Does the Johnson & Johnson Vaccine Stand Up to Scrutiny?

How does the Johnson & Johnson vaccine compare with Pfizer and Moderna? A close look at how public health experts discuss the data.

[Update on 4/21/2021: After the CDC and FDA recommended a pause on use of the Johnson & Johnson COVID-19 vaccine on April 13, and after the FDA said on April 21 that unsanitary and unsuitable conditions were found in the Baltimore factory that ruined millions of doses, the situation has obviously changed. The question of the relative merits of this vaccine has become moot for the time being, as it is not currently being offered in the United States.]

When I checked in for my vaccine appointment this week (yay!), I was told I was getting Johnson & Johnson. I had heard, as you probably have as well, that Pfizer’s vaccine has a 95% efficacy in preventing COVID, Moderna has 94%, and Johnson & Johnson has 66%. And I wondered whether this meant I wasn’t getting the best. This post reviews how public health experts are talking about the data on this question.

All three vaccines are excellent. First, all three vaccines–plus Novavax and Astra-Zeneca, which aren’t yet approved in the U.S.–are extremely effective at preventing severe COVID. A tweet from Dr. Ashish Jha, Dean of Brown University’s School of Public Health, pointed out on Twitter that in trials, nobody who’s been vaccinated has died or needed hospitalization due to COVID-19. 

source: Twitter

To be clear, these zeroes aren’t a guarantee that you won’t get severe COVID. The trials included tens of thousands of people, and as the vaccines roll out to millions of people, it’s all but inevitable that we’ll see outliers. In Israel, after over 700,000 people were vaccinated with Pfizer or Moderna, 16 people (or 0.002%) eventually were hospitalized with COVID, according to Vox. Getting severely ill with COVID after vaccination is still possible, just extremely unlikely.

Efficacy numbers aren’t a fair comparison. Back to the comparison. Experts warn that we shouldn’t directly compare the top-line efficacy numbers of the three vaccines, as the trials weren’t conducted head-to-head. This means that there were differences between the trials in the kinds of people who were included and in what numbers, in the protocols, and even in definitions of what constitutes a case or severe case of COVID. 

source: NYT

Most importantly, according to Jha, whereas Pfizer and Moderna were mostly trialed in the United States, Johnson & Johnson was tested in multiple countries including Brazil and South Africa, in the presence of widespread variants and during a more severe phase of the pandemic. Although only real-world use will tell how the vaccines are working in our current conditions, as the above chart from the New York Times shows, all of the vaccines trialed in the presence of B.1.351 have come back with lower efficacy numbers. As Jha and others have observed, it’s a very real possibility that Johnson & Johnson’s lower number is because of these differences in the trial conditions.

So the other way of looking at this is that Johnson & Johnson is the only vaccine currently approved in the U.S. that has trial data showing its efficacy against the more contagious B1351 (South African) variant. And there’s some evidence that Pfizer and Moderna may be weaker against this variant.

Johnson & Johnson’s efficacy continues to grow. Johnson & Johnson’s efficacy also starts early and (ahem) grows over time. In Johnson & Johnson’s application for FDA emergency use authorization, the placebo and vaccinated groups start to have different outcomes as early as one week after the shot, and the efficacy against severe COVID continues to increase for about two months, until it reaches 95% to 100%. Preventing severe COVID and death is the main goal of these vaccines, and by 56 days after your jab, Johnson & Johnson does that spectacularly well.

source: FDA
source: FDA

For most of us, our best shot is the first shot that’s offered. Yes, Pfizer and Moderna have stronger proven efficacy against mild forms of the disease, and the performance of all of these vaccines relative to long COVID remains to be seen. Because of this, Dr. William Schaffner, a professor of health policy at Vanderbilt University, conceded to the New York Times that if he had a choice, he’d pick Pfizer or Moderna. But, he said, that if the choice was between Johnson & Johnson today or another vaccine three weeks from now, he and other experts he knows would take the one that’s available now.

Especially as case counts begin to rise again in the U.S., the vaccine in your arm today is probably worth more than two that may or may not be in your calendar in the future.

The last thing that health experts are talking about is that regardless of which vaccine we each start with, we may all be offered booster shots later. Moderna is testing a booster targeting the South African variant and Pfizer is preparing to do so as well. Johnson & Johnson has a trial underway to test the efficacy of two versus one doses; depending on the results, those of us who started with this vaccine may have a second shot in our future.

Getting an updated COVID shot may become an annual phenomena, like a seasonal flu vaccine, and something called “heterologous prime-boost vaccination”–in which you get a first dose from one manufacturer and a second dose of another kind–is currently being tested. So my Johnson & Johnson shot was my first COVID vaccine, but probably not my last. 

After all this is said, you might still have reasons to pursue or avoid one vaccine in particular. Whether because of logistics or a discomfort with needles, the single-dose Johnson & Johnson may work better for you. If you have an allergy to a specific vaccine ingredient or have other medical needs, your doctor may advise one or another. We’re lucky to have three great vaccines–and all this reading has left me satisfied (and extremely grateful) that I was able to get my shot.

So yes, there are real differences between the vaccines, but for most of us, the vaccine we’re offered first really is the best. 

Recommended Reading and Listening

Finally, a Covid Conversation You Can Feel Good Abou‪t  (podcast) by Ezra Klein, The New York Times (Mar 12, 2021)

Is Choice Always Worth the Anxiety? By Zeynep Tufekci (Mar 8, 2021)

The Differences Between the Vaccines Matter by Hilda Bastian, The Atlantic (Mar 7, 2021)

We’re Not Looking at the Most Important Vaccine Statistic by Kelsey Piper, Vox (Feb 11, 2021)

What do Vaccine Efficacy Numbers Actually Mean? by By Carl Zimmer and Keith Collins, The New York Times (March 3, 2021)


Littldata’s goal is to help parents figure out their family logistics by sharing tools such as maps, calendars, lists, and spreadsheets–as well as research-backed blog posts and data graphics. If you have feedback or ideas for future content, please contact me (Lian) at littldata@gmail.com!

Join Littldata’s mailing list here.

How to Stay Home: The Three Easiest Things You Can Do to Keep Your Family Well While Staying In During COVID-19

Billions of people around the world are now staying at home. Whether due to preventative social distancing, quarantines, or riding out mild symptoms in isolation, many of the challenges of not being able to leave the house are the same. 

My own family has been feeling cooped up and longing to return to the days when we can enjoy simple pleasures like meeting up with friends at a park or joining the hustle and bustle downtown. Then I realized that, as a researcher and designer who has worked on the mundanity of our domestic environments from the point of view of architecture and environmental cognition, I’ve actually spent years preparing for this situation.

So we started incorporating some simple practices during our own shelter-in-place that have been helping us meet some of the physiological, psychological, and social needs that we typically meet by going out into the world. And over the course of a two posts, I’m going to share these ideas.

This first part has three really simple takeaways that have to do with bringing aspects of the outside world into your home:

  1. Open your windows for fresh air
  2. Get as much light as possible
  3. Reach out to others

In the second part, I’ll share some ideas about some more unusual and creative ways that you can inhabit and manipulate your space to boost your family’s well-being–but here in Part One, I wanted to share the simplest and highest impact actions. So let’s dig in.

1. Open your windows for fresh air

The problem: Air inside a building is rarely as healthy as outdoor air, and poor indoor air quality causes significant and measurable changes in our mood, mental and physical performance, and even our long-term health. With your whole household crammed in the same space nearly 24/7, the air is getting warm, humid, low on oxygen, and high on substances such as exhaled carbon dioxide, volatile organic compounds and pollutants such as carbon monoxide from cooking and other household activities–and even gasses such as methane from your flatulence. While this problem can be especially acute in modern buildings, which tend to be more airtight, most of us would benefit from opening our windows more.

The solution: Open your windows. This clears out your stale air, letting in fresh oxygen and diluting smells, humidity, and pollutants that tend to accumulate indoors. Opening your window also lets in the sounds, smells, and views of the outside world, supporting a sense of connection to the world outside.

If you live in a multi-unit building with a centralized forced-air heating or cooling, bringing more outdoor air into your unit is especially important, as it can dilute any coronavirus virus particles or other pathogens that are circulating. A recent study has found that maintaining a minimum level of outdoor air ventilation actually reduces transmission of the influenza virus as much as would happen by vaccinating 50-60% of the building’s occupants.

Concern: Weather. What if it’s cold or hot out? You still need fresh air, but you can open your windows more at whatever time of day when the outdoor temperature is more moderate. You can also adjust your thermostat by a few degrees to spare your heating/cooling bill, and adapt your attire to stay comfortable. Then make yourself a hot tea or ice water, and enjoy that outdoor feeling.

Concern: Letting in the virus. If your window opens directly onto a busy sidewalk, you may be concerned about the virus wafting in. In this case, try using a different window or door facing another exterior space–or ventilate at off-peak times. But you’ll still benefit from fresh air, and most of us should be opening our windows wide and often.

2. Get as much light as possible

The problem: Sunlight is much brighter than what we get indoors. Outdoors, we might experience up to 100,000 lux of brightness on a sunny day, or 1,000 lux on a cloudy day, as compared with 50-250 lux inside a home or office. Among other health benefits, daily exposure to sunlight promotes the release of mood-boosting serotonin, which helps us focus and feel calm; and melatonin, which regulates our sleep-wake cycles. Staying indoors nearly 24/7 could nudge us towards a form of depression akin to seasonal affective disorder, even in the spring or summer.

The solution: Open your blinds during the day, get brighter artificial lights if you need to, and soak up some rays. Let as much natural light in as possible to your home, and don’t hold back if you want to follow those sunbeams around like a cat. If your lighting and mood are dim, consider investing in a light therapy lamp, which is a very bright full-spectrum light; or simply swapping some bright bulbs into your existing fixtures. If you’re going out at all, try to go when it’s sunny. It’ll be good for your mood, health, and vitamin D production.

Of course, if you’re lucky enough to have a balcony, backyard, or other private outdoor space–even if it’s shaded–you’ll benefit from any time you can spend out there, especially in the morning and midday.

Possible concern: Will manipulating my light exposure disrupt my sleep? Not if you dim your lights, reduce screen time, and/or use a color shifting app on your devices for up to three hours before bedtime. Daylight and bright, full-spectrum light are otherwise beneficial for sleep throughout the day, and especially in the morning.

3. Reach out to others

The problem: You’re lonely. The social distancing that is necessary right now is also deeply alienating, as we’ve lost many of our usual social patterns and outlets. Family members outside your household, friends, work colleagues–and even the stranger with whom you would normally exchange nods or make small talk–are now farther away.

The solution: Keep reaching out, to those closest to you, to distant friends, and even to strangers. Most of us have been using texts, phone calls, and video conferences to connect with family and close friends. One day, this might mean sharing meals with loved ones via FaceTime. Another day, it could be rounding up a group of friends to watch a movie at the same time, with a line open for real-time chatter. Or video playdates with your children’s friends. The feeling of presence–of sharing the same space and time with others–is a goal in itself, so don’t feel pressure for every moment to be dense or high quality in interaction. You can be quiet, tired, or bored together.

It might feel awkward to reach out to people who you know less well, but it’s been shown that weak social ties are also important to our sense of well-being. If you normally chat with your nail technician or a colleague in another department for an hour each week, you’re now missing that interaction. So if you can, give a quick text to say hello. The same goes for old friends, your soccer teammates, online parenting group, and anyone else you might usually interact with.

And yes, the same goes for strangers. Fleeting interactions can still be part of our routine, even if it’s just waving at a neighbor you’ve never met before, from your balcony.

If you strike up a conversation with a neighbor, consider offering to exchange contact information (while keeping 6′ of distance), especially if they’re elderly or vulnerable. Prosocial behavior has been shown to reduce the negative impacts of stress on our mental health, so building ties and offering help will be good for you, as well.

Possible concern: This is awkward. Yep. But remember that everyone is going through this same experience right now, and others are likely missing out on social time, too.

Your Takeaways

So, to review: get air, get light, and connect with others, since these are three things that are in short supply when we’re holed up indoors. While these ideas are obvious, I think it’s safe to say that most of us would benefit from doing one or more of these with more consistency, so now it’s your turn to start putting these into practice.

In Part Two, I’ll talk about the bodily, sensory, and spatial practices and experiences that you can try out to relieve some of the grinding repetitiveness that can otherwise come from inhabiting the same space without reprieve. To be the first to know when Part Two is posted, and to keep in touch with Littldata’s other content for parents, please join my free mailing list. I’ll be sharing the most helpful, practical tips for parenting during the pandemic that I can find, as well as other content to help you figure out your family logistics.

Until then, thank you for reading, and be well. If you’re interested in indoor toys for independent play, outdoor toys to make socially-distanced outings more fun, a map of COVID-19-friendly outdoor destinations in San Francisco, please check out these posts and more on Littldata’s COVID-19 page.

Get the latest Littldata here.

About Littldata: At Littldata, my goal is to help parents figure out their family logistics by sharing calendars, maps, lists, and spreadsheets–as well as research-backed blog posts and data graphics. This post uses Amazon Affiliate and referral links.

I would love to hear from you anytime at littldata@gmail.com. Join Littldata’s mailing list here for updates and special content to make your family logistics easier. Follow Littldata on Twitter @littldata, and on Facebook at Littldata.

A Map of Outdoor Destinations in San Francisco Where Social Distancing May Be Possible

[Updated March 28, 2020 – Many outdoor destinations have now been closed, including all Parks in Marin County and parking lots at Ocean Beach, Beach Chalet, and Marina Green in San Francisco. I’ve updated the map to reflect this, added more locations for coverage throughout the city, and taken a more cautious attitude towards assessing the suitability of locations for social distancing.]

Given our current Shelter in Place order and the continually escalating COVID-19 situation, it’s clear that the best option is to stay at home whenever possible. However, given the reality of small San Francisco apartments, it’s also clear that many people will choose to go out for exercise as long as it’s allowed.

So, the goal of this map is to help San Franciscans find free outdoor spaces where it may be possible to exercise while maintaining the legally required 6′ of distance from anyone outside your own household. You can filter for destinations by your accessibility needs (stroller, easy walks, and hikes) and by–very roughly–how crowded they tend to be. Of course, if your chosen destination is crowded, please keep moving until you find a more suitable spot.

Get the map by joining Littldata’s email list here.

Some of the city’s most popular parks (and of course all playgrounds) are not included on this map, since they’re often so busy that I didn’t feel comfortable recommending them at all. Also, the city is encouraging everyone to stick to outside areas within walking distance of our own homes and has closed parking lots at many major destinations. You can find the newest info on closures at the top of the SF Recreation + Parks website.

Please email me anytime at littldata@gmail.com with tips, and any other feedback!

Get the map by joining Littldata’s email list here.

Once you join the email list, you’ll automatically be redirected to the map, which you can bookmark so that you can return to it anytime.

On my email list, I’ll periodically be sharing tools and content for parents, such as spreadsheets, calendars, maps, lists, and more. Some content, like this map, will be more specific to San Francisco and the Bay Area, but much of it will be for all parents of young children. You can opt out of the email list at any time, and of course I will never sell your email address.

If you’re looking for some ideas to make all these forests, fields, and cemeteries a little more lively, check out this list of social distance-friendly outdoor toys. Littldata also has a list of indoor toy and activity ideas (including some that are great for patios and backyards). Finally, if you’re among the billions of people currently staying home due to COVID-19, here are the three easiest things you can do to help your family meet some of the physiological, psychological, and social needs that we typically address by going out into the world.

Get the latest Littldata here.

About Littldata: At Littldata, my goal is to help parents figure out their family logistics by sharing calendars, maps, lists, and spreadsheets–as well as research-backed blog posts and data graphics. This post uses Amazon Affiliate and referral links.

I would love to hear from you anytime at littldata@gmail.com. Join Littldata’s mailing list here for updates and special content to make your family logistics easier. Follow Littldata on Twitter @littldata, and on Facebook at Littldata.

How Families can Prepare for COVID-19 Before It Arrives

[Updated March 9, 2020] As the situation is rapidly evolving and I don’t want to present out of date information, I’ve removed parts of this article that refer to changing policies. Please check the CDC’s information on travel and pregnant women and children.

Otherwise, read on for tips on ways that parents can prepare for the very real possibilities of school and business closures, working from home, or caring for a sick family member.

Things To Do

Brush up on basic hygiene, and reinforce practices with your children. The CDC recommends avoiding close contact with people who are sick, avoid touching your eyes, nose, and mouth, washing your hands thoroughly and often with soap (hand sanitizer is a second choice as necessary), covering your cough (but not with your hands), and staying home when you are sick. If you get a fever and symptoms of respiratory illness, contact your doctor immediately and check out the CDC’s info.

In terms of travel, check out the CDC’s information on restrictions and recommendations. In order to reduce your personal risk and to help protect medically fragile members of your community, you may want to consider reducing travel by leaning on staycations for leisure, and on conference calls for work, whenever possible.

For childcare, what are your options in case your children’s school, daycare, or preschool closes for a month or more? If there are reasonable steps you can take now to make this outcome less stressful, consider taking them.

  • Do you have a family member, nanny, or friend who may be able to help? Talk with them about this possibility.
  • Is there another family in your area that you could swap playdates with?
  • Consider stocking up on inexpensive toys and books that could entertain your children at home, pre-purchasing their next birthday gift just in case you need it, or swapping unused toys with friends.
  • Identify nearby outdoor and natural areas where your children can play. Because the virus spreads through close contact, outdoor activities such as hiking and kite-flying safer than, say, a visit to the indoor playground. If you’re in San Francisco, you can access Littldata’s map of family-friendly outdoor destinations by joining my free email list.

Working from home might become optional or necessary, where feasible.

  • Do you need to get set up with VPN or any other resources?
  • Stay home if you feel even a little sick, and encourage your colleagues to do so as well.
  • If your workplace does not yet have a work from home option but your role would be compatible with it, ask about this possibility.

Join your neighborhood group on Nextdoor or Facebook, to keep up to date on resources and information, and to find ways to help each other.

Choose a room in your home where a sick family member can be separated, ideally one with access to a separate bathroom. The CDC has advice on how to take care of a flu patient at home, including how to clean their room daily, to reduce the chance of transmission.

For medically fragile people: What would they need in terms of help, resources, and supplies if there were a lockdown in your community? Elderly family members, friends, and neighbors are particularly vulnerable, and could benefit from active assistance or just a plan to check in on them regularly.

Things to Buy

While it’s important to not buy more than you need, you should keep the following supplies on hand, as a hedge against supply-chain disruptions, so that you’re ready to self-quarantine, and in order to reduce your exposure by consolidating and minimizing outings. I’ve linked to the best option I’ve found from Amazon or other suppliers, if you want to keep things simple.

  • Prescription medicines: While you shouldn’t hoard, make sure to keep any current prescriptions filled, ideally with a two-week supply.
  • Over-the-counter medicines: Make sure your adult acetaminophen (Tylenol), adult ibuprofen (Advil), liquid acetaminophen for children, and liquid ibuprofen for children, as well as any other over-the-counter medicines you typically use, are topped up and not expired.
  • A thermometer is a must, and this ear thermometer can be easily, hygienically, accurately used for the whole family. If you’re on a budget, this oral one is also great.
  • Basic hygiene supplies: Toilet paper, tissues, and paper towels; soap, hand sanitizer, and feminine hygiene products–enough for a few weeks is plenty.
  • Baby supplies: Diapers, baby food, formula, wipes, and anything else your baby regularly needs.
  • Household cleaning: disinfecting spray cleaner, disinfecting wipes, laundry detergent, dish sponges. An inexpensive jug of bleach, stored well out of the reach of children, is also indispensable if there is illness in your home. If you’re concerned about the toxicity of conventional cleaning products, consider investing in a Force of Nature kit–it is an EPA registered disinfectant.
  • Face masks are now proven to be a crucial tool in keeping yourself and others safe. Surgical masks are widely available and provide efficient filtration; cloth masks are reusable and may fit better than a disposable surgical mask; and N95 masks are the gold standard for higher-exposure situations, but are expensive and often difficult to find. A well-fitting KN95 mask from a major supplier can be used instead of an N95 mask, and can be layered with a cloth or surgical mask for extra protection. Note that any valves need to be covered with tape or another mask, and that masks are only for adults and children aged two and older.
  • Toys and books that could keep your kids entertained if their usual childcare or school arrangements are disrupted.
  • Fuel in your car’s tank, and batteries for anything essential that requires them (though of course, you are using a charger for rechargeable batteries).
  • Nonperishable food that you can keep at home and actually enjoy eating, which could include nuts, cereals, beans, canned fruit, pasta and sauce, shelf-stable milk, granola and protein bars, coffee, tea–and obviously, chocolate and wine. Don’t forget food for any pets. (If you’re looking for another retailer, Thrive Market ships shelf-stable organic food and household goods, as well as frozen meat, throughout the mainland United States at relatively affordable prices.)
  • Vitamins can be a nutritional hedge if a disrupted food supply changes your usual eating habits. This is a good general multivitamin.
  • Perishable food such as eggs, milk, yogurt, cheese, bread, meat, frozen prepared foods, and fresh produce are obviously preferable to shelf-stable alternatives. If you’re able, keeping your fridge on the fuller side (while not buying more than you will eat before food spoils) can help you be ready for an unexpected family illness.

Context and Details

[Note as of March 9, 2020: I am not updating this section, as the situation is evolving so quickly. Please check the CDC or major news outlets for current developments.] On February 25, the Centers for Disease Control and Prevention advised that Americans should begin preparing for the spread of coronavirus (officially known as COVID-19) in the United States. “It’s not so much of a question of if this will happen anymore but rather more of a question of exactly when this will happen,” Dr. Nancy Messonnier, director of the National Center for Immunization and Respiratory Diseases, said according to the New York Times. “We are asking the American public to prepare for the expectation that this might be bad.” Stocks markets have also been in decline this week over concerns about growing economic disruptions worldwide.

Coronavirus is a problem because there’s no vaccine for it yet; it spreads easily and can be incubated and transmitted by people for up to 14 days without symptoms; and because its effects can be severe. While much is still unknown, and treatment in the United States may be more successful than in China, Coronavirus has been fatal for somewhere between 0.4% and 2.3% of people in mainland China. This is higher than the death rate from the flu in the United States, which is closer to 0.1%.

That said, your chances of getting Coronavirus and of it becoming severe depend on your age. Most of the people getting Coronavirus are adults from 30-70, but deaths have been concentrated among the elderly. So it’s a good time to help your older family and community members to stay in good health and avoid contact with anyone who may be sick; and to enjoy some peace of mind that no children under 10 have died from Coronavirus to date.

Further Reading

Littldata’s content to support parents during the pandemic is on our Taking Care of Your Family During COVID-19 page, and includes a list of indoor toys for independent play; outdoor toys that are conducive to social distancing; a map of outdoor places in San Francisco where socially distanced exercise is possible; and the three easiest things you can do to help your family stay sane while staying at home.

Get the latest Littldata here.

About Littldata: At Littldata, my goal is to help parents figure out their family logistics by sharing calendars, maps, lists, and spreadsheets–as well as research-backed blog posts and data graphics. This post uses Amazon Affiliate and referral links.

I would love to hear from you anytime at littldata@gmail.com. Join Littldata’s mailing list here for updates and special content to make your family logistics easier. Follow Littldata on Twitter @littldata, and on Facebook at Littldata.

A demographic look at the State of Babies Yearbook 2019

A summary of the State of Babies Yearbook 2019 report and a chart comparing key scores from the report with basic political and economic indicators.

This text appears over a photo of a smiling Black toddler with an adult smiling and clapping behind her.  "Babies are born with unlimited potential. For the 12 million infants and toddlers in the United States, the state where they are born and live during their first three years makes a big difference in their chance for a strong start in life. The littlest among us face big challenges, and we can’t afford to squander the potential of a single child."
Source: State of Babies Yearbook 2019

Nonprofits Zero to Three and Child Trends just dropped a motherlode of data on the wellbeing of babies and toddlers, on both a state-by-state and national level in the U.S. Their State of Babies Yearbook 2019 delves into data across three broad domains: health, families, and early learning.

A table that displays the following text: ZERO TO THREE’s policy framework, grounded in the science of early childhood development, promotes supports for infants and toddlers’ healthy development in three domains: Good Health, Strong Families, and Positive Early Learning Experiences. These domains form the basis for the indicators in the State of Babies Yearbook: 2019.

*Good Health:
Health Care Access/Affordability Food Security
Nutrition
Maternal Health
Child Health
Infant and Early Childhood Mental Health

*Strong Families:
Basic Needs Support
Child Welfare
Home Visiting
Supportive Policies/Paid Leave

*Positive Early Learning Experiences:
Early Care and Education Opportunities Early Intervention and Prevention Services
When babies and toddlers do not have the supports they need to thrive, their development can suffer, leading to lifelong consequences.
Source: State of Babies Yearbook 2019

In each domain, they’ve gathered analyzed a range of data points that provide a snapshot of how babies and families are doing. Some of the factors are direct measures of policies (such as the percent of income-eligible children who have access to Head Start programs), while others are the more complex result of social, economic, and family circumstances (such as the percent of babies whose parents sing and read to them each day). These factors are summarized in a score for each of the three domains. Here’s a page from the resulting report card for California:

A page from the State of Babies Yearbook 2019 PDF that shows the scores for California for Good Health and Strong Families, accompanied by textual analysis.
Source: State of Babies Yearbook 2019

The State of Babies project summarizes each state’s progress in each domain with a score of G (Getting Started), R (Reaching Forward), O (Improving Outcomes), or W (Working Efficiently). In other words, it’s a simple 1-4 scale and a convenient data point to be compared with other factors. So I wanted to see how these indicators of baby and toddler wellbeing compared with basic political and economic factors.

To measure how politically left- or right-leaning each state is, I used data aggregated by Gallup from their 2018 tracking poll, in which respondents were asked whether their political views as liberal, moderate, or conservative. Gallup then creates a “Conservative Advantage” number that is the gap between the percent who identify as conservative and those who identify as liberal. Median household income from the 2015 U.S. Census is used as an indicator of the economic wellbeing of families in each state.

The results are in the chart below. A score of “1” in the State of Babies sections indicates the best conditions for babies, and “4” the worst. For the Conservative Advantage, higher numbers reflect more conservative politics, and lower/negative numbers reflect more liberal politics.

A heatmap chart that shows the three scores from the State of Babies alongside the 'conservative advantage' score from Gallup and median household income, for each state. States are sorted from strongest to weakest State of Babies scores.

The overall trend is that greater wellbeing for babies and toddlers is associated with both more liberal politics and higher median household incomes. A few other points that stand out at a glance:

  • Vermont and Rhode Island both received top State of Babies scores, even though their median household incomes aren’t quite as high as the other states with top scores.
  • Iowa looks like an overachiever in baby care, receiving top scores in both Strong Families and Early Learning, while its politics and median incomes are middle-of-the road.
  • Conversely, Nevada looks like an underachiever in baby care, receiving the lowest scores on all three measures, while its politics and income are both relatively moderate.
  • California is doing well on Good Health and Strong Families, but received the lowest score on Early Learning. The report notes that this “reflects the state’s more burdensome infant care costs as a percentage of single and married parents’ incomes, and its lower percentage of parents who read to and sing songs to their babies daily, when compared to most other states.”
  • Baby and toddler wellbeing indicators tend to trend together, but not always. California, North Carolina, Idaho, New Mexico, and Kentucky all received the lowest score in at least one area while receiving the highest score in another.
  • Alaska is an outlier in a few ways, presumably because of its unique geography, climate, and culture: it has a high income but is quite conservative, and its Strong Families score is high but the others are middle of the road.

This is just a first read, and there’s a ton more data in the Babies Yearbook 2019, which you can access as an interactive or a PDF. They even provide a toolkit if you want to use the data to ask your state and federal lawmakers to make policy changes.

Get the latest Littldata here.

About Littldata: At Littldata, my goal is to help parents figure out their family logistics by sharing calendars, maps, lists, and spreadsheets–as well as research-backed blog posts and data graphics. This post uses Amazon Affiliate and referral links.

I would love to hear from you anytime at littldata@gmail.com. Join Littldata’s mailing list here for updates and special content to make your family logistics easier. Follow Littldata on Twitter @littldata, and on Facebook at Littldata.

How to protect your family from the measles

The short answer is, obviously, to make sure you’re all vaccinated. But vaccination schedules can have variations and there are a few factors at play. Given the current measles scare, I wanted to make sure my family was doing all we could to protect ourselves, as this is what I found.

First, why are we talking about measles? Because there’s an outbreak right now. According to the CDC, in January 2019, seventy-nine cases of measles were confirmed, across ten states. There have been outbreaks (defined as 3 or more cases) in New York State, New York City, and Washington State, associated with travelers coming back from Israel and Ukraine. [Update as of April 10, 2019: There are now 228 cases just in Williamsburg, and 285 in Brooklyn, NY overall, which have prompted the city to declare a state of emergency and institute mandatory vaccines, with fines for non-compliance.]

Outbreaks happen when there isn’t herd immunity, when not enough people are immune in a community and the disease starts to spread. The best way to prevent measles is through the MMR vaccine.

Is your family immune?

Babies 0-12 months are probably not immune.

What you can do: Especially if there are measles cases in your area, try to make sure family, friends, and caregivers spending time with your baby are vaccinated. If your baby is in a high-risk context, such as traveling internationally or in contact with many unvaccinated people, it may be worth asking your pediatrician about getting vaccinated before the standard 12-15 months. Early vaccination for babies 6-11 months is recommended by the CDC for babies traveling internationally or in an epidemic situation.

Details: Babies often have some “passive immunity” due to antibodies received from their mother in utero or through breastmilk, but most babies likely don’t have enough to protect them from the disease. Babies can, however, be vaccinated before 12 months. It’s not harmful but is simply less likely to be effective, because a baby’s low-level passive immunity can prevent them from reacting to the vaccine with a sufficient immune response to become protected. Note that babies immunized before 12 months will likely still need two additional shots in the future at the usual ages. It can be an extra step to take during an outbreak or in higher-risk contexts, but because the vaccine is less likely to be effective before 12 months, remember that it’s not a substitute for avoiding crowds and people who may have the measles.

Adults and children over 1 year are probably immune, by two weeks after their first MMR shot.

What you can do: Check your medical records to make sure both doses of the MMR vaccine have been given on schedule. Check your state’s vaccination laws or databases to confirm the vaccination rates at your children’s schools. If your child is in a high-risk context, such as living in a city with an outbreak, or attending a Waldorf or religious school without herd immunity, you could ask your pediatrician about getting the second shot earlier. If your child has a medical condition that means they can’t get the MMR vaccine and there are measles cases in your area, you may want to make sure that anyone in regular contact with them is vaccinated.

Background: Current CDC recommendations are for two doses. The first dose, typically given between 12 and 15 months, is effective in causing immunity for 93% of people. With the second dose, typically given between 4 and 6 years of age, 97% of people become immune. Here’s the thing: the second shot can be given earlier than 4 years, as long as it has been at least 28 days since the first shot. Waiting until age 4 to 6 has more to do with “administrative considerations,” that is, so that immunizations required for school attendance can be conveniently given and recorded all at once. So it’s possible to ask about getting the second shot early; just know that your child may still need another shot before attending school and that the additional shot may not be covered by your insurance.

And yes, you can get a blood draw to check whether measles antibodies are present. If I were considering optional travel to a place with a current measles outbreak (at the time of posting, that’s Israel and Ukraine, but you can check current travel notices here), I might get the blood draw done to see if I have immunity or not. Otherwise, though, if you’re getting a needle anyways, your doctor may suggest that you just get an MMR booster instead.

Who needs a booster?

Measles immunity is considered to last for life, so anyone who has received two shots should not need another. According to the CDC, you will be assumed to be adequately vaccinated if any one of the following applies:

  • one or more doses of a measles-containing vaccine administered on or after the first birthday for preschool-age children and adults not at high risk
  • two doses of measles-containing vaccine for school-age children and adults at high risk, including college students, healthcare personnel, and international travelers
  • laboratory evidence of immunity (blood draw/titer)
  • laboratory confirmation of measles
  • birth before 1957 (note: this is because the vaccine was introduced in 1963, so people born in 1957 or earlier almost certainly have been exposed to measles already.)

The vaccine isn’t old enough for lifetime immunity to be completely assured, however, so if you’re concerned, check with your doctor about getting a titer (blood draw) or booster shot.

Looking for data? Each state has different vaccination laws, but you can get a snapshot and click through to details on each state here. If you’re curious about state legislative changes, you can find those here. In California, you can check vaccination rates at all daycares and preschools, elementary schools, and middle schools. California vaccination rates have gone up since 2016, when a new law banning personal belief exemptions came into force, but there are still schools where there is not herd immunity. You can also check school vaccination rates for other states, including Texas, New York, Pennsylvania, and Washington.

You can also check out the New York Times’ measles explainer, published on February 20, 2019.

Disclaimer: I’m not a physician, just a worried parent. Check with your doctor!

Get the latest Littldata here.

About Littldata: At Littldata, my goal is to help parents figure out their family logistics by sharing calendars, maps, lists, and spreadsheets–as well as research-backed blog posts and data graphics. This post uses Amazon Affiliate and referral links.

I would love to hear from you anytime at littldata@gmail.com. Join Littldata’s mailing list here for updates and special content to make your family logistics easier. Follow Littldata on Twitter @littldata, and on Facebook at Littldata.

Cars, guns, and the deaths of American children

Every death of a child is a tragedy. According to a recent study in the New England Journal of Medicine (NEJM), these tragedies are all too common in the United States, with children here being 57% more likely than children in other wealthy countries to die by the age of 19. Deaths of children and teenagers from age one to nineteen in the U.S. are also now more likely to be due to injuries (61%) rather than illnesses (39%).

This is in part because over the years, advances in sanitation, vaccination, diagnosis, and treatment have reduced the chance of dying from infectious diseases. In 1900, pneumonia, tuberculosis, and diarrhea and enteritis were the most common causes of death for the entire U.S. population, with 40% of these deaths being those of children. By 2016, the most recent data available, none of these diseases were among the ten leading causes of death for children.

Among injury deaths, most (57%) were unintentional, with suicides (21%) slightly more common than homicides (20%).

Cars, or motor vehicle collisions, comprised the largest single cause of death, killing 4,074 young people in the United States in 2016, or 20% of child deaths overall. At 15%, firearms are the second largest cause, with 59% of these deaths classified as homicides, 35% as suicides, and 4% as unintentional. Although drowning is a relatively less common cause of death, it was the most common cause of death among the youngest children, age one to four.

Child deaths from car crashes have decreased significantly since the early 2000s, which the authors attribute to seat belt and child car seat use, more stringent safety standards and features in cars and roads, graduated driver-licensing programs, and campaigns to reduce teen drinking and driving. But more recently, from 2013 to 2016, the rate of car crash deaths has increased. According to the authors, the causes for this reversal are not yet fully known, but likely include an increase in distracted driving due to peer passengers and the use of cell phones. Of course, this time period coincides with increased ownership of smartphones among teenagers, with smartphone ownership among all Americans increasing from 35% to 70% between 2011 and 2016.

As the rate of unintentional gun-related deaths has remained relatively stable, the increase in gun deaths from 2013 to 2016 reflects rising rates of firearm homicide (increased by 32%) and suicide (by 26%). In 2016, there were 126 unintentional child firearm deaths (and 50 more with an undetermined intention), which could have been made less likely through safer gun practices. This leaves almost 3,000 gun-related deaths of children through homicide and suicide.

Instead of seeing child injury deaths simply as “accidents,” the study’s authors pointed out that these are “social ecologic phenomena that are amenable to prevention.” Public health initiatives have made progress in reducing the number of children who die from car crashes, drowning, and residential fires, but in comparison with other countries, the United States has a long way to go. For cars and even more so for guns, the United States has the highest rates of child death as compared with other wealthy countries. Maybe this isn’t so surprising, given that the United States is the only country in the world with more guns than people.

If you’re wondering what you can do to protect the children and teens in your life, you can check out the CDC’s child injury prevention tips. For motor vehicle collisions, these tips include things like using seat belts and child car seats correctly and consistently. The CDC child injury page does not mention guns.

The study, published in the New England Journal of Medicine, analyzed data from the Wide-ranging Online Data for Epidemiologic Research (WONDER) system of the Centers for Disease Control and Prevention (CDC), which collects information from U.S. death certificates. Check it out here for more details.

Get the latest Littldata here.

About Littldata: At Littldata, my goal is to help parents figure out their family logistics by sharing calendars, maps, lists, and spreadsheets–as well as research-backed blog posts and data graphics. This post uses Amazon Affiliate and referral links.

I would love to hear from you anytime at littldata@gmail.com. Join Littldata’s mailing list here for updates and special content to make your family logistics easier. Follow Littldata on Twitter @littldata, and on Facebook at Littldata.