident decision-making is so commonly referred to as “listening to your gut.” Logic isn’t everything—and it never can be. 

2. Your answer exists, but your permission might not.

Most often what’s lacking from our inner knowing is the absence we permit ourselves to obey our own call. We might think, “But I have a decent job, friends, a good family… must I want more/something else/something different?” 

The answer is yes, if something stirs within you. Because you cannot eradicate your desires. All that’s missing is your permission to let them become real.

3. You are stuck in judgment.

When you type an address into Google maps, it tells you the fastest route and the time it will take you to get there from your current location. That’s it. All it needs is where you are right now and the destination. It doesn’t ask, “Wait, have you been there before? But are you sure? Where were you yesterday/last week/last year?”

A big part of truly knowing what you want and going for it is losing what’s happened in the past as a barometer of where-to-from-here. Maybe you regret not taking a job because it scared you. Maybe you regret breaking off a relationship because commitment freaked you out.

Forget (and forgive yourself!) for what you have or haven’t done until now. It’s all OK! All that matters is today and what’s next for you. Yes, really.  

4. Intuition is real. (It’s in there!) 

If you don’t feel intuitively guided, it just means you are not fully aligned with yourself in the present moment. Maybe you are stressed out, over-tired, or over-thinking. That’s OK too. You might just need some quiet time or more sleep. 

A clear (rested) head provides massive mental and emotional clarity. “Sleep on it” is sage advice. If you still need help with decision-making even when you're in a calm, relaxed place, you can ask yourself these 12 questions.

5. Fear is your filter. 

Fear is behind every excuse we give ourselves to keep saying, “I don’t know!” So ask yourself: “If fear could leave my body for just a few seconds, what would I do next?”

Try this for a few minutes. Sit down. Relax your shoulders. Do whatever it takes to even make your body feel even 5 percent more comfortable. Take 20 deep, calming breaths (not just two or three). Imagine that, just for a few minutes, fear could leave your body entirely—poof! Without fear as a meddler, what comes up for you? What do you really, truly know for sure?

The answers to your life’s questions begin and end with you. You’re the only person who knows what you truly want. So stop asking around. Stop saying “I don’t know!” Turn inward. Start knowing. It might not be easy, but you do have the answers, don’t you? 

And you are ready for them. I promise. 

Susie Moore is Greatist's life coach columnist and a confidence coach in New York City. Sign up for free weekly wellness tips on her website and check back every Tuesday for her latest No Regrets column!

21 (Not-Boring) Chicken Breast Recipes Made for Meal Prep

There are a lot of benefits to prepping chicken meals for the week on Sunday. For one thing, you’re not dealing with raw meat more than once. Plus, who wants to think about what to pack for lunch or what to make for dinner once Monday rolls around and that to-do list explodes? Stay ahead of the game (at least where eats are concerned) by cooking chicken into pre-portioned, healthy dinners—or lunches—to enjoy throughout the week. And we’re not talking about unseasoned, blah-tasting stuff either. These 21 chicken breast recipes are simple, but they’re anything but boring. 

1. Healthy Roasted Chicken and Veggies Taste the rainbow—the healthier, non-Skittles way—with this super-straightforward recipe. The veggies and chicken are roasted at the same time in the same pan, so there’s minimal prep necessary. Add a cooked grain to round out the meal.  2. Chicken Shawarma and Sweet Potato Fry Bowls Skip the Middle Eastern food truck and create your own version of shawarma at home, using spices such as paprika and cumin to coat your chicken. With couscous, olives, and a tahini yogurt sauce making this portable dish taste even more authentic, you’ll be the envy of your coworkers.  3. Healthy Greek Chicken Meal-Prep Bowls Sectioned plastic containers are a must for meal-prep purposes, and this recipe is a perfect example of how useful they are. The yogurt sauce, chicken and veggies, and farro are best kept divided until it’s time to eat. 4. Spicy Chicken and Sweet Potato Chicken Meal-Prep Magic It’s easy, it’s got fewer than five main ingredients, it makes eight servings, it’s well-balanced, and it’s delicious. Magic is a pretty perfect word for this meal-prep recipe. 5. Pesto Chicken Pita Pockets You can always make your own pesto, but, like most meal-preppers, if time is a limited resource for you, a store-bought version works just fine. Stir it into a pile of roasted chicken and veggies, and pack the mixture into pita pockets. 6. Cilantro Lime Chicken With Cauliflower Rice Lime juice and cilantro keep the chicken tasting light and fresh, while the spicier cauliflower rice and black bean combo gives it a kick of flavor. And since it’s equally tasty eaten hot or cold, it’s an ideal option for an on-the-go meal.      7. Jerk Chicken Meal-Prep Bowls Recipes like this prove that meal prepping is totally worth it. With spicy chicken, sweet pineapple relish, and fragrant Spanish rice, it might be hard to believe, but this flavor-packed combo really can come together in just 30 minutes... and last you through four lunches or dinners.  8. Fiesta Chicken Rice Bowls Fiesta is right—brimming with spiced corn, brown rice, salsa, and peppers, these colorful chicken and rice bowls make every meal feel festive. They’re also prepped and ready to go in just 20 minutes. If only all parties were this easy to put together! 9. Meal-Prep Chicken Burrito Bowls Skip the lines at Chipotle, but not your Mexican fix. From the chicken and the corn to the rice and the beans, these quick and easy combos give you everything you want in a burrito bowl, while kale and cherry tomatoes add even more nutrition.  10. One-Pan Healthy Chicken and Veggies These vibrant meals are as tasty as they are good-looking, thanks to seasonings like chili powder, onion powder, and paprika coating the colorful veg. There’s the option to add cheese, but with so much other fun stuff going on, we doubt you’ll miss it if you leave it out.  11. Tex-Mex Chicken Meal-Prep Bowls The Tex-Mex flavor in these hearty chicken, rice, black bean, and veggie bowls comes from the easy addition of taco seasoning. They keep well for four days, so you’re set from Monday to Thursday, with the night off on Friday to celebrate your (not so) hard work.  12. Asian-Style Chicken, Veggies, and Rice Meal Prep Sweet, sesame-coated chicken is a great complement to the simpler steamed veggies here, while brown rice (instead of the usual white) adds some extra fiber. Pack into separate containers, and it’ll look just like something out of your local Chinese take-out place. 13. Chicken Butternut Squash Pasta Pasta salad is a pretty popular make-in-advance dish, but you can make it even easier by pre-portioning it for your weekday meals. This one is a satisfying mix of goat cheese, butternut squash, and walnuts; nutmeg and basil add some unique flavor.  14. Chicken, Apple, and Pecan Salads in a Jar Pack your meals in mason jars and you’ll look forward to digging into them every day. This layered salad doesn’t just look pretty, but with dried cranberries and apples alongside the chicken in a creamy Greek yogurt dressing, it gives you tons of flavor in every bite.  15. Italian Chicken Meal-Prep Bowls This recipe uses quick-cooking, microwave-friendly rice for when you're short on time (isn't that always?). Better yet, you can be completely flexible on the types of veggies and seasonings you choose to add to the dish. So open the fridge and use whatever you have in there. Just treat this recipe as an easy guide to making simple Italian-style dinners that’ll last you all week. 16. Harvest Chicken Salad Buying a salad can be a smart, nutritious option, but it can also get expensive and not so healthy (can you please add goat cheese, avocado, and bacon? Oh, and eggs, and wow, that fried chicken looks good. I'll have ranch dressing, please.). This one keeps things wholesome, but with apples, sweet potatoes, blue cheese, and almonds, it’s nowhere near boring.  17. Thai Chicken Lunch Bowls A creamy peanut butter sauce jazzes up chicken, rice, and veggies with some sweet and tangy Thai-inspired taste. Drizzle it on top right when you’re packing the portions into their individual containers so that there’s plenty of time for the flavors to soak up.  18. Teriyaki Chicken Stir-Fry Meal-Prep Lunch Boxes This recipe calls for chicken thighs, but you can easily use breasts and get away with it. Whatever you use, it’ll easily soak up the homemade teriyaki sauce, which keeps the sugar count much lower than if you were to use a bottled variety.  19. Meal-Prep Slow Cooker Chicken Teriyaki Bowls If you have no time to meal-prep, let your kitchen appliances do the work for you. A slow cooker lets the chicken, pineapple, and peppers simmer for three hours in a sweet and tangy sauce, while a rice cooker takes care of the quinoa. All you have to do is scoop everything into containers. 20. Baked Chicken, Broccoli, and Sweet Potatoes It’s back to basics with this three-ingredient meal. The combo is the quintessential healthy dinner—and for good reason: It’s easy to prep, affordable, and doesn’t require a lot of seasoning to be delicious.  21. Pizza Chicken Meal Prep Hold off on grabbing a greasy midday slice for lunch. This recipe, designed to make four individual meals, has the seasonings and sauce of a classic pizza, but pairs them with chicken and spaghetti squash instead of bread for a higher-protein, fiber-packed meal that’ll keep you full longer. 

 

New Vaccine Recommendation Cuts Number Of HPV Shots Children Need

You’d think that a vaccine that protects people against more than a half-dozen types of cancer would have people lining up to get it. But the human papillomavirus (HPV) vaccine, which can prevent roughly 90 percent of all cervical cancers as well as other cancers and sexually transmitted infections caused by the virus, has faced an uphill climb since its introduction more than a decade ago.

Now, with a new dosing schedule that requires fewer shots and a more effective vaccine, clinicians and public health advocates hope they may move the needle on preventing these virus-related cancers.

In December, the Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices recommended reducing the number of shots in the HPV vaccine from three to two for girls and boys between the ages of 9 and 14. The recommendation was based on clinical trial data that showed two doses was just as effective as a three-dose regimen for this age group. (Children older than 14 still require three shots.)

The study was conducted using Gardasil 9, a version of the vaccine approved by the Food and Drug Administration in late 2014. It protects against nine types of HPV: seven that are responsible for 90 percent of cervical cancers and two that account for 90 percent of genital warts.

In addition, the new version of Gardasil improved protection against HPV-related cancers in the vagina, vulva, penis, anus, rectum and oropharynx — the tongue and tonsil area at the back of the throat.

An earlier version protected against four types of HPV.

From the start, clinicians have run into some parental and political roadblocks because the vaccine, which is recommended for preteens, protects against genital human papillomavirus — a virus transmitted through sexual contact. Many physicians are also reluctant about discussing the need for the vaccine, and for many parents, the vaccine’s cancer-prevention benefits were overshadowed by concerns about discussing sexual matters with such young kids. Yet for maximum protection, the immunizations should be given before girls and boys become sexually active.

The focus should not have been on sexually transmitted infections, some say. “You only get one chance to make a first impression,” said Dr. H. Cody Meissner, a professor of pediatrics at Tufts University School of Medicine and a member of the American Academy of Pediatrics’ committee on infectious diseases. “This vaccine should have been introduced as a vaccine that will prevent cancer, not sexually transmitted infections.”

The HPV virus is incredibly common. At any given time, nearly 80 million Americans are infected, and most people can expect to contract HPV at some point in their lives. Most never know they’ve been infected and have no symptoms. Some develop genital warts, but the infection generally goes away on its own and many people never have health problems.

However, others may develop problems years later. There are approximately 39,000 HPV-related cancers every year, nearly two-thirds of them in women. In addition to cervical cancer, more than 90 percent of anal cancers and 70 percent of vaginal and vulvar cancers are thought to be caused by the HPV virus. Recent studies show that about 70 percent of cancers in the oropharynx may also be linked to HPV.

A 2015 study published in the Journal of the National Cancer Institute estimated that earlier versions of the HPV vaccine could reduce the number of HPV-related cancers by nearly 25,000 annually, and the new version of the vaccine could further reduce the number of such cancers by about 4,000.

The vaccine is estimated to prevent 5,000 cancer deaths annually, said Dr. Paul Offit, professor of pediatrics and director of the Vaccine Education Center at the Children’s Hospital of Philadelphia.

But compliance is an ongoing problem. “They’re not getting the one vaccine that protects against diseases from which they’re most likely to suffer and die,” Offit said, noting that deaths from pertussis and meningococcal disease, for which adolescents are also vaccinated at that age, are minuscule compared with HPV-related cancers.

In 2015, 87 percent of 13-year-olds were up-to-date with the Tdap vaccine that protects against tetanus, diphtheria and pertussis, and 80 percent had received the meningococcal vaccine, according to the Centers for Disease Control and Prevention. But just 30 percent of girls and 25 percent of boys at that age had received all three doses of the HPV vaccine. In contrast to other vaccines, however, the HPV vaccine is required only in a few states for secondary school.

Public health advocates say they think the shift to a two-dose regimen could make a big difference in the number of adolescents who get all the necessary doses of the HPV vaccine. For one thing, the fewer shots the better, in general, they say.

In addition, because the second HPV shot is supposed to be given anywhere from six months to a year after the first one, “parents can fit it into a routine regimen when people go in for their 12-year-old’s regularly scheduled visit,” said Dr. Joseph Bocchini Jr., chairman of pediatrics at Louisiana State University Health in Shreveport who is president-elect at the National Foundation for Infectious Diseases.

Please visit khn.org/columnists to send comments or ideas for future topics for the Insuring Your Health column.

Leggings on a plane: Delta weighs in on United Airlines controversy

It was the leggings policy heard ’round the world.

After United Airlines declined to allow girls who were wearing leggings to board a flight on pass travel and another passenger tweeted about it, the question of airline dress policies went viral.

>> PREVIOUS STORY: United Airlines kicks two girls off flight for wearing leggings

But some have also pointed out that airlines often have more stringent policies for employees’ friends or family who are traveling on reduced-rate buddy passes. It’s a familiar issue in Atlanta, where Delta Air Lines is the largest employer and the metro area is home to tens of thousands of airline employees.

Actress Justine Bateman, best known from the 1980s TV show “Family Ties,” is among those who pointed out the distinction on Twitter over the weekend.

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“To be fair, these guidelines for ’employee passes’ have been in place for decades. All the traveling airline employees know about them,” Bateman tweeted on Sunday.

“I had to do the same when I flew on ‘passes’ as a kid, to be fair,” she tweeted.

Delta says it does not have an “item-specific” clothing policy for employees and pass travel.

“We ask our employees and their family and friends flying on pass privileges to use their best judgment when deciding what to wear on a flight,” Delta said in a written statement.

And Delta emphasized that in a tweet on Monday.

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