Employers’ efforts to reduce stress get low grades in a new poll by NPR, the Robert Wood Johnson Foundation and Harvard’s T.H. Chan School of Public Health.

In particular, among those working adults who say they’ve experienced a great deal of stress at work in the past 12 months, the vast majority (85 percent) rate the efforts of their workplace to reduce stress as fair or poor.

Overall, 43 percent of working adults who told us their job negatively affects their stress levels. Others said their job negatively affects their eating habits (28 percent), sleeping habits (27 percent) and weight (22 percent).

“The takeaway here is that job No. 1 for U.S. employers is to reduce stress in the workplace,” said Robert J. Blendon, professor of health policy and political analysis at the Harvard Chan School, who directed the survey. It included interviews with 1,601 workers, by landline and cellphone. The margin of error is 2.9 percentage points.

The poll also found that only about half of working adults have workplaces that offer wellness or health-improvement programs. About 1 in 4 rate their workplace as fair or poor in providing a healthy work environment, and more than 4 in 10 rate their workplace as fair or poor in providing opportunities for physical exercise or healthful food options at work.

About 1 in 5 working adults (22 percent) say something at their job may be harmful to their health, with chemicals and contaminants topping the list at 30 percent of those who have concerns about their workplace. We found 43 percent of construction or outdoor workers and 34 percent in medical jobs have health concerns in the workplace.

One of the obvious reasons for stress in the workplace may be overwork.

As is detailed in the poll report, working adults in our sample lived up to America’s reputation for being workaholics, with almost two-thirds of them saying they often or sometimes work overtime or on the weekends. About 1 in 5 say they work 50 or more hours each week in their main job.

Of course, taking breaks and vacations may help relieve stress. But our survey found that even among those who get paid vacations days, less than half use all or most of the days they earned in the past year. And when they do take vacation, 43 percent of high-pay workers say they often or sometimes work on vacation, with 28 percent of average pay workers and 18 percent of low-pay workers saying the same.

Why do Americans work so much? A majority (56 percent) of people working 50-plus hours a week in their main job say they do so because “it’s important for their career to work longer hours.” Half (50 percent) say they do so because they “enjoy it,” and 37 percent say they “need the money.”

These responses may be reflected somewhat in the chart below, where higher-paid workers more frequently say they work 50-plus hours, versus lower-pay workers.

It’s a similar story when it comes to sick leave. A majority of workers who get paid sick days and who did not use them all (73 percent) say they weren’t sick enough to use all of their days. More than one-third (37 percent) say a major reason why they didn’t take all their sick days is that they want to save them for another time, while 28 percent say there wouldn’t be enough people to cover their work.

Twenty percent of those who didn’t use all their sick pay say their workload made it too hard to take sick days, while another 20 percent say working more (and not taking sick leave) would help them get ahead at work.

Overall, just 16 percent of workers have used all of their paid sick days in the past year, while 6 percent used most, 45 percent used only some and 32 percent used none.

And then there are those who get no sick leave at all. While two-thirds of full- or part-time employed workers overall say their workplace offers them paid sick days, just 38 percent of workers in low-pay jobs say they get paid sick leave. Those ranking lowest in paid sick leave were those in construction/outdoor jobs (42 percent) and restaurant jobs (22 percent).

Does reluctance to use paid leave lead workers to go to work sick? A majority of working adults in our survey say they do just that. Of interest: Half of restaurant workers and more than half of workers in medical jobs say they still go to work always or most of the time when they have a cold or the flu.

But the connection between paid leave and going to work is fuzzy. Laura Brown, who studies the issue at the Centers for Disease Control and Prevention, tells NPR’s Rae Ellen Bichell that their studies don’t show a strong link between the two.

“Forty percent of workers did say to us that they’d worked while sick in the past because they wouldn’t get paid if they didn’t work,” she says. “But when we look at the data statistically, that doesn’t really seem to be a large driving factor in whether or not people actually work when they’re sick.”

Leaving their coworkers short-staffed was a more likely reason for going to work while sick, she says.

In one of the first stories in our series, “The Workplace and Your Health,” we will look at the issue of juggling medical care with work in more depth, and how the lack of paid leave can lead to more medical problems. In another story, we’ll hear more about the stress that people with disabilities experience at work. Over 6 in 10 (62 percent), say their job has a bad impact on their stress level, compared with 41 percent of workers without disabilities.

Our poll found many working adults have concerns about safety at work. As the chart below shows, those in low paying jobs were more likely than those in high-paying jobs to say they often or sometimes face potentially dangerous situations.

And it’s unclear from the survey why so many restaurant and retail outlet workers say they often or sometimes face potentially dangerous situations on the job. But we did find that, overall, 19 percent of working adults have seen or heard of violence against employees in their workplace.

And while shift workers (54 percent) are more likely than day workers (38 percent) to say they face danger, a significant proportion of shift workers say they do so because it is better for their lifestyle (39 percent) and/or it makes it easier to care for the family (38 percent). Half say better pay associated with shift work is the reason they do it.

But it may be that the workplace is getting safer overall. Among those who ever face potentially dangerous situations at work, almost three-quarters (73 percent) believe their workplace is actively working to reduce these dangerous conditions.

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Recommended article from FiveFilters.org: Most Labour MPs in the UK Are Revolting.

Theranos was poised to revolutionize the blood testing industry by using only a few drops of blood in inexpensive tests. But now, federal regulators say they will bar the company’s dynamic founder and CEO Elizabeth Holmes from owning or operating a lab for at least two years.

“Last year the government began to scrutinize the company after experts found that the results of the blood tests were inaccurate,” as NPR’s Laura Sydell told our Newscast unit.

Centers for Medicare & Medicaid Services, a federal regulator, said in a letter made public Friday that it is also revoking certification for the company’s Newark, California laboratory and cancelling the lab’s approval to receive Medicare payments. The sanctions will not take full effect until September and the company can appeal.

The company will also be fined $10,000 for every day it is out of compliance with the regulator’s recommendations on how to run the labs, starting on July 12.

Theranos repeatedly failed to prove it had corrected issues previously identified by the regulator, according to the CMS letter, including a finding of “immediate jeopardy to patient health and safety.” According to The New York Times, “that apparently referred to erroneous results in a test of blood clotting used for patients who take the blood thinner warfarin.”

Erik Gordon, a business professor at the University of Michigan, told Laura that while the company can appeal, the likelihood for success is miniscule. “If the technology doesn’t work, there’s nothing. There’s just smoke and mirrors. A lot of hype and nothing,” he said. As for Holmes: “She’s radioactive at this point,” Gordon says. “I mean, she can’t stay at the company.”

Theranos said in a statement that it accepts “full responsibility” and vowed to “work non-stop to resolve the issues identified.” It added that Holmes will continue to lead the company and denied that any patients were harmed by their tests.

Holmes dropped out of Stanford at 19 to found the company, which sought to disrupt the tech industry with cheaper, simpler tests. As Laura reported, “Theranos was valued at 9 billion dollars; it had a contract with Walgreens.” Holmes herself was viewed as a wunderkind and drew comparisons to Apple co-founder Steve Jobs, Laura said:

“Holmes had a beautiful vision, backed by hundreds of millions of dollars in investment, and a board of big names like Henry Kissinger and George P. Schulz. The media had a love fest. Time magazine called Holmes one of the 100 most influential people in the world. She was profiled in Fortune andThe New Yorker.”

But as Laura reported, the Theranos story is now viewed as a cautionary tale, “and questions are being raised about whether applying hardware and software business culture to biotechnology is dangerous.”

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Tough love, interventions and 12-step programs are some of the most common methods of treating drug addiction, but journalist Maia Szalavitz says they’re often counterproductive.

“We have this idea that if we are just cruel enough and mean enough and tough enough to people with addiction, that they will suddenly wake up and stop, and that is not the case,” she tells Fresh Air‘s Terry Gross.

Szalavitz is the author of Unbroken Brain, a book that challenges traditional notions of addiction and treatment. Her work is based on research and experience; she was addicted to cocaine and heroin from the age of 17 until she was 23.

Szalavitz is a proponent of “harm reduction” programs that take a nonpunitive approach to helping addicts and “treat people with addiction like human beings.” In her own case, she says that getting “some kind of hope that I could change” enabled her to get the help she needed.

Interview Highlights

On her criticism of 12-step programs

I think that 12-step programs are fabulous self help. I think they can be absolutely wonderful as support groups. My issue with 12-step programs is that 80 percent of addiction treatment in this country consists primarily of indoctrinating people into 12-step programs, and no other medical care in the United States is like that. The data shows that cognitive behavioral therapy and motivational enhancement therapy are equally effective, and they have none of the issues around surrendering to a higher power, or prayer or confession.

I think that one of the problems with the primary 12-step approach that we’ve seen in addiction treatment is that because the 12 steps involve moral issues, it makes people think that addiction is a sin and not a disease. The only treatment in medicine that involves prayer, restitution and confession is for addiction. That fact makes people think that addiction is a sin, rather than a medical problem. I think that if we want to destigmatize addiction, we need to get the 12 steps out of professional treatment and put them where they belong — as self-help.

On the efficacy of maintenance treatment

Buprenorphine and methadone are the two most effective treatments that we have for opioid addiction, and that is when they are taken indefinitely and possibly for a lifetime. So these medications are opioids themselves. They each have slightly different properties … but what they do is they allow you to function completely normally. You can drive. You can love. You can work. You can do everything that anybody else does. …

The way they are able to do that is because if you take an opioid in a regular steady dose every day at the same time and the dose is adjusted right for you, you will not experience any intoxication. The way people with addiction experience intoxication is that they take more and more and more, they take it irregularly, the dosing pattern is completely different. But if you do take it in a steady-state way — which is what happens when you are given it at a clinic every day at the same time — you then have a tolerance to opioids which will protect you if you relapse, and will mean that the death rate from overdose in people who are in maintenance is 50 to 70 percent lower than the death rate for people who are using other methods of treatment, and that includes all of the abstinence treatments.

So maintenance is a really important treatment option for people with opioid addiction. It should be the standard of care. No one should ever be denied access to it. Unfortunately, we have this idea that if you take methadone or buprenorphine, you are just substituting one addiction for another.

On using harm reduction instead of tough love to help addicts

We do know from looking at the data that if you are kind and supportive and empathetic — if you do things like provide clean needles, provide opportunities for people to reverse overdose, provide safe injecting spaces — those things do not prolong addiction. And if tough love was the answer, and the idea was you shouldn’t enable addiction, if that theory was correct, those things should all prolong addiction, and the exact opposite is true. When you go into a needle exchange, one of the most amazing things is people are just treated with dignity and respect. And when you’re an active drug user, when you are injecting, everybody crosses the street to avoid you. And here you’re just seen as a person who deserves to live, and you deserve a chance. And it’s that that gives people hope. And it’s that that shortens the period of addiction.

On not serving any time in prison after being caught with 2.5 kilos of cocaine when she was 20 years old

I have to say that being white and being female and being a person who was at an Ivy League school and being privileged in many other ways had an enormous amount to do with … why I was not incarcerated and why I’m not in prison now. I think our laws are completely and utterly racist. They were founded in racism, and they are enforced in a thoroughly biased manner. I was extraordinarily lucky to have an attorney and a judge that saw that I was getting better, and that allowed me to avoid that.

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Prescription drug prices continue to climb, putting the pinch on consumers. Some older Americans appear to be seeking an alternative to mainstream medicines that has become easier to get legally in many parts of the country. Just ask Cheech and Chong.

Research published Wednesday found that states that legalized medical marijuana — which is sometimes recommended for symptoms like chronic pain, anxiety or depression — saw declines in the number of Medicare prescriptions for drugs used to treat those conditions and a dip in spending by Medicare Part D, which covers the cost on prescription medications.

Because the prescriptions for drugs like opioid painkillers and antidepressants — and associated Medicare spending on those drugs — fell in states where marijuana could feasibly be used as a replacement, the researchers said it appears likely legalization led to a drop in prescriptions. That point, they said, is strengthened because prescriptions didn’t drop for medicines such as blood-thinners, for which marijuana isn’t an alternative.

The study, which appears in Health Affairs, examined data from Medicare Part D from 2010 to 2013. It is the first study to examine whether legalization of marijuana changes doctors’ clinical practice and whether it could curb public health costs.

The findings add context to the debate as more lawmakers express interest in medical marijuana. This year, Ohio and Pennsylvania passed laws allowing the drug for therapeutic purposes, making it legal in 25 states, plus Washington, D.C. The approach could also come to a vote in Florida and Missouri this November. A federal agency is considering reclassifying medical marijuana under national drug policy to make it more readily available.

Medical marijuana saved Medicare about $165 million in 2013, the researchers concluded. They estimated that, if medical marijuana were available nationwide, Medicare Part D spending would have declined in the same year by about $470 million. That’s about half a percent of the program’s total expenditures.

That is an admittedly small proportion of the multibillion dollar program. But the figure is nothing to sneeze at, said W. David Bradford, a professor of public policy at the University of Georgia and one of the study’s authors.

“We wouldn’t say that saving money is the reason to adopt this. But it should be part of the discussion,” he added. “We think it’s pretty good indirect evidence that people are using this as medication.”

The researchers found that in states with medical marijuana laws on the books, the number of prescriptions dropped for drugs to treat anxiety, depression, nausea, pain, psychosis, seizures, sleep disorders and spasticity. Those are all conditions for which marijuana is sometimes recommended.

The study’s authors are separately investigating the effect medical marijuana could have on prescriptions covered by Medicaid, the federal-state health insurance program for low-income people. Though this research is still being finalized, they found a greater drop in prescription drug payments there, Bradford said.

If the trend bears out, it could have other public health ramifications. In states that legalized medical uses of marijuana, painkiller prescriptions dropped — on average, the study found, by about 1,800 daily doses filled each year per doctor. That tracks with other research on the subject.

Marijuana is unlike other drugs, such as opioids, in which overdoses are fatal, said Deepak D’Souza, a professor of psychiatry at Yale School of Medicine, who has researched marijuana. “That doesn’t happen with marijuana,” he added. “But there are whole other side effects and safety issues we need to be aware of.”

Study author Bradford agreed: “Just because it’s not as dangerous as some other dangerous things, it doesn’t mean you want to necessarily promote it. There’s a lot of unanswered questions.”

Because the federal government classifies marijuana as a Schedule I drug, doctors can’t technically prescribe it. In states that have legalized medical marijuana, they can only write patients a note sending them to a dispensary.

Insurance plans don’t cover it, so patients using marijuana pay out of pocket. Prices vary based on location, but a patient’s recommended regimen can be as much as $400 per month. The Drug Enforcement Agency is considering changing that classification — a decision is expected sometime this summer. If the DEA made marijuana a Schedule II drug, the move would put it in the company of drugs such as morphine and oxycodone, making it easier for doctors to prescribe and more likely that insurance would cover it.

To some, the idea that medical marijuana triggers costs savings is hollow. Instead, they say it is cost shifting. “Even if Medicare may be saving money, medical marijuana doesn’t come for free,” D’Souza said. “I have some trouble with the idea that this is a source of savings.”

Still, Bradford maintains that if medical marijuana became a regular part of patient care nationally, the cost curve would bend because marijuana is cheaper than other drugs.

Lester Grinspoon, an associate professor emeritus of psychiatry at Harvard Medical School, who has written two books on the subject, echoed that possibility. Unlike with many drugs, he argued, “There’s a limit to how high a price cannabis can be sold at as a medicine.” He isn’t associated with the study.

And, in the midst of the debate about its economics, medical marijuana still sometimes triggers questions within the practice of medicine.

“As physicians, we are used to prescribing a dose. We don’t have good information about what is a good dose for the treatment for, say pain,” D’Souza said. “Do you say, ‘Take two hits and call me in the morning?’ I have no idea.”

Kaiser Health News is a national health policy news service that is part of the nonpartisan Henry J. Kaiser Family Foundation.

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While a sense of inevitability often surrounds the topic of teen drinking, adults can play an important role in preventing underage alcohol use.

Two recent studies provide guidance for parents. One finds that parents who set limits in a warm and supportive environment reduced the risk that their adolescent children would binge drink. The other study reports on the potential of a home-based program that educates parents and children about alcohol prevention.

The stakes are high. About 1 in 6 teens drank alcohol before turning 13, and about the same proportion of high school kids has binged on alcohol, according to the latest biannual Youth Risk Behavior Survey by the Centers for Disease Control and Prevention. Overall, a third of teenagers drink — down from about half of teens 25 years ago, but still a problem.

“Although it is common for adolescents and young adults to try psychoactive substances, it is important that this experimentation not be condoned, facilitated, or trivialized by adults,” notes the introduction to an updated screening protocol by the American Academy of Pediatrics. The group encourages doctors to ask adolescents about drug and alcohol use during routine visits.

At home, how Mom and Dad manage their roles — and the signals they send about alcohol use — affect their children’s future drinking behavior. Parenting style, drinking frequency, and expectations influence whether adolescents will binge drink, according to results of a study published in the July issue of Prevention Science. In the same issue, another study finds that a home-based prevention program used by parents with their elementary school-age children made the kids less inclined to drink four years after the start of the program.

When adolescents drink, they tend to do so excessively, making the most of their limited access to alcohol. Binge drinking — consuming four, for females, or five, for males, drinks at a time — puts the imbiber at risk of fatal accidents, injuries, violence and legal problems. Social psychologist William D. Crano at Claremont Graduate University in Claremont, Calif., and his colleagues wondered whether certain conditions in adolescence “had any predictive power for what’s going to happen” in terms of alcohol use and incarceration.

The researchers looked at data from the National Longitudinal Study of Adolescent to Adult Health (Add Health), which has interviewed a nationally representative group four times, beginning in the 1994-1995 school year, when the participants were in seventh through 12th grades. The most recent survey occurred in 2008, when the respondents had reached ages ranging from 24 to 32. Parent interviews occurred in the first year of the project.

Crano and his group focused on four factors from the first wave of interviews:

• whether parents monitored their teens,
• the warmth parents expressed to their teens,
• how frequently parents drank,
• whether parents thought their kids were drinking.

The study involved more than 9,400 adolescents and their parents. Teens answered questions about parental monitoring and warmth; parents responded to queries about their drinking and expectations. In later surveys, the Add Health project collected data on teen and young adult binge drinking and incarceration rates.

Adolescents whose parents neither kept an eye on them nor provided a supportive home environment were more likely to binge drink. These parental behaviors, along with underage drinking, predicted binge drinking as young adults. Furthermore, those who binged as teens and young adults were more likely to be arrested.

The study suggests that parents do make a difference. “Parental monitoring and warmth are a protective device against kids’ binge drinking,” says Crano. But the two need to go hand in hand. “If you have surveillance without warmth, you’ve got a problem,” he adds. “You want the relationship between a parent and a child to be close enough and warm enough that the child discloses behaviors and what they are thinking, and the parent can offer advice” that reinforces rules but doesn’t disparage the child.

The study also found that how often parents drank was predictive of teen and young adult binge drinking. While the survey didn’t ask about the amount of alcohol consumed, the research supports the idea that parents’ drinking behavior can send a powerful message to kids in terms of what is acceptable.

Finally, it was more likely that adolescents were drinking if their parents expected they were drinking. This self-fulfilling prophecy may stem from parents not intervening and educating their kids when they suspect alcohol use, says Crano, even though that is exactly what is needed.

Crano and his group argue that national prevention campaigns would do well to target parents, not just teens. “Parents are an easier audience,” he says. “They are quite open to learning how to do better for their children.”

Armed with the right information, parents can direct a prevention campaign in their own living rooms. Social ecologist Christine Jackson at RTI International in Durham, N.C., and colleagues there and at the University of North Carolina, Chapel Hill report on a home-based parenting program meant to counter parents’ misconceptions about kids and alcohol, support communication in the family, and encourage parents to set rules regarding alcohol use.

Jackson notes that a child’s first taste of alcohol often comes from a drink offered by a parent. Contrary to the belief that sipping will satisfy kids’ curiosity about alcohol and deter future drinking, previous work by Jackson and colleagues found that fifth-grade children permitted by parents to try an alcoholic beverage were twice as likely to drink in seventh grade as peers not granted sips.

“In the short term, allowing children to try alcohol simply teaches them that parents don’t mind if they have alcohol,” Jackson says. “In the long term, allowing children to have alcohol increases their odds of underage drinking during adolescence.”

If kids have positive ideas about alcohol — for example, that drinking makes one popular — they are more likely to drink, notes Jackson. The program set out to provide alternative, protective ideas. It helped parents discuss how alcohol is harmful to children’s health and commit to keeping kids alcohol-free. It also sought to empower kids to reject social pressures to drink.

To test the approach, the researchers recruited third-grade children and their mothers from school districts in three Southern states, primarily North Carolina. Just over 1,000 children were randomly divided into two groups, one whose families received the five-month-long alcohol prevention program, and one provided with an obesity-prevention program for comparison. The materials included magazines, games and role-playing activities.

Jackson and her colleagues interviewed the kids about their beliefs and attitudes regarding alcohol before the program started. At the same time, they queried mothers about how often both parents drank and about the mother’s racial and ethnic identity and education. In the second and third years of the study, families received a one-month booster program. Four years from the start of the program, the researchers asked the kids again about their alcohol-related beliefs and attitudes.

The third-graders who had received the alcohol prevention program were significantly less inclined to drink at the four-year follow-up, when they were in seventh grade, than those in the obesity program. This was true regardless of their parents’ drinking habits or mother’s education, race or ethnicity. “This means that the program has a sustained effect on children’s attitudes and intentions about alcohol use,” says Jackson.

Kids develop ideas about alcohol with or without their parents’ direct input. “Encourage conversation with kids about issues that are important to them,” says Crano. “You want to be the person to help them.”

Aimee Cunningham is a freelance science journalist based in the Washington, D.C., area.

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The Obama administration is making it easier for people addicted to opioids to get treatment.

Health and Human Services Secretary Sylvia Burwell announced new rules Wednesday to loosen restrictions on doctors who treat people addicted to heroin and opioid painkillers with the medication buprenorphine.

Doctors who are licensed to prescribe the drug, which is sold mostly under the brand name Suboxone, will be allowed to treat as many as 275 patients a year. That’s almost triple the current limit of 100, and HHS estimated that as many as 70,000 more people may have access to the drug as a result.

“There are a number of ways we are trying to increase access to medication-assisted treatment,” said Michael Botticelli, the director of national drug control policy, on a conference call with reporters. “This rule itself expands access and gets more physicians to reach more patients.”

Suboxone is itself an opioid. It eases withdrawal symptoms and cravings, but doesn’t make people high.

In 2000, Congress passed legislation that allows doctors who are trained and pass a test to offer office-based buprenorphine treatment. However, the same law capped how many patients a doctor can treat. These are the only medications that are under such restrictions.

In a related move, HHS said it is changing how it uses patient satisfaction surveys to determine Medicare payments. Burwell said some doctors and hospitals said they felt pressure to prescribe opioid painkillers because the surveys could affect their income.

“This rule eliminates the connection between pain management questions in the survey and payments to doctors and to hospitals,” she said on the conference call.

Even as they announced the new rules, administration officials urged Congress to allocate more money to help pay for more addiction treatment programs.
House and Senate negotiators are considering a series of opioid treatment bills, but those proposals don’t include all the funding President Obama requested.

Botticelli said many Democrats in the House have said they won’t sign off on a compromise bill unless it includes the $1.1 billion that the president requested.

Botticelli said an average 129 people a day die from opioid overdoses.

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The debate over how to overhaul the $10 billion Veterans Choice program is the latest skirmish between those who would like to privatize the VA and supporters of government health care.

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I was never good at strolling.

If I had a destination, I walked quickly. Not because I wanted exercise, mind you, but because it felt natural.

That all changed with my first pregnancy. The nonpregnant me bolted across a street with five seconds left on the crossing signal. The uber-pregnant me much preferred a full 30-second allotment. Anything less and I waited for the next traffic cycle.

This change of pace was entirely out of my control. As I neared my due date, my once-brisk stride was shorter, my stance wider, my torso tilted farther backward.

I had morphed into a waddler! And I could only waddle so fast.

Now, at 28-weeks pregnant with my second child, I’m beginning to waddle again. I’m thrilled to be expecting, but I’m already missing my normal speed.

Obstetricians tell us that there’s a good explanation for why pregnancy changes our gaits.

“There are a lot of joints in the pelvis. Those are going to loosen as the pregnancy goes on, which is probably how the body adapts to allow a fairly good-sized baby to fit through,” explains Dr. Daniela Carusi, director of both general gynecology and surgical obstetrics at Brigham and Women’s Hospital in Boston. The loosening of the joints and the downward pressure from the growing belly actually cause the pelvis to get wider, she says. A wider pelvis means a wider stance.

That explains part of the waddle. The other part, according to Carusi, is caused by a shift in our center of balance. “As the belly gets bigger, which is the spot in the body which marks the center point, the weight moves forward and that makes the spine curve more inward,” she says.

We pregnant women can’t help but lean back.

I wondered what would happen if I attempted to trade comfort for more graceful motion, if it was even possible to force myself to return to something closer to my former stride.

Carusi warns that it wouldn’t work. “You could reposition your legs, but it’s hard to make your hips narrower,” she says. “What you’d be doing is compensating for the change instead of overriding it.”

“I don’t think it makes sense to narrow the gait,” agrees Stephanie Prendergast, a physical therapist at The Pelvic Health and Rehabilitation Center in Los Angeles. “Keeping the gait wider is safer for balance reasons.”

Prendergast says we could consider making slight adjustments to the way we stand. “When they’re standing still, many pregnant women will push their bellies out and lean backward,” she explains. “But then your ligaments at the front of the hip are holding up your weight.” If we don’t lean back so far, she says, our gluteal muscles could take some of the weight and our hips would hurt less.

I tried to adjust my stride anyway, of course. Unsurprisingly, it felt terrible. When I straightened my back, my shoulders arched forward. When I narrowed my stance, my balance was all off. Other women have had similar experiences.

“I tried to walk with my feet closer together, but after a while that hurt more than changing my gait,” says mother-to-be Keke Gibb, a science professor at Baker University in Baldwin City, Kan., who spoke with me on her due date. “It’s most comfortable if you widen your stance a lot,” she explains. “It feels like my thighs hate each other. I try not to let them touch while I do a really awkward sashay through the neighborhood. I use my whole body to swing one leg forward at a time.”

There is no fighting the pregnant waddle.

I take some comfort in knowing that there’s a small community of scientists investigating how this altered motion affects our lives. These researchers attach reflective stickers to a pregnant woman’s body and then use special cameras to capture the 3-D movement of the stickers as she walks, stands up, or does other simple tasks that can become challenging late in pregnancy.

“When we look in our software, the women look like stick figures moving in 3-D, so we can capture different aspects of how they move, rotate, flex and extend,” says Jean McCrory, a biomechanist at West Virginia University who studies gait and balance in pregnant women.

McCrory documented, for example, how pregnant women walk with pelvises tilted backward and feet spread wider apart. Others have shown how we rise from chairs more slowly, and with a greater attention to balance.

In a recent study, scientists at Hiroshima University studied the mechanics of movement as pregnant and nonpregnant women rose from a chair, picked up two stacked plates, turned to the right, and then walked away. The researchers showed that pregnant women flex their hips less while walking and lean back more while standing.

These findings will come as no surprise to obstetricians or anyone who has ever had a baby bump of her own. But studies like these might one day help scientists figure out how to make everyday tasks safer for pregnant women. McCrory, for example, wants to use her knowledge of pregnant motion to find ways to prevent pregnant women from falling — a worthy goal since over a quarter of pregnant women fall at some point.

I joined that statistic during my last pregnancy when I got overexcited about an old friend visiting. As she got out of her car, I momentarily forgot to waddle and leaped forward to hug her. My toe caught the sidewalk and I fell so slowly and awkwardly that she thought it was intentional — that I was trying to entertain her with some sad attempt at pregnant lady slapstick. The baby and I were fine.

So far I’ve managed to stay on my feet this pregnancy. For the moment, I also still have some of my prepregnancy speed. I know this because, like so many aspects of pregnancy, people comment on it. Last week, as I strode past two men on my way to work, I overheard one say, “Whoa! Look at how fast she walks — for a pregnant lady.”

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The Obama administration is making a push to get young adults covered on the health insurance marketplaces, both for their own good and that of the marketplaces. The insurance exchanges need healthy people to balance sicker ones in the risk pool.

Despite beefed-up outreach planned for the coming months, several factors may throw a wrench into enrollment plans for young people.

To start with, the transition from children’s Medicaid to adult coverage can be bumpy. Nineteen is the age at which lower-income young adults are generally no longer eligible to be covered as children by the Medicaid or Children’s Health Insurance Program. Options for them include moving to adult Medicaid in states that have expanded coverage to 138 percent of the federal poverty level (about $16,000), or buying a subsidized plan on the health insurance marketplace.

“I’m sure there are states that do transitions really well, but I can’t point to one,” said Shelby Gonzales, a senior health policy analyst who focuses on enrollment and eligibility issues for the Center on Budget and Policy Priorities. “In general, a lot of states are struggling, when [young adults are] being terminated from Medicaid, with getting them on a pathway that’s smooth to the marketplace.”

The transition to adult Medicaid can also be problematic. Thirty-one states and the District of Columbia have expanded coverage, and it’s available for some of these young adults, she said.

Clunky computer systems and uninformative coverage notices may make it easier to drop coverage at age 19 than continue it. Sometimes, for example, a young adult will receive a notice explaining that she’s no longer eligible for Medicaid under a particular section of the law, but not receive information about other coverage options.

Or some states don’t have a routine process to check whether the 19-year-old is eligible for another category of Medicaid after aging out of child coverage. Or she may get sent to the marketplace for coverage, but wind up filling out all the application information from scratch even though her Medicaid file already has the information.

When young people try to apply for coverage on the marketplace, they may run into another snag: difficulty proving their identity, the first step in the enrollment process. With little or no credit history, they may have to verify their identity by phone or submit documentation that proves they are who they say they are. Such frustrations can lead young people to walk away from the process.

“Any of these are points where you might lose someone,” Gonzales said.

Since the health law passed, the uninsurance rate among young people between ages 19 and 25 has fallen by more than 50 percent, according to the Centers For Medicare & Medicaid Services. But young adults are still more likely than other adults to be uninsured.

The Obama administration has acknowledged the difficulty in transitioning young people from Medicaid or their parents’ policies to other coverage. It noted that at age 19, the uninsured rate jumped nearly 7 percentage points in 2014, according to the Census data, while 26-year-olds’ rate of uninsurance increased 4 percentage points as they aged off their parents’ plans.

New restrictions on special enrollment periods may also pose a particular problem for young people, experts say. If people experience certain life events they can qualify for a special enrollment period during the middle of the year to pick a new plan. Insurers complained that people were using a special enrollment period to sign up for coverage to receive medical treatment, then dropping coverage after they got the care they needed. So the Obama administration said that it will begin to require that people document that they really did experience some of the most common life events that have triggered the new enrollment, including marriage, the birth of a child, loss of another type of coverage and a permanent move.

Young people are disproportionately affected by these events. In addition to marriage and childbirth, young adults between the ages of 20 and 29 relocate at twice the rate of older adults, according to Young Invincibles, an advocacy organization for young people.

“I think the new documentation requirements regarding [special enrollment periods] could really backfire, and the result could be different than the administration intends,” said Sabrina Corlette, research professor at the Georgetown University Center on Health Insurance Reforms.

One of the challenges of insuring young adults is convincing them that they need it. Many young adults are relatively healthy. When money is tight, health insurance may seem like a luxury they can forgo.

Young Invincibles is trying to get the word out that marketplace coverage can be extremely affordable with premium tax credits and cost-sharing subsidies, said Erin Hemlin, the group’s national director of training and consumer education. Young Invincibles also highlights the preventive care benefits that are available in all marketplace plans at no charge to consumers.

Coverage of birth control pills alone may be enough to boost sign-ups. “For young women, they say birth control is the No. 1 selling point,” Georgetown’s Corlette said.

Kaiser Health News is an editorially independent news service that is part of the nonpartisan Henry J. Kaiser Family Foundation. Michelle Andrews is on Twitter:@mandrews110.

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Episiotomy, a once-routine surgical incision made in a woman’s vaginal opening during childbirth to speed the baby’s passage, has been officially discouraged for at least a decade by the leading association of obstetrician-gynecologists in the United States.

Nonetheless, despite evidence that the procedure is only rarely necessary, and in some cases leads to serious pain and injuries to the mother, it is still being performed at much higher than recommended rates by certain doctors and in certain hospitals.

In one recent case, Kimberly Turbin, a 29-year-old dental assistant who lives in Stockton, Calif., is suing her former obstetrician for assault and battery after he performed an episiotomy on her in 2013. A video of the birth, with Turbin begging the doctor not to cut her, has been viewed more than 420,000 times.

After the episiotomy, Turbin says, “I had major, major, major, major pain.”

In 2006, the American College of Obstetricians and Gynecologists released a recommendation against the routine use of episiotomy, finding that except in relatively rare cases, the procedure benefited neither mothers nor newborns. In 2008, the National Quality Forum also endorsed limiting the routine use of episiotomies.

Since then, the use of this surgical incision has dropped significantly — from 21 percent of all vaginal births in California in 2005, for example, to fewer than 12 percent in 2014. National trends have been similar.

But that overall drop masks some giant disparities. While the majority of California’s hospitals now have episiotomy rates under 10 percent, according to state data, the technique’s use at individual hospitals can be five or six times as high.

Dr. Alexander Friedman, an assistant clinical professor of obstetrics and gynecology at Columbia University Medical Center in New York City, who has studied the issue, says sky-high rates at some institutions are surely based on factors that go beyond medical need.

“If you perform an episiotomy, you’re more likely than not going to cause more postpartum pain and discomfort,” says Friedman, who was lead author of a 2015 report, published in JAMA, the Journal of the American Medical Association, about the variation in episiotomy rates among hospitals nationally. While the ideal rate of episiotomy is unknown, he says, it should likely be less than 10 percent.

As recently as the late 1970s, episiotomy was used in more than 60 percent of vaginal deliveries across the U.S. because doctors believed a clean incision helped prevent tears between the vagina and rectum, that a clean cut was easier to stitch than a tear, and that the incision prevented overstretching of the muscles surrounding the vagina.

In the past few decades, though, research has shown that the cuts sometimes cause serious pain and injuries, including deep tissue tears, incontinence and sexual dysfunction. The repaired incisions often prove slower to heal than a natural tear.

Armed with this information, many pregnant women started refusing the procedure, and most obstetricians stopped doing it routinely.

But certain doctors are going against that trend.

Dr. Emiliano Chavira, a maternal and fetal medicine specialist at Dignity Health’s California Hospital Medical Center in Los Angeles, says he suspects three main reasons why some providers continue to perform routine episiotomies: They’ve always done them; they lack awareness of best practices; or they want to speed up deliveries.

“Certain segments of the obstetric community are very slow to modernize the practice,” Chavira says. “They’re very slow to abandon procedures that are not a benefit and, in fact, may be harmful. And it’s really disappointing.”

There can also be great variation from hospital to nearby hospital, research shows.

For example, in Los Angeles each of the six hospitals owned by AHMC Healthcare have continued to do episiotomies in more than 29 percent of vaginal births, according to state data. And two of the institutions — Garfield Medical Center in Monterey Park and Whittier Hospital Medical Center in the city of Whittier — have episiotomy rates close to 60 percent. Representatives of the chain and its hospitals didn’t return repeated calls and emails requesting comment.

Meanwhile, Kaiser hospitals in Northern California have seen huge reductions in the use of the procedure since the Oakland-based managed care organization undertook an intentional effort to address overuse.

Dr. Tracy Flanagan, director of women’s health and maternity at Kaiser Permanente in Northern California, says her office began examining episiotomy rates at different hospitals four or five years ago. They first looked at rates at the hospital level, then at the physician level, she says, and found ” a lot of variation.”

They first sent the data to the individual hospitals. Then, doctors at each hospital who rarely performed episiotomies were asked to educate their colleagues about the appropriate use and relative risks of the procedure.

Physicians tend to respond best if other physicians present them with a compelling argument to change their ways, Flanagan says. Reliable data, transparency and peer-to-peer education, she adds, is a good recipe for narrowing variation.

The average episiotomy rate for the Northern California Kaiser hospitals is now about 3 percent, Flanagan says.

Zero percent would be too low, she adds; in some cases — if a baby’s shoulder is stuck, for instance, or the infant’s heart rate drops, or if the mother is exhausted and wants an episiotomy — the procedure’s use is warranted.

Dr. Elliott Main, medical director of the California Maternal Quality Care Collaborative and a clinical OB-GYN professor at Stanford University, says the episiotomy data offer a lesson in how quickly practices can change. This evidence also highlights the hospitals where doctors refuse to alter their ways, he says.

In the case of C-sections, doctors may be motivated to perform the procedures because they allow for faster deliveries or better pay, Main says. But the main reason some doctors still perform too many episiotomies is probably that they always have done so — in some cases for decades.

“It is always hard for people to relearn,” Main says.

His organization is leading an effort to provide doctors and hospitals with data on certain childbirth practices, to show them how they compare with their peers around the state. Beginning in 2010, the group partnered with the March of Dimes to educate providers about the dangers of elective delivery prior to 39 weeks. Within three years, that practice had dropped off rapidly, he says. The organization is currently undertaking similar efforts related to C-sections.

Chavira, the maternal and fetal medicine specialist at California Hospital in Los Angeles, says he would like to see similar transparency with data on episiotomies.

“If you have a hospital where people are doing 5 percent episiotomies and one guy is doing 60 percent episiotomies, all of a sudden he sticks out like a sore thumb,” Chavira says.

A lot of women don’t want the procedure, Chavira notes, and doctors are supposed to honor their patients’ wishes.

In June, a Superior Court judge in Los Angeles County ruled that Turbin’s lawsuit against her former obstetrician can go to trial in the fall. Meanwhile, Turbin says she is terrified of getting pregnant again.

“If I go back to that day, there’s nothing I could have done,” she says. “That doctor was going to cut me, no matter what.”

Kaiser Health News is an editorially independent news service that is part of the nonpartisan Henry J. Kaiser Family Foundation. (Kaiser Permanente has no relationship with Kaiser Health News.)

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