Health officials say teenagers are using e-cigarettes at epidemic rates. Lawmakers in a number of Midwest states, like Indiana, Illinois and Minnesota, are addressing the problem and so is the FDA.

We spoke with Mitch Zeller, director of the agency’s Center for Tobacco Products, about efforts to curb the use of smokeless tobacco among youth.

Mitch Zeller, J.D., Director, Center for Tobacco Products CREDIT FOOD AND DRUG ADMINISTRATION

Araceli Gomez-Aldana: Mr. Zeller ,you have stated your biggest goal this year is to reduce diseases and death from tobacco, what are your plans to achieve that goal?

Zeller: Overall tobacco use, unfortunately remains the leading cause of preventable diseases and death in the United States. This is cigarette use, smokeless tobacco use and what we are launching now is an expansion of our smokeless tobacco youth prevention campaign aimed at the most vulnerable and at risk teens. That’s teenage boys growing up in rural communities around the country. We have a national smokeless tobacco usage rate for teenage boys of just under 9 percent. In Indiana it’s almost double, it’s 15.7 percent based upon the last data that we saw. It’s nothing short of an epidemic when it comes to teenage boys growing up in rural communities in states like Indiana. And the tagline of the campaign is simple ‘Smokeless doesn’t mean harmless.’ Too many boys are walking around thinking, ‘Well I’m not smoking a cigarette, I see my dad dipping, I see my uncle dipping.’ It’s a rite of passage and they don’t think about the health consequences.

Gomez-Aldana: What are some of the challenges you are facing when it comes to electronic cigarettes and youth?

Zeller: Not only do kids not know what the nicotine content is of e-cigarettes, there’s a whole bunch of teenagers walking around, at least based upon the survey data, not even knowing that nicotine is present because they harshness of the nicotine is masked by the flavors. So nationally we have an epidemic of e-cigarette use amongst teens and this is another one of the FDA’s major priorities when it comes down to how we can use the dollars that we have to invest in paid advertising to get the word out to those who are at greatest risk.

E-cigarettes are by far the most popular category of tobacco products with 12 to 17 year olds nationally. When it comes to teenage boys living and growing up in rural communities the problem is smokeless tobacco. We are also going to have an effort focusing on reducing the number of boys that become smokeless tobacco users. But we need to do all of this together; it’s a concerted effort. In their efforts to try and curb the use of e-cigarettes among youth, the FDA is partnering with Scholastics to educate children and teens about nicotine addiction. They are also providing information for all ages on their “The Real Cost Campaign” website.

This story was produced by Side Effects Public Media, a news collaborative covering public health.

After more than 20 years, an early tool of genetic engineering in crops is doing more than just killing pests. It’s providing environmental benefits, too, according to a new study in the journal Biological Control.

Genetically engineered seeds inserted with proteins from soil bacteria called Bacillus thuringiensis (Bt) take on the proteins’ insect-killing powers. Crops grown from those seeds are then protected from a specific pest, for example, a corn seed that won’t get devastated by the European corn borer.

In reviewing hundreds of studies, researchers say Bt seeds also lead to less insecticide being sprayed.

“Because we can now control certain major pest insects in the crop through this gene being expressed in the plant, that eliminates largely the need to spray insecticides to do the same job,” according to entomologist Steve Naranjo of the U.S. Department of Agriculture’s Arid-Land Agricultural Research Center in Maricopa, Arizona.

He added that when insecticides are sprayed on Bt crops, they are typically used less frequently and in a more targeted manner, meaning beneficial insects and spiders are spared.

Bt crops have been grown on more than 1 billion acres worldwide. Naranjo said another ancillary effect is that many fields planted with traditional seeds that are adjacent to ones with Bt crops have also seen a reduction in problem pests.

“The economic benefits were as great for people who didn’t buy the technology as those who did,” Naranjo said, “in terms of controlling that insect pest.”

But Naranjo and other entomologists caution that insects are adaptable and can develop resistance to even the best tools.

“Eventually, over time, I think the insects will win,” said Iowa State University entomologist Erin Hodgson, who was not involved with the study. “In some cases, like corn borer, it has worked really well. In other cases, like corn rootworm, it hasn’t held up as strongly.”

Hodgson recommended that farmers continue to use an integrated crop management program with genetically engineered seeds, crop rotation and targeted uses of insecticides.

Overall, she said the correlation between Bt seeds and reduced dependence on broad spectrum sprayed-on insecticides also helps pollinator health because it results in less upheaval to the natural ecosystem.

And it may benefit humans as well.

“I’d personally rather eat, like, a sweet corn that has Bt than that has been sprayed 10 times with a synthetic insecticide,” Hodgson said. “I feel like it’s better for my health, too.”

Follow Amy on Twitter: @agamyinames

Copyright 2019 Harvest Public Media. To see more, visit Harvest Public Media.

Crumbling sidewalks, gas line failures and cracked concrete — the problems at Brookfield Zoo are a metaphor for what’s wrong with public infrastructure throughout Illinois.

As lawmakers begin negotiating a statewide spending plan to fix it, the zoo is among a growing list of those coming to Springfield with their paws out.

The Chicago Zoological Society, the nonprofit that runs the zoo, is asking state lawmakers for help rehabbing and improving its facilities from a promised capital plan.

“The more we receive from the state to help repair crumbling infrastructure, the more we’re able to focus on sustaining and expanding our STEM education, conservation education, science, nature, leadership and accessibility programs that directly benefit communities from our region,” Stuart Strahl, president of the Chicago Zoological Society, said at a news conference Wednesday.

They put their infrastructure needs at around $260 million, but aren’t asking for the full amount from the state. Still, without some funding, Strahl said they may have to raise admission prices or cut education programs.

For Illinois, lawmakers have to figure out how to pay for a capital plan, the first in more than decade. They are tight lipped about the possibilities, but past plans have increased vehicle registration fees and sought new revenue from video gambling.

Beyond funding, they need to decide which projects would get the money.

“Transparent and Objective”

There is the state’s own long list of needed infrastructure projects – the interstates that need to be repaved and buildings that need to be repaired.

State colleges and universities have asked for around $2 billion in capital funds for the next fiscal year (PDF). City and county governments and transit authorities will have requests as well.

Then there are community and economic development projects, like the Brookfield Zoo improvements or Democratic state Sen. Andy Manar’s proposal for $50 million for a new Southern Illinois University building in downtown Springfield.

Beverly Bunch, a University of Illinois Springfield public administration professor, said there are two schools of thought for divvying up capital spending: give each lawmaker a pot of money and let them select the most needed projects in their district, with the assumption that local officials know their district best; or create a statewide system for assessing and ranking projects to decide which will get money.

“In reality, it’s something in between the two,” she said.

And that seems to be the case for this year’s capital plan.

The governor’s transition team for infrastructure called for a “transparent and objective project prioritization” in its report released last week.

“I heard loud and clear from planning agencies throughout the state that we should do this on a needs basis, some kind of an assessment to put in place to make sure that the needs of the declining infrastructure are met,” said state Rep. Jay Hoffman, a Belleville Democrat and a co-chair of the committee.

“And new projects are assessed on a basis of whether or not they’re really needed for growth in areas or for other reasons, like safety.”

State agencies, like the departments of Transportation and Natural Resources and the Environmental Protection Agency, will have a role in assessing needs, Hoffman said. But legislators will have to make their cases, too.

“What you’re going to have to do is you’re going to have show that some of the needs of people in their district, whether it’s a road or a bridge or school, are being addressed,” Hoffman said.

The transition team’s report also said the plan should prioritize projects that drive economic growth as well as ones that address health and safety risks, such as water contamination and deficient bridges.

Bunch said those types of arguments can be subjective.

On top of that, state leaders have to take into account getting enough votes to approve a big piece of legislation that will likely include some unpopular ways to pay for the projects, such as raising fees or taxes.

“You’d like to think statewide, we’re looking at what are the highest priorities, but [lawmakers] also tend to look at what it’s going to take to get the bill through,” Bunch said.

The last major capital plan, the $31 billion Illinois Jobs Now! Act (PDF), was signed by then-Gov. Pat Quinn in 2009. Two-thirds went to transportation related projects. Another several billion went to K-12 and higher education facilities, and environmental and economic development projects.

Several hundred million dollars was earmarked for community development projects, including $17 million for Brookfield Zoo.

Brookfield’s Case

Chicago Zoological Society President Stuart Strahl outlined some the infrastructure problems the Brookfield Zoo is experiencing. CREDIT MARY HANSEN / NPR ILLINOI

Richard Gamble, the chief operating officer for the Chicago Zoological Society, said the money from 2009 resulted in $51 million in economic activity.

“Additional funding will help build new exhibits that inspire conservation, help expand free admission programs for those from under-resourced communities and allow for greater outreach and communities for years to come,” he said.

Brookfield Zoo does have friends at the statehouse. State Rep. Kathleen Willis, an Addison Democrat, said she appreciates the educational programs that serve schools in her district.

“Brookfield Zoo is something that everybody throughout the entire state benefits [from],” she said. “So it’s not just strictly for the district that the zoo is housed in.”

Lawmakers will likely hear similar arguments for projects as the capital plan negotiations continue. They’ll get input from the public as well.

The Senate Transportation and Appropriations committees announced last week they will hold joint public hearings on a capital plan around the state in the coming weeks. Dates and venues have not yet been announced.

One page from the letter, which fills six frames. CREDIT STEPH WHITESIDE/WSIU

Dr. Don Arnold’s home office overflows with medical textbooks, old anatomical prints and six pages of a recommendation letter from his first application to medical school – framed and hanging on the wall.

“It says I have very unique and viable talents that would serve me well, but on paper a very poor academic record,” he says. “So this is code. For those who don’t know. Nobody’s going to outwardly tell you not to take a person, but this is how they write it in code.”

Despite the less-than-stellar recommendation, Arnold, who is black, did eventually get into and graduate from medical school. Today, he is chief of surgery at Herrin Hospital, just outside of Carbondale, Illinois. Getting there wasn’t easy.

In 2018, fewer than 4 percent of incoming medical students in Illinois were black men. It’s a concerning statistic as research suggests a lack of diversity among physicians could negatively impact health outcomes in their community. The roots of this problem are deep. But medical schools and even health insurers in Illinois are taking steps to address the problem. Next month, a summit in Chicago will bring together medical providers to talk about improving physician diversity.

Educational Barriers Start Early

Arnold says the recommendation letter was far from the first challenge he faced while becoming a physician. During high school, his mother, frustrated with how quickly he finished his homework, suggested he enroll in advanced physics. The school at first said no – although they did eventually allow him in the course.

His story isn’t unique. African-American students are less likely to enroll in advanced classes than their white counterparts, especially math and science, which are critical for future medical careers. In Illinois, black students make up 17 percent of the student population – but just 7.8 percent of AP students.

Jonathan Tyes holds a bear a friend gave him to remind him of his goals. CREDIT STEPH WHITESIDE/WSIU

On top of that, minority students tend to be concentrated in higher poverty areas. That means less funding for schools, which tend to be lower performing.

That’s something Jonathan Tyes, an aspiring medical school student, realized when he arrived at Morehouse College in Georgia. Tyes grew up in Ohio before attending the historically black college. He graduated from his public high school near the top of his class.

“Getting to undergrad at Morehouse, I realized how behind I really was,” he says. “Because I was competing with students who had been at private schools, and so they were testing into classes three classes past any math class I had to take.”

A Financial Stretch

Education isn’t the only hurdle to cross. There are financial hurdles as well. Simply applying to medical school costs thousands of dollars.

“It was hard for me to afford the testing at each level in this whole process, which is another reason I think you don’t see many African-Americans,” Arnold said. “You know, some of these exams, my mother wouldn’t pay bills so I would have money for the exams.”

The wealth gap in America is significant. As of 2016, African-American families had a median net worth of less than $18,000. Compare that to white families, whose median wealth came in at $171,000.

Arnold’s recommendation letter also noted that he faced financial challenges while in college, which could contribute to poor academic performance. Tyes, a first-generation college student, was also helping care for his nine younger siblings and aging grandparents.

Once enrolled, the average medical student graduates with nearly $200,000 in debt. Residency and fellowship applications cost additional money – all before a physician starts working.

In a highly competitive process where students often apply to 15  or more residency programs in hopes of getting in, Arnold was constrained by finances. He only applied to three.

“I had three interviews. I could only afford to go to two,” he says.

Creating Change

MEDPREP courses help students prepare to apply for medical school. CREDIT STEPH WHITESIDE/WSIU

Tyes is involved in the MEDPREP program at Southern Illinois University Medical School. The post-college program helps academically disadvantaged students improve their performance before applying to

medical school. Arnold attended a similar program in Chicago.

But programs like that can only serve a limited number of students.

Insurer Blue Cross Blue Shield is looking for other ways to increase diversity among physicians with a summit in Chicago in March. It will bring together medical schools, providers, and philanthropic organizations. One focus will be the pipeline to medical school that starts as early as elementary school.

Dr. Derek Robinson, chief medical officer for Blue Cross and Blue Shield of Illinois, acknowledges it’s an unusual topic for an insurer to address. But he says the costs of health disparities provide a business case for increasing physician diversity.

“This [is an] opportunity for us to help focus some attention on ensuring that we’re delivering a workforce that is best prepared to care for the growing, diverse population that we have both in the state and generally across the nation,” he says.

Addressing costs could also improve healthcare outcomes. Black men are more likely to suffer from chronic illness than their white counterparts. They’re more likely to die of heart disease or prostate cancer.

Research shows that black men are more likely to have preventative care done if their physician is also an African-American man. And that could reduce cardiovascular deaths.

It is, Robinson admits, a long-term goal and one that will take years to achieve.

But Arnold says students should have hope – he knows from experience that hard work and perseverance can go far.

“I’m nobody special. I didn’t come from it, it wasn’t given to me. I’m nobody but a person who had a dream and a person that persevered to achieve it,” he said.

Increasingly, sports teams, especially in the NBA, are hiring “sleep coaches” to help players. This follows research that good sleep can be as beneficial as performance-enhancing drugs.

Getting enough sleep can be difficult for professional athletes, especially those in the National Basketball Association.

That’s partly because they travel tens of thousands of miles each season and play at night. They’re essentially working the swing shift.

Robin Lopez is in his 10th season with the Chicago Bulls. Like other NBA players, he plays 82 games in six months. That’s just the regular season. Add team practices, workouts, traveling across time zones, and you’re left with little time for sleep and recovery. So how does he cope?

“I’m a big proponent of naps. Ever since I came into the league, the schedule with shootarounds in the morning and games at night – it really just fosters a culture of naps,” said Lopez.

To combat sleep deprivation, NBA teams are hiring sleep coaches or consultants. The strategy is simple: Quality sleep could equal better performances – and more wins.

To get the best out of its players, the Bulls turn to Chip Schaefer, the team’s director of performance health. He says everyone should pay closer attention to their sleep.

“Then, I think, if people realized how important sleep was – you know, the benefits are really akin to performance-enhancing drugs. And if people realized that, I think that they would pay more attention to it,” Schaefer said.

Dr. Phyllis Zee, a sleep researcher at Northwestern University, agrees that nighttime workers are most affected by sleep deprivation.

“Those two types of shifts [swing and overnight] are associated with the highest risk for long-term metabolic cardiovascular disease and even for substance use,” said Zee.

Shift work is also common for police officers. In Indianapolis, the police department has an entire unit devoted to wellness. Sergeant Aaron Snyder, who heads it, says he always asks his officers how they’re sleeping.

“Forty percent of officers have at least one sleep disorder. About a third of officers are suffering from sleep apnea,” he added.

Snyder says he got sick after switching back and forth from the night shift.

“And my doctor at one point said to me, ‘Aaron, you’re a healthy person. Your background’s in exercise physiology, you know how to eat right, you know how to exercise. This job’s killing you. Slowly, it’s killing you,’” said Snyder.

New sleep technology can help – like watches, rings or phone apps that track sleep activity. The Bulls’ Schaefer says many NBA teams use technology to help players focus on their sleep.

For his players, he recommends a sleep monitor that’s placed under a mattress to track sleep patterns. But getting players to comply is a struggle — and it is technology that also keeps players up at night.

“I’ve had players tell me that they’re up playing video games till four or five o’clock in the morning,” said Schaefer. “It’s just nuts, and all you can do is strongly discourage that and try and educate them.”

Snyder says education is important for him, too, as he travels to police departments across the country to talk about sleep as a component of wellness.

He says the stress and trauma that comes with being a police officer is certainly a problem. But not giving your body enough time to recover can be deadly.

“They will sacrifice their own physical health,” he said. “Either, you know at times an officer will take a bullet for a stranger. Or sometimes it’s slowly by sacrificing their physical and mental health over the span of a 20 year career.”

This story was produced by Side Effects Public Media, a news collaborative covering public health.

Dr. Wanda Thruston and Dr. Barb Pierce are examining what they call a “wicked problem” – helping children deal with trauma and violence. We sat down with the professors from Indiana University Purdue University Indianapolis to discuss their work.

Wanda Thruston, a clinical assistant professor in the Indiana University School of Nursing. CREDIT INDIANA UNIVERSITY-PURDUE UNIVERSITY INDIANAPOLIS

Araceli Gomez-Aldana: How would you define a “wicked problem?”

Dr. Pierce: “A wicked problem is a problem that is kind of intractable or kinda really hard to cope with.”

Dr. Thruston: “It’s severe and persistent exposure to violence. Maybe violence that they see within their families, within their communities or they experience themselves. It could be just disruption in their home. You know a parent gets incarcerated, being a witness to domestic violence, having police cars come past your house every single night and hearing those kinds of sirens. Those kinds of things that create trauma in children.”    

Barbara Pierce, an associate professor in the IU School of Social Work. CREDIT INDIANA UNIVERSITY-PURDUE UNIVERSITY INDIANAPOLIS

Araceli Gomez-Aldana : What are your overall hopes for this project?

Dr. Thruston: “Our hope is that we are able to not only work with the teachers and the children but also inform parents. We want to try to make a change in everybody that touches that child. Change the culture in Indianapolis.”  

Funding from the Robert Wood Johnson Foundation will cover training over the next three years. The ultimate goal is to create a culture of change within schools and focus on the complex health issues faced by large communities.

The project will focus on students in Washington Township’s 12 public schools as well as two charter schools, Indianapolis Metropolitan High School and Vanguard Collegiate of Indianapolis.

This story was produced by Side Effects Public Media, a news collaborative covering public health.

In theory, closing off China’s soybean market due to the trade dispute with the U.S. on top of generally low prices for the commodity should affect all industry players, big to small. Agriculture economist Pat Westhoff begged to differ.

“The impact on total revenue may be very similar across the scale of production,” according to Westhoff, who’s an ag economics professor at the University of Missouri. “But sometimes the effect on net revenue can be very different. So a given price that may be difficult for a large producer can be catastrophic for a small producer.”

In other words, if you’re a farmer who plants only soybeans on relatively few acres, you’re probably in trouble.

Large agribusinesses have worldwide sources and markets in lots of countries, and even medium-sized farmers in the U.S. have diversified enough to stay afloat.

That’s the case for Robert Alpers, a farmer in the central Missouri town of Prairie Home. He farms 4,000 acres, about half soybeans, half corn. But his family also has a 550-head cattle operation and a side business of making and fixing farm necessities equipment like feeding troughs and livestock gates.

The trade war and subsequent rough soybean market has had a negative impact on his family, but those other sources of income and the size of his operation has mitigated some of the pain.

“Our family’s fortunate enough, we’ve got over 300,000 bushels of storage,” Alpers said while taking a break from tending to newborn calves. “So we’re able to hold our crop for a better price. We’ve got livestock, and the corn market has moved up a little, so we have moved some corn on the cash market.”

Alpers said between diversification and the tariff bailout payments from the U.S. Department of Agriculture, he’s in a good spot, but most of his friends and neighbors aren’t as lucky.

They’ll have to make some difficult decisions this year, he said, because farmers don’t suddenly go bankrupt. They start cutting, borrowing more and eventually get in over their heads. And the low prices and lack of market access due to the tariffs are the kind of thing that can get that ball rolling.

Even with his storage, cattle business and corn crop, Alpers said if there’s another round tariffs, he’ll be forced to make tough decisions. But it won’t sink him.

The smallest soybean farmers are most susceptible to the effects of the trade war. CREDIT AMY MAYER / HARVEST PUBLIC MEDIA FILE PHOTO

“This farm has been in my family for almost a century. And we have plans to keep that going,” he said.

Protected by a global reach

Alpers also knows that large agribusinesses, the ones that buy, sell and process soybeans, will be fine.

“The CEOs of the big companies, they’re not sitting there in their offices twiddling their thumbs,” he said, “they’re trying to move product, somewhere.”

Cargill, Archer Daniels Midland, Bayer and even CropLife America, the trade group that represents the industry, declined Harvest Public Media’s requests to comment.

But Cargill CEO David MacLennan told Yahoo Finance in late January that the company has “had to shift supply chains from North America to South America” — buying instead soybeans from Brazil and Argentina.

Those places, Westhoff noted, aren’t in a trade war with China, and are markets that the multinational corporations already work in.

“South American soybeans are going to be capturing a premium in the Chinese market than would they would have had, had it not been for the tariffs,” he said.

Large agribusiness companies are lobbying the Trump administration for an end to the trade war so U.S. soybeans can fully return to the Chinese market. Cargill’s MacLennan specifically said in an January interview with Bloomberg that it’s in his company’s best interests to protect North American farmers.

But as the tariffs continue, how long anyone in the soybean business will be able to last depends on how big they are.

Follow Jonathan on Twitter: @JonathanAhl

Rural hospitals aren’t just providers of medicine and health care, but also are often major employers and a massive part of a town’s tax base. However, mounting challenges are forcing these hospitals to merge and close in droves.

Since 2010, 95 rural hospitals have closed around the U.S., according to the North Carolina Rural Health Research Program, while 380 have merged between 2005 and 2016.

The American Hospital Association wants Congress to do something about it, and recently published a point-by-point overview of all the challenges rural health care systems face and what can be done.

The troubles, according to the report, are a mixture of long-term problems (staff shortages, aging infrastructure), more recent problems (rising drug costs, federal regulation changes) and emerging problems, like the opioid crisis and cyber threats.

“Many rural hospitals, especially those with very limited resources, become overburdened as challenges intensify, accumulate, and compound each other,” the report stated. “Moreover, the issues of today may hinder rural providers’ preparedness for the challenges of tomorrow.”

Those problems are nothing new to David Schreiner, who’s the CEO of Katherine Shaw Bethea Hospital in Dixon, Illinois. He said employee wages and benefits, prescriptions costs and infrastructure upkeep are the biggest costs for his hospital, which was first built in 1897.

“Many rural hospitals especially are (operating) in buildings that were built a while ago,” he said, adding that the costs mount every year and with every change that’s needed to keep up with its aging clientele.

Both Schreiner and the report specifically pointed out how rural hospitals could use more reimbursement for their services. For example, the report states that in 2017, more than half of rural hospital revenue came from patients with Medicaid or Medicare — for which rural hospitals only get reimbursed about 87 cents for every dollar they spend.

Rural patients overall are also older, sicker and poorer than their urban counterparts.

Schreiner said many lawmakers from urban areas don’t understand what’s going on in rural hospitals, and rural hospitals can only shout so loud on their own.

While there’s been expert testimony in U.S. Senate committees and subcommittees in the past few months, the discussions often highlight more differences of opinion than a straightforward set of solutions.

U.S. Representative Cheri Bustos, a western Illinois Democrat, worked with rural health care networks for years before being elected to Congress. Just appointed to the House Appropriations Committee, Bustos said she wants to use her position to make sure rural hospitals have the funding they need.

She looked at the AHA report, and told Harvest Public Media that “it’s deeply concerning to me that nearly 100 rural hospitals have closed just since 2010.”

The report recommends expanding telehealth and health worker training, which Bustos said are “important,’ adding she plans to “work tirelessly to tackle these pressing issues for our rural communities.”

Even though hospitals have faced unique challenges for a while, the report said, “more recent and emergent challenges are exacerbating their financial instability — and by extension, the economic health of their communities.” One example given was the soaring costs of prescription drugs.

Overall, the authors of the report said that it’s up to the federal government to “play a principal role by updating policies and investing new resources in rural communities.”

Follow Madelyn on Twitter: @MadelynBeck8

The U.S. trade war with China has created a financial burden for farmers and companies that import Chinese goods. Consumers, on the other hand, have mostly been spared from the conflict.

That could all change if this month’s negotiations between the U.S. and China don’t go well.

Harvest Public Media’s Grant Gerlock looks at the trade war from a consumer’s standpoint.

An analysis by the New York Federal Reserve estimated consumer prices overall are about 0.3 percent higher than they would be without the tariffs. President Donald Trump wants to narrow the trade deficit and protect American technology, but if there’s no deal by March 1, a 10 percent tariff on thousands of Chinese imports will more than double to 25 percent.

At that point, suppliers and retailers who admit they’ve been absorbing the cost of the tariffs will likely be forced to push the cost toward customers.

“At 10 percent you can come to a very minimal change, at 25 percent it becomes a different deal,” said Irv Blumkin, CEO of home furnishings chain Nebraska Furniture Mart.

Holding back

The largest round of U.S. tariffs against China came in September — a 10 percent import tax was imposed on thousands of products. Many of them are chemicals and raw materials, but the list also includes household items ranging from tools and auto parts to shampoo and cosmetics.

“I can’t stress to you how much companies care about maintaining (price) stability,” said Uche Jarrett, a professor of international economics at the University of Nebraska-Lincoln. “It drives their profit margins. It drives their estimates for the future. Whenever there is a change, there’s a lot of uncertainty that follows.”

When businesses absorb tariffs, Jarrett said, the taxes are less effective; imported Chinese goods are still cheaper than American products.

“The idea is the higher the tariffs, the more you make consumers flip over,” Jarrett said. “But if those prices aren’t changing then you’re not going to get the desired effect that you want.”

Retailers like Nebraska Furniture Mart are bracing for March. Blumkin said a 25 percent tariff is more than suppliers can absorb, so it’ll raise prices for many of his company’s products like carpet and leather furniture.

Manufacturers could move production out of China to countries like Vietnam, Malaysia or Mexico, but Blumkin said there’s a limit to that strategy.

“I mean, China is a powerhouse when it comes to producing things for our industry,” Blumkin said, adding that he is concerned higher tariffs could sour consumer confidence. After the government shutdown and recent stock market volatility, he said shoppers are more likely to hold onto their money.

“You know, they hear the news every day and they see some of the uncertainties that are going on and I think that impacts how people think,” Blumkin said.

Missed shot

Importers are not the only businesses trying to work around the tariffs. Manufacturers whose products are made in the U.S. are trying to manage extra costs that can be traced back to the trade dispute.

Bison, Inc., mostly makes its sports hardware — think soccer goals, volleyball nets and driveway basketball hoops — with steel. CEO, Nick Cusick, said almost all the parts and pieces come from U.S. suppliers.

“Since we compete against a fair number of companies that do buy offshore, you would think we would benefit from (the tariffs),” said Cusick, whose company is based in Lincoln, Nebraska. “We’re supposed to be the winners.”

Instead, after the U.S. announced tariffs on imported steel in March 2018, the price for American steel went up as much as 50 percent, Cusick said. The company had to raise prices for 2019 to cover the cost.

“We passed as much as we thought we were comfortable with without losing market share. But the end users — the schools, the consumers on the residential basketball side of our business — they’re the ones that are getting hit. So it’s kind of counterproductive,” he said.

And depending how the talks go with China, more businesses like Bison may have to bring customers off the sidelines of the trade war and into the game.

Follow Grant on Twitter: @ggerlock

Copyright 2019 Harvest Public Media. To see more, visit Harvest Public Media.

The U.S. trade war with China, now approaching a year, is often framed as hurting manufacturing and agriculture the most. But that’s mainly collateral damage in an international struggle over power and technology that has its roots in the Cold War, when China was still considered a largely undeveloped country.

Intellectual property thefts that were once considered petty are a mounting cost for the U.S. economy — at least $225 billion and at most $600 billion annually, according to a National Bureau of Asian Research report — and China is one the biggest offenders.

The beginnings

President Ronald Reagan talked about the benefits of international free trade throughout his presidency, especially as the Cold War lingered. Many congressional politician hoped opening up trade to markets like China could spread democracy, end Cold War trading blocs and bolster U.S. interests.

“We have begun to write a new chapter for peace and progress in out histories with America and China going forward hand in hand,” Reagan said to a crowd in Beijing in 1984.

It hasn’t worked out like Reagan expected.

“There’s a recognition that although there have been benefits, there have also been costs to the United States from this increased economic relationship with China,” said Aaron Friedberg, a Princeton University professor who’s been watching U.S.-China relations for about 20 years.

China has been strengthening its industries using a top-down model: That is, the communist Chinese government can use its power to carry out specific tasks, he said. For example, it used to require some foreign companies to hand over proprietary information to start working in China.

The opportunity to grow in China was huge, so a lot of companies still made that trade in the 1990s and early 2000s. At that time, Friedberg said Chinese industries were still lagging behind other industrialized nations “so if they were cutting corners and doing things to promote their development of less-advanced industries, I think the feeling (of the U.S. government) was that this didn’t matter so much.”

But China’s growth and laser-like focus on high-tech industries — ranging from cellphones to artificial intelligence — changed things.

According to Friedberg, foreign companies are now less sure they’ll be able to survive in China because “the Chinese are using a variety of methods that we consider to be unfair to promote their own companies to the detriment of our own.

“So, it’s a lot of things that have come together in the last few years that have kind of tipped the balance towards a more pessimistic view of the relationship and pressures to do something to change it.”

A rise in technology, dominance and complaints

While the United States leads the world in high-tech manufacturing, China is a close No. 2, according to the U.S. Trade Representative office, which advises the president on trade. Specifically, China aims to bolster its medical, clean energy, transportation and ag tech sectors, among others — all publicly outlined in its Made in China 2025 initiative.

Countries around the world vie for power in technology sectors, but there’ve been dozens of allegations that China is getting ahead by playing dirty.

To join the World Trade Organization in 2001, China promised that it would no longer force foreign companies to hand over technology or private data to do business there. Still, several companies have told the federal government that this is still a requirement, just one usually spoken aloud in backroom meetings or simply implied.

Cyberattacks tied to China also increased as technology advanced. Coincidentally, many of them were against companies with the kind of technology that China has publicly stated it wants to master.

The Obama administration tried to take China to task, sometimes in lawsuits through the World Trade Organization, and sometimes bilaterally. In 2015, Obama and Chinese president Xi Jinping signed an agreement that neither government would conduct or encourage hacking into private businesses to steal intellectual property. However, a massive federal investigation found that while those attacks may have slowed down, they didn’t stop. Neither did other Chinese tactics, such as direct theft of property like robot arms.

The Trump administration is now going after China more directly. The first major step in the trade war was President Donald Trump putting tariffs on between $50 billion and $60 billion worth of Chinese goods on March 22, 2018; a massive federal investigation about China’s intellectual property theft was published that same day.

Trump could have tried to do this through established World Trade Organization channels, but that could have been a years-long process with uncertain results — and the president was highly critical of the WTO even before taking office.

Ron Kirk was the U.S. Trade Representative for the Obama administration from 2009 to 2013. He said he’s hopeful that Trump’s approach will work, but added group efforts have been shown to be more effective, using allies to pressure China instead of taking the country on alone.

“It is easier for China to comply with a mandate from the World Trade Organization than to say, ‘Oh, the United States came over again and is telling us how to run our economy,’” Kirk said.

Friedberg also said working with allies would help give the U.S. a better chance at forcing China to make significant changes.

“Whatever our complaints about the trade policies of the (European Union) or Japan or South Korea, they pale in comparison to the legitimate complaints we have against China,” he said.

Agriculture’s role

When the Trump administration made the decision to act unilaterally — taking on China without other countries — China retaliated with tariffs on U.S. steel, aluminum and agriculture, targeting Trump’s political base, rural America.

CREDIT U.S. DEPARTMENT OF AGRICULTURE

China hasn’t been making major purchases of American agricultural products for very long. Its middle class began to markedly grow in the 1990s, and that drove a greater demand for meat. More meat means more livestock and a need for more animal feed like soybeans.

By the mid-1990s, Chinese imports of soybeans and soybean consumption spiked, according to the U.S. Department of Agriculture. And China only emerged as one of the top few buyer of U.S. ag goods in the early 2000’s, according to Dave Salmonsen, senior director for congressional relations at the American Farm Bureau.

But as the current trade war has gone on, the AFB and other farm groups across the U.S. have voiced concerns and encouraged the president to find at least some short-term relief for trade as U.S. and China hash out the major issues over intellectual property theft.

Salmonsen believes, though, a larger agreement is necessary. Some ag companies have been subject to possible Chinese cyberattacks and in one case, a Chinese national was convicted of stealing Monsanto and DuPont Pioneer seeds in Iowa.

There are signs the trade war is loosening ahead of an all-important March 1 deadline. China recently agreed to buy 5 million metric tons of soybeans, which is a win for agriculture groups and farmers. However, that’s a modest amount compared to the 30-35 million metric tons China’s been good for in recent years.

Princeton’s Friedberg is concerned Trump may declare complete victory with these ag wins without changing China’s overall approach to getting U.S. intellectual property. And a larger, Chinese-centric market could create fissures in international trade as certain countries start trading in blocs, leading to goods becoming more expensive for U.S. consumers.

That’s “not the end of the world,” Friedberg said. “That’s a little bit more what the world looked like during the Cold War. We’d prefer not to go back to that, but that may be the direction we’re going.”

Follow Madelyn on Twitter: @MadelynBeck8

Copyright 2019 Harvest Public Media. To see more, visit Harvest Public Media.

Two decades ago, Jim Nace was a national ice cream salesman, on cross-country flights 20 days a month. He was on top of the world.

“I had a great lifestyle, lots of money, vacations; I was very caught up in the world I was in,” he said. “And then I got a sore throat.”

His wife, a dental hygienist, saw something that didn’t look quite right. A visit to the doctor confirmed the worst: It was tonsil cancer. Soon after his diagnosis, his company terminated his job.

More people are surviving cancer each year. But as patients face life after treatment, many find the burden of cancer doesn’t end when remission starts. Cancer can cause depression in patients just as the world expects them to celebrate.

“There I was, happy I was going to live but dejected, because I’m not going to have a job,” he said. “I was making a lot of money; I was worthwhile; I was important. All of a sudden, I was an invalid.”

Nace survived, thanks to radical surgeries that opened up his head and cycles of chemotherapy and radiation.

But it took a toll. For Nace, being a salesman and a breadwinner for his wife and children was a big part of his identity. After his cancer was gone, he took a 60-percent pay cut to work at a new sales job. But there was a new struggle: finding out who he was.

A New Identity

A changing sense of identity is one of the reasons former patients struggle with depression and anxiety. An estimated one in five cancer patients has depression. And studies have found cancer survivors die by suicide at a rate of 24 per 100,000 — nearly 1.5 times the general population.

While he never thought about ending his life, for Nace the struggle was especially hard after the disease came back in 2015. That was the year doctors removed a portion of his jaw. He had to learn how speak and eat again.

“I thought, ‘If I’m not able to communicate, and I’m not able to work … I‘m back to not being able to provide,’” he said.

Nace’s new company stood by him through his treatment. He got his voice back and learned to eat by using a feeding tube, a blender and a plunger.

It’s common for cancer to cause physical changes that make people feel disconnected from their bodies: food loses its taste, breasts are reconstructed and weight is lost or gained. The disease can also leave patients with enormous financial burdens and medical debt. Cancer patients are two and a half times more likely to declare bankruptcy than others, according to a 2013 study of Washington patients.

And going back to “normal” life after the support structure of friends and doctors disappears can be lonely and confusing.

‘Just Be Where You Are’

“When the casseroles stop and the flowers stop and the Caring Bridge sites close, for a lot of survivors, that’s when the hardest work might begin,” said Rebecca Palpant Shimkets, an Atlanta-based cancer treatment consultant.

Doctors and patients are often so focused on the end game of eliminating cancer, they sometimes ignore what happens to patients after treatment is done, she said. As a thyroid cancer survivor, she knows that struggle firsthand. After treatment, she spiraled into a months-long clinical depression.

“You have society telling you that you were supposed to pop the cork and drink a glass of champagne, and, ‘Congratulations, let’s celebrate!’” she said. “The last thing I felt like doing was celebrating.”

The way cancer survivors are viewed can also be damaging to certain people, she said. Some people might not necessarily want to be inspiring success stories.

“You don’t have to be the person in the brightly colored t-shirt with the balloons,” Palpant Shimkets said. “Just be where you are.”

The National Academies of Science, Engineering, and Medicine want doctors to start paying more attention to patients’ emotional needs post-treatment.

“Health providers, patient advocates and other stakeholders should work to raise awareness of the needs of cancer survivors [and] establish cancer survivorship as a distinct phase of cancer care,” members from the academy’s cancer policy board wrote in a 2006 report.

Doctors should work mental-health screenings and discussions into follow-up appointments, Palpant Shimkets said.

But just talking about post-cancer depression can be helpful in removing stigma and helping patients know what to expect, she said. Patients, their families and friends should know it’s normal to feel sad and lonely after the cancer’s gone and that they might need help from a professional counselor or psychiatrist.

Finding Help

Companionship also can help ease post-treatment depression. A 2018 study from St. Louis University found people with families and spouses are less likely to die by suicide than single patients.

But for people without families, there are still ways to connect.

“So many people come through our door and say, ‘I’m done with treatment, but I was so busy getting through treatment, now that I’m done, I feel really alone,’” said Dannielle Hodges, program director at the Cancer Support Community of Greater St. Louis in west St. Louis County. The center is a hub for current and former cancer patients and their friends and families.

A large percentage of its members are post-treatment patients, Hodges said. They go to exercise classes, support groups and cooking demonstrations together.

Former patients can help each other. Because members are at different stages of their cancer and recovery, they can offer advice and perspective.

“They just understand that general concept of, ‘Cancer isn’t in front of my eyes right now, but it’s hovering in the periphery all of the time,’” Hodges said.

While experts emphasize that everyone has different needs, most say a patient will need to adjust to a new normal after treatment.

“Initially, everybody wants to get back to where they were before, but the reality is, it will be a new you,” Jim Nace said.

That change can bring a renewed sense of purpose. After cancer, Palpant Shimkets now devotes herself to helping former cancer patients with their mental health.

Nace found a new job, too. But his biggest transformation was rediscovering his faith. A chance run in with football player Kurt Warner at a barbershop soon after Nace’s original diagnosis turned into an impromptu prayer circle after the former Rams quarterback espoused the benefits of worship.

Since then, Nace has become a devout Christian who helps other cancer patients through treatment and beyond.

“The new you sometimes may be better,” Nace said.

Follow Sarah on Twitter: @petit_smudge

At her desk in Greeley, Colorado, Shelly Woods pulls out three thick stacks of manila folders. These files represent dozens of local farmers who’ve applied for safety-net programs, including tariff relief through the Farm Service Agency. While Woods and about 800,000 federal colleagues were furloughed for 35 days, the work piled up.

Now that the FSA office has reopened, she said, these files require her immediate attention and that means missing out on the annual Colorado Farm Show, which she’d been looking forward to.

“Our supervisor said we could (go) if we wanted but I just feel an obligation to get this all done.“ Woods said.

Some of her coworkers spent their unexpected time off tackling home improvement projects or visiting family. But as the breadwinner. Woods said she worried about how she’d support her family without a paycheck. Then she learned of a local bank offering interest-free loans for furloughed federal workers.

“I took advantage of that and that was a godsend because it helped me because I was a nervous wreck to be honest,” she said.

The reopening of the federal government also is a relief to farmers who were without access to resources like the market facilitation program. The Trump Administration program, via the U.S. Department of Agriculture, offers direct payouts to help people who grow crops like soybeans, cotton and corn recoup their losses due to the ongoing trade war with China.

Employees at the Farm Service Agency in Greeley, Colorado, are sifting through the work that piled up during the recent government shutdown. CREDIT ESTHER HONIG / HARVEST PUBLIC MEDIA

Ron Farmer of Greeley grows corn, and said he couldn’t sell his grain until the government reopened, because he needed to report to the FSA how much he’d harvested in order to qualify for payments.

“So we were waiting to report our bushels, which is what I’m in here doing today,” he said.

On Jan 8, the U.S. Department of Agriculture announced they’d be extending the application period until Valentine’s Day; the original cutoff date had lapsed during the shutdown.

Farmer said he’d been through several shutdowns but none that ever lasted this long.

“It’s been an ornery situation for everybody to have to deal with,” he said.

According to the FSA office staff, January is typically a slower month for the agency; the visitor’s log lists just five names since they reopened Monday. It’s in the spring when they see more activity as farmers put crops in the ground.

Diane Pierson, who manages an FSA program for crop disasters, said only a few programs were interrupted. Had the shutdown stretched into March, she said, farmers would have been unable to report their annual sales.

“(It) could have become an issue, which it still can if we close down again,” she said.

Congress and President Donald Trump need to strike a deal before Feb. 15, at which point the stopgap funding bill expires. If they’re unsuccessful, federal workers could be furloughed and farmers would again be without their assistance.

Follow Esther on Twitter: @estherhonig

Illinois could save millions of dollars on incarceration costs if the federal ban on Pell Grants for inmates was lifted, according to a new report from the Vera Institute of Justice. Pell Grants are awarded to low-income undergraduate students to help them pay for college. The report, called “Investing in Futures: Fiscal Benefits of Postsecondary Education in Prison,” cites numerous economic and other benefits to states across the country if prisoners were able to apply for and receive federal Pell Grants.

Inmates, who had previously been eligible, were barred from receiving Pell Grants under the 1994 Violent Crime Control and Law Enforcement Act signed into law by then-president Bill Clinton. The federal government estimates that about 23,000 incarcerated people lost access to Pell Grants.

Since then, research has shown that more education behind bars reduces recidivism rates and saves states money on incarceration expenses. Under the Obama administration, the U.S. Department of Education introduced the Second Chance Pell Pilot Program, which provided Pell Grants for about 12,000 inmates nationwide. The report from Vera, however, estimates that almost half a million incarcerated people would qualify for the grants if the federal ban were lifted — including roughly 16,000 potentially eligible Illinois inmates.

Currently, only about 9 percent of inmates participate in some form of post-secondary education while behind bars, and only 2 percent earn an associate’s degree while incarcerated, according to report.

The report estimates that Illinois could save between $8 million and $26 million annually on incarceration costs if the Pell Grant eligibility were restored to inmates. The report also estimates that earnings for inmates are likely to increase once they’re released from prison, and more education for those who are incarcerated will translate into lower crime rates after they return to society. The report also argues that businesses will have a more educated pool of applicants to choose from if more inmates are able to enroll in college while in prison.

Margaret diZerega, one of the co-authors of the report, is hopeful that Congress will eventually reinstate Pell Grants for prisoners. She said the concept has bipartisan support, and increasing interest among those advocating criminal justice reforms.

“There’s support for this. I think there’s a lot of interest from employers in thinking about how to have more people with the skills they’re looking for. If we can provide access to these opportunities, I think many people will benefit from them,” she said.

Key facts from the report:

• 64 percent of people ages 18-74 incarcerated in federal and state prison had, at most, a high school degree or equivalent in data collected between 2012 and 2014.
• The majority of incarcerated people are academically eligible to advance to post-secondary level courses.
• The report estimates that expanding access to education in prison would result in a $45.3 million increase in combined earnings of formerly incarcerated workers during the first year after release.
• The report estimates that more access to education will result in decreased recidivism rates. The decrease in recidivism is projected to save states a combined $365.8 million per year on incarceration costs.

This story was produced by Lee V. Gaines with support from the Education Writers Association Reporting Fellowship program.