Though it seems like members of our collective society can rarely agree upon anything these days, the subject of worsening mental health in our young adult population is not one where there is a lack of consensus. The COVID-19 pandemic did not cause the problem, it simply made it worse. Prolonged isolation, virtual learning, and financial instability were all contributing factors.

A recent youth poll from the Harvard Kennedy School Institute of Politics found that greater than 70% of young adults interviewed believe that there is a mental health crisis in this country. Approximately a quarter of the young adults surveyed reported having attempted suicide. Furthermore, 26% of respondents report that they know someone who has died by suicide.

To some, these numbers may not produce a visceral effect as it does to me. Over the past several months, a couple of our local universities have experienced student deaths because of suicide. The overall number of deaths may seem small, but one is too many. 

Our young adults are dealing with the pressures of social media. Portrayed virtual lives appear to be so perfect. Young people witness the happy couples, the latest expensive tennis shoes, the hip, new Tik-Tok dance or challenge, and every other manufactured lie on the web. These virtual traps place an overabundance of stress on these young people whether they can identify it or not. Additionally, young people also share their thoughts about not wanting to live any more on these media platforms which can lead to copycat behavior in their peers. 

Recognizing depression and anxiety early could be lifesaving to individuals who believe that all hope is gone, and they have no way out. Speaking up about mental health concerns has been an issue in the black community for years. Our community is notorious for keeping family secrets and for promoting the “keep the family business private” concept. This behavior is extremely dangerous because it impedes individual and family healing.

Hosea, chapter 4:6 states that “my people are destroyed for lack of knowledge.” Our bodies are not compartmentalized, meaning you cannot separate your mental health from your physical and spiritual health. You are one living and breathing vessel that was fearfully and wonderfully made. Therefore, when you are not well mentally, your physical body will also suffer, causing you to experience all types of ailments that may mirror a variety of other diseases.

Often when you are depressed, your appetite changes. Some people may overeat while others may eat at all and begin to lose weight. Sleep is also affected. I have patients who tell me that they just stay in bed all day. They feel tired and sluggish. Some depression sufferers report headaches, abdominal pain, and diarrhea. I have had patients want to pursue an entire GI work-up when the issue was simply their depression or anxiety. 

The statistics tell it all. More young people are suffering from depression and anxiety. In addition, suicide rates are also up. Per the Centers for Disease Control and Prevention (CDC), from 2007 to 2018 suicides among young people and children aged 10 to 24 rose 57%. These rates are quite alarming and should cause all of us to pause and reflect upon what we will do differently to address these concerns. 

Our language around mental health needs to change. Our behavior towards people suffering with mental health conditions needs to change. Our sole reliance on friends and the church and not a mental health professional needs to change. Please hear me clearly. I am not saying you cannot seek counsel with your trusted pastor or priest. However, if that individual is not a licensed mental health professional, your treatment is incomplete. Please go back and refer to Hosea 4:6. 

This pandemic has revealed the fragility of our communities. But one thing I am proud of is the fact that we are a resilient people. How else could we have survived slavery and the Jim Crow era? Therefore, let’s buckle up and do what we need to do to help improve the mental health of our communities. 

If you feel suicidal or are in a crisis situation, and need immediate assistance, please call 1-800-273-TALK.

Dr. Denise Hooks-Anderson

Photo by Jennifer Sarti

Denise Hooks-Anderson, M.D., FAAFP is SLUCare Family Medicine interim assistant dean of Diversity, Equity, and Inclusion and an associate professor.

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Kate becomes patron of organisation working to support mental health of mothers

The Duchess of Cambridge has said no mother is “immune to experiencing anxiety and depression” as she became patron of a “fantastic organisation” supporting the mental health of women.

Kate said it was crucial for those “struggling” to be given the “right support at the right time” and also urged society to play its part, saying everyone needed to help “parents and carers, and all those who are raising children today”.

Her words were spoken in a video message recorded to mark her new role as patron of the Maternal Mental Health Alliance (MMHA), announced during Maternal Mental Health Awareness Week, which ends on Sunday.

The MMHA is a UK-wide charity and network of more than 100 organisations, working to ensure women and families affected by perinatal mental health problems have access to high-quality comprehensive care and support.

The duchess said in her video, the message of the week was about the “power and importance of connection” and how the past two years had reminded everyone about the role of relationships in long-term health and happiness, especially at the start of life for infants.

She added: “But we all know that pregnancy, childbirth and the first months and years of a child’s life can be hugely demanding. Parents often feel lonely and overwhelmed by these early years.

“Around 20% of women in the UK are reported to experience perinatal mental illness. Sadly, we also know that many more are suffering in silence. No one is immune to experiencing anxiety and depression during this time.

“It is crucial, therefore, that all those who might be struggling are given the right support at the right time, so that they’re able to share these feelings without fear of judgment and can access the information, care and support they need to recover.”

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WEDNESDAY, May 4, 2022 (HealthDay News) — For patients with moderate-to-severe atopic dermatitis (AD), abrocitinib is safe and efficacious regardless of prior response to dupilumab, according to a study published online April 15 in the Journal of the American Academy of Dermatology.

Vivian Y. Shi, M.D., from the University of Arkansas for Medical Sciences in Little Rock, and colleagues examined the efficacy and safety of abrocitinib (200 or 100 mg once daily) in a phase 3 extension among patients with moderate-to-severe AD who had received prior dupilumab.

The researchers found that among prior dupilumab responders, 93.5 and 90.2 percent of patients who received 12 weeks of abrocitinib 200 and 100 mg, respectively, achieved ≥75 percent improvement in the Eczema Area and Severity Index (EASI-75); and 89.7 and 81.6 percent, respectively, achieved ≥4-point improvement in the Peak Pruritus Numerical Rating Scale (PP-NRS4). Among nonresponders to prior dupilumab, EASI-75 was achieved in 80.0 and 67.7 percent of those receiving 200 and 100 mg abrocitinib, respectively; PP-NRS4 was achieved in 77.3 and 37.8 percent, respectively. Nasopharyngitis, nausea, acne, and headache were the most common adverse events reported among abrocitinib-treated patients. Conjunctivitis occurred less often with abrocitinib than with dupilumab.

“The proportion of responders with abrocitinib was generally higher among prior dupilumab responders; however, prior nonresponse to dupilumab did not preclude a substantial proportion of patients from achieving efficacy responses with abrocitinib,” the authors write.

Several authors disclosed financial ties to pharmaceutical companies, including Pfizer, which manufactures abrocitinib and funded the trial.

Abstract/Full Text

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The Jackson County Department of Public Health announces a new Healthy Living Support Group. This support group is intended to offer a safe space to process feelings and experiences of individuals striving to implement healthy habits.

The group will offer educational and supportive strategies to assist in living a healthy lifestyle, but is not intended to diagnose, treat or provide healthcare for any specific medical condition.

This group will be facilitated by Ruhamah Caulkins, RD, MHS. The facilitator and participants will address topics such as healthy meal planning, physical activity, stress management, healthy coping skills and other topics of interest to the participants.

There are many benefits to attending a support group. Participants will have the opportunity to learn coping strategies to deal with the challenges of implementing healthy lifestyle changes. Individuals can grow personally through shared experiences.

Support groups offer the accountability some find helpful in sticking to their personal goals. This experience will give participants time to focus on self-care. Also, as society is gradually coming out of the pandemic, support groups can help participants feel less isolated. 

The group will begin meeting monthly on the first Fridays of the month beginning this Friday from noon until 1 p.m. There is no cost for attending the group. However, participants will need to register by calling 587-8245.

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One of the best things Black women can do for their health may be to get a college education, according to results of a national analysis.

“Essentially what this study observed was that for Black women, the higher your education level, the lower your allostatic load,” says Dr. Justin Xavier Moore, epidemiologist at the Medical College of Georgia and Georgia Cancer Center, referencing the impact the wear and tear of chronic stress and life have on the body and health.

Investigators led by Moore looked at data on 4,177 Black women ages 18 and older from the National Health and Nutrition Examination Survey, or NHANES, collected between 1999-2018.

While Black women have generally been shown to have higher allostatic loads than other race-gender groups, including Black men, higher education appears to help reduce their load, Moore and his colleagues report in the journal BMC Women’s Health.

High allostatic load is considered to have a broad, negative impact on the body including accelerating aging, memory decline and increasing the risk for top killers like cardiovascular disease and cancer.

The investigators found that Black women with a college or higher degree had a 14.3% lower prevalence of high allostatic load compared to their counterparts with less formal education; an 18% lower prevalence when compared to those with less than a high school education.

Women with higher education represented nearly 18% of the women in the study overall. In general, they also had a lower number of pregnancies, fewer reports of depressive disorder, fewer smokers and a lower mean waist circumference. They also reported fewer health problems like chest pain and heart attack.

Even controlling for age, poverty status and underlying chronic diseases, the investigators found that Black women without a college degree had a higher prevalence of higher allostatic load.

Even women who report high racial discrimination rates have lower allostatic loads if they have more formal education, the investigators write.

Others have shown that Black women with lower levels of formal education have higher levels of the stress hormone, epinephrine, or adrenaline, and a larger waist circumference but few studies have looked specifically at educational attainment, rather included education more broadly in the context of socioeconomic status, Moore says.

Their study does not say that education causes a low allostatic load, it says they are associated, Moore notes.

Their findings do further confirm that higher education is a social determinant of health, Moore says, which the Centers for Disease Control and Prevention defines as “conditions in the places where people live, learn, work and play that affect a wide-range of health and quality of life risks and outcomes.”

For the study, allostatic load was defined as the total of abnormal measures of eight indicators of health that include top and bottom blood pressure numbers, total cholesterol and triglyceride levels in the blood, body mass index, or BMI, (height to weight ratio), glycosylated hemoglobin levels (higher levels indicate a higher blood sugar level, a risk for diabetes), blood levels of creatinine (an indicator of kidney function) and albumin (an indicator of kidney and liver function as well as inflammation and infection).

They examined a broad array of health data like age of onset of menses, number of pregnancies and bouts of depressive disorder, smoking status and diagnosed physical illnesses like cancer and heart failure, as well as factors like income.

More study is needed to further explore issues like the specific degrees the women obtained and the overarching issue of how more education might mitigate allostatic load. That includes further exploring issues like the “superwoman schema,” often attributed to Black women, which reportedly can both positively and negatively affect their health as they strive to put a strong front to the world and sacrifice to help others.

“If we really want to understand why this is happening, then we need to do cohort studies where we follow people over time,” Moore says, assessing biomarkers at the onset and then over time put together which factors contributed to a high allostatic load.

Hypotheses could include because the college-educated women likely have higher incomes, they have health insurance and can more likely pay to see a mental health professional if they need help dealing with their stress, Moore says. You may also be more likely to have a place and the time to go for a walk or run to release stress, he says, while a lower socioeconomic status means less options in terms of coping. “If you have a lower income, you may barely be able to afford anything. You are just trying to make it from day to day. You don’t have the money, or time or ability to get to the resources,” Moore says.

Moore was a coauthor on a paper published in the International Journal of Environmental Research and Public Health this year that also found Black men with college degrees have a lower prevalence of high allostatic load than those with lower levels of educational attainment.

In a study published last year in the journal Preventive Medicine, Moore and his colleagues used the same data source, NHANES, to look at allostatic load over 30 years in 50,671 individuals and found adults age 40 and older had more than a twofold increase over that period, and that regardless of the time period, Black and Latino adults has an increased risk of a high allostatic load over their white counterparts. Black and Latino women had the highest allostatic scores. “At age 20, their allostatic load was comparable to their 30-year-old counterparts,” says Moore, a trend that persisted throughout their life course.

NHANES is a CDC program that uses physical examinations and interviews to assess the health and nutritional status of adults and children in the United States.

The research was funded by the National Institute on Minority Health and Health Disparities.

Source:

Medical College of Georgia at Augusta University

Journal reference:

Williams, B.M., et al. (2022) Examining educational attainment and allostatic load in non-Hispanic Black women. BMC Women s Health. doi.org/10.1186/s12905-022-01641-0.

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Health officials are investigating at least 30 cases of severe hepatitis in children across 10 US states. The Minnesota Department of Health received two reports of severe hepatitis, one in an infant and another in a 2-year-old, the Associated Press reported on Saturday. One child was treated “several months ago” and required a liver transplant, according to the article. 

Worldwide cases surpass 200, including 34 cases in the United Kingdom, the UK Health Security Agency announced last Friday. Most cases have occurred in the UK, but there have been more than 55 probable and confirmed hepatitis cases in children in 12 countries in the European Union or the European Economic Area. Cases have also been identified in Asia, with both Japan and Singapore reporting one case each of acute hepatitis, Bloomberg reports. Additionally, three children in Indonesia died from acute hepatitis last month, but the total number of cases in that country was not available.

Although the total number of worldwide cases remains small, the severity of the cases — as well as their unexplained cause — have health officials on alert, said David Lee Thomas, MD, MPH, of the Viral Hepatitis Center at Johns Hopkins Medicine in Baltimore. “There are some kids who would have died if not for liver transplants,” he told Medscape Medical News.

In the United States, the only confirmed cases are in Alabama, where nine patients were admitted for severe hepatitis between October 2021 and February 2022. Beyond the two suspected cases in Minnesota, health officials are investigating at least 19 other potential cases in eight states, according to NBC News: Delaware (1), Georgia, Illinois (3), Louisiana (1), New York, North Carolina (2), Tennessee (6), and Wisconsin (4). (New York and Georgia did not specify the number of cases being investigated.)

Reported cases have occurred in patients aged 1 month to 16 years old. Globally, at least 17 patients have needed liver transplants, according to a World Health Organization alert on April 23. While WHO officials said there has been at least one death globally linked to hepatitis, that does not include the three deaths in Indonesia. One death has also been reported in Wisconsin, but the state’s Department of Health Services did not confirm whether this death was included in the WHO announcement.

The cause of these severe hepatitis cases has yet to be identified, but these cases have tested negative for more common viruses that can cause hepatitis in children. There is no link between these cases and COVID-19 vaccination, according to WHO, because most affected children have not been vaccinated.

Adenovirus is a possible contributing factor in these cases, as many of the cases in Europe tested positive for the virus. In an analysis of the nine Alabama cases released April 29 by the Centers for Disease Control and Prevention, adenovirus was detected in the blood samples of all nine children. Five of the nine children tested positive for Adenovirus type 41, which is a common cause of acute gastroenteritis in children. While the six liver biopsies performed showed varying degrees of hepatitis, there were “no viral inclusions observed, no immunohistochemical evidence of adenovirus, or no viral particles identified by electron microscopy,” according to the report. None of the children tested positive for COVID-19 or had a documented history of previous COVID-19 infection.

“At this time, we believe that adenovirus may be the cause for these reported cases, but other potential environmental and situational factors are still being investigated,” the CDC said in a media statement. The CDC added that the report was specific to the nine Alabama cases, and that the agency is working to investigate other potential cases with state and local public health officials.

While the “growing consensus” among experts is that adenovirus could be behind these severe cases, there are many unanswered questions, Thomas added, such as why this strain of adenovirus causes such severe hepatitis, and why the liver biopsies do not show classic signs of viral infection. That information will come as investigations continue, he noted.

“From a provider point of view, if you have a child with an unexplained liver problem, report it to the CDC,” he advised. “Right now, we have to learn more about [these cases],” and that requires more research like the investigations in Alabama, he noted.

For more news, follow Medscape on Facebook, Twitter, Instagram, YouTube, and LinkedIn

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Therapies that can help ease long COVID symptoms

Occupational therapy or low-impact exercise might be the key to relieving long-haul COVID symptoms like extreme fatigue, breathlessness and brain fog, a pair of new studies from Ireland suggest.

The studies reflect two different — in some ways, opposite — approaches to dealing with symptoms that tend to plague long COVID patients.

One study taught long COVID patients through a four-week occupational therapy program how to better manage their fatigue, with an emphasis on energy planning, stress management and sleep hygiene.

Are vegetarian diets healthy for growing kids?

Vegetarian diets are a healthy choice for growing kids — though they may slightly raise the odds of youngsters being underweight, a new study suggests.

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The study, of nearly 9,000 young children, found that those on vegetarian diets were, on average, of similar weight and height as their peers who ate meat. They were also on par when it came to blood levels of iron and vitamin D — which could potentially be harder to get on a diet free of meat, fish and, sometimes, dairy products.

Does race affect the odds of developing multiple sclerosis?

Black Americans are as likely to get multiple sclerosis (MS) as their white counterparts, but rates are much lower among Hispanic and Asian Americans, new research shows.

The findings refute the long-held belief that MS is rare in Black people, according to the study authors. The findings were published online April 27 in the journal Neurology.

Teens used their school mental health services more in 2019

School mental health (MH) service use increased among adolescents in 2019 compared with previous years, according to a research letter published online May 2 in JAMA Pediatrics.

Adam S. Wilk, Ph.D., from the Rollins School of Public Health at Emory University in Atlanta, and colleagues evaluated whether school MH service use increased among U.S. adolescents (aged 12 to 17 years) in 2019. The analysis included data from the National Survey on Drug Use and Health (2009 to 2019; 165,686 adolescents).

***

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The Comprehensive Breast Centers at The Hospital of Central Connecticut (HOCC) and MidState Medical Center are wrapping patients in comfort in the literal sense – and the impact is being felt in more ways than one.

Instead of being asked to wear a standard gown, women who arrive for breast imaging and consultations are given a spa-like robe.

“The whole idea came about because we wanted to go above and beyond and give our patients a warm and comfortable experience,” said Natalie Pelletier, Mammography Manager for HOCC and MidState Medical Center. “Most breast centers don’t offer something like this so we are very proud.”

Women are taking notice. Recent patient satisfaction scores show the robes are well-received and doing exactly what they were intended to do. After a patient wears the robe, it’s picked up by a laundry service, cleaned and then returned for others to use.

“These robes are just one example of the steps we take to help patients feel more supported and encouraged as they complete their routine screenings and are sometimes faced with a cancer diagnosis,” said Camelia Lawrence, MD, Director of Breast Surgery at HOCC and MidState Medical Center. “That high standard of quality care makes a big difference.”

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President Joe Biden toasted the reporters at the packed White House Correspondents’ Association Dinner and received his share of roasting, too. In other Washington news, emails released by a House select committee show Trump administration official did not take public health officials’ advice on guidance for religious services, and limits on health savings contributions are rising.

Bloomberg:
Biden Attends Correspondents’ Dinner As Virus Stalks Washington

President Joe Biden attended the White House Correspondents’ Association Dinner for the first time as commander-in-chief, even as the coronavirus continues to infect those around him. “We’re here to show the country we’re getting through this pandemic,” Biden told the crowd of some 2,600 people at the Washington Hilton on Saturday night, adding all attendees had to be fully vaccinated and boosted. “We have to stay vigilant.” Biden told the room that Vice President Kamala Harris, who spent this week working from her residence after receiving a positive diagnosis, was doing well although she couldn’t attend. White House Communications Director Kate Bedingfield announced on Friday via Twitter that she too had tested positive as the virus advanced further into the president’s inner circle. (Cook, 5/1)

AP:
Sen. Rand Paul Wants To Investigate Origins Of COVID-19

U.S. Sen. Rand Paul promised Saturday to wage a vigorous review into the origins of the coronavirus if Republicans retake the Senate and he lands a committee chairmanship. Speaking to supporters at a campaign rally, the libertarian-leaning Kentucky Republican denounced what he sees as government overreach in response to the COVID-19 pandemic. He applauded a recent judge’s order that voided the federal mask mandate on planes and trains and in travel hubs. (Schreiner, 5/1)

The Hill:
Sen. Bennet Tests Positive For COVID-19

Sen. Michael Bennet (D- Colo.) on Sunday announced that he has tested positive for COVID-19, after cases among his colleagues delayed some Senate business last week. “I am vaccinated and boosted and thankfully experiencing only minor, cold-like symptoms,” Bennet said in a statement announcing his diagnosis.  “I will work virtually while quarantining in Denver according to the guidance set forth by the Senate Attending Physician,” he added. (Beals, 5/1)

On news about the previous administration —

Washington Post:
Trump Officials Muzzled CDC On Church COVID Guidance, E-Mails Show

Trump White House officials in May 2020 removed public health advice urging churches to consider virtual religious services as the coronavirus spread, delivering a messaging change sought by the president’s supporters, according to emails from former top officials released by a House panel on Friday. The Centers for Disease Control and Prevention sent its planned public health guidance for religious communities to the White House on May 21, 2020, seeking approval to publish it. The agency had days earlier released reports saying that the virus had killed three and infected dozens at church events in Arkansas and infected 87 percent of attendees at a choir practice in Washington state, and health experts had warned that houses of worship had become hot spots for virus transmission. (Diamond, 4/29)

The Hill:
House Panel Documents Reveal Trump Officials Overrode CDC On COVID-19 Church Guidance

The House select subcommittee investigating the U.S. coronavirus response released new evidence on Friday detailing how Trump administration officials involved themselves in COVID-19 guidance from the Centers for Disease Control and Prevention (CDC) related to faith-based communities. The CDC had sent guidance for faith-based communities to the White House in May 2020. In an email exchange shared by the subcommittee, administration officials, including then-White House counselor Kellyanne Conway, discussed the proposal and offered edits. (Vakil, 4/29)

Also —

CNBC:
Amid Inflation, IRS Boosts Health Savings Account Contribution Limits

If you’re eligible for health savings account contributions, you can deposit more money starting in 2023, thanks to an inflation adjustment from the IRS. In 2023, you can save up to $3,850 with an individual health insurance plan, up from $3,650 in 2022, the IRS announced Friday. And you can soon contribute up to $7,750 with a family plan, boosted from $7,300.To qualify, you’ll need eligible high-deductible health insurance, with an annual deductible of at least $1,500 for self-only coverage or $3,000 for family plans. (Dore, 4/29)

This is part of the KHN Morning Briefing, a summary of health policy coverage from major news organizations. Sign up for an email subscription.

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According to a report published this week by the American Lung Association, almost half of Americans – 137 million people – are experiencing more days of “very unhealthy” and “hazardous” air quality than in the previous two decades combined.

The Lung Association’s State of the Air report also revealed that 72 million people of color live in counties that received at least one failing grade for ozone and particle pollution.

More than 14 million dwell in areas where health officials doled out failing grades on all three measures.

The report looks at America’s exposure to two types of air pollution: ozone, also called smog, and particle pollution, commonly called soot.

The American Lung Association has issued the State of the Air for 23 years using data analyzed from official air quality monitors.

Officials have pushed the motto that the more you learn about the air you breathe, the more you can protect your health and take steps to make the air cleaner and healthier.

“We’ve seen much better air quality in most areas today than when we started the report. But over the last five years, we’ve seen an uptick, and we attribute a lot of that to climate change,” said Paul Billings, senior vice president of public policy for the American Lung Association.

“We’ve had some of the hottest years on record – creating dry conditions that lead to drought and wildfires,” Billings stated.

State of the Air 2022 shows that an “unacceptable number of Americans are still living in areas with poor air quality that could impact their health,” said Harold Wimmer, American Lung Association president and CEO.

“More than 137 million Americans live in counties that had unhealthy levels of particle pollution or ozone. In addition, communities of color are disproportionately exposed to unhealthy air.”

The report also found that people of color were 61% more likely than white people to live in a county with a failing grade for at least one pollutant and 3.6 times as likely to live in a county with a failing grade for all three pollutants.

Other highlights from the report include:

Some 72 million people of color live in counties that received at least one failing grade for ozone and/or particle pollution. Over 14 million people of color live in counties that received failing grades on all three measures, including nearly 10 million Hispanics.

People experiencing poverty—More than 15.9 million people with incomes meeting the federal poverty definition live in counties that received an F for at least one pollutant. Over 2.6 million people in poverty live in counties failing all three measures.

Children and older adults—Some 31 million children under age 18 and nearly 21 million adults age 65 and over live in counties that received an F for at least one pollutant. Almost 4.7 million children and 2.8 million seniors live in counties failing all three measures.

People with underlying health conditions.

Asthma—2.3 million children and nearly 10 million adults with asthma live in counties that received an F for at least one pollutant. More than 320,000 children and 1.4 million adults with asthma live in counties failing all three measures. According to the Department of Health and Human Services, in 2019, non-Hispanic Blacks were almost three times more likely to die from asthma related causes than the non-Hispanic white population and Black children had a death rate eight times that of non-Hispanic white children.

Chronic Obstructive Pulmonary Disease (COPD)—Over 6.1 million people with COPD live in counties that received an F for at least one pollutant. Almost 800,000 people with COPD live in counties failing all three measures.

Lung Cancer—More than 66,000 people diagnosed with lung cancer in 2018 live in counties that received an F for at least one pollutant. And 7,400 people diagnosed with lung cancer live in counties failing all three measures.

Cardiovascular Disease—More than 8 million people with cardiovascular disease live in counties that received an F for at least one pollutant. More than 1 million people live in counties failing all three measures.

The American Lung Association recommends that every federal agency, the White House, and Congress must immediately act to dramatically reduce air and climate pollution and drive an urgent nationwide transition to zero-emission transportation and electricity.

It said 40% of the investments made to meet these goals must improve air quality, health, and life in underserved communities.

Additionally, local governments have the power to help ensure that city and county operations are zero-emission and that residents can choose zero-emission forms of transportation and electricity, the officials said.

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