

OSF Healthcare


He is the author of 13 books including Uncommom Sense, the Spiritual Chocolate series, Grandpa's Store, Minister's Guidebook insights from a fellow minister. His column is published weekly in over 600 publications in all 50 states. The views expressed are those of the author and are not necessarily representative of any other group or organization. We welcome comments and views from our readers. Submit your letters to the editor or commentary on a current event 24/7 to editor@oursentinel.com.
He is the author of 13 books including Uncommom Sense, the Spiritual Chocolate series, Grandpa's Store, Minister's Guidebook insights from a fellow minister. His column is published weekly in over 600 publications in all 50 states. The views expressed are those of the author and are not necessarily representative of any other group or organization. We welcome comments and views from our readers. Submit your letters to the editor or commentary on a current event 24/7 to editor@oursentinel.com.
Country music star Tim McGraw’s “Live Like You Were Dying” tries to sum up the emotions of a terminal illness.
It’s not just Hollywood. Rita Manning counsels patients and their loved ones as a pastoral care professional and bereavement coordinator for OSF HealthCare. She says there are ways to make the person’s final days more peaceful.
Getting the diagnosis
Before the “what’s next?” phase sets in, Manning says gut reactions to a terminal illness diagnosis can vary widely. Some have been in declining health, and they may show less of an emotional response. Others learn the news unexpectedly and abruptly.
“Those that are broadsided probably have more of an impact of mental and emotional things,” Manning says.
People might talk about being afraid of death or ask lots of questions. Some may want to go “full speed ahead,” as Manning puts it, and do things while they can. They may travel or catch up with old friends. Others may retreat and want to contemplate the future alone. Depression and other mental health issues can follow.
Helping out
Here’s a phrase to try when starting the conversation with a loved one:
“You may not want to talk about this now. Just know that whenever you are ready, I’m ready to listen and be there,” Manning says, putting herself in the shoes of a caregiver.
In other words, try to meet the person where they are. Don’t try to fix something that can’t be fixed. Acknowledge that the news is tough. Sit and cry with your loved one if that’s the emotion they show. Or if you don’t wear your emotions on your sleeve, offer help in other ways. Offer to mow the yard or take care of groceries.
Manning advises to avoid cliché phrases like “How are you doing?” Instead, try “How’s your day treating you?”
Another poor phrase: “You’re going to a better place.”
“Those types of phrases might be factual for them in their faith journey. It still may not be the time they want to hear that,” Manning says.
End of life discussions
It’s not uncommon for an adult with a terminal illness to put off talking about their funeral, estate and other matters once they have passed away. But there comes a time when there’s little time left to get things in order. Approach it delicately, Manning suggests.
“We just want to honor your wishes,” Manning says, again posing as a caregiver. “If you could help us understand what those are, that would help us to know how to move forward.”
Other phrases that may work: What is your greatest concern? What is your greatest hope? How can we make your final days full and comfortable?
Children and terminal illnesses
Consoling and supporting a child who will soon pass away requires a different approach, Manning says. You should still be honest, but they may not understand death. So, explain it in a way they understand.
First, reassure the child that the situation is not their fault.
Try something like: “Sometimes people just get sick. As hard as we try, we just can’t find that solution to make you well again.”
If they ask a question, an adult may need to ask one back to make sure they grasp what the child is thinking. For example: does the child’s stomach hurt because they are nervous or because of the illness? The response will shape what the adult says.
Relate to what children know, like a pet who died or even leaves falling off trees in the winter. But don’t be afraid to use words like “death” and “dying.” Using words like “lost” may cause confusion, Manning says. For example: a parent says, “We lost grandma today.” A child may respond, “Let’s go find her.”
Manning adds that there are books from trusted sources that talk about death.
“They’re still going to have questions,” Manning points out. “But it starts the hard task. Reading helps them engage and understand better.”
Learn more
Learn more about resources for people nearing the end of their life on the OSF HealthCare website.
Previous research established the association of particulate matter (PM) pollution to CVD death and disability. However, questions remain about the worldwide impact from this type of pollution and how it has been changing over time, the study authors noted.
“We focused on examining the burden globally because particulate matter pollution is a widespread environmental risk factor that affects all populations worldwide, and understanding its impact on cardiovascular health can help guide public health interventions and policy decisions,” said Farshad Farzadfar, M.D., M.P.H., D.Sc., senior author of the study and a professor of medicine in the non-communicable diseases research center of the Endocrinology and Metabolism Research Institute at Tehran University of Medical Sciences in Iran.
The researchers analyzed PM pollution as a risk factor for death and disability using freely available data from 204 countries collected between 1990 and 2019 and detailed in the Global Burden of Disease (GBD) study. Exposure to PM pollution was estimated using a tool from the 2019 update to the GBD study that incorporated information from satellite and ground-level monitoring, computer models of chemicals in the atmosphere and land-use data.
Among the many types of heart disease, the current analysis of cardiovascular disease is restricted to stroke and ischemic heart disease (a lack of blood and oxygen supply to portions of the heart, usually due to plaque build-up in the arteries) because the 2019 GBD study on the global burden of disease attributed to PM pollution only examined these two diagnoses. The Institute for Health Metrics and Evaluation (IHME), which provides the GBD estimates, only reports data for a certain risk factor if there is a large body of evidence about its association with a disease, Farzadfar noted.
“Until now, only the association of PM pollution with ischemic heart disease and stroke has been demonstrated in a large number of studies,” Farzadfar said. “The IHME may include other CVDs in the future. Moreover, ischemic heart disease and stroke contribute to a significant majority of CVDs, and our estimates, despite having limitations, may be used as a good estimate of PM pollution burden on CVDs.”
The investigators analyzed changes over time in years of life lost due to premature death (YLLs), years lived with disability (YLDs) and disability-adjusted life years (DALYs). DALYs is a measure that considers both the loss of life and the impact on quality of life to assess the full impact of a health condition on a population. The cardiovascular disease burden was assessed both overall and with age standardization, which compares health outcomes across a population with a wide range of ages.
The analysis found:
“The declines in deaths may be considered positive news, as they indicate improvements in health care, air pollution control measures and access to treatment. However, the increase in disability-adjusted life years suggests that although fewer people were dying from cardiovascular disease, more people were living with disability,” Farzadfar said.
The researchers also found that between 1990 and 2019, age-standardized CVD death and disability attributed to outdoor PM pollution rose by 8.1%, while age-standardized cardiovascular death and disability attributed to household PM pollution, which is produced by solid cooking fuels such as coal, charcoal, crop residue, dung and wood, fell by 65.4%.
“The reason for the decrease in the burden of household air pollution from solid fuels might be better access and use of cleaner fuels, such as refined biomass, ethanol, liquefied petroleum gas, solar and electricity. Moreover, structural changes, such as improved cookstoves and built-in stoves, chimney hoods and better ventilation, might be effective in reducing pollution exposure to solid fuels. Finally, the effects of educational and behavioral interventions should be considered,” Farzadfar said. “The shifting pattern from household air pollution due to solid fuels to outdoor, ambient PM pollution has important public policy implications.”
In a 2020 scientific statement and a 2020 policy statement, the American Heart Association details the latest science about air pollution exposure and the individual, industrial and policy measures to reduce the negative impact of poor air quality on cardiovascular health. Reducing exposure to air pollution and reversing the negative impact of poor air quality on cardiovascular health, including heart disease and stroke, is essential to reducing health inequities in Black and Hispanic communities, those that have been historically marginalized and under-resourced, and communities that have the highest levels of exposure to air pollution.
The study has several limitations. Because the assessment of exposure to particulate matter pollution in the study is based on regional estimates, it may not accurately reflect individual exposure. In addition, results from this analysis of the association between particulate matter pollution and cardiovascular outcomes may not be generalizable to other health conditions or other pollutants.
Juan Campos has been working to save at-risk teens from gun violence for 16 years.
As a street outreach worker in Oakland, California, he has seen the pull and power of gangs. And he offers teens support when they’ve emerged from the juvenile justice system, advocates for them in school, and, if needed, helps them find housing, mental health services, and treatment for substance abuse.
But, he said, he’s never confronted a force as formidable as social media, where small boasts and disputes online can escalate into deadly violence in schoolyards and on street corners.
Teens post photos or videos of themselves with guns and stacks of cash, sometimes calling out rivals, on Facebook, Instagram, Snapchat, or TikTok. When messages go viral, fueled by “likes” and comments, the danger is hard to contain, Campos said.
“It’s hundreds of people on social media, versus just one or two people trying to guide youth in a positive way,” he said. Sometimes his warnings are stark, telling kids, “I want to keep you alive.” But, he said, “it doesn’t work all the time.”
Shamari Martin Jr. was an outgoing 14-year-old and respectful to his teachers in Oakland. Mixed in with videos of smiling friends on his Instagram feed were images of Shamari casually waving a gun or with cash fanned across his face. In March 2022, he was shot when the car he was in took a hail of bullets. His body was left on the street, and emergency medical workers pronounced him dead at the scene.
In Shamari’s neighborhood, kids join gangs when they’re as young as 9 or 10, sometimes carrying guns to elementary school, said Tonyia “Nina” Carter, a violence interrupter who knew Shamari and works with Youth Alive, which tries to prevent violence. Shamari “was somewhat affiliated with that culture” of gangs and guns, Carter said.
Shamari’s friends poured out their grief on Instagram with broken-heart emojis and comments such as “love you brother I’m heart hurt.”
One post was more ominous: “it’s blood inna water all we want is revenge.” Rivals posted videos of themselves kicking over flowers and candles at Shamari’s memorial.
Such online outpourings of grief often presage additional violence, said Desmond Patton, a University of Pennsylvania professor who studies social media and firearm violence.
More than a year later, Shamari’s death remains unsolved. But it’s still a volatile subject in Oakland, said Bernice Grisby, a counselor at the East Bay Asian Youth Center, who works with gang-involved youth.
“There’s still a lot of gang violence going on around his name,” she said. “It could be as simple as someone saying, ‘Forget him or F him’ — that can be a death sentence. Just being affiliated with his name in any sort can get you killed.”
The U.S. surgeon general last month issued a call to action about social media’s corrosive effects on child and adolescent mental health, warning of the “profound risk of harm” to young people, who can spend hours a day on their phones. The 25-page report highlighted the risks of cyberbullying and sexual exploitation. It failed to mention social media’s role in escalating gun violence.
Acutely aware of that role are researchers, community leaders, and police across the country — including in Baltimore, Chicago, Los Angeles, Oakland, Pittsburgh, St. Louis, and Washington, D.C. They describe social media as a relentless driver of gun violence.
Michel Moore, the Los Angeles police chief, called its impact “dramatic.”
“What used to be communicated on the street or in graffiti or tagging or rumors from one person to another, it’s now being distributed and amplified on social media,” he said. “It’s meant to embarrass and humiliate others.”
Many disputes stem from perceived disrespect among insecure young adults who may lack impulse control and conflict-management skills, said LJ Punch, a trauma surgeon and director of the Bullet-Related Injury Clinic in St. Louis.
“Social media is an extremely powerful tool for metastasizing disrespect,” Punch said. And of all the causes of gun violence, social media-fueled grudges are “the most impenetrable.”
Calls for Regulation
Social media companies are protected by a 1996 law that shields them from liability for content posted on their platforms. Yet the deaths of young people have led to calls to change that.
“When you allow a video that leads to a shooting, you bear responsibility for what you put out there,” said Fred Fogg, national director of violence prevention for Youth Advocate Programs, a group that provides alternatives to youth incarceration. “Social media is addictive, and intentionally so.”
People note that social media can have a particularly pernicious effect in communities with high rates of gun violence.
“Social media companies need to be better regulated in order to make sure they aren’t encouraging violence in Black communities,” said Jabari Evans, an assistant professor of race and media at the University of South Carolina. But he said social media companies also should help “dismantle the structural racism” that places many Black youth “in circumstances that resign them to want to join gangs, carry guns to school, or take on violent personas for attention.”
L.A.’s Moore described social media companies as serving “in a reactionary role. They are profit-driven. They don’t want to have any type of control or restrictions that would suppress advertising.”
Social media companies say they remove content that violates their policies against threatening others or encouraging violence as quickly as possible. In a statement, YouTube spokesperson Jack Malon said the company “prohibits content reveling in or mocking the death or serious injury of an identifiable individual.”
Social media companies said they act to protect the safety of their users, especially children.
Rachel Hamrick, a spokesperson for Meta, which owns Facebook and Instagram, said the company has spent about $16 billion in the past seven years to protect the safety of people who post on its apps, employing 40,000 people at Facebook who work on safety and security.
“We remove content, disable accounts and work with law enforcement when we believe there is a genuine risk of physical harm or direct threats to public safety,” Hamrick said. “As a company, we have every commercial and moral incentive to try to give the maximum number of people as much of a positive experience as possible on Facebook. That’s why we take steps to keep people safe even if it impacts our bottom line.”
Meta platforms generated revenue of over $116 billion in 2022, most of which came from advertising.
A spokesperson for Snapchat, Pete Boogaard, said the company deletes violent content within minutes of being notified of it. But, Fogg noted, by the time a video is removed, hundreds of people may have seen it.
Even critics acknowledge that the sheer volume of content on social media is difficult to control. Facebook has nearly 3 billion monthly users worldwide; YouTube has nearly 2.7 billion users; Instagram has 2 billion. If a company shuts down one account, a person can simply open a new one, said Tara Dabney, a director at the Institute for Nonviolence Chicago.
“Things could be going great in a community,” Fogg said, “and then the next thing you know, something happens on social media and folks are shooting at each other.”
Playing With Fire
At a time when virtually every teen has a cellphone, many have access to guns, and many are coping with mental and emotional health crises, some say it’s not surprising that violence features so heavily in children’s social media feeds.
High school “fight pages” are now common on social media, and teens are quick to record and share fights as soon as they break out.
“Social media puts everything on steroids,” said the Rev. Cornell Jones, the group violence intervention coordinator for Pittsburgh.
Like adults, many young people feel validated when their posts are liked and shared, Jones said.
“We are dealing with young people who don’t have great self-esteem, and this ‘love’ they are getting on social media can fill some of that void,” Jones said. “But it can end with them getting shot or going to the penitentiary.”
While many of today’s teens are technologically sophisticated — skilled at filming and editing professional-looking videos — they remain naive about the consequences of posting violent content, said Evans, of the University of South Carolina.
Police in Los Angeles now monitor social media for early signs of trouble, Moore said. Police also search social media after the fact to gather evidence against those involved in violence.
“People want to gain notoriety,” Moore said, “but they’re clearly implicating themselves and giving us an easy path to bring them to justice.”
In February, New Jersey police used a video of a 14-year-old girl’s vicious school beating to file criminal charges against four teens. The victim of the assault, Adriana Kuch, died by suicide two days after the video went viral.
Preventing the Next Tragedy
Glen Upshaw, who manages outreach workers at Youth Alive in Oakland, said he encourages teens to express their anger with him rather than on social media. He absorbs it, he said, to help prevent kids from doing something foolish.
“I’ve always offered youth the chance to call me and curse me out,” Upshaw said. “They can come and scream and I won’t fuss at them.”
Workers at Youth Advocate Programs monitor influential social media accounts in their communities to de-escalate conflicts. “The idea is to get on it as soon as possible,” Fogg said. “We don’t want people to die over a social media post.”
It’s sometimes impossible, Campos said. “You can’t tell them to delete their social media accounts,” he said. “Even a judge won’t tell them that. But I can tell them, ‘If I were you, since you’re on probation, I wouldn’t be posting those kinds of things.’”
When he first worked with teens at high risk of violence, “I said if I can save 10 lives out of 100, I’d be happy,” Campos said. “Now, if I can save one life out of 100, I’m happy.”
The national survey of 1,271 adults conducted by KFF revealed the severe physical and psychological harm exacted by firearm violence, especially in minority communities.
Nearly 1 in 5 respondents, including 34% of Black adults, 18% of Hispanic adults, and 17% of white adults, said a family member had been killed by a gun.
The survey “confirms that firearm-related injuries are ubiquitous,” said Dr. Selwyn Rogers, a surgeon and founding director of the UChicago Medicine trauma center. “For every person killed, there are two or three people harmed. These are people who have had fractures, who may have been paralyzed or disabled.”
Beyond causing physical injuries, gun violence has left many Americans living with trauma and fear, Rogers said.
Just over half of adults say gun-related crimes, injuries, and deaths are a “constant threat” or “major concern” in their communities. Black and Hispanic adults were more likely than white adults to describe gun violence as a constant threat or major concern. About 3 in 10 Black or Hispanic adults say they feel “not too safe” or “not safe at all” from gun violence in their neighborhoods. (Hispanics can be of any race or combination of races.)
Women also reported high rates of concern about firearm violence, with 58% saying gun-related crimes are a constant threat or major concern, compared with 43% of men. More than half of intimate partner homicides are committed with guns.
Parents are worried about their children as well.
About 1 in 4 parents of children under 18 say they worry daily or almost daily about gun violence, the KFF survey found, and 84% of adults report having taken at least one precaution to reduce their family’s risk from gun violence. More than one-third of adults say they have avoided large crowds, such as at music festivals or crowded bars, for example.
Gun violence surged during the pandemic. There were a record 48,830 firearm-related deaths in 2021, an increase of 23% from 2019, according to an analysis by the Pew Research Center. The increase among children was even sharper. Firearm deaths among Americans under 18 — which include those due to homicide, suicide, and gun-related accidents — increased 50%, from 1,732 in 2019 to 2,590 in 2021.
Guns have become the leading cause of death among children and adolescents ages 1 to 19, according to the Centers for Disease Control and Prevention.
The pandemic also coincided with a huge increase in gun purchases, which grew an estimated 64% from 2019 to 2020.
According to the KFF survey, 29% of adults have purchased a gun at some point to protect themselves or their families, with 44% of parents of children under 18 keeping a gun in the home. Yet 78% of parents in gun-owning households fail to follow safety recommendations, such as locking guns and ammunition, storing guns unloaded, and storing guns and ammunition separately, practices that have been shown to reduce the risk of thefts, accidents, and suicides.
Dr. Abdullah Pratt, an emergency physician at the UChicago Medicine trauma center, has lost a dozen close friends to gun violence, including his brother. His father never recovered from that loss and died about seven years later, at age 64.
“As soon as my brother got killed, he stopped taking his medications and started chain-smoking out of nowhere,” Pratt said.
Gun violence also wears away communities, Pratt said.
In neighborhoods with high crime rates, the daily drumbeat of loss can lead residents to conclude there’s no point in voting, going to school, or trying to improve their lives. “They think, ‘What am I voting for if I can’t have basic access to safety on a day-to-day basis?’” Pratt said.
And while mass shootings and homicides grab headlines, Rogers, the surgeon, noted that suicides account for more than half of firearm-related deaths in the U.S. and cause ripples of grief throughout a community. Researchers estimate that every suicide leaves at least six people in mourning.
Pratt said he feels guilty he wasn’t able to help a close friend who died by suicide with a gun several years ago. The man had recently lost a job and had his car repossessed and came to Pratt to talk about his troubles. Instead, Pratt spent the visit asking for parenting advice, without realizing how much his friend was hurting.
“There were no red flags,” Pratt said. “A couple days later, he died.”
Gun violence has also shaped the trajectory of Bernice Grisby’s life.
Grisby, now 35, was shot for the first time when she was 8, while playing on the swings at her school in Oakland, California. She was shot a second time at age 15, when she was talking to friends after school. One of her friends died that day, while another lost an eye; Grisby was shot in the hip and experiences chronic pain from the wound.
Two of her brothers were fatally shot in their 20s. Her 15-year-old daughter was recently robbed at gunpoint.
Rather than leaving Oakland, Grisby is trying to save it. She works as a street counselor to young people at high risk of gun violence through Oakland’s East Bay Asian Youth Center, which aims to help young people living in poverty, trauma, and neglect.
“My life is a gift from God,” Grisby said. “I am happy to be here to support the youth and know that I am making a difference.”