Well: Shopping Cart Injuries Remain Common

Shopping carts might not seem like a particularly dangerous place for a child, but from 1990 to 2011, an average of 66 children a day wound up in emergency rooms after injuries sustained in and near them.

Researchers studied children under 15 and made estimates of injuries based on a sample of emergency room visits in 100 hospitals nationwide. Most of the injured were children under 4 who fell out of a cart, and more than 90 percent of their wounds were to the head. Carts tipping over, running into or falling over the cart, and entrapment of extremities accounted for the rest of the damage. The findings are published online in Clinical Pediatrics,

Over all ages, about 80 percent of injuries were to the head, 14 percent to the upper extremities, and 6 percent to the lower extremities. In the 22 years covered by the study, about 16,500 children were injured seriously enough to be admitted to a hospital.

Voluntary standards for shopping carts were introduced in 2004, but the number of injuries has not decreased since then.

"The take-home message is that the standard can be strengthened and we can do much better," said the lead author, Dr. Gary A. Smith, director of the Center for Injury Research and Policy at Nationwide Children's Hospital. "These injuries can be prevented."

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Well: Ask Well: Parabens in Our Lotions and Shampoos

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Parabens are old-time chemical preservatives – they were first introduced in the 1950s after bacteria-contaminated facial lotions caused a small outbreak of blindness. Today, they are used in a wide range of personal care items – from cosmetics to toothpaste, as well as some foods and drugs.

It is partly because of their stable history that the Food and Drug Administration describes them as safe, at least in the trace amounts – 0.01 to 0.3 percent – found in most consumer products.

However, and here's where the answer gets complicated, in recent years, environmental health advocates have challenged that conclusion. Their concerns grew after a 2004 study found paraben compounds in breast cancer tumors.

Although no real link to the cancer was established, research has also found that parabens are weak estrogen mimics, capable of altering cell growth in culture, and may also act as endocrine disruptors, which can disrupt the normal function of hormones and interfere with development. The F.D.A.'s position is that parabens are too weak in this regard to cause any real concern.

The primary issue has become their ubiquity. "Parabens are found in between 13,000 and 15,000 personal care products," said Janet Gray, director of the science, technology and society program at Vassar College. "So we are not talking about a single exposure but a more pervasive one."

A 2006 analysis by the Centers for Disease Control and Prevention found evidence of parabens in more than 90 percent of people tested, with women – who use more cosmetics – registering higher levels than men. And a recent report in Environmental Science & Toxicology found that parabens were so common in products like baby lotion that infants may also receive a relatively high dose.

Researchers like Dr. Gray say we need to get a much better sense of such potentially riskier exposures. "The standard model of studying one paraben at a time isn't telling us what we need to know," she said. "It's the bigger picture that matters."

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Do you have a health question? Submit your question to Ask Well.

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Well: Exercise to Age Well, Whatever Your Age

Phys Ed

Gretchen Reynolds on the science of fitness.

Offering hope and encouragement to the many adults who have somehow neglected to exercise for the past few decades, a new study suggests that becoming physically active in middle age, even if someone has been sedentary for years, substantially reduces the likelihood that he or she will become seriously ill or physically disabled in retirement.

The new study joins a growing body of research examining successful aging, a topic of considerable scientific interest, as the populations of the United States and Europe grow older, and so do many scientists. When the term is used in research, successful aging means more than simply remaining alive, although that, obviously, is the baseline requirement. Successful aging involves minimal debility past the age of 65 or so, with little or no serious chronic disease diagnoses, depression, cognitive decline or physical infirmities that would prevent someone from living independently.

Previous epidemiological studies have found that several, unsurprising factors contribute to successful aging. Not smoking is one, as is moderate alcohol consumption, and so, unfairly or not, is having money. People with greater economic resources tend to develop fewer health problems later in life than people who are not well-off.

But being physically active during adulthood is particularly important. In one large-scale study published last fall that looked at more than 12,000 Australian men aged between 65 and 83, those who engaged in about 30 minutes of exercise five or so times per week were much healthier and less likely to be dead 11 years after the start of the study than those who were sedentary, even when the researchers adjusted for smoking habits, education, body mass index and other variables.

Whether exercise habits need to have been established and maintained throughout adulthood, however, in order to affect aging has been less clear. If someone has slacked off on his or her exercise resolutions during young adulthood and early middle-age, in other words, is it too late to start exercising and still have a meaningful impact on health and longevity in later life?

To address that issue, researchers with the Physical Activity Research Group at University College London and other institutions turned recently to the large trove of data contained in the ongoing English Longitudinal Study of Aging, which has tracked the health habits of tens of thousands of British citizens for decades, checking in with participants multiple times and asking them how they currently eat, exercise, feel and generally live.

For the study, appearing in the February issue of the British Journal of Sports Medicine, scientists isolated responses from 3,454 healthy, disease-free British men and women aged between 55 and 73 who, upon joining the original study of aging, had provided clear details about their exercise habits, as well as their health, and who then had repeated that information after an additional eight years.

The researchers stratified the chosen respondents into those who were physically active or not at the study's start, using the extremely generous definition of one hour per week of moderate or vigorous activity to qualify someone as active. Formal exercise was not required. An hour per week of "gardening, cleaning the car, walking at a moderate pace, or dancing" counted, said Mark Hamer, a researcher at University College London who led the study.

The scientists then re-sorted the respondents after the eight-year follow-up, marking them as having remained active, become active, remained inactive or become inactive as they moved into and through middle-age. They also quantified each respondent's health throughout those years, based on diagnosed diabetes, heart disease, dementia or other serious conditions. And the scientists directly contacted their respondents, asking each to complete objective tests of memory and thinking, and a few to wear an activity monitor for a week, to determine whether self-reported levels of physical activity matched actual levels of physical activity. (They did.)

In the eight years between the study's start and end, the data showed, those respondents who had been and remained physically active aged most successfully, with the lowest incidence of major chronic diseases, memory loss and physical disability. But those people who became active in middle-age after having been sedentary in prior years, about 9 percent of the total, aged almost as successfully. These late-in-life exercisers had about a seven-fold reduction in their risk of becoming ill or infirm after eight years compared with those who became or remained sedentary, even when the researchers took into account smoking, wealth and other factors.

Those results reaffirm both other science and common sense. A noteworthy 2009 study of more than 2,000 middle-aged men, for instance, found that those who started to exercise after the age of 50 were far less likely to die during the next 35 years than those who were and remained sedentary. "The reduction in mortality associated with increased physical activity was similar to that associated with smoking cessation," the researchers concluded.

But in this study, the volunteers did not merely live longer; they lived better than those who were not active, making the message inarguable for those of us in mid-life. "Build activity into your daily life," Dr. Hamer said. Or, in concrete terms, if you don't already, dance, wash your car and, if your talents allow (mine don't), combine the two.

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Well: Me Versus the Scale

The scale and I have reached détente. That is: I leave it alone, and it affords me the same courtesy. I rarely step on it, and we're both better off.

I have earned the right of refusal. As someone who weighed herself almost daily between the ages of 10 and 25, who spent six years at fat camps and traveled around the Middle East with a scale buried in the pit of her backpack (I know, I know…), I've done my time. I won't even weigh myself at the doctor's office. Nothing good can come from the knowledge that I'm three pounds lighter, or two pounds heavier.

"People are obsessed with it — they go crazy over a tenth of a pound," said Jim White, a registered dietitian nutritionist and a spokesman for the Academy of Nutrition and Dietetics. "I've had clients who are losing major inches and body fat and looking and feeling great, but if the scale doesn't budge they get defeated. The number defines them."

I had pretty much been blessedly scale-free until a few months ago, when I signed up for a month-long, twice-weekly fitness class. Shedding pounds was not my goal; I just wanted a good, hard workout. The instructor insisted on taking our "before" and "after" measurements, including our weight and body fat percentages.

I balked, but after the teacher promised "I won't tell you what it is," I held my breath and shuffled onto the scale as if to the guillotine. I was curious, of course, but I squeezed my eyes shut and didn't peek.

And that was the end of that — until a week later, when I opened a group email from her and found a list of the entire class's names, along with our weights and measurements.

A ball of rubber bands wove its way from my stomach and lodged in my throat. "Really?" I thought.

It seemed a major violation. So many of us can recite the intimate details of our friends' sex lives, their pharmacological habits, their rents. But question their weights and their mouths clamp shut. Not even the N.S.A. knows that.

"How often do we ask someone what they weigh? Unless you really know them well, you don't," said Allan Geliebter, a senior researcher at The New York Obesity Nutrition Research Center at St. Luke's-Roosevelt Hospital Center. "The last thing you tell someone is that they gained a lot of weight."

After stewing about it, I realized that I didn't really care if 15 strangers knew my weight. I just didn't want to know — especially since it was about five pounds higher than I would have liked. It haunted me.

The teacher apologized. But, she said, the weight was "just a number." "The real thing you should worry about is body fat."

Indeed, most experts agree that body fat percentage is a better indicator of health than overall weight, with obesity often defined as greater than 25 percent body fat in men and 35 percent in women. Belly, or visceral, fat can be more harmful than the subcutaneous fat found directly under the skin and stored in the thighs and derriere — neither of which a traditional scale gauges.

"Weight in itself is an imperfect measurement of health," said Dr. Philip Schauer, director of the Cleveland Clinic Bariatric and Metabolic Institute. "Someone who is 30 pounds overweight and has mainly a pear shape can be pretty healthy. You can be an apple shape and 30 pounds overweight and have diabetes."

A quicker and more accurate assessment, he said, is measuring waist circumference — more than 35 inches for women or more than 40 inches for men is problematic — or using calipers to determine the amount of fat under the skin. Those measurements tend to be more reliable than body mass index, or B.M.I., which doesn't distinguish between fatty and lean tissue or take body shape into consideration.

So if the scale is such a flawed measure, why is it still so widely used?

"It can be an effective tool," said Jennifer Linde, an associate professor of epidemiology at the University of Minnesota Twin Cities, in Minneapolis. "It gives you feedback every day, and you can coach people to look at the number as a neutral thing. It doesn't have to be a value judgment."

Presuming it's possible to look at it as a "neutral" thing, some studies have shown that the more frequently you weigh yourself the better off you are, at least in terms of weight control. A six-month study of overweight and obese adults who were looking to lose weight, published last September in Obesity, confirmed that sentiment. During the study, which included a mobile scale for daily weighing, a web-based weight loss graph and weekly feedback from researchers, participants who weighed themselves daily lost 13 pounds on average. Those in the other group, who weighed themselves weekly, lost nothing.

David A. Levitsky, a professor of nutrition and psychology at Cornell University who has conducted studies on the efficacy of daily weighing since 1992, believes that daily self-weighing is necessary to help prevent weight gain.

"I don't see any way that we are going to tax fats or tax soda or have people exercise more in order to control their weight," he said. "There's enough data to show that doesn't work. But if you step on that scale first thing in the morning, that's protective of those subtle cues in our environment that make us eat a little more than we expend."

The best news, at least for us scale avoiders, is that most medical professionals agree that self-monitoring — whether it is counting calories, writing down how much one eats or weighing oneself regularly — is the greatest predictor of success. Our task is to choose the thing that makes us the least crazy, and stick with it.

And that is why, in the end, I skipped getting weighed at my last exercise class. There was no reason to. I felt stronger, my clothes fit better, and that was enough for me.

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Abby Ellin is the author of "Teenage Waistland: A Former Fat-Camper Weighs in on Living Large, Losing Weight, And How Parents Can (And Can't) Help."

A version of this article appears in print on 01/28/2014, on page D4 of the NewYork edition with the headline: Me Versus the Scale.

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Personal Health: Helping Smokers Quit, or Not Start in the First Place

Personal Health

Jane Brody on health and aging.

"Even 50 years after the first surgeon general's report on smoking and health, we're still finding out new ways that tobacco kills and maims people," Dr. Thomas Frieden, director of the Centers for Disease Control and Prevention, recently told me. "It's astonishing how bad it is."

Dr. Frieden and public health specialists everywhere are seeking better ways to help the 44 million Americans who still smoke to quit and to keep young people from getting hooked on cigarettes. "Fewer than 2 percent of doctors smoke. Why can't we get to that rate in society as a whole?" he wondered.

One reason: Smoking rates are highest among the poor, poorly educated and people with mental illness, populations hard to reach with educational messages and quit-smoking aids.

But when I mentioned to Dr. Frieden, a former New York City health commissioner, that the city's streets are filled with young adult smokers who appear to be well educated and well dressed, he said television seems to have had an outsize influence.

Focus groups of white girls in New York private schools have suggested a "Sex in the City" effect, he said: Girls think smoking makes them look sexy. In the last two years, middle-aged men, too, have begun smoking in increasing numbers after a half-century decline. Dr. Frieden cited "Mad Men," the popular TV series featuring admen in the early 1960s, when well over half of American men smoked.

Dr. Frieden said that an antismoking effort begun in 2008 by the World Health Organization "can make a huge difference in curbing smoking, and we should fully implement what we know works." The program is called Mpower:

■ M stands for monitoring tobacco use and the effectiveness of prevention programs like antismoking videos on YouTube.

■ P for protecting people from secondhand smoke. Half the country still lacks laws mandating smoke-free public places. The latest national health survey found that about half of children from nonsmoking households have metabolites of tobacco in their blood, Dr. Frieden said.

■ O for offering help to the 70 percent of smokers who say they would like to quit. "Tobacco use remains egregiously undertreated in health care settings," Dr. Helene M. Cole, associate editor of JAMA, The Journal of the American Medical Association, and Dr. Michael C. Fiore, a professor of medicine at the University of Wisconsin, wrote this month in the journal.

Medical aids for quitting smoking, which can triple the likelihood of success, should become available, without a co-pay, to many more people under the Affordable Care Act, Dr. Frieden said.

■ W for warning about smoking hazards through larger and more graphic messages on cigarette packs and paid advertising on radio and television.

■ E for enforcing bans on tobacco marketing, advertising, promotion and sponsorships. In bodegas throughout the country, Dr. Frieden said, "tobacco ads are used as wallpaper." Smoking is freely depicted in movies and popular TV shows.

■ R for raising taxes, which studies have shown is the single most effective way to reduce smoking in the population, especially among teens.

"A higher cigarette tax is not a regressive tax, because it would help poor people even more than the well-to-do," Dr. Frieden noted. President Obama has proposed an additional 94-cent-per-pack tax on cigarettes, which would yield $80 billion to fund universal prekindergarten.

Smokers ready to quit can choose from among a cornucopia of aids as wide-ranging as nicotine substitutes, low-dose antidepressants, hypnosis and acupuncture. While none by itself has a high rate of success, different methods have proved effective for different people. Many former smokers required several attempts before they managed to quit for good.

But quitting smoking does not necessarily require assistance. As two public health specialists, Andrea L. Smith and Simon Chapman at the University of Sydney in Australia, have pointed out, "The vast majority of quitters do so unaided." A Gallup Poll conducted last year in the United States found that "only 8 percent of ex-smokers attributed their success to [nicotine replacement therapy] patches, gum or prescribed drugs," these experts noted. "In contrast, 48 percent attributed their success to quitting 'cold turkey' and 8 percent to willpower, commitment or 'mind over matter'."

They added, "For many smokers, having a reason to quit (a why) was more important than having a method to quit (a how)."

For my husband, who smoked a pack a day for 50 years, the "why" was his distress at seeing two beautiful young nieces smoking; he made a pact with them to quit if they would, and he followed through.

Techniques that can help people trying to quit when troubled by the urge to smoke include waiting 10 minutes and distracting yourself; avoiding situations you associate with smoking, at least until you have become a committed ex-smoker; using stress reducers like physical activity, yoga, deep breathing, muscle relaxation and self-hypnosis; seeking moral support from a nonsmoking friend, family member or online stop-smoking program; and oral distractions like chewing sugarless gum or raw vegetables.

Electronic cigarettes are being promoted by some as a way to resist the real thing. E-cigarettes, invented in 2003 by a Chinese pharmacist, contain liquid nicotine that is heated to produce a vapor, not smoke. More than 200 brands are now on the market; they combine nicotine with flavorings like chocolate and tobacco.

But their contents are not regulated, and their long-term safety has not been established. In one study, 30 percent were found to produce known carcinogens. Dr. Frieden said that while e-cigarettes "have the potential to help some people quit," the method would backfire "if it gets kids to start smoking, gets smokers who would have quit to continue to smoke, gets ex-smokers to go back to smoking, or re-glamorizes smoking."

Nearly two million children in American middle and high schools have already used e-cigarettes, Dr. Frieden said. In an editorial in the Canadian Medical Association Journal last year, Dr. Matthew B. Stanbrook, an assistant professor of medicine at the University of Toronto, suggested that fruit-flavored e-cigarettes and endorsements by movie stars could lure teens who would not otherwise smoke into acquiring a nicotine habit.

A survey in 2011 of 75,643 South Korean youths in grades 7 through 12 by researchers at the University of California, San Francisco, revealed that four of five e-cigarette users also smoked tobacco. It could happen here: Stanton A. Glantz, the study's senior author and a professor of medicine at the university, described e-cigarettes as "a new route to nicotine addiction for kids."

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This is the second of two articles on smoking. The first: Coming a Long Way on Smoking, With a Way to Go

A version of this article appears in print on 01/28/2014, on page D5 of the NewYork edition with the headline: Fighting Smoking, 50 Years Later.

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The New Old Age: When They Don’t Know They Are Ill

Soon after his wife was diagnosed with frontotemporal dementia, Bill Floyd consulted a neurologist who had been a member of his church. People with this illness don't know they have it, the doctor warned. They don't understand that anything is wrong.

This little-known yet common consequence of this kind of dementia, Alzheimer's disease and other brain disorders is called anosognosia, and it leaves people unaware that they are compromised by illness.

Imagine someone who survives a stroke and is paralyzed on the left side of his body, but is convinced he can walk without assistance. A less extreme example: Someone with moderate memory deficiency gets lost on the road or has accidents, but thinks she is driving just as well as ever.

This is not denial, said Sandra Weintraub, a professor of psychiatry and neurology at Northwestern University. "It's a lack of insight and awareness," she said. "Everyone else around them is aware they're not the same, and they are not."

Sometimes anosognosia is selective: An aging parent may realize she has a problem with one kind of activity but is oblivious to other difficulties. But in other cases, the lack of self-awareness is more extensive. According to some estimates, up to 42 percent of people with early Alzheimer's disease have symptoms of anosognosia. And as dementia progresses, the symptoms also advance, evidence suggests.

Trying to make someone with this problem understand that they have changed and need to accept new limits often is an exercise in frustration, Dr. Weintraub said. Reasoning and evidence make little difference to these patients.

Brain studies suggest that the lack of awareness may be linked to the deterioration of the frontal lobes, especially on the right side, which play an important role in problem-solving, planning, and understanding the context and meaning of experiences and social interactions. Some studies also point to atrophy in the temporal lobes.

"Really, as of yet, we have no idea what's going on," Dr. Weintraub said.

Mr. Floyd, 70, a professional photographer in Evanston, Ill., spoke publicly about his experience as a caregiver at a conference on frontotemporal dementia sponsored by Northwestern University that I attended late last year. "My wife never ever acknowledged she had this disease, and to bring it up was painful," he told the audience.

Connie Floyd died in September at age 67. She was an accomplished woman, Mr. Floyd said in an interview: a director of children's programs at her church for over 20 years. Theirs was a deeply satisfying marriage until July 2010, the first time he suggested his wife needed to see a doctor. For several years, close friends had been telling him privately that something didn't seem right. And several months before she sought help, a physician who knew Mrs. Floyd well had confessed that he was worried she might have a brain tumor, an aneurysm or dementia.

There had been signs at home, times when Mrs. Floyd would seem to forget how to make the bed or would start talking when she and her husband were praying in bed at night. She forgot to hold a soup spoon steady while bringing it to her mouth and pushed her chair out several feet from the dining room table. When Mr. Floyd suggested she move in closer, she would push the chair to the side.

But when Mr. Floyd tried to raise his concerns with his wife, she was shocked. The problems weren't significant, and there were explanations for all of them, she insisted. She couldn't see what he was worried about and felt like she was being unfairly criticized.

From that day on, Mr. Floyd said, she saw him as her accuser. In prepared remarks for the Northwestern conference, he wrote:

For 42 years we discussed everything, sorrows, joys and concerns. In all those things, Connie was my partner and I hers. Suddenly, here we were facing the biggest challenge of our marriage and Connie was the one person with whom I couldn't discuss it. One of the saddest and most frustrating parts of this journey was that we never became a team.

"She seemed to feel that if she could hide the symptoms, the disease wouldn't be there," he told me, adding that she didn't want anyone to know about her illness. "I kept telling her this journey would be so much easier with other people at our side, but she just didn't see it that way."

Any time Mr. Floyd tried to point out her difficulties and offer assistance, his wife would take offense. "She couldn't make the connection between her symptoms and herself," he said.

How do you try to help someone in these circumstances? Mr. Floyd decided to confront his wife only when her safety or that of other people might be compromised. Otherwise, he would let things slide or take care of them on his own.

Mrs. Floyd's condition took a sharp turn for the worse last spring, and by the beginning of September it was clear she was dying. Unable to swallow or talk, she was living in a nursing home and entirely dependent on others. Nonetheless, she looked alarmed and startled when her daughter suggested that Mrs. Floyd's own mother would be waiting for her with open arms in heaven, Mr. Floyd recalled.

"Even at the very end, she had an absolute failure to recognize what was going on," he said. Mr. Floyd was never able to say a real goodbye to his partner of 44 years, he said, a woman he loved with all his heart.

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The New Old Age: A Risk in Caring for Abusive Parents

Who could condemn someone for staying far away from a parent, even an ailing or dying parent, who mistreated him or her as a child? The last time I wrote about this emotional subject, most readers understood that response. Many who had suffered through similar experiences said they had taken the same stance.

"He was a terrible father and mean, so I didn't feel bad about moving out of state a few years before he died," wrote Murre from Alaska. "I was glad not to see him anymore and relieved when he died."

Adam from Phoenix spent his childhood traumatized by his parents' abuse. "They remain unapologetic, and I'd gladly let them rot if they one day could not fend for themselves," he wrote.

Yet we also heard from people who had agreed to become caregivers even if their parents had been, or remained, abusive. "I live by a moral code," said Minerva from New York City, who cared for her alcoholic and bipolar mother. "It was my responsibility and I stepped up to the plate."

Helen S. from Connecticut supervised her angry, meddlesome mother's care and had lunch with her nearly every Sunday until she died. "I felt I had done the decent thing, and it helped me to put the remaining anger and resentment to rest," Helen wrote.

We know relatively little about how many adults become caregivers for abusive or neglectful parents, or about why they choose to — or not to. But thanks to a recent study, we can see that those who report having endured childhood maltreatment are more vulnerable than other caregivers to depression when tending to their abusive parents.

This finding emerged from a study by two Boston College researchers, using 2003 to 2005 data from a continuing survey in Wisconsin.

The researchers located 1,001 adults over age 65 who were caring for one parent (generally a mother) or both. Almost 19 percent reported physical, verbal or sexual abuse as children, and 9.4 percent reported neglect. That is a substantial percentage — perhaps because the definition of abuse included frequent swearing and insults, or perhaps because corporal punishment was more common 50 years ago, said Sara M. Moorman, a sociologist and co-author of the study. But it is in line with what other studies have found when participants are asked to recall their experiences.

The researchers divided their sample into three categories: those with no history of childhood abuse or neglect; those who had been abused and were caring for their non-abusive parent; and those who had been abused and were, to borrow the study's memorable title, "caring for my abuser." They also compared caregivers neglected as children with those who were not neglected.

Those who had been abused or neglected were more likely to have symptoms of depression — like lack of appetite, insomnia, trouble concentrating, sadness and lethargy — than those who had not been. No surprise there, perhaps.

But the link was strongest for the third category. "The key was caring for the abusive parent," said the lead author, Jooyoung Kong, a doctoral candidate in social work. Years later, "they are still affected. They're more depressed."

Like many studies, this one raises questions as well as answers them. Its definition of caregiving — having ever provided personal care to a parent for a month or longer — could have included all kinds of arrangements. "It doesn't measure how long ago they provided care, or whether they lived with a parent or not," Ms. Kong said. She plans to include details from other surveys as her research continues.

But the study does indicate that caregivers with a history of maltreatment should be aware of the risk they are taking — and, if the strain of caregiving becomes overwhelming, the increased risk that they will abuse their charges, perpetuating a sorrowful cycle.

"It's such an untenable position to be placed in," Dr. Moorman said. "My guess is, people only do it if they're forced to, if there's no one else to do it." People in that situation should "be aware of the signs and symptoms of depression," she said, and seek therapy or find a support group.

The rest of us are hardly in a position to judge those who walk away. But our society's overreliance on unpaid family caregiving can make that difficult to do. As Dr. Moorman pointed out, "Not only nice people get old."

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Paula Span is the author of "When the Time Comes: Families With Aging Parents Share Their Struggles and Solutions."

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Well: Not Your Grandmother’s Gratin

In my kitchen, leftovers often become the inspiration for a week of Recipes for Health. This happened last week. If you had opened my refrigerator on Sunday you would have found a selection of roasted vegetables, which I had prepared over the weekend for various dinners and recipe tests. By Tuesday those vegetables had found their way into three winter gratins.

A vegetable gratin is a casserole that is baked in the oven in a heavy baking dish until the top and sides are browned, or gratinéed. Roasting vegetables for a gratin adds another level of caramelized flavor to the dish. Roasted winter squash is particularly sweet. Roasting cauliflower coaxes flavor out of this somewhat bland vegetable: the small flowers brown and crisp, and I was hard pressed to save enough for my gratin, so tempting a snack were they. I begin just about any eggplant dish I make by roasting the eggplant, as this method of cooking requires much less oil than frying.

I didn't roast the vegetables in every one of this week's recipes, but in all of the gratins the vegetables are cooked before being mixed with aromatics, cheese, eggs and, in all but one recipe, milk (in the cauliflower gratin, there is a tomato sauce rather than a milk and egg custard). I served them as main dishes and have been enjoying leftovers for lunch. They are delicious at room temperature as well as hot.

Potato and Sorrel Gratin: A gratin that is not a typical creamy sliced potato gratin but more like a potato pie.

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Roasted Squash and Red Onion Gratin With Quinoa: Roasting the squash results in a sweet layer of flavor in this beautiful gratin.

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Fennel, Kale and Rice Gratin: Two different greens provide contrast in this casserole.

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Roasted Cauliflower Gratin With Tomatoes and Goat Cheese: A beautiful, light gratin with Middle Eastern spices.

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Roasted Eggplant and Red Pepper Gratin: A Mediterranean gratin seasoned with cumin and thyme.

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Voices: Treat Reckless Driving Like Drunk Driving

On a rainy, foggy night earlier this month, a New York City taxi driver making a left turn at a light apparently did not see my 9-year-old nephew and his 6-foot-3 father crossing the street at a crosswalk, beckoned by a lighted "walk" sign. Whether because of haste, inattention, cellphone use or perhaps the poor weather conditions, the cab driver drove directly into them. My beloved nephew, Cooper Stock, died instantly. His father suffered minor injuries. The Manhattan District Attorney's office is investigating the circumstances of Cooper's death.

The first question everyone asked after Cooper was killed was whether the driver was drunk. The police reassured my brother-in-law, Dr. Richard G. Stock, who was holding Cooper's hand at the time of the crash, that a Breathalyzer done at the scene was negative.

Yet merely looking for alcohol or drug involvement by the driver misses the point. During the first 12 days of 2014, cars killed seven pedestrians, including Cooper, in New York City. More attention needs to be paid to the reasons behind these fatalities. Were they true "accidents"? Or was careless behavior on the part of drivers the reason seven people lost their lives?

Reckless driving, circa 2014, is what drunk driving was prior to 1980: it is poorly defined in the law, sometimes poorly investigated by police and almost never results in a criminal charge. A recent story in The New York Post reported that at least 21 taxi drivers have killed or injured pedestrians or bicyclists in New York City over the past five years and only one has been charged criminally. Most received only traffic violations and paid a fine.

The recent spate of pedestrian deaths at the hands of motorists has spurred Mayor Bill de Blasio to start a major new program called Vision Zero. The Mayor announced plans to increase the number of traffic cops, create a specially-trained collision investigation team, install speed cameras and form a high-powered Vision Zero panel with the goal of eliminating traffic-related fatalities in New York City.

While I support the initiative, I also understand the many pitfalls Vision Zero is likely to encounter. As the author of a book on the history of drunk driving, I know that efforts to criminalize drunk driving were long stymied by a cultural indifference to the problem. Well into the 1970s, police and prosecutors looked the other way, seeing drunk drivers either as diseased alcoholics, young men sowing their wild oats or, paradoxically, victims themselves, even if they killed or maimed people. Judges and juries — perhaps because they, too, secretly drank and drove or knew those who did — were reluctant to convict.

Police told family members that their loved ones — the actual victims — had been "in the wrong place at the wrong time." Crashes were called accidents.

Things finally changed in the 1980s when Remove Intoxicated Drivers (RID) and Mothers Against Drunk Driving (MADD) burst on the scene. Members of these groups had often lost children at the hands of drunk drivers, many of whom had several previous arrests and no convictions. These parents were viscerally offended when they learned that killers were allowed to plead down to traffic or parking violations.

This activism affected a sea change. Drunk driving is no longer seen as youthful folly but a serious crime. Between 1980 and 1985, states passed more than 700 laws lowering the acceptable blood alcohol level and tightening loopholes. "Friends," we were told, "do not let friends drive drunk."

Perhaps the most important lesson learned was that drunk drivers were still responsible for the damage they caused, even though the harms they inflicted were unintentional. Driving drunk, critics said, was like walking around with a loaded gun.

The carnage caused by reckless driving, like that caused by drunk driving, should also be viewed as criminal. We do not yet know all of the circumstances of Cooper's death, but we know the tremendous loss we all feel in his absence. Cooper was a wonder.  Everyone loved him.  He was obsessed with basketball — especially the Knicks — and had an encyclopedic knowledge of N.B.A. stars back to Wilt Chamberlain. But mostly he was just a joy, "the life of the party even when there wasn't a party," to quote a family friend.

If Cooper died because an impatient or distracted driver made a careless decision, then that driver should be as guilty of a crime as someone who drank alcohol or used drugs before driving. Let's make destruction caused by irresponsible driving a true crime. And let's do it soon. Last weekend, after the launch of Mayor de Blasio's Vision Zero initiative, three more pedestrians in New York City died, struck by cars as they were crossing the street.

Barron H. Lerner, professor of medicine and population health at New York University, is the author of "One for the Road: Drunk Driving Since 1900" and the forthcoming "The Good Doctor."

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The New Old Age: The Company I Keep

The very title of this blog suggests the continual shifting of ground underneath all of us of a certain age. Whatever we thought old age meant yesterday, it means something different today.

Sixty when the blog began, I'm now 66. That's not a complaint but an indisputable fact, and with the years come my own idiosyncratic observations. Hard-wired for pessimism, one would think they would be gloomy. Mostly they aren't.

I love Medicare, Social Security, a fixed-benefit pension, senior movie tickets and even the occasional person who offers me a seat on the bus. I love caring less about what other people think of me and more about what I think of myself. I'm hoping all that eventually balances the hard reality that goals and dreams from my 20s and 30s that haven't happened yet aren't going to (Pulitzer Prizes, children and grandchildren, running a marathon).

I particularly love (pleasure and pain not being mutually exclusive) how the rooms where I live, even my nightly dreams and the conversations in my head, are more and more populated by ghosts — loved ones now dead but blessedly not "gone." They are always welcome here, and why would I want it otherwise?

"Gone" is too final. To me, it means six feet under, a memorial yahrzeit candle on the anniversary of a death, the prayer for the dead chanted in Hebrew during the period of mourning and on certain religious holidays. "Gone" doesn't mean that life goes on in a better place. To chase my ghosts away, to silence their voices — and I'm not sure I could — would be in effect a second death. I don't want them gone.

I would rather talk to my mother, dead more than 10 years but still saying the same things she said to me as long as I can remember. "Pay the $2," she reminded me just the other day, even if only I could hear — a family joke about the cost of undeserved parking tickets long ago. I was about to waste time, energy and heartache fighting for money that I would likely not get in the end. She was telling me to cut my losses.

I would rather talk to my father, himself a journalist, who died in 1973 but still reminds me that writers' block is nothing more than procrastination. "If you can't write, type," he says. Or a variant: "Lay bricks." He means that work is work, so sit down and do it.

Another often-heard-from ghost, 19 years dead of a brain tumor at the age of 53, was my Times colleague in California, he the seasoned bureau chief in Los Angeles and me the rookie in San Francisco. His moral compass was so true he only had to stare at me to keep me from taking company legal pads home for personal use. When I was on the verge, the other day, of walking off with a pen (by accident, I swear) after signing for a credit card purchase, "gone" though he might be, he shot me a look and I shamefacedly returned the pen.

These conversations are not one-sided. Recently, overwhelmed by a run of problems I didn't know how to solve, I silently raged at him. "Your job was to take care of me — that was the deal. I took care of you when you were sick and was fine with that. But now I need you, badly, and where the hell are you?"

Ashamed to be so angry at a dead person, I almost missed his reply. "It isn't fair," he told me. "And I'm so, so sorry."

Would I rather he were really here? Of course. But that isn't one of the choices, is it?

Then there is my oldest childhood friend, from the time she was 5 and I, 6. Her advice was often caustic, even unwelcome. But her taste was impeccable — mine admittedly less so — and her job was to ensure I didn't have a pixie cut when everyone else a ponytail, or big horned-rim glasses when the itty-bitty wire ones were in style, and to buy me earrings I was too cheap to buy for myself.

Cancer almost killed her in her 40s; instead she had 20 more years. Now she's the ghost who shops with me. Invisible to the optometrist, she chose not one but two pairs of eyeglass frames, both too expensive. Never once have I regretted spending the money. And she is with me wherever I wear them.

There are others, many more. The ghosts sometimes seem to outnumber the "real" people, and that will only be more true as time passes, I know. But early January was a doozy: two deaths over one weekend, and both memorialized in this newspaper on the very same day.

Susan Rasky, 61, was my colleague at The Times. She regularly brought food when I was recovering from surgery many years ago; she took halting walks with me when that was the only activity I was allowed. Very few people left at The Times even remember her. The loss of who we used to be — and how quickly we are forgotten — is a death of a different kind.

Don Forst, 81, was my first newspaper editor, the man who made my career a reality. As he saw me through its beginning, he also saw me through its end. At 60, I pounced on a voluntary buyout yet was stunned by the loss of my job. "Get used to it," he said. "You'll feel this way forever. That's what happens when you lose what you're best at and love most."

His obituary ends with an anecdote about him waking each morning, postretirement, and designing the front page of a newspaper he no longer ran. He had told me that story many times, neither flippant nor gruff, just plain old sad.

How strange for all of us, as we age, to move into a time of life when so many of the voices we hear are of people no longer living. Yet what might be a mournful chorus is rather consoling company. We are alive and they are dead, but we are not who we used to be. There is no talking to those ghosts, no keeping them alive. Instead, with the help of loved ones who got there before us, there is a slow recognition that doors once open are now closed and that others open if you let them.

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