How Worried Should I Be About Sunscreen Absorbing Into My Blood?

Welcome to Ask a Beauty Editor, our new column in which Sarah Jacoby, SELF’s senior health and beauty editor, goes on the hunt to find the science-backed answers to all of your skin-care questions. You can ask Sarah a question at askabeautyeditor@self.com.

Confession: I haven’t always been great at using sunscreen, but when I hit my late twenties I finally started taking it a lot more seriously. Now, I apply and reapply whenever I’m in the sun, and I wear SPF on my face every single day. I finally feel like a good, responsible sunscreen-user…and then I read that report that sunscreen is seeping into our blood?! WTF?

So, wait, is sunscreen not the holy grail item I should be slathering on diligently? And are all sunscreens leaking into our bodies, or just certain kinds? (I use any old sunscreen on my body, but I stick to mineral sunscreens with just zinc oxide or titanium dioxide on my face, because my face is super sensitive and burns like hell when I put the other stuff on it.)

On a scale of 1-10, how panicked should we be about sunscreen absorbing into our bodies?

Sincerely,
To Apply or Not Apply

Let me just say that you are absolutely not the only person wondering this. My friends, family, and even my therapist have asked me about sunscreen absorption in recent weeks, wondering if this healthy habit may actually be leading to something else.

“I’ve gotten lots of questions about this,” Mary L. Stevenson, M.D., assistant professor in the Ronald O. Perelman Department of Dermatology at NYU Langone Health, tells SELF. In the era of clean beauty, informed consumers are already paying more attention to what they put on their skin before they reach for sunscreen, she says, so it makes sense that this would catch their eye.

So, why are we all worried about this all of a sudden? Well, it may have something to do with the many, many headlines talking about how your blood is actually FULL of sunscreen, and asking, with some deeply suspicious side-eye, how safe are all those sunscreens anyway?

I’ll dig into the science behind these stories in a bit, but the main takeaway is this: This study doesn’t show that it’s dangerous for sunscreen to absorb into your bloodstream—just that it happens. So keep wearing sunscreen, because we do know what happens when you don’t.

These headlines came from a study published a few months ago in JAMA. For the study, FDA researchers had 24 people each test one of four sunscreens, which included two sprays and two lotions. The participants applied their sunscreen to 75 percent of their body four times a day for four days. The researchers also took blood samples from the participants over seven days, which included three days after their sunscreen application ended.

The blood tests showed that starting after just the first day, the concentration of all four chemical sunscreen ingredients tested for (avobenzone, oxybenzone, octocrylene, ecamsule) in participants’ blood tests was over the limit of 0.5 ng/mL. That definitely doesn’t sound ideal! But it’s also not necessarily as scary as it seems.

“Just because something is absorbed does not make it unsafe,” Theresa Michele, M.D. director of the FDA’s Division of Nonprescription Drug Products, tells SELF. “What it does mean is that those ingredients need to be tested further to see how safe they are in the body.” And that’s exactly where the FDA hopes to go from here, she says.

The FDA performed this study for a couple of different reasons, Dr. Michele explains, which are all related to the FDA’s proposed rule changes for the way sunscreens should be regulated.

First off, we know much more about how drugs are absorbed by the body than we did back in the 1970s when sunscreens were first approved. “We used to think that what you put on the skin stayed on the skin and that was it,” Dr. Michele says. We now know that’s definitely not the case. Note that this is not an inherently bad thing! Some drugs—nicotine patches, birth control patches, etc.—are purposely delivered through the skin and into the bloodstream.

But it does mean that we need to be aware of how much is getting through the skin and what effects that might have. We also have more sensitive testing these days to detect lower levels of those chemicals in the bloodstream, which makes now the perfect time to revisit these issues.

Second, the way we’re using sunscreens has evolved in the past few decades. It used to be something fair-skinned people would put on at the beach for a few days and then not think about until their next vacation. But now “sunscreens are being recommended by many public health authorities for use on a daily basis by pretty much everybody in the population beginning at 6 months,” Dr. Michele says. With more people using sunscreen more often, it’s even more important to make sure we’re doing this safely.

There’s also an important deadline looming in the background here, Dr. Stevenson explains. President Obama signed the Sunscreen Innovation Act into law back in 2014, which was designed to cut through the backlog of sunscreen applications at the FDA and get new formulas and technologies into consumers’ hands quickly, she explains. One component of this plan requires the FDA to update its sunscreen monograph (the formulation template that companies use to create their products) within five years of the Act’s approval, meaning November 2019. So, the pressure is on.

But how much does this one study really tell us? Actually not that much. Remember that the study is small—24 people tested four sunscreens, meaning only six people tested each product—because it’s a preliminary finding. We’re not meant to draw any major conclusions from this except to know that, yes, more research needs to be done and should be a priority.

Also, remember how the sunscreen was applied in the study: Participants put it on 75 percent of their bodies (basically everything a swimsuit wouldn’t cover) four times a day for four days. These conditions—termed “maximal use”—were meant to replicate the way someone might use sunscreen on a beach vacation, Dr. Michele says. And if you actually follow the instructions on your sunscreen bottle (something too few of us do, really), this is what you should be doing.

But this isn’t necessarily the same type of sunscreen use that most of us actually do day to day. Applying a relatively small amount of sunscreen to your face and neck every morning is not the same as applying a large amount of it to nearly your entire body. It’s not clear whether or not we’d see similar results from someone simply using a daily face moisturizer with SPF 30.

And, finally, remember that we need to balance the unknown possible risks of using these sunscreens with the very painful, real, and possibly deadly risks of not wearing sunscreen, namely sunburns and skin cancer. For now, the known benefits of wearing sunscreen still outweigh the potential risks.

If, after all of these caveats, you are still worried, the bottom line is that you should absolutely keep wearing a sunscreen—but know that you have a lot of options. The sunscreens included in this study were all chemical blockers, which protect the skin by changing UV rays into a form that doesn’t damage skin. If you’re currently using a chemical sunscreen you can easily swap it out for one that relies on physical (mineral) blocker ingredients instead. “If you’re going to be absolutely risk averse,” Dr. Stevenson says, you can look for sunscreens containing only these mineral ingredients, like titanium dioxide and zinc oxide, which would be generally recognized by the FDA as safe and effective (GRASE, in FDA terminology) in the proposed sunscreen rule.

The bottom line is, we don’t currently have conclusive evidence that sunscreen ingredients are doing anything harmful even when they get into your bloodstream. But we do know that sunscreen is one of your best defenses against skin cancer and other types of UV-related skin damage. So, for now, keep wearing sunscreen. And soon, thanks to research like this, we may have even more sunscreen options to choose from.

Related:

Offering children a wide variety and large quantities of snack food encourages them to eat more

A new study has found that offering children a wide variety and large quantities of snack food encourages them to eat more — and this practice may be contributing to Australia’s weight problem.

The research*, led by the Murdoch Children’s Research Institute and published in the latest International Journal of Obesity, also found that how snacks are presented (in a large or small container) has little influence on how much children snack.

Lead researcher Dr Jessica Kerr said their study found children weren’t greatly affected by container size, with food consumption mainly driven by the quantity/variety of snacks on offer.

“There has been a popular push by nutritionists and public health officials towards replacing large dishware with smaller versions to nudge people towards healthier decisions,” she said. “But we have found dishware size has very little effect on the amount of food consumed.”

Dr Kerr said while the overconsumption of snack foods is an important contributor to obesity, most people do not recognise the impact it has on their calorie intake.

“Children and adults should only consume energy-dense snacks occasionally — they do not need to be part of daily energy intake,” she said. “But the reality is that Australians typically get around 30-40 per cent of their energy intake from snack foods.”

Dr Kerr said three times as many children in Australia are now overweight or obese compared to 30 years ago.

“About 20 per cent (1 in 5) of children are overweight or obese,” she said. “There are many complications of children being overweight such as type 2 diabetes, orthopaedic and respiratory disorders, liver problems and sleep apnoea.”

Dr Kerr said until now studies into snacking behavior were limited by self-reported data or small sample sizes.

“Past dietary studies have mostly focused on main meals,” Dr Kerr said. “It is important to determine on a larger scale how dishware size and the quantity, variety, and energy density of snacks affect both child and adult snacking behavior when apart from each other outside of the family environment,” she said.

For the study, participants ate during a 15-minute snack break between 20 other health assessments at the Child Health CheckPoint, which looked at the health of 1800 children, aged 11-12 years, and their parents across a variety of factors from physical activity to sleep.

The children and parents were given a snack box containing non-perishable items such as crackers, cheese, a muesli bar, biscuits, a tub of peaches and chocolate.

The quantity/number and variety of snack food items and the container sizes that the food was presented in varied. Children and parents ate separately and at different times.

Researchers recorded how much food each child and parent left in the box uneaten, and calculated the total grams and kilojoules consumed.

“Children who were offered more snack items consumed considerably more energy and a slightly higher food mass. Manipulating box/container size had little effect on consumption,” she said.

The impact on adults was little, however Dr Kerr said adults were more aware that they were being observed and this may have impacted their eating behaviour.

Dr Kerr said further research should be done with parents and community leaders to better understand the use and purpose of snack food items in the face of time pressures, marketing, and child preferences.

“Although there is sometimes a place for snack items to bridge the gap between main meals, our results reinforce calls to educate parents and schools about appropriate snack items and amounts of food to offer children,” she said.

“Our research indicates that more attention and resources should be directed to toward offering children smaller amounts of food and, specifically, fewer and less variety of energy-dense foods and pre-packaged items. Interventions should not solely invest in reducing dishware size in the expectation that this will lead to reduced intake of snack foods.”

Researchers from the University of Melbourne, Erasmus University Rotterdam, University of South Australia, Monash University, Deakin University, University of Sydney and the University of Auckland also contributed to the findings.

Hearing loss tied with mental, physical, and social ailments in older people

Hearing loss is the world’s fourth-leading cause of years lived with disability. The condition may worsen an array of mental, physical, and social complications. As over 90% of hearing loss is age-related, its burden is notably growing amid aging populations.

Hearing ability is integrally tied with communication, and hearing loss leads to communication barriers. This in turn increases stress and restricts the ability to venture outdoors. It may also be tied with cognitive decline and dementia.

A team of Japanese researchers centered at the University of Tsukuba sought to shed further light on the relation of hearing loss and other illnesses among older people. They examined three key areas and found hearing loss had a clear link with all three, especially memory loss. The researchers reported their findings in the journal, Geriatrics & Gerontology International.

The team took advantage of the large-scale 2016 Comprehensive Survey of Living Conditions of Japan, a nationwide, population-based cross-sectional questionnaire of more than 220,000 households. From this, they targeted 137,723 survey respondents aged 65 or older and without dementia. The survey’s self-reported responses on conditions including hearing loss allowed valuable comparisons to be made.

“Japan is the world’s most rapidly aging country, and this is a large and compelling data set of its citizens,” lead author Masao Iwagami says. “It was a solid foundation for examining correlations between hearing loss and three key problems: outdoor activity limitations, psychological distress, and memory loss.”

About 9% of the 137,723 survey respondents examined had reported hearing loss. Their responses also showed the condition increased with age. The researchers further adjusted and refined their analysis to account for factors such as smoking, alcohol intake, and income. The differences between those with and without hearing loss were quite telling.

Of those reporting limitations in outdoor activities such as shopping or travel, 28.9% of those with hearing loss were affected vs. just 9.5% of those without. For psychological distress it was 39.7% vs 19.3%. For memory loss, the gap was the most profound: 37.7% vs 5.2%. These patterns were similar irrespective of age or sex.

“Hearing loss takes an enormous toll on older people in so many ways, physically and mentally, while limiting activities of daily living,” study co-author Yoko Kobayashi says. “Greater awareness of the burden of hearing loss will help improve their quality of life. Measures such as hearing aids and social support by volunteers in the community can also provide them with assistance.”

Story Source:

Materials provided by University of Tsukuba. Note: Content may be edited for style and length.

The Submission Guidelines for SELF’s 2019 Fitness Awards Are Here!

As SELF editors, we spend a lot of time obsessing over and trying the newest, coolest fitness apparel and gear. This year, for our annual fitness and gear awards, we will be focusing on seven core categories—from sports bras and leggings to sneakers and trackers—to bring readers the best new gear available. To determine our winners, we’ll be tapping our editors and our network of respected athletes and trainers to rigorously test each item during various types of workouts, keeping tabs on key factors like performance, fit, comfort, and style.

Below you’ll find a list of our 2019 gear categories followed by submission guidelines. Please read through each section carefully before reaching out to submit a product.

Healthy Fitness Awards Categories 2019

  • Sports Bras: Including low-impact, medium-impact, high-impact in all cup sizes; plus longline bras and crop tops

  • Leggings: Including leggings for yoga, HIIT, barre, cycling (indoor and outdoor), high-waisted, cold weather, compression, recovery, outdoor/hiking; plus running tights, joggers, and bodysuits

  • Shorts: Including running shorts, short-shorts (volleyball shorts), soccer shorts (or other longer styles), and skorts

  • Sneakers: Including shoes for running (stability, neutral, minimal/racing flats), studio, CrossFit, cycling, walking, weightlifting, all-day/leisure, and trail

  • Tops: Including tank tops, technical t-shirts and long-sleeves, and all-weather jackets

  • Fitness tech: Including GPS smartwatches, everyday activity trackers, sleep trackers, swim trackers, running watches, and headphones

  • Gym Accessories: Including water bottles, gym duffel bags and backpacks, commuter/cycling bags, running backpacks, yoga mats, and hot yoga towels

Editor’s Note: This list may change. We may add or remove categories.

Submission Guidelines

  • Products must be new and released after October 1, 2018 and available nationwide by September 30, 2019.
  • For apparel, any item submitted must be available in all sizes up to XL and preferably also available in extended sizing.
  • To submit a product, email the product name along with info sheets or press releases to health@self.com. Where applicable, please include size range.
  • Please do NOT send samples. If we decide to test your product, we’ll contact you to request samples. Please note that any products tested cannot be returned.
  • Product submissions are due by Friday, August 9, 2019.

Any questions? Email health@self.com with “Fitness Awards” in the subject line and we’ll get back to you ASAP. Thank you and good luck!

You’re Probably Forgetting to Put Sunscreen on These 8 Places

When I was a kid, I distinctly remember trying to wiggle away as my mom rubbed sunscreen on my face, neck, back, and limbs. It seemed to take way too long for her to rub it in so I could waddle around in the ocean or roll around in the sand. I wish I could say my relationship with sunscreen is better now that I’m older, wiser, and mature enough not to wiggle away from my own hands. But I still feel like applying sunscreen to every inch of my body before a pool day is robbing me of valuable time I could spend floating on one of those cute unicorn-shaped rafts. That said, I’m an adult (and a health editor), so I know that it’s important to apply sunscreen even when I’d rather not—especially to body parts that dermatologists say are easy to overlook.

Sorry, but you absolutely do need to use sunscreen.

Yes, the sun feels delightful on your skin, but the different types of UV light it emits can cause skin damage in as little as 15 minutes. UVA rays can lead to signs of aging, and UVB rays can cause sunburns, according to the Mayo Clinic. Most important, too much exposure to either UVA or UVB rays can lead to skin cancer, which is the most commonly diagnosed cancer in the United States, according to the American Academy of Dermatology (AAD).

Sadly, even a slight tan is actually a mild case of sun damage, according to the Centers for Disease Control and Prevention (CDC). As you’re lying out, your body sends extra melanin to your skin to protect it from further damage, leading to a darker skin color. If you give those rays enough time to really harm the cells in your skin, it can lead to a sunburn.

To avoid all of this, the AAD recommends using a broad-spectrum sunscreen, meaning it protects from UVA and UVB rays. Both chemical and mineral sunscreens can do this in different ways—the former with chemicals that change UV light to heat that won’t harm your skin, and the latter primarily by creating a physical shield on top of your skin, as SELF previously reported. Knowing which one you’re using helps ensure that you’re applying it correctly.

Chemical sunscreen should be applied about 15 minutes before sun exposure, while mineral sunscreen works immediately. The AAD also suggests using sunscreen with a sun protection factor (or SPF) of at least 30. Reapply as often as recommended on the bottle (typically around every two hours or more often if you’re sweating or coming into contact with water).

It’s not enough just to choose the right sunscreen. You also have to use enough of the stuff. Generally speaking, if a regular-sized bottle of sunscreen lasts you the entire summer, there’s a solid chance you’re not using enough, Mary L. Stevenson, M.D., assistant professor of dermatology at NYU Langone Health, tells SELF. (Obviously, this depends on how often you do things like take beach trips, but it’s still a good rule of thumb.)

The AAD recommends using about an ounce of sunscreen for your entire body. This is enough to fill a shot glass, which might sound exorbitant. But that really is around how much most adults need in order to get sunscreen on all the right places.

“Sometimes people try to put their sunscreen around their swimsuits, but that’s how you end up missing spots,” Dr. Stevenson says. Even if you do strip down before covering yourself in sunscreen, don’t forget these often-ignored body parts:

1. Your ears

It’s incredibly easy to accidentally skip your ears during sunscreen application, Alyx Rosen, M.D., assistant professor at the Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery at University of Miami Health System, tells SELF. But applying sunscreen to your ears before you head outside is important. Whether you have short hair, pull your hair back, or just it tuck it back sometimes, chances are your ears will rack up some sun. Even if you’re wearing something like a beach hat, it’s good to protect your ears in case of accidental exposure. Put sunscreen behind your ears, onto their tops, sides, and bottoms, and also onto any other external parts that are visible, Dr. Rosen says.

2. Your scalp and hairline

Dr. Stevenson says that you might not think about your scalp when applying sunscreen if your hair seems to quite literally have it covered. But if your hair is on the thin side or you have a hairstyle that leaves your scalp visible (hello, cornrows), Dr. Stevenson suggests using a sunscreen spray on this vulnerable part of your body. (Be sure you’re not doing this somewhere super windy.) Grabbing a hat is a great alternative, but that sunscreen is necessary if you plan to remove the hat at all. Also, don’t neglect your hairline, Dr. Stevenson says—it deserves some sunscreen love, too.

3. Your eyelids

The skin around your eyes is thin and susceptible to both sun damage and skin cancer, Dr. Rosen says. “People often don’t do a good job of applying sunscreen around the eyes,” she adds. To protect yours, you can use a mineral sunscreen for sensitive skin (which may be less irritating than the chemical kind if it gets in your eyes), Dr. Rosen says, adding that you should wear sunglasses that have broad-spectrum UV protection as well.

4. Your lips

Dr. Rosen often sees boaters and other people who are frequently outdoors come in with actinic cheilitis, or precancerous growths on the outer layer of their lips. Protecting this delicate skin is a must. The CDC recommends using lip balm with broad-spectrum SPF of 15 or greater. If your favorite balm has no SPF, you can use a regular sunscreen on your lips instead. Either way, be diligent about reapplying. “Sunscreen on your lips dissolves if you’re eating and drinking, so you’ll need to be conscious of that,” Dr. Rosen says.

5. Your neck and chest

People typically forget to go over their necks and chests with sunscreen, Dr. Stevenson says. Additionally, if you have short hair or put yours up, you might forget that the back of your neck is going to get a lot of sun when you’re venturing outside. As is the case with other parts of the body, this leaves your skin exposed to potential sun damage.

6. The backs of your hands

Your hands do all the work of covering other parts of your body with sunscreen, and they need just as much protection—if not more. The tops of your hands are almost always exposed to sunlight when you’re outside, Dr. Stevenson says. And, as Dr. Rosen points out, even if you do apply sunscreen to the backs of your hands, frequent handwashing could rinse a lot of it right off. Much like with your lips, you may need to be extra aware of reapplying sunscreen to this spot.

7. Your shins and the backs of your knees

Commit to applying and reapplying sunscreen to your legs, particularly your shins and the backs of your knees, Dr. Rosen says. These are both easy-to-miss spots. This is especially important for women, because the lower legs are the most common site for melanoma to appear, according to the Mayo Clinic.

8. The soles of your feet

While it’s possible to ignore your poor feet entirely when applying sunscreen, most people are especially forgetful about the bottoms of their feet, Dr. Stevenson says. It’s important for everyone to remember to layer some sunscreen onto the soles of their feet before possible exposure, like a day at the beach, but this can be especially key for Black people and anyone else with darker skin. People with dark skin tones are more susceptible to acral lentiginous melanoma, a generally rare type of skin cancer that can show up in surprising spots like the bottoms of the feet. This can happen even without much sun exposure, the Mayo Clinic explains, so it’s particularly critical to protect yourself if you have dark skin and are exposing your feet to the sun.

Now that you know some of the most often-overlooked spots when it comes to sunscreen application, take the extra time to show them some attention before you head outdoors. Is it the most fun thing in the world? Nah. But your skin can’t talk, so we’re making this request on its behalf.

Related:

Maternal race not a factor for children experiencing a ‘language gap’

In a first of its kind study, researchers from the University of North Carolina at Chapel Hill’s Frank Porter Graham Child Development Institute evaluated the language use of black mothers in comparison with white mothers with the same education levels to measure the amount and complexity of the words they use with their infants and young children. This study resulted in the new discovery that race played no role in the amount and quality of the words they used with their children or with the language skills their children later develop.

Researchers found that maternal education did play an important role in predicting the amount and quality of the mother’s language use and the child’s language development. This is significant because earlier studies have shown that children of parents with lower socioeconomic backgrounds and education levels have lower language skills when entering school, but those studies included parents with higher incomes who were primarily white and parents with lower incomes who were primarily black. As a result, educators and other child professionals were not able to distinguish between race, income or education as the cause of the language gap until now. These new findings were published in the journal Child Development on July 17, 2019.

“Over time, there were summaries of this early research that misrepresented the data. Many of these summaries suggested that black and African American mothers, especially those with lower-incomes, provided less and lower quality language to their children than white mothers,” said Lynne Vernon-Feagans, Ph.D.

“Our findings represent a big shift from previous thinking that race-based differences in maternal language play a significant role in children’s language outcomes,” said Mary Bratsch-Hines, Ph.D.

Researchers Lynne Vernon-Feagans, Mary Bratsch-Hines and Elizabeth Reynolds of Frank Porter Graham Child Development Institute teamed up with Michael Willoughby, Ph.D., of RTI International on the study to determine if and how much a mother’s race or her education played a role in her child’s language development.

Researchers were also able to determine that maternal education was very related to children’s later language at school age regardless of maternal race, and that mothers’ early language input quality and complexity were even more related to children’s later language at school age.

These new discoveries will help improve parent, teacher and school system efforts by shaping their understanding of the importance of maternal education for both black and white children and allowing experts to focus available efforts and resources in better ways to improve child outcomes.

Story Source:

Materials provided by University of North Carolina at Chapel Hill. Note: Content may be edited for style and length.

The Art of Saying No to Invites When You REALLY Don’t Want to Do Something

Rachel Wilkerson Miller

There are few social interactions more panic-inducing than the moment a kind, friendly person invites you to do an activity or attend an event that you really don’t care to do but you also don’t have a “good” reason to say no. You know the reason is just “…nah,” but you are also a kind and friendly person, so you aren’t going to just say that. You have manners! And empathy! And—now, apparently—an obligation to go roller skating next Saturday with a bunch of strangers, even though you deeply don’t want to!

It can be difficult to say no to an invite when your reason boils down to “I just don’t want to,” because a lot of us don’t think of that as a valid excuse. Which is…kind of fucked up! Not wanting to do something optional and fairly low-stakes is a perfectly good reason to not do it! I don’t know about you, but I certainly don’t want to live in a world where anyone lacking the “right” excuse is expected to participate in whatever activities other people deem important, their own needs and desires be damned. Which is why I feel so strongly that we all need to give ourselves permission to say no to this type of request more often.

Of course, there are times you should genuinely consider their invite, like if the person is a close friend or a pal who is inviting you to something that means a lot to them. Sometimes, having close relationships means doing things that aren’t really your idea of a good time. You should definitely give your friend’s improv show or housewarming party real consideration before you reflexively refuse. But I’m talking more about the instances in which it’s not a super close friend and/or the invite is relatively unremarkable…like, say, an invitation to attend a lecture or see a movie you’re not interested in, or to go out to dinner on a weeknight at a restaurant that’s across town and too pricey for your taste. In those situations—when you can technically go, but you just don’t want to—it’s actually OK to decline. Really!

The case for saying no

First of all, your time, money, and energy (TME) are your most valuable resources; how you choose to spend them is directly related to who you are and, ultimately, the life you want to live. And if you don’t decide how you want to spend your TME—and then protect those resources accordingly—other people will decide for you. You can’t really be your happiest, most authentic self if you regularly abdicate this responsibility.

Beyond that, I look at saying no to hangout requests as a gateway drug to setting boundaries in general. Realizing you have the right and the ability to say “no thanks” or “I’m not into that” without the world coming to an end is pretty life-changing. Do it a few times and you’ll begin to see that a cornucopia of possibility and freedom awaits! On the other hand, if you can’t tell a total stranger “oh, no thank you, I’d rather not” when they try to offer you a perfume sample at the mall or get you to sign their petition in the park, you’re probably not going to be comfortable telling a friend it’s time for a subject change when their “I hate my boss” monologue enters its third hour, or telling your parents you can only stay for a weekend—instead of their proposed 14 days—on your next trip home. It’s a good idea to practice saying no to the small(ish) low-stakes asks when they present themselves; over time, the bigger requests will begin to feel less daunting.

Saying no also gives you a chance to learn more about the people in your life, and how they treat you. Here’s the thing: anyone who refuses to take no for an answer with regard to the relatively minor requests probably isn’t great at respecting boundaries in general—which is helpful information to have! Because boundaries are about way more than just roller skating on a Saturday; they can also be about your bodily autonomy, your money, your belongings, and your privacy. And you might find that a person who reacts very badly to “Oh, thank you for the invite, but I’m actually not a big fan of roller skating” has problems taking no for an answer when it comes to the bigger stuff. If your people are guilt-tripping you, pressuring you to do something, or otherwise not “letting” you say no, that’s a Them Problem, not a You Problem. The people who are actually worthy of your time, money, and energy will take care to communicate that they respect your needs, preferences, and TME, even if they feel a little disappointed by your “no” in the moment.

Refusing an invitation early on also allows you to avoid the scenario in which you dread the event for weeks and ultimately cancel at the last minute. I have a lot of thoughts on canceling plans (tune into a future installment of A Little Better if you’d like to hear them!!!) but I think we can all agree that dreading an event for weeks is a bummer (and way more emotionally draining than just saying no in the first place!), and being canceled on at the last minute is pretty frustrating. Also frustrating: Hanging out with a person who doesn’t actually want to be there! If my options, as the inviter, are “be momentarily disappointed before finding a buddy who will enjoy the activity I’m proposing” and “spend *my* valuable TME hanging out with someone who doesn’t want to be here, and secretly—or not-so-secretly—resents me for it,” I’m going to choose the former every time! Agreeing to do something you really don’t want to do isn’t necessarily kind; it can actually be pretty selfish.

Speaking of selfish, when I’m feeling really guilty about the idea of saying no in these situations, I find it’s helpful to think about whether saying my no is really going to break this person’s heart, or if I just think my presence is way more important than it really is. It can be easy to tell yourself your attendance is a huge deal, or that this event means soooo much to this other person…only to say no and have them shrug and invite someone else without giving it a second thought. Of course, sometimes they really do care if you say yes! But even if they’re a little disappointed, they will likely understand and get over it—which is a fine outcome! Taking care of yourself a medium or big amount is more important than avoiding disappointing a friend a small amount. So before you begrudgingly agree to go, you may want to step back and ask yourself if you’re perhaps overestimating how much your attendance really matters to your friend.

Finally, remember that by declining, you are—whether it feels this way or not—actually showing up for the other person. Because when you graciously say no, you communicate, “This is a relationship where we are allowed to ask for what we want. This is a world in which we are allowed to ask for what we need.” If you can’t do this for yourself, do it for Future Them.

What to actually say

I know declining an invitation can feel stressful or guilt-inducing in the moment, but it doesn’t have to be that way! It just takes practice. The more you do it, the more you’ll realize that most people can actually handle it, and that it won’t negatively affect your relationships. If you need a little help formulating a response for these situations, below are some scripts based on conversations I’ve had in my own life to get you started. As always, you can/should tweak these so they feel right for the request and the relationship.

Regardless of what you say, your tone matters a lot; aim for warm, but relatively neutral and matter-of fact. And keep it short. There’s also no need to beg for forgiveness, get into all your boring personal reasons, or present an eight-part defense as though you’re ADA Alexandra Cabot in a Law & Order: SVU rerun. Treat saying no as normal (because it is normal).

If it’s date-specific, and you’d prefer to be doing Not This on the day/time in question:

“Oh, thank you so much for thinking of me! Unfortunately I won’t be able to make it, but thank you for the invitation!”

“Oh that sounds lovely, but I won’t be able to make it. But have a great time!”

If you’re probably never going to be up for doing an activity at the suggested day/time:

“Oh, that concert sounds really fun, but I can’t really do big outings on weeknights because of work! But have a great time!”

“Ah, that sounds lovely, but I have a rule that I don’t make plans on Sundays—it’s my day [to decompress and not talk to anyone][catch up with my parents][do all my chores and errands]. But thank you for thinking of me!”

“Oh, that sounds like a blast, but I’m pretty committed to my 10 p.m. sleep schedule on weeknights these days. But thank you for the invite!”

“Roller skating isn’t really my thing, so I’m going to sit this one out!”

“Thank you for thinking of me, but [music festivals/the beach/amusement parks] aren’t really my speed!”

You could also add something like, “But I’d love to see you and catch up soon! How about [some alternative programming that you both enjoy]?”

If you’re low on bandwidth and expect to be for the foreseeable future

“Ah, I’d love to [see you/catch up/hang out], but I haven’t been able to get much time for myself lately and I promised myself I’d just hunker down and have a quiet weekend!”

“I don’t really have the bandwidth for much socializing right now, but I would love to [do something else][in a couple days/weeks/months when you’d be up for it].”

“I don’t have much room for extracurriculars these days, but I would love to [do something else][at some date in the future when you’d be up for it].”

“Ah, that sounds [lovely/fun/amazing], but I haven’t been sleeping well lately and promised myself I’d stop going to so many [happy hours/pool parties/roller skating networking events] so I can establish a more consistent schedule.”

“I know I haven’t been able to come the last few times you’ve invited me, but it’s not because I don’t want to! [My schedule is just busy][I’m feeling broke[I can’t really do things on weeknights][In general, roller skating isn’t really my jam][I’ve been pretty depressed, honestly, so socializing is a bit of a struggle right now] But I hope the stars will align soon and I’ll be able to attend!”

Note: This last one is a good option when you’ve declined a couple invites from the same person and are concerned that they’ll think you’re cancelling because you just don’t want to hang out with them. In my experience, it’s way better to be honest and clear about why you’re declining invitations (more on that in a moment!), especially if they’re from close friends who would probably love to know a) how you’re doing, and b) that it’s not about them.

And by the way, you don’t have to offer an alternative hangout at some other future date in any of the above examples if you’d prefer not to! In that case, you can just say, “but thank you for the invitation” instead!

If you need a moment to compose yourself before you respond:

“Let me check my calendar and get back to you!”

(And then actually get back to them quickly—don’t wait for them to follow up!)

A note on making up excuses

I am, in general, against fabricating a reason when declining an invite. Here’s why: If you tell a lie that you can’t attend on that particular date (when it’s really about the activity itself), the person might respond by asking you to do this activity on a different day, which will put you in an awkward position. Or they might assume you actually love roller skating and want to be on the invite list for all future local roller skating events. This outcome is good for exactly no one!

Alternatively, if they somehow find out you didn’t actually have “real” plans (or the plans you claimed to have) that day, or they later discover that you do, in fact, like roller skating, they might actually feel worse—because they’ll assume it was personal, that you just didn’t want to hang out with them. (Which may or may not be true! But even if it is about them, you’re probably not trying to communicate that.)

When you’re simply a little bit more honest about the reason why you can’t make it, you communicate important information: I do, in fact, like you. But I don’t, in fact, like roller skating or weeknight hangouts. The honest response tells them that you trust them enough to be authentic and open with them, and that you care about them enough to build a relationship where you feel seen and known.

But also: refusing an invitation is not that deep! It’s literally fine.

By the way…

If we want to be allowed to say no, we have to be willing to extend that option to others. So remember: if someone declines your invitation, it’s really, really OK. It doesn’t necessarily mean they don’t like you, or that they don’t want to be your friend. And, look, if someone only ever declines your invitations and you do start to suspect they don’t really want to be friends, that is another matter. But it also might mean they don’t want to be your friend! Which is disappointing and stings, but is also fine—because you don’t actually want to be friends with people who don’t want to be friends with you, or who don’t share any of your interests.

If you’re feeling bummed about the “no thank you,” remind yourself that declining an invite can leave a person feeling vulnerable, and requires courage—even from relatively assertive people. So they must feel pretty strongly about this. I’ve also found it helpful to view a “no” not as a slight, but as a favor—because, again, there is nothing worse than knowing someone was dreading spending time with you, or regretted investing their TME in something you wanted to do. They’re also doing you the favor of saying no now, instead of saying yes and then flaking on you. And they’re giving you permission to say no to them someday.

So if someone says, “I can’t make it,” let that be good enough. Trust that they have their reasons, respect their willingness to protect their TME, and move on. If someone says, “I don’t like roller skating,” believe that they simply don’t like roller skating. If someone says they are too busy, don’t judge them for spending the evening “doing nothing” instead. (Making the choice to do nothing, when you are otherwise busy, is a big deal!) If someone says they can’t afford to join you for dinner, don’t mentally catalogue all of the expensive shoes they own and the amount of $5 lattes you’ve seen them consume this week. Know that a “no” simply means “This is not how I want to spend my TME at this moment” and that even if it feels a little bad, it’s OK.


Rachel Wilkerson Miller is the author of Dot Journaling: A Practical Guide and a former senior editor at BuzzFeed. She is currently working on her second book, The Art of Showing Up: A Guide to Taking Care of Yourself and Other People (The Experiment, Spring 2020). You can follow her on Twitter and Instagram, and read her blog here.


The content of each “A Little Better” column is the opinion of the writer and does not necessarily reflect the views of SELF or SELF editors.

6 Emergency Contraception Mistakes People Shouldn’t Make

You may have heard that taking emergency contraception like Plan B during ovulation makes it less effective, and unfortunately, that’s one rumor that’s true (more on that below). But there are a host of other factors that can make emergency contraception fail, from not taking it soon enough to continuing to have unprotected sex after you take it. The good news is, emergency contraception exists in several different forms, so chances are, there’s one that will work for you. That said, taking it properly is crucial for it to protect you to the fullest extent. Here are six things you should know about taking emergency contraception to avoid pregnancy—including whether Plan B is effective if you are already ovulating.

First, here’s what you need to know about emergency contraception.

There are a few types of emergency contraception, and some work better than others. According to Planned Parenthood, you basically have two options:

  • Go to your doctor to get a Paragard IUD within five days of having sex without protection. Paragard creates a toxic environment for sperm, and it prevents pregnancy more than 99.9 percent of the time. That’s why it’s considered the most effective type of emergency contraception, according to Planned Parenthood.

  • Take an emergency contraceptive pill (often referred to as the morning-after pill) within five days of unprotected sex. There are two types of morning-after pills: A brand called Ella uses the drug ulipristal acetate to delay ovulation, and according to Planned Parenthood, is the most effective type of morning-after pill. The only hitch: You need a prescription to get it (that said, you can get a fast medical consultation and prescription with next-day delivery online). Your other option is an OTC morning-after pill like Plan B or Next Choice, both of which use levonorgestrel, a synthetic version of the hormone progesterone, to delay ovulation. These pills work best the sooner you take them, but you can take them up to five days after unprotected sex, according to Planned Parenthood.

Your final option is to take multiple doses of regular birth control pills as emergency contraception—and no, that does not mean simply “doubling up.” Popping two birth control pills is typically recommended when you’ve missed just one dose of your birth control, but it doesn’t work as emergency contraception. For emergency contraception, you have to take more than two, and the amount you need depends on the brand you use. Known as the Yuzpe method, this method has been around since the ’70s. That said, you have to be precise about it (read more here), so talk to your doctor or pharmacist about your specific birth control before trying it. They can tell you if this or another EC option would be best for your situation.

Now that you understand your options, here, ob/gyns explain the factors that can make emergency contraception fail.

1. You don’t take it soon enough.

Morning-after pills like Plan B and Next Choice are effective if you take them within five days of unprotected sex. The major caveat here is that they work best when taken within 72 hours, then the efficacy starts dropping. Within three days after unprotected sex, these kinds of morning-after pills are between 75 and 89 percent effective at preventing pregnancy, according to Planned Parenthood. “The sooner you take it, the better it’s going to work,” Mary Jane Minkin, M.D., a clinical professor of obstetrics and gynecology at Yale Medical School, tells SELF. Although levonorgesterel-based options like Plan B and Next Choice prevent pregnancy up to five days after unprotected sex, think of those first 72 hours as prime time.

Ella, the prescription morning-after pill, is also effective for up to five days after unprotected sex, but it’s equally as effective the entire time, Katharine O’Connell White, M.D., M.P.H., director of fellowship in family planning, Boston University/Boston Medical Center, tells SELF. Ella decreases your risk of getting pregnant by 85 percent if you take it within the appropriate window.

Paragard also needs to be inserted within that five-day window in order to be effective.

2. You throw up after taking EC.

Years ago, emergency contraception relied on estrogen to do its job, Dr. Minkin explains. “The estrogen in these things—they used mondo doses—used to make people nauseated,” she says. Now, forms of EC like Plan B and Ella don’t rely on estrogen, so nausea is less likely (in fact, morning-after pill side effects are short-lived and cause little more annoyance than bleeding between periods or nausea, according to Planned Parenthood. That said, nausea can still happen, especially due to nerves. If you opt for the method of taking multiple birth control pills as your EC, there’s a decent chance you could ralph. “[Taking multiple birth control pills is] great in a pinch, but it often leads to nausea and vomiting, which are a risk factor for failure,” Dr. White says.

No matter what, if you throw up within an hour or so of taking EC, you’ll need another dose. Your body might not have had enough time to metabolize it, Dr. White explains. “It’s really unlikely that this would happen after around an hour, but if you ever vomit and can see a pill, that’s a concern,” Dr. White says, and you should probably take another to play it safe.

3. Your BMI is over a certain number.

Although BMI is a tricky measure for things like health, it does come into play with EC. If your BMI is over 25, morning-after pills like Plan B are less likely to be effective. “It has to do with the distribution of the drug,” Dr. White explains. Some science suggests Ella may also become less effective at higher BMIs, though it’s not yet clear how true this may be.

“Being obese or overweight doesn’t render emergency contraception ineffective, just less effective,” Dr. Minkin says. In this instance, the copper IUD can be an especially great option for EC. “Paragard will work very nicely as emergency contraception in someone with a higher BMI, and the other advantage is it will give you long-term contraception anyway,” Dr. Minkin says.

4. You start hormonal birth control right after taking Ella.

After a slip-up requiring emergency contraception, it might seem like you should immediately hop back on the non-baby-making train by getting yourself a scrip for birth control, stat. But you shouldn’t start or continue any form of hormonal birth control within the first five days of taking Ella, Dr. White explains. “Another hormonal birth control method can decrease Ella’s efficacy,” she says. In return, Ella can mess with hormonal birth control’s mechanisms, according to its website. To be safe, after using Ella, use condoms until your next period, and don’t use hormonal birth control until five days have passed.

5. You took Plan B during ovulation.

Now for the mother of all questions: Is Plan B effective if you are already ovulating? Here’s the deal: Preventing pregnancy with Plan B—or any form of EC—is all about timing. Sperm can live inside your body for up to five days after sex, waiting for an egg to join up with. If you ovulate during that time, the sperm and egg can meet and cause pregnancy. Morning-after pills work by temporarily stopping ovulation, but if your ovary has already released an egg, your EC won’t keep you from getting pregnant, according to Planned Parenthood. So, if you happen to have unprotected sex during your fertile window—four days before you ovulate, the day you ovulate, and the day after—you’re just naturally more likely to get pregnant, Dr. White explains.

So what should you do if you had unprotected sex during ovulation? Your best bet is the Paragard IUD. “It’s the best emergency contraception we have. Because it works by inhibiting sperm, the timing in your cycle doesn’t matter as much,” Dr. White says. Of course, getting an IUD is way different than taking the morning-after pill, but it may be worth it if you’re looking for the most effective EC possible.

6. You have more unprotected sex after you take EC.

Sometimes people think that after a dose of EC, they a sexual get-out-of-jail-free card, Dr. White explains. That’s not true. “Ovulation is just delayed, not stopped, so further acts of unprotected sex put you in the line of fire,” she says.

Once more, with feeling: Everyone makes mistakes. If you need emergency contraception, there’s no reason to feel down on yourself. It only becomes somewhat concerning if it becomes a habit, because it means there might be a better birth control option out there for you. “If you find yourself needing morning-after contraception on several occasions, it’s not dangerous, but we can do better,” Dr. Minkin says. “If you’re sick of taking birth control pills, we can get you an IUD, the Nexplanon implant, or something else—there are lots of options, and you don’t have to rely on morning-after contraception.”

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Coaching scientists to play well together

When scientists from different disciplines collaborate — as is increasingly necessary to confront the complexity of challenging research problems — interpersonal tussles often arise. One scientist may accuse another of stealing her ideas. Or, a researcher may feel he is not getting credit for his work or doesn’t have access to important data.

“Interdisciplinary team science is now the state of the art across all branches of science and engineering,” said Bonnie Spring, professor of preventive medicine at Northwestern University Feinberg School of Medicine. “But very few scientists have been trained to work with others outside of their own disciplinary silo.”

The skill is critical because many National Institute of Health and National Science Foundation grants require applicants to show readiness for team science.

A free, online training tool developed by Northwestern, teamscience.net, has been been proven to develop skills to work with other scientists outside their own discipline.

A new study led by Spring showed scientists who completed the program’s modules — called COALESCE — significantly boosted their knowledge about team science and increased their self-confidence about being able to successfully work in scientific teams. Most people who completed one or more modules (84%) said that the experience of taking the modules was very likely to positively impact their future research.

The study will be published July 18 in the Journal of Clinical and Translational Science.

There are few training resources to teach scientists how to collaborate, and the ones that are available don’t have evidence of their effectiveness.

teamscience.net is the only free, validated-by-research tool available to anyone at any time.

Almost 1,000 of the COALESCE users opted voluntarily to respond to questions about the learning modules, providing information about how taking each module influenced team science knowledge, skills and attitudes.

‘You stole my idea’

The most common area of dispute among collaborating scientists is authorship concerns, such as accusations that one person stole ideas from another or that a contributor was not getting credit for his or her work, the study authors said. Other disputes arise around access to and analysis of data, utilization of materials or resources, and the general direction of the research itself. Underlying all of these issues is a common failure to prepare for working collaboratively with other scientists.

“Preparing in advance before starting to collaborate, often through the creation of a formal collaboration agreement document, is the best way to head off these types of disputes,” said Angela Pfammatter, assistant professor of preventive medicine at Feinberg and a coauthor on the paper.

Spring suggested “having scientists discuss their expectations of one another and the collaboration to prevent acrimonious conflicts.”

Skills to play well together

These skills are critical to a successful scientific team, the authors said:

    1) The ability to choose team members who have the right mix of expertise, temperament and accessibility to round out a team.

    2) The ability to anticipate what could go wrong and to develop contingency plans in advance.

    3) The ability to manage conflict within the team.

The teamscience.net modules help scientists acquire these skills by letting them interact with different problem scenarios that can arise in team-based research. They can try out different solutions and learn from mistakes in a safe, online environment.

More than 16,000 people have accessed the resource in the past six years. Demand for team science training is expected to increase as interdisciplinary teams set out to tackle some of science’s most challenging problems.

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Materials provided by Northwestern University. Note: Content may be edited for style and length.

Recurrent Yeast Infections Are the Worst—Here’s How to Handle Them

Recurrent yeast infections can be super frustrating. No matter what you do, they just keep coming back. You know you have a yeast infection if your vagina is constantly burning, itching, and releasing a thick, white, odorless discharge. But having chronic yeast infections is even worse—that’s when your vagina decides to be a real jerk and gives you four or more yeast infections a year, according to the Mayo Clinic.

If you get yeast infections this often, you probably know the drill. At the first sign of yet another one, you may hightail it to your local drugstore, cruise through that aisle, and search for a yeast infection treatment that will make your symptoms disappear ASAP. But before you just accept a lifetime of creams and suppositories, you should know that it doesn’t have to be like this. Keep reading to learn why you may be dealing with recurrent yeast infections, plus how to get some much-needed relief.

First, you need to understand what a yeast infection is.

A yeast infection happens when a fungus called Candida albicans overgrows in your vagina and causes severe itchiness, irritation, and discharge, according to the Mayo Clinic. This is the type of fungus that most commonly causes yeast infections, per the Mayo Clinic.

Before you get grossed out, remember that it’s totally natural to have some Candida albicans in your vagina! Lactobacillus bacteria produces acid to prevent an overgrowth of this yeast and generally help keep your vagina happy and healthy. It’s only when this yeast grows too much that you can begin to have an issue.

What causes yeast infections?

If something disrupts the balance of your vagina’s pH, yeast can get out of control and cause an infection, Sherry A. Ross, M.D., a women’s health expert and author of She-ology: The Definitive Guide to Women’s Intimate Health. Period., tells SELF.

There are a few things that can disrupt that balance and cause a yeast infection, including:

  • Antibiotics: Antibiotic use is a huge one, since it can kill the healthy bacteria in your vagina that helps to ward off infections, according to the Mayo Clinic.
  • Scented products: In some cases, a new soap or laundry detergent with fragrance can set you up for a yeast infection by disrupting your natural pH balance. For similar reasons, you should keep douches of all forms away from your vagina: Trying to “clean” inside of yourself can promote pH disruption and is seriously unnecessary.
  • Hanging around in damp clothes: Wearing sweaty gym clothes or a wet bathing suit for too long can also contribute to yeast infections. Yeast loves warm, moist environments, and your workout gear or a wet bathing suit can trap heat and sweat, allowing yeast to flourish, Christine Greves, M.D., a board-certified ob/gyn at the Winnie Palmer Hospital for Women and Babies, tells SELF.
  • High estrogen levels: Having elevated estrogen levels due to pregnancy, taking high-estrogen birth control pills, or using estrogen hormone therapy can increase your risk of yeast infections. Excess estrogen can promote higher levels of glycogen (a stored form of glucose, also known as sugar) in the vagina. Yeast love sugar, Dr. Greves explains, which is extremely relatable and also why people with diabetes who have trouble controlling their blood sugar levels are often at a higher risk of getting yeast infections.
  • Having sex: Unfortunately, having sex can also promote yeast infections, although yeast infections aren’t considered a sexually transmitted infection, the Mayo Clinic notes.
  • A weak immune system: Having lowered immunity makes you more susceptible to getting yeast infections, according to the Mayo Clinic.

If you’re getting recurrent yeast infections, it could be that yours is being caused by a different type of fungus (instead of Candida albicans). In that case, your doctor would take a sample of your vaginal fluid and get it tested to figure out which fungus is to blame for your yeast infections, according to the Mayo Clinic. IDing the fungus is critical because it can help them prescribe more effective treatment so you can kick your recurrent yeast infections for good.

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