The set has all of the trappings of a serious make-out scene: two college students, a couch, and the suggestion of a keg in the background, props familiar to most college graduates, whether you came of age watching Happy Days or Jersey Shore.

But as the action begins, the woman expresses discomfort as the man’s advances grow more aggressive—the dynamic shifting from mutual consent to possible coercion. That’s when two students observing from the sidelines chime in like a Greek chorus, explaining all of the things that are wrong with this picture. “What’s up with him?” the female onlooker demands, pointing to the woman’s obvious distress. “Does that seem like enthusiastic consent?”

“Mr. Suave here thinks he can change her mind because he’s just that good,” says her male counterpart.

“But she’s clearly not consenting clearly and actively…” she says, watching with approval as the young woman on the couch suggests her date step into the shower, so she can slip out the door to safety.

There are no celebrities in this clip, or even a funny cat, but this video could well be one of the most watched on college campuses this year. Part of “Not Anymore,” an interactive online training effort taking aim at the high incidence of sexual assault on college campuses, the program has just become part of the curriculum at Princeton University, the University of Iowa, and a host of other institutions. All of them are trying to keep pace with Title IX standards that compel colleges to investigate and resolve student reports of sexual assault, whether or not these incidents are reported to the police.

While these provisions have been in place for years, a rising tide of student activists have complained that many colleges aren’t taking reports of rape seriously enough—in fact, one study found that fewer than a third of sexual assault cases result in expulsion. Findings like these prompted the Education Department’s Office of Civil Rights to issue a “Dear Colleague” letter in 2011 to clarify the obligations colleges have when it comes to creating a safe environment for all students. Currently, 86 colleges and universities are under federal investigation for concerns about how they’ve handled reports of sexual assault.

The list includes Ivy Leagues such as Harvard and Dartmouth, small liberal arts colleges including Swarthmore and Sarah Lawrence, and large public universities from the University of Michigan to University of California–Berkeley. Also on the list are 12 schools undergoing a more sweeping “compliance review,” including the University of Virginia, where a recent controversial—and later questioned—Rolling Stone report about an alleged fraternity gang rape has inspired nationwide soul-searching about why cheating among college students is often investigated more aggressively than is sexual violence.

That’s one reason why Caroline Vellenga-Buban ’17 (Monmouth, Ill.) says she has no complaints about being required to watch the “Not Anymore” training program before arriving on campus as a freshman last year. Macalester has made the program mandatory for every new student since 2007, part of a campus-wide effort to make students aware of the school’s zero tolerance policy toward sexual assault. The program also promotes the concept of affirmative consent—replacing “no means no” as the slogan of choice with the “yes means yes” definition gaining hold across college campuses. (In September, California became the first state in the nation to adopt the language as the new definition for sexual consent—a move applauded by many victims’ rights advocates.)

“It’s easy to think that because you’re on a small campus and you recognize most of the people you see everyday, that sexual assault isn’t a problem,” says Vellenga-Buban, a student coordinator of Feminists in Action/Students Together Against Rape and Sexual Assault. In fact, a study from the White House Council on Women and Girls reports that one in five women are the victims of sexual assault during their time on campus—regardless of the size of the school—and only 12 percent will report the attack. “It makes me feel reassured that Macalester’s being so proactive about this and reminding people of the risks. It makes me feel safer to know we’re all being educated about it.”

A Proactive Approach
A generation ago, many campus sexual violence prevention programs offered little more than tips for keeping track of your drink, or how to call a campus escort when leaving the library late at night. “I would say 25 years ago it was more about promoting personal safety, maybe calling in a martial arts instructor,” says Lisa Broek, associate director of health services. That model was based largely on the myth that the risks students face come from outside the campus community; more recent studies have found that nearly 90 percent of college sexual assault victims know their assailant.

While college women are still more likely to be victims of sexual assault, 15 percent of men are also victims of forced sex during their time in college. More than a quarter of college men, and more than 40 percent of college women report experiencing violent and abusive behaviors— including assault, stalking, and cyber-bullying—from someone they dated.

“The stranger myth is reassuring in a way, because it means you just have to avoid that guy,” says Keith Edwards, director of Campus Life. “It’s harder to think I have to be thoughtful about the person I’m interested in, or my lab partner, or the friend who offers to walk me back to my residence hall at night.” That’s why, over the last decade, Macalester has created a multi-tiered approach to sexual violence prevention designed to convey everything from what consent really means in an intimate relationship, to what a healthy relationship should look like, to what bystanders can do to stop sexual violence before it happens.

For transfer and first-year students, the training starts with the “Not Anymore” module that every student views before they can register for classes, and continues with “This Matters @ Mac,” a freshman orientation session that covers the college’s academic and community values. The concept of affirmative consent is addressed early on, with orientation leaders taking turns demonstrating sexy ways to ask for consent from an enthusiastic partner. The message, often repeated, is that sexual consent calls for an active and ongoing yes—affirmation that’s not possible if your partner is incapacitated by alcohol or drugs. (Alcohol plays a role in 75 percent of campus assaults.)

“We really overplay it and it can be kind of silly, but the idea is to help remove some of the stigma and taboo of talking about sex,” says Maya Agata ’16 (La Crosse, Wis.), an orientation leader and a volunteer with SEXY (Students Educating X’s and Y’s), a peer-run program of the Health and Wellness Center. “It tells everyone that this is a conversation we’re going to have at Macalester. It’s not something we’re going to mention once and never talk about again.”

The potent mixture of alcohol, new faces, and unfamiliar surroundings combine to make the first 15 weeks of freshman year a particularly high-risk time for students, studies have found, which is one reason SEXY volunteers fan out to dormitory floors every fall with a program about sexual health and safety. SEXY educator Hannah Lair ’16 (Chicago) often breaks the ice by asking audience members to share their perceptions of what’s normal in the world of college sex. “I’ll ask, ‘What do you think is an average number of sexual partners?’” she says. “One…two… three?” As the numbers go up, hands start to rise—the same trend Macalester’s health and wellness center sees when they ask students to share their perceptions of marijuana and alcohol consumption on campus.

“The big myth is that college is some bacchanalian orgy, but that’s not reality at all,” says Edwards. In spite of a sexually super-charged music and media culture, the boundaries haven’t been pushed back nearly as much as some students may think. “People who are not having sex or having sex in a monogamous relationship are sometimes thinking ‘I must be weird,’ when in fact, they’re normal,” he says.

Another program that gives students a better roadmap for navigating relationships is “Consent is Mac,” a student-led campaign that encourages classmates to sign a pledge (see facing page) committing to their rights and responsibilities in intimate encounters. Among the tenets: I have the right to trust my own instincts and experiences; I have the responsibility to check my actions and decisions to make sure they are good for me and others; I have the right to change my mind whenever I want. Launched nearly a decade ago, Consent is Mac is a consistently popular program—not just because of the free T-shirt that comes with each promise.

“I think consent has become part of our culture at large,” says Alejandra Marin ’15 (Santa Ana, Calif.), who coordinates the program. Consent is Mac sponsors a popular sex trivia event every year, and posts to a tumblr blog that keeps the concept of consent at the top of students’ minds. “Just making consent part of the conversation is so important. We’ve definitely had people thank us for doing this, especially transfer students. It’s something that defines Macalester and who we are.”

Complications of Consent
As the conversation about campus sexual violence builds momentum, so too have reported cases nationwide. A 2014 study from the Washington Post found there were more than 3,900 reports of sexual offenses on college campuses in 2012, a 50 percent surge over the past three years.

“One of the challenges is that the better we are at educating students about this, the more sexual assault numbers we’re going to see,” says Edwards, who lectures widely on the subject of sexual violence prevention, and who recently served as chair of the College Student Educators International’s Commission for Social Justice Educators. “In my talks, I tell people I’m not scared of the campus where they have a high number of sexual assault reports over the last few years—but I’m petrified of the school that has none. It doesn’t mean it’s not happening— it means no one is getting the resources they need.”

Associate Dean of Students Lisa Landreman, who coordinates all of Macalester’s sexual assault prevention efforts, says her office handles about a dozen initial inquiries from students every year, about half of which proceed through an official reporting process with possible sanctions for accused students. Although Title IX complaints can include everything from criminal reports of rape to hostile classroom environments, Landreman says, “Most often it’s people who either are casually dating or haven’t chosen to date but make an agreement to have some sort of initial intimacy, and often what they’re describing is consistent until one person says, ‘Wait, I didn’t agree to this part.’”

An online reporting form and a small campus Sexual Assault Support Team are designed to provide student victims and potential perpetrators fair process and privacy. In many cases, Landreman says, the victim doesn’t want to see the accused student expelled, but also doesn’t want to see the person every day—a virtual impossibility on a campus as small as Macalester. “The challenge is that we’re a residential community and everybody knows each other,” Landreman says. “On the positive side is that people pretty universally care about this issue, they care about people being harmed in this community, and they want to prevent it.”

Direct, Delegate, Distract
Mac’s tight-knit community can be a source of strength when it comes to preventing sexual assault, one reason the college has put a growing emphasis on the value of bystander intervention. Studies suggest that one in three sexual assaults begin in the presence of a bystander who could take action to prevent the problem—skills Hannah Lair learned more about at a Green Dot Training program the college provided for student leaders.

“We talk a lot about the three D’s—direct, delegate, and distract,” says Lair, who prefers the direct approach when it comes to keeping friends safe. “If someone’s dancing on you at a party, I’m not afraid to say, ‘Are you okay with this? Is everything good?’” Delegating a potential problem to an authority figure is another strategy; causing a distraction by spilling a drink or demanding a private conversation can work just as well. “You can tell someone that their car is being stolen, or because we’re at Macalester, that their bike is being stolen,” she says. “The idea is that if you’re concerned, you need to do something. Even if you cause an awkward situation, your intentions were good.”

Lair joined a recent Continuing Conversations discussion titled “Your Defining Moment,” in which students strategized ways to help friends caught in unhealthy relationships or potentially dangerous situations, one of many conversations Mac students have been having about the topic. Every Monday, a small but growing group called Mr. M—short for Macalester Reimagines Masculinity—explores how to shift away from the “toxic masculinity” that fuels violence and sexual assault.

“I define toxic masculinity as that ‘boys will be boys’ attitude that boys are taught from a young age,” says Jake Greenberg ’17 (Boston), who says that Mr. M discussions often explore the ways sexism contributes to creating a culture of rape. “I think one of the most harmful attitudes is ‘I don’t commit sexual violence, therefore I don’t need to care,’” he says. Sexism and the potential of becoming a victim of sexual assault “is not something that hurts women every once in awhile, it affects them in different ways every day—there’s never a day when women don’t have to think about it.”

Conversations like this are a hopeful sign that campuses can turn the tide on sexual violence, says Edwards, and become safe havens for all students. “Rape may be a reality, and we need to be mindful of that, but a proactive approach asks, how are we going to stop that from happening? How are we going to learn about whom the perpetrators are? How can we educate them, how can we reach them? How are we going to change the culture?

“Those of us who’ve been doing sexual assault prevention work have long said, ‘Can you just imagine what we could do if we got the attention this issue deserves?’” he says. “Now this topic has everyone’s attention, and I think it could be transformative.”

LAURA BILLINGS COLEMAN is a regular contributor to Macalester Today.

A friend of mine got a degree from a top-flight business school and took a job at one of those Fortune 500 companies where “full-time” means a minimum of 60 hours a week. At first she loved the pace, the travel, the nicely padded expense account, and the employee gym where she and her colleagues were actually encouraged to brainstorm Big Ideas on the cardio equipment. But as the economy started to tank and one wave of voluntary buy-outs was followed by successive waves of not-so-voluntary ones, the extra workload made it hard to keep her dates with the elliptical machine, or increasingly, to leave her desk for lunch. The manager who hired her was let go and replaced by another prone to yelling in the hallways, and not long after her dentist recommended a mouth guard to protect her molars from the teeth-grinding habit she took up at night. During a particularly stressful deadline crunch, her eczema flared up for the first time in years, an embarrassment she felt all the more keenly when she was called to a meeting with human resources and shown the details of her severance package.

The good news–her eczema went away. The bad news–so did her health insurance.

This recession seems intent on reminding us to take stock of a great many things, not the least of which may be the very delicate balance between what we do and how we feel. Work can offer so many ingredients essential to good health—a steady pay check, access to health coverage, and the sense of purpose and meaning that research says is essential to living a long, happy life. Yet, as the quaking economy has fueled everything from “survivor’s guilt” and “recession depression,” to a sudden surge in sleeping disorders, it’s clear that having a job in this economy is no guarantee that you’re actually feeling good.

“Stress affects every cell in the human body, and while there are certainly other sources of stress in our lives, work-related stress is huge,” explains Mary Jo Kreitzer, founder and director of the Center for Spirituality and Healing at the University of Minnesota. “Chronic stress can have such long-term negative effects that take a toll on employees and can be a huge drain on an organization, not only in terms of productivity, but also creativity.”

In fact, estimates suggest that unmanaged work-related stress costs this country more than $200 billion a year as a result of missed days, health and mental health issues, and lost productivity—so much so that the Bureau of Labor Statistics has ranked “neurotic reaction to stress” as the fourth most debilitating labor-related injury. “I’m often surprised at how many of us think that what goes on our in our emotional world is somehow separate from our bodies’ response—but I think that’s beginning to change,” says Michelle Duffy, professor of human resources and industrial relations at the U of M’s Carlson School of Management. An expert on anti-social workplace behavior, Duffy says the damage done by bullying, sabotage, and other undermining behavior adds another $24 billion to the total bill.

Monday mornings have long been the most popular time of the week for a heart attack—a trend that requires no explanation for anyone who has felt the gathering dread of a Sunday night. But a growing body of research suggests it’s the accumulation of those manic Mondays that really raise our health risks over time. Working in a field where the cost of failure is high—air traffic control, for instance—has been shown to trigger a cascade of stress hormones that can increase blood pressure, boost the likelihood for bad behavior (like skipping exercise, or eating out of the vending machine) and actually accelerate the aging process. In fact, researchers at the Cleveland Clinic, who’ve pioneered the notion of chronological versus biological age, estimate that American presidents age the equivalent of two biological years for every one they spend in the White House—which helps explain the touch of gray we noticed on Obama almost the moment he stepped into office.

Though some job sectors have undergone seismic shifts since the downturn  (car-makers, bankers, and the media all come to mind), a Swedish study released last year confirmed that a major source of workplace stress is present even in the most stable office environment, from Dunder Mifflin on down—the incompetent boss. In fact, a study published in Occupational and Environmental Medicine found that workers who had a boss they thought of as inconsiderate, arbitrary and unjust were more likely to experience angina or heart attacks than those who worked for bosses they perceived as fair, good communicators, and capable of giving useful feedback. Worse, the cardiac risk seemed to go up the longer the employee stayed in the job.

Early retirement may not be the cure. Researchers at the University of California, Davis, recently compared hypertension rates among retirees and found that men who had been managers had lower rates of hypertension in retirement, while those were managed at work had higher rates. The highest rates of hypertension corresponded with those who had the lowest status jobs, and the smallest role in making decisions.

While most water-cooler crowds could draw some easy conclusions about why bosses are having fun in their golden years while the bossed are still fuming, new research about workplace bullying further complicates the picture. A 2008 Zogby poll found that more than half of American workers say they have suffered or witnessed workplace bullying (a definition that included sabotage, verbal abuse, undermining behavior and abuse of power). Surprisingly, 40 percent of those bullies were women, who were more than 70 percent likely to bully another female.

And while programs like The Office and 30 Rock would suggest it’s the devious malcontents on the periphery of the office power structure who cause the most damage (Dwight and Frank, respectively), Duffy and her colleagues recently examined undermining behavior in organizational settings and found just the opposite. “I had thought it would be the people on the outskirts who were doing the most undermining, but in fact it was the highest performers, the people who had the most contact with their peers, who were the most likely to be undermining their competitors,” says Duffy, who notes that this is not the first time research has suggested workplace politics mirror that of high school.

The good news about this bad news in the economy, says Kreitzer, is that more workers are tuning into the ways their work environments may not be healthy, and are taking steps to change it. “I’ve certainly heard from people that have realized they’ve stayed on the job longer than was healthy because the job provided health insurance,” says Kreitzer, who says her center’s classes on mindfulness and reducing stress have been particularly popular during this downturn. “And I’ve certainly heard from people who say losing the job was the best and worst thing that ever happened to them because it forced to do something that was closer to their hearts, to do what they really wanted to do.”

In my friend’s case, she started her own business several months ago with the remains of her severance package, and has already hired two part-time employees. While she can’t yet offer them health insurance, she figures that treating them with consideration, encouraging them to eat lunch, and letting them cut out early could also be the start of a very nice benefits package.

Work Stress Stats

Employees who think workers have more stress on the job than they did a generation ago: 3 in 4.

Percentage of job turnover rate attributed to stress: 40.

Workers who say they feel stressed on the job: 8 in  10.

Of those workers, number who say they could use some help managing stress: 1 in 2.

Percentage who say their coworkers could use the same: 42

Percentage of workers who says they’ve felt like screaming on the job because of stress: 25.

Percentage of workers who say they felt like hitting a colleague in the last year but didn’t: 14 percent.

Source: The American Institute of Stress

Written for Mpls/St. Paul Magazine, September 2009

One of my favorite health columns from Mpls/St. Paul, probably because going for regular hikes is the one health directive I’m truly fanatic about. (Flossing and five servings of vegetables a day, not so much.) The kids were this size when I first wrote this, but we’ve walked thousands of miles through the woods together since. Here they are laying stones at the cabin site of great American hiker Henry David Thoreau who believed “Every walk is a sort of crusade…” 

Jodi Hiland is not the sort to offer unsolicited advice to parents. She believes we all get quite enough of it already, thank you very much. But on rare occasions, when she finds herself in the company of a squalling infant or a pair of squabbling siblings or a preteen who’s suddenly gotten too cool to participate in conversation, she might make the following suggestion to the child’s parents: “Have you tried going outside?”

Hiland first discovered the sanity- saving effects of the great outdoors when, having exhausted all the other tricks for consoling her crying infant son, she bundled him up and took him outside. “It was like the power switch turned off,” she recalls. His frantic crying was replaced by a sudden calm and an instant curiosity about his new surroundings. “It was like there was something totally familiar and reassuring to him. Like he was saying, ‘Hey, I remember this.’ ”

What she observes now in the faces of her sons when they’re outdoors is what biologists often call “biophilia,” an innate love of living things that may be hardwired into our genetic heritage—and which a growing body of research suggests may be essential to our health. In fact, just being able to see trees from a hospital bed, instead of a brick wall, can speed healing and cut the need for painkillers. Access to green space, gardens, and public parks has been shown to cut the health gap between rich and poor in half. Mother Nature may even be more effective than some medication when it comes to calming active minds: A recent study from the University of Illinois found that a 20-minute nature walk improved the focus of children with attention disorders.

But this good news about the great outdoors comes at a time when people are getting out in nature less. For the first time in history, most people on the planet live in urban areas, and technology has so altered our landscape that a “tweet” is more likely to come from a cell phone than a songbird. All of this helps explain why Hiland founded the Happy Trails Family Nature Club, a loose-knit, non-dues-paying group of parents who gather at parks and nature preserves around the Twin Cities for what Hiland terms “planned spontaneity.’’ She got the idea after reading Richard Louv’s 2005 bestseller, Last Child in the Woods, in which he connects the shrinking amount of time children spend playing outdoors with growing rates of attention deficit, obesity, and depression. (He even came up with a catchy moniker for the problem: “nature-deficit disorder.”)

I must report that none of the dozen or so kids I encountered at a Happy Trails event one unseasonably cold spring night at the Dodge Nature Center in West St. Paul seemed depressed in the slightest—shouting their hellos to a snowy egret making its way through a marsh, climbing and leaping off a stand of trees, and offering helpful suggestions to several adults struggling to make a campfire out of soggy kindling. (“Have you tried lighter fluid?” offered one.) Hiland says this exuberance is the natural side effect of bringing children outdoors, and that helping harried adults see how this works is her only agenda. “I just want to show other parents what we’ve learned, which is when you go out in nature, you teach kids how to shift from one gear to another—and that’s a really important skill to have.”

Happy Trails is one of a growing number of nature clubs across the country, inspired by Louv’s book and driven by the “No Child Left Inside” movement—also the name of an environmental education bill that passed the U.S. House of Representatives last fall. If you think kids don’t need government funding to get outside, it’s a good guess you grew up with the Little Rascals and not The Backyardigans. A 2007 study from the group Natural England found that in only four generations, the natural habitat of childhood has been so constrained that a grandfather who spent his boyhood walking six miles to a favorite fishing hole now has a great-grandson allowed to roam no farther than 300 yards from his front door.

Part of this confinement in play space can be blamed on the spread of cities—after all, the unpaved county roads where I spent long hours on my 10-speed pedaling nowhere in particular have all been filled in with suburban subdivisions with no sidewalks. And while my kids could theoretically walk to our neighborhood school, the street they’d have to cross looks like a freeway most mornings—which is why most parents in my neighborhood fire up the minivan for the eight-block ride.

But Marti Erickson, a retired University of Minnesota developmental psychologist—who, with Louv, was one of the founding members of the nonprofit Children & Nature Network—suggests my generation’s trust issues go beyond that busy crosswalk. “This is a generation of parents who are really caught up in fear,” says Erickson, who hosts the local FM 107.1 radio show Good Enough Moms with her daughter Erin Erickson Garner. The 24/7 news cycle, with its appetite for lost and endangered children, has reinforced the idea that letting kids explore the world around them is unsafe. Add to that the lure of cable TV, iPods, Facebook, and the siren call of organized soccer, and the average child now spends three hours a day in front of a television and gets only 30 minutes of unstructured play outdoors—every week.

The loss of that downtime comes with a downside. A recent study from the journal Pediatrics found that kids who had 15 minutes or more of recess every day were better behaved and performed better in school than kids who didn’t get that downtime. Another study from the Journal of School Health found that the more physical fitness tests students passed, the better they did on academic tests.

“Isn’t this what teachers have known for generations?” asks Megan O’Hara, chair of Minnesota Children and Nature Connection, a resource group aimed at connecting kids to the outdoors. “You release kids into the outdoors and let them run wild, and when they come back they’re calmer and more focused.” O’Hara, who is married to Minneapolis mayor R. T. Rybak, believes that adults are the target audience for this message and may just need some extra encouragement to leave their comfort zones. “We have all of these beautiful parks in the Twin Cities and fantastic nature programs, but one of the things you hear from [park employees] is they need help reaching out to families,” O’Hara says, noting that the first hurdle is “often parents who don’t want their kids to get dirty or get wet”—two things we’ll have to get over if we want our kids to reap the benefits of going outdoors.

Fortunately, the kids I met at the Happy Trails walk seemed to understand this fact intuitively, taking turns rolling down a grassy berm, pulling rocks from a muddy creek bed, and setting out with flashlights to “go find some wolves” (even though their parents explained that wolves are not native to West St. Paul). The promised bonfire at the end of the trail never fully ignited, but even so, Hiland was confident the outing had helped to kindle a lifelong love of the outdoors in the kids that night—a love that may even make their lives longer.

Originally published in Mpls/St. Paul magazine, 2009

June 14 is National Get Outdoors Day, but any summer day is the perfect time to take your kids outdoors, especially if you follow these tips:

Start ’Em Young: Don’t wait until they’re old enough for the rock wall at REI. Babies and toddlers are naturally curious about the environment and only need a little guidance to get started. Go for regular nature strolls, collect cool leaves in your stroller basket, look for birds, or let them nap on a blanket in the backyard. “They’re never too young,” says retired developmental psychologist Marti Erickson, who has equipped each of her toddler grandchildren with headlamps, and who once took an 18-month-old on a canoe trip down Minnehaha Creek. “We did get wet,” she says. “But that’s also part of the fun.”

Think Beyond the Playground: Research shows that kids play more creatively, enjoy problem-solving, and collaborate more in unstructured (read: less adult-controlled) environments. Hang back and let them do their own thing.

If you figure it takes about a week to work through the effects of the average rhinovirus, this means that forty-four weeks out of the year, or almost ten months out of twelve, someone in my family is sick. That’s in a bad year. In a good year—well, we’ve never had a good year. Given our highly infectious history, it’s easy to imagine the viruses likely to visit us in the near future, hitching a ride home from preschool or lurking on the sticky fish tank at the pediatrician’s office that my two-year-old can’t resist licking.

Two years ago, when public health officials convened in St. Paul for a pandemic influenza summit, I read every newspaper report, studied the state’s published emergency plan, followed the movement of birds infected with avian flu from Turkey to Ukraine, quizzed my pediatrician about the effectiveness of Tamiflu, and even stocked up on canned tuna fish after someone in the federal government said I should. In the midst of this activity, one of our kids complained that his eyelids were stuck together. By the time he passed his pink eye to every member of the family, the buds were back on the trees and I forgot all about the flu—until the following year’s flu season, when my fretfulness resumed.

This is not the most productive approach to the flu—or to any health threat—but public health experts say it’s typical. According to Buddy Ferguson, the Minnesota Department of Health’s risk communications specialist, most of us have a short attention span when it comes to what he calls the “disease du jour” that dominates the day’s headlines. Whether it’s seasonal flu or the pandemic influenza that health officials have been warning us about during the past few years, our risk is often more enduring than our interest in doing anything about it. “That’s why when there’s a window open—an educable moment when the public will listen to our message—we try to make the most of it,” Ferguson says.

That window opened wide in 2005, when a shortage of seasonal flu vaccine forced people waiting for a shot to stand in long lines (the line I stood in reached into a frozen parking lot). Reports of human deaths caused by the H5N1 avian flu virus had made headlines and President Bush announced plans to use the National Guard to enforce quarantines in the event of a pandemic. Then Minnesota epidemiologist Michael Osterholm, now director of the state’s Center for Infectious Disease Research and Policy, sent chills up the public’s back when he was asked what would happen if a pandemic were to strike that year and he answered, “We’re screwed.”

In response to the pandemic concern, the legislature appropriated $500,000 for the health department to begin an awareness campaign to help Minnesotans prevent and prepare for such an event. But by the time the session concluded and the check was cut, says Ferguson, “it was already clear that people were turning their attention elsewhere. The educable moment had passed.”

The moment passed, but the threat did not. “Influenza experts assume a pandemic is in our future—it’s part of the natural history of the influenza virus,” says Elizabeth McClure, medical director of the Academic Health Center Office of Emergency Response at the University of Minnesota and an associate at CIDRAP. What experts can’t predict is whether the next pandemic will be as widespread as the one was in 1918, when influenza killed an estimated 40 million men, women, and children worldwide, or whether it will be less severe, more like the pandemics of 1957 and 1968.

An influenza pandemic remains the worst-case scenario, but each year seasonal influenza takes a toll of its own. Though flu-related deaths among adults aren’t reported to the U.S. Centers for Disease Control, pediatric deaths reported nationally paint a grim picture of seasonal influenza. Across the country, 153 children died of flu-associated deaths during the 2003-04 flu season. During last year’s season, which the CDC described as “generally mild,” sixty-eight children died.

“Influenza is one of the leading causes of death, year in and year out,” says Ferguson. But getting that message out can be a challenge, even in a media-saturated culture such as ours. Go too far while telling the public the human toll a severe flu season—or, worse, a full-scale pandemic—could take and you “scare people into denial,” Ferguson continues. Beat the drum too often and the public becomes bored, an effect dubbed “flu fatigue.” Tell the public how quickly our world would change in the event of a pandemic (businesses closed, flights grounded, students and workers sent home in an effort to break the chain of exposure) and you face ridicule and resistance in a post-9/11 world grown weary of alerts and official advice to stock up on duct tape and plastic sheeting.

McClure says the idea of planning for emergencies is a foreign concept to most of us, who have never even had to stock up for a winter storm. “It’s very counterintuitive for us to think we have to put anything aside because we can go anywhere and get anything we want, at any time,” she says. “We don’t even have seasonal vegetables anymore. But I try to remind people that all of that stuff in front of us is supported by a very thin supply chain that can be interrupted.

“If you haven’t experienced [a public health emergency],” McClure says, “it’s very difficult to believe it can happen.” But it will happen, she insists. “It isn’t a matter of if, it’s a matter of when.”

When a pandemic does happen, I’m going to need a lot of dog food.
That was one of the discoveries I made recently, after creating an emergency-planning kit as prescribed by codeready.org, the emergency preparedness website created by the state departments of public health and public safety. The goal of the codeReady campaign, which the state rolled out last spring, is to get Minnesotans to plan for a pandemic or other emergency that would require them to stay home for extended periods of time or otherwise strain the official emergency response. So far, more than 57,000 individual visitors have gone to the site, and nearly 11,000 say they’ve created an emergency kit as I did, starting with a comprehensive shopping list of items a family would need in a worst-case situation.

When I went to the site to figure out what a one-week preparedness plan would look like, I expected instructions for turning my basement into a bunker. But the suggestions seemed surprisingly reasonable. For instance, my family of five would need 137 servings of protein, which seemed excessive until I learned I could cover that with a few pounds of dry beans, two jars of peanut butter, and the tuna fish I had left over from last year’s flu season. The thirty-five gallons of water the site says we’d need seemed more daunting.

“I say do what you can do,” Elizabeth McClure says. “If it gets you off zero, that’s a start.”
The checklist that accompanies the codeReady planning kit helped me determine the specific needs of my family. A few boxes of diapers, for example, are a must-have for my brood, while extra supplies of blood-pressure medication might be a concern for older neighbors down the street. Because my kids are fever-prone and a quick trip to Walgreen’s may not be an option in an emergency, I need to make sure I’ve got a fresh supply of Advil. The pet store may be as inaccessible as the pharmacy, which is why I need to stock a week’s worth—fourteen cups—of kibble for our dog. Yes, calculating our needs like that makes me feel as though I’m playing a cameo role in one of those depressing post-apocalyptic disaster movies.

“People think,‘Oh, no, I don’t want to be one of those basement people,’ ” says McClure. But, she adds, taking stock—and stocking up—could prove an enormous help during an emergency. Instead of my usual “just-in-time” fretting, a clear-headed plan and well-supplied cupboards could help cut down on the anxiety of caring for my family in a bad situation. It might even allow me to help friends and neighbors who are harder hit, by simply keeping out of the way.

“Our hope is that disaster preparedness becomes a kind of social norm, if you will,” McClure says. “That it means we’re ready to help each other in our communities if something unexpected happens.”

Thinking proactively about the dark side may have another bright side. “I believe [the threat of] pandemic flu has made people more aware of seasonal flu and that will only serve to help us,” McClure explains, noting that when we’re alert to the dangers we’re more likely to cover our mouth when we cough, get flu shots, and practice other infection-control measures. “I know that when someone in our family got sick, I used to think, ‘Oh, great, now we’re all going to get it,’ ” she says. “Now I say, ‘No. Let’s try washing our hands, let’s not share towels and glasses, let’s see if we can’t avoid everyone getting sick.’ ”

She’s definitely onto something. I notice that the more I think about what’s beyond my control, the more committed I become to what’s within it. I can’t do anything about the respirator shortage that made headlines two years ago, but I can keep my kids home from school when they’re sick. I can’t predict what the federal response to a pandemic will be, but I can wash my hands more often. In fact, a recent review in the British Medical Journal of more than fifty studies concluded that hand-washing and using germ barriers such as face masks may be more useful than drugs in preventing the spread of respiratory viruses such as influenza and SARS.

My family is making other changes that don’t feel like emergency prevention, but probably are. My husband and I take turns supervising our boys’ tooth-brushing ritual and insist they use separate cups. On Dr. McClure’s recommendation, I bought my first bottle of alcohol-based hand sanitizer.

Forty-four colds a year may have been the norm at our house, but with this new plan in place we might end up breathing a little easier.

Laura Billings is a St. Paul–based journalist and regular contributor to Mpls.St.Paul Magazine.

World Diabetes Day 2013 with Caring Chain from Andrew Morrow on Vimeo.

Here’s something Virginia wrote about what it’s like to live with Type 1:

My theory about having diabetes is it’s like a conjoined twin. It’s always with me even when I don’t want it to be. I tell people, you have it, you don’t like it, but you have to deal with it.

My family is really open and not shy about diabetes. I see some of my friends hide their pumps or checkers. I don’t mind telling people about diabetes when they look at my technology. This week someone called us from a newspaper to interview us about everything we’re doing for World Diabetes Day and I told her my conjoined twin theory. She didn’t know very much about Type 1 diabetes. Most people don’t.

It’s fun having everyone get excited about World Diabetes Day. It makes me feel like I don’t have to keep diabetes a secret because the day is all about it and me. When I show friends or groups how I check my number they all think I’m really brave. One day, my sister’s friends added up that I’ve had about 20,000 pokes in my fingers when you add it up.

I want a cure to get rid of diabetes. I wish I never had to check my number again. Or get a pump change because it hurts having a needle poking through my flesh. Literally. Not everyone can say they get a needle stuck in their arm for 10 days. And when I’m high I’m starving but I can’t eat. When I can’t eat it feels horrible. When I get a cure my fingers will finally get a break.

The boys and girls at Galtier Magnet Elementary School don’t know it yet, but they’re about to become the guinea pigs in an experiment that could have ripple effects throughout St. Paul’s public schools–and possibly beyond.

As they slide their trays through the school’s cafeteria line one bright spring day, each receives a bowl of beef barley soup and two pieces of bread, one round and one square. A team of women in clinical white smocks hover at the edge of the room with clipboards, poised to record what happens next. “It’s a big day here,” says Jean Ronnei, director of nutrition services for the St. Paul public schools. The round bread was made by the district’s regular supplier, while the square slice was baked in district ovens from a new recipe that uses heart-healthy whole grain flour but looks as white, fluffy, and familiar as Wonder Bread. “We’re very interested in finding out which kind of focaccia the kids like best,” Ronnei explains.

If focaccia was a foreign concept in the school cafeteria where you cut your teeth, chances are you also survived your formative years without partaking of a substance known as Flaming Hot Cheetos. Before the item was banned from the Galtier lunchroom, this bright red nutrition-free menace was a major source of calories for kids—and a major source of concern for principal John Garcia. More than 80 percent of the students at this magnet school two blocks off University Avenue in the heart of St. Paul qualify for free or reduced-price lunches. More than 70 percent also take part in the school’s subsidized breakfast program, running in from the morning bus and eating so ravenously that Garcia says, “It’s clear a lot kids haven’t eaten a real meal since lunch the day before. They come hungry.”

As he’s watched his students eat—wolfing down fatty, sugary treats, and turning up their noses at fresh fruit and vegetables—something else became clear too: “For many of these kids, everything they’re learning about food and nutrition, they’re learning at school.” With a third of the nation’s children overweight—the obesity rates are even higher rates among low-income and minority students such as those who attend Galtier—the school decided it was time to improve its nutritional lesson plan.

That’s why the women in the white coats—“quality control specialist” is their title—move through the cafeteria, urging some students to try another spoonful of soup (never mentioning the fantastic fiber content of barley) and encouraging others to dunk their focaccia in the soup, like it’s a donut. (Donuts, yet another high-fat, low-nutrient menu item, has also been mostly removed from the Galtier lunchroom—to the chagrin of many faculty members.) Though parents have generally supported Galtier’s recent nutritional push, some have also sent their kids to school with maple syrup on French toast day, apparently believing that the fruit toppings served in its place may simply be too great a sacrifice to expect from sixth-graders.

The notion that kids will reject healthy food is commonly held, often by parents as we’re trying to rationalize another trip to a McDonalds drive-thru. But Ronnei, who was recently named food service director of the year by the School Nutrition Association, believes that kids could develop a taste for what’s good for them if we regularly put good stuff in front of them. “They like green beans—I’ve seen it myself,” she says. As if to demonstrate her point, two girls sitting at the next table sniff suspiciously at the focaccia before taking tentative bites from each piece. After a couple of mouthfuls, the wrinkles in their noses smooth out.

“I like the square one,” says the girl with pigtails. “So do I,” says her friend.

“See there,” Ronnei says. “Two votes for the healthy stuff.”

Though the federal government will spend more than $1 billion this year on nutritional education—including posters promoting healthy snacks and videos starring dancing fruit—a review of fifty-seven such programs found they had almost no effect on what kids ate.

Unfortunately, these results, as they say in the fine print, may not be typical. Though the federal government will spend more than $1 billion this year on nutritional education—including posters promoting healthy snacks and videos starring dancing fruit—an Associated Press review of fifty-seven such programs last summer found they had almost no effect on what kids ate. In fact, in one federal pilot program, students who were given fruit and veggies became less willing to eat them as the year wore on. Among the hurdles on the path to healthier eating are the twenty-one TV commercials the average elementary school student will see every day for candy, snacks, sweetened cereal, and fast food ,and the fact that a lot of us parents aren’t great role models when it comes to eating right. The average American eats only three servings of fruit and vegetables a day, while the latest dietary guidelines recommend we get two to four times that amount. This is why schools, overburdened as they are, may be our best hope in fighting the country’s escalating battle of the bulge.

“It’s not a question of if schools will have an influence, but whether that influence will stick when youth are surrounded by environments, both inside and outside the school, that are incompatible with making good choices,” says Ruth Bowman, who recently evaluated several nutrition education curricula as part of her doctoral dissertation at the University of Minnesota. Bowman points out that Americans will spend $118 billion annually on obesity-related conditions and illnesses that are largely preventable. “We can’t afford to ignore or abandon the issue.”

Still, that’s a lot to expect from school nutrition staffs, who have to craft menus with meager budgets (the average elementary school meal costs approximately $2.50 and must contain a federally mandated minimum of 668 calories), in the face of official indifference (remember when the Reagan administration classified ketchup as a vegetable?), and a student population prone to pitching healthy food in the garbage. But recently school lunch ladies have received unexpected support from famous foodies who recognize the role they play in shaping kids’  tastes. Three years ago, Chez Panisse’s renowned chef Alice Waters persuaded the Berkeley, California, school district to offer academic credit for lunch, making good eating part of the district’s core curriculum. Two years ago, Britain’s “Naked Chef,” Jamie Oliver, gave that nation’s school menus a healthy make-over. And here at home, Seth Bixby-Daugherty, named by Food and Wine as one of the country’s best new chefs in 2005, gave up his gig at Minneapolis’s Cosmos restaurant last winter to, among other things, help figure out how low-income single moms working with the Wilder Foundation could manage to make seven healthy family meals from the average $70 they receive in food stamps.

“It wasn’t easy,” admits Bixby-Daugherty. “Eating poorly, with high fat and processed foods, is definitely cheaper. It’s why obesity has become a problem of poverty.” He compares the obesity crisis to illiteracy, with life consequences just as dire. “That’s why, when I turned forty, I figured I’m half done—what am I going to do the other forty years to really make a difference?” he says. The answer, he and his wife, Karen, decided, was to create a kind of nonprofit consulting group, Real Food Initiatives, to help schools and other organizations change the way this country’s kids eat.

When Bixby-Daugherty quit his high profile job at Cosmos, a local radio station asked him to “go up against” Jean Ronnei from the St. Paul schools. “I guess they expected us to be combative and for me to be really critical of what the schools are doing,” he says. Instead, the two turned out to be kindred spirits, with the chef praising Ronnei and others like her for “the miracles” they’re able to accomplish for pennies a day. Ronnei rewarded him with a homework assignment—to remake the district’s 600-pound recipe for meat lasagna.

“So far, I’ve taken out sixty-five pounds of sugar, and I cut the seventy pounds of salt in half,” reports Bixby-Daughtery, whose new and improved recipe will undergo a test run at St. Paul’s Como High his fall. Though Bixby-Daugherty made his own menu at Cosmos, his experience feeding his own kids, Emma and Cole, has taught him that the crowd at Como High may be harder to please than his paying customers. “It not hard to make things healthier, but you have to make them appealing, too,” he says.

“That’s always the question you have to consider. Will they eat it?”

But, as many school nutritionists will tell you, the answer to that question doesn’t always match the effort put in. Hopkins’s public schools earned nationwide attention when they hired Bertrand Weber, a Swiss-born hotel and restaurant manager, formerly of Minneapolis’s Whitney Hotel, to remake the district’s meal plan. Weber and his staff waged an impressive campaign, removing trans fats and high-fructose corn syrup from the schools’ offerings and creating almost 75 percent of the menu from scratch. They replaced standard cafeteria chicken patties with chicken mole, flabby pastas with heartier whole grains such as quinoa, kasha, and couscous. The changes cost money—about thirty-five cents more a plate at Hopkins High. Sadly, the changes also cost the district student participation in its lunch program.

“I’d say 90 percent of the parents were in favor of what we were doing,” says Michele Wignall, who worked with Weber and took over as the district’s manager of student dining when he departed last year. But, she says, parents at one school decided the revised offerings “weren’t kid-friendly enough,” and participation dropped by 10 percent. The same effect has been noted in Great Britain, where Jamie Oliver’s remade menu resulted in a 30 percent drop in participation at some schools. A British TV series that followed the menu makeover frequently showed parents slipping bags of potato chips through school gates. “It’s really important to educate before you do a change like that,” Wignall says. “Even if people are on board, you have to keep drowning them with information about why this matters.”

St. Paul officials say they’ve learned a few lessons from the Hopkins experience, and are trying to involve the district’s 44,000 students in the menu-making process. A “coolest vegetable” contest yielded high marks for jicama, which is now served is salad bars throughout the district. A recipe for szechuan green beans was rewritten when student feedback revealed that kids like their beans spicier than the original offering. (More like Flaming Hot Cheetos perhaps.) And a veggie meatloaf that “seemed good on paper,” according to Ronnei, “was a total disaster.”

So, all things considered, is the St. Paul initiative working? The average number of fruit and vegetable servings at lunch in the district has risen from 1.98 in 2001-02, to 2.47 in 2005-06. “We’re going up and holding steady,” Ronnei says, even though the district’s kids can no longer take a second serving of French fries, which used to over-represent the amount of veggies served per meal.

More encouraging to Ronnei and her staff are the signs that students will eat what’s good for them, if given a choice. The final tally of the great focaccia experiment was eighty-four votes in favor of the whole grain recipe versus fifty-five for the other. Thanks to the thumbs-up from the discriminating lunch crowd at Galtier, whole-grain focaccia will be served in cafeterias across St. Paul this fall.

originally published in Mpls/St.Paul

I’ve done it in the back seats of cars, and darkened movie theaters, and with my dress hiked up to my chin in a country club ladies room while other wedding guests waited outside crossing their legs. I’ve done it in the back pews at church, and department store dressing rooms, and behind the horse barn at the State Fair. Since I’m able to just disrobe with one hand, passersby are usually unaware of what I’m doing. But one time I wound up exposing myself in a Galleria bookstore.

“It’s wonderful what you’re doing,” said a lovely woman who threw herself in front of me while I hurried to cover up. “I did it with all of my kids, too.”

Breast-feeding is the missing verb here – though, as many nursing mothers find out, a more explicit physical activity might raise fewer eyebrows. Though mothers have been breast-feeding their children since the dawn of time, but the act of stopping everything, sitting down, and lifting your shirt to nurse a hungry baby doesn’t always mesh so well with the pace and protocols of modern life.

Nevertheless, a recent report from the U.S. Centers for Disease Control finds that three out of four new American moms are breast-feeding their infants– the highest rate in decades, and for good reason. This simple act, most experts agree, can strengthen and sweeten the bond between mother and child, boost and buffer of baby’s immune system, lower of baby’s risk of obesity, diabetes, allergies, asthma, and even raise his or her IQ a couple of points. Breast-feeding helps a new mom burn off the extra baby weight and lowers he risk of breast and ovarian cancer. The money saved on infant formula could even be used to start college savings account.

“There’s really no debate anymore – breast-feeding is better for moms and babies in every way,” says Laura Duckett, an associate professor at the University of Minnesota School of Nursing. That’s why, she says, the American Academy of Pediatrics strengthened its recommendations three years ago, advising new moms to breast feed their babies exclusively for the first six months of life and to continue breast-feeding for the first year and beyond – “as long as mutually desired by mother and child.” The longer you can do it, the better.

Unfortunately, few new moms make it to that goal. According to the same CDC study, while 77 percent of new moms try to breast-feed, only one in three breast-feed exclusively for six months and only one in five carries on through  the first year. Of course, there are many reasons a woman might choose to stop breast-feeding. What troubles breast-feeding advocates is the possibility that many women are giving up not because they want to, but because they don’t know how to continue.

“We often hear from women who are new to this country that they don’t believe mothers breast-feed in America because they never see it – it’s not out in the open,” says Colly Huberty, a lactation consultant for the Women, Infants and Children program of the St. Paul – Ramsey County Department of Health. Advocates say nursing women need to come out of the shadows to get the support they need and to serve as role models for the next wave of new mothers.”It’s the best thing I ever did – not just for my babies but for myself,” says Duckett, who has studied and promoted breast-feeding for 35 years. “The more we learn about the benefits, the more important it is that we talk to women and get the word out.”

Fortunately, breast-feeding happens to be a popular topic of conversation among new moms. When St. Paul author Andy Steiner set out to write a book on the subject, she was surprised by how many women sought her out to tell their stories. What did they want her to know? “That breast-feeding was nothing like they thought,” says Steiner. “It was harder than they’ve been told it would be, more challenging – but also more rewarding.”

Among the difficulties Steiner recounts in Spilled Milk: Breast-feeding Adventures and Advice from Less-than-Perfect Moms are leaky nipples, painful letdowns, grandparents who wonder whether their breast-feeding daughters are hippie freaks, and partners who were looking forward to the instant breast augmentation that accompanies lactation but were appalled by what a naturally engorged breast really looks like. “The word bovine came up a lot,” Steiner notes.

Another reoccurring topic is the stress that new mom’s experience while breast-feeding – wondering whether they’re doing the right thing, the right way, for the right duration and for the right reasons. “Women feel guilty and ashamed if they didn’t do it for very long, and they filled guilty and ashamed if they think they did it too long,” says Steiner.

“We really set women up for failure in this country,” says Joanne Slavin, a professor in the Food Science and Nutrition department at the U of M, who believes our “drive-by style of birth and delivery–the way we expect a new mom to go home and paint her house during maternity leave,” is antithetical to a healthy breast-feeding start. Many new moms are discharged from the maternity ward before their milk “comes in,” a complex hormonal process that takes place two to five days after delivery. What’s more, a generation or two ago a new mother often returned home to a circle of female family members and friends, who would help guide the breast-feeding process. But nowadays, Slavin says, “Grandmas aren’t around.”

Even if they were– those grandmas may not have much experience to share. That’s because breast-feeding rates fell during the 1960s and early 1970s, plummeting to a historic low in 1972, just as our current generation of moms were born. Experts say the support and encouragement of a woman’s inner circle is important for breast-feeding success and duration. “If you don’t know many people who breast-feed, it’s less likely you’ll try it or get the support you need,” says Huberty.

Complicating matters is the aggressive marketing of infant formula. According to the CDC, the number of people who mistakenly believe that “formula is just as good as breastmilk” nearly doubled between 1999 and 2003, roughly thesame time the U.S. formula industry increased its ad spending from $29 million more than $46 million. The practice of sending new moms home from the hospital with a complimentary diaper bag packed with also sends a mixed message about the importance of breast-feeding. A recent study published in the American Journal of Public Health revealed that women who went home with complimentary formula were 39 percent more likely to stop exclusive breast-feeding at 10 weeks than women who didn’t receive the freebies.

“One of the problems in the U.S. model of healthcare is that there’s no money to be made from breast-feeding,” says Slavin, adding that many hospitals no long have lactation consultants on staff because their services aren’t reimbursed. At the same time, according to the U.S. Department of Agriculture, private and government insurers spend at least $3.6 billion every year to treat diseases and conditions that breast-feeding could help prevent.

“It’s a terrible shame,” Slavin says, “because it takes just a little investment of time and attention for the mother and baby to work it out, and there are these critical moments when just a little help can make a world of difference.”

For Kelly Maynard, a St. Paul copyeditor, the critical moment came a few days after she returned home from the hospital with her son, Noel. She worried she wasn’t making enough milk (a common fear among the new moms – and often the reason they turn to formula), but Marusia Kachkowski, a St. Paul – Ramsey County public health nurse, weighed the baby and reassured his mother that he was doing fine (breast-fed babies tend to be leaner then bottle-fed babies). She also showed Maynard how to make sure the latch between the breast and baby’s mouth was right and advised her to relax and take are cues from the baby. “She was like a sea of calm” says Maynard, who has breast fed her son successfully for a year. “Who knows what would have happened if she hadn’t been there?”

Small interventions – whether they’re from a La Leche League volunteer, a board-certified lactation consultant such as catch Kachkowski, or a friend down the street – help many new mothers over the first hurdle of breast-feeding. “You usually find that these women after darkest day – their milk is coming in, they can’t remember the directions they got at the hospital, and they’re overwhelmed,” says Kachkowski, who just completed a master’s thesis entitled “Barriers to Breast-feeding in the 21st Century.” “It’s amazing what a little help can do to get a new family on the right path.”

Another hurdle is the transition back to work–particularly for moms in Minnesota who return to paying jobs in greater numbers than women almost anywhere in the nation. Though state law requires employers to allow a nursing woman the time and a reasonable place to pump, the rules can mean different things in different places. When I worked in a newsroom, I could excuse myself to visit a designated nursing mom’s room, but a friend of mine who worked at an art gallery had to repair to the least used bathroom and hope no one walked in on her. “It can be a hassle, but I try to tell women it’s really a very short period of time that you’re inconvenienced,” says Huberty.

Often the final obstacle to completing a full year of breast-feeding is getting comfortable doing it anywhere that your baby is hungry. A 2003 Porter Novelli survey found that 37 percent of Americans believe women “should breast-feed in private places only.” But that view seems to be changing. When The View’s Barbara Walters complained about being seated next to a nursing mother on an airplane, more than 200 “lactivist” moms held a “nurse-in” outside ABC Studios. (Any one of the women might have pointed out that nursing relieves the air pressure in a newborn’s in years during an airplane’s takeoff and landing.)

Protests like that – and the celebrations were likely to see you during international breast-feeding week in August – remind us that breast-feeding moms are a new majority among new moms in this country. “But to me,” says Kachkowski, “just to seeing a mother at Rainbow nurse her baby is more important than any big kumbaya event you might see on television.” Sometimes, she says, she can’t resist giving that nursing mom an encouraging nudge. “I am so proud when I see uneventful, every day nursing that I’ll sometimes say, ‘That’s really great what you’re doing–keep it up.”

Mpls/St.Paul, August 2008