Black youth in racist communities fare worse in mental health treatment

A study finds that community-level racism makes it harder for Black youth to benefit from talk therapy

Peer-Reviewed Publication

ELSEVIER

Washington, DC, June 2, 2022 – A study in the Journal of the American Academy of Child and Adolescent Psychiatry (JAACAP), published by Elsevier, reports that Black youth living in communities with high (vs. low) anti-Black racism are less likely to benefit from psychotherapy ("talk therapy;" such as cognitive behavioral therapy).

Racism is a system that labels and ranks racial groups, deeming specific groups as inferior and affording them fewer opportunities and resources. Racism exists across different levels: internally (e.g., low self-esteem due to internalizing racial stereotypes), interpersonally (e.g., being called a racist slur), and structurally (i.e., attitudes and laws/policies that hinder the well-being of people of Color, such as redlining policies). Previous studies find that anti-Black racism across all three levels is related to worse mental health for Black people, though few have examined whether racism affects intervention efficacy (i.e., how beneficial an intervention, such as psychotherapy or medication, is).

This meta-analytic study – led by Dr. Maggi Price, an Assistant Professor at the Boston College School of Social Work – is the first to assess whether structural racism is associated with mental health treatment efficacy. Specifically, the research team used publicly available data on anti-Black racist attitudes to create a measure of state-level structural racism and analyzed randomized controlled trial data from youth psychotherapy studies of mostly Black youth (36 RCTs representing N=2,182 youth).  

Dr. Price and her team found that psychotherapies in states with higher (vs. lower) levels of anti-Black racism were less effective.

While summarizing the study's main finding, Dr. Price said, "The extent to which racism or other prejudicial attitudes are endorsed in a given community – such as a neighborhood or a state – varies across the country. Our study found that the level of racism in one's community affects how well one does in mental health treatment."  

Dr. Price and her colleagues conducted a similar study on structural sexism and found that girls living in places with more (vs. less) sexism also fared worse in treatment. When asked about these studies' implications for mental health treatment providers, Dr. Price said that since "identity and stigma are central to an individual's well-being—and seemingly help to account for how well one responds to mental health treatment—practitioners should address stigma in treatment."

“Providers should also incorporate advocacy into their practice by recognizing and making efforts to reduce sexism and racism in their patients' environments. Some examples might include advocating for  changes in school policies to eliminate racist disciplinary practices or to integrate implicit bias training to help teachers to be more aware of their biases."  

Dr. Price concluded with a call to improve training and education for providers: “Many training programs don't prepare providers to adequately address stigma and identity with patients. We need to enhance training in culturally responsive care, including how to address racism, sexism, and other stigmas in treatment. Doing so is essential and will help us better serve our patients.”

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Notes for editors
The article is "Meta-analysis: Are Psychotherapies Less Effective for Black Youth in Communities With Higher Levels of Anti-Black Racism?” by Maggi A. Price, PhD, John R. Weisz, PhD, Sarah McKetta, MSc, Nathan L. Hollinsaid, BS, Micah R. Lattanner, PhD, Allecia E. Reid, PhD, Mark L. Hatzenbuehler, PhD (https://doi.org/10.1016/j.jaac.2021.07.808). It currently appears on the JAACAP Articles In Press page and will appear in the Journal of the American Academy of Child and Adolescent Psychiatry, volume 61, issue 6 (June 2022), published by Elsevier.

Copies of this paper are available to credentialed journalists upon request; please contact the JAACAP Editorial Office at support@jaacap.org or +1 202 587 9674. Journalists wishing to interview the authors may contact Maggi Price, PhD, e-mail at maggi.price@bc.edu.

About JAACAP
Journal of the American Academy of Child and Adolescent Psychiatry (JAACAP) is the official publication of the American Academy of Child and Adolescent Psychiatry. JAACAP is the leading journal focusing exclusively on today's psychiatric research and treatment of the child and adolescent. Published twelve times per year, each issue is committed to its mission of advancing the science of pediatric mental health and promoting the care of youth and their families.

The Journal's purpose is to advance research, clinical practice, and theory in child and adolescent psychiatry. It is interested in manuscripts from diverse viewpoints, including genetic, epidemiological, neurobiological, cognitive, behavioral, psychodynamic, social, cultural, and economic. Studies of diagnostic reliability and validity, psychotherapeutic and psychopharmacological treatment efficacy, and mental health services effectiveness are encouraged. The Journal also seeks to promote the well-being of children and families by publishing scholarly papers on such subjects as health policy, legislation, advocacy, culture and society, and service provision as they pertain to the mental health of children and families.

About Elsevier
As a global leader in information and analytics, Elsevier helps researchers and healthcare professionals advance science and improve health outcomes for the benefit of society. We do this by facilitating insights and critical decision-making for customers across the global research and health ecosystems.

In everything we publish, we uphold the highest standards of quality and integrity. We bring that same rigor to our information analytics solutions for researchers, health professionals, institutions and funders.

Elsevier employs 8,700 people worldwide. We have supported the work of our research and health partners for more than 140 years. Growing from our roots in publishing, we offer knowledge and valuable analytics that help our users make breakthroughs and drive societal progress. Digital solutions such such as ScienceDirect, Scopus, SciVal, ClinicalKey and Sherpath support strategic research management, R&D performance, clinical decision support, and health education. Researchers and healthcare professionals rely on our over 2,700 digitized journals, including The Lancet and Cell; our over 43,000 eBook titles; and our iconic reference works, such as Gray's Anatomy. With the Elsevier Foundation and our external Inclusion & Diversity Advisory Board, we work in partnership with diverse stakeholders to advance inclusion and diversity in science, research and healthcare in developing countries and around the world.

Elsevier is part of RELX, a global provider of information-based analytics and decision tools for professional and business customers. www.elsevier.com

 

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JOURNAL

Journal of the American Academy of Child & Adolescent Psychiatry

DOI

10.1016/j.jaac.2021.07.808 

METHOD OF RESEARCH

Meta-analysis

SUBJECT OF RESEARCH

People

ARTICLE TITLE

Meta-analysis: Are Psychotherapies Less Effective for Black Youth in Communities With Higher Levels of Anti-Black Racism?

Black, Hispanic people more likely to die than white people after some types of stroke

Peer-Reviewed Publication

AMERICAN ACADEMY OF NEUROLOGY

MINNEAPOLIS – Black and Hispanic people are more likely to die in the first month after certain types of stroke than white people, according to a study published in the June 1, 2022, online issue of Neurology®, the medical journal of the American Academy of Neurology.

“We’ve known that there are disparities in death from stroke among racial and ethnic groups in the U.S. due to higher stroke rates, higher burden of risk factors for stroke, socioeconomic inequality and structural racism, but we have needed more information breaking these differences down by type of stroke,” said study author Hugo J. Aparicio, MD, MPH, of Boston University School of Medicine in Massachusetts and a member of the American Academy of Neurology. “These results will help us to better understand the nature of this health inequity.”

For the study, researchers reviewed health records of 37,790 people who had strokes and were hospitalized in the Veterans Health Administration over a 10-year period. They then looked at which participants died during the following month and for more than a year after the stroke.  

A total of 89% of the strokes were ischemic, which are strokes caused by a blood clot. Another 9% were intracerebral hemorrhage strokes and 2% were subarachnoid hemorrhage strokes, both of which are caused by bleeding in the brain. Men made up 98% of the participants.

When researchers adjusted for factors that could affect risk of death after stroke, such as smoking, diabetes, and heart disease, Hispanic people who had subarachnoid hemorrhage strokes had a 10.3% higher risk of death during the month after the stroke than white people with the same type of stroke, with Hispanic people having a 30% increased risk and white people having a 20% increased risk. Black people who had intracerebral hemorrhage strokes had a 3% higher risk of death during the month after the stroke than white people with that type of stroke, with Black people having a 30% increased risk and white people having a 27% increased risk.

“Differences in mortality by race or ethnicity varied substantially when considering specific types of stroke, especially the different types of hemorrhagic stroke,” said Aparicio. “If all types of stroke are considered together as one disease, it may mask underlying racial or ethnic disparities, since risk factors, such as age or blood pressure, and underlying social determinants of health, such as access to health care or structural racism, may vary differently between these outcomes. Given these differences in stroke mortality by race and ethnicity, it is clear that more research is also needed in Native American, Alaska Native, Native Hawaiian and Asian American groups.”

Aparicio noted that future studies should look into group differences in vascular risk factors and management of risk factors, stroke severity, and the effects of racism that may contribute to this inequity in surviving after a stroke.

A limitation of the study was that nearly all of the participants were male veterans, so the results may not apply to women and the general population. In addition, the researchers were not able to adjust for the severity of the strokes.

The study was supported by the Department of Veterans Affairs.

Learn more about stroke at BrainandLife.org, home of the American Academy of Neurology’s free patient and caregiver magazine focused on the intersection of neurologic disease and brain health. Follow Brain & Life® on Facebook, Twitter and Instagram.

When posting to social media channels about this research, we encourage you to use the hashtags #Neurology and #AANscience.

The American Academy of Neurology is the world’s largest association of neurologists and neuroscience professionals, with over 38,000 members. The AAN is dedicated to promoting the highest quality patient-centered neurologic care. A neurologist is a doctor with specialized training in diagnosing, treating and managing disorders of the brain and nervous system such as Alzheimer’s disease, stroke, migraine, multiple sclerosis, concussion, Parkinson’s disease and epilepsy.

For more information about the American Academy of Neurology, visit AAN.com or find us on Facebook, Twitter, Instagram, LinkedIn and YouTube.

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JOURNAL

Neurology

Racial and ethnic disparities in stroke outcomes

Black and Hispanic patients experienced poorer survival after certain strokes

Peer-Reviewed Publication

BOSTON UNIVERSITY SCHOOL OF MEDICINE

(Boston)—Stroke is the fifth leading cause of death in the U.S. Despite declines in stroke mortality in the overall population in recent decades, disparities in incidence remain persistent among Black and Hispanic Americans. Now a new study has found that inequality in survival among Black and Hispanic Americans varies by stroke type.

“While racial and ethnic disparities in stroke outcomes exist, differences by stroke type are less understood. Current evidence for racial and ethnic disparities in stroke mortality, particularly by stroke type, is needed to better understand and characterize the scope of this health inequity,” explained corresponding author Hugo J. Aparicio, MD, MPH, assistant professor of neurology at Boston University School of Medicine and an investigator at the Framingham Heart Study.

Health disparities in stroke patients were investigated among patients admitted to VA hospitals in the U.S. between the years 2002-12. Strokes were categorized into three types: acute ischemic stroke (AIS), intracerebral hemorrhage (ICH), and subarachnoid hemorrhage (SAH). Race and ethnicity data were collected, and patients were categorized as either non-Hispanic White, non-Hispanic Black (African American), or White or Black Hispanic (Latino). The researchers then compared the incidence of death at various time periods after the stroke (hospital admission date to 30 days, 31-90 days, 91 days to one year, and greater than one year).

While Black patients were less likely to die within the first 30 days of hospital admission for AIS, compared to White patients, Black patients experienced higher mortality (3.2 percent higher) compared to White patients within the first 30 days following ICH, while Hispanics had similar mortality compared to Whites for ICH. For SAH, Hispanics had a higher 30-day mortality (10.3 percent higher) compared to Whites, but no other differences in mortality were seen between the two groups for other time periods.

According to the researchers, some causes of disparities seen in survival could be attributed to decreased access to health care services (e.g., for blood pressure medication prescription), less community outreach for preventive health interventions, or variations in acute care or post-hospital discharge processes of care for minority populations. “Furthermore, the prevalence of uncontrolled high blood pressure in the Black population could contribute to higher rates of stroke. Therefore further investigation categorized by stroke type is warranted to address determinants of health inequity, such as individual health risk factors, care process within the hospital, or factors outside the healthcare system, that could be contributing to stroke mortality,” adds Dr. Aparicio.

The researchers believe future studies should investigate group differences in vascular risk factors and risk factor management, stroke severity, the effects of structural racism, and social determinants of health that may contribute to this inequity in stroke survival.

These findings appear in the journal Neurology®, the medical journal of the American Academy of Neurology.

Funding for this study was provided by Veterans Affairs Merit Award I01 CX001025 (Wilson & Cho). Dr. Aparicio is supported by the National Institute on Aging (R01AG054076-02S1), the National Institute of Neurological Disorders and Stroke (L30 NS093634), an American Academy of Neurology Career Development Award, and the Boston University Aram V. Chobanian Assistant Professorship.

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JOURNAL

Neurology

METHOD OF RESEARCH

Data/statistical analysis

SUBJECT OF RESEARCH

People

ARTICLE TITLE

Racial and Ethnic Differences in Short- and Long-term Mortality by Stroke Type

How can changes to urban neighborhoods and buildings affect microclimates and energy use?

Computational work uses a Chicago neighborhood to understand and quantify climate effects on building energy use from changes in urban design.

DOE/US DEPARTMENT OF ENERGY

Researchers used a neighborhood in Chicago (seen here looking south) to improve understanding and quantification of climate effects on building energy use in cities and microclimate impacts that can occur from changes in urban design. view more

The Science

Heating and cooling for buildings is a large part of global energy demand. In the United States in 2010, buildings accounted for the biggest share (41 percent) of the nation’s energy consumption. This partly explains why despite having only 4.4 percent of the world’s population, the United States consumes 19 percent of the world’s primary energy production. U.S. building energy use amounts to 40 percent of total U.S. carbon dioxide emissions, contributing to global warming and to regional climate change. This research demonstrates a process for testing the design of neighborhoods to understand how it affects local and regional weather patterns and how changing weather patterns can influence building energy demands.

The Impact

The amount of energy that buildings demand depends on very small-scale factors. Buildings’ urban microclimate reflects local weather, the heat from direct and reflected sunlight, and the temperature of other buildings and the ground. This microclimate is also a product of heat exchange between neighboring buildings, heat transfer due to wind, the temperature of city infrastructure, and other urban heat island effects. This can reduce heating demand during colder months, but it may also increase the demand for cooling in the summer. This study’s Chicago Loop test case shows that the design of even a small new development in a neighborhood affects not only its own microclimate, but also the microclimate of the overall neighborhood. These changes affect how all the buildings in a neighborhood use energy. This research helps to evaluate potential changes to future microclimates and building energy demand using global climate projections, combining the effects of population shifts and urbanization. It aids in quantifying and analyzing the relationships among climate, urban morphology, land cover, and energy use. Researchers can use this information for energy-efficient urban development and planning.

Summary

Researchers demonstrated a process for creating and testing example morphologies for new neighborhoods for their impact on local and regional meteorology within a two-way-coupled mesoscale weather model. Their approach enabled them to allocate resulting building-level meteorological profiles to each building in a neighborhood for parallel computation of building-by-building energy use. To accomplish this process, five one-year, four-domain (with different levels of horizontal resolution), nested meteorological simulations using 2015 data were run using the Weather Research and Forecasting (WRF) model on the Titan and Eos supercomputers at Oak Ridge National Laboratory (ORNL) for two locations: one for the ORNL research campus and four for the Chicago Loop area. The researchers generated urban terrain inputs (binary, readable by WRF) using ORNL-produced shapefiles from LiDAR imagery and laser measurement and included these inputs in the WRF simulations. The researchers generated future neighborhood morphologies using the concept of Urban Tissues, in which physical elements and relationships of the existing neighborhood are identified, subsetted, and recombined for the morphology of the new neighborhood. For each of the five meteorological simulations, researchers defined building-specific meteorological profiles at a 90-meter resolution and initialized each building in massively parallel EnergyPlus building energy simulations. As mesoscale models are often coupled with Earth system models to understand regional impacts of large-scale systems under future scenarios, this methodology may be used further to understand global impacts and feedbacks from changes in climate and in urban terrain due to projected shifts in urban population and changes in urbanization.

 

Funding

This research was supported by the DOE Office of Science through the MultiSector Dynamics, Earth, and Environmental System Modeling program.

How buildings contribute to urban heating during heat waves

A bottom-up approach quantifies the contributions of human-caused heating from building energy use during extreme heat events.

DOE/US DEPARTMENT OF ENERGY

Downtown Los Angeles. A new modeling method examined in high resolution how buildings contribute to heat islands, especially during heat waves. view more

Credit: Image courtesy of Pixabay (https://pixabay.com/photos/los-angeles-usa-california-4313327/)

The Science

Previous research has found that heat waves and urban heat island effects reinforce each other’s effects. These heat islands are concentrations of buildings, paved areas, and other surfaces that absorb and retain heat. Emissions of heat from buildings are an important part of this heat island effect. Researchers therefore need to understand the interplay of urban microclimates and these building heat emissions. New research developed a method for modeling urban building energy and associated human-caused heat during city-wide heat waves. The researchers used the method to examine the variation over time and space in emissions of waste heat from buildings in Los Angeles. The study incorporated building type, urban microclimate, and large-scale climate conditions.

The Impact

The method provides a high-resolution representation of how buildings contribute to heat islands during heat waves. It details both the magnitude and distribution of these heating effects. The simulation indicates that heat dispersing from buildings to the urban environment increases by as much as 20 percent during a heat wave. Most of this heat is waste heat from air conditioning. The study’s results will serve as a fundamental step in continued investigations of the feedback between changes in building waste heat and urban microclimates during extreme heat events.

Summary

The world is experiencing more frequent and longer-duration heat waves. These heat waves are a serious threat to human health and the stability of electrical grids. Previous studies have identified positive feedbacks between heat waves and urban heat island effects. Heat discharges from buildings and associated energy use have significant effect on the urban environment, and researchers therefore need to understand the interactive effects of urban microclimate and building heat emissions on the urban energy balance. In this study, scientists developed a coupled-simulation approach to quantify these effects, mapping urban environmental data generated by the mesoscale Weather Research and Forecasting (WRF) model, coupled to the Urban Canopy Model (UCM), to simulate urban building energy flows. The scientists conducted a case study in Los Angeles, California, during a five-day heat wave event in September 2009.

The researchers analyzed the surge in city-scale building heat emission and energy use during the extreme heat event. They first simulated the urban microclimate at high resolution (500 by 500 meters) using WRF-UCM. Next, they generated grid-level building heat emission profiles and aggregated them using prototype building energy models informed by spatially disaggregated urban land use and urban building density data. They analyzed the spatial patterns of anthropogenic heat discharge from the building sector. They also assessed the quantitative relationship with weather conditions and urban land-use dynamics at the grid level. The simulation results indicate that during a heat wave, a rise in building energy use follows, and the associated discharge of anthropogenic waste heat from the buildings to the environment increases by as much as 20 percent on average, varying significantly, both in time and space. Notably, air-conditioning use within buildings intensifies, and resulting waste heat discharges outside of the buildings contribute most (86.5 percent) of the total waste heat transferred to the surrounding urban environment. The study also found that the waste heat discharge in inland, dense urban districts is more sensitive to extreme events than it is in coastal or suburban areas. The generated anthropogenic heat profiles can be used in urban microclimate models to provide a more accurate estimation of urban air temperature rises during heat waves.

 

Funding

This research was supported by the Department of Energy Office of Science as part of research in the MultiSector Dynamics, Earth, and Environmental System Modeling Program.

Understanding the health and environmental risks of microplastics

Reports and Proceedings

AMERICAN CHEMICAL SOCIETY

Studies have shown that tiny plastic pieces are nearly everywhere — in the air, water, food and even inside the human body — but it’s unclear what risks nano- and microplastics pose to the environment or to human health. According to a cover story in Chemical & Engineering News, an independent news outlet of the American Chemical Society, researchers are beginning to investigate the risks of microplastics, using lessons learned from nanotoxicology.

Microplastics (plastic pieces less than 5 mm in diameter) and nanoplastics (pieces less than 1 µm in diameter) can be different sizes and shapes and can be made of various materials, writes Senior Correspondent Britt E. Erickson. Because not all microplastics are created equally, they can have different effects on human health and the environment, and therefore studying them is complicated. Most researchers so far have used polystyrene beads in their experiments because they are easily accessible, but these beads are not representative of microplastics found in the environment. Most microplastics found in the air and water are fragments, not spheres. Polystyrene is not the only polymer found in the environment; polyethylene, polypropylene and polyamide are also common. And once in the environment, ultraviolet light and contaminants can change the particles’ properties.

Because there are limited exposure data on microplastics, making regulatory decisions is a challenge. The toxicology community has had similar issues with nanoparticles in the past decade, and so scientists hope that lessons from nanotoxicology can be applied to microplastics. Researchers are beginning to standardize the various micro- and nanoplastics used in studies, so that results can be reproduced and better replicate real-world situations. Scientists are using systems in the lab that simulate bodily functions to figure out how ingested and inhaled particles could affect human gut and lung cells. Although scientists are unsure whether the influx of funding toward toxicology research will lead to meaningful regulatory changes, there is hope that more information about the health risks of these materials is on the horizon.

The article is freely available at cenm.ag/microplastics-risks. 

The American Chemical Society (ACS) is a nonprofit organization chartered by the U.S. Congress. ACS’ mission is to advance the broader chemistry enterprise and its practitioners for the benefit of Earth and all its people. The Society is a global leader in promoting excellence in science education and providing access to chemistry-related information and research through its multiple research solutions, peer-reviewed journals, scientific conferences, eBooks and weekly news periodical Chemical & Engineering News. ACS journals are among the most cited, most trusted and most read within the scientific literature; however, ACS itself does not conduct chemical research. As a leader in scientific information solutions, its CAS division partners with global innovators to accelerate breakthroughs by curating, connecting and analyzing the world’s scientific knowledge. ACS’ main offices are in Washington, D.C., and Columbus, Ohio.

To automatically receive news releases from the American Chemical Society, contact newsroom@acs.org.

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JOURNAL

Chemical & Engineering News

ARTICLE TITLE

Getting a grip on microplastics’ risks

Metal mayhem: New research finds toxic metals absorbed by Great Salt Lake plants and insects

Peer-Reviewed Publication

S.J. & JESSIE E. QUINNEY COLLEGE OF NATURAL RESOURCES, UTAH STATE UNIVERSITY

 

IMAGE: PLANTS IN GREAT SALT LAKE WETLAND ECOSYSTEMS ARE ABLE TO PULL HAZARDOUS METAL POLLUTION FROM THE LAKE AND SOMETIMES PASS IT UP THE FOOD CHAIN, ACCORDING TO NEW RESEARCH FROM UTAH STATE UNIVERSITY. view more 

CREDIT: USFWS MOUNTAIN-PRAIRIE

Plants in Great Salt Lake wetland ecosystems are able to pull hazardous metal pollution from the lake and sometimes pass it up the food chain, according to work by a team of researchers from the Department of Watershed Sciences led by Edd Hammill. The study, coauthored by former master’s student Maya Pendleton and current faculty Janice Brahney, Karin Kettenring, and Trisha Atwood, sampled three types of native plants (threesquare, hardstem, and alkali bulrush) and invasive phragmites to monitor concentrations of metals and see where in the plants they accumulated.

Toxic metals reach the Great Salt Lake predominantly by way of runoff and atmospheric pollution from human industry, such as mines and refineries. Wetland plants absorb metals from the soil and store them belowground (in roots, bulbs, and rhizomes) or aboveground (in shoots, leaves, and seeds). Where in the plant these metals end up residing has implications for environmental health, according to the research.

“All the plants sampled were adept at storing selenium and arsenic belowground,” said Hammill. “However, the phragmites had the highest concentrations of lead and mercury in their seeds, and all the plants had significant concentrations of other metals in their aboveground tissues.”

Toxic metals in aboveground plant tissues are a cause for concern for the insects that eat them and the terrestrial food web as whole, the researchers said.

“The metals are fat soluble,” said Hammill, “so every bit consumed by herbivorous insects is stored in the insect tissues and gets passed on to predatory insects like spiders, damselflies, and dragon flies. Larger predators consume the predatory insects and the toxic metals move right up the food chain in larger concentrations.”

The research found copper and cadmium levels ten times higher in predatory insects than in wetland plants, a hazard to resident waterfowl and the large numbers of migratory birds who flock to Great Salt Lake wetlands and feed on insects before passing on to other far-off habitats. In future studies, the team hopes to take a closer look at toxic metal concentrations in Great Salt Lake waterfowl, which are under consumption advisories.

The propensity for wetland plants to absorb hazardous metals could be useful as a way to clean up lake pollution, said Hammill. To remove or decrease toxic metal pollution should be the ultimate goal, but considering this study, leaving wetland root systems intact while cutting the aboveground foliage and burying it in low-impact locations would be a practice worthy of consideration by management agencies, he said.

The negative impact of metals in plants and animals ties into the broader conversation about conservation of the Great Salt Lake, particularly when it comes to lake water levels which have declined to record lows.

“Keeping the Great Salt Lake watered is critical to making sure the metals stay where they are now,” said Hammill. “If the lakebed gets exposed, dust and metals become airborne, which has a considerable human impact and makes the whole problem worse.”

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JOURNAL

Ecotoxicology

DOI

10.1007/s10646-022-02550-6 

METHOD OF RESEARCH

Experimental study

SUBJECT OF RESEARCH

Not applicable

ARTICLE TITLE

Metal concentrations in wetland plant tissues influences transfer to terrestrial food webs

Could time limits on opioid prescriptions reduce misuse?

Hundreds of thousands of surgical and dental opioid prescriptions are filled a month or more after writing, but one state’s law helped reduce this “delayed dispensing”

Peer-Reviewed Publication

MICHIGAN MEDICINE - UNIVERSITY OF MICHIGAN

Most people who get a prescription for opioid painkillers to ease the pain of an operation or dental procedure fill it right away. But a new study shows that some fill these prescriptions more than a month later – long after the acute pain from their care should have subsided.

In 2019, 1% of opioid prescriptions from dentists and surgeons were filled more than 30 days after writing, according to the new study in JAMA Network Open by a team from the University of Michigan. While low, that percentage would translate to more than 260,000 opioid prescriptions per year if it generalized to all surgical and opioid prescriptions in the U.S. 

“Our findings suggest that some patients use opioids from surgeons and dentists for a reason or during a time frame other than intended by the prescriber,” says lead author Kao-Ping Chua, M.D., Ph.D, a U-M pediatrician and member of the Susan B. Meister Child Health Evaluation and Research (CHEAR) Center and the U-M Institute for Healthcare Policy and Innovation. “These are both forms of prescription opioid misuse, which in turn is a strong risk factor for opioid overdose.”

The study authors note that state and federal laws regulating the expiration periods for controlled substance prescriptions may be partly to blame.

In 2019, 18 states allowed prescriptions for Schedule II opioids and other controlled substances – those with the highest risk of being diverted for misuse – to be filled up to 6 months after writing. Another eight states allowed these drugs to be dispensed up to 1 year after the prescription.

“It’s perplexing that states would allow controlled substance prescriptions to be filled so long after they are written,” says Chua. He notes that tightening state laws could be a straightforward way to prevent or reduce misuse associated with delayed dispensing of opioids.

As evidence, the study examined the effects of a law in Minnesota, which in July 2019 prohibited opioid dispensing more than 30 days after writing. After implementation, delayed dispensing dropped rapidly compared to other states.  

The authors note that an across-the-board rule limiting the time window for filling opioid prescriptions might inadvertently harm patients who take the drugs for chronic pain. Instead, they say, policymakers could implement laws that limit this time window only when opioids are written for acute pain.

The authors also note that prescribers can reduce delayed dispensing by including instructions on the prescription not to dispense opioids after a certain time frame.

In addition to Chua, the study’s authors include Romesh Nalliah from the U-M School of Dentistry, Michael Smith from the U-M School of Pharmacy, research assistant Shreya Bahl, and Jennifer Waljee and Chad Brummett, both of whom are co-directors of the Michigan Opioid Prescribing and Engagement Network.

OPEN, as it’s known, offers evidence-based opioid prescribing guidelines and educational materials for opioids for acute pain, and works to increase safe disposal options.

Citation: Estimation of the Prevalence of Delayed Dispensing Among Opioid Prescriptions From US Surgeons and Dentists, JAMA Netw Open. 2022;5(5):e2214311. doi:10.1001/jamanetworkopen.2022.14311

https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2792751

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JOURNAL

JAMA Network Open

DOI

10.1001/jamanetworkopen.2022.14311 

METHOD OF RESEARCH

Data/statistical analysis

SUBJECT OF RESEARCH

People

ARTICLE TITLE

Estimation of the prevalence of delayed dispensing among opioid prescriptions from US surgeons and dentists

Aromatherapy can reduce post-surgical opioid use by half, preliminary US study finds

Reports and Proceedings

THE EUROPEAN SOCIETY OF ANAESTHESIOLOGY AND INTENSIVE CARE (ESAIC)

Aromatherapy reduces post-surgical opioid use by half in hip replacement patients anxious before their operation, according to a new preliminary study being presented at the annual meeting of the European Society of Anaesthesiology and Intensive Care (ESAIC) in Milan, Italy (4-6 June).

Previous research has shown that anxiety, depression and catastrophising (patients who believe they are going to die during surgery) increase post-operative pain and opioid use by up to 50%.

Aromatherapy, the use of essential oils to enhance wellbeing, has been used for thousands of years and a number of recent studies have found that lavender and peppermint aromatherapy, in particular, can reduce anxiety.1  

However, most of these studies have looked at series of patients, rather than having a more rigorous randomised, placebo-controlled design, which has made it difficult to draw firm conclusions from the results.

This study, from Professor Jacques Chelly and colleagues at the Department of Anaesthesiology, University of Pittsburgh, Pittsburgh, USA, is one of the first to employ a randomised, placebo-controlled design to look at whether aromatherapy reduces anxiety.

Since January 2020, patients undergoing primary total hip replacements at UPMC Presbyterian-Shadyside Hospital, Pittsburgh, and who consent to taking part in the study, have filled in a survey that screens them for anxiety (PROMIS Emotional Distress – Anxiety – Short Form 8a).

To date more than 350 patients have been screened in this way.

Those scoring as having a moderate level of anxiety or above are enrolled in the study, which is ongoing and aims to enrol 60 patients.

Participants are randomised to an active treatment (aromatherapy) or placebo group. Those in the active treatment group are given a lavender and peppermint “aromatab”, an adhesive patch that slowly releases essential oils when stuck onto clothes, skin or a hospital gown, to wear from at least an hour before their operation.

The patches are changed every 12 hours and are worn for 72 hours after surgery.

Those in the placebo group wear a patch which emits sweet almond oil – an oil not credited with anxiety-lowering qualities.

Levels of anxiety, depression, catastrophising, pain and opioid consumption are recorded over the course of the study.

Preliminary data on the first 25 participants (average age 60.6 years, 13 males and 12 females) is presented here.  The primary outcome is the effect of aromatherapy on anxiety 48 hours after surgery.

The baseline (pre-operative) anxiety score was similar in both groups (23.5 in aromatherapy group vs. 22.9 in placebo group).

48 hours post-operation, the anxiety score had fallen in both groups but the drop was greater in the aromatherapy group (anxiety score of 13.5 in aromatherapy group vs. 16.2 in placebo group).

Total opioid use in the first 48 hours after surgery was 50% lower in the aromatherapy group (12 OME) than in the placebo group (24.75 OME).  (OME, oral morphine equivalent, is a measure that allows comparison between different drugs and methods of administration).

The data on levels of pain, depression and catastrophising has yet to be analysed.

The researchers concluded: “Our results suggest that, by controlling anxiety, aromatherapy can help control pain and reduce opioid consumption. This is important, given the established role of the use of opioids in surgical patients in the overall opioid crisis in the US.”

Opioids have sedative and analgesic effects and are widely prescribed to after surgery to control pain. They are also addictive.

Drug overdose deaths involving opioids (prescription and non-prescription, such as heroin) have increased more than six-fold since 1999 in the US and nearly 600,000 people in the US and Canada have died from opioid overdoses over the past two decades.2

Professor Chelly says: “The pandemic has made the situation even worse, with over 100,000 drug overdose deaths reported in 2021.”

It has recently been estimated that, without urgent intervention, including public health policy reform and stricter corporate regulations, there will be an additional 1.2 million opioid deaths in North America by 2029.2

Although North America is at the centre of the opioid crisis, opioid misuse is an increasing public health concern in the UK.

Professor Chelly says: “Evidence supports the concept that routine operations can be a gateway to long-term opioid use and addiction (opioid use disorder) and it is therefore important to consider techniques that may reduce the perioperative use of opioids and therefore the development of opioid-use disorders following surgery.

"Aromatherapy is a simple and cost-effective technique which can minimise the impact of anxiety on post-operative pain and opioid consumption.

“We hope that providing objective evidence about the benefits of aromatherapy will help address the concerns of those who are sceptical about its value.

“At UPMC Presbyterian-Shadyside Hospital, we are routinely using lavender-peppermint aromatherapy in patients who indicate they are anxious before surgery.”

One possible mechanism of action of aromatherapy is through the limbic system, a brain structure known to regulate pain, emotion and anxiety. Professor Chelly and colleagues plan to study the effect of aromatherapy on the brain next, using MRI.

To arrange an interview, please email the study’s author: Professor Jacques Chelly, Department of Anaesthesiology, University of Pittsburgh, Pittsburgh, USA. E) ChelJE@anes.upmc.edu or contact the University of Pittsburgh Medical Center (UPMC) public relations office T) +1 412 647 3555 E) mediarelations@upmc.edu 

Alternative contact: Tony Kirby in the Euroanaesthesia Media Centre. T) +44 7834 385827 E) tony@tonykirby.com

Notes to editors:

References:

1. Jones T et al. Lavender Aromatherapy to Reduce Anxiety During Intrauterine Insemination: A Randomized Controlled Trial. Glob Adv Health Med. 2021 Nov 17

2. https://www.thelancet.com/journals/lanpub/article/PIIS2468-2667(22)00043-3/fulltext

 

The aromatabs were supplied by Beekley Medical. The authors declare no conflicts of interest.

This press release is based on abstract 08AP02-05 at Euroanaesthesia, the annual meeting of the European Society of Anaesthesiology and Intensive Care (ESAIC). The material has been peer reviewed by the congress selection committee. There is no full paper at this stage.

Note, since submitting their work, the authors have updated it and these changes are included in the poster. No abstract is supplied for this reason. 

For press release in Spanish, click here

 For press release in Portuguese, click here

 

Young adults turn crushes into love, UC Davis study suggests

First study to look at early relationships and how they do and do not develop

Peer-Reviewed Publication

UNIVERSITY OF CALIFORNIA - DAVIS

The image of young adults living in a hookup culture with emotionally meaningless relationships might be a common theme in movies and daytime talk shows. But it does not seem to be the norm in real college life, suggests a new study from University of California, Davis, researchers.

The study, published May 28, is the first of its kind to look at early relationship development — the time period in which people experience rising and falling romantic interest for partners who could, but often do not, become committed partners; in other words, “crushes.” Previous studies have examined committed relationships on one extreme, and first impressions on the opposite extreme.

To obtain their data, researchers surveyed 208 heterosexual college students at a Midwestern university about their dating habits, their various likes and dislikes, and attraction to potential partners over a seven-month period. Participants described an average of five crushes during this stretch of time and reported about 15% of them turning into dating relationships at some point. They collected a total of over 7,000 reports on these potential partners.

What predicted whether or not these attractions ultimately fizzled?

“What took us by surprise is that many of the important factors were the same things you would have seen in a committed relationship,” noted Paul Eastwick, UC Davis professor in the Department of Psychology and lead author of the study. “This supposed hookup melee actually looks a lot like people taking relationships for a test run.”

The authors used machine-learning approaches to identify the strongest predictors of romantic interest in each crush. Machine learning, or the use of algorithms and statistical models to analyze and draw inferences from patterns in data, is especially useful at identifying predictors that are likely to be robust and replicable, the authors said.

Over the course of the study, some of the best predictors of sustained interest in a partner turned out to be markers of attachment, such as seeking out someone’s presence as much as possible, feeling distressed when separated from them, and wanting to tell them about successes. These features are traditionally considered markers of pair-bonded relationships.

“When feelings of attachment and emotional connection start to kick in, young adults seem to take it as a sign that this is a crush worth pursuing,” said study co-author Samantha Joel, an assistant professor of psychology at Western University. “Sexual and emotional attraction seem to go hand-in-hand, even before a committed relationship materializes.”

Other factors that were known to be critical in initial impression contexts had no effect at all in the current study. Specifically, physical attractiveness — the most commonly studied variable in the whole initial attraction literature — was surprisingly weak.

Participants also uploaded photographs of their crushes, and the researchers used a team of coders, who didn’t know the subjects of the photographs or anything about them, to rate how physically attractive the crushes were on a 1-10 scale. This variable turned out to be completely irrelevant to whether participants were romantically interested in the crushes.

“If we had been looking at a bar, or speed-dating — a setting where you have to compete to be noticed — these coder ratings of physical attractiveness should have been exceptionally good at predicting which partners were highly desired and which ones were not,” Eastwick explained. “But that isn’t what the data revealed at all.”

According to Eastwick, these findings imply that early relationship development is a mating context in which people search for evidence of compatibility. “It isn’t about fighting to get the ‘most valuable’ partner you can,” he said. “It’s about trying to find someone who inspires both a sexual and emotional connection. That’s how young people initiate relationships.”   

The study, “Predicting Romantic Interest During Early Relationship Development: A Preregistered Investigation Using Machine Learning,” was published in The European Journal of Personality. Co-authors were Joel; Kathleen Carswell, assistant professor, Durham University; Daniel C. Molden and Eli J. Finkel, professors, Northwestern University; and Shelley A. Blozis, professor of psychology, UC Davis. This study was designed by Molden and Finkel.

 

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JOURNAL

European Journal of Personality

DOI

10.1177/08902070221085877 

METHOD OF RESEARCH

Survey

SUBJECT OF RESEARCH

People

ARTICLE TITLE

Predicting romantic interest during early relationship development: A preregistered investigation using machine learning