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World Report on Disability 2011

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The first ever World report on disability , produced jointly by WHO and the World Bank, suggests that more than a billion people in the world today experience disability.

People with disabilities have generally poorer health , lower education achievements, fewer economic opportunities and higher rates of poverty than people without disabilities. This is largely due to the lack of services available to them and the many obstacles they face in their everyday lives. The report provides the best available evidence about what works to overcome barriers to health care, rehabilitation , education, employment, and support services, and to create the environments which will enable people with disabilities to flourish. The report ends with a concrete set of recommended actions for governments and their partners.

This pioneering World report on disability will make a significant contribution to implementation of the Convention on the Rights of Persons with Disabilities. At the intersection of public health , human rights and development, the report is set to become a "must have" resource for policy-makers, service providers, professionals, and advocates for people with disabilities and their families.

• Collapse All
• Acknowledgements
• Contributors
• Introduction
• What is disability?
• Disability and human rights
• Disability and development
• Measuring disability
• Prevalence of disability – difficulties in functioning
• Health conditions
• Demographics
• The environment
• Disability and poverty
• Needs for services and assistance
• Costs of disability
• Conclusion and recommendations
• Understanding the health of people with disabilities
• Addressing barriers to health care
• Understanding rehabilitation
• Addressing barriers to rehabilitation
• Reforming policies, laws, and delivery systems
• Developing funding mechanisms for rehabilitation
• Increasing human resources for rehabilitation
• Expanding and decentralizing service delivery
• Increasing the use and affordability of technology
• Expanding research and evidence-based practice
• Understanding assistance and support
• Barriers to assistance and support
• Addressing the barriers to assistance and support
• Understanding access to physical and information environments
• Addressing the barriers in buildings and roads
• Addressing the barriers in public transportation
• Barriers to information and communication
• Addressing the barriers to information and technology
• Educational participation and children with disability
• Understanding education and disability
• Barriers to education for children with disabilities
• Addressing barriers to education
• Understanding labour markets
• Barriers to entering the labour market
• Addressing the barriers to work and employment
• Disability: a global concern
• Recommendations
• Technical appendix A Estimates of disability prevalence (%) and of years of health lost due to disability (YLD), by country
• Technical appendix B Overview of global and regional initiatives on disability statistics
• Technical appendix C Design and implementation of the World Health Survey
• Technical appendix D Global Burden of Disease methodology
• Technical appendix E World Health Survey analysis for Chapter 3 – Health

The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted lines on maps represent approximate border lines for which there may not yet be full agreement.

The mention of specific companies or of certain manufacturers' products does not imply that they are endorsed or recommended by the World Health Organization in preference to others of a similar nature that are not mentioned. Errors and omissions excepted, the names of proprietary products are distinguished by initial capital letters.

All reasonable precautions have been taken by the World Health Organization to verify the information contained in this publication. However, the published material is being distributed without warranty of any kind, either expressed or implied. The responsibility for the interpretation and use of the material lies with the reader. In no event shall the World Health Organization be liable for damages arising from its use.

All rights reserved. Publications of the World Health Organization are available on the WHO web site ( www.who.int ) or can be purchased from WHO Press, World Health Organization, 20 Avenue Appia, 1211 Geneva 27, Switzerland (tel.: +41 22 791 3264; fax: +41 22 791 4857; e-mail: tni.ohw@sredrokoob ). Requests for permission to reproduce or translate WHO publications – whether for sale or for noncommercial distribution – should be addressed to WHO Press through the WHO web site ( http://www.who.int/about/licensing/copyright_form/en/index.html ).

• Cite this Page World Report on Disability 2011. Geneva: World Health Organization; 2011.
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WHO. World Report on Disability (2011)

About 15% of the world's population lives with some form of disability, of whom 2-4% experience significant difficulties in functioning. The global disability prevalence is higher than previous WHO estimates, which date from the 1970s and suggested a figure of around 10%. This global estimate for disability is on the rise due to population ageing and the rapid spread of chronic diseases, as well as improvements in the methodologies used to measure disability.

The first ever WHO/World Bank World report on disability reviews evidence about the situation of people with disabilities around the world. Following chapters on understanding disability and measuring disability, the report contains topic-specific chapters on health; rehabilitation; assistance and support; enabling environments; education; and employment. Within each chapter, there is a discussion of the barriers confronted, and case studies showing how countries have succeeded in addressing these by promoting good practice. In its final chapter, the report offers nine concrete recommendations for policy and practice which if put in place could lead to real improvements in the lives of people with disability.

The summary report is available in easy-to-read, audio, and screen reader compatible formats. Braille versions (English, Spanish and French) can be ordered by contacting  disability [at] who.int .

Related evidence brief(s)

What are the most effective strategies for strengthening health systems for disability inclusive development, how can we promote access to assistive technology for individuals with disabilities in low- and middle-income settings, what works to ensure older men and women with disabilities are equally included in social protection programmes, how can access barriers be removed to ensure that people with psychosocial, developmental, and neurological disabilities can access all forms of healthcare.

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World Health Organization: World Health Statistics 2011

2011 report from the World Health Organization on progress in meeting the U.N.'s health-related Millennium Development Goals.

Republish this article

This work is licensed under a Creative Commons Attribution-NoDerivatives 4.0 International License .

by Rozanne Larsen, The Journalist's Resource June 8, 2011

This <a target="_blank" href="https://journalistsresource.org/economics/world-health-statistics-2011/">article</a> first appeared on <a target="_blank" href="https://journalistsresource.org">The Journalist's Resource</a> and is republished here under a Creative Commons license.<img src="https://journalistsresource.org/wp-content/uploads/2020/11/cropped-jr-favicon-150x150.png" style="width:1em;height:1em;margin-left:10px;">

At the 2000 United Nations Summit a plan was developed to combat problems facing the world’s most impoverished populations. The plan was based on eight major objectives, known as the Millennium Development Goals (MDGs); the World Health Organization (WHO), part of the U.N., was responsible for coordinating efforts on the health-related objectives.

The WHO’s report “World Health Statistics 2011” identifies nine indicators for assessing progress: life expectancy and mortality; cause-specific mortality and morbidity; infectious diseases; health service coverage; risk factors; health workforce, infrastructure and essential medicines; health expenditure; health inequities; and demographic and socioeconomic statistics.

The report’s findings include:

• According to estimates, the percentage of underweight children under 5 years old declined, from 25% in 1990 to 16% in 2010. However, some 115 million such children remain underweight and 178 million of all children (under 18) exhibit stunted growth.
• While overall child mortality rates fell globally by a third over the last 20 years — from 12.4 million in 1990 to 8.1 million in 2009 — the rate of deaths for children actually rose over the same time period on the African continent and among other of the lowest-income countries.
• The two most common causes of child mortality are pneumonia and diarrheal diseases, both of which remain easily treatable if a child has access to health care.
• Over the past 20 years, global measles immunization rose by 9%, putting the current overall figure at 82%.
• Maternal mortality rate decreased at an average annual rate of 2.3%; however, this is only half of the necessary rate to achieve the 2015 target. 99% of maternal deaths occurred in developing countries.
• The percentage of the world’s population with access to clean drinking water increased from 77% to 87%. That puts the U.N. on track to achieve the goal of halving the percentage of those without access by 2015. Progress is lagging, though, on goals for improving issues relating to  toilets and sanitation.
• In more than 40 low- and middle-income countries, basic generic medicines were only available in 42% of public health centers. This forces patients to buy generic medicines from private providers; those cost on average 630% more than the international reference price.

Tags: children, water

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WHO report on the global tobacco epidemic 2011

Warning about the dangers of tobacco.

This report is the third in a series of WHO reports on the status of global tobacco control policy implementation.

All data on the level of countries’ achievement for the six MPOWER measures have been updated through 2010, and additional data have been collected on warning the public about the dangers of tobacco. The report examines in detail the two primary strategies to provide health warnings – labels on tobacco product packaging and anti-tobacco mass media campaigns. It provides a comprehensive overview of the evidence base for warning people about the harms of tobacco use as well as country-specific information on the status of these measures.

To continue the process of improving data analysis, categories of policy achievement have been refined and, where possible, made consistent with new and evolving guidelines for the implementation of the WHO Framework Convention on Tobacco Control. Data from the 2009 report have been re-analyzed to be consistent with these new categories, allowing for more direct comparisons of the data across both reports.

Sandra Doorley timeline: Police chief defends officer who stopped DA in viral video case

A New York official has come under national scrutiny for her behavior toward police during a routine traffic stop, during which she was caught on camera refusing to comply with orders in a now-viral video.

Sandra Doorley, the District Attorney (DA) of Monroe County, New York, was elected in 2011 and has served as the DA since then.

Her name made headlines outside of the upstate New York region following the release of body-worn camera footage showing her refusal to submit to a traffic stop when clocked going 55 mph in a 35 mph zone.

The nearly 30-minute video shows Doorley refusing to pull over for police, leading him instead to her home, and having a heated and contentious exchange with the officer after exiting her car.

In the video, taken April 22 , she tells the officer she has called the chief of police to get him to "leave her alone," says "she doesn't care" about her speeding, swears at and insults the officer and tells him she will use her position to throw away the ticket against herself if he does issue it.

Prep for the polls: See who is running for president and compare where they stand on key issues in our Voter Guide

Eventually, Doorley accepts the ticket. She pleaded guilty the following day but quickly became the subject of scrutiny later the same week when police released the footage.

A series of statements and apologies, video appearances and calls for professional probes later, Doorley remains in office while te public waits to hear the results of multiple investigations.

Here's everything we know that's happened so far in the Sandra Doorley saga.

Doorley controversy: Sandra Doorley email highlights tensions in DA's Office amid viral confrontation fallout

Doorley is elected District Attorney of Monroe County, New York.

Who is Sandra Doorley: Monroe County DA under fire after her response to traffic stop

Doorley is re-elected after running uncontested.

April 22, 2024

Doorley is clocked driving 55 miles per hour in a 35-mile-per-hour zone , according to Webster, NY police officer Cameron Crisafulli, who then initiates a traffic stop.

Doorley fails to pull over after the officer pulls behind her and turns on his lights. In a later interview, she said she did not realize he was trying to pull her over initially and thought he might be pursuing someone else.

In the bodycam footage taken during the incident, she tells the officer that she did not expect someone to run her plates and still pull her over and repeatedly references speaking with his boss, the police chief.

Once she realizes the officer is attempting to pull her over, Doorley does not stop, instead turning onto her home street and pulling into her driveway. She later said that she felt this to be the best move because her street had less traffic.

She also admitted in later interviews and on the body cam footage to calling Webster Police Chief Dennis Kohlmeier from her car while driving with the officer behind her.

Both Doorley and the officer get out of their cars once in her driveway. In now-viral footage, Doorley can be seen behaving confrontationally, refusing to submit to the stop, calling the officer names and having a heated exchange with Crisafulli who says “I don’t know why you’re acting like this toward me."

At one point, Doorley tells Crisafulli “I’m  the  DA … I’m  the  DA of Monroe County," to which he responds "I understand that. But that doesn’t give you the right to go 55 in a 35.”

Crisafulli eventually calls a supervisor to the scene to assist. After a lot of back-and-forth, which includes Doorley telling the officer she will "be prosecuting herself" for the infraction and will therefore just get rid of it anyway, she finally accepts the ticket at the end of the nearly 30-minute video.

Watch Video: DA Sandra Doorley defies police orders in traffic stop

Doorley pleads guilty to the traffic violation.

The Monroe County Office of Public Integrity also makes a public comment saying that an investigation would begin on Doorley "immediately." Janson McNair, director of the office and chair of the county's Board of Ethics, told the Rochester Democrat and Chronicle, part of the USA TODAY Network, that Doorley would be investigated by both entities and results would be shared with the public.

While the county's ethics code does prohibit officials from using or attempting to use their official position to secure unwarranted privileges or exemptions" and violations of this code could result in removal from office, McNair told the D&C that his office does not have the power to execute this, saying only the governor has this capability.

The D&C confirms the ticket with the DA's office, which releases a statement on behalf of Doorley later that day.

"Less than half a mile from my neighborhood, I noticed a Webster Police car behind me," she said in the statement. "Once I realized that the intention of the car was to pull me over, I called the Webster Police Chief to inform him that I was not a threat and that I would speak to the Officer at my house down the street."

"By 1:00 PM the following day (after the ticketing), I pled guilty and sent the ticket to the Webster Town Court because I believe in accepting responsibility for my actions and had no intention of using my position to receive a benefit. Nobody, including your District Attorney, is above the rule of law, even traffic laws," the statement continued.

A small group of protestors convene outside the DA's office the same day to demand Doorley's resignation.

The Webster Police Department releases the body-worn camera footage of responding officer Cameron Crisafulli and other officers to the public in response to a Freedom of Information Law request.

The video quickly picks up steam, eventually amassing millions of views.

The Rochester City Council writes a letter to the New York State Attorney General Letitia James asking for an inquiry into Doorley.

"Recent body camera footage, shared by the Webster Police Department, has raised significant concerns regarding Ms. Doorley's behavior during a traffic stop in Webster, New York," the letter reads.

"This incident has led us to question her fitness to serve as District Attorney, and we believe an investigation by your office is warranted. The behavior exhibited by Ms. Doorley during the traffic stop, as captured in the body camera footage, appears to violate these standards. Such behavior undermines the credibility and integrity of our justice system and erodes public trust."

Doorley releases a 30-second video apology. In it, she says in part, "Last Monday I failed you and the standards that I hold myself to," Doorley says at the outset of the 30-second video. "For that I am sorry, What I did was wrong and I take full responsibility."

She also says she will submit an attorney grievance complaint against herself for investigation.

Doorley grants an exclusive interview to local TV station WHEC-TV. In it, she says she has "no good answer" for why she didn't stop for the police and says she regrets what she did.

She also explains calling the police chief during the attempted traffic stop, saying she wanted to let him know "it was me" and that "I wasn't a threat."

She repeatedly says she "made a mistake" that she "regrets" and while she "doesn't have an answer" for why she did it, she wishes she could "go back" and change how she behaved.

May 2, 2024

Webster Police Chief Dennis Kohlmeier issues a statement for the first time following the incident, backing up his involved officers.

" I am extremely proud of our police department for handling a dynamic event with such professionalism. Our body-worn camera policy is designed to provide transparency; in this situation, it confirms the integrity and character of our officers. I also want to publicly thank Officer Crisafulli for his dedication to his duty and the safety of our community.

Due to pending investigations, it is inappropriate to comment further."

Doorley also has a column published in the D&C in which she again apologizes for an explains her actions. In it, she says that while it is "no excuse," she was stressed that day from dealing with three murder cases and learning of a "frightening medical" issue concerning her husband.

"Last week, I made a mistake. A big one. You already know about  my viral video  where I disrespected a  police officer who was ticketing me for speeding . All officers — including this one — deserve respect. I didn’t give it. That’s why  I apologized to him ," she writes in the column.

"No one is above the law, which is why I immediately pled guilty, asked for a prosecutor from another county to review the matter, and will refer myself to the Attorney Grievance Committee. I’ll fully cooperate."

At this time, Doorley has not indicated any intentions to step down from her position. Investigations into her behavior are ongoing.

Contributing: Gary Craig , Marcia Greenwood , Kinsey Crowley

More than 321,000 U.S. children lost a parent to drug overdose from 2011 to 2021

Federal study shows lives lost from overdose crisis are felt across generations, emphasizing need to include children and families in support

An estimated 321,566 children in the United States lost a parent to drug overdose from 2011 to 2021, according to a study published in JAMA Psychiatry . The rate of children who experienced this loss more than doubled during this period, from approximately 27 to 63 children per 100,000. The highest number of affected children were those with non-Hispanic white parents, but communities of color and tribal communities were disproportionately affected. The study was a collaborative effort led by researchers at the National Institutes of Health’s (NIH) National Institute on Drug Abuse (NIDA), the Substance Abuse and Mental Health Services Administration (SAMHSA), and the Centers for Disease Control and Prevention (CDC).

Children with non-Hispanic American Indian/Alaska Native parents consistently experienced the highest rate of loss of a parent from overdose from 2011 to 2021 – with 187 per 100,000 children affected in this group in 2021, more than double the rate among non-Hispanic white children (76.5 per 100,000) and among non-Hispanic Black children (73 per 100,000). While the number of affected children increased from 2011 to 2021 across all racial and ethnic populations, children with young non-Hispanic Black parents (18 to 25 years old) experienced the highest – roughly 24% – increase in rate of loss every year. Overall, children lost more fathers than mothers (192,459 compared to 129,107 children) during this period.

“It is devastating to see that almost half of the people who died of a drug overdose had a child. No family should lose their loved one to an overdose, and each of these deaths represents a tragic loss that could have been prevented,” said Nora Volkow, M.D., NIDA director. “These findings emphasize the need to better support parents in accessing prevention, treatment, and recovery services. In addition, any child who loses a parent to overdose must receive the care and support they need to navigate this painful and traumatic experience.”

From 2011 to 2021, 649,599 people aged 18 to 64 died from a drug overdose. Despite these tragic numbers, no national study had previously estimated the number of children who lost a parent among these deaths. To address this gap, researchers used data about people aged 18 to 64 participating in the 2010 to 2019 National Surveys on Drug Use and Health (NSDUH) to determine the number of children younger than 18 years living with a parent 18 to 64 years old with past-year drug use. NSDUH defines a parent as biological parent, adoptive parent, stepparent, or adult guardian.

The researchers then used these data to estimate the number of children of the nearly 650,000 people who died of an overdose in 2011 to 2021 based on the national mortality data from the CDC National Vital Statistics System. The data were examined by age group (18 to 25, 26 to 40, and 41 to 64 years old), sex, and self-reported race and ethnicity.

The researchers found that among the estimated 321,566 American children who lost a parent to overdose from 2011 to 2021, the highest numbers of deaths were among parents aged 26 to 40 (175,355 children) and among non-Hispanic white parents (234,164). The next highest numbers were children with Hispanic parents (40,062) and children with non-Hispanic Black parents (35,743), who also experienced the highest rate of loss and highest year-to-year rate increase, respectively. The racial and ethnic disparities seen here are consistent with overall increases in overdose deaths among non-Hispanic American Indian/Alaska Native and Black Americans in recent years, and highlight disproportionate impacts of the overdose crisis on minority communities.

“This first-of-its-kind study allows us to better understand the tragic magnitude of the overdose crisis and the reverberations it has among children and families,” said Miriam E. Delphin-Rittmon, Ph.D., HHS Assistant Secretary for Mental Health and Substance Use and the leader of SAMHSA. “These data illustrate that not only are communities of color experiencing overdose death disparities, but also underscore the need for responses to the overdose crisis moving forward to comprehensively address the needs of individuals, families and communities.”

Based on their findings, the researchers emphasize the importance of whole-person health care that treats a person with substance use disorder as a parent or family member first and foremost, and provides prevention resources accordingly to support families and break generational cycles of substance use. The study also points to the need to incorporate culturally-informed approaches in prevention, treatment, recovery, and harm reduction services, and to dismantle racial and ethnic inequities in access to these services.

“Children who lose a parent to overdose not only feel personal grief but also may experience ripple effects, such as further family instability," said Allison Arwady, M.D., M.P.H., director of CDC’s National Center for Injury Prevention and Control. “We need to ensure that families have the resources and support to prevent an overdose from happening in the first place and manage such a traumatic event.”

If you or someone you know is struggling or in crisis, help is available. Call or text 988  or chat at  988lifeline.org . To learn how to get support for mental health, drug or alcohol issues, visit  FindSupport.gov . If you are ready to locate a treatment facility or provider, you can go directly to  FindTreatment.gov or call  800-662-HELP (4357) . 

• CM Jones, et al. Estimated Number of Children Who Lost a Parent to Drug Overdose, US, 2011-2021 . JAMA . DOI: 10.1001/jamapsychiatry.2024.0810 (2024).

About the National Institute on Drug Abuse (NIDA): NIDA is a component of the National Institutes of Health, U.S. Department of Health and Human Services. NIDA supports most of the world’s research on the health aspects of drug use and addiction. The Institute carries out a large variety of programs to inform policy, improve practice, and advance addiction science. For more information about NIDA and its programs, visit www.nida.nih.gov .

About the National Institutes of Health (NIH): NIH, the nation’s medical research agency, includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. NIH is the primary federal agency conducting and supporting basic, clinical, and translational medical research, and is investigating the causes, treatments, and cures for both common and rare diseases. For more information about NIH and its programs, visit www.nih.gov .

About substance use disorders: Substance use disorders are chronic, treatable conditions from which people can recover. In 2022, nearly 49 million people in the United States had at least one substance use disorder. Substance use disorders are defined in part by continued use of substances despite negative consequences. They are also relapsing conditions, in which periods of abstinence (not using substances) can be followed by a return to use. Stigma can make individuals with substance use disorders less likely to seek treatment. Using preferred language can help accurately report on substance use and addiction. View NIDA’s online guide .

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News Release

Wednesday, May 8, 2024

More than 321,000 U.S. children lost a parent to drug overdose from 2011 to 2021

Federal study shows lives lost from overdose crisis are felt across generations, emphasizing need to include children and families in support.

An estimated 321,566 children in the United States lost a parent to drug overdose from 2011 to 2021, according to a study published in JAMA Psychiatry . The rate of children who experienced this loss more than doubled during this period, from approximately 27 to 63 children per 100,000. The highest number of affected children were those with non-Hispanic white parents, but communities of color and tribal communities were disproportionately affected. The study was a collaborative effort led by researchers at the National Institutes of Health’s (NIH) National Institute on Drug Abuse (NIDA), the Substance Abuse and Mental Health Services Administration (SAMHSA), and the Centers for Disease Control and Prevention (CDC).

Children with non-Hispanic American Indian/Alaska Native parents consistently experienced the highest rate of loss of a parent from overdose from 2011 to 2021 – with 187 per 100,000 children affected in this group in 2021, more than double the rate among non-Hispanic white children (76.5 per 100,000) and among non-Hispanic Black children (73 per 100,000). While the number of affected children increased from 2011 to 2021 across all racial and ethnic populations, children with young non-Hispanic Black parents (18 to 25 years old) experienced the highest – roughly 24% – increase in rate of loss every year. Overall, children lost more fathers than mothers (192,459 compared to 129,107 children) during this period.

“It is devastating to see that almost half of the people who died of a drug overdose had a child. No family should lose their loved one to an overdose, and each of these deaths represents a tragic loss that could have been prevented,” said Nora Volkow, M.D., NIDA director. “These findings emphasize the need to better support parents in accessing prevention, treatment, and recovery services. In addition, any child who loses a parent to overdose must receive the care and support they need to navigate this painful and traumatic experience.”

From 2011 to 2021, 649,599 people aged 18 to 64 died from a drug overdose. Despite these tragic numbers, no national study had previously estimated the number of children who lost a parent among these deaths. To address this gap, researchers used data about people aged 18 to 64 participating in the 2010 to 2019 National Surveys on Drug Use and Health (NSDUH) to determine the number of children younger than 18 years living with a parent 18 to 64 years old with past-year drug use. NSDUH defines a parent as biological parent, adoptive parent, stepparent, or adult guardian.

The researchers then used these data to estimate the number of children of the nearly 650,000 people who died of an overdose in 2011 to 2021 based on the national mortality data from the CDC National Vital Statistics System. The data were examined by age group (18 to 25, 26 to 40, and 41 to 64 years old), sex, and self-reported race and ethnicity.

The researchers found that among the estimated 321,566 American children who lost a parent to overdose from 2011 to 2021, the highest numbers of deaths were among parents aged 26 to 40 (175,355 children) and among non-Hispanic white parents (234,164). The next highest numbers were children with Hispanic parents (40,062) and children with non-Hispanic Black parents (35,743), who also experienced the highest rate of loss and highest year-to-year rate increase, respectively. The racial and ethnic disparities seen here are consistent with overall increases in overdose deaths among non-Hispanic American Indian/Alaska Native and Black Americans in recent years, and highlight disproportionate impacts of the overdose crisis on minority communities.

“This first-of-its-kind study allows us to better understand the tragic magnitude of the overdose crisis and the reverberations it has among children and families,” said Miriam E. Delphin-Rittmon, Ph.D., HHS Assistant Secretary for Mental Health and Substance Use and the leader of SAMHSA. “These data illustrate that not only are communities of color experiencing overdose death disparities, but also underscore the need for responses to the overdose crisis moving forward to comprehensively address the needs of individuals, families and communities.”

Based on their findings, the researchers emphasize the importance of whole-person health care that treats a person with substance use disorder as a parent or family member first and foremost, and provides prevention resources accordingly to support families and break generational cycles of substance use. The study also points to the need to incorporate culturally-informed approaches in prevention, treatment, recovery, and harm reduction services, and to dismantle racial and ethnic inequities in access to these services.

“Children who lose a parent to overdose not only feel personal grief but also may experience ripple effects, such as further family instability," said Allison Arwady, M.D., M.P.H., director of CDC’s National Center for Injury Prevention and Control. “We need to ensure that families have the resources and support to prevent an overdose from happening in the first place and manage such a traumatic event.”

If you or someone you know is struggling or in crisis, help is available. Call or text  988  or chat at  988lifeline.org . To learn how to get support for mental health, drug or alcohol issues, visit  FindSupport.gov . If you are ready to locate a treatment faxility or provider, you can go directly to  FindTreatment.gov or call  800-662-HELP (4357) .

About the National Institute on Drug Abuse (NIDA): NIDA is a component of the National Institutes of Health, U.S. Department of Health and Human Services. NIDA supports most of the world’s research on the health aspects of drug use and addiction. The Institute carries out a large variety of programs to inform policy, improve practice, and advance addiction science. For more information about NIDA and its programs, visit www.nida.nih.gov .

About the National Institutes of Health (NIH): NIH, the nation's medical research agency, includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. NIH is the primary federal agency conducting and supporting basic, clinical, and translational medical research, and is investigating the causes, treatments, and cures for both common and rare diseases. For more information about NIH and its programs, visit www.nih.gov .

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CM Jones, et al.  Estimated Number of Children Who Lost a Parent to Drug Overdose, US, 2011-2021 .  JAMA.  DOI: 10.1001/jamapsychiatry.2024.0810 (2024).

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Here is what Stormy Daniels testified happened between her and Donald Trump

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Porn performer Stormy Daniels took the witness stand Tuesday in the hush money case against former President Trump, who looked on as she detailed their alleged sexual encounter and the payment she got to keep it quiet.

Prosecutors allege Trump paid Daniels to keep quiet about the allegations as he ran for president in 2016. Her testimony aired them very publicly as the presumptive Republican presidential nominee seeks to win the White House again.

Trump denies having sex with Daniels , and his lawyers unsuccessfully pushed for a mistrial midway through her testimony.

It was a major spectacle in the first criminal trial of a former American president, now in its third week of testimony in Manhattan.

Here are some takeaways from Daniels’ testimony:

Who is Stormy Daniels?

The case centers on a $130,000 payment to Daniels from Trump’s then-lawyer, Michael Cohen, in the final weeks of Trump’s 2016 campaign. Prosecutors say it was part of a scheme to illegally influence the campaign by burying negative stories about him.

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His lawyers have sought to show that Trump was trying to protect his reputation and family — not his campaign — by shielding them from embarrassing stories about his personal life.

Daniels, whose real name is Stephanie Clifford, told jurors that she started exotic dancing in high school and appearing in adult films at age 23, eventually moving to direct more than 150 films and winning a roster of porn industry awards.

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Meeting Trump

Daniels testified she first met and chatted with Trump at a 2006 Lake Tahoe celebrity golf outing where her studio was a sponsor.

He referred to her as “the smart one” and asked her if she wanted to go to dinner, she said. Daniels testified that she accepted Trump’s invitation because she wanted to avoid dinner with her co-workers and thought it might help her career. Trump had his bodyguard get her number, she said.

When they met up later in his penthouse, she appreciated that he seemed interested in the business aspects of the industry rather than the “sexy stuff.” He also suggested putting her on his TV show, “The Apprentice,” a possibility she hoped could help establish her as a writer and director.

She left to use the bathroom and was startled to find Trump in his underwear when she returned, she said. She didn’t feel physically or verbally threatened but realized that he was “bigger and blocking the way,” she testified.

“The next thing I know was: I was on the bed,” and they were having sex, Daniels recalled. The encounter was brief but left her “shaking,” she said. “I just wanted to leave,” she testified.

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Payments for silence

Daniels was asked if Trump ever told her to keep things between them confidential, and said, “Absolutely not.” She said she learned in 2011 that a magazine had learned the story of their encounter, and she agreed to do an interview for $15,000 to make money and “control the narrative.” The story never ran.

In 2016, when Trump was running for president, Daniels said she authorized her manager to shop the story around but did not initially receive interest from news outlets. She said that changed in October with the release of the “Access Hollywood” tape in which Trump bragged about grabbing women sexually without asking permission . She said she learned that Cohen wanted to buy her silence.

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Mistrial push

Midway through her testimony, Trump’s lawyers moved for a mistrial.

Defense lawyer Todd Blanche argued that Daniels’ testimony about the alleged encounter and other meetings with him had “nothing to do with this case,” and would unfairly prejudice the jury.

The judge rejected it, and he faulted defense attorneys for not raising more of their objections while she was testifying.

Before Daniels took the stand, Trump’s lawyers had tried to stop her from testifying about the encounter’s details, saying it was irrelevant in “a case about books and records.”

Prosecutors countered that Daniels’ testimony gets at what Trump was trying to hide and they were “very mindful” not to draw too much graphic detail. Before Daniels took the stand, they told the judge the testimony would be “really basic,” and would not “involve any details of genitalia.”

While the judge didn’t side with Trump’s lawyers, he acknowledged that some details were excessive. The objections could potentially be used by Trump’s lawyers if he is convicted and they file an appeal.

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Cross-examination

Trump’s lawyers tried to attack Daniels’ credibility, suggesting she was motivated by money and that her account has shifted over the years.

“Am I correct that you hate President Trump?” defense lawyer Susan Necheles asked Daniels at one point. Daniels acknowledged she did.

“And you want him to go to jail?” the lawyer asked.

“I want him to be held accountable,” Daniels said. Pressed again whether that meant going to jail, she said: “If he’s convicted.”

The defense pressed Daniels on the fact that she owes Trump hundreds of thousands of dollars in legal fees stemming from an unsuccessful defamation lawsuit, and on a 2022 tweet in which she said she “will go to jail before I pay a penny.” Daniels dug in at times in the face of pointed questions, forcefully denying the idea that she had tried to extort money from Trump.

Trump whispered frequently to his attorney during Daniels’ testimony, and his expression seemed to be pained at one point as she recounted details about the dinner she says they shared. He shook his head and appeared to say something under his breath as Daniels testified that Trump told her he didn’t sleep in the same room as his wife.

On the way out of the courthouse, Trump called it “a very revealing day.” He didn’t address Daniels’ testimony explicitly but claimed the prosecutors’ case was “totally falling apart.”

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Jarring split screen

Trump’s appearance in court Tuesday, like all other days he’s stuck in the courtroom, means he can’t be out on the campaign trail as he runs for president a third time. It’s a frequent source of his complaints, but Daniels’ testimony in particular might underscore how much of a distraction the trial is from the business of running for president.

While Trump was stuck in a Manhattan courthouse away from voters and unable to speak for much of the day, President Biden was attending a Holocaust remembrance ceremony and condemning antisemitism .

It’s an issue Trump has sought to use against Biden in the campaign by seizing on the protests at college campuses over the Israel-Hamas war .

Associated Press writer Price reported from New York, Whitehurst from Washington. AP writers Michael Sisak, Jennifer Peltz, Jake Offenhartz and Alanna Durkin Richer contributed to this story.

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In a decade of drug overdoses, more than 320,000 American children lost a parent

Rhitu Chatterjee

Esther Nesbitt lost two of her children to drug overdoses, and her grandchildren are among more than 320,000 who lost parents in the overdose epidemic. Andrew Lichtenstein/Corbis via Getty Images hide caption

Esther Nesbitt lost two of her children to drug overdoses, and her grandchildren are among more than 320,000 who lost parents in the overdose epidemic.

More than 320,000 children across the United States lost a parent due to a drug overdose between 2011 and 2021. That's according to a new study published in JAMA Psychiatry Wednesday.

"It's a call to arms to pay close attention to the consequences of a parent who dies due to a drug overdose," saysHarvard neuroscientist Charles Nelson III , who wasn't involved in the new study.

The impact of the country's overdose epidemic on children is something "we really don't speak much about," says Dr. Nora Volkow , director of the National Institute on Drug Abuse and an author of the new study.

"The [overdose] numbers and mortality are so high that it attracts all of the attention and urgency to address it, to protect people from dying," she adds. "But at the same time, we've basically neglected to realize that when someone dies, there is a family that's left behind. And if the family has young children, that makes them very, very vulnerable."

Several federal agencies including the Substance Abuse and Mental Health administration and the US Centers for Disease Control and Prevention conducted the study.

Kids who experience the death of a parent or a primary caregiver are at risk of a range of poor health and educational outcomes, according to previous research.

For example, the death of a parent makes children more likely to do poorly at school and even drop out . A 2018 study found that children who experienced the sudden death of a parent are more likely to have trouble functioning and have symptoms of depression and post traumatic stress disorder.

The new paper was inspired by recent studies on estimates of children who lost a parent or primary caregiver to Covid-19 , says Volkow, drawing attention to the multigenerational effects of the pandemic.

Volkow and her co-authors found that the rate of children who lost a parent from an overdose rose by 134% during the study period – from 27 per 100,000 children in 2011 to 63 per 100,000 in 2021.

More children — over 192,000 — lost a father to drug overdose compared to the 129,000 who lost a mother.

More than half of these bereaved kids had parents who died between the ages of 26 to 40 years, followed by 41 to 64 years, and 18 to 25 years.

The largest number of parents who died were non-Hispanic White, followed by Hispanic and Black. However, the highest rate of parental drug overdose losses were among American Indian and Alaska Native children.

"Children that come from underrepresented groups with higher adversity, economic and social, which already puts them at higher risk for behavioral health disorders and mental health disorders," says Volkow. Those risks can be further exacerbated by the death of a parent due to overdose, she adds.

"When I read the [new] paper, I had this sense of déja vu," says Nelson, who is an author of a 2021 study that estimated the number of children in the United States who lost a parent due to COVID-19-related causes.

However, the long term risks may be even greater for kids who lost a parent due to a drug overdose, says Nelson.

A memorial for those lost to the opioid epidemic in Binghamton, NY, in Aug. 2021. A study in JAMA Psychiatry Wednesday tallies how many children lost parents to overdoses. Andrew Lichtenstein/Corbis via Getty Images hide caption

A memorial for those lost to the opioid epidemic in Binghamton, NY, in Aug. 2021. A study in JAMA Psychiatry Wednesday tallies how many children lost parents to overdoses.

"There's so many factors involved so that kids could get very, very tangled up in their thinking about why their parent overdosed," says Nelson.

For example, a child might get preoccupied with questions like "Was it preventable? Why did my father do this? Why didn't they stop taking drugs?" he says.

Besides, as the study points out, growing up in a household where a parent uses substances is itself a childhood trauma with potential for long-term health consequences for a child. "There's all the neglect that goes along with that, with certain substances. That's very common," says Nelson. "There is the abuse that sometimes travels with that."

As a result, a child whose parent died from a drug overdose may experience complex grief, and need more specialized mental health care, he adds.

There are other factors adding more stress to the lives of these bereaved children, says Nelson. "The worst of it is the stigma associated with having lost a parent to an overdose," he says. "So that would mean that these kids could be stigmatized in school."

Then there is the risk of future substance use. "As these kids get to adolescence, they too might start using drugs," says Nelson. "It gets really complicated."

Volkow hopes the study will spur actions to better address the needs of these children, so their long-term risks can be minimized. For example, she hopes there will be efforts made to keep children with their siblings and/or other relatives, with families receiving the supports and services they need to address these children's mental health needs.

"If a child loses a parent, [and] the child welfare system comes in and they remove them and take them away from other siblings, and then they lose not just the parent, they lose the sibling, they lose the school system that they have," says Volkow.

And there is a lot more to be done to prevent the death of parents due to overdoses in the first place, says Volkow, through policies that encourage parents to seek treatment for their substance use.

However, parents, especially mothers (and pregnant women) face tremendous stigma and punitive state laws which discourage them from seeking treatment, she says.

'As a physician, if someone comes to me and they are actually taking drugs and say they are pregnant, I have to report that," Volkow says.

In some states, such reporting eventually leads to the child being taken away from the mother soon after birth. Laws like these discourage women from seeking treatment for substance use, she adds. "Seeking treatment should not be something that people should be afraid of."

• opioid addiciton
• opioid crisis
• children grief

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