It’s well-known that COVID-19 protocols caused financial hardship — particularly among lower-and middle-class families — and now a new study highlights the toll those struggles took on children’s mental health.
A new study led by researchers from Columbia University and Weill Cornell Medicine, both in New York, suggests that family economic hardship was the biggest driver of “stress, sadness and COVID-related worry” among kids.
The study, published in the JAMA Network, also suggested that COVID-related school closures did not have an impact on kids’ mental health.
AS EMERGENCY ROOMS SEE MORE OF AMERICA’S MENTALLY ILL KIDS, NEW STUDY PINPOINTS ISSUES
Researchers analyzed data from the Adolescent Brain Cognitive Development Study, which was funded by the National Institutes of Health. That study surveyed 6,030 children between 10 and 13 years old in 21 U.S. cities between 2020 and 2021.
It also gathered data from kids and their guardians about their experiences during the pandemic, including job loss, remote schooling and COVID-related policies.
Additionally, it included questions about the link between sleep and mental health.
A new study suggests that family economic hardship was the biggest driver of “stress, sadness and COVID-19-related worry” among kids during the lockdowns. (iStock)
Dr. Michael Roeske, a licensed clinical psychologist and senior director of the Newport Healthcare Center, which is headquartered in California, was not involved in the study but said he was not surprised that financial struggles impacted kids’ mental health.
COVID-19 SHOCKER: PARENTS LIED ABOUT THEIR KIDS’ SICKNESS STATUS AND BROKE QUARANTINE RULES, STUDY FINDS
“Kids are often highly attuned to stress in the home,” he told Fox News Digital in an email.
“If there were feelings of uncertainty and concern, which almost certainly comes from loss of a job or reductions in income, it would undoubtedly impact them. If the parents are overly stressed or scared themselves, kids may no longer feel safe in the home. This can be devastating developmentally.”
“If parents are overly stressed or scared themselves, kids may no longer feel safe in the home.”
And in even more dire cases, kids may become worried about basic necessities and housing, he added.
Dr. Roeske said he is seeing the effects of the pandemic firsthand via Newport Healthcare, which operates a series of mental health treatment centers across the country.
“We’re counseling more kids struggling with depression, anxiety and suicidality than we saw previously,” he said.
Study suggests school closures had no mental health impact
While other studies have found that school closures did indeed cause a spike in children’s mental health struggles, this research did not identify any such link.
PARENTS, STUDENTS ON THE IMPACT OF SCHOOL CLOSURES THREE YEARS LATER
Dr. Yunyu Xiao, an assistant professor at Weill Cornell Medicine who co-authored the study, offered one possible explanation for what may seem like a surprising lack of impact.
“If children had more protective factors like increased parental care at home during lockdown, that would help with mental health,” she said in an email to Fox News Digital.
“Kids are often highly attuned to stress in the home,” one psychiatrist told Fox News Digital. “If there were feelings of uncertainty and concern, which almost certainly comes from loss of a job or reductions in income, it would undoubtedly impact them.”(iStock)
The study didn’t use specific measures of mental health, so it couldn’t speak to severity or whether new disorders emerged, said Dr. Roeske.
“Certainly, it is hard to argue that no association between school closures and children’s mental health existed given the isolation, uncertainty and even added time on devices that occurred as a result,” he said.
MAJORITY OF COLLEGE STUDENTS SUFFERING FROM MENTAL ILLNESS, ANXIETY AND DEPRESSION ON THE RISE: STUDY
“The disruption of one’s normal routine in such an extreme way alone can cause anxiety and symptoms of depression.”
Communication, mental health care are key
To protect kids’ mental health during times of hardship, it’s essential to maintain age-appropriate lines of communication, said Roeske, and to carefully consider how much children hear and know about any financial struggles.
KIDS’ SCREEN TIME SKYROCKETED DURING PANDEMIC — AND IT’S STILL HIGHER THAN PRE-COVID
“Know the signs of distress, like changes in behaviors, eating patterns and sleep,” he said.
“And get your child help if things do not improve or continue to worsen; do not wait for things to get really bad.”
It’s important for parents to recognize signs of distress and to know how to get help for their kids.(iStock)
Dr. Roeske pointed out that many parents don’t know where to turn for help.
He cited a recent survey of 1,000 parents of teens ages 13-17 conducted by Wakefield Research for Newport Healthcare.
The researchers didn’t look at the severity or onset of new psychiatric disorders.
While nearly half of parents (46{bf0515afdcaddba073662ceb89fbb62b6b1bf123143c0e06b788e1946e8c353f}) reported that the pandemic allowed them to see more of their teens’ mental health struggles during quarantine and remote learning, nearly 70{bf0515afdcaddba073662ceb89fbb62b6b1bf123143c0e06b788e1946e8c353f} lacked the knowledge of what to do if their teen were experiencing problems that might require treatment.
Study had limitations
Because the data was self-reported, Dr. Xiao said there is a chance that responses were biased or inaccurate. Also, the researchers didn’t look at the severity or onset of new psychiatric disorders.
“Future research should incorporate more precise mental health measurements, such as clinical scales, and make use of advanced techniques for more efficient and bias-corrected estimations,” she said.
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There may also be other disruptive factors, such as COVID-19-related deaths in the family, which could affect mental health, Dr. Xiao also said.
“While our study aimed to correct bias for family financial and school disruptions, it does not imply that no other significant disruptions are present,” she explained.
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The study also did not have a large enough sample to segment by race, age, gender or family environment.
Melissa Rudy is health editor and a member of the lifestyle team at Fox News Digital.
As the federal government moves to change rules for what foods can sport “healthy” labels, manufacturers are pushing back.
Some of the biggest makers of cereals, frozen and packaged food have submitted dozens of claims to the Food and Drug Administration objecting to new rules that would exclude food with high amounts of added sugar and salt from being labeled as “healthy” on packaging. Some manufacturers have even called the regulations unconstitutional, saying they violate companies’ First Amendment rights.
The FDA last fall moved to update its requirements around what foods can use the word “healthy” on packaging — the first change since the rule was implemented in the 1990s. The proposed changes would leave out high-sugar, low-fat products that currently are allowed to use the healthy label today, such as fruit-flavored low-fat yogurts and Raisin Bran cereal.
That’s unfair, many food companies gripe, complaining that the more rigorous nutritional standards would wrongly malign a range of popular foods. The rule “automatically disqualifies entire categories of nutrient dense foods,” Kellogg’s wrote in a February 16 comment on the agency’s proposal.
General Mills goes further, arguing that the FDA’s “overly restrictive” rule violates companies’ rights to free speech.
“[T]he Proposed Rule precludes many objectively healthy products, including those promoted by the Dietary Guidelines, from engaging in truthful, nonmisleading commercial expression — and these overly restrictive boundaries for ‘healthy’ violate the First Amendment,” the packaged-food giant writes.
General Mills has a slew of well-known brands, including Annie’s, Betty Crocker, Cascadian Farm, Pillsbury and Yoplait, as well as cereals Chex, Cheerios, Choco Puffs, Cinnamon Toast Crunch, Raisin Nut Bran and Wheaties.
The window for submitting public comments on the proposed rules closed earlier this month. The FDA will now review the feedback, though the timing of a final rule is uncertain.
FDA proposes new rules for plant-based milks
04:16
The Consumer Brands Association, whose members include Coca-Cola, PepsiCo, Hain Celestial and the Campbell Soup Company, took a similar tack, writing that “consumers have a First Amendment right to receive truthful information about products and manufacturers have a First Amendment right to provide it to them.” The group estimated that 95{bf0515afdcaddba073662ceb89fbb62b6b1bf123143c0e06b788e1946e8c353f} of foods currently on the market would not qualify for a “healthy” label under the government’s new requirements.
KIND, the granola bar company, took issue with the FDA’s proposed limits on added sugars in foods, saying they “created a barrier for fruit, vegetable, and protein food innovation” and would lead to more companies using artificial sweeteners in their products to mimic the taste of sugar-sweetened food.
“Criteria for use of ‘healthy’ should not be so restrictive that they allow only a very limited number of foods to qualify, because this could lead consumers to conclude that other nutrient dense food choices are ‘unhealthy,'” the company added.
No label, no customers?
Conagra Brands, creator of the “Healthy Choice” brand of frozen meals, offered a blunt assessment: If it reinvents “Healthy Choice” to comply with the new rules, people won’t buy it, the company said.
“Conagra cannot continue to invest in ‘healthy’ innovation if we are not able to meet the necessary taste, eating trends and affordability our consumers expect. If the food does not taste good, people will not buy it,” Conagra said.
FDA hasn’t reviewed some food additives in decades
02:33
Many “Healthy Choice” items have been criticized for their high amount of sugar or salt. For instance, the “Healthy Choice Sweet and Sour Chicken” meal contains 21 grams of added sugar — 42{bf0515afdcaddba073662ceb89fbb62b6b1bf123143c0e06b788e1946e8c353f} of the current recommended daily value — while providing just 390 calories.
“Meeting people where they are”
The American Frozen Food Institute said that restrictions on sodium would result in “nutritious frozen items being excluded due to a small amount of sauce that makes the item much more likely to be consumed.”
“Consumers already know that whole fruits and vegetables are healthy and may not be consuming such products for a variety of reasons,” the Institute said, adding that the FDA should be “meeting people where they are.”
The Consumer Brand Association echoed this comment, writing: “Many consumers are constrained from preparing meals and snacks from ‘plain’ ingredients due to limited time, affordability, easy access to stores that sell these ingredients, kitchen resources, and cooking skills. And most consumers do not typically eat foods in a plain, unflavored form.”
Despite this industry’s grousing, many nutrition experts have come out in favor of the FDA’s revised guidelines. Requirements for the “healthy” label haven’t changed in the 28 years since it was first created, even as the public understanding of what’s nutritious has evolved.
“We want to use policies that advocate for a healthier diet than we currently have, and that’s why we believe the healthy claims should be allowed only for foods that are truly healthy,” said Eva Greenthal, senior policy scientist at the Center for Science in the Public Interest. The CSPI mostly supports the new rules but says they allow too much refined grain and processed fruit.
Powerful marketing
Under the FDA’s proposed rules, foods high in sugar, sodium or refined grains won’t be banned; rather, food makers won’t be allowed to label such products as “healthy,” which can be a powerful marketing claim.
“There are currently some products labeled ‘healthy’ that contain insane amounts of sugars,” Greenthal said.
That’s a remnant of the low-fat craze of the early nineties, when processed-food manufacturers created a slew of supposedly low-fat snacks that contained high amounts of sugar and salt to compensate for the loss of taste. Since then, research has overturned the belief that all fat is bad for health while demonstrating the harmful effects of high sugar consumption.
Greenthal sees the revised FDA guidelines as mostly positive, although she doubts it will have much impact on Americans’ eating habits.
“What we really need are mandatory labels that force companies to disclose information they otherwise conceal,” she said. “Companies are very quick to tell us if a product is high in fiber or vitamin C, but not when a product is high in saturated fat, sodium, or sugar. These are the products that are linked to heart disease, high blood pressure and diabetes.”
The CSPI recently petitioned the FDA to require food makers to prominently label these ingredients on the front of a food package.
“The FDA just needs to consider its mission, to protect public health, and use that as its guiding star as it faces industry pressure to prioritize industry interests over public health,” Greenthal said.
Jeff and Kareen King received a hospital bill for $160,000 a few weeks after Jeff had a procedure to restore his heart rhythm.
Bram Sable-Smith/KHN
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Bram Sable-Smith/KHN
Jeff and Kareen King received a hospital bill for $160,000 a few weeks after Jeff had a procedure to restore his heart rhythm.
Bram Sable-Smith/KHN
Kareen King calls it “the ultimate paradox”: The hospital that saved her husband Jeff’s heart also broke it.
What Happened Jeff King, of Lawrence, Kan., needed his heart rhythm restored to normal with a procedure called an ablation — sooner rather than later, his doctor said. Jeff asked the hospital for a cost estimate, but said he didn’t hear back before his scheduled surgery in January 2021 at Stormont Vail Health in Topeka, Kan.
The real pain came when the bill arrived in the mail a few weeks later. The Kings, who were uninsured at the time, were on the hook for nearly all of the cost.
Jeff King, 63, Lawrence, Kan.
Approximate Medical Debt: $160,000
Medical Issue: Heart ablation
Jeff and Kareen King received the bill for $160,000 a few weeks after Jeff had the procedure to restore his heart rhythm. The Kings were initially on the hook for almost all of it.
Instead of signing up for traditional health insurance, the Kings had joined what’s called a “medical cost-sharing plan” with a company called Sedera, which describes its service as a “refreshing non-insurance approach to managing large and unexpected health care costs.” With this alternative to health insurance, members agree to share one another’s expenses. The plans are often faith-based and have surged in popularity in recent yearsbecause they can be cheaper than traditional insurance — the Kings said their plan cost $534 a month, plus an additional $118 a month to join a direct primary care medical practice.
But the sharing plans offer fewer protections than insurance and come with provisos. The Kings said their plan did not fully cover preexisting conditions like Jeff’s heart condition for the first two years of coverage — and he needed the surgery after 16 months.
In a statement a Sedera spokesperson said it’s important that members understand the cost-sharing model and membership guidelines. “Sedera members read and agree to these prior to joining,” the statement read.
The Kings have dabbled in all sorts of health coverage in their 42 years of marriage. Jeff’s work as an evangelical pastor in his hometown of Osage City, Kan., almost never provided insurance for the couple or their five children, all of whom are now grown. The exception came during Jeff’s most recent stint leading a congregation, starting in 2015. Kareen remembered feeling “unworthy” of the $1,800 a month the congregation paid for their insurance.
“We certainly had never come up with those kinds of premiums ourselves,” she recalled.
But Jeff decided he had to leave that job in 2018. He said he felt forced out over differences with some of his congregants on eternal damnation (“As a loving parent, I could never punish my child forever”) and gay marriage (“Maybe God is a whole lot more inclusive than we are”).
After Jeff resigned, the Kings briefly bought insurance through the Affordable Care Act marketplace, but later dropped it because they weren’t eligible for subsidies and felt they couldn’t afford it.
That’s when they joined the Sedera plan. They knew the preexisting condition clause was a gamble, but medication had managed Jeff’s heart condition for years, and they didn’t expect he’d need medical procedures to address it.
What’s Broken: Without employer-sponsored insurance or federal subsidies to help fund their coverage, the Kings felt priced out of traditional insurance. But being uninsured left them exposed to hospital charges that ordinary patients typically never see.
Hospital charges are generally understood by health economists to bear little resemblance to the actual prices that are typically paid. Instead, they are more of an opening salvo in the high-stakes negotiations between hospitals trying to get as much money as they can for providing care and insurance companies trying to pay as little as possible.
But patients lack the bargaining power of large insurers, which may cover hundreds of thousands of patients in any given hospital’s catchment area. For patients like Jeff, the main recourse is to go through a hospital’s financial assistance program, although even with that help many patients can’t afford the bills hospitals send them.
Stormont Vail’s assistance program eventually knocked about $107,000 off Jeff’s original bill a few months later. Sedera provided a negotiator to help him haggle over costs.
Stormont Vail provided $19.5 million in financial assistance in tax year 2020 and wrote off about $13 million in bad debt, according to tax filings. Its net revenue from patient services was $838.7 million.
Bill Lane, a Stormont Vail administrator, said that in addition to providing financial assistance, the hospital works with patients facing high bills and offers payment plans with zero interest. Payments are often in the range of 10{bf0515afdcaddba073662ceb89fbb62b6b1bf123143c0e06b788e1946e8c353f} of a person’s monthly income,” Lane said. For some patients the hospital has a “catastrophic discount” program that caps their balance at 30{bf0515afdcaddba073662ceb89fbb62b6b1bf123143c0e06b788e1946e8c353f} of their gross household income. The hospital also works with a local bank to provide loans to patients to pay their bills. And the hospital sometimes sends patient balances to debt collection agencies.
Lane said he generally recommends that patients carry traditional insurance. He also said the hospital offers a “patient estimates module” and suggests patients wait to schedule surgery, if possible, if they want an estimate “to make an informed decision.”
What’s Left: Despite Sedera’s two-year waiting period to cover preexisting conditions, the plan did give Jeff $15,000 to help with his bills. After Jeff paid that to the hospital and then negotiated for several months, his final balance was reduced to $37,859.34 in November 2021.
For his payment plan, Jeff said he was told the hospital would accept no less than $500 per month — the equivalent of an additional mortgage payment for the Kings. Jeff estimates it will take the family more than six years to pay it off.
“I never expected this to not cost me anything,” Jeff said, “but I wasn’t expecting what it turned out to be either.”
The Kings are piecing together the funds to pay what they owe the hospital. A few months after Jeff’s ablation, they sold their home in Osage City — where they raised five children and where Jeff grew up — and bought a smaller house in Lawrence. They had hoped to use that money to build their retirement account, since Jeff’s decades of pastoral work didn’t include a pension or 401(k).
Instead, the home sale is helping pay Jeff’s medical debt. Kareen has part-time jobs, and the couple leveraged their life insurance policy, as well.
Jeff began work as a hospice chaplain — for the extra income, but especially to qualify the couple for health insurance. That meant less time for his passion project, running a nonprofit called Transmuto through which he provides spiritual guidance.
In February, Kareen checked again on whether the couple could afford Affordable Care Act insurance so Jeff could get back to Transmuto full time. Her Google searches for the federal government’s health insurance marketplace (HealthCare.gov) instead unwittingly landed her on websites that sell consumer information to insurance brokers. Speaking to one of those brokers on the phone, she bought what she said she was told was an Aetna plan. But it turned out to be a membership in a cost-sharing plan with a company called Jericho Share, which has received over 160 complaints on the Better Business Bureau website in the past year.
Jericho Share spokesperson Mark Hubbard said in a statement that the organization is “issuing full refunds when there is consumer confusion” and is continuing to “evaluate and update our marketing efforts to increase transparency and awareness.”
Hubbard also said Jericho Share is cooperating with regulators in California and New Hampshire that have questioned whether the organization meets state requirements of a health care sharing ministry. California is also questioning whether Jericho Share has indeed received 501(c)(3) nonprofit status from the IRS.
After canceling that plan and getting their money back, the Kings eventually did sign up for an ACA marketplace plan. Jeff has reduced his hours as a chaplain, freeing up more time for Transmuto. All in all, the couple feels pretty fortunate.
“It’s just so tragic the way our system is,” Jeff said. “It puts so many people into impossible financial straits.
KHN (Kaiser Health News) is a national, editorially independent program of KFF (Kaiser Family Foundation).
Open the website of Workit Health, and the path to treatment starts with a simple intake form: Are you in danger of harming yourself or others? If not, what’s your current opioid and alcohol use? How much methadone do you use?
Within minutes, patients looking for online treatment for opioid use and other addictions can complete the assessment and book a video visit with a provider licensed to prescribe suboxone and other drugs.
But what patients probably don’t know is that Workit was sending their delicate, even intimate, answers about drug use and self-harm to Facebook.
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A joint investigation by STAT and The Markup of 50 direct-to-consumer telehealth companies like Workit found that quick, online access to medications often comes with a hidden cost for patients: Virtual care websites were leaking sensitive medical information they collect to the world’s largest advertising platforms.
On 13 of the 50 websites, STAT and The Markup documented at least one tracker — from Meta, Google, TikTok, Bing, Snap, Twitter, LinkedIn, or Pinterest — that collected patients’ answers to medical intake questions. Trackers on 25 sites, including those run by industry leaders Hims & Hers, Ro, and Thirty Madison, told at least one big tech platform that the user had added an item like a prescription medication to their cart, or checked out with a subscription for a treatment plan.
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The trackers that STAT and The Markup were able to detect, and what information they sent, is a floor, not a ceiling. Companies choose where to install trackers on their websites and how to configure them. Different pages of a company’s website can have different trackers, and this analysis did not test every page on each company’s site.
All but one website examined sent URLs users visited on the site and their IP addresses — akin to a mailing address for a computer, which can be used to link information to a specific patient or household — to at least one tech company. The only telehealth platform that the analysis did not find sharing data with outside tech giants was Amazon Clinic, a platform recently launched by Amazon.
Health privacy experts and former regulators said sharing such sensitive medical information with the world’s largest advertising platforms threatens patient privacy and trust and could run afoul of unfair business practices laws. They also emphasized that privacy regulations like the Health Insurance Portability and Accountability Act (HIPAA) were not built for telehealth. That leaves “ethical and moral gray areas” that allow for the legal sharing of health-related data, said Andrew Mahler, a former investigator at the U.S. Department of Health and Human Services’ Office for Civil Rights.
“I thought I was at this point hard to shock,” said Ari Friedman, an emergency medicine physician at the University of Pennsylvania who researches digital health privacy. “And I find this particularly shocking.”
In October and November, STAT and The Markup signed up for accounts and completed onboarding forms on 50 telehealth sites using a fictional identity with dummy email and social media accounts. To determine what data was being shared by the telehealth sites as users completed their forms, reporters examined the network traffic between trackers using Chrome DevTools, a tool built into Google’s Chrome browser.
On Workit’s site, for example, STAT and The Markup found that a piece of code Meta calls a pixel sent responses about self-harm, drug and alcohol use, and personal information — including first name, email address, and phone number — to Facebook.
The investigation found trackers collecting information on websites that sell everything from addiction treatments and antidepressants to pills for weight loss and migraines. Despite efforts to trace the data using the tech companies’ own transparency tools, STAT and The Markup couldn’t independently confirm how or whether Meta and the other tech companies used the data they collected.
After STAT and The Markup shared detailed findings with all 50 companies, Workit said it had changed its use of trackers. When reporters tested the website again on Dec. 7, they found no evidence of tech platform trackers during the company’s intake or checkout process.
“Workit Health takes the privacy of our members seriously,” Kali Lux, a spokesperson for the company, wrote in an email. “Out of an abundance of caution, we elected to adjust the usage of a number of pixels for now as we continue to evaluate the issue.”
“Advertisers should not send sensitive information about people through our Business Tools,” Dale Hogan, a spokesperson for Meta, wrote in an email.
Patients may assume that health-related data is always protected by privacy regulations including HIPAA. Workit, for one, begins its intake form with a promise that “all of the information you share is kept private and is protected by our HIPAA-compliant software.”
“The very reason why people pursue some of these services online is that they’re seeking privacy,” said David Grande, a digital health privacy researcher at the University of Pennsylvania.
But the reality online is more complex, making it all but impossible for the average user to know whether the company they’re entrusting with their data is obligated to protect it. “Individually, we have a sense that this information should be protected,” said Mahler, who is now vice president of privacy and compliance at CynergisTek, a health care risk auditing company. “But then from a legal and a regulatory perspective, you have organizations saying … technically, we don’t have to.”
Rather than providing care themselves, telehealth companies often act as middlemen connecting patients to affiliated providers covered by HIPAA. As a result, information collected during a telehealth company’s intake may not be protected by HIPAA, while the same information given to the provider would be.
“All the privacy risks are there, with the mistaken but entirely reasonable illusion of security,” said Matthew McCoy, a medical ethics and health policy researcher at the University of Pennsylvania. “That’s a really dangerous combination of things to force the average consumer to deal with.”
In response to questions for this story, representatives of Meta, Google, TikTok, Bing, Snap, and Pinterest said advertisers are responsible for ensuring they aren’t sending sensitive information via the tools. Twitter did not respond to requests for comment.
“Doing so is against our policies and we educate advertisers on properly setting up Business tools to prevent this from occurring,” wrote Meta’s Hogan. “Our system is designed to filter out potentially sensitive data it is able to detect.”
LinkedIn’s tracker “collects URL information which we immediately encrypt when it reaches our servers, delete within 7 days and do not add to a profile,” Leonna Spilman, a spokesperson for the company, wrote in an email.
Nevertheless, three of the seven big tech companies also said they had taken action to investigate or stop the data sharing.
Google is “currently investigating the accounts” in question, spokesperson Elijah Lawal wrote in an email.
“In response to this new information, we have paused data collection from these advertisers’ sites while we investigate,” Snap spokesperson Peter Boogaard wrote in an email.
Pinterest “offboarded the companies in question,” spokesperson Crystal Espinosa wrote in an email.
A boom industry on the edge of the law
Together, the companies in this analysis reflect an increasingly competitive — and lucrative — direct-to-consumer health care market. The promise of a streamlined, private prescription process has helped telehealth startups raise billions as they seek to capitalize on a pandemic-driven boom in virtual care.
Hims & Hers, one of the largest players in the space, is now a publicly traded company valued at more than $1 billion; competitor Ro has raised $1 billion since its founding in 2017, with investors valuing the company at $7 billion. Thirty Madison, which operates several telehealth companies focused on different medical needs, is valued at more than $1 billion.
The industry’s rapid growth has been enhanced by its ability to use data from tools like pixels to target advertisements to increasingly specific patient populations and to put ads in front of users who have visited their site before. The companies we analyzed mostly provide care and prescriptions for conditions like migraines, sexual health, or mental health disorders rather than comprehensive primary or urgent care — making browsing their websites inherently sensitive.
In the same way visiting an opioid use disorder treatment center can identify an individual as an addiction patient, data about someone visiting a telehealth site that treats only one condition or provides only one medication can give advertisers a clear window into that person’s health. Direct answers to onboarding forms could be even more valuable because they’re more detailed and specific, said McCoy. “And it’s more insidious because I think it would be all that much more surprising to the average person that information that you put in a form wouldn’t be protected. It’s both worse and more unexpected.”
Consider the form for Thirty Madison’s Cove, which offers migraine medications. It prompts visitors to share details about their migraines, past diagnoses, and family history — and during our testing sent the answers to Facebook and Google. If a user added a medication to the cart, detailed information about the purchase, including the drug’s name, dose, and price, were also sent to Facebook, along with the user’s hashed full name, email, and phone number.
While hashing obscures those details into a string of letters and numbers, it does not prevent tech platforms from linking them to a specific person’s profile, which Facebook explicitly says it does before discarding the hashed data.
A Google tracker collects answers to medical screening questions on Cove’s website.
A tracker tells Facebook when a user adds a medication to the cart. It also sends the user’s hashed name, email, and phone number.
“It’s a pure monetization play,” said Eric Perakslis, chief science and digital officer at the Duke Clinical Research Institute. “And yes, everybody else is doing it, it’s the way the internet works. … But I think that it’s out of step with medical ethics, clearly.”
In particular, experts worry that health data could be used to target patients in need with ads for services and therapies that are unnecessary or even harmful.
The big tech platforms that responded for this story say they do not allow targeted advertising based on specific health conditions, and some telehealth companies said they only use the data collected to measure the success of their advertising. However, as The Markup has previously reported, advertisers may still be able to target ads on Facebook using terms that are close proxies for health conditions.
On 35 of the 50 websites, STAT and The Markup found trackers sending individually identifying information to at least one tech company, including names, email addresses, and phone numbers.
That presents patients with a Catch-22. “It requires anyone that wants to take advantage of telehealth … to expose a lot of the same information that they would reveal within a protected health care relationship,” said Woodrow Hartzog, a privacy and technology law professor at Boston University — but without the same protections.
In recent months, regulators have begun cracking down on the indiscriminate collection and sale of personal health data.
After issuing a warning to businesses about selling health information in July, the Federal Trade Commission sued data broker Kochava, alleging that the company put consumers at risk by failing to protect location data that could reveal sensitive details about people’s health, such as a visit to a reproductive health clinic or addiction recovery center. Kochava has asked for the case to be dismissed and countersued the FTC.
The increased attention reflects growing fears about how health data may be used once it enters the black boxes of corporate data warehouses — whether it originates from a hospital, a location tracker, or a telehealth website.
“The health data market just continues to kind of spiral out of control, as you’re seeing here,” said Perakslis.
But thanks to their business structures, many of the companies behind telehealth websites appear to be operating on the outskirts of health privacy regulations.
‘It does seem deceptive’
When users visit Cerebral, a mental health company whose prescribing and business practices came under federal investigation this year, they are required to answer a series of “clinically tested questions” that can cover a wide range of conditions, including depression, anxiety, bipolar disorder, and insomnia. During testing, with every response — such as clicking a button to indicate feeling depressed “more than half the days” over the last two weeks — a pixel sent Facebook the text of the answer button, the specific URL the user was visiting when clicking the button, and the user’s hashed name, email address, phone number.
At a doctor’s office, that kind of detail collected on an intake form would likely be subject to HIPAA. But as with most of the telehealth companies in this analysis, Cerebral Inc. itself doesn’t provide care; its website connects patients with providers like those employed by Cerebral Medical Group, P.A. and others. While those medical groups are HIPAA-covered entities that cannot share protected health information with third parties except under narrow circumstances, Cerebral claims in its privacy policy to be a go-between that is not covered by HIPAA — except in limited cases when it acts as a business associate of a medical group, pharmacy, or lab.
Cerebral did not answer detailed questions that would clarify what these cases might be. But in a Nov. 30 email, spokesperson Chris Savarese said the company would adjust its use of tracking tools. “We are removing any personally identifiable information, including name, date of birth, and zip code from being collected by the Meta Pixel,” he wrote.
However, when STAT and The Markup tested Cerebral’s website again on Dec. 7, reporters found that a Meta Pixel was still sending answers to some intake questions and hashed names to Facebook, and trackers from Snap and Pinterest were also collecting hashed email addresses.
A Facebook tracker collected answers from a Cerebral intake form during an October test by STAT and The Markup.
During a December test, a Facebook tracker was still collecting Cerebral’s intake form answers.
The telehealth companies that responded to detailed queries said their data-sharing practices adhered to their privacy policies. Those kinds of policies commonly include notice that some — but not all — health data shared with the site is subject to HIPAA. Many companies responded that they were careful to ensure that data shared via third-party tools was not considered protected health information.
But the structure of the companies’ businesses — and the inscrutable language in their privacy policies and terms of use — make it difficult for consumers to know what data would qualify as protected, and when.
“There is so much intransparency, and that makes it complex and maybe even deceptive for consumers,” said Sara Gerke, a professor of health law and policy at Penn State Dickinson Law.
Several telehealth companies claimed that the information collected from their websites was not personally identifiable because it was hashed. HIPAA allows health information to be shared when it has been de-identified. However, hashing does not anonymize data for the tech platforms that receive it and match it to user profiles. And every data packet sent by a tech company’s tracker includes the user’s IP address, which is one of several unique identifiers that explicitly qualify health data for protection under HIPAA.
Further complicating decisions for patients, at least 12 of the direct-to-consumer companies examined in this investigation promise on their websites that they are “HIPAA-compliant.” That could encourage users to think all the data they share is protected and lead them to divulge more, said Hartzog. Yet the regulations apply to the websites’ data use only in limited cases.
Monument, a site that offers alcohol treatment, starts its intake form by saying, “Any information you enter with Monument is 100{bf0515afdcaddba073662ceb89fbb62b6b1bf123143c0e06b788e1946e8c353f} confidential, secure, and HIPAA compliant.” Yet in its responses to STAT and The Markup, it said that it does not consider information transmitted to third parties from that form — including answers to questions like “In the past year, have you continued to drink even though it was making you feel depressed or anxious or adding to another health problem? or after having had a memory blackout?” — to be protected health information under HIPAA.
“If they’re not covered by HIPAA and they have a HIPAA-compliant badge, that seems like a case the FTC could bring,” said Justin Brookman, the director of technology policy for Consumer Reports and former policy director with the FTC, which has previously charged companies for deceptive use of HIPAA-compliant badges. “There’s an implication there that you’re regulated in certain ways, that your data is protected, and so it does seem deceptive.”
Such data sharing could be particularly damaging to patients seeking care for substance use disorders, said Jacqueline Seitz, senior staff attorney for health privacy at the Legal Action Center — especially if it enters opaque data brokerages where it can be resold and repurposed indefinitely.
Several companies in this analysis are capitalizing on federal waivers activated during the pandemic that allow controlled substances like suboxone, which is used to treat opioid use disorder, to be prescribed virtually. Under federal law, qualifying addiction treatment providers — including those that prescribe suboxone — are held to patient privacy standards even stricter than HIPAA. For example, Workit’s physician group states it is forbidden from acknowledging “to anyone outside of the program that you are a patient or disclos[ing] any information identifying you as a substance use disorder patient” except in narrow situations.
Nonetheless, STAT and The Markup found that Workit and other telehealth companies — in their role connecting patients to providers — share information that identifies a user as someone seeking addiction treatment. On Boulder Care’s website, a pixel sent Facebook our name and email when we joined a suboxone treatment program waitlist. And trackers on the website of Bicycle Health, another online suboxone provider, notified Google and Bing that our email address had been entered on an “enrollment confirmation” URL.
Boulder Care chief operating officer Rose Bromka said the company had started improving its “website hygiene” before being contacted for this article, and restricted the information sent by the Meta pixel after reviewing our findings.
However, Bromka added that Boulder still tracks some information about website visitors to guide its advertising.
“We are always looking to balance ensuring we are able to get the word out about options with holding to our value set,” she said.
Big tech’s black boxes
Meta, Google, TikTok, Bing, LinkedIn, Snap, and Pinterest say they have policies against using sensitive health data to help target advertisements.
“We clearly instruct advertisers not to share certain data with us and we continuously work with our partners to avoid inadvertent transmission of such data,” TikTok spokesperson Kate Amery wrote in an email, adding, “[W]e also have a policy against targeting users based on their individual health status.”
Meta and Google claim to have algorithmic filters that identify and block sensitive health information from entering their advertising systems. But the companies did not explain how those systems work or their effectiveness. By Facebook’s own admission to investigators from the New York Department of Financial Services in 2021, its system was “not yet operating with complete accuracy.”
To trace what happened to data collected by trackers, STAT and The Markup created dummy accounts logged into Facebook, TikTok, and Twitter while testing the telehealth websites. Reporters then used the platforms’ “download your data” tools in an attempt to determine whether any health information the trackers collected was added to our profiles.
The information provided by those tools was so limited, however, that STAT and The Markup couldn’t confirm how or whether the sensitive health information was used.
For example, a Meta Pixel on RexMD, which prescribes erectile dysfunction drugs, collected the name of the medication in our cart, our email, gender, and date of birth. Facebook’s transparency tool, however, only showed 10 “interactions” on RexMD’s website, with generic descriptions like “ADD_TO_CART.” It did not provide details about the specific data Facebook ingested during those interactions. A TikTok pixel collected some of that same information from RexMD, but TikTok’s report on our “usage data from third-party apps and websites” had just one line: “You have no data in this section.”
Our Twitter data showed that the company knew the dummy account user had selected a product on RexMD’s website and the exact URL on which that product was selected.
On some websites, users’ data was also being collected by “custom events,” meaning that a website owner deliberately created a custom tracking label that could have a phrase such as “checkout” in it but wouldn’t necessarily show up in the tech platforms’ transparency tools.
Only four companies answered whether they had ever been notified by Facebook of potentially sensitive health information. Monument and Favor had data flagged but said they determined it wasn’t sensitive. Lemonaid received a notification in error related to a promotional code, and Boulder Care had received none.
Telehealth websites should be held accountable for the trackers they install, said Hartzog, the Boston University law professor. But “big platforms that are deploying these surveillance technologies also need to be held accountable, because they’re able to vacuum up every ounce of personal data on the internet in the absence of a rule that tells them not to.”
The companies in this investigation said their services fill an important need. “The makeup of the traditional health care system has in many cases prevented people from accessing treatment for conditions that should be easy to treat,” Scott Coriell, a spokesperson for Hims & Hers, wrote in an email. Companies that serve patients with mental health or substance use disorders emphasized that long wait times to see in-person providers, and the stigma associated with seeking care, made virtual services especially valuable.
Marketing supported by third-party tracking is part of making that care accessible, some argued. “Monument uses online advertising platforms to raise awareness of our evidence-based treatment for alcohol use disorder, and get people the support and relief they deserve,” wrote CEO Michael Russell. “We transmit the minimum amount of data required to allow us to track the effectiveness of our advertising campaigns.” Favor spokesperson Sarah Abboud argued that calling standard industry practices into question could threaten trust in those services.
But health privacy and policy experts see a disconnect between the industry’s stated emphasis on privacy and its data-sharing practices. “Telemedicine providers should have realized from the get-go that if their entire business model is to seamlessly move people from marketing to care and the care will be online, then there’s going to be more personal identifiable information submitted and thus more privacy risk and thus more privacy liability,” said Christopher Robertson, a health law and policy professor at Boston University.
One problem may be that marketing teams don’t fully understand privacy regulations, and legal teams don’t have a handle on how the marketing tools work.
Sara Juster, privacy officer for the weight-loss telehealth company Calibrate, wrote in an email that the company doesn’t “send any health information collected in our eligibility flow back to platforms.” But a Meta Pixel on its site sent data including height, weight, BMI, and other diagnoses, like diabetes, to Facebook. Juster then clarified the pixel was a duplicate that should have been removed in a tracking audit earlier this year.
However, as of Dec. 7, a Meta Pixel was still present on the site and sharing hashed identifiers and checkout events with Facebook. The pixel appeared to have been reconfigured, though, to send less information than it had during our original testing.
Without updated laws and regulations, experts said patients are left to the whims of rapidly evolving telehealth companies and tech platforms, who may choose to change their privacy policies or alter their trackers at any time.
“It doesn’t make any sense that right now, we only have protections for sensitive health information generated in certain settings,” said McCoy, “but not what can be equally sensitive health information generated in your navigation of a website, or your filling out of a very detailed form about your history and your prescription use.”
This article was co-reported with The Markup, a nonprofit newsroom that investigates how powerful institutions are using technology to change our society. Sign up for its newsletters here.
What are the Big nutrition and health issues? The pitfall I see many people today producing is becoming a member of a health and fitness center or health group and working extremely difficult day in and working day out undertaking “all the ideal things” – strength education, cardiovascular and endurance instruction – but however not carrying out their goals.
Exercising is just one element of a healthy life-style. Nutrition and accountability are similarly, if not a better component of an over-all healthy way of life. Why is it so challenging to remain on track with nourishment? The issue is accountability and mentality. With health and fitness courses, as soon as you are registered or have gotten your pals collectively to attend class, you are accountable to go. With nourishment the accountability is much more based mostly on you as the person. With that becoming mentioned, right here are a several problems a lot of persons make and tips on how to keep away from all those.
Mistake 1:The Diet.I have met so numerous people today who have tried using all the fad diets, long gone on and off diverse applications, dropped fat and obtained it back again just to be trapped in the disheartening cycle of “dieting” all of the time. When making life style alterations it is important to believe life-style somewhat than food plan. Likely on weight loss plans that limit calories and deny yourself of factors you enjoy for a selected time till you drop X range of lbs . is a recipe for failure.
Recommendation: Decide on whole foodstuff, try to eat in moderation and stay away from processed meals that have elements you simply cannot pronounce. Try to eat 4 to six smaller meals a working day.
Slip-up 2:Rolling Solo. When individuals sense element of a group, regardless of whether it’s mates, a way of life group or relatives members, people today are a lot more very likely to accomplish the goals that they established.
Recommendation: Get a life-style team alongside one another and do a problem. Hold each individual other accountable and have entertaining accomplishing it. Surrounding by yourself with persons who have identical objectives and are supportive of your objectives is important for good results.
Slip-up 3:Placing Far too Several Plans.When you test to alter as well numerous items at at the time, you are not environment you up for achievements to accomplish any of all those goals. I have achieved with people today who want to lose pounds, exercise at minimum 5 times a 7 days, cook a new recipe every single week etc… Then when it will get also overwhelming making an attempt to make all of these changes that are new to them, they are not able to adhere with any of them.
Recommendation: Start off with a solitary objective. Stick to it for a thirty day period and then incorporate in a new target. This is going to established you up to achieve your aims and direct to a satisfied and healthful life style that is going to be sustainable.
In conclusion, if you are battling with sticking to your conditioning and diet goals, re-set, reevaluate and re-start! Adhere with just one purpose, have an accountability group and guidance each individual other with encouraging healthful eating habits and exercise objectives.
CAT Burke is the proprietor of GETCATFIT Marco Island Conditioning Bootcamp. She has around 30 years’ expertise as a health and fitness qualified, retains a BS in Kinesiology, is an ACE Qualified Own Coach, Group Physical fitness Teacher and Fitness Nourishment Specialist. CAT is also lively in the pure bodybuilding field as a professional athlete and decide. CAT may possibly be reached at data@getcatfit.com. Internet site:www.getcatfit.com.
**CAT Burke is not a health practitioner or registered dietitian. The contents of this post must not be taken as clinical tips. It is not supposed to diagnose, treat, remedy, or avoid any overall health issue – nor is it meant to replace the suggestions of a medical professional. Usually consult your doctor or skilled wellbeing skilled on any matters with regards to your well being. **
