School-based wellness initiative shown to reduce average student BMI

Researchers at MUSC’s Boeing Center for Children’s Wellness report in the Journal of School Health that participation in its school-based wellness initiative is associated with decline in average student BMI over time in a diverse array of schools

Peer-Reviewed Publication

MEDICAL UNIVERSITY OF SOUTH CAROLINA

 

IMAGE: PHYSICAL ACTIVITY OPPORTUNITIES LED BY PE TEACHER, “MR. C”. AT FLOWERTOWN ELEMENTARY SCHOOL IN SUMMERVILLE, SOUTH CAROLINA. view more 

CREDIT: MEDICAL UNIVERSITY OF SOUTH CAROLINA. PHOTOGRAPH COURTESY OF THE MUSC BOEING CENTER FOR CHILDREN'S WELLNESS.

Health impacts students’ ability to learn. Leaders at  MUSC’s Boeing Center for Children’s Wellness (MUSC BCCW) believe that lessons on healthy living can be part of every student’s school experience.

“Healthier students are better learners, and better learners actually live healthier adult lives,” said Kathleen Head, M.D., MUSC BCCW associate medical director.

In a recent study published in the Journal of School Health, a research team led by Head and BCCW director Janice Key, M.D., compared the average student body mass index (BMI) in schools both participating and not participating in the MUSC BCCW School-based Wellness Initiative. The team used BMI data from the SC FitnessGram project, a statewide program to collect and track student health and fitness data in public schools.

Schools participating in the initiative saw their average student BMIs decrease significantly over time, regardless of school type. The average student BMI in the schools that used more wellness tools and programs was up to 15% lower than the schools that used fewer.

Implementing the School-based Wellness Initiative

Between 2014 and 2018, 103 South Carolina schools across five counties participated in  the School-based Wellness Initiative. The program targets policy, systems and environmental (PSE) change, such as schoolwide gardening projects or classwide stress reduction strategies, instead of solely individual changes.

To achieve this, the initiative uses the School Wellness Checklist (SWC). The SWC features seven categories of evidence-based strategies that schools can use to promote a culture of wellness  that includes getting started, nutrition, physical activity, social-emotional wellness, wellness culture, staff wellness and sustainability. Schools can choose which SWC items work best for them, and they are assigned points based on how many they use. One goal of the study is to determine which of these seven categories is most associated with average student BMI decreases.

Designing a wellness plan for a school using the SWC is a community effort. Head said that each school’s Wellness Committee designs a wellness plan specific to that school’s needs, explaining that the committee includes teachers, staff, administrators and parents, as well as community members, some of whom may have children at the school or just live in the area and are invested in advocacy.

She emphasized that the school-based nature of the initiative is particularly important. “The environment surrounding us as humans is critically important to our overall wellness,” she explained. “Children spend the majority of their day, five days per week, in school, eating, learning and playing.”

Bringing the initiative to schools also ensures program equity, as school-based programs reach all children regardless of medical access. “We want to reach all children and provide more than we can at a doctor visit,” said Key. “The BCCW must go where children are, which is school.”

Defining wellness in childhood

Over the past 40 years, childhood obesity rates have gone up 240%. Obesity is the state of having a BMI greater than 30, and the term overweight applies to those with BMIs between 25 and 30. This category changed in 1998 from a BMI between 27 and 30, shifting 25 million Americans from the normal weight to the overweight category.

About one third of the students in the study had a BMI in the obese or overweight category. Because children are still growing, their weights cannot be measured against preset ranges. Instead, pediatric BMIs are grouped together based on age and sex. Children in the 85th to 95th percentile of their group are considered overweight, and those above the 95th percentile are considered obese.

Though having an overweight or obese BMI is not a one-to-one guarantee of a negative health outcome, Head said that children who are categorized as obese are four times more likely to be diagnosed with diabetes by the time they’re age 25.

Key expressed that there are instances in which the BMI does not give an accurate picture of a child’s body composition, such as in an athletic student who may carry above average muscle mass.

“For something that is simple and easy to check for a whole classroom of kids, height and weight is the best we’ve got,” she said. “But when you’re looking at an individual patient, you would go beyond that.”

Building equitable and effective systems of wellness

Average BMIs went down in schools that participated in the initiative and went up in schools that did not. Additionally, in schools that participated for two years or more, a higher SWC score was associated with greater BMI decreases. Students in schools that scored 250 SWC points were 15% less likely to have overweight or obese BMIs than students in schools that earned only 50 SWC points.

Just as importantly, however, results were spread evenly across schools, Head explained.

“Our results were the same regardless of if the school was elementary, middle or high school, or if it was rural or urban, or if it was a Title I school or a non-Title I school,” she said.

Past school wellness programs have failed to deliver health benefits across different types of schools.

Though physical activity had the largest association with decreased BMI, followed by social-emotional wellness and staff wellness, nutrition education did not. “The disappointment to us was that decreased BMI wasn't associated with the score of nutrition interventions,” Key said.

She explained that this may be because students can actively practice physical activity and social-emotional wellness at school. However, food choice does not happen in the same way. Most food choices and options for students, such as nightly dinners, happen outside of the school and the wellness initiative.

Despite such challenges, Key said that they will not give up on nutrition.

Team members also want to diversify the data they track to monitor the effectiveness of their program. “In the future,” Head explained, “we’d like to measure knowledge, attitudes and behaviors associated with some of our interventions rather than skipping straight to BMI.

 

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About MUSC

Founded in 1824 in Charleston, MUSC is the state’s only comprehensive academic health system, with a unique mission to preserve and optimize human life in South Carolina through education, research and patient care. Each year, MUSC educates more than 3,000 students in six colleges – Dental Medicine, Graduate Studies, Health Professions, Medicine, Nursing and Pharmacy – and trains more than 850 residents and fellows in its health system. MUSC brought in more than $297.8 million in research funds in fiscal year 2022, leading the state overall in research funding. For information on academic programs, visit musc.edu.

As the health care system of the Medical University of South Carolina, MUSC Health is dedicated to delivering the highest quality and safest patient care while educating and training generations of outstanding health care providers and leaders to serve the people of South Carolina and beyond. Patient care is provided at 14 hospitals with approximately 2,500 beds and five additional hospital locations in development, more than 350 telehealth sites and connectivity to patients’ homes, and nearly 750 care locations situated in all regions of South Carolina. In 2022, for the eighth consecutive year, U.S. News & World Report named MUSC Health the No. 1 hospital in South Carolina. To learn more about clinical patient services, visit muschealth.org.

MUSC and its affiliates have collective annual budgets of $5.1 billion. The nearly 25,000 MUSC team members include world-class faculty, physicians, specialty providers, scientists, students, affiliates and care team members who deliver groundbreaking education, research and patient care.

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JOURNAL

Journal of School Health

DOI

10.1111/josh.13292 

METHOD OF RESEARCH

Experimental study

SUBJECT OF RESEARCH

People

Wastewater sector emits nearly twice as much methane as previously thought

Peer-Reviewed Publication

PRINCETON UNIVERSITY, ENGINEERING SCHOOL

 

IMAGE: RESEARCHERS STAND WITH THE PRINCETON CHEMISTRY EXPERIMENT MOBILE LABORATORY view more 

CREDIT: BUMPER DEJESUS / PRINCETON UNIVERSITY

Municipal wastewater treatment plants emit nearly double the amount of methane into the atmosphere than scientists previously believed, according to new research from Princeton University. And since methane warms the planet over 80 times more powerfully than carbon dioxide over 20 years, that could be a big problem.

“The waste sector is one of the largest anthropogenic sources of methane in the world,” said Mark Zondlo, professor of civil and environmental engineering and associated faculty at the Andlinger Center for Energy and the Environment. “As cities continue to urbanize and develop net-zero plans, they can’t ignore the liquid wastewater treatment sector.”

Zondlo led one of two new studies on the subject, both reported in papers published in Environmental Science & Technology. One study performed on-the-ground methane emissions measurements at 63 wastewater treatment plants in the United States; the other used machine learning methods to analyze published literature data from methane monitoring studies of various wastewater collection and treatment processes around the globe.

“Not many people have studied the methane emissions associated with wastewater infrastructure, even though we know that it’s a hotspot for methane production,” said Z. Jason Ren, who led the second study. Ren is a professor of civil and environmental engineering and the Andlinger Center for Energy and the Environment.

The Intergovernmental Panel on Climate Change (IPCC) has established guidelines that allow researchers and institutions like the U.S. Environmental Protection Agency (EPA) to estimate methane emissions from wastewater treatment plants based on their specific treatment processes. However, those guidelines were developed from limited measurements at a relatively small number of wastewater treatment plants.

And when the researchers used the Princeton Atmospheric Chemistry Experiment (PACE) Mobile Laboratory to quantify plant-wide emissions by measuring the plumes of 63 treatment plants on the east coast and in California, they found that the IPCC guidelines consistently underestimated treatment plants of all sizes and treatment processes.

If the results from those 63 plants are representative, actual methane emissions from wastewater treatment facilities across the U.S. would be about 1.9 times greater than emissions estimates that use existing IPCC and EPA guidelines, meaning that those guidelines underestimate methane emissions equivalent to 5.3 million metric tons of carbon dioxide.

Interestingly, the research team who performed the second independent study to analyze literature data on methane emissions came to a similar conclusion: estimated methane emissions from municipal wastewater treatment in the U.S. were around double of what existing guidelines would predict.

“We were able to show, using two different approaches, that methane emissions are a much bigger issue for the wastewater sector than previously thought,” Ren said.

The Princeton Chemistry Experiment Mobile Laboratory

CREDIT

Bumper DeJesus / Princeton University

The usual suspects in wastewater methane emissions

The researchers believe that since the IPCC guidelines were developed from limited measurements at a small number of wastewater treatment plants, they might not accurately represent the variation in emissions that exists between facilities.

“The guidelines assume a certain level of efficiency in these wastewater treatment systems that may not exist on a plant-to-plant basis,” said Daniel Moore, first author of the direct measurement study and a graduate student in civil and environmental engineering. He pointed to leaks and inefficient equipment that may go undetected at wastewater treatment plants but could lead to significant greenhouse gas emissions.

Cuihong Song, first author of the critical review and a postdoctoral researcher in civil and environmental engineering at Princeton, said that treatment plants equipped with anaerobic digesters were among the biggest methane leakers.

Anaerobic digesters are airtight vessels containing anaerobic microbes that work without oxygen to break down wastewater sludge or solid waste and produce methane-rich biogas in the process. That methane can be used to generate heat or electricity to power other aspects of the treatment process.

But when anaerobic digesters operate inefficiently, leaks and pressure buildups can allow methane to escape as fugitive emissions. “If the digester is not gas-tight, you can end up with high methane emissions,” Song said. The researchers found that plants with anaerobic digesters emitted more than three times the methane than plants without digesters.

Higher emissions from anaerobic digesters could be a serious problem: while wastewater treatment plants equipped with anaerobic digesters account for less than 10% of all treatment plants in the U.S., most of those plants are large facilities that, combined, treat around 55% of the wastewater in the country.

“A lot of money is going into decreasing emissions by implementing these digesters, because, in theory, they’re closed systems. When they’re working correctly, you can centralize the methane into one location,” Moore added. “It’s the inefficiencies and leakages that cause many of the problems.”

Along with anaerobic digesters, the critical review found that methane emissions from sewer systems contribute significantly to nationwide methane emissions. However, current guidelines largely do not account for fugitive methane emissions from sewers, which the researchers said are important to account for in future greenhouse gas inventories.

“We have more than a million miles of sewers in the U.S., filled with rich organic matter that may be causing methane emissions, but we have very little understanding of their scope,” Ren said.

Researcher Daniel Moore inspects the Princeton Chemistry Experiment Mobile Laboratory

CREDIT

Bumper DeJesus / Princeton University

Better monitoring, better guidelines

The researchers are now working with partners to build an inventory and methodology that would allow managers to easily monitor their methane emissions. By identifying the sources in the wastewater treatment process that release the most methane emissions, their work can also inform efforts to mitigate fugitive emissions.

“Methane has a short lifetime in the atmosphere, so if we’re able to cut off the spout of emissions across the country, methane’s contribution to warming will quickly diminish,” said Moore. “Ten years from now, we wouldn’t have to worry so much about methane.”

Ren added that the methane produced from processes like anaerobic digestion also serves as a valuable energy source. “By identifying and mitigating fugitive methane emissions, we would see double benefits,” he said. “We would reduce greenhouse gas emissions in the near term, and we would maximize the amount of methane we can recover from the wastewater treatment process.”

Still, more work is needed to monitor methane emissions at various timescales from treatment plants and sewer networks of different sizes and treatment processes.

For example, few studies have performed long-term, continuous monitoring of methane emissions from wastewater treatment plants, even though the emissions rate can vary daily or even seasonally, being generally higher in the spring and summer than in the winter. “Ultimately, we need to have a full accounting of the emissions from plants across many timescales,” Zondlo said. He added that preliminary analyses of subsequent measurements from additional plants at various times of the year have highlighted the importance of understanding seasonal variation in emissions.

At the same time, researchers will need to develop better sampling methods to understand emissions from hard-to-reach areas like sewers, since the diffuse nature of sewer networks along with their high humidity levels make it difficult to capture an accurate picture of emissions with existing methodologies.

By overcoming those hurdles and continuing their monitoring efforts, the researchers could contribute to a wider effort to create updated guidelines that better estimate methane emissions from the wastewater sector.

“Many agencies are recognizing that methane emissions from wastewater sector are important to study,” Ren said. “This research is not just reporting our own findings. We’re echoing what the broader research community has observed and identified as a significant gap of knowledge.”

The article, “Underestimation of sector-wide methane emissions from United States wastewater treatment,” with Daniel Moore as first author and Mark Zondlo as lead PI, was published in Environmental Science & Technology on Feb. 27. In addition to Moore and Zondlo, authors include Nathan Li, Lars Wendt, Mark Falinski, Jun-Jie Zhu, Cuihong Song, and Z. Jason Ren of Princeton; as well as Sierra Castañeda, a former Princeton student who is currently a Ph.D. student at Stanford University.

The article, “Methane Emissions from Municipal Wastewater Collection and Treatment Systems,” with Cuihong Song as first author and Z. Jason Ren as lead PI, was published in Environmental Science & Technology on Feb. 3. In addition to Song and Ren, authors include Jun-Jie Zhu, Daniel Moore, and Mark Zondlo of Princeton; as well as John Willis of Brown and Caldwell.

Support for the research projects was provided by the Energy and Environment Program at the Alfred P. Sloan Foundation (awarded alongside fellow project lead Francesca Hopkins of the University of California, Riverside), the High Meadow Environmental Institute via the Clear Water Challenge, and the Water Research Foundation via the Paul L. Busch Award.

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JOURNAL

Environmental Science & Technology

DOI

10.1021/acs.est.2c05373 

SUBJECT OF RESEARCH

Not applicable

ARTICLE TITLE

Underestimation of Sector-Wide Methane Emissions from United States Wastewater Treatment

ARTICLE PUBLICATION DATE

27-Feb-2023

Plant-based low-carbohydrate diet linked with lower risk of premature death for people with type 2 diabetes

Peer-Reviewed Publication

HARVARD T.H. CHAN SCHOOL OF PUBLIC HEALTH

Key points:

• Adhering to a plant-based low-carbohydrate diet was associated with a reduction in overall, cardiovascular, and cancer mortality among people with type 2 diabetes
• Researchers observed the strongest health benefits among people who not only adhered to this diet but also had other healthy habits, such as exercising, not smoking, and consuming alcohol in moderate amounts

For immediate release: Tuesday, February 28, 2023

Boston, MA—Following a low-carbohydrate diet comprised primarily of plant-based foods was significantly associated with lower risk of premature death among people with type 2 diabetes, according to a new study led by researchers at Harvard T.H. Chan School of Public Health. It is the first prospective cohort study to examine the relationship between low-carbohydrate diet patterns and mortality among people with diagnosed type 2 diabetes.

“While avoiding refined and highly-processed carbohydrates has been widely recommended to lower the risk of developing type 2 diabetes, our study provides the first empirical evidence on how low-carb diets can help manage the progression of existing diabetes,” said lead author Yang Hu, research associate in the Department of Nutrition.

The study was published online February 14, 2023, and will appear in the April issue of Diabetes Care.

The researchers analyzed 34 years of health data from 7,224 women participating in the Nurses’ Health Study and 2,877 men participating in the Health Professionals Follow-up Study, all of whom developed type 2 diabetes after those studies began. The participants completed questionnaires on lifestyle and medical history every other year, allowing the researchers to assess the compositions of their diets and score them according to intake of animal proteins and fats, vegetable proteins and fats, high-quality carbohydrates, and low-quality carbohydrates.

The findings showed a 24% reduction in all-cause mortality among those adhering to a low-carbohydrate dietary pattern. The health benefits were stronger for low-carbohydrate diets that emphasized plant-based foods and high-quality carbohydrates, such as fruits, vegetables, and whole grains. Those diets were also associated with a lower cardiovascular disease and cancer mortality. Low-carbohydrate diets that emphasized animal products and low-quality carbohydrates, such as potatoes, added sugars, and refined grains, were not significantly associated with lower mortality.

The researchers observed the strongest health benefits among people adhering to other healthy habits, such as not smoking, regularly exercising, and drinking alcohol in moderation, alongside a plant-based low-carbohydrate diet.

“This study, once again, underscores the importance of diet quality when choosing among various diets for diabetes control and management,” said Qi Sun, senior author and associate professor in the Departments of Nutrition and Epidemiology.

Other Harvard Chan School co-authors included Edward Yu, JoAnn E. Manson, Eric B. Rimm, Liming Liang, Walter C. Willett, and Frank B. Hu.

Funding for the study—and for the Nurses’ Health Study and Health Professionals Follow-up study underpinning it—came from National Institutes of Health grants UM1 CA186107, P01 CA87969, R01 HL034594, U01 CA167552, R01 HL35464, R01 HL60712, R01 DK120870, R01 DK126698, R01 DK119268, U2C DK129670, DK119268, R01 ED022981, and R21 AG070375.

“Low-Carbohydrate Diet Scores and Mortality Among Adults With Incident Type 2 Diabetes,” Yang Hu, Gang Liu, Edward Yu, Biqi Wang, Clemens Wittenbecher, JoAnn E. Manson, Eric B. Rimm, Liming Liang, Kathryn Rexrode, Walter C. Willett, Frank B. Hu, Qi Sun, Diabetes Care, April 2023, doi: 10.2337/dc22-2310

Visit the Harvard Chan School website for the latest news, press releases, and multimedia offerings.

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Harvard T.H. Chan School of Public Health brings together dedicated experts from many disciplines to educate new generations of global health leaders and produce powerful ideas that improve the lives and health of people everywhere. As a community of leading scientists, educators, and students, we work together to take innovative ideas from the laboratory to people’s lives—not only making scientific breakthroughs, but also working to change individual behaviors, public policies, and health care practices. Each year, more than 400 faculty members at Harvard Chan School teach 1,000-plus full-time students from around the world and train thousands more through online and executive education courses. Founded in 1913 as the Harvard-MIT School of Health Officers, the School is recognized as America’s oldest professional training program in public health.

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JOURNAL

Diabetes Care

DOI

10.2337/dc22-2310 

METHOD OF RESEARCH

Observational study

SUBJECT OF RESEARCH

Not applicable

ARTICLE TITLE

Low-Carbohydrate Diet Scores and Mortality Among Adults With Incident Type 2 Diabetes

More proof that too many medications leads to adversity for older cancer patients

Peer-Reviewed Publication

UNIVERSITY OF ROCHESTER MEDICAL CENTER

When older adults with cancer take multiple medications — including ordinary drugs like blood pressure pills, supplements, or antacids — it can result in more toxic chemotherapy side effects and even a need to stop cancer treatment, according to new research at the Wilmot Cancer Institute.

The latest study, published in the journal Cancer, provides a cautionary note to both patients and physicians regarding “polypharmacy,” a buzz word describing the concurrent use of multiple medications. It’s extremely common, applying to nearly 92 percent of older adults with cancer.

A key finding: Individuals who had one or more major potential drug interactions also had 59-percent-higher odds of having to stop cancer treatment earlier than recommended.

“It’s possible that polypharmacy affects both the experience and the effectiveness of chemotherapy,” said Erika Ramsdale, M.D., a Wilmot oncologist, geriatrics specialist, data scientist, and senior author of the paper.  

Last year, Ramsdale and colleagues published a descriptive study that laid out the scope of the polypharmacy problem and categorized medication issues in a nationwide sample of 718 adults with a mean age of 77 who had stage 3 or 4 cancer and other health conditions. Read more.

In that first study, researchers showed that the majority of the patients had at least one other serious health concern, often cardiovascular disease. Other details included:

• 70 percent were at risk of drug-drug interactions;
• 67 percent were taking at least one drug that was potentially inappropriate;
• 61 percent of the patients were taking five or more medications before starting chemotherapy;
• and nearly 15 percent were taking 10 or more medications.

Both studies suggest that physicians should carefully screen for medication usage and possible drug interactions upon a new patient’s cancer diagnosis.

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JOURNAL

Cancer

DOI

10.1002/cncr.34642 

METHOD OF RESEARCH

Randomized controlled/clinical trial

SUBJECT OF RESEARCH

People

ARTICLE TITLE

Association of polypharmacy and potential drug-drug interactions with adverse treatment outcomes in older adults with advanced cancer

COI STATEMENT

Supriya G. Mohile received funding from Carevive for projects outside the submitted work. Megan Wells owns stock in AGENUS. Kah Poh Loh reports personal fees from Pfizer Canada Inc. and Seattle Genetics outside the submitted work. Erika E. Ramsdale reports honoraria from Flatiron Health outside the submitted work. The remaining authors made no disclosures.

International Space Station National Laboratory opens technology advancement research announcement

Grant and Award Announcement

INTERNATIONAL SPACE STATION U.S. NATIONAL LABORATORY

The International Space Station (ISS) National Laboratory today released a new research announcement soliciting flight concepts for “Technology Advancement and Applied Research Leveraging the ISS National Lab.” This solicitation is open to a broad range of technology areas including chemical and material synthesis in space, bonding, translational medicine, in-space edge computing and on-demand cloud computing technologies, and the use of ISS remote sensing data to improve geospatial analytics for commercial use.

Space-based technology development and demonstration is a strategic priority for the ISS National Lab, as it provides an opportunity for accelerated technology maturation to enable advancements that improve life on Earth and build commerce in low Earth orbit. Through this research announcement, offerors may propose to use the unique ISS environment to develop, test, or mature products and processes that have a demonstrated potential to produce near-term and positive direct or indirect economic impact.

More specifically, emphasis will be placed on proposals for the testing and space qualification of hardware prototypes and for advancing process improvements, such as (but not limited to):

• Hardware prototype testing: Innovations addressing hardware product development gaps and emerging technology proliferation in the areas of computing, electronics, nanotechnologies, robotics, sensors, communications, remote sensing, and satellite technology.
• Process improvements: Use of the ISS as a test bed for advancing development of facilities for high-throughput investigations, use of space-based data to facilitate modeling of industrial systems, or demonstration of new methodologies for spaceflight research and development.
• Advanced materials: Current advanced materials research that addresses the development of next-generation production methods, the testing of novel materials, and the exploitation of materials with unique properties.
• Translational medicine: Validation of accelerated disease modeling, analyzation of macromolecular structures for drug design, and demonstration of novel drug delivery and diagnostic services.

This research announcement will follow a two-step proposal submission process. Before being invited to submit a full proposal, all interested investigators must submit a Step 1: Concept Summary for review. The Center for the Advancement of Science in Space, Inc. (CASIS), manager of the ISS National Lab, will host a webinar on Thursday, March 9, 2023, at 2 p.m. EST to discuss ISS facilities and capabilities associated with this research announcement. A recording of the webinar will be made available to the research community through the research announcement webpage.

Step 1: Concept Summaries must be submitted by end of day on April 17, 2023. Step 2: Full Proposals (from those invited to submit) will be due by end of day July 17, 2023.

Flight concepts selected via this research announcement may be awarded funding to enable mission integration and operations support for projects that will be implemented on the ISS. The total set aside funding for this research announcement is approximately $750,000, with an expectation to make three to five awards. To learn more about this opportunity, including how to submit a Step 1: Concept Summary, please visit the research announcement webpage. To learn more about the ISS National Lab and the science that it sponsors, please visit our website at www.ISSNationalLab.org.

Depression & anxiety symptoms linked to vaping nicotine and THC in teens and young adults

American Heart Association Epidemiology, Prevention, Lifestyle & Cardiometabolic Health Scientific Sessions 2023, Abstract 602

Reports and Proceedings

AMERICAN HEART ASSOCIATION

Research Highlights:

• A study of more than 2,500 people ages 13-24 found that nicotine-only vapers, THC-only vapers and dual vapers (of nicotine and THC) were more likely to report anxiety symptoms, depressive symptoms and suicidal thoughts when compared with their peers who did not use electronic cigarettes or vape THC.
• Approximately 60% of the nicotine-only, THC-only and dual vapers self-reported that they experienced anxiety symptoms, versus about 40% of participants who never vaped. Anxiety symptoms were more frequently reported among THC-only vapers.
• Over half of the nicotine-only, THC-only and dual vapers self-reported that they experienced symptoms of depression versus 25% of non-vapers.

Embargoed until 3 p.m. CT/4 p.m. ET, Tuesday, February 28, 2023

DALLAS, February 28, 2023 — A survey of more than 2,500 teens and young adults led by the American Heart Association found that vaping nicotine and THC, the psychoactive component in marijuana, was associated with self-reported symptoms of depression and anxiety. The study’s preliminary findings will be presented at the Association’s Epidemiology, Prevention, Lifestyle & Cardiometabolic Health Scientific Sessions 2023, which will be held in Boston, February 28-March 3, 2023, and offers the latest science on population-based health and wellness and implications for lifestyle and cardiometabolic health.

The use of pod-based e-cigarettes has surged among youth and young adults in recent years. Previous studies have identified links between vaping and symptoms of both anxiety and depression among young adults.

“Younger people have long been vulnerable to tobacco use, may experience greater harm from nicotine and other drugs and may be targeted by tobacco advertisers and marketers,” said study author Joy Hart, Ph.D., a professor of communication at the University of Louisville in Kentucky. “E-cigarette devices are still relatively new compared to other tobacco products, such as combustible cigarettes and pipes, so more research is needed to try to better understand the popularity of e-cigarettes, including reasons for vaping and the associated health risks among youth.”

The researchers, several of whom work for the Association, conducted an online survey among 2,505 teens and young adults, ages 13-24, to gauge mental health differences among nicotine-only vapers, THC-only vapers, dual vapers of both nicotine and THC and people who had never vaped any product. The study was focused on 1,921 people who had never vaped or were current vapers, defined as having vaped in the past 30 days. Of those participants, 562 individuals reported they had never vaped, 370 had vaped only nicotine, 159 had vaped only THC, and 830 were dual vapers of nicotine and THC.

The analysis of the participants’ survey responses found:

• Approximately 70% of the THC-only vapers and 60% of the nicotine-only vapers and dual vapers reported experiencing anxiety symptoms — such as worries, flashbacks, panic attacks and situational anxieties— within the past week, compared to about 40% of participants who had never vaped.
• Over half of the nicotine-only vapers, THC-only vapers and dual vapers reported experiencing symptoms of depression — such as difficulty engaging in or being interested in activities normally enjoyed, whether they felt that depression interfered with their ability to do the things they needed to do at work, at school or at home and whether depression interfered with their social life and relationships — within the past week, compared to 25% of non-vapers.
• More than 50% of people in all vaping groups reported having suicidal thoughts within the past 12 months, compared to only one-third of the non-users.
• About a quarter of the dual vapers and nicotine-only vapers started vaping nicotine to calm down or feel less stressed, and one-third of participants in both groups reported that they currently vaped nicotine to cope with feelings of anxiety. In contrast, about half of THC-only vapers started vaping THC and currently vaped THC to relieve anxiety symptoms.
• Around 20% of nicotine-only vapers and dual vapers started vaping to help feel less depressed and currently vaped for this reason. About one-third of THC-only vapers started vaping THC and nearly half currently vaped TCH to feel less depressed.

Dual vapers were significantly more likely than nicotine-only vapers to indicate addiction to nicotine, which was defined in this study as behavior such as waking up at night to vape. Dual vapers of nicotine and THC were also significantly more likely to say they felt less depressed after they started vaping, whereas nicotine-only vapers were more likely to report that vaping had no impact on their feelings of depression. This may be related to dual users’ stronger addiction to these products, rather than the positive impacts of the products on their mental health, the researchers said.

“Although we knew that THC was commonly vaped, we were surprised to have so many dual vapers—more than double the nicotine-only vapers. Dual use may either compound the addictive nature of vaping or attract people who are more prone to addiction, as well as have an impact on symptoms of depression. These findings suggest the importance of addressing the use of THC and the need for building resilience and coping skills for teens and young adults,” Hart said.

The study had limitations: the use of cross-sectional data did not allow researchers to assess whether symptoms of anxiety and depression, as well as suicidal thoughts, were caused or exacerbated by the use of the THC and nicotine vapes, or whether the existence of those symptoms had an effect on the use of the vape products; collecting online data via a web-based panel meant that participants may not be representative of all U.S. teens and young adults; and the data were self-reported.

“When better coping skills are developed, there may be fewer temptations to try to manage anxiety symptoms and similar mental health challenges through vaping, as well as better refusal skills if offered an electronic cigarette. Increased priority on more positive behaviors to alleviate tension and manage anxiety symptoms may reduce the likelihood of vaping, possible addiction and the increased risk of negative health outcomes,” said Rose Marie Robertson, M.D., FAHA. Robertson is deputy chief science and medical officer of the American Heart Association, co-director of the Association’s National Institutes of Health/U.S. Food and Drug Administration-funded Tobacco Center of Regulatory Science and senior author on the study. “There is also an urgent need for effective communication campaigns and educational programs to increase understanding among youth and young adults of the risks of using e-cigarettes.”

Future research, Robertson said, is needed to examine the long-term connections between mental health and vaping, whether nicotine-only, THC-only or both nicotine and THC.

“This study showed the striking significance of issues with mental health in users of both nicotine vapes as well as THC vapes, and as new products continue to come on the market, I think that this is something that we will continue to see,” said Loren E. Wold, Ph.D., FAHA. Wold is assistant dean for biological health research in the College of Nursing, a professor in the Colleges of Nursing and Medicine (physiology and cell biology) at The Ohio State University and lead of the writing committee for the Association’s 2022 Statement on Cardiopulmonary Consequences of Vaping in Adolescents. “These products were developed as smoking cessation tools for those that use traditional cigarettes, so I’m very curious now what the implications are with mental health in users who are using these products to help stop smoking.”

Additional co-authors are Jeffrey Willett, Ph.D.; Allison Groom, M.A.; Robyn L. Landry; Angel Bassett, M.A.; Mary Dunn, Ph.D.; Kandi Walker, Ph.D.; Thomas Payne, Ph.D.; and Anshula Kesh, M.P.H., B.D.S. Authors’ disclosures are listed in the abstract.

The study was funded by a grant from the Kaiser Permanente National Community Benefit Fund at the East Bay Community Foundation. Through the American Heart Association Tobacco Center for Regulatory Science, the Association works closely with investigators at institutions across the country to pursue research that adds to the existing knowledge about the health impacts of smoking and nicotine-related products including e-cigarettes, findings that can help inform public health and the regulation of tobacco products.

Statements and conclusions of studies that are presented at the American Heart Association’s scientific meetings are solely those of the study authors and do not necessarily reflect the Association’s policy or position. The Association makes no representation or guarantee as to their accuracy or reliability. Abstracts presented at the Association’s scientific meetings are not peer-reviewed, rather, they are curated by independent review panels and are considered based on the potential to add to the diversity of scientific issues and views discussed at the meeting. The findings are considered preliminary until published as a full manuscript in a peer-reviewed scientific journal.

The Association receives funding primarily from individuals; foundations and corporations (including pharmaceutical, device manufacturers and other companies) also make donations and fund specific Association programs and events. The Association has strict policies to prevent these relationships from influencing the science content. Revenues from pharmaceutical and biotech companies, device manufacturers and health insurance providers and the Association’s overall financial information are available here.

Additional Resources:

• Multimedia is available on the right column of release link https://newsroom.heart.org/news/depression-anxiety-symptoms-linked-to-vaping-nicotine-and-thc-in-teens-and-young-adults?preview=c30b14f8eb24c1a3519f6e7e9e0d0513
  • Video interview: Rose Marie Robertson, M.D., FAHA, senior author on the study and deputy chief science and medical officer of the American Heart Association and co-director of the Association’s National Institutes of Health/U.S. Food and Drug Administration-funded Tobacco Center of Regulatory Science.
  • Video interview: American Heart Association volunteer expert, Loren E. Wold, Ph.D., FAHA, assistant dean for biological health research in the College of Nursing, a professor in the Colleges of Nursing and Medicine (physiology and cell biology) at The Ohio State University and lead of the writing committee for the Association’s 2022 Statement on Cardiopulmonary Consequences of Vaping in Adolescents.
• AHA news release: Use of e-cigarettes had negative cardiovascular effects similar to smoking cigarettes (October 2022)
• AHA news release: People who vape had worrisome changes in cardiovascular function, even as young adults (October 2022)
• AHA news release: No health benefits among adults who used both e-cigarettes and traditional cigarettes (May 2022)
• AHA health information: Quit Vaping – Quit Smoking – Quit Tobacco
• AHA health information: The Ugly Truth About Vaping
• For more news from AHA EPI Lifestyle Conference 2023, follow us on Twitter @HeartNews #EPILifestyle23.

The American Heart Association’s EPI/LIFESTYLE 2023 Scientific Sessions is the world’s premier meeting dedicated to the latest advances in population-based science. The meeting will be held Tuesday-Friday, February 28 – March 3, 2023, at the Omni Boston Seaport in Boston, Massachusetts. The primary goal of the meeting is to promote the development and application of translational and population science to prevent heart disease and stroke and foster cardiovascular health. The sessions focus on risk factors, obesity, nutrition, physical activity, genetics, metabolism, biomarkers, subclinical disease, clinical disease, healthy populations, global health and prevention-oriented clinical trials. The Councils on Epidemiology and Prevention and Lifestyle and Cardiometabolic Health (Lifestyle) jointly planned the EPI/Lifestyle 2023 Scientific Sessions. Follow the conference on Twitter at #EPILifestyle23.

About the American Heart Association

The American Heart Association is a relentless force for a world of longer, healthier lives. We are dedicated to ensuring equitable health in all communities. Through collaboration with numerous organizations, and powered by millions of volunteers, we fund innovative research, advocate for the public’s health and share lifesaving resources. The Dallas-based organization has been a leading source of health information for nearly a century. Connect with us on heart.org, Facebook, Twitter or by calling 1-800-AHA-USA1.

Precarious work associated with high BMI

UIC study published in Obesity

Peer-Reviewed Publication

UNIVERSITY OF ILLINOIS CHICAGO

A study from the University of Illinois Chicago links precarious work with increases in body mass index.

The study adds to a growing body of evidence that precarious work may contribute to poor health outcomes. 

The UIC scientists who wrote the paper defined precarious work as an accumulation of “unfavorable facets of employment,” such as low wages, insecure employment contracts, irregular hours and lack of union representation.

“Over the last few decades, there has been an increase in the number of Americans engaging in precarious work — we see this with the rise of the ‘gig’ economy or the number of people working for ride-share companies, for example. With millions of Americans now engaging in precarious work, we need to pay closer attention to the health impacts of type of employment, ” said study author Vanessa Oddo, assistant professor of kinesiology and nutrition at the UIC College of Applied Health Sciences.

To understand the impact of precarious work on BMI, the researchers analyzed 20 years of data from the National Longitudinal Survey of Youth adult cohort (1996–2016). The average age of the participants was 44.

They looked at seven precarious employment dimensions — material rewards, working time arrangements, employment stability and collective organization, for example — and identified 13 self-reported survey indicators of precarious employment. Computational and statistical models were used to compare these indicators with BMI, a rough indicator of obesity.

Indicators of precarious employment were highest among Latino and Black women with lower education. A 1-point increase in precarious employment was associated with a 2.18-point increase in BMI.

The findings are reported in Obesity.

The researchers say that “these modest changes in BMI may have important implications at the population level, given that small changes in weight affect chronic disease risk.

“Policies and workplace interventions to improve employment quality warrant consideration to protect American workers and mitigate the growing burden of obesity-related chronic diseases in the United States,” the authors write.

Co-authors of the study, titled “Association between precarious employment and BMI in the United States,” are Castiel Chen Zhuang, Jerome A. Dugan, Sarah B. Andrea, Anjum Hajat, Trevor Peckham and Jessica C. Jones-Smith.

The study was primarily supported by a grant from the National Institute on Minority Health and Health Disparities (R00MD012807). Additional support was provided by the National Institute on Aging (R01AG060011) and National Institute on Minority Health and Health Disparities (F31MD013357).

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JOURNAL

Obesity

DOI

10.1002/oby.23591 

METHOD OF RESEARCH

Meta-analysis

ARTICLE TITLE

Association between precarious employment and BMI in the United States