The rising risk of flooding and the role of nature-based solutions

University of Vermont

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For decades, flooding has remained one of the most destructive and deadly natural disasters in the United States, causing an average of $8 billion in damages and nearly 90 deaths each year.

With climate change intensifying storms and urban development replacing natural flood barriers, both the frequency and severity of flood events are on the rise.

Warming temperatures allow the atmosphere to hold more moisture, fueling heavier rainfall. At the same time, as cities grow, natural landscapes are being replaced with concrete and asphalt, increasing runoff and overwhelming stormwater systems. 

As a result, flood risks are rising nationwide, including in states that have not historically faced frequent flooding. By 2100, the number of Americans exposed to flooding could nearly double.

Investing in Natural Spaces

Nature-based solutions (NbS), such as restoring wetlands and reconnecting floodplains, can significantly reduce flood impacts by slowing and absorbing runoff. Unlike dams and levees, these approaches also deliver added benefits, including improved air quality, carbon storage, biodiversity, and aesthetic and recreational value. Despite these advantages, NbS remain underused.

University of Vermont researchers supported by the Cooperative Institute for Research to Operations in Hydrology probed public perception and attitudes on flood mitigation through a nationally representative study. The study published in the journal, People and Nature, reveals that while many people recognize the value of engineered structures, interest is growing in natural alternatives, specifically when their additional benefits are realized. 

Public Awareness and Support

Numerous obstacles need to be overcome to enhance the usage of NbS for addressing flood risk, including technological, financial, political, and social barriers. 

Currently, public knowledge remains limited. 

“Only about half of respondents knew that wetlands reduce flood risk, and many were unfamiliar with basic flood terminology. Less familiar terms like ‘flood stage’ and ‘areal flood’ caused widespread confusion,” notes Dr. Jessica Balerna, a University of Vermont post-doctoral scholar who led the publication of these results. 

This lack of knowledge contributes to uncertainty and resistance toward unfamiliar solutions, as well as misinterpretation of flood warning messages.

Investment Preferences

When asked about how municipalities should use public funds to mitigate floods, most respondents preferred a balanced approach, with a 50/50 investment between natural and engineered solutions. Balerna said that shows people are not necessarily opposed to natural solutions, but they are more comfortable when they are paired with traditional infrastructure.

Brendan Fisher, professor in the Rubenstein School and co-lead on the project, said “there is not much work comparing the full costs and benefits of nature-based solutions and hard infrastructure approaches to flood mitigation. There are going to be places in the landscape where one option is going to make much more sense than the other. Natural solutions offer a suite of co-benefits to people and biodiversity when preferred, but our work here shows that the average citizen isn’t that familiar with just how, and how much, natural solutions can benefit them."

Today, most communities across the United States rely solely on grey infrastructure solutions, like dams and levees, for flood mitigation. With more than 90,000 dams across the nation, and most of them over 60 years old, engineered solutions have long dominated the public’s perception in terms of flood control.

Those with less flood experience or who live outside flood-prone areas tended to favor engineered structures, reflecting the influence of familiarity.

Shaping Support for Nature-Based Solutions

Support for nature-based approaches among those surveyed in the study was strongest among people with higher education, greater flood literacy, and awareness of their local flood risk.

Those who were more knowledgeable about the benefit of natural spaces wanted to see more investment of government and tax-payer dollars into these spaces, even at the expense of engineered structures.

The more benefits participants recognized, the more likely they were to favor public investment in interventions such as restoring wetlands and implementing riparian forest buffers.

Political identity also played a role: liberals and moderates were more supportive of NbS than conservatives, likely due to associations with climate change policy. This highlights the need to frame environmentally-oriented interventions for flood mitigation around local, practical benefits rather than national political narratives. 

Closing the Gap

The study underscores that education and local engagement are key to expanding support for nature-based flood solutions. Clear communication about flood risks and the economic, recreational, and community benefits of NbS can build trust and reduce political resistance. Community-focused planning and transparent decision-making can help normalize these approaches.

As flooding becomes more widespread and unpredictable, proactive engagement and investment are critical. By improving flood literacy and highlighting how working with nature enhances resilience, communities can adopt more effective, sustainable strategies to protect lives and property.

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Journal

People and Nature

DOI

10.1002/pan3.70229 

Method of Research

Survey

Article Title

Survey-based study of public perceptions and preferences for mitigating flood risk via nature-based solutions in the United States

Article Publication Date

7-Jan-2026

AMERIKA

When (and why) doctors might ask patients about guns

How clinicians can effectively counsel patients about the risk of firearm injury

University of California - Davis Health

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To assess a patient’s overall well-being and identify potential health risks, clinicians routinely ask questions on a wide range of topics, such as car seats, mental health, diet, sexual activity, alcohol, exercise and smoking.

Physicians and researchers at the University of California, Davis, are hoping providers consider a new item for their list: firearms.

In a new paper published in the New England Journal of Medicine Evidence, the authors make a case for why discussions about firearms and personal safety are appropriate in the exam room for patients who may be at risk of harm.

Their suggestion is supported by statistics.

In 2022, there were 48,204 firearm deaths in the United States. More than half of those — 56% — were suicides, and 41% were homicides. Additionally, every year, an estimated 85,000 people sustain firearm injuries, which can leave survivors with long-lasting harm.

“Clinicians routinely ask about safety concerns, but most feel unprepared to talk about firearms,” said Amy Barnhorst, first author of the study and a psychiatrist at UC Davis Health. “And it can be a difficult topic because it’s often politically charged.”

Barnhorst is a professor of psychiatry and the director of the BulletPoints Project, which is funded by the state of California. The initiative trains health providers to identify patients at risk of firearm injury and help them reduce that risk.

“Patients view their health care provider as a trusted source of information. That trust needs to be maintained. Our framework gives clinicians practical tools to identify risk and engage patients in harm-reduction strategies without judgment or politics,” Barnhorst said.

A growing need as gun ownership and beliefs change in the U.S.               

Firearm ownership is increasing in the U.S. Almost one third (32%) of adults own firearms, and an additional 10% live in households with firearms.

Between January 2019 and April 2021, about 7.5 million people became new firearm owners, three times the expected number based on prior trends.

The belief that firearms make a home safer has also increased. In 2000, 35% of the general public thought having a firearm made a home safer, which rose to 63% in 2014.

The percentage of firearm owners who thought guns made the home safer rose from 75% in 2017 to 81% in 2023.

Researchers point out that although firearms in the home may offer a sense of protection, they also pose risks.

People with firearm access have more than triple the risk of suicide and double the risk of being a homicide victim than those without firearm access.

A large-scale study in California found that handgun owners had firearm suicide rates that were almost eight times higher for men and 35 times higher for women than nonowners.

Firearms rarely discussed with health care providers

Research has shown that clinicians and firearm owners are receptive to discussing firearm safety, but these conversations rarely occur. Only 7.5% of adults in homes with firearms have ever discussed firearm access with a health care provider, according to surveys.

“This is about shared goals — keeping patients and families safe,” said Angela M. Bayer, first co-author and director of engagement and impact at the UC Davis Centers for Violence Prevention. Bayer also manages the BulletPoints Project. “By framing conversations around risk and safety, clinicians can build trust and tailor interventions to help prevent tragedies,” she explained.

The 3As Framework for Firearm Injury Prevention Counseling is designed to help clinicians from various disciplines identify patients and clients at risk of firearm homicide, suicide or other injury. This includes physicians, physician assistants, nurse practitioners, nurses, psychologists, social workers and therapists.

The authors outline three steps — the 3As — clinicians can take to reduce harm from firearms.

1. Approach: Be informed, respectful and focused on harm reduction. The approach should be individual to the patient. Know why people own firearms and understand they may be a key part of a patient’s identity.
2. Assess: Identify risk factors for suicide or interpersonal violence, such as mental health conditions, alcohol misuse, dementia, relationship loss and job loss, as well as thoughts or threats of harming themselves or others. When there are children in the home, clinicians should routinely ask about firearms.
3. Act: Select interventions based on the type and level of risk, ranging from safe storage counseling to temporary firearm transfers, mental health holds or civil protective orders.

The authors emphasize that conversations should be collaborative and individualized, focusing on harm reduction rather than risk elimination. They encourage clinicians to:

• Educate themselves on firearm basics, safe storage options and local laws.
• Use neutral, non-stigmatizing language that highlights risk and safety, not right and wrong.
• Offer practical resources, including locking devices or referrals to local programs.
• Follow up regularly, as risk factors can change over time.

“These conversations can feel difficult. But with training and a risk‑based approach, clinicians can guide patients and their families to better understand the risks of having firearms in the home,” Barnhorst said. “They can also help them recognize when and how to reduce access. Taking these steps can potentially prevent injury or death.”

Clinicians can learn more and register for the free online, on-demand continuing education course, “Preventing Firearm Injury: What Clinicians Can Do.”

Additional authors include Amanda J. Aubel, Hilary Gonzales, Rocco Pallin, and Garen Wintemute from the Violence Prevention Research Program and the Firearm Violence Research Center at the University of California, Davis.

Resources:

• Read the study in NEJM Evidence
• Visit the BulletPoints Project website
• Learn how to keep kids safe in homes with guns
• Read a related study in BMC Emergency Medicine

BulletPoints Project In the News:

• Remembering Papa: Northern California’s elderly face hidden epidemic of gun suicides
• Rural Minnesota doctors find patients open to off-site gun storage as suicide prevention
• New resource guide equips clinicians to discuss firearm access with patients

 

 

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Journal

NEJM Evidence

DOI

10.1056/EVIDccon24001 

Method of Research

Commentary/editorial

Subject of Research

People

Article Title

How Can Clinicians Effectively Counsel Patients about the Risk of Firearm Injury?

 

Non-surgical beauty treatments: A double-edged sword for skin health, new review reveals

Journal of Dermatologic Science and Cosmetic Technology

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image: 

The three-core functional triad of skin—equilibrium, resistance, and self-healing—underpins skin health and is impacted by non-surgical aesthetic procedures, and Schematic diagram of skin structure and the impact of non-surgical aesthetics (NSA) on skin.

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Credit: HAN Ruifang et al. / MOYAL LAB

As demand for non-surgical aesthetics (NSA) grows globally, a new review uncovers how these procedures impact the very foundation of skin health. Researchers analyzed six common NSA treatments—mesotherapy, photorejuvenation, fractional and picosecond lasers, Thermage, and microfocused ultrasound—and found that while they improve skin appearance, they often challenge the skin’s ability to stay balanced, defend itself, and heal.

“Healthy skin relies on three core functions: equilibrium, resistance, and self-healing,” explains corresponding author CUI Bin of MOYAL LAB. “NSA procedures, though minimally invasive, can temporarily disrupt these functions, leading to redness, sensitivity, infection risk, or pigmentation issues.”

The study details how each procedure interacts with skin biology. For example, lasers may compromise barrier integrity and alter microbial balance, while injectables can trigger immune reactions. Importantly, the team also outlines targeted post-care strategies—such as barrier repair creams, strict sun protection, and microbiome-friendly products—to help skin recover safely and effectively.

“Understanding these interactions allows clinicians to personalize treatments and aftercare, reducing complications while maximizing benefits,” adds HAN Ruifang, first author of the review. “It’s not just about enhancing beauty—it’s about preserving skin health.”

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Journal

Journal of Dermatologic Science and Cosmetic Technology

DOI

10.1016/j.jdsct.2025.100090 

Method of Research

Literature review

Subject of Research

Not applicable

Article Title

The impacts of non-surgical aesthetics on the core functional triad of skin

COI Statement

The authors declare the following financial interests/personal relationships which may be considered as potential competing interests. Authors Ruifang Han, Xiang Li, Juntong Li, Shuyu Wang, Shengnan Li, Junpeng Yuan, Jian Zhou, Bin Cui are employed by the company Shenzhen Moore Vaporization Health & Medical Technology Co., Ltd. The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.