Most non-English speakers in the U.S. are turned away before their first cancer visit according to new research in JNCCN

New study from the University of Michigan found English speakers who call a hospital general information line were able to get information on next steps to access cancer care 94% of the time, compared to 38% for Spanish speakers and just 28% for Mandarin

Peer-Reviewed Publication

NATIONAL COMPREHENSIVE CANCER NETWORK

 

IMAGE: DEBBIE W. CHEN, MD, UNIVERSITY OF MICHIGAN view more 

CREDIT: NCCN

PLYMOUTH MEETING, PA [September 6, 2023] — New research in the September 2023 issue of JNCCN—Journal of the National Comprehensive Cancer Network reveals an alarming lack of access for non-English speakers who called hospitals across the United States looking for information on cancer care services. The researchers from University of Michigan set up a series of simulated patient calls to various hospital general information lines, speaking in English, Spanish, and Mandarin. Nearly all of the English-speaking callers were provided with next steps to access cancer care—such as a telephone number for presumed clinic or transfer to the department that was presumed to provide the requested care—while just over a third of the Spanish speakers had the same experience, and even fewer for Mandarin-speaking callers.

“Our study found significant language-based disparities in patients’ access to cancer care well before they are seen by a physician,” said lead researcher Debbie W. Chen, MD, University of Michigan. “If patients with cancer cannot access information on where to obtain the appropriate cancer care, what other critical information and services are they not able to access in our healthcare system?”

Dr. Chen continued, referencing a 2005 audit study in which simulated Spanish-speaking callers contacted the hospital general information line of New York City hospitals and requested the telephone number for one of the hospital’s out-patient clinics[1]: “Even though our study takes place 16 years later, during a time when more than 25 million individuals with limited English proficiency live in the United States, our study found even lower success rates for non-English-speaking persons seeking to access cancer care services. Most of the barriers that the simulated non-English-speaking callers encountered were systems-level issues, including being told ‘no’ or being hung up on by hospital staff, or being disconnected because the hospital’s automated message required input but did not provide language-concordant instructions, plus issues at the level of Interpreter Services.”

The simulated calls were made to a random selection of 144 hospitals evenly distributed across 12 demographically diverse U.S. states, including California, Florida, New York, Texas, Arizona, Illinois, Massachusetts, New Jersey, Michigan, Missouri, Oregon, and Pennsylvania. The calls were made Monday through Friday between 8:00am and 5:00pm local time, between November 8, 2021 and June 23, 2022. A total of 1,296 calls were completed; 432 in each language. Overall, 53% resulted in callers being provided with next steps to access cancer care. However, the Mandarin-speaking callers received that information only 28% of the time; Spanish-speakers were slightly higher at 38%, while English-speakers were connected to next steps 94% of the time. The researchers anticipate that patients who speak other, less commonly spoken, non-English languages may face even greater barriers to care.

Dr. Chen, et. al., proposed several potential interventions based on the different reasons for incomplete calls. They suggest that automatic messaging should be sure to include instructions for accessing the message in different languages and should default to a live person instead of disconnecting in instances where no input is made. They also recommend that general information personnel remain on the line when connecting callers to a language interpreter in order to help provide the sought-after information through the translator, who may not be able to answer questions about care on their own.

“The results of this important study highlight what we see every day on the ground level,” commented Darcie Green, Executive Director, Latinas Contra Cancer, who was not involved in this research. “Spanish-speaking patients, as well as others who are not English-proficient, face preventable barriers in access to care starting at one of the most basic expectations we have when calling our health care provider—the ability to call in for an appointment or advice. This health inequity from the very start can lead to late detection, erosion of trust, disengagement from the healthcare system, and many other adverse health outcomes that serve to only deepen cancer care disparities.”

Green will be among the speakers at an upcoming NCCN Oncology Policy Summit taking place in Washington D.C. on Tuesday, September 12 on Measuring and Addressing Health-Related Social Needs in Cancer. She continued: “Additionally, as we lean into greater investment in community health workers and patient navigation to reduce disparities in detection, treatment, and survivorship, it is crucial that the patients who need these services the most do not face unnecessary barriers to accessing them. This study should serve as an affirming but urgent call to action for accountability and to support and invest in the strategies and infrastructure needed to eliminate language-based health inequity in access to care.”

To read the entire study, visit JNCCN.org. Complimentary access to “Hidden Disparities: How Language Influences Patients’ Access to Cancer Care” is available until December 10, 2023.

# # #

About JNCCN—Journal of the National Comprehensive Cancer Network
More than 25,000 oncologists and other cancer care professionals across the United States read JNCCN—Journal of the National Comprehensive Cancer Network. This peer-reviewed, indexed medical journal provides the latest information about innovation in translational medicine, and scientific studies related to oncology health services research, including quality care and value, bioethics, comparative and cost effectiveness, public policy, and interventional research on supportive care and survivorship. JNCCN features updates on the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®), review articles elaborating on guidelines recommendations, health services research, and case reports highlighting molecular insights in patient care. JNCCN is published by Harborside/BroadcastMed. Visit JNCCN.org. To inquire if you are eligible for a FREE subscription to JNCCN, visit NCCN.org/jnccn/subscribe. Follow JNCCN on Twitter @JNCCN.

About the National Comprehensive Cancer Network

The National Comprehensive Cancer Network® (NCCN®) is a not-for-profit alliance of leading cancer centers devoted to patient care, research, and education. NCCN is dedicated to improving and facilitating quality, effective, equitable, and accessible cancer care so all patients can live better lives. The NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) provide transparent, evidence-based, expert consensus recommendations for cancer treatment, prevention, and supportive services; they are the recognized standard for clinical direction and policy in cancer management and the most thorough and frequently-updated clinical practice guidelines available in any area of medicine. The NCCN Guidelines for Patients® provide expert cancer treatment information to inform and empower patients and caregivers, through support from the NCCN Foundation®. NCCN also advances continuing education, global initiatives, policy, and research collaboration and publication in oncology. Visit NCCN.org for more information.

---

[1] Getting in the Door: Language Barriers to Health Services at New York City’s Hospitals. Available at: https://comptroller.nyc.gov/wp-content/uploads/documents/jan10-05_geting-in-the-door.pdf

---

JOURNAL

Journal of the National Comprehensive Cancer Network

DOI

10.6004/jnccn.2023.7037 

SUBJECT OF RESEARCH

People

ARTICLE TITLE

Hidden Disparities: How Language Influences Patients’ Access to Cancer Care

ARTICLE PUBLICATION DATE

6-Sep-2023

 

Concussions early in life tied to late life cognitive decline

Peer-Reviewed Publication

AMERICAN ACADEMY OF NEUROLOGY

MINNEAPOLIS – A study of twins shows that having a concussion early in life is tied to having lower scores on tests of thinking and memory skills decades later as well as having more rapid decline in those scores than twins who did not have a concussion, or traumatic brain injury (TBI). The study is published in the September 6, 2023, online issue of Neurology®, the medical journal of the American Academy of Neurology.

“These findings indicate that even people with traumatic brain injuries in earlier life who appear to have fully recovered from them may still be at increased risk of cognitive problems and dementia later in life,” said study author Marianne Chanti-Ketterl, PhD, MSPH, of Duke University in Durham, North Carolina. “Among identical twins, who share the same genes and many of the same exposures early in life, we found that the twin who had a concussion had lower test scores and faster decline than their twin who had never had a concussion.”

The study involved 8,662 men who were World War II veterans. The participants took a test of thinking skills at the start of the study when they were an average age of 67 and then again up to three more times over 12 years. Scores for the test can range from zero to 50. The average score for all participants at the beginning of the study was 32.5 points.

A total of 25% of the participants had experienced a concussion in their life.

Twins who had experienced a concussion were more likely to have lower test scores at age 70, especially if they had a concussion where they lost consciousness or were older than 24 when they had their concussion. Those twins with traumatic brain injury with loss of consciousness, more than one traumatic brain injury and who had their injuries after age 24 were more likely to have faster cognitive decline than those with no history of traumatic brain injury.

For example, a twin who experienced a traumatic brain injury after age 24 scored 0.59 points lower at age 70 than his twin with no traumatic brain injury, and his thinking skills declined faster, by 0.05 points per year.  

These results took into account other factors that could affect thinking skills, such as high blood pressure, alcohol use, smoking status and education.

“Although these effect sizes are modest, the contribution of TBI on late life cognition, in addition to numerous other factors with a detrimental effect on cognition, may be enough to trigger an evaluation for cognitive impairment,” Chanti-Ketterl said. “With the trend we are seeing with increased emergency room visits due to sports or recreation activity injuries, combined with the estimated half million members of the military who suffered a TBI between 2000 and 2020, the potential long-term impact of TBI cannot be overlooked. These results may help us identify people who may benefit from early interventions that may slow cognitive decline or potentially delay or prevent dementia.”  

A limitation of the study was that traumatic brain injuries were reported by the participants, so not all injuries may have been remembered or reported accurately.  

The study was supported by the National Institute on Aging and the U.S. Department of Defense.

Learn more about traumatic brain injury 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 40,000 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.

---

JOURNAL

Neurology

 

Still work to do on making mental health services accessible for LGBTIQA+ people in distress

Barriers to accessing potentially life-saving support persist, according to new research into suicidality in the LGBTIQA+ community.

Reports and Proceedings

RMIT UNIVERSITY

 

IMAGE: AN ILLUSTRATION OF TWO PEOPLE WITH A HAND HOLDING THE PRIDE FLAG IN THE BACKGROUND. THE TORRES STRAIT ISLAND, ABORIGINAL AND PRIDE FLAGS ARE ALSO ON THE LEFT SIDE. view more 

CREDIT: JACQ MOON

Barriers to accessing potentially life-saving support persist, according to new research into suicidality in the LGBTIQA+ community. 

An RMIT-led study with Switchboard, Roses in the Ocean and University of Sydney interviewed members of the LGBTQA+SB community to understand their lived experiences of suicidal thoughts and behaviours, and uncover factors that protect people at these times of distress. 

The acronym SB in LGBTIQA+SB stands for sistergirl and brotherboy, acknowledging the trans women and trans men of First Nations gender-diverse people within some, but not all, Aboriginal and Torres Strait Islander communities. 

Project lead and Dean of RMIT’s School of Global, Urban Social Studies, Professor Katherine Johnson, said despite LGBTIQA+ Australians being 20 times more likely to have considered suicide, there remained a lack of research into the types of support needed, especially for people with intersecting identities, including First Nations people, people of colour, and people with disabilities. 

Many participants in the study said their suicidal distress started at an early age with fluctuating levels of intensity.  

Alarmingly, it also found concealing this distress, or not accessing support, was common among younger people.  

It echoes a previous study revealing almost 2/3 of LGBTIQA+ people in Australia aged 14 to 21 did not access professional support after experiencing some form of suicidal distress. 

Barriers to accessing support 

Johnson said people in LGBTIQA+ communities often embodied several marginalised identities, which can create unique and complex systems of disadvantage and discrimination. 

“Understanding the context in which LGBTIQA+ people attempt to live affirmatively must be the starting point for effective policy and services,” she said. 

As well as fear of discrimination in terms of sexuality, gender and racism, barriers to accessing support included a lack of knowledge of where to find it, cost and distrust of the health system due to negative medical experiences.  

Concerns around confidentiality were also complex, especially for First Nations people, people of colour and religious participants in remote and rural communities.  

Some participants were uncomfortable seeking support services where they were too easily identifiable.  

Understanding help-seeking behaviour  

Johnson said seeking support was a challenge overall, but her research found help-seeking behaviour often changed over time, with people becoming more adept at finding ways to manage their suicidal distress. 

While gender identity and sexuality played a part, participants said it was fears of social and cultural isolation and rejection associated with homophobia, transphobia and racism that were the main contributing factors in their distress. 

“Living with suicidal distress is exhausting. It can limit people’s ability to form and maintain social connections and significantly disrupt daily life, which may lead to other psychosocial factors like homelessness and unemployment,” said Johnson.  

“That’s why we need targeted early interventions in order to reduce suicidality over an LGBTIQA+SB person’s lifetime.” 

Johnson said the lack of support services in remote and rural areas can also be isolating as it forced people to travel to more urban areas to access support.  

“Developing referral pathways, reducing out-of-pocket expenses and ensuring LGBTIQA+SB affirming services are available, particularly in regional areas, will facilitate access to safer and more effective supports,” she said. 

Family relationships, friendships and supportive social spaces were significant sources of acceptance and affirmation for LGBTIQA+ people. However, Johnson said they could also be drivers of distress and shame, shaping how people reach out for help.  

“We found family support was vital, but it was not always available or positive,” she said.  

“Meanwhile, participants of colour often sought support from friends due to family being overseas.” 

Johnson said employing a diverse representation of LGBTIQA+SB peer workers, including First Nations, people of colour and people with disabilities, within mainstream and queer-friendly services can help improve perceptions of safety and confidentiality.  

“Rainbows are nice, but people like to connect with others who understand the nuances of their identity, circumstances, background and culture,” she said. 

“With appropriate and effective support, LGBTIQA+SB people can, and do, find ways of living with suicidal distress.” 

More work needs to be done 

Johnson said this research is just the beginning of a bigger call for more attention to the lived experiences of suicidality in diverse LGBTIQA+SB communities. 

RMIT’s Social Change Enabling Impact Platform has funded the translation of Johnson’s research into training materials. Switchboard will help fund the roll-out of the training across Victoria.  

Switchboard CEO Joe Ball said he would like to see national investment to introduce the training around the country.  

“The potential impact of our suicide prevention training cannot be overstated — this has the power to change lives, and we welcome strong partnerships to do this work together,” Ball said. 

“LGBTIQA+SB people, no matter who they are or where they live, deserve tailored support. 

“The time is well overdue for more sophisticated approaches to supporting our communities. We are not one-dimensional people — we live intersectional lives and deserve support from services that acknowledge and strengthen this.” 

Co-author and University of Sydney and University of New South Wales Adjunct Professor Vanessa Lee-Ah Mat said the research is laying the foundations in understanding queer First Nations suicidal behaviours from their lived experiences.  

“Putting culture first has been a guiding hand,” said Lee-Ah Mat, a Yupungathi and Meriam woman.  

“The insight drawn from this research has enabled us to begin to understand the many experiences that lead to depression, anxiety and suicidal behaviours in Aboriginal and Torres Strait Islander LGBTIQA+SB people.” 

Co-author and Switchboard Suicide Prevention Manager Anna Bernasochi said the training to be rolled out was the first of its kind to use insights from lived experiences of LGBTQA+SB people.  

“By integrating insights from these lived experiences, services will be more equipped to help LGBTIQA+SB people live through suicidal distress. Completing our training is an excellent first step,” said Bernasochi.  

“Understanding LGBTQA+SB suicidal behaviour and improving support: insight from intersectional lived experience” was prepared for and funded by Suicide Prevention Australia (DOI: https://doi.org/10.25439/rmt.23640978.v1).  

Katherine Johnson, Nicholas Hill, Vanessa Lee-Ah Mat, Anna Bernasochi and Martina McGrath are co-authors. 

---

DOI

10.25439/rmt.23640978.v1 

METHOD OF RESEARCH

Case study

SUBJECT OF RESEARCH

People

ARTICLE TITLE

Understanding LGBTQA+SB suicidal behaviour and improving support: insight from intersectional lived experience. Report PEER REVIEWED Understanding LGBTQA+SB suicidal behaviour and improving support: insight from intersectional lived experience.

COI STATEMENT

This research was funded by a Suicide Prevention Australia Innovation Grant.

 

After treatment with semaglutide, newly diagnosed Type 1 diabetes patients needed little or no insulin

Study’s senior author says it “could possibly be the most dramatic change in treating Type 1 diabetes since the discovery of insulin in 1921,” if findings are borne out in larger studies over extended follow-up periods

Peer-Reviewed Publication

UNIVERSITY AT BUFFALO

 

IMAGE: PARESH DANDONA, MD, PHD, IS THE LEAD AUTHOR ON THE STUDY. view more 

CREDIT: SANDY KICMAN/UNIVERSITY AT BUFFALO

BUFFALO, N.Y.— Treating newly diagnosed Type 1 diabetes patients with semaglutide (trade names Ozempic, Wegovy and Rybelsus) may drastically reduce or even eliminate their need for injected insulin.

 

Those are the remarkable findings of a small University at Buffalo study reported in the New England Journal of Medicine and published online on Sept. 6.

 

“Our findings from this admittedly small study are, nevertheless, so promising for newly diagnosed Type 1 diabetes patients that we are now absolutely focused on pursuing a larger study for a longer period of time,” says Paresh Dandona, MD, PhD, SUNY Distinguished Professor in the Department of Medicine, former chief of the Division of Endocrinology in the Jacobs School of Medicine and Biomedical Sciences at UB and senior author on the paper.

 

A total of 10 patients at UB’s Clinical Research Center in the Division of Endocrinology were studied from 2020 to 2022, all of whom had been diagnosed in the past three to six months with Type 1 diabetes. The mean HbA1c level (an individual’s average blood sugar level over 90 days) at diagnosis was 11.7, far above the American Diabetes Association’s HbA1c recommendation of 7 or below.

 

The patients were treated first with a low dose of semaglutide while also taking meal-time (bolus) insulin and basal (background) insulin. As the study continued, semaglutide dosing was increased while mealtime insulin was reduced in order to avoid hypoglycemia.

 

“Within three months, we were able to eliminate all of the mealtime insulin doses for all of the patients,” says Dandona, “and within six months we were able to eliminate basal insulin in 7 of the 10 patients. This was maintained until the end of the 12-month follow-up period.”

 

During that time, the patients’ mean HbA1c fell to 5.9 at six months and 5.7 at 12 months.

 

Applying Type 2 diabetes drugs to treat Type 1 diabetes

 

For more than a decade, Dandona has been interested in how drugs developed for Type 2 diabetes might be utilized in treating Type 1 diabetes as well.

 

He and his colleagues were the first to study how liraglutide, another drug for Type 2 diabetes, might work in patients with Type 1 diabetes in a study he published in 2011.

 

“As we extended this work, we found that a significant proportion of such diabetics still have some insulin reserve in the beta cells of their pancreas,” Dandona explains. “This reserve is most impressive at the time of diagnosis, when 50% of the capacity is still present. This allowed us to hypothesize that semaglutide, which works through stimulation of insulin secretion from the beta cell, could potentially replace mealtime insulin administration.”

 

From the outset, the goal of the current study was to see if semaglutide treatment could be used to replace mealtime insulin, thereby reducing the insulin dosage, improving glycemic control, reducing the HbA1c and eliminating potentially dangerous swings in blood sugar and hypoglycemia.

 

The most common side effects for patients were nausea and vomiting as well as appetite suppression, which led a number of patients to experience weight loss, an outcome that Dandona says is generally an advantage since 50% of patients with Type 1 diabetes in the U.S. are overweight or obese.

 

“As we proceeded with the study, we found that even the dose of basal insulin could be reduced or eliminated altogether in a majority of these patients,” he says. “We were definitely surprised by our findings and also quite excited. If these findings are borne out in larger studies over extended follow-up periods, it could possibly be the most dramatic change in treating Type 1 diabetes since the discovery of insulin in 1921.”

---

JOURNAL

New England Journal of Medicine

METHOD OF RESEARCH

Observational study

SUBJECT OF RESEARCH

People

ARTICLE TITLE

Semaglutide in Early Type 1 Diabetes

ARTICLE PUBLICATION DATE

6-Sep-2023

 

Use of common painkillers alongside hormonal contraception linked to heightened risk of blood clots

Absolute risk remains low but women should be advised accordingly, say researchers

Peer-Reviewed Publication

BMJ

Women who use non-steroidal anti-inflammatory painkillers alongside hormonal contraception appear to be at a small increased risk of blood clots known as venous thromboembolism (VTE), finds a large Danish study published by The BMJ today.

The risk was greater in women using combined oral contraceptives containing third or fourth generation progestins, but smaller in women using progestin-only tablets, implants and coils, alongside the non-steroidal anti-inflammatory drugs (NSAIDs) ibuprofen, diclofenac, and naproxen.

The researchers stress that the absolute risk of developing a serious blood clot is low, even in women using high risk hormonal contraception. But given the widespread use of both hormonal contraception and NSAIDs, they say women should be advised of this potential drug interaction accordingly. 

NSAIDs have previously been linked to blood clots, but little is known about whether using NSAIDs influences the risk of venous thromboembolism in otherwise healthy women using hormonal contraception.

To address this, researchers used national medical records to track first time diagnoses of venous thromboembolism among 2 million women aged 15 to 49 years living in Denmark between 1996 and 2017 with no history of blood clots, cancer, hysterectomy or fertility treatment.

Hormonal contraception was divided into high, medium and low risk, according to their association with VTE based on previous studies.

High risk hormonal contraception included combined oestrogen and progestin patches, vaginal rings, and pills containing either 50 mcg oestrogen or third or fourth generation progestins. Medium risk contraception included all other combined oral contraceptives and the medroxyprogesterone injection, while progestin-only tablets, implants, and hormone intrauterine devices (coils) were classed as low or no risk.

A range of potentially influential factors such as age, education level, pregnancy history, prior surgery, high blood pressure and diabetes, were also taken into account.

In the study, NSAIDs were used by 529,704 women while using hormonal contraception. Ibuprofen was the most frequently used NSAID (60%), followed by diclofenac (20%) and naproxen (6%).

Over an average 10-year monitoring period, 8,710 venous thromboembolic events occurred (2,715 pulmonary embolisms and 5,995 deep venous thromboses), and 228 (2.6%) women died within 30 days of their diagnosis.

In absolute terms, NSAID use was associated with four extra venous thromboembolic events per week per 100,000 women not using hormonal contraception, 11 extra events in women using medium risk hormonal contraception, and 23 extra events in women using high risk hormonal contraception.

Among individual NSAIDs, the association was strongest for diclofenac compared with ibuprofen and naproxen.

This is an observational study, so can’t establish cause, and the researchers highlight several limitations, such as missing information about smoking and obesity, which they say may have affected their results.

Nevertheless, this was a large study based on high quality registry data and the researchers were able to adjust for a wide range of potentially influential factors. What’s more, the associations persisted after further analysis, suggesting that they are robust.

As such, the researchers conclude: “Using high quality, linkable, national registries, this nationwide study adds new knowledge on the risk of a potentially fatal event during concomitant use of two drug classes often prescribed to otherwise healthy women.”  

They add: “Women needing both hormonal contraception and regular use of NSAIDs should be advised accordingly.”

These data raise important concerns about using NSAIDs, particularly diclofenac, and high risk hormonal contraception concomitantly, writes Morten Schmidt at Aarhus University Hospital, in a linked editorial.

He suggests that healthcare authorities and regulators should include these findings in their safety assessment of available over-the-counter diclofenac, and women using hormonal contraception and their clinicians should consider alternatives to NSAIDs for analgesia. 

“If treatment with NSAIDs is needed, agents other than diclofenac seem preferable, along with lower risk hormonal contraceptives such as progestin only tablets, implants, or intrauterine devices,” he concludes.

---

JOURNAL

The BMJ

DOI

10.1136/bmj-2022-074450 

METHOD OF RESEARCH

Observational study

SUBJECT OF RESEARCH

People

ARTICLE TITLE

Research: Venous thromboembolism with use of hormonal contraception and non-steroidal anti-inflammatory drugs: nationwide cohort study

ARTICLE PUBLICATION DATE

6-Sep-2023

COI STATEMENT

All authors have completed the ICMJE uniform disclosure form at https://www.icmje.org/disclosure-of-interest/ and declare: support from the Danish Heart Foundation, which funded AM’s salary, including this study; LSM has received grants from the health insurance organisation “Denmark,” the Danish Cancer Society’s Scientific Committee, and Novo Nordisk for research unrelated to the present study; CTP has received grants from Novo Nordisk and Bayer outside the current study; no other relationships or activities that could appear to have influenced the submitted work.

 

Capturing carbon in savannas: New research examines role of grasses for controlling climate change

Peer-Reviewed Publication

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

 

IMAGE: NEW RESEARCH SHOWS THAT IN ADDITION TO TREES, HUMBLE GRASSES PLAY AN ESSENTIAL ROLE IN CAPTURING CARBON TO FIGHT CLIMATE CHANGE IN SAVANNA ECOSYSTEMS LIKE THIS ONE IN KRUGER NATIONAL PARK, SOUTH AFRICA. view more 

CREDIT: YONG ZHOU

In recent years, the escalating impact of global warming has prompted efforts to reverse troubling trends, often by planting trees to capture and remove carbon dioxide from the atmosphere and store it. New research from a team led by Young Zhou, from the Quinney College of Natural Resources and the Ecology Center, shows that, in addition to trees, humble grasses also play an essential role in capturing carbon — more important than previously thought.

A recent initiative set its sights on capturing carbon in tropical savannas, an ecosystem characterized by shared space of trees and grasses. The project initiated a tree planting effort (afforestation) to capture carbon dioxide from the air, which resulted in stored carbon in two primary places: the woody biomass of the growing trees, and in soils. While the effectiveness of storing carbon in trees has been well-established in research, how carbon storage functions in soils was not well defined, and Zhou and his colleagues set out to determine the role grasses played in this effort.

The team, which included scientists from Yale University, Lawrence Berkeley National Laboratory, University of Cape Town, Texas A&M, Kruger National Park, Harvard University, and University of Oregon, conducted a comprehensive study investigating the contribution of grasses to carbon content in savannas soils and assessed the potential impact of increasing tree cover in tropical savannas on soil carbon storage. The study was published in the journal Nature Geoscience.

Using the case study conducted in Kruger National Park, South Africa, and data synthesized from tropical savannas worldwide, the research team demonstrated that savanna soils enriched with carbon from grasses exhibited comparatively higher concentrations of carbon. Their findings showed that grasses accounted for over half of the soil carbon content across tropical savannas, including soils directly beneath trees. This underscores the significant role that grasses play in the accumulation of carbon within tropical savannas.

Their findings showed both carbon gains and losses, as tree cover increased across tropical savannas. The most significant variation was observed in savannas receiving higher rainfall, where tree planting is more likely to thrive, as well as in areas with clay soils and savanna sites that had substantial contributions of carbon storage from grasses.

“This underscores the nuanced nature of increasing tree cover on the dynamics of carbon in savanna soils,” Zhou said. “On average, the increase in soil carbon storage resulting from the expansion of tree cover across tropical savannas is negligible.”

This finding aligns with the team's previous research published in Nature, which demonstrated that increasing tree cover due to fire suppression led to increased carbon storage in woody biomass, but did not affect soil carbon storage.

"Our findings challenge the commonly held assumption that afforestation uniformly boosts soil carbon storage," Zhou said. "However, we have yet to pinpoint the precise factors responsible for the substantial variation observed in the soil carbon storage response to increased tree cover across tropical savannas."

In general, forests primarily store their carbon in the woody trunks and aboveground leaves. In contrast, a significant portion of carbon in grassy ecosystems, such as savannas and grasslands, is stored in the soil, primarily within the extensive root systems of the grasses as well as decaying organic matter. In the context of long-term carbon storage, carbon retained in soils proves to be more reliable, particularly for a vulnerable future marked by warming and increased likelihood of drought and wildfires, he said.

“It makes even more clear that savannas play crucial roles in the global carbon cycle in their unique ways, underscoring the importance of preserving and protecting these ecosystems in an equitable manner,” he said.

---

JOURNAL

Nature Geoscience

DOI

10.1038/s41561-023-01232-0 

METHOD OF RESEARCH

Case study

SUBJECT OF RESEARCH

Not applicable

ARTICLE TITLE

Soil carbon in tropical savannas mostly derived from grasses

 

Street medicine filling a major gap by providing behavioral health care for people who are homeless

While they are more at risk for mental health and substance use disorders, unhoused people in California face barriers to accessing treatment.

Peer-Reviewed Publication

KECK SCHOOL OF MEDICINE OF USC

 

IMAGE: GABRIELLE JOHNSON, BRETT FELDMAN AND EDDIE MENACHO WORK AS PART OF THE STREET MEDICINE TEAM AT USC, WHICH PROVIDES MEDICAL CARE TO PEOPLE WHO ARE LIVING ON THE STREETS. view more 

CREDIT: CHRIS SHINN

Mental health and substance use disorders are prevalent among people experiencing homelessness, yet access to care for these health issues is challenging for people living on the streets. Now, a new survey conducted by a team of researchers from USC Street Medicine found that, in California, street medicine programs are helping to fill this gap, delivering critical, high-level mental health and substance use treatments to the state’s unsheltered population.

The survey, published in Community Mental Health Journal, shows that street medicine has the potential to serve as the basis for a strategy to expand access to behavioral health care for people who are unhoused.

“This survey showed that there is tremendous need for mental health and substance use services and that street medicine programs are providing more services and higher-level care out of necessity,” said Brett Feldman, director and co-founder of USC Street Medicine, assistant professor of family medicine at Keck School of Medicine of USC, and one of the authors of the study. “We found that street medicine teams have trained up to provide a higher level of behavioral health care because there’s little access to psychiatric care, especially on the street.”

The authors noted that addressing the mental health and substance use problems, common among the state’s homeless population, is one key to improving communities’ efforts to address homelessness. 

Need is great, resources are sparse

The researchers from the Keck School of Medicine surveyed 29 street medicine teams in California, 26 of which completed the survey. One was excluded because it is too new a program to have meaningful data. Street medicine organizations reported that 64% of their patients have mental health problems and 67% have substance use disorders. All but one of the street medicine programs provides some mental health and treatment for substance use disorders. 

Despite the need, most of the street medicine programs reported having difficulty successfully referring their patients to mental health and addiction treatment programs. Referring unhoused patients to specialists is often difficult, noted Feldman, since many have no address, phone number or transportation to make visits to specialists. 

Eight of the street medicine programs surveyed include a psychiatrist, but only two of them are full-time. Six of the teams have part-time psychiatrists who provide between four to 10 hours a week of care. Feldman added that there is a national shortage of psychiatrists, which has made it increasingly difficult for disadvantaged people, such as people living on the streets, to access psychiatric services. 

Street medicine programs are typically staffed with primary care providers who are trained to treat some mental health issues, but people with complex or severe mental health problems often need the type of care that only a psychiatrist can provide. 

Addressing the problem of access

The study concludes that street medicine is a promising approach to improving access to mental health and substance use care for people who are unsheltered. Feldman said 60% of the state’s programs provide very high-level care, such as medication-assisted therapy, which involves treating substance use disorders with medications, such as suboxone, in combination with counseling and behavioral therapy. 

Street medicine providers have also embraced using long-acting antipsychotics for people with severe mental illness. These drugs last up to about a month, which makes adherence simpler for people living on the street and stabilizes them for longer periods of time than daily oral medications. 

The study’s authors also suggest novel approaches to providing behavioral health services should be explored, such as using telehealth during street visits to provide patients with access to psychiatric care or treatment for addiction. They also assert that additional research should be done to understand the barriers that exist to providing medications to treat psychiatric problems and substance use disorders and find new ways to improve access. Finally, the authors conclude that the all of the strategies for providing behavioral health care through street medicine should be further studied and evaluated to allow for the development of evidence-based practices that can be tested, replicated, reimbursed and operationalized.

About this study

Additional authors of this study include Kimberly Y. Su, Corinne T. Feldman, Sonali Saluja, Alexis M. Coulourides Kogan and Michael R. Cousineau of the Keck School of Medicine of USC. 

---

JOURNAL

Community Mental Health Journal

DOI

10.1007/s10597-023-01169-z 

METHOD OF RESEARCH

Survey

SUBJECT OF RESEARCH

People

ARTICLE TITLE

Behavioral Health Care Delivery Through Street Medicine Programs in California