Measles in Texas: Primary Care Tips to Stay Safe, Spot Symptoms, and Know When to Call Your Provider

Monica McKitterick • April 28, 2025

Key Takeaways:

  • Texas has reported an increase in measles cases in 2025, with confirmed outbreaks in multiple counties.
  • Koplik spots and flu-like symptoms often appear before the measles rash and can aid in early detection.
  • Two doses of the MMR vaccine provide strong protection, with about 97% effectiveness.
  • Vitamin A may be used during treatment to reduce complications in children with measles.
  • Unvaccinated individuals exposed to measles may be required to quarantine for up to 21 days.

Measles in Texas: Primary Care Tips to Stay Safe, Spot Symptoms, and Know When to Call Your Provider

In early 2025, Texas began reporting an alarming rise in confirmed cases of measles—a disease once declared eliminated in the United States in 2000. What started with a few isolated cases quickly escalated into a broader public health concern, with clusters emerging across various counties, especially in West Texas. 


As of April, the Texas Department of State Health Services (DSHS) has reported dozens of cases, prompting increased surveillance and renewed public education efforts.


This outbreak is not confined to Texas. Neighboring states like New Mexico have also reported a growing number of infections, raising questions about how a vaccine-preventable illness like measles could make such a strong comeback in a country with established immunization programs.

Why Measles Is Making a Comeback

Several interconnected factors are contributing to the resurgence of measles in 2025, not only in Texas but across multiple U.S. regions.


1. Vaccine Hesitancy

One of the primary drivers of the outbreak is declining vaccination rates. Measles is highly preventable with the MMR (measles, mumps, and rubella) vaccine, which has been proven to be safe and over 97% effective when two doses are administered. 


However, misinformation about vaccine safety continues to circulate widely, especially on social media platforms. This has led to a growing number of parents choosing not to vaccinate their children, leaving entire communities vulnerable to outbreaks.


In Tarrant County, Texas, Mercy Culture Preparatory Academy has garnered attention for having the state's lowest measles vaccination rate. School leaders have publicly embraced this status, reflecting how deeply vaccine misinformation has permeated the community. 


This situation underscores the challenges public health officials face in countering false narratives and promoting vaccination in areas where misinformation is prevalent.


2. Funding Cuts and Public Health Gaps

Recent reductions in funding for public health initiatives have left many local agencies under-resourced. According to NBC News, cuts to the U.S. Department of Health and Human Services (HHS) programs have impacted vaccine outreach, education, and availability in certain communities. 


When public health infrastructure weakens, so does the ability to contain preventable diseases before they spread.


3. Misinformation and Mixed Messaging

Contradictory public messages from political figures and influencers have created confusion about the necessity and safety of vaccines. 


While health authorities like the CDC and WHO remain clear in their guidance, opposing voices—often without scientific credentials—continue to gain traction. This confusion has eroded public trust, particularly in communities already facing healthcare access barriers.

Impact on Public Health Systems and Community Spread

Measles is one of the most contagious viruses known to science. Measles is known to remain in the air for up to two hours after an infected person has left the area, and up to 90% of unvaccinated individuals who come into contact with the virus will become infected.


This level of contagiousness puts tremendous pressure on hospitals, schools, and local health departments. 

Hospitals, particularly in rural areas, have struggled with aging infrastructure and limited resources, making it difficult to manage the surge in suspected cases. The outbreak has highlighted the need for improved public health infrastructure to effectively contain such infectious diseases. ​


Schools in affected districts have also taken measures to control the spread of measles. For instance, in Lubbock, children at a day care with confirmed cases were required to stay home for 21 days post-exposure if they were unvaccinated. Additionally, some schools have reviewed vaccination records and may temporarily exclude unvaccinated students to prevent further transmission.


Moreover, the outbreak has highlighted the gaps in adult immunity. Some adults may have received only one dose of the vaccine or none at all, depending on the era in which they were born. This has led to increased demand for immunity screening and booster vaccinations.

How Health Agencies Are Handling the Outbreak

The Centers for Disease Control and Prevention (CDC) and the Texas Department of State Health Services (DSHS) have been working together to manage case tracking, vaccine distribution, and public outreach. Mobile vaccination clinics have been deployed in affected regions, particularly in West Texas counties like Gaines, Lubbock, and Midland.


The CDC has also issued updated guidance to healthcare providers on diagnosis, isolation protocols, and reporting procedures.


Statements from Officials and Public Health Alerts

In early April, Texas health officials released a statewide health advisory urging residents to verify their vaccination status and seek medical care promptly if symptoms develop. The alert emphasized the contagious nature of measles and warned of potential school and workplace exclusions for unvaccinated individuals.


Public figures and local health leaders have participated in press briefings to reinforce vaccine safety and encourage community action. Bilingual educational materials and targeted social media campaigns are also being used to reach hesitant populations.


Community Impact and Funding Cuts

The outbreak has exposed weaknesses in local health infrastructure—particularly in under-resourced rural counties. Budget cuts to the U.S. Department of Health and Human Services (HHS) in previous years have hindered immunization outreach and slowed public education initiatives, as reported by NBC News.


Clinics are struggling to meet the surge in demand for vaccinations and immunity screenings, while schools and employers face difficult decisions about excluding unvaccinated individuals.


Broader Policy and Public Trust in Science

Beyond the outbreak itself, this situation reflects a growing divide in public attitudes toward science, vaccines, and health policy. Mixed messages, online misinformation, and politicized health debates have eroded trust in institutions—making it harder to execute rapid and effective responses to disease outbreaks.


Experts stress the importance of rebuilding trust through transparency, community engagement, and consistent public messaging grounded in medical evidence.

How Measles Spreads and Who’s at Risk

Measles isn’t just highly contagious—it spreads easily, even before symptoms appear. Understanding how it transmits and who is vulnerable can help prevent further spread and guide effective public health responses.


How Contagious Is Measles?

Measles is considered one of the most infectious diseases in the world. It spreads through airborne droplets released when an infected person coughs, sneezes, or talks. Unlike many respiratory viruses, measles can linger in the air or on surfaces for up to two hours, which means transmission can occur even without direct contact.


The basic reproduction number (R0) for measles is between 12 and 18, meaning one infected person could potentially infect up to 18 others in an unvaccinated population. For comparison, the seasonal flu has an R0 of around 1.3, and the original strain of COVID-19 had an R0 of about 2–3.


People with measles are contagious from four days before to four days after the rash appears, which makes early containment challenging. During this period, they may unknowingly spread the virus to others, especially in crowded settings like schools, clinics, or public transportation.


Can You Get Measles Even If Vaccinated?

The measles component of the MMR (measles, mumps, and rubella) vaccine is about 93% effective after one dose and 97% effective after two doses, according to the CDC. While breakthrough cases are rare, they can occur, especially in individuals who only received one dose or have compromised immune systems.


Immunity from the vaccine typically lasts for life, but waning immunity has been observed in some adults—particularly those born between 1957 and 1989 who may have received only one dose or an early, less effective version of the vaccine.


For adults unsure of their vaccination status, a blood test (titer) can confirm immunity. The CDC recommends that anyone at increased risk—such as international travelers, healthcare workers, or those in outbreak areas—ensure they are fully vaccinated.


Where in Texas Is the Measles Outbreak?

The current measles outbreak has affected multiple parts of Texas, with a concentration of confirmed cases in the western region. Local health officials are working quickly to contain the spread and raise awareness, particularly in areas with low vaccination coverage.


Latest Confirmed Locations

According to updates from the Texas Department of State Health Services (DSHS) and confirmed news sources like NBC and Reuters, cases have been reported in:

  • Cochran County
  • Dallam County
  • Dawson County
  • Gaines County
  • Garza County
  • Lynn County
  • Lamar County
  • Lubbock County
  • Terry County
  • Yoakum County


While some cases are travel-related, several have resulted from local transmission—especially in communities with lower immunization rates. Contact tracing and mobile vaccination units have been deployed in these areas to limit further exposure.


Community and Regional Responses

Local hospitals and clinics have been urged to isolate suspected measles cases immediately. Schools in affected areas are reviewing vaccination records and may temporarily exclude unvaccinated students to prevent further spread, following CDC guidelines.


Public health campaigns, including mobile clinics and multilingual information sessions, have been launched in partnership with community organizations to boost vaccination rates and combat misinformation.


Recognizing and Responding to Measles Symptoms


Early identification of measles can prevent further spread and ensure timely treatment. While symptoms may look similar across age groups, there are some differences between how the disease presents in children versus adults. It’s also important to distinguish measles from other common conditions like heat rash, which can share overlapping features.


What Do Measles Look Like?

Measles typically begins with symptoms that resemble a common viral illness:

  • High fever (often over 101°F)
  • Cough
  • Runny nose
  • Red, watery eyes (conjunctivitis)


These early signs are followed by the appearance of Koplik spots—tiny white spots inside the mouth that are unique to measles—and then the most recognizable symptom: a red, blotchy rash.


The rash usually starts on the face at the hairline and spreads downward to the rest of the body, including the trunk, arms, and legs. It often merges into larger patches and may feel slightly raised. The rash lasts about 5–6 days and may be accompanied by skin peeling as it fades.


Differences Between Children and Adults

While the symptoms are broadly similar, adults may experience:

  • More severe fevers and fatigue
  • Longer recovery times
  • Greater risk of complications, such as pneumonia or encephalitis (brain swelling)


Children, especially those under 5, are also at higher risk for complications, including ear infections and diarrhea, which can lead to dehydration.


Measles vs. Heat Rash: What Are the Differences?

During warmer months or in hot climates like parts of Texas, heat rash can easily be mistaken for measles. However, there are some key distinctions that can help tell them apart.


Feature Measles Heat Rash (Prickly Heat)
Onset Begins with fever, then rash appears after 3–5 days Appears quickly, especially after sweating or overheating
Rash Appearance Red, blotchy, often starts on face and spreads Tiny red bumps or clear blisters, usually localized
Symptoms Before Rash Fever, cough, runny nose, conjunctivitis, body aches Usually no systemic symptoms
Rash Distribution Spreads from head to toe Mostly affects areas with friction (neck, back, armpits)
Itchiness Generally not itchy Often itchy or prickly
Duration Lasts 5–6 days, fades gradually Clears within a few days with cooling and hygiene

Tips for Accurate Self-Identification

  • If a rash is accompanied by fever, cough, and red eyes, it’s more likely to be measles.
  • If the rash appears suddenly after heat exposure and feels itchy, it could be heat rash.
  • When in doubt, consult a healthcare provider, especially during an active measles outbreak.

What to Do If You’re Exposed


If you've come into contact with someone who has measles—especially during an active outbreak—knowing what to do next is important not only for your health, but also for the safety of those around you. Prompt action can help prevent further spread of the virus and reduce complications.


Do You Need to Take Quarantine Measures?

Yes—quarantine or isolation may be recommended depending on your vaccination status and whether you are showing symptoms.


According to the Centers for Disease Control and Prevention (CDC), individuals who are not fully vaccinated and have been exposed to measles should quarantine for up to 21 days, which is the incubation period of the virus. This is especially important for:

  • School-aged children who haven't had two doses of the MMR vaccine
  • Adults born after 1957 without documented immunity
  • Immunocompromised individuals

In Texas, the Department of State Health Services (DSHS) recommends excluding unvaccinated individuals from schools or workplaces if they've been exposed and cannot confirm immunity. In certain cases, health authorities may require isolation even for asymptomatic individuals during high-risk periods.


Steps to Take After Potential Exposure

If you believe you’ve been exposed to measles:

  1. Check your vaccination records. If you’ve had two doses of the MMR vaccine, you’re 97% protected.
  2. Monitor for symptoms—especially fever, cough, and rash—for at least 21 days after exposure.
  3. Avoid public places during the monitoring period if you’re unvaccinated or immunocompromised.
  4. Contact your healthcare provider to discuss whether post-exposure prophylaxis (like immune globulin) or a catch-up vaccine is appropriate.


Prevention: Vaccines and Vitamin A – What Really Works?

The most effective way to prevent measles is through vaccination. While Vitamin A has supportive uses in treatment, it is not a substitute for immunization.


The Role of the MMR Vaccine


The MMR (measles, mumps, rubella) vaccine is a well-established preventive measure with decades of evidence supporting its safety and efficacy. According to the CDC, one dose is about 93% effective, while two doses are approximately 97% effective at preventing measles.


Schedule for Children and Adults:

  • First dose: 12–15 months of age
  • Second dose: 4–6 years of age
  • Adults born after 1957 without immunity: at least one dose, or two if in high-risk settings (e.g., healthcare or international travel)

Myths vs. Facts on Vaccine Safety

Despite misinformation circulating online, the MMR vaccine:

  • Does not cause autism, as repeatedly confirmed by multiple large-scale studies
  • Has a long-standing record of safety and effectiveness
  • Rarely causes side effects, and when it does, they are typically mild (e.g., low-grade fever or soreness at the injection site)

Why Vitamin A Is Sometimes Used with Measles

Vitamin A is used in treating measles, particularly in children, to reduce the risk of complications like pneumonia and vision problems. 


The World Health Organization (WHO) recommends high-dose Vitamin A supplementation for children diagnosed with measles in areas with high rates of deficiency or malnutrition.


However, Vitamin A is not a preventative measure against the virus. It serves as a supportive therapy, not a substitute for the MMR vaccine. Using it in place of vaccination is not supported by medical or scientific guidelines.


Clear Differentiation: Prevention vs. Supportive Care

  • MMR vaccine: Prevents measles infection by building long-term immunity.

  • Vitamin A: Supports recovery in diagnosed cases but does not prevent infection.


What You Can Do Right Now to Help Stop the Spread

The 2025 Texas measles outbreak is a clear reminder that vaccine-preventable diseases can and will return if public health vigilance fades. With rising case counts, strained local clinics, and school disruptions, the ripple effects are being felt throughout communities large and small.


Avoid misinformation. Look to trusted sources like the CDC, your local health department, and licensed primary healthcare providers for guidance.


Direct Primary Care providers like Impact Family Wellness also play a key role by offering accessible, personalized care and helping patients stay up to date with their vaccination and wellness needs.


Together, informed decisions and community cooperation can stop the spread and protect the most vulnerable among us. Learn more about our vaccination programs and start making your health a priority.

FAQs


Is measles deadly in adults?

While measles is more commonly severe in children under five, adults—especially those with weakened immune systems or underlying health conditions—can experience serious complications. These may include pneumonia, encephalitis (brain swelling), and in rare cases, death. Prompt medical attention is critical.


What should I do if I was exposed but feel fine?

If you’ve been exposed, monitor yourself closely for symptoms for 21 days, which is the incubation period. Even if you feel fine, you could still be contagious if you're not immune. Check your vaccination records and contact your healthcare provider, especially if you’re unvaccinated or unsure of your immunity.


Can I get tested to check my immunity?

Yes. A blood test called a measles IgG antibody titer can determine whether you have immunity. This is especially useful for adults who are unsure about their vaccination status or have lost documentation. You can go to websites that offer direct to consumer testing or contact your local health service agency


Do I need a booster shot as an adult?

If you received two doses of the MMR vaccine, a booster isn’t typically necessary. However, adults born between 1957 and 1989 who only had one dose may benefit from a second. Healthcare workers, international travelers, and people in outbreak areas may be advised to get revaccinated.


What’s the difference between measles and other viruses with rashes?

Measles typically begins with cold-like symptoms, followed by a high fever and a spreading rash that starts on the face. Other viral rashes (like rubella or roseola) may have different symptom patterns and milder presentations. A confirmed diagnosis requires clinical evaluation and sometimes lab testing.

By Monica McKitterick May 16, 2025
Key Takeaway: Every man should make it a point to schedule these 15 key checkups: Annual Physical Exam Blood Pressure Screening Cholesterol Testing Diabetes Screening Colorectal Cancer Screening Prostate Cancer Screening Testicular Exam Lung Cancer Screening Mental Health Checkup Immunization Updates Eye & Vision Screening Dental Checkups Skin Cancer Screening Hormonal Health & Testosterone Testing Bone Density Test (DEXA Scan) For men, health needs shift with age, making it even more important to adopt preventive care practices tailored to each life stage. From managing blood pressure in your 20s to screening for chronic conditions after 40, each decade brings its own set of recommended evaluations. While many may feel fine, checkups are not just for when something feels wrong, but a reliable way to stay on top of long-term health. So, how often should men get checked out? At a minimum, a yearly visit with a primary care provider is recommended. This allows for consistent monitoring and the opportunity to adjust care based on changing health markers or lifestyle habits. 1. Annual Physical Exam The annual physical exam provides a comprehensive snapshot of overall wellness and helps build a lasting relationship with a healthcare provider. During this visit, doctors assess vital signs, review medical history, and often perform basic lab work to evaluate markers such as cholesterol and blood sugar. What Age Should A Man Get A Physical? Ideally, routine physicals should begin in the early 20s and continue yearly thereafter, even if no symptoms are present. Regular exams can identify subtle changes that might otherwise go unnoticed. How Much Does An Annual Physical Exam Cost? At Impact Family Wellness , this service is included in a membership that starts at $75 per month , which also covers unlimited office visits with no unexpected charges. This model removes common barriers to care and encourages consistent monitoring. 2. Blood Pressure Screening Blood pressure checks are a simple yet highly informative screening that can detect one of the leading contributors to heart disease: hypertension. High blood pressure often has no symptoms, which is why it's important to monitor it regularly—even for those who feel healthy. Men should begin having their blood pressure checked at age 20 , with annual follow-ups. If readings are elevated or there's a family history of heart conditions, more frequent checks may be necessary. Keeping blood pressure within the recommended range reduces the risk of heart attack, stroke, and kidney damage. 3. Cholesterol Testing High cholesterol can quietly increase the risk of cardiovascular issues. A standard lipid panel measures total cholesterol, LDL ("bad" cholesterol), HDL ("good" cholesterol), and triglycerides. These levels help determine whether lifestyle changes or medications are needed. Men should have their cholesterol levels tested every 4 to 6 years starting at age 20 , unless they have additional risk factors such as obesity, diabetes, or a family history of heart disease. In such cases, more frequent testing is often advised. Regular monitoring allows for early intervention and better long-term heart health outcomes. 4. Diabetes Screening Type 2 diabetes often develops gradually, making early detection through screening essential. Elevated blood sugar levels can cause damage to organs and nerves long before any symptoms appear. A fasting blood glucose test or A1C test is commonly used to assess risk. Screening is recommended every three years starting at age 35 , but men with additional risk factors—such as obesity, a sedentary lifestyle, or a family history of diabetes—may need to begin earlier and test more frequently. Identifying elevated glucose levels early allows for dietary and lifestyle changes that can delay or even prevent the onset of diabetes. 5. Colorectal Cancer Screening Colorectal cancer is one of the most preventable types of cancer when caught early through regular screening. A colonoscopy is considered the most effective method, as it not only detects cancer but can also remove polyps before they become problematic. At what age should a man get a colonoscopy? Current guidelines recommend beginning at age 45 for average-risk men. Those with a family history of colorectal cancer should consult their provider about starting even earlier. While colonoscopy remains the gold standard, there are less invasive alternatives like stool-based tests, which may be an option for those at lower risk or who prefer a non-invasive approach. 6. Prostate Cancer Screening Prostate cancer is one of the most common cancers among men, but it's often slow-growing and highly treatable when detected early. Screening typically involves a prostate-specific antigen (PSA) blood test, sometimes paired with a digital rectal exam (DRE). Most guidelines suggest starting at age 50 for average-risk men. However, those with a family history or who are part of higher-risk groups—such as African American men—may benefit from earlier testing. Discussing the benefits and risks with a healthcare provider can help determine the right time to begin screening. 7. Testicular Exam Although testicular cancer is relatively rare, it tends to affect younger men, particularly those between the ages of 15 and 35. Because of this, awareness and routine checks are important early in life. Doctors recommend monthly self-exams beginning in the late teens or early 20s. These help men become familiar with their normal anatomy, making it easier to notice any unusual lumps, swelling, or discomfort. In addition, testicular exams should be a part of routine physical checkups with a healthcare provider. 8. Lung Cancer Screening Lung cancer is the leading cause of cancer death globally, often because it’s diagnosed at a later stage. Fortunately, early detection through screening can significantly improve outcomes. Men between the ages of 50 and 80 who have a significant smoking history—defined as 20 pack-years or more—are recommended to undergo annual low-dose computed tomography (CT) scans . This painless scan can detect lung abnormalities before symptoms appear, providing a greater chance for effective treatment. Even for those who have quit smoking within the last 15 years, the risk may still be elevated, making regular screening a prudent choice. 9. Mental Health Checkup Mental health is just as important as physical well-being, yet it often goes unaddressed in routine care. Depression, anxiety, and chronic stress can quietly impact every aspect of life, from sleep and energy to work and relationships. An annual mental health checkup allows men to discuss emotional challenges and life stressors openly with a trusted provider. These visits may involve short screening questionnaires and supportive conversation, to identify early signs of conditions that might otherwise go unnoticed. Taking time to assess mental health can be a key part of managing overall well-being and preventing burnout or more severe emotional struggles. 10. Immunization Updates Vaccines aren’t just for children. Adults need to keep immunizations current to maintain protection against serious diseases. Depending on age, medical history, and previous vaccination status, men should stay up to date with: Influenza (flu) – every year Tetanus, diphtheria, and pertussis (Tdap) – every 10 years Shingles (herpes zoster) – starting at age 50 Human papillomavirus (HPV) – for those not vaccinated earlier COVID-19 – including any applicable boosters A healthcare provider can confirm which vaccines are needed based on personal risk factors and public health guidelines. 11. Eye & Vision Screening Maintaining eye health goes beyond just reading glasses. Eye exams can detect early signs of conditions like glaucoma, macular degeneration, and diabetic retinopathy—many of which present no symptoms in the early stages. Men under 40 should have a comprehensive eye exam every 2 to 4 years . After age 40 , the frequency should increase to once every 1 to 2 years , or more often if there are known vision problems or risk factors such as diabetes. 12. Dental Checkups Oral health plays a bigger role in overall wellness than many realize. Gum disease or periodontitis has been linked to heart conditions, diabetes, and even respiratory issues. Routine dental care helps prevent these complications and keeps teeth and gums healthy. It’s generally recommended that men schedule dental checkups twice a year . These visits typically include professional cleanings, examinations for cavities, and screenings for oral cancer. Staying current with dental appointments can help avoid more complex and costly issues down the line. 13. Skin Cancer Screening Skin cancer is one of the most common cancers in men, particularly those with lighter skin tones or high sun exposure . Fortunately, it’s also among the most treatable—especially when detected early. A yearly full-body skin exam by a dermatologist is advised. During the exam, providers check for any suspicious moles, lesions, or skin changes that could indicate melanoma or other types of skin cancer. Men should also perform regular self-checks and report anything unusual between appointments. 14. Hormonal Health & Testosterone Testing As men age, hormone levels—especially testosterone—can begin to decline. This may affect mood, energy, sex drive, and muscle mass. Common signs of low testosterone in men include low libido, persistent fatigue, irritability or depression, and decreased muscle strength. Testosterone testing is generally recommended for men over 40 experiencing these symptoms or for those undergoing a routine health assessment where hormonal balance may be relevant. Simple blood tests can evaluate testosterone levels, and results help guide further treatment or lifestyle recommendations if needed. Testosterone therapy is available to supplement the natural decline of testosterone levels as men age. 15. Bone Density Test (DEXA Scan) Osteoporosis isn’t just a women’s health issue—men can also experience bone density loss, especially after age 50 . Factors like low testosterone, smoking, or long-term use of certain medications can increase risk. A DEXA scan (dual-energy X-ray absorptiometry) measures bone strength and helps detect early signs of osteoporosis. While it’s not always part of standard screenings, it should be considered for men with risk factors or those over 50 who show signs of bone weakness, such as frequent fractures or unexplained back pain. Regular bone assessments help prevent fractures and maintain long-term mobility and quality of life. Take Charge Of Your Health Today Taking control of your health starts with being informed and proactive. These 15 checkups are the foundational steps toward preventing illness and maintaining long-term well-being. Whether you're scheduling your first annual physical or updating essential screenings, each choice supports a healthier future. For personalized, affordable, and convenient care, consider becoming a member at Impact Family Wellness , where comprehensive medical services are tailored to your needs. Don’t wait— schedule a checkup today ! FAQs About Men’s Health Checkups What Are The Most Important Health Screenings For Men In Their 20s And 30s? While younger men may feel healthy, it's important to monitor blood pressure, cholesterol, mental health, and start discussions about family history to assess risks early. Are Virtual Health Checkups Effective For Routine Monitoring? Yes, a study notes that telehealth can be as useful for reviewing symptoms, mental health consultations, and managing chronic conditions as physical exams do , though some screenings still require in-person visits. How Can Men Prepare For Their Annual Checkup? Bring a list of symptoms, medications, family history updates, and lifestyle changes. Wear comfortable clothing and prepare to discuss mental, sexual, and physical health openly.
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