One-size-fits-all content moderation fails the Global South

Reports and Proceedings

CORNELL UNIVERSITY

ITHACA, N.Y. – Social media companies need content moderation systems to keep users safe and prevent the spread of misinformation, but these systems are often based on Western norms, and unfairly penalize users in the Global South, according to new research at Cornell University.

Farhana Shahid, lead researcher and doctoral student in information science, interviewed people from Bangladesh who had received penalties for violating Facebook’s community standards. Users said the content moderation system misinterpreted their posts, removed content that was acceptable in their culture and operated in ways they felt were unfair, opaque and arbitrary.

“Pick any social media platform and their biggest market will be somewhere in the East,” said co-author Aditya Vashistha, assistant professor of information science. “Facebook is profiting immensely from the labor of these users and the content and data they are generating. This is very exploitative in nature, when they are not designing for the users, and at the same time, they’re penalizing them and not giving them any explanations of why they are penalized.”

Shahid will present their work in April at the Association for Computing Machinery (ACM) CHI Conference on Human Factors in Computing Systems.

Even though Bengali is the sixth most common language worldwide, Shahid and Vashistha found that content moderation algorithms performed poorly on Bengali posts. The moderation system flagged certain swears in Bengali, while the same words were allowed in English. The system also repeatedly missed important context. When one student joked “Who is willing to burn effigies of the semester?” after final exams, his post was removed because it might incite violence.

Another common complaint was removing posts that were acceptable in the local community, but violated Western values. When a grandmother affectionately called a child with dark skin a “black diamond,” the post was flagged for racism, even though Bangladeshis do not share the American concept of race. In another instance, Facebook deleted a 90,000-member group that provides support during medical emergencies because it shared personal information – phone numbers and blood types in emergency blood donation request posts by group members.

The restrictions imposed by Facebook had real-life consequences. Several users were barred from their accounts – sometimes permanently – resulting in lost photos, messages and online connections. People who relied on Facebook to run their businesses lost income during the restrictions, and some activists were silenced when opponents maliciously and incorrectly reported their posts.

Participants reported feeling “harassed,” and frequently did not know which post violated the community guidelines, or why it was offensive. Facebook does employ some local human moderators to remove problematic content, but the arbitrary flagging led many users to assume that moderation was entirely automatic. Several users were embarrassed by the public punishment and angry that they could not appeal, or that their appeal was ignored.

“Obviously, moderation is needed, given the amount of bad content out there, but the effect isn’t equally distributed for all users,” Shahid said. “We envision a different type of content moderation system that doesn’t penalize people, and maybe takes a reformative approach to better educate the citizens on social media platforms.”

Instead of a universal set of Western standards, Shahid and Vashistha recommended that social media platforms consult with community representatives to incorporate local values, laws and norms into their moderation systems. They say users also deserve transparency regarding who or what is flagging their posts and more opportunities to appeal the penalties.

“When we’re looking at a global platform, we need to examine the global implications,” Vashistha said. “If we don’t do this, we’re doing grave injustice to users whose social and professional lives are dependent on these platforms.”

For additional information, see this Cornell Chronicle story.

Cornell University has dedicated television and audio studios available for media interviews.

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DOI

10.1145/3544548.3581538 

Research Brief: Genetic background, social rank identified as factors in aging and lifespan in animals

Peer-Reviewed Publication

UNIVERSITY OF MINNESOTA MEDICAL SCHOOL

MINNEAPOLIS/ST. PAUL (04/13/2023) — Published in PNAS, University of Minnesota Medical School researchers found that genetic background and social rank are critical contextual modifiers of aging and lifespan in animal models of social stress. 

“This is the largest translational study yet on the impact of lifelong social stress on healthspan, aging-associated diseases, epigenome and lifespan. This work provides a preclinical, experimental model to study the impact of social determinants of health disparities and accelerated aging in human populations,” said Maria Razzoli, PhD, a senior scientist at the U of M Medical School.

Low social status is associated with greater levels of stress, which is known to have negative consequences on health and aging. However, individual differences make it unclear whether genetic predispositions and/or the experienced degree of stress are critical risk factors for disease and mortality. This study sought to address this gap in knowledge and test whether genetic background moderates the effect of social status on health and aging. 

The research team found low social status corresponded to a shorter lifespan in their study population. However, the study revealed that low status, high status and unstable social status were each identified as the most disadvantageous in different genetic backgrounds. The research team also linked social status to effects on survival with changes in global DNA methylation patterns in the liver.

Further research will focus on the timing of stress exposure from pre-conception to old age. Additionally, future studies are suggested to examine the ability to measure the biological age of an individual using a variety of approaches and determine how stress accelerates it in relation to the individual’s chronological age. This would allow researchers to estimate the risk of disease development and life expectancy. 

“The ultimate goal of this research is to develop preclinical approaches to support the development of therapeutic interventions to protect against the negative toll of life stress on aging-associated diseases,” said Alessandro Bartolomucci, PhD, a professor at the U of M  Medical School.

Funding for this research was provided by the National Institutes of Health’s National Institute on Aging (R01AG043972, R61AG078520), the Minnesota Partnership for Biotechnology and Medical Genomics, Fesler-Lampert Chair in Aging Studies and IBP Grant Accelerator Program.

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About the University of Minnesota Medical School

The University of Minnesota Medical School is at the forefront of learning and discovery, transforming medical care and educating the next generation of physicians. Our graduates and faculty produce high-impact biomedical research and advance the practice of medicine. We acknowledge that the U of M Medical School, both the Twin Cities campus and Duluth campus, is located on traditional, ancestral and contemporary lands of the Dakota and the Ojibwe, and scores of other Indigenous people, and we affirm our commitment to tribal communities and their sovereignty as we seek to improve and strengthen our relations with tribal nations. For more information about the U of M Medical School, please visit med.umn.edu.

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JOURNAL

Proceedings of the National Academy of Sciences

DOI

10.1073/pnas.2211755120 

METHOD OF RESEARCH

Randomized controlled/clinical trial

SUBJECT OF RESEARCH

Animals

ARTICLE TITLE

Contextual modifiers of healthspan, lifespan, and epigenome in mice under chronic social stress

ARTICLE PUBLICATION DATE

12-Apr-2023

COI STATEMENT

B.H.C. is a full-time employee of FOXO Technologies Inc., which seeks to commercialize epigenetic technologies in the life insurance industry. B.H.C. owns stock in Illumina Inc., the manufacturer of the DNA methylation arrays used in this study. B.H.C. is listed as a co-inventor in filed patents on commercial applications of epigenetic prediction models. The other authors declare no competing interest.

LGBTQ+ adults report higher rates of pain, US survey data shows

Western University sociology professor says pain can be used as an overall holistic measure of physical and psychological wellbeing at the population level

Peer-Reviewed Publication

UNIVERSITY OF WESTERN ONTARIO

A new study analyzing data from the 2013 - 2018 National Health Interview Survey (NHIS) has found the number of people who report being in pain is significantly higher among LGBTQ+ adults than straight adults. 

Western University sociology professor Anna Zajacova said pain has not been studied from a population perspective in the past because it was assumed to be a symptom of something else.

“However, chronic pain is now widely understood as a condition in its own right. It’s an important condition, too, given its high burden in the population and tremendous impact individuals’ quality of life,” said Zajacova, a co-author on the study recently published in the journal Pain. “In fact, we view pain as an overall holistic measure of physical and psychological wellbeing at the population level.”

The analysis was conducted by researchers from Western, the University at Buffalo, State University of New York, Michigan State University, Ohio State University and National Center for Complementary and Integrative Health. The researchers found LGBTQ+ adults (those who self-identified in the National Health Interview Survey as gay, lesbian, bisexual or “something else”) reported markedly higher levels of pain.

The results showed that compared with straight adults, gay and lesbian adults had a 47 per cent higher prevalence of pain and a 33 percent higher prevalence of chronic pain, bisexual adults had a 105 per cent higher prevalence of pain and an 88 percent higher prevalence of chronic pain.

Of the other factors examined, the one most strongly linked with higher prevalence of pain in LGBTQ+ groups was psychological distress. Socioeconomic status and health care covariates played only modest roles, which were not statistically significant.

“These findings highlight the importance of psychosocial inputs and supports that seem to be driving a lot of the differences," Zajacova said.

The authors suggest  the stigma and discrimination faced by members of these groups may increase the risk of pain. They called for additional research to develop a fuller understanding of pain disparities by sexual identity, with the ultimate goal of eliminating disparities and reducing pain to achieve better health and well-being.

The authors stress t this kind of data collection is important in the Canadian context as well.

“I suspect  we might see similar patterns in Canada despite it being more advanced in terms of sociolegal acceptance of LGBTQ+ adults, because what we are seeing seems to hint at the psychosocial issues that may be influencing higher prevalence of pain,” Zajacova said.

The data used in this analysis are for adults aged 18 to 64 who participated in the 2013–2018 waves of the NHIS. They also answered questions about chronic pain, defined in the survey as having pain most days or every day in the past three months (2013–2015 and 2018) or six months (2016 and 2017) and pain at three or more sites (defined as positive responses to questions about three or more of the following: low-back pain, neck pain, severe headache or migraine, facial or jaw ache or pain, and persistent joint pain). Data were also collected on a variety of other factors such as socioeconomic characteristics, health behaviours and psychological distress.

Read the full study here: https://pubmed.ncbi.nlm.nih.gov/37017364/

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JOURNAL

Pain

DOI

10.1097/j.pain.0000000000002891 

METHOD OF RESEARCH

Data/statistical analysis

SUBJECT OF RESEARCH

People

ARTICLE TITLE

Chronic pain among U.S. sexual minority adults who identify as gay, lesbian, bisexual, or "something else"

Kombucha to kimchi: Which fermented foods are best for your brain? 

Reports and Proceedings

MICROBIOLOGY SOCIETY

Many countries around the world have their own staple fermented foods which are ingrained into culture and diet. It can’t be a coincidence that this has happened again and again. It seems logical that fermented foods offer more than a method of preservation.  

Diet can hugely impact your mental health and previous research has shown that some foods are particularly good at positively impacting your brain. Fermented foods are a source of tryptophan, an amino acid key to the production of serotonin, a messenger in the brain which influences several aspects of brain function, including mood. The foods may also contain other brain messengers (known as neurotransmitters) in their raw form. It’s no surprise then that research has shown that eating fermented foods may have various long- and short-term impacts on brain function, such as reducing stress. But which foods have the biggest impact on brain health?  

Researchers at APC Microbiome, University College Cork, and Teagasc (Ireland’s Agriculture and Food Development Authority) in Moorepark, Cork, Ireland are currently working on a large study to finally answer this question. Ramya Balasubramanian and the team at APC compared sequencing data from over 200 foods from all over the world, looking for a variety of metabolites that are known to be beneficial to brain health.   

The study is still in it’s initial stages, but researchers are already surprised by preliminary results. Ramya explains, “I expected only a few fermented foods would show up, but out of 200 fermented foods, almost all of them showed the ability to exert some sort of potential to improve gut and brain health”. More research is needed to fully understand which groups of fermented foods have the greatest effects on the human brain, but results are showing an unexpected victor. 

“Fermented sugar-based products and fermented vegetable-based products are like winning the lottery when it comes to gut and brain health”, explains Ramya.  

“For all that we see on sugar-based products being demonised, fermented sugar takes the raw sugar substrate, and it converts it into a plethora of metabolites that can have a beneficial effect on the host. So even though it has the name ‘sugar’ in it, if you do a final metabolomic screen, the sugar gets used by the microbial community that's present in the food, and they get converted into these beautiful metabolites that are ready to be cherry picked by us for further studies.”  

These further studies are what’s next for Ramya. She plans to put her top ranked fermented foods through rigorous testing using an artificial colon and various animal models to see how these metabolites affect the brain.   

Ramya hopes that the public can utilise these preliminary results and consider including fermented foods in their diet as a natural way of supporting their mental health and general well-being. 

BU faculty member receives Midwifery Award

Grant and Award Announcement

BOSTON UNIVERSITY SCHOOL OF MEDICINE

FOR IMMEDIATE RELEASE, April 13, 2023

 

BU Faculty Member Receives Midwifery Award 

(Boston)—JoAnna Rorie, CNM, PhD, clinical associate professor of obstetrics & gynecology at Boston University Chobanian & Avedisian School of Medicine, has been selected to receive the Dorthea Lang Pioneer Award, the most prestigious midwifery award by the American College of Nurse Midwives (ACNM). This award honors one exceptional CNM who has exhibited vision, leadership, and innovation, and made a lasting mark on the field of midwifery and midwifery educational programs and the integration of midwifery into the health care systems.

 

Rorie was also selected by the Boston Celtics to receive their Hero Among Us Award which is presented to an individual who, through their unique commitment and humanitarian spirit, has made exceptional and lasting contributions to our community. She was given this award during the halftime show at a recent Boston Celtics game.

 

A tireless member of the midwifery service at Boston Medical Center, Rorie can be found on rounds, checking in on new mothers in the hours following birth, educating medical students and residents and traveling into the community on the Curbside Care for Moms and Babies mobile unit which provides comprehensive mother-infant dyadic care during the first six weeks of life.

 

Rorie has advocated and provided care to the most vulnerable members of the Boston community for more than 40 years working with the incarcerated at MCI-Framingham medium security prison where she was the first midwife to provide prenatal care to inmates. She provided full scope midwifery care to women in conflict with the law at a residential treatment program the Neil J. Houston House on the Dimock Community Health Center in Roxbury and worked for HealthCare Without Walls, providing care to the unhoused people of Boston.

 

Rorie started the first midwifery service at Boston’s Beth Israel Deaconess Medical Center (BIDMC) in 1981 developing their policies and procedures while increasing staffing to care for women from community health centers delivering at BIDMC. She also initiated midwifery care at the Dimock Health Center, providing full scope care there for more than 20 years while directing their women’s health program. During her tenure, Dimock was chosen to be one of the first sites funded by the national Healthy Baby Healthy Child Program.

 

Rorie helped initiate and taught in the joint program for midwifery and public health at Boston University School of Public Health. During her tenure as faculty she advocated, supported and mentored young midwives of color – aware more than  30 years ago that this is key to improving health outcomes for black and brown members of our community.

 

Currently she serves as an advisor to the Neighborhood Birth Center, a stand-alone birth center set to open in 2024 in Roxbury. This birth center will center the experience of black and brown birthing people in a time of devastating increases in black maternal morbidity and mortality.  

Effectiveness of COVID-19 mRNA vaccination for children and adolescents confirmed by multi-state study

Peer-Reviewed Publication

REGENSTRIEF INSTITUTE

A multi-state study from the Centers for Disease Control and Prevention’s (CDC’s) VISION Network confirms that the Pfizer-BioNTech mRNA COVID-19 vaccine has provided children and adolescents, ages 5-17, with protection against both moderate and severe COVID-19 outcomes.

The study found that for 12-17 year olds, vaccine effectiveness was high against the Delta variant but lower during Omicron dominance, including BA.4 and BA.5. Due to the youngest age (5-11) group’s ineligibility for vaccination during Delta predominance, vaccine effectiveness could be estimated for these children only during the Omicron predominant period. Vaccine protection against emergency department/urgent care visits (markers for moderate disease) were similar across the 5-17 age range during Omicron.

In addition to differing by predominant circulating virus variant, vaccine effectiveness against COVID-19-associated emergency department/urgent care visits and hospitalizations fluctuated by vaccination and, if age eligible, a first booster dose. Protection waned substantially five months after a second vaccine dose for all age groups. In adolescents, protection increased after a booster. Children younger than 12 were ineligible for a booster.

COVID-19 in children and teens is often mild but can lead to hospitalization and death. Data reviewed by the study authors showed that 83 percent of COVID positive hospitalizations of 5–17-year-olds were among unvaccinated patients. Of those hospitalized, 38 percent were non-Hispanic White, 26 percent were Hispanic and 17 percent were non-Hispanic Black.

The Pfizer-BioNTech mRNA COVID-19 vaccine was authorized by the U.S. Food and Drug Administration in December 2020 for immunocompetent individuals 16 years or older, in May 2021 for 12–15-year-olds and in October 2021 for 5-11-year-olds.

“This study adds to what we knew about vaccine effectiveness for children and adolescents. Vaccination protected against emergency department/urgent care visits and hospitalizations, indicating that it protected well against the moderate and severe outcomes of COVID-19,” said study co-author Shaun Grannis, M.D., M.S., Regenstrief Institute vice president for data and analytics. “This study is important because we weren't sure if the vaccine was going to work well in children and adolescents and how it would work. We found effectiveness decreased during Omicron, which hadn’t been clear, but vaccination still provided significant protection. Effectiveness increased after the monovalent booster for those who were eligible.

“We can’t predict the future, so we are studying severity and trends through different epochs, different eras of COVID. It's important to continue doing what we're doing, which is monitoring the effectiveness of the vaccines over time, because we're dealing with variants that behave differently,” Dr. Grannis observed.

This study included pediatric electronic health record (EHR) data from April 2021 through September 2022 from 201 emergency departments, 105 urgent care clinics and 164 hospitals from nine VISION network partners across 10 states: Baylor Scott and White Health, Columbia University Irving Medical Center, HealthPartners/Children’s Minnesota, Intermountain Healthcare, Kaiser Permanente Northern California, Kaiser Permanente Northwest, Paso del Norte Health Information Exchange, Regenstrief Institute and University of Colorado. Vaccination data from state and local immunization registries and claims were also reviewed.

“If parents are looking for support for their decision or inclination to vaccinate their child, this study provides good evidence that the vaccine is helpful and offers protection,” said Dr. Grannis, who is also a professor of family medicine at Indiana University School of Medicine. “This analysis also provides scientifically-based guidance to clinicians who care for children and adolescents.”

“Effectiveness of BNT162b2 COVID-19 Vaccination in Children and Adolescents” is published in Pediatrics, the official peer-reviewed flagship journal of the American Academy of Pediatrics, the largest professional association of pediatricians in the U.S.

Regenstrief Institute authors of this VISION Network study, in addition to Dr. Grannis, are Brian Dixon, PhD, MPA, interim director of the Center for Biomedical Informatics; William F. Fadel, PhD, Nimish Ramesh Valvi, DrPH, MBBS; and former Institute president and current affiliated scientist Peter EmbÍ, M.D.

All authors of the study are:

Nicola P. Klein, M.D., PhD1; Maria Demarco, PhD2; Katherine E. Fleming-Dutra, M.D.3; Melissa S. Stockwell, M.D., MPH4,5,6; Anupam B. Kharbanda, M.D., MSc7; Manjusha Gaglani, MBBS8,9; Suchitra Rao, MBBS, MSCS10; Ned Lewis, MPH1; Stephanie A. Irving, MHS17; Emily Hartmann, MPP11; Karthik Natarajan, PhD6,12; Alexandra F. Dalton, PhD3; Ousseny Zerbo, PhD1; Malini B. DeSilva, M.D., MPH13; Deepika Konatham, B.S.8; Edward Stenehjem, M.D., MSc14; Elizabeth A. K. Rowley, DrPH2; Toan C. Ong, PhD10; Shaun J. Grannis, M.D., M.S.15,16; Chantel Sloan-Aagard, PhD11,18; Jungmi Han, B.S.12; Jennifer R. Verani, M.D.3; Chandni Raiyani, BDS, MPH8; Kristin Dascomb, M.D., PhD14; Sarah E. Reese, PhD2; Michelle A. Barron, M.D.10; William F. Fadel, PhD15,16; Allison L. Naleway, PhD17; Juan Nanez, R.N., BSN11; Monica Dickerson, B.S.3; Kristin Goddard, MPH1; Kempapura Murthy, MBBS, MPH8; Nancy Grisel, MPP14; Zachary A. Weber, PhD, M.S.2; Brian E. Dixon, PhD, MPA15,16; Palak Patel, MBBS, MPH3; Bruce Fireman, MA1; Julie Arndorfer, MPH14; Nimish R. Valvi, DrPH15; Eric P. Griggs, MPH3; Carly E. Hallowell, MPH, M.S.2; Peter J. EmbÍ, M.D., M.S.15,19,20; Sarah W. Ball, ScD, MPH2; Mark G. Thompson3; Mark W. Tenforde, M.D., PhD3; and Ruth Link-Gelles, PhD3.

1Kaiser Permanente Vaccine Study Center, Kaiser Permanente Northern California Division of Research, Oakland;

2Westat, Rockville, Maryland;

3Centers for Disease Control and Prevention

COVID-19 Response Team, Atlanta, Georgia;

4Division of Child and Adolescent Health,

Department of Pediatrics, Columbia University Vagelos College of Physicians and Surgeons, New York, New York;

5Department of Population and Family Health, Columbia University

Mailman School of Public Health, New York, New York;

6New York-Presbyterian Hospital, New York;

7Children's Minnesota, Minneapolis, Minnesota;

8Department of Pediatrics, Section of Pediatric Infectious Diseases, Baylor Scott & White Health, Temple, Texas;

9Department of Medical Education, Texas A&M University College of Medicine, Temple, Texas;

10Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, Colorado;

11Paso del Norte Health Information Exchange (PHIX), El Paso, Texas;

12Department of Biomedical Informatics, Columbia University Irving Medical Center, New York, New York;

13HealthPartners Institute, Minneapolis, Minnesota;

14Division of Infectious Diseases and Clinical Epidemiology, Intermountain Healthcare, Salt Lake City, Utah;

15Center for Biomedical Informatics, Regenstrief Institute, Indianapolis, Indiana; 16Fairbanks School of Public Health, Indiana University, Indianapolis;

17Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon; 18Brigham Young University Department of Public Health, Provo, Utah;

19School of Medicine, Indiana University, Indianapolis, Indiana; 20Vanderbilt University Medical Center, Nashville, Tennessee

About Shaun Grannis, M.D., M.S.

In addition to his role as the vice president of data and analytics at Regenstrief Institute, Shaun Grannis, M.D., M.S., holds the Regenstrief Chair in Medical Informatics and is a professor of family medicine at Indiana University School of Medicine.

About Regenstrief Institute

Founded in 1969 in Indianapolis, the Regenstrief Institute is a local, national and global leader dedicated to a world where better information empowers people to end disease and realize true health. A key research partner to Indiana University, Regenstrief and its research scientists are responsible for a growing number of major healthcare innovations and studies. Examples range from the development of global health information technology standards that enable the use and interoperability of electronic health records to improving patient-physician communications, to creating models of care that inform practice and improve the lives of patients around the globe.

Sam Regenstrief, a nationally successful entrepreneur from Connersville, Indiana, founded the institute with the goal of making healthcare more efficient and accessible for everyone. His vision continues to guide the institute’s research mission.

About IU School of Medicine

IU School of Medicine is the largest medical school in the U.S. and is annually ranked among the top medical schools in the nation by U.S. News & World Report. The school offers high-quality medical education, access to leading medical research and rich campus life in nine Indiana cities, including rural and urban locations consistently recognized for livability. 

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JOURNAL

PEDIATRICS

DOI

10.1542/peds.2022-060894 

ARTICLE TITLE

Effectiveness of BNT162b2 COVID-19 Vaccination in Children and Adolescents

In-person vs virtual education and community COVID-19 case incidence following school re-openings

JAMA Network Open

Peer-Reviewed Publication

JAMA NETWORK

About The Study: In a study of matched pairs of counties that reopened with in-person versus virtual instruction at the secondary school level in the 2020 to 2021 academic year, counties with in-person school instructional models early in the COVID-19 pandemic experienced increases in county-level COVID-19 incidence at six and eight weeks after in-person reopening, compared with counties with virtual instructional models. 

Authors: Meredith Matone, Dr.P.H., of Children’s Hospital of Philadelphia, is the corresponding author. 

To access the embargoed study: Visit our For The Media website at this link https://media.jamanetwork.com/ 

(doi:10.1001/jamanetworkopen.2023.8300)

This link will be live at the embargo time http://jamanetwork.com/journals/jamanetworkopen/fullarticle/10.1001/jamanetworkopen.2023.8300?utm_source=For_The_Media&utm_medium=referral&utm_campaign=ftm_links&utm_term=041423

About JAMA Network Open: JAMA Network Open is an online-only open access general medical journal from the JAMA Network. On weekdays, the journal publishes peer-reviewed clinical research and commentary in more than 40 medical and health subject areas. Every article is free online from the day of publication.

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JOURNAL

JAMA Network Open

PRISON NATION U$A

Analysis of health and prescription data suggests chronic health conditions in U.S. incarcerated people may be severely undertreated

Findings suggest conditions go untreated in prison inmates compared to general population

Peer-Reviewed Publication

JOHNS HOPKINS BLOOMBERG SCHOOL OF PUBLIC HEALTH

Chronic conditions such as type 2 diabetes, asthma, HIV infection, and mental illness may be greatly undertreated in the U.S. jail and prison population, suggests a new study from researchers at the Johns Hopkins Bloomberg School of Public Health.

For their analysis, the researchers used national health survey data covering 2018 to 2020 to estimate rates of chronic conditions among recently incarcerated people, and a commercial prescription database to estimate the distribution of medication treatments to the jail and prison population. Their analysis suggests that for many common and serious conditions, incarcerated people are substantially less likely to be treated compared to the general U.S. population.

The study found that recently incarcerated individuals with type 2 diabetes represented about 0.44 percent of the U.S. burden of the condition, but got only 0.15 percent of oral anti-hyperglycemic medications—nearly a threefold difference. Incarcerated individuals with asthma accounted for 0.85 percent of the total U.S. asthma population, but just 0.15 percent of asthma treatment volume, a more than fivefold difference.

The study will be published online April 14 in JAMA Health Forum.

“Our findings raise serious concerns about the access to and quality of pharmacologic care for very common chronic health conditions among the incarcerated,” says study senior author G. Caleb Alexander, MD, professor in the Department of Epidemiology at the Bloomberg School. “We knew going in that the U.S. incarcerated population has a higher prevalence of some chronic diseases. But we were really surprised by the extent of potential undertreatment that we identified.”

Prior studies have found evidence that health care provided to the U.S. incarcerated population—roughly two million individuals—is often understaffed, underfunded, and of poor quality. Yet studying health care issues among the incarcerated involves many challenges. Few studies have examined treatment of common and chronic diseases such as diabetes and asthma.

“Health care provided in jails and prisons is provided by a patchwork of health care providers, most commonly private contractors who do not widely share information about the services they provide to incarcerated people,” says study co-author Brendan Saloner, PhD, an associate professor in the Bloomberg School’s Department of Health Policy and Management. “The lack of transparency means that advocates and policymakers have a very incomplete picture of the medicines that are available during a stay in jail or prison.”

The lack of transparency also makes it difficult to research. For their study, the researchers generated two sets of estimates: one for the prevalence of specific conditions among recently incarcerated inmates, the other on the percentage of common chronic illness prescriptions going to jails and state prisons.

For the disease prevalence estimates, the researchers used recent data from U.S. government-sponsored National Surveys on Drug Use and Health. These annual surveys don’t cover prison and jail populations directly, but the researchers estimated condition prevalence among adult survey respondents who either had or had not reported being on parole or having been arrested and booked in the prior year. They combined these figures with U.S. Census data, and generated population estimates for state prisons and local jails to gauge the approximate numbers of incarcerated and non-incarcerated individuals with different conditions.

To get a sense of prescriptions dispensed to the incarcerated vs. the non-incarcerated populations, the researchers used data from the same time period from the health care technology company IQVIA. Because of the lack of data on federal prison inmates, the incarcerated population for the analysis included only individuals in local jails and state prisons. The authors made adjustments for the possibility of missing data, and note that their numbers may underestimate disparities between incarcerated individuals and their counterparts.

The analysis yielded estimates for the prevalence of chronic conditions that suggested particularly heavy burdens of some illnesses in the incarcerated population—for example, hepatitis (6.08 percent prevalence among the incarcerated vs. 1.41 for the non-incarcerated), HIV infection (0.84 percent vs. 0.28 percent), depression (15.10 percent vs. 7.64 percent), and severe mental illness (13.12 percent vs. 4.89 percent).

As for prevalence-treatment differentials among the incarcerated, the study also found that incarcerated individuals with HIV represented about 2.2 percent of the U.S. burden of the condition, but got only 0.73 percent of HIV antivirals—a threefold difference. Incarcerated individuals with severe mental illness represented an estimated 1.97 percent of disease burden, but only 0.48 percent of treatment volume consisting of antipsychotics and mood stabilizers, a fourfold difference.

Alexander says that the findings may reflect not only institutional neglect but also factors such as the temporary nature of many local jail stays, and the high prevalence of mental illness—which tends to complicate treatment of other conditions—in the incarcerated population.

“We hope our results will motivate further investigations that continue to explore these vital matters using a variety of data sources,” he says.

“Estimated Use of Prescription Medications Among Individuals Incarcerated in Jails and State Prisons in the US” was co-authored by Jill Curran, Brendan Saloner, Tyler Winkelman, and G. Caleb Alexander.

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JOURNAL

JAMA Health Forum

DOI

10.1001/jamahealthforum.2023.0482 

ARTICLE TITLE

Estimated Use of Prescription Medications Among Individuals Incarcerated in Jails and State Prisons in the US

ARTICLE PUBLICATION DATE

14-Apr-2023

Offering medications for opioid addiction to incarcerated individuals leads to decrease in overdose deaths

Peer-Reviewed Publication

BOSTON MEDICAL CENTER

BOSTON – New research from Boston Medical Center concluded that offering medications to treat opioid addiction in jails and prisons leads to a decrease in overdose deaths. Published in JAMA Network Open, the study also found that treating opioid addiction during incarceration is cost-effective in terms of healthcare costs, incarceration costs, and deaths avoided.

Overdoses kill more than 100,000 people per year in America and this number continues to increase every year. People with addiction are more likely to be incarcerated than treated, with those from communities of color who use drugs more likely to be incarcerated than White people. Most prisons and jails in the United States discontinue medications for opioid use disorder (MOUD) upon incarceration, even if taken stably prior to incarceration, and do not initiate MOUD prior to release. Patients often suffer withdrawal symptoms while incarcerated and the post incarceration period is a time of very high-risk for overdose death.

“Offering medications for opioid addiction for incarcerated individuals saves lives. Specifically, offering all three medications—buprenorphine, methadone, and naltrexone—is the most effective at saving lives and is more cost-effective,” said lead author Avik Chatterjee, MD, primary care and addiction medicine physician at Boston Medical Center and Boston Healthcare for the Homeless and assistant professor of medicine at Boston University Chobanian & Avedisian School of Medicine. “We hope our study supports policy change at the state and federal level, requiring treating opioid use disorder with medications among people who are incarcerated.”

The study modeled the impact of MOUD access during and upon release from incarceration on population-level overdose mortality and OUD-related treatment costs in Massachusetts using three different strategies: 1) no MOUD provided during incarceration or upon release, 2) offer only extended-release naltrexone (XR-NTX) upon release from incarceration, and 3) offer all three MOUD at intake.

Among 30,000 incarcerated people with OUD, offering no MOUD was associated with 40,927 MOUD treatment starts over a 5-year period and 1,259 overdose deaths after 5 years. Over 5 years, offering XR-NTX at release led to 10,466 additional treatment starts and 40 fewer overdose deaths. In comparison, offering all three MOUD at intake led to 11,923 additional treatment starts, compared to offering no MOUD, and 83 fewer overdose deaths. Among everyone with OUD in MA, “XR-NTX only” averted 95 overdose deaths over 5 years—a 0.9% decrease in state-level overdose mortality, while the all-MOUD strategy averted 192 overdose deaths—a 1.8% decrease.

In this simulation modeling study, researchers found that offering any MOUD to incarcerated individuals with OUD would prevent overdose deaths and offering all three MOUD would prevent more deaths and save money.

Researchers believe that a treatment-based approach is more appropriate than an incarceration-based one for treating addiction. Proactively offering treatment during incarceration can save lives and is a cost-effective health intervention, while also supporting the dignity of people who are incarcerated.

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About Boston Medical Center

Boston Medical Center is a leading academic medical center with a deep commitment to health equity and a proud history of serving all who come to us for care. BMC provides high-quality healthcare and wrap around support that treats the whole person, extending beyond our physical campus into our vibrant and diverse communities. BMC is advancing medicine, while training the next generation of healthcare providers and researchers as the primary teaching affiliate of Boston University Chobanian & Avedisian School of Medicine. BMC is a founding member of Boston Medical Center Health System, which supports patients and health plan members through a value based, coordinated continuum of care.

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JOURNAL

JAMA Network Open

DOI

10.1001/jamanetworkopen.2023.7036 

ARTICLE TITLE

Associated With Use and Nonuse of Medications for Opioid Use Disorder During Incarceration and at Release in Massachusetts

ARTICLE PUBLICATION DATE

14-Apr-2023

Volunteering or donating to charity could help ease your physical pain, study suggests

New study suggests that volunteering or donating money to charity reduces the effects of physical pain on the ability of people in UK to work.

Peer-Reviewed Publication

CITY UNIVERSITY LONDON

A new, first-of-its-kind study suggests that volunteering with any organisation, or donating money to charity, reduces the effects of physical pain on the ability of people to work, with volunteering having a larger effect than donating to charity.

The study from City, University of London and Harvard University also suggests that the more money donated to charity, the more physical pain was eased. It did not find a similar dose-dependent effect for the number of hours volunteered with an organisation. However, the study did suggest that the magnitude of pain easing from volunteering was more than ten times the effect that each additional year of age of a participant had on increasing pain interference in their work.

While both volunteering and donating to charity was associated with a larger reduction in pain interference than volunteering alone, the difference in the results was not statistically significant.

The authors argue that the positive emotions that have previously been linked with engaging in prosocial behaviour can help explain the current findings. In particular, volunteering has been found to be strongly associated with social connection which is a key predictor of wellbeing, including in relation to physical pain.

While prosocial behaviours, such as volunteering or donating to charity, have long been linked to benefits to one’s mental and physical health, until now, no study had investigated whether such behaviours were directly linked to reductions in physical pain.

In the study, the researchers performed analyses of responses to the United Kingdom Household Longitudinal Survey (UKHLS) between the years 2011 and 2020. The UKHLS is ongoing and is administered to participants annually, face-to-face. It was designed to be representative of the UK population as respondents represent all regions of the UK, ages, as well as educational and socioeconomic sectors.

In the main analysis, the responses of approximately 35,000 participants were used, responding to questions of whether they volunteered or not, donated to charity or not, and which were compared to their responses to whether physical pain interfered with their normal work (be it outside the home or housework) provided on a five-point scale of 0 (not at all) to 5 (extremely).  The average (mean) age of participants ranged from 49 to 48 years old across donating/volunteering groups, to 42 to 46 years old in the non donating/volunteering groups, with about 45 per cent of the respondents being men.

Further analyses found that, overall, respondents who did versus did not donate money to charity reported a slower rise in pain over time, although this effect was not found for those who volunteered.

While the authors cannot fully rule out concerns about reverse causality playing a part in the findings, whereby people experiencing more pain may not engage in prosocial behaviours, they argue that the longitudinal study design, and other factors help counteract these concerns.

Physical pain is one of the main reasons people visit the accident and emergency room in the UK. Approximately nine million people in the UK live with chronic pain and musculoskeletal pain alone accounts for 30 per cent of the country’s medical consultations. Physical pain is known to adversely affect a person’s quality of life, including their mental health, productivity at work, and their experience of their family and workplace. Understanding factors that help to reduce pain is necessary for the design of the public health policies needed to address the issue.

Lead author of the study, Dr Lucía Macchia, Lecturer in Psychology at City, University of London, said:

“This research contributes to the new and fast-growing literature that studies pain from a socioeconomic, psychosocial, and behavioural perspective. The work provides useful information for the design and evaluation of public health policies by uncovering how engaging in prosocial behaviour, which can create powerful positive emotions and reduce negative mood like stress, can positively affect one’s pain.”

The study is published online in the Journal of Psychosomatic Research.

ENDS

Notes to Editors

To speak to Dr Lucía Macchia, contact Shamim Quadir, Senior Communications Officer, School of Health Sciences, City, University of London. Tel: +44(0) 207 040 8782 Email: shamim.quadir@city.ac.uk.

Read the research article in the Journal of Psychosomatic Research:

https://www.sciencedirect.com/science/article/pii/S0022399923001824

City, University of London

• City, University of London is a global higher education institution committed to academic excellence, with a focus on business and the professions and an enviable central London location.
• City’s academic range is broadly-based with world-leading strengths in business; law; health sciences; mathematics; computer science; engineering; social sciences; and the arts including journalism and music.
• City has around 20,000 students (46% at postgraduate level) from more than 160 countries and staff from over 75 countries.
• In the last REF, City doubled the proportion of its total academic staff producing world-leading or internationally excellent research.
• More than 140,000 former students from over 180 countries are members of the City Alumni Network.
• The University’s history dates from 1894, with the foundation of the Northampton Institute on what is now the main part of City’s campus.  In 1966, City was granted University status by Royal Charter and the Lord Mayor of London became its Chancellor. In September 2016, City joined the University of London and HRH the Princess Royal became City’s Chancellor.

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JOURNAL

Journal of Psychosomatic Research

DOI

10.1016/j.jpsychores.2023.111325 

METHOD OF RESEARCH

Survey

SUBJECT OF RESEARCH

People

ARTICLE TITLE

Prosocial behaviour helps to ease physical pain: Longitudinal evidence from Britain