Certain community health care worker programs often exploit volunteers, Mount Sinai researchers report

Peer-Reviewed Publication

THE MOUNT SINAI HOSPITAL / MOUNT SINAI SCHOOL OF MEDICINE

More than half of volunteer community health care workers in 19 countries experience labor exploitation, including sub-minimum-wage pay and excess work hours, Mount Sinai researchers report in the first systematic review of the subject.

The researchers focused on two-tiered or dual-cadre programs, in which salaried community health workers work alongside a volunteer group of community health workers. The study, published in Lancet Global Health on September 19, provides a global estimate of the presence, prevalence, and magnitude of labor exploitation among volunteer community health care workers.

The review also underscores the need for immediate attention to public policies that ensure fair compensation and safe working conditions for all community health care workers, which will subsequently improve the quality of care and overall health outcomes.

The study found that about 59 percent of unsalaried community health care workers in programs with both salaried and volunteer employees experienced labor exploitation, which is defined as pay below the country’s minimum wage coupled with excessive work hours or complex tasks. A significant percentage of unsalaried community health care workers, or about 17 percent of volunteers in dual-cadre programs, would need to work 40 hours per week to fulfill their responsibilities. Therefore, a full work load on a voluntary basis, which may include complex tasks beyond the original role—known as “task shifting”—could result in workers experiencing distress from these working conditions, the researchers said.

“Volunteering is wonderful and should be encouraged, but volunteers should not bear the responsibility for delivering essential health services,” said senior author Madeleine Ballard, PhD, Assistant Professor of Global Health and Health System Design at the Arnhold Institute for Global Health, part of the Icahn School of Medicine at Mount Sinai. “It’s fundamentally exploitative to expect the poor to volunteer as a condition to guarantee their own right to health.”

Amidst the worldwide shortage of health care workers, dual-cadre community health worker programs are increasingly common, especially in low- or middle-income countries. Health care delivered by community health workers—a majority-female labor force—can improve health outcomes and equity, providing a return on investment of up to 10 to 1, according to a United Nations study. However, this review found that two-tiered community health worker programs can result in health care of subpar quality.

The team completed a systematic review of 117 peer-reviewed reports on unsalaried community health workers in 19 countries in the Pacific, sub-Saharan Africa, south Asia, and east Asia that were published between 1988 and 2021. They extracted data on salaries, workload, task complexity, and self-reported experiences. Work hours of 10 hours or more per week for unsalaried community health workers, and 48 hours or more per week for salaried community health workers, met the threshold for exploitation in the review.

The researchers concluded that labor laws should be upheld and fair contracts prioritized, while volunteers should not bear the majority of the responsibilities for delivering essential health services and should be able to contribute to policy decisions. The Mount Sinai team said future patient care strategies should focus on optimizing the roles and responsibilities of community health care workers to ensure they can deliver effective services without being overburdened.

Community Health Impact Coalition, a nonprofit directed by Ballard, co-led this study.

About the Mount Sinai Health System

Mount Sinai Health System is one of the largest academic medical systems in the New York metro area, with more than 43,000 employees working across eight hospitals, more than 400 outpatient practices, more than 300 labs, a school of nursing, and a leading school of medicine and graduate education. Mount Sinai advances health for all people, everywhere, by taking on the most complex health care challenges of our time—discovering and applying new scientific learning and knowledge; developing safer, more effective treatments; educating the next generation of medical leaders and innovators; and supporting local communities by delivering high-quality care to all who need it.

Through the integration of its hospitals, labs, and schools, Mount Sinai offers comprehensive health care solutions from birth through geriatrics, leveraging innovative approaches such as artificial intelligence and informatics while keeping patients’ medical and emotional needs at the center of all treatment. The Health System includes approximately 7,400 primary and specialty care physicians; 13 joint-venture outpatient surgery centers throughout the five boroughs of New York City, Westchester, Long Island, and Florida; and more than 30 affiliated community health centers. Hospitals within the System are consistently ranked by Newsweek’s® “The World’s Best Smart Hospitals” and by U.S. News & World Report’s® “Best Hospitals” and “Best Children’s Hospitals.” The Mount Sinai Hospital is on the U.S. News & World Report’s® “Best Hospitals” Honor Roll for 2023-2024.

For more information, visit https://www.mountsinai.org or find Mount Sinai on Facebook, Twitter and YouTube.

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JOURNAL

The Lancet Global Health

ARTICLE TITLE

Labour conditions in dual-cadre community health worker programmes: a systematic review

ARTICLE PUBLICATION DATE

19-Sep-2023

 

Tall buildings could be built quicker if damping models were correct, study finds

Peer-Reviewed Publication

UNIVERSITY OF BRISTOL

Multi-storey buildings are assembled over cautiously to withstand wind strengths, researchers have found.

This is because there are several difficulties in estimating damping – the method of removing energy in order to control vibratory motion like noise and mechanical oscillation, accurately in high-rise buildings

The findings, published today in the journal Structures, addresses the draw back and were compiled by a team at the University of Bristol who studied the damping and natural frequency characteristics of a 150 m tall building in London (UK) obtained from the full-scale wind-induced responses using a minimal monitoring system.

In general, the response of a structure subjected to dynamic loading is strongly affected by its damping.

Some mathematical damping models have been developed and used for convenience, though they cannot accurately describe the physical process behind them. In fact, the lack of universally accepted principles to predict the damping factors in complex systems has led to the use of predominantly empirical models which cannot be generalised accurately to all types of buildings. As one of the objectives, this research intends to address this drawback by studying the damping

Lead author Daniel Gonzalez-Fernandez from Bristol’s School of Civil, Aerospace, and Design Engineering explained: “After evaluating the identified modal parameters in relation to a series of factors, including time, amplitude, wind speed and wind direction, the dominant effects were found to be amplitude and time in the case of natural frequencies and amplitude in the case of damping ratios.

“The changes in the identified natural frequencies, with the monitoring time and response amplitudes, are attributed to the mass increase under the increasing occupancy and large-amplitude structural softening, respectively.

“The identified trends between the measured total damping and wind speed for different relative wind directions indicate that the amplitude of the lateral building motion, rather than aerodynamic wind characteristics, primarily influence the observed variation in the modal damping.”

The team used a set of three accelerometers and an ultrasonic anemometer to measure the wind-induced vibrations and associated wind conditions on top of the structure over a period of one year since it was first constructed.

The natural frequencies and damping ratios were identified from the estimated acceleration Power Spectral Densities and correlated with the wind data. Several environmental parameters were investigated, including the magnitude and the relative directions of the wind with respect to the building motion. A finite element model of the tower was also employed to support the experimental observations.

 Wind effects are a primary concern in the design of tall buildings. In this context, significant uncertainty can be attributed to important phenomena such as damping and its sources. Additionally, given the complexity of these systems, the underlying predictive models require validation. This is where the in-situ measured modal characteristics, such as the natural frequencies and modal damping, provide an essential resource for model updating.

Daniel said: “For tall buildings, occupant comfort is directly related to wind-induced sway, which can interfere with the occupants’ daily activities and general well-being. In addition, these insights might be applied in future to improve the design and mitigate the negative effects of the vibrations on the structures to enhance their performances, increase their lifespans and reduce failure risk.

“Understanding these issues has become more critical in recent years since there is a trend for tall buildings to become more slender and hence more sensitive to wind-induced vibrations.”

 

Paper:

‘Identification of varying modal parameters of a tall building from the full-scale wind-induced responses’ by Daniel Gonzalez-Fernandez et al in Structures.

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JOURNAL

Structures

METHOD OF RESEARCH

Observational study

SUBJECT OF RESEARCH

Not applicable

ARTICLE TITLE

Identification of varying modal parameters of a tall building from the full-scale wind-induced responses

 

Study finds the placenta holds answers to many unexplained pregnancy losses

Peer-Reviewed Publication

YALE UNIVERSITY

 

IMAGE: DOMENIQUE RICE, 33 WEEKS PREGNANT WITH HER FIFTH CHILD, HOLDING A PICTURE FRAME OF HERSELF WITH HER STILLBORN SON TJ. view more 

CREDIT: PHOTOGRAPH BY NANCY BOROWICK

New Haven, Conn. — Yale researchers have shown that placental examination resulted in the accurate pathologic determination of more than 90% of previously unexplained pregnancy losses, a discovery that they say may inform pregnancy care going forward.

The findings were reported Sept. 19 in the journal Reproductive Sciences.

There are approximately 5 million pregnancies per year in the United States, with 1 million ending in miscarriage (a loss occurring prior to 20 weeks of gestation) and over 20,000 ending in stillbirth at or beyond 20 weeks of gestation. As many as 50% of these losses are categorized as “unspecified.”

Patients who suffer such pregnancy outcomes are often told that their loss is unexplained and that they should simply try again, contributing to patients’ feeling of responsibility for the loss, said senior author Dr. Harvey Kliman, a research scientist in the Department of Obstetrics, Gynecology, and Reproductive Sciences at Yale School of Medicine.

“To have a pregnancy loss is a tragedy. To be told there is no explanation adds tremendous pain for these loss families,” said Kliman, who is also director of the Reproductive and Placental Research Unit. “Our goal was to expand the current classification systems to decrease the number of cases that remained unspecified.”

For the study, Kliman worked with Beatrix Thompson, currently a medical student at Harvard University, and Parker Holzer, a former graduate student in Yale’s Department of Statistics and Data Science, to develop an expanded classification system for pregnancy losses based on pathologic examination of loss placentas.

The team started with a series of 1,527 single-child pregnancies that ended in a loss that were sent to Kliman’s consult service at Yale for evaluation. After excluding cases without adequate material for examination, 1,256 placentas from 922 patients were examined. Of these, 70% were miscarriages and 30% were stillbirths.

By adding the explicit categories of “placenta with abnormal development” (dysmorphic placentas) and “small placenta” (a placenta less than the 10th percentile for gestational age) to the existing categories of cord accident, abruption, thrombotic, and infection, for example, the authors were able to determine the pathologic diagnoses for 91.6% of the pregnancies, including 88.5% of the miscarriages and 98.7% of the stillbirths.

The most common pathologic feature observed in unexplained miscarriages were dysmorphic placentas (86.2%), a marker associated with genetic abnormalities. The most common pathologic feature observed in unexplained stillbirths was a small placenta (33.9%).

“This work suggests that the over 7,000 small placentas per year associated with stillbirths could have been detected in utero — flagging those pregnancies as high risk prior to the loss,” said Kliman. “Likewise, the identification of dysmorphic placentas may be one way to potentially identify genetic abnormalities in the almost 1 million miscarriages that occur in our country every year.”

He added, “Having a concrete explanation for a pregnancy loss helps the family understand that their loss was not their fault, allows them to start the healing process, and, when possible, prevent similar losses — especially stillbirths — from occurring in the future.”

When asked what the most effective way might be to prevent stillbirths, Kliman responded, “Measure the placenta!”

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JOURNAL

Reproductive Sciences

 

China global Merged Surface Temperature dataset (CMST) reveals 2023 on Track to Be Hottest Year Ever

Peer-Reviewed Publication

INSTITUTE OF ATMOSPHERIC PHYSICS, CHINESE ACADEMY OF SCIENCES

 

IMAGE: OBSERVATORY WITH MACAO METEOROLOGICAL AND GEOPHYSICS BUREAU view more 

CREDIT: QINGXIANG LI

The climate crisis is reaching unprecedented levels of urgency as global temperatures soar to record-breaking heights, with July 2023 marking another alarming milestone. United Nations Secretary-General  António Guterres  declared it a "disaster for the whole planet," emphasizing that the era of "global warming" has given way to an era of "global boiling." This alarming assessment is supported by recent findings from Professor Qingxiang Li 's team at the School of Atmospheric Sciences, Sun Yat-sen University, based on the China global Merged Surface Temperature dataset 2.0 (CMST 2.0). Prof. Li is also a distinguished research fellow at the Xinjiang Institute of Ecology and Geography Chinese Academy of Sciences.

Unprecedented Monthly Highs since May

Professor Qingxiang Li 's team analyzed the CMST 2.0 dataset and discovered that 2023 has already experienced the third hottest first half-year since records began, narrowly trailing behind the warmest year in 2016 and the second warmest in 2020. The global mean sea surface temperatures (SSTs) surged to an all-time high in April, while global mean land surface air temperatures followed suit by reaching their second-highest monthly level in June. This combination resulted in May being crowned the hottest month ever recorded for global mean surface temperatures.

The research further reveals that global surface temperatures continue to rise into the second half of 2023, driven by factors including El Niño and widespread wildfires. Both global mean SSTs and global mean land surface air temperatures reached unprecedented highs for July, shattering previous records. Given the current trajectory and short-term forecast results of El Niño, along with the extremely positive phase of the Atlantic Multidecadal Oscillation (AMO), which strongly influences global surface temperatures, 2023 is on track to become the hottest year on record. Moreover, 2024 may witness even higher global surface temperatures.

The research is published as a News&Views article on September 19 in Advances in Atmospheric Sciences.

The CMST 2.0 Dataset - A Global Benchmark

The CMST 2.0 dataset, developed by Professor Li Qingxiang's team, stands as the most comprehensive global surface temperature benchmark dataset to date. It incorporates data from China, filling a critical gap in global temperature monitoring. The dataset integrates over a century's worth of global land surface air temperature data and incorporates state-of-the-art research from across the globe, resulting in an invaluable resource for climate scientists and policymakers. In 2022, the dataset was expanded to include Arctic surface temperature data, enhancing its global coverage.

Accessible to both the scientific community and the general public, the CMST 2.0 dataset is freely available on the Global Climate Change Observation and Modeling Data Platform at http://www.gwpu.net/en/.

Understanding the Complex Factors behind Global Warming

While human activities, including greenhouse gas emissions, are the primary drivers of long-term global warming, short-term variations are influenced by internal climate system changes such as El Niño and the Pacific Decadal Oscillation (PDO). As global warming accelerates, the likelihood of extreme weather events and disasters increases, necessitating urgent action.

Global warming also has profound regional impacts, manifesting in extreme temperature fluctuations. For instance, in East Asia, circulation anomalies like the North Atlantic Oscillation (NAO) have led to frequent extreme cold events in winter, offsetting the overall rise in average temperatures. However, the rise in summer maximum temperatures and the decline in winter minimum temperatures result in larger fluctuations in extreme temperatures.

Furthermore, the pace of human discomfort due to rapid temperature increases, particularly in low-latitude regions, is a growing concern that demands our attention. The CMST 2.0 dataset and Professor Qingxiang Li's team's research underscore the urgency of addressing the climate crisis. 

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Global mean surface temperature anomalies for the whole year/first half of the year based on the CMST 2.0 (The blue line represents the GMST in the first half of the year, the gray bar represents the annual GMST (the dark gray column refers to the average predicted temperature in 2023 in the past 5 years), the black line represents the GMST, and the red line represents the regional mean ST in China)

CREDIT

Qingxiang Li

JOURNAL

Advances in Atmospheric Sciences

DOI

10.1007/s00376-023-3200-9 

ARTICLE TITLE

Record-breaking High-temperature Outlook for 2023: An Assessment Based on the China Global Merged Temperature (CMST) Dataset

ARTICLE PUBLICATION DATE

19-Sep-2023

 

Yogurt may be the next go-to garlic breath remedy

Study finds proteins in particular have strong deodorizing effect

Peer-Reviewed Publication

OHIO STATE UNIVERSITY

COLUMBUS, Ohio – It turns out yogurt may have a previously unknown benefit: eliminating garlic odors.

A new study conducted in a lab – with follow-up human breath tests being planned – showed that whole milk plain yogurt prevented almost all of the volatile compounds responsible for garlic’s pungent scent from escaping into the air.

Researchers tested the garlic deodorizing capacity of yogurt and its individual components of water, fat and protein to see how each stood up to the stink. Both fat and protein were effective at trapping garlic odors, leading the scientists to suggest high-protein foods may one day be formulated specifically to fight garlic breath.

“High protein is a very hot thing right now – generally, people want to eat more protein,” said senior study author Sheryl Barringer, professor of food science and technology at The Ohio State University.

“An unintended side benefit may be a high-protein formulation that could be advertised as a breath deodorizer in addition to its nutritional claims,” she said. “I was more excited about the protein’s effectiveness because consumer advice to eat a high-fat food is not going to go over well.”

The study was published recently in the journal Molecules.

Barringer has a history of identifying foods that can combat garlic breath, among them apples, mint and lettuce and milk, thanks to their enzymes and fat, respectively, that snuff out the sulfur-based compounds that cause garlic’s persistent smell.

After encountering speculation that yogurt might have a deodorizing effect, Barringer and first author Manpreet Kaur, a PhD student in her lab, decided to check it out.

For each treatment experiment, the researchers placed equal amounts of raw garlic in glass bottles and confirmed the cluster of offending sulfur-based volatiles were released in concentrations that would be detected by the human nose. They used mass spectrometry to measure levels of the volatile molecules in gaseous form present before and after each treatment.

Results showed that yogurt alone reduced 99% of the major odor-producing raw garlic volatiles. When introduced separately, the fat, water and protein components of yogurt also had a deodorizing effect on raw garlic, but fat and protein performed better than water.

In the case of fat, a higher quantity of butter fat was more effective at deodorization. The proteins studied included different forms of whey, casein and milk proteins, all of which were effective at deodorizing garlic – likely because of their ability to trap the volatile molecules before they were emitted into the air. A casein micelle-whey protein complex performed the best.

“We know proteins bind flavor – a lot of times that’s considered a negative, especially if a food with high protein has less flavor. In this case, it could be a positive,” Barringer said.

Additional experiments involving changing the pH of the yogurt to make it less acidic – from 4.4 pH to 7 pH – reduced the yogurt’s deodorization effect on the garlic. Changing the pH of water, on the other hand, did not make any difference in water’s deodorization effect.

“That’s telling me it goes back to those proteins, because as you change pH you change the configuration of proteins and their ability to bind. That said we definitely should be looking at these proteins,” Barringer said. “It probably depends on the protein, as well, because different proteins react differently to pH. So that may be an important thing as we look at other proteins for their garlic deodorization effect.”

Barringer and Kaur tested the deodorizing effect of yogurt and its separate components on fried garlic as well, and in the process, they discovered that frying garlic alone significantly reduces most of garlic’s odor-causing volatile compounds. Yogurt and its individual ingredients neutralized a lower percentage of volatile compounds of fried garlic compared to raw garlic, presumably because there were fewer volatiles to trap than were present in the raw cloves, the researchers theorized.

The findings are a good foundation for future studies analyzing a variety of proteins that might be formulated into the perfect garlic-breath-reducing product and seeking to verify yogurt’s ability to curb actual garlic breath in people.

In the meantime, Barringer predicts that Greek yogurt, with a higher-protein profile than the whole milk plain yogurt used in the study, may be particularly effective at getting rid of garlic breath. Fruit-flavored yogurts will probably work, too, she said – and whatever is used, it must quickly follow ingestion of raw garlic.

“With apples, we have always said to eat them immediately,” she said. “The same with yogurt is presumed to be the case – have your garlic and eat the yogurt right away.”

#

Contact: Sheryl Barringer, Barringer.11@osu.edu

Written by Emily Caldwell, Caldwell.151@osu.edu; 614-292-8152

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JOURNAL

Molecules

DOI

10.3390/molecules28155714 

METHOD OF RESEARCH

Experimental study

SUBJECT OF RESEARCH

Not applicable

ARTICLE TITLE

Effect of Yogurt and Its Components on the Deodorization of Raw and Fried Garlic Volatiles

 

New recipes for origin of life may point way to distant, inhabited planets

A team led by scientists at UW–Madison has exploited those limitations of chemical combinations to write a cookbook with hundreds of recipes that have the potential to give rise to life

Peer-Reviewed Publication

UNIVERSITY OF WISCONSIN-MADISON

 

IMAGE: LIFE REQUIRES REPETITION OF CHEMICAL REACTIONS. DESCRIBING THE KINDS OF REACTIONS AND CONDITIONS REQUIRED FOR SELF-SUSTAINING REPETITION — CALLED AUTOCATALYSIS — COULD FOCUS THE SEARCH FOR LIFE ON OTHER PLANETS. view more 

CREDIT: BETÜL KAÇAR

Life on a faraway planet — if it’s out there — might not look anything like life on Earth. But there are only so many chemical ingredients in the universe’s pantry, and only so many ways to mix them. A team led by scientists at the University of Wisconsin–Madison has exploited those limitations to write a cookbook of hundreds of chemical recipes with the potential to give rise to life.

Their ingredient list could focus the search for life elsewhere in the universe by pointing out the most likely conditions — planetary versions of mixing techniques, oven temperatures and baking times — for the recipes to come together.

The process of progressing from basic chemical ingredients to the complex cycles of cell metabolism and reproduction that define life, the researchers say, requires not only a simple beginning but also repetition.

“The origin of life really is a something-from-nothing process,” says Betül Kaçar, a NASA-supported astrobiologist and UW–Madison professor of bacteriology. “But that something can’t happen just once. Life comes down to chemistry and conditions that can generate a self-reproducing pattern of reactions.”

Chemical reactions that produce molecules that encourage the same reaction to happen again and again are called autocatalytic reactions. In a new study published Sept. 18 in the Journal of the American Chemical Society, Zhen Peng, a postdoctoral researcher in the Kaçar laboratory, and collaborators compiled 270 combinations of molecules — involving atoms from all groups and series across the periodic table — with the potential for sustained autocatalysis.

“It was thought that these sorts of reactions are very rare,” says Kaçar. “We are showing that it's actually far from rare. You just need to look in the right place.”

The researchers focused their search on what are called comproportionation reactions. In these reactions, two compounds that include the same element with different numbers of electrons, or reactive states, combine to create a new compound in which the element is in the middle of the starting reactive states.

To be autocatalytic, the outcome of the reaction also needs to provide starting materials for the reaction to occur again, so the output becomes a new input says Zach Adam, a co-author of the study and a UW–Madison geoscientist studying the origins of life on Earth. Comproportionation reactions result in multiple copies of some of the molecules involved, providing materials for the next steps in autocatalysis.

“If those conditions are right, you can start with relatively few of those outputs,” Adam says. “Every time you take a turn of the cycle you spit out at least one extra output which speeds up the reaction and makes it happen even faster.”

Autocatalysis is like a growing population of rabbits. Pairs of rabbits come together, produce litters of new rabbits, and then the new rabbits grow up to pair off themselves and make even more rabbits. It doesn’t take many rabbits to soon have many more rabbits.

Looking for floppy ears and fuzzy tails out in the universe, however, probably isn’t a winning strategy. Instead, Kaçar hopes chemists will pull ideas from the new study’s recipe list and test them out in pots and pans simulating extraterrestrial kitchens.

“We will never definitively know what exactly happened on this planet to generate life. We don't have a time machine,” Kaçar says. “But, in a test tube, we can create multiple planetary conditions to understand how the dynamics to sustain life can evolve in the first place.”

Kaçar leads a NASA-supported consortium called MUSE, for Metal Utilization & Selection Across Eons. Her lab will focus on reactions including the elements molybdenum and iron, and she is excited to see what others cook up from the most exotic and unusual parts of the new recipe book.

“Carl Sagan said if you want to bake a pie from scratch, first you must create the universe,” Kaçar says. “I think if we want to understand the universe, first we must bake a few pies.”

This research was funded in part by grants from NASA Astrobiology Program (80NSSC22K0546), the John Templeton Foundation (62578 and 61926), the Research Corporation for Science Advancement (28788) and the Australian Research Council (DP210102133 and FT220100757).

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JOURNAL

Journal of the American Chemical Society

DOI

10.1021/jacs.3c07041 

ARTICLE TITLE

Assessment of Stoichiometric Autocatalysis across Element Groups

ARTICLE PUBLICATION DATE

18-Sep-2023

How does smoking tobacco and cannabis affect depression risk?

Peer-Reviewed Publication

UNIVERSITY OF CALIFORNIA - SAN FRANCISCO

People who use both cannabis and tobacco have significantly higher rates of depression and anxiety than those who use either substance alone or not at all, according to a new study by UC San Francisco researchers.

The study, published Sept. 13, 2023 in the online journal PLOS ONE, comes amid expanding legalization of cannabis products, resulting in more dual use with tobacco nationwide. Earlier studies relied on data collected before the legalization trend, prompting the need for a new analysis.

Understanding the association between the use of both drugs and mental health could lead to more effective prevention and treatment options, the paper’s authors said.

“We provide mental health treatment, but it’s not linked with support for cannabis and tobacco cessation,” said the paper's lead author, Nhung Nguyen, PhD, assistant professor in the Division of General Internal Medicine at Zuckerberg San Francisco General Hospital and Trauma Center and a researcher with UCSF’s Center for Tobacco Control Research and Education. “We cannot provide tobacco cessation without addressing mental health or without considering cannabis use. These comorbidities are closely linked to tobacco use.”

A harmful combination

In conducting this study, the researchers were able to tap into an existing data source: the COVID-19 Citizen Science Study – a mobile app developed by UCSF researchers that contained a wealth of data, including mental health status and substance use, collected from participants around the country through online surveys.

They analyzed responses from 53,843 Americans from March 2020 to April 2022 who answered questions about tobacco and cannabis use over a 30-day period, and paired this with monthly assessments of the participants’ mental health status 

Among people who used both substances, 26.5% reported anxiety and 28.3% reported depression. Percentages of anxiety and depression were only 10.6% and 11.2% in people who used neither substance. Those who only used tobacco had higher rates of anxiety and depression than those who did not.

The study did not delve into whether mental health conditions are exacerbated or triggered by tobacco or cannabis use or vice versa.

"Some believe that cannabis might mitigate against the ill effects of tobacco,” said the paper’s senior author, Gregory Marcus, MD, MAS, professor of medicine and associate chief of research for the Division of Cardiology, “But, these data suggest the combination is particularly harmful to mental health.”

Authors: Additional UCSF authors include Pamela Ling, MD, MPH, Noah Peyser, PhD, Jeffrey Olgin, MD, Mark Pletcher, MD, MPH, Alexis Beatty, MD, MAS, and Madelaine Modrow, MPH.

Funding and disclosures: The research is supported by the California Tobacco-Related Disease Research Program (grants T31FT1564 and T32KT5071) and the National Center for Advancing Translational Sciences, National Institutes of Health, through UCSF Clinical and Translational Science Institute (grant UL1 TR001872-06). The authors have no conflicts of interest to disclose.

 

About UCSF: The University of California, San Francisco (UCSF) is exclusively focused on the health sciences and is dedicated to promoting health worldwide through advanced biomedical research, graduate-level education in the life sciences and health professions, and excellence in patient care. UCSF Health, which serves as UCSF's primary academic medical center, includes top-ranked specialty hospitals and other clinical programs, and has affiliations throughout the Bay Area. UCSF School of Medicine also has a regional campus in Fresno. Learn more at https://ucsf.edu, or see our Fact Sheet.

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JOURNAL

PLoS ONE

ARTICLE PUBLICATION DATE

13-Sep-2023

 

Stigmatization of smoking-related diseases is a barrier to care and the problem may be on the rise

Researchers begin to embrace language guidance to reduce stigma in lung cancer research

Reports and Proceedings

INTERNATIONAL ASSOCIATION FOR THE STUDY OF LUNG CANCER

 

IMAGE: NATHAN HARRISON, FLINDERS UNIVERSITY, IN AUSTRALIA view more 

CREDIT: NATHAN HARRISON, FLINDERS UNIVERSITY, IN AUSTRALIA

[Singapore -- 10:35 a.m. SGT--September 10, 2023) –The stigma that patients face when diagnosed with lung cancer is associated with poorer psychosocial outcomes, including distress and isolation, delayed help-seeking, and concerns about the quality of care, according to research presented today at the International Association for the Study of Lung Cancer (IASLC) 2023 World Conference on Lung Cancer in Singapore.

The study, conducted by a team of researchers led by Nathan Harrison, a behavioral scientist and PhD student from Flinders University, in Australia, aimed to identify and synthesize existing interventions to combat stigma associated with lung cancer and smoking-related respiratory diseases, including chronic obstructive pulmonary disease (COPD).

Meanwhile, IASLC Patient Advocate Jill Feldman presented data at the same press briefing that showed a significant percentage of lung cancer researchers have embraced the IASLC Language Guide. The lung cancer community recognizes that some commonly used words and phrases used in medicine may be contributing to the lung cancer stigma problem. As a result, advocates are working collaboratively with clinicians and scientists toward changing the language used when discussing topics regarding smoking, tobacco use, and related topics.

In 2021, IASLC published the IASLC Language Guide detailing preferred language and phrasing for all oral and written communications, including presentations at IASLC conferences. Feldman’s analysis of 519 presentations at the IASLC World Conference on Lung Cancer 2022 in Vienna found that 177 presentations discussed smoking status, 77 presenters used non-stigmatizing language, while 100 presenters used the stigmatizing term "smoker." Thus, in only one year of implementation, a significant number of presenters had already adopted the recommended changes that play an important role in creating a patient and advocate-friendly environment at IASLC meetings and activities.

Stigma linked to smoking-related respiratory diseases often leads to externalized devaluation, such as discrimination or judgmental comments, and internalized self-blame or shame.  

As denormalization strategies have been central to population-level tobacco control responses that discourage smoking, evidence suggests that stigma around lung cancer and respiratory diseases may be on the rise. To address this issue, developing stigma-reducing interventions for affected individuals has been identified as a priority.

Harrison and his colleagues conducted a systematic review that identified 10 studies, describing nine distinct interventions from 427 records, aimed at reducing stigma related to lung cancer and smoking-related respiratory diseases. Most interventions focused on guiding behavior change through group programs, providing formal psychotherapeutic intervention, or offering information/instruction and reference materials to individuals. These interventions primarily targeted symptomatic individuals or higher-risk groups in high-income countries.

The researchers searched four electronic databases (PsycINFO, CINAHL, PubMed, and Scopus), focusing on lung cancer, COPD, and stigma-related terms, for relevant records published up to December 2022. Eligible studies described an intervention designed to reduce externalized or internalized stigma associated with smoking-related respiratory disease and were assessed using JBI critical appraisal tools as appropriate for the varied (case report, qualitative, quasi-experimental, and randomized controlled trial) study designs.

Notably, the study revealed that most of the identified interventions reported achieving reductions in stigma. Both remote and digital intervention delivery showed similar effects to traditional in-person modes, indicating promise in increasing accessibility for individuals with comorbidities or respiratory disease-related functional impairments.

“We need to further develop and evaluate stigma-reducing interventions with larger samples in diverse socio-cultural contexts,” Harrison said.  “Additionally, including validated stigma assessments in a wider variety of interventional studies could help identify more effective techniques for targeted stigma reduction.”

About the IASLC:

The International Association for the Study of Lung Cancer (IASLC) is the only global organization dedicated solely to the study of lung cancer and other thoracic malignancies. Founded in 1974, the association's membership includes more than 8,000 lung cancer specialists across all disciplines in over 100 countries, forming a global network working together to conquer lung and thoracic cancers worldwide. The association also publishes the Journal of Thoracic Oncology, the primary educational and informational publication for topics relevant to the prevention, detection, diagnosis, and treatment of all thoracic malignancies. Visit www.iaslc.org for more information.

About the WCLC:

The WCLC is the world’s largest meeting dedicated to lung cancer and other thoracic malignancies, attracting more than 7,000 researchers, physicians, and specialists from more than 100 countries. The goal is to increase awareness, collaboration, and understanding of lung cancer, and to help participants implement the latest developments across the globe. The conference will cover a wide range of disciplines and unveil several research studies and clinical trial results. For more information, visit https://wclc2023.iaslc.org.