Tuesday, May 07, 2024

Beyond therapy: Virtual reality shows promise in fighting depression

JMIR PUBLICATIONS

(Toronto, May 6, 2024) A new study published in JMIR Mental Health sheds light on the promising role of virtual reality (VR) in treating major depressive disorder (MDD). Titled "Examining the Efficacy of Extended Reality–Enhanced Behavioral Activation for Adults With Major Depressive Disorder: Randomized Controlled Trial," the research, led by Dr Margot Paul and team from Stanford University, unveiled the effectiveness of extended reality (XR)–enhanced behavioral activation (XR-BA) in easing symptoms of depression.

MDD affects millions worldwide, and access to evidence-based psychotherapies remains a challenge for many. Traditional treatments often face barriers, prompting researchers to explore innovative solutions. XR, which includes VR, encompasses various immersive technologies involving computer-generated environments that blend physical and digital worlds. Leveraging the immersive power of XR, this study explored XR-BA as a potential game-changer in MDD treatment.

Dr Paul and team conducted a randomized controlled trial among 26 outpatients with MDD receiving remote care. Using a VR Meta Quest 2 headset, the participants engaged in simulated pleasant or mastery activities, including playing a magical VR board game, deciphering clues to solve puzzles, dancing to music, and playing mini golf alone or with friends. Though the learning curve for using the headset was high, participants reported that the experience became more enjoyable and useful over time.

The results were comparable to traditional behavioral activation delivered via telehealth. Both XR-BA and traditional behavioral activation helped reduce the severity of depression in a significant way, as measured by the Patient Health Questionnaire–9. Moreover, the findings suggest that individuals in the XR-BA group might have experienced a heightened expectancy or placebo response because of the novelty of the technology and implicit beliefs regarding mental health treatment.

"These results indicate that XR may help to de-stigmatize mental healthcare and reduce barriers to individuals seeking care. Clinicians could use XR as a treatment tool to help motivate clients to actively participate in their psychotherapy treatment by completing ‘homework’ that is novel, fun, and accessible," remarked Dr Paul.

The study underscores the potential of VR, particularly XR-BA, in revolutionizing depression treatment by offering efficacy akin to traditional therapy. This is a promising avenue for enhancing treatment outcomes and addressing barriers to accessing evidence-based psychotherapies for MDD, potentially expanding care for affected individuals. Additionally, the exploration of XR's capacity to amplify placebo effects hints at the transformative possibilities of technology-assisted mental health therapies.

Please cite as:

Paul M, Bullock K, Bailenson J, Burns D

Examining the Efficacy of Extended Reality–Enhanced Behavioral Activation for Adults With Major Depressive Disorder: Randomized Controlled Trial

JMIR Ment Health 2024;11:e52326

doi: 10.2196/52326

URL: https://mental.jmir.org/2024/1/e52326

###

About JMIR Publications:

JMIR Publications is a renowned publisher with a long-standing commitment to advancing digital health research and progressing open science. Our portfolio includes a wide array of prestigious open access, peer-reviewed journals dedicated to the dissemination of high-quality research in the field of digital health. JMIR Publications is celebrating its 25th anniversary in 2024 as the leading open access, digital health publisher.

To learn more about JMIR Publications, please visit jmirpublications.com or connect with us via Twitter, LinkedIn, YouTube, Facebook, and Instagram.

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The content of this communication is licensed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, published by JMIR Publications, is properly cited.

JOURNAL

JMIR Mental Health

DOI

10.2196/52326

METHOD OF RESEARCH

Randomized controlled/clinical trial

SUBJECT OF RESEARCH

People

ARTICLE TITLE

Examining the Efficacy of Extended Reality–Enhanced Behavioral Activation for Adults With Major Depressive Disorder: Randomized Controlled Trial

VR poses privacy risks for kids. A new study finds parents aren’t as worried as they should be

NORTH CAROLINA STATE UNIVERSITY

New research finds that, while an increasing number of minors are using virtual reality (VR) apps, not many parents recognize the extent of the security and privacy risks that are specific to VR technologies. The study also found that few parents are taking active steps to address those security and privacy issues, such as using parental controls built into the apps.

“In recent years we have seen an increase in the number of minors using VR apps that have social interaction elements, which increases security and privacy risks – such as unintended self-disclosures of sensitive personal information and surveillance of a user’s biometric data,” says Abhinaya S B, co-author of a paper on the work and a Ph.D. student at NC State.

“We wanted to see how much parents know about security and privacy risks associated with these VR apps, and what they are currently doing to address those risks,” Abhinaya says. “These findings will help us identify areas where parents, technology designers, and policymakers could do more to enhance children’s security and privacy.”

For the study, researchers conducted in-depth interviews with 20 parents who have children under the age of 18 at home who use VR apps. The interviews were designed to capture what sort of risks parents perceived regarding VR apps, what strategies the parents used to protect their children’s security and privacy in regard to VR apps, and which VR stakeholders the parents felt were responsible for protecting children who use the apps.

“We found that parents were primarily worried about physiological development issues,” Abhinaya says. “For example, some parents were worried about VR damaging children’s eyesight or children injuring themselves while using the apps.”

“There were also concerns that children would interact with people online who would be a bad influence on them,” says Anupam Das, co-author of the paper and an assistant professor of computer science at NC State. “In terms of privacy, there were concerns that children might reveal too much information about themselves to strangers online.”

“We found that parents did not seem too worried about data surveillance or data collection by the VR companies and app developers; they were more worried about risks of self-disclosure in social VR apps,” Abhinaya says.

“VR technologies capture a tremendous amount of data on user movement, which can be used to infer information ranging from a user’s height to medical conditions,” Das says.

“VR technologies also capture a user’s voice, and there are some concerns that voice recordings could be misused,” Das says. “For example, it’s possible that voice recordings might be manipulated with generative AI tools to create fake recordings. Only one parent was concerned about potential misuse of voice recordings.”

“To be clear, most parents were aware of the possibility of data surveillance, but the vast majority were not concerned about it,” Abhinaya says.

When it came to risk management strategies, the study found parents were having conversations with their children about being safe and not sharing personal information online. Many parents were also sharing VR accounts with their children, so that they could monitor their children’s VR app use.

However, very few parents were making use of parental controls that were built into the VR technologies.

“Most parents were aware that the controls existed, they just weren’t activating them,” Abhinaya says. “In some cases, parents felt their children were more tech-savvy than themselves, and wanted to give their kids autonomy regarding VR usage. This was particularly the case for teens. But in some cases, parents didn’t make use of the controls due to technical challenges.”

“In other words, some parents didn’t know how to properly activate the controls,” Das says. “There was also a desire for parental controls to incorporate additional features, such as a summary of what a child did while using a given app, who they interacted with, and so on.”

The study found that parents felt they had the primary responsibility for protecting their children against risks associated with VR use. However, the parents also felt that VR companies should incorporate usable parental controls to help parents reduce risks. In addition, parents felt policymakers should stay abreast of emerging technologies to create or modify laws and regulations that protect children online. Lastly, parents felt that schools have a role to play in teaching children how to navigate these new technologies safely.

“It is essential for parents to experience and understand VR before they let their children use it, to get a sense of the security and privacy risks VR may pose,” Das says. “However, while parents serve as the first line of defense for protecting children against these risks in VR, it is imperative for other stakeholders such as educators, developers, and policymakers to take proactive steps to ensure the comprehensive protection of children in VR environments.”

The paper, “Understanding Parents’ Perceptions and Practices Toward Children’s Security and Privacy in Virtual Reality,” will be presented at the IEEE Symposium on Security and Privacy, being held May 20-22 in San Francisco, Calif. The paper was co-authored by Jiaxun Cao and Pardis Emami-Naeini of Duke University.

This work was supported in part by an award from Meta Research.

METHOD OF RESEARCH

Survey

SUBJECT OF RESEARCH

People

COI STATE

Study: humans rate artificial intelligence as more ‘moral’ than other people

AI responses to questions of morality are getting better, and it raises some questions for the future

GEORGIA STATE UNIVERSITY

ATLANTA — A new study has found that when people are presented with two answers to an ethical question, most will think the answer from artificial intelligence (AI) is better than the response from another person.

“Attributions Toward Artificial Agents in a Modified Moral Turing Test,” a study conducted by Eyal Aharoni, an associate professor in Georgia State’s Psychology Department, was inspired by the explosion of ChatGPT and similar AI large language models (LLMs) which came onto the scene last March.

“I was already interested in moral decision-making in the legal system, but I wondered if ChatGPT and other LLMs could have something to say about that,” Aharoni said. “People will interact with these tools in ways that have moral implications, like the environmental implications of asking for a list of recommendations for a new car. Some lawyers have already begun consulting these technologies for their cases, for better or for worse. So, if we want to use these tools, we should understand how they operate, their limitations and that they’re not necessarily operating in the way we think when we’re interacting with them.”

To test how AI handles issues of morality, Aharoni designed a form of a Turing test.

“Alan Turing, one of the creators of the computer, predicted that by the year 2000 computers might pass a test where you present an ordinary human with two interactants, one human and the other a computer, but they’re both hidden and their only way of communicating is through text. Then the human is free to ask whatever questions they want to in order to try to get the information they need to decide which of the two interactants is human and which is the computer,” Aharoni said. “If the human can’t tell the difference, then, by all intents and purposes, the computer should be called intelligent, in Turing’s view.”

For his Turing test, Aharoni asked undergraduate students and AI the same ethical questions and then presented their written answers to participants in the study. They were then asked to rate the answers for various traits, including virtuousness, intelligence and trustworthiness.

“Instead of asking the participants to guess if the source was human or AI, we just presented the two sets of evaluations side by side, and we just let people assume that they were both from people,” Aharoni said. “Under that false assumption, they judged the answers’ attributes like ‘How much do you agree with this response, which response is more virtuous?’”

Overwhelmingly, the ChatGPT-generated responses were rated more highly than the human-generated ones.

“After we got those results, we did the big reveal and told the participants that one of the answers was generated by a human and the other by a computer, and asked them to guess which was which,” Aharoni said.

For an AI to pass the Turing test, humans must not be able to tell the difference between AI responses and human ones. In this case, people could tell the difference, but not for an obvious reason.

“The twist is that the reason people could tell the difference appears to be because they rated ChatGPT’s responses as superior,” Aharoni said. “If we had done this study five to 10 years ago, then we might have predicted that people could identify the AI because of how inferior its responses were. But we found the opposite — that the AI, in a sense, performed too well.”

According to Aharoni, this finding has interesting implications for the future of humans and AI.

“Our findings lead us to believe that a computer could technically pass a moral Turing test — that it could fool us in its moral reasoning. Because of this, we need to try to understand its role in our society because there will be times when people don’t know that they’re interacting with a computer and there will be times when they do know and they will consult the computer for information because they trust it more than other people,” Aharoni said. “People are going to rely on this technology more and more, and the more we rely on it, the greater the risk becomes over time.”

—By Katherine Duplessis

JOURNAL

Nature

SUBJECT OF RESEARCH

People

ARTICLE TITLE

Attributions toward artificial agents in a modified Moral Turing Test

AI to make crop production more sustainable

University of Bonn researchers publish agenda for the smart digitalization of agriculture

UNIVERSITY OF BONN

Drones in agriculture — IMAGE:
AMONG OTHER THINGS, RESEARCHERS IN THE PHENOROB CLUSTER OF EXCELLENCE AT THE UNIVERSITY OF BONN ARE INVESTIGATING THE USE OF DRONES IN AGRICULTURE.
view more
CREDIT: PHOTO: VOLKER LANNERT / UNIVERSITY OF BONN

Drones monitoring fields for weeds and robots targeting and treating crop diseases may sound like science fiction but is actually happening already, at least on some experimental farms. Researchers from the PhenoRob Cluster of Excellence at the University of Bonn are working on driving forward the smart digitalization of agriculture and have now published a list of the research questions that will need to be tackled as a priority in the future. Their paper has appeared in the European Journal of Agronomy.

That the Earth feeds over eight billion people nowadays is thanks not least to modern high-performance agriculture. However, this success comes at a high cost. Current cultivation methods are threatening biodiversity, while the production of synthetic fertilizers generates greenhouse gases, and agricultural chemicals are polluting bodies of water and the environment.

Many of these problems can be mitigated by using more targeted methods, e.g. by only applying herbicides to those patches of a field where weeds are actually becoming a problem rather than treating the whole area. Other possibilities are to treat diseased crops individually and to only apply fertilizer where it is really needed. Yet strategies like these are extremely complicated and virtually impossible to manage at scale by conventional means.

Harnessing high tech and AI to become more sustainable and efficient

“One answer could be to use smart digital technologies,” explains Hugo Storm, a member of the PhenoRob Cluster of Excellence. The University of Bonn has partnered with Forschungszentrum Jülich, the Fraunhofer Institute for Algorithms and Scientific Computing in Sankt Augustin, the Leibniz Centre for Agricultural Landscape Research in Müncheberg and the Institute of Sugar Beet Research in Göttingen on the large-scale project geared toward making farming more efficient and more environmentally friendly using new technologies and artificial intelligence (AI).

The researchers hail from all manner of different fields, including ecology, plant sciences, soil sciences, computer science, robotics, geodesy and agricultural economics. In their recently published position paper, they set out the steps that they believe have to be tackled as a priority in the short term. “We’ve identified a few key research questions,” Storm says. One of these relates to monitoring farmland to spot any nutrient deficiency, weed growth or pest infestations in real-time. Satellite images provide a rough overview, while drones or robots enable a much more detailed monitoring. The latter can cover a whole field systematically and even record the condition of individual plants in the process. “One difficulty lies in linking all these pieces of information together,” says Storm’s colleague Sabine Seidel, who coordinated the publication together with him: “For example, when will a low resolution be sufficient? When do things need to get more detailed? How do drones need to fly in order to achieve maximum efficiency in getting a look at all the crops, particularly those at risk?”

The data obtained provides a picture of the current situation. However, farmers are chiefly interested in weighing up various potential strategies and their possible implications: how many weeds can my crop withstand, and when do I need to intervene? Where do I need to apply fertilizer, and how much should I put down? What would happen if I used less pesticide? “To answer questions like these, you have to create digital copies of your farmland, as it were,” Seidel explains. “There are several ways to do this. Something that researchers still need to find out is how to combine the various approaches to get more accurate models.” Suitable methods also need to be developed to formulate recommendations for action based on these models. Techniques borrowed from machine learning and AI have a major role to play in both these areas.

Farmers have to be on board

If crop production is actually to embrace this digital revolution, however, the people who will actually be putting it into action—the farmers—will also need to be convinced of its benefits. “Going forward, we’ll have to focus more on the question of what underlying conditions are needed to secure this acceptance,” says Professor Heiner Kuhlmann, a geodesist and one of the Cluster of Excellence’s two speakers alongside the head of its robotics group Professor Cyrill Stachniss. “You could offer financial incentives or set legal limits on using fertilizer, for instance.” The effectiveness of tools like these, either on their own or in combination, can likewise be gauged nowadays using computer models.

In their paper, the researchers from PhenoRob also use examples to demonstrate what current technologies are already capable of doing. For instance, a “digital twin” of areas under cultivation can be created and fed a steady stream of various kinds of data with the help of sensors, e.g. to detect root growth or the release of gaseous nitrogen compounds from the soil. “In the medium term, this will enable levels of nitrogen fertilizer being applied to be adapted to crops’ needs in real time depending on how nutrient-rich a particular spot is,” Professor Stachniss adds. In some places, therefore, the digital revolution in agriculture is already closer than one might think.

Involved institutions and funding

The PhenoRob Cluster of Excellence is home to researchers from the University of Bonn, Forschungszentrum Jülich, the Fraunhofer Institute for Intelligent Analysis and Information Systems (IAIS) in Sankt Augustin, the Leibniz Centre for Agricultural Landscape Research in Müncheberg and the Institute of Sugar Beet Research in Göttingen. The project is funded by the German Research Foundation (DFG).

Information from various airborne or ground sensors are combined to help agriculture become much more efficient and environmentally friendly in the future.

CREDIT

Ansgar Dreier / University of Bonn

JOURNAL

European Journal of Agronomy

DOI

10.1016/j.eja.2024.127178

ARTICLE TITLE

Research priorities to leverage smart digital technologies for sustainable crop production

ARTICLE PUBLICATION DATE

6-Apr-2024

How likely are English learners to graduate from high school? New study shows it depends on race, gender, and income

Analysis of four-year graduation rates of English learners shows influence of individual characteristics

Peer-Reviewed Publication

NEW YORK UNIVERSITY

English learners are, on average, less likely to graduate high school in four years than students who never needed to learn English in school. But social identities like race and gender make a difference, and some groups of English learners are actually more likely to graduate, according to a new study by a team of education researchers at NYU and the University of Houston.

For instance, young women who ever learned English in school are more likely to graduate in four years than young men who did not. Similarly, Black English learners tend to have better four-year graduation rates than Black peers who never needed to learn English in school.

"Language learning doesn’t happen in a vacuum, so students—both those who are currently learning English and students who have already become fluent in the language—have a whole host of social factors that influence their school trajectories in ways that might be really different from students who never had to learn English in school,” says Michael Kieffer, an associate professor of literacy education at NYU Steinhardt School of Culture, Education, and Human Development and the senior author of the study, which appears in the journal Educational Researcher.

“This study highlights the very diverse outcomes of students who learn English in school and shows that this group is not a monolith,” says Benjamin Le, a doctoral student at NYU Steinhardt and the lead author of the study. “We see that English learner classification does matter for high school graduation, but more importantly, the extent that it matters depends on other social identities of the student.”

Le, Kieffer, and their co-authors analyzed data for 127,931 New York City high school students who began 9th grade in 2013 and 2014 to see whether students graduated on time, defined as graduating within four years. Their data included race/ethnicity, gender, socioeconomic status, and English learner status. They classified English learners based on whether students had ever received federally mandated language services to become proficient in English (“ever-ELs”) and compared them with students who never had to learn English in school (“never-ELs”).

Overall, their findings showed that never-ELs were four percent more likely to graduate within four years than ever-ELs, consistent with previous research. However, comparing English learner status with the added variable of gender revealed different outcomes: ever-EL young women were four percent more likely to graduate than never-EL young men. In addition, Black students were the only racial/ethnic group for which English learners were more likely to graduate in four years. Latine English learners were found to be the least likely to graduate in four years, and Asian/Pacific Islander ever-ELs were substantially more likely to graduate than Latine and Black students, regardless of the latter groups’ English learner status.

Differences in graduation between ever-ELs and never-ELs also depended on socioeconomic status. Ever-ELs in low-income neighborhoods (where the median household income was below $40,000) were equally likely to graduate compared to never-ELs in similar neighborhoods. But in middle- and high-income neighborhoods with household incomes above $40,000, ever-ELs were less likely to graduate than never-ELs in similar neighborhoods.

The study was supported by a grant (R305C200016) from the Institute of Education Sciences, U.S. Department of Education.

JOURNAL

Educational Researcher

METHOD OF RESEARCH

Data/statistical analysis

SUBJECT OF RESEARCH

People

ARTICLE TITLE

Ever English Learner 4-Year Graduation: Towards an Intersectional Approach

ARTICLE PUBLICATION DATE

6-May-2024

Science doesn't understand how ice forms (video)

AMERICAN CHEMICAL SOCIETY

WASHINGTON, May 6, 2024 — This video contains incredible macro footage of supercooled water droplets nucleating ice. All George wanted to do was make a crystal-clear ice cube. Instead, he ended up rediscovering dendritic crystal growth, a beautiful phenomenon first described in the 17th century. You’ll never look at your freezer the same way again. https://youtu.be/24TB1vPuzIU?feature=shared

Reactions is a video series produced by the American Chemical Society and PBS Digital Studios. Subscribe to Reactions at http://bit.ly/ACSReactions and follow us on X, formerly Twitter @ACSReactions.

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.

Accountability standards based on rules of democracy needed in times of rising political violence, scholar argues

Democratic backsliding, rising fascism necessitate administrators, scholars hewing to rules of liberal democracies, government researcher writes

UNIVERSITY OF KANSAS

LAWRENCE — When a family or group of friends sit down to play a familiar game they’ve played many times before, they generally don’t need to refer to the rules — unless someone breaks them. The values of liberal democracy have been transgressed in numerous forms in the last decade, yet many are unfamiliar with what the “rule book” would say those values are.

A University of Kansas scholar who fears Americans have forgotten the rules of democracy has published a study calling for a renewed dedication to democratic values and assigning accountability standards for government workers and scholars.

Christopher Koliba, Edwin O. Stene Distinguished Professor of Public Affairs and Administration at KU, has written a piece that draws from contemporary political and legal philosophies of “small-l liberalism” and democracy to define a set of seven standards focusing on authority, rights, tolerance, truth claims and professional deference. The standards are especially timely in an age of growing populism, democratic backsliding and polarization, he wrote.

The work, published in the journal Public Administration Review and subject of a recent presentation by Koliba at the Kansas City and County Managers Conference, stemmed from research he conducted on the public health and administration crisis of 2020.

“I was looking for the potential that norms and standards were being violated here and then started to look at the literature on democracy, especially the small-l liberal variety that the U.S. and other systems were founded on,” Koliba said. “That led to revisiting the works of political philosophers about what is liberal democracy in the context of modern society and what it entails. I argue we’ve taken those values for granted and assume we all know what we’re talking about. I feel that is what we’re up against.”

Koliba examines liberalism not as it is commonly referred to in political discourse as being associated with certain political parties, such as the Democratic Party in the U.S. or Labor Party in the United Kingdom. Instead, he means the version that has shaped democracies with values such as eschewing abuse of power, preeminence of individual rights, honoring tolerance and restraint, and appealing to reason and truth.

Those values have been challenged the last decade as democracies around the world — including the United States, Poland, Hungary and Brazil — have seen rising populism, openness to authoritarianism, retractions of rights and apathy to truth-telling, Koliba said. That has also resulted in increasing threats of violence, incivility at public government meetings, polarization and false accusations.

“Politics has always been a contact sport, but when it comes to poll workers and local government administrators having their lives threatened while carrying out the public’s business, we need to have a clear set of democratic principles that we can at least debate and then hold each other accountable to. This should be the beginning of a conversation,” Koliba said.

That process should begin with a renewed dedication by public administrators and public administration scholars to a set of seven liberal democratic accountability standards outlined in the study:

Citizen authority standard

Citizens have authorizing and monitoring power over elected officials and democratic institutions.

Individual rights standards

Individuals in liberal democracies are endowed with rights to freedom of expression, assembly and pursuit of “the good life.”

Checked authority standard

Liberal democratic institutions and elected officials and public administrators who run them will have their powers checked and balanced.

Tolerance standard

Policy actors will exercise tolerance of differences.

Institutional forbearance standard

Policy actors will willfully restrain coercive actions in order to preserve existing accountability standards and democratic institutions.

Truthfulness standard

Policy actors are obligated to pursue and draw on truth claims as the basis of their practices and actions on behalf of the public.

Professional discretion standard

Professional policy actors will adhere to codes of conduct, ethics and standards of practice associated with the legal, political, bureaucratic and professional institutions of liberal democracies.

The standards can and should be debated, Koliba said, but they are especially timely given growing distrust in the government, deep and persistent polarization, growing expressions of intolerance and apathy toward truthfulness. Those trends present potential irreparable harm toward democratic institutions, necessitating the need for public officials and scholars to commit to historical standards and principles of liberal democracy.

While there has long been such disagreement, polarization and populism throughout democratic history, especially in the United States, current trends and resulting threats of politically motivated violence make the standards especially salient, Koliba said. For example, populist movements of the past such as the American Revolution, Women’s Suffrage and Civil Rights movements were dedicated to expanding rights instead of restricting them. Given recent exacerbation of those trends as well as democratic backsliding, liberal democratic accountability standards should be factored into public standards of accountability as well as empirical studies and theoretical frameworks, he said.

“It’s easy to take democracy for granted. I myself have done it,” Koliba said. “I’m thinking deeply about how to embrace these standards in the curriculum I teach. Our field is globalized, and there is a debate about universal values in public administration. I think there is a lot of work to be done to elevate democratic governance principles. And in speaking with some of our leaders of city and county government, I believe this sentiment resonates with them as well.”

JOURNAL

Public Administration Review

DOI

10.1111/puar.13831

METHOD OF RESEARCH

Literature review

SUBJECT OF RESEARCH

Not applicable

ARTICLE TITLE

Liberal democratic accountability standards and public administration

Rising child mortality in the U.S. has the most impact on Black and Native American youth

As young Americans face higher death rates, a new VCU study reveals the disproportionate effect on certain racial and ethnic groups

Peer-Reviewed Publication

VIRGINIA COMMONWEALTH UNIVERSITY

RICHMOND, Va. (May 6, 2024) — Researchers at Virginia Commonwealth University and Children’s Hospital of Richmond at VCU are shedding new light on how the increasing rate of child mortality in the United States has disproportionately affected certain racial and ethnic groups.

Their previous research found that child and adolescent mortality rates in the United States rose by 18.3% between 2019 and 2021, the largest such increase in at least half a century. In their latest study, published May 4 in the Journal of the American Medical Association, their analysis revealed that Black and Native American (American Indian and Alaska Native) youth died at significantly higher rates than white youth – primarily due to deaths from injuries – and the gap is widening.

Death rates among young Americans had been in decline for decades thanks to breakthroughs in medicine and expanded access to health care. However, these gains in public health have since been eclipsed by the rise of injury-related fatalities, including homicide, drug overdoses, motor vehicle accidents and suicide.

“Once you start looking at these trends with a magnifying glass, it becomes clear that mortality rates are not consistent across all racial and ethnic groups,” said Elizabeth Wolf, M.D., an associate professor in the VCU School of Medicine’s Department of Pediatrics, a pediatrician at Children’s Hospital of Richmond at VCU and lead author of the study. “While we saw that the overall pediatric all-cause mortality rate in the United States began to increase around 2020 and 2021, for Native American, Black and Hispanic populations, pediatric mortality rates began increasing as early as 2014.”

“Our earlier research on pediatric mortality revealed a great tragedy in that injury-related deaths are reversing the progress we’ve made in pediatric care. This latest study uncovers another layer of tragedy in that injury-related deaths are also reversing our progress in closing racial disparities in mortality,” added Steven Woolf, M.D., director emeritus of the VCU Center on Society and Health and a professor in the VCU School of Medicine’s Department of Family Medicine.

Wolf and Woolf are part of a research team that reviewed more than 20 years of death certificate data from the Centers for Disease Control and Prevention to assess how the risk of death at ages 1 to 19 differed by race and ethnicity.

The data showed that differences in pediatric mortality rates between racial and ethnic groups were improving until 2013. However, in more recent years, the disparities in death rates have widened, especially for Black and Native American populations. Between 2014 and 2020, mortality rates increased by 36.7% in Black youth and 22.3% in Native American youth while increasing 4.7% in white youth.

This shift was primarily driven by disparities in injury-related deaths, according to the analysis. Between 2016 and 2020, nearly 13 in every 100,000 Black youth died by homicide, which is more than 10 times higher than the rate among white youth. During the same period, about 11 in every 100,000 Native American youth died by suicide, more than two times higher than the rate among white youth.

The data also revealed that many of the recorded deaths caused by homicide and suicide involved firearms. Between 2016 and 2020, about 13 in 100,000 Black youth and 7 in 100,000 Native American youth died from gun-related injuries. These mortality rates were four and two times higher than among white youth, respectively. The data also showed that firearm fatalities have become more frequent over time for both groups. Between 2013 and 2020, the risk of death from gun violence increased by 108% among Black youth and 124% among Native American youth.

The observed disparities are not limited to deaths from injuries, as they also are seen in deaths from diseases such as asthma, influenza and heart failure. About 1 in every 100,000 Black youth died from asthma, nearly eight times higher than the rate among white youth. Additionally, 1 in every 100,000 Native American youth died from pneumonia and influenza, more than three times higher than the rate among white youth.

Wolf and Woolf said a number of factors are potentially linked to the country’s rise in pediatric mortality and the associated disparities across racial and ethnic groups. For example, the racial imbalance seen in suicide rates may be due in part to differences in poverty levels, childhood experiences and access to mental health services. On the other hand, the racial inequities in death from asthma could be tied to differences in exposure to tobacco smoke and other air pollutants, as well as unequal access to asthma medications.

The researchers also stressed that the various conditions contributing to the widening racial gaps in child death ultimately reflect the legacy of systemic racism in the United States.

“At the end of the day, the history of systemic racism in this country lies at the root of this tragedy by creating gaps in the social, economic and environmental conditions in which children are being raised,” Woolf said. “Addressing these systemic factors is essential for mitigating the disproportionate risks of injury and disease experienced by children of color.”

According to the researchers, the most effective way to reverse the country’s pediatric mortality trends is through bold policy actions. For instance, they noted the importance of enacting sensible gun policies to prevent child access to firearms, as well as providing better access to behavioral health services to address the current mental health crisis affecting children and adolescents.

“As doctors, we tend to first focus on the health care system, but many of the issues driving these spikes in mortality cannot simply be treated at a hospital or clinic – such as a person’s income level, education and environment,” Wolf said. “We need to look beyond the sphere of health care and into the sphere of public policy.”

“There are many clear policy recommendations on how to save the lives of our children,” Woolf added. “We just need to act on it.”

JOURNAL

JAMA

DOI

10.1001/jama.2024.3908

ARTICLE TITLE

Racial and Ethnic Disparities in All-Cause and Cause-Specific Mortality Among US Youth

ARTICLE PUBLICATION DATE

4-May-2024