More cities and states are introducing bills to decriminalize and regulate access to psychedelic drugs, which could potentially become another option to treat mental health conditions and substance use disorders. But the substances remain illegal under U.S. federal law and scientific evidence about their effectiveness is still far from conclusive.

This month alone, California lawmakers introduced a bill to allow people 21 and older to consume psychedelic mushrooms under medical supervision. In Massachusetts, lawmakers are working on a bill that would legalize psilocybin, the active ingredient of psychedelic mushrooms. And Arizona legislators have also introduced a bill that would make psychedelic mushrooms available as a mental health treatment option.

Last December, Congress passed legislation that included funding for psychedelic clinical trials for active-duty service members. And in January this year, the Department of Veterans Affairs announced that it will begin funding research on MDMA, also known as ecstasy, and psilocybin, to treat veterans with post-traumatic stress disorder and depression. This is the first time since the 1960s that the VA is funding research on such compounds, according to the department.

The rise of proposed and passed legislation in recent years necessitates more journalistic coverage. But it’s important for journalists to go beyond what the bills and lawmakers say and include research studies about psychedelics and note the limitations of those studies.

Major medical organizations, including the American Psychiatric Association, have not yet endorsed psychedelics to treat psychiatric disorders, except in clinical trials, due to inadequate scientific evidence.

The authors of a 2023 study published in the journal Therapeutic Advances in Psychopharmacology, also advise “strong caution” regarding the hype around the potential medical use of psychedelics. “There is not enough robust evidence to draw any firm conclusions about the safety and efficacy of psychedelic therapy,” they write.

Scientists are still trying to better understand how psychedelics work, what’s the best dose for treating different mental health conditions and how to reduce the risk of potential side effects such as intense emotional experiences or increased heart rate and blood pressure, the authors of a February 2024 study published in the journal Progress in Neuro-Psychopharmacology and Biological Psychiatry write.

In a 2022 study published in JAMA Psychiatry, Dr. Joshua Siegel and his colleagues at Washington University in St. Louis write that while legislative reform for psychedelic drugs is moving forward rapidly, several issues have not been addressed, including:

• A mechanism for verifying the chemical content of drugs that are obtained from outside the medical establishment.
• Licensure and training criteria for practitioners who wish to provide psychedelic treatment.
• Clinical and billing infrastructure.
• Assessing potential interactions with other drugs.
• How the drugs should be used in populations such as youths, older adults and pregnant people.

“Despite the relative rapidity with which some have embraced psychedelics as legitimate medical treatments, critical questions about the mechanism of action, dose and dose frequency, durability of response to repeated treatments, drug-drug interactions, and the role that psychotherapy plays in therapeutic efficacy remain unanswered,” Siegel and colleagues write.

What are psychedelics?

Psychedelics are among the oldest class of mind-altering substances, used by humans for thousands of years in traditional or religious rituals.

In 2021, 74 million people 12 years and older reported using hallucinogens, according to the National Survey on Drug Use and Health.

The terms “psychedelics” and “hallucinogens” are used interchangeably in public discourse, but scientifically, hallucinogens fall into three groups based on chemical structure and mechanism of action, according to NIH’s National Institute on Drug Abuse:

• Psychedelic drugs, also called “classic psychedelics” or simply “psychedelics,” mainly affect the way the brain processes serotonin, a chemical that carries messages between nerve cells in the brain and the body. These drugs can bring on vivid visions and affect a person’s sense of self, according to NIDA. Drugs in this category include:
  • Psilocybin is the active ingredient in psychedelic mushrooms, also known as “magic” mushrooms or shrooms. It’s a Schedule 1 drug in the U.S. under the Controlled Substances Act, which means it has a high potential for abuse and has no accepted medical use. However, some states have decriminalized it, according to NIDA. The drug has also been given the Breakthrough Therapy designation from the FDA, a process to speed up the development and review of drugs, for the treatment of major depressive disorder.
  • LSD, or lysergic acid diethylamide, is a synthetic chemical made from a fungus that infects rye. It’s a Schedule 1 drug.
  • DMT, or dimethyltryptamine, found in certain plants native to the Amazon rainforest, has been used in religious practices and rituals. The plants are sometimes used to make a tea called ayahuasca. DMT can also be made in the lab as a white powder. DMT is generally smoked or consumed in brews like ayahuasca. It’s a Schedule 1 drug.
  • Mescaline, a chemical compound found in a small cactus called peyote, has been used by Indigenous people in northern Mexico and the southwestern U.S. in religious rituals. Mescaline can also be produced in the lab. Mescaline and peyote are Schedule 1 drugs.
• Dissociative drugs affect how the brain processes glutamate, an abundant chemical released by nerve cells in the brain that plays an important role in learning and memory. These drugs can make people feel disconnected from their bodies and surroundings. Drugs in this category include:
  • PCP, or phencyclidine, was developed in the 1950s as an injectable anesthetic but was discontinued because patients became agitated and delusional. Today it is an illegal street drug. It’s a Schedule 2 drug, which means it has a high potential for abuse, but lower compared to Schedule 1 drugs.
  • Ketamine, a drug developed in the 1960s and used as an anesthetic in the Vietnam War, is approved by the FDA as an anesthetic. It has been shown to play a role in pain management and treatment of depression. It is also illegally used for its hallucinogenic effects. It is a Schedule 3 drug, which means it has a moderate to low potential for physical and psychological dependence. A chemically-similar drug called esketamine is approved by the FDA for the treatment of depression that doesn’t respond to standard treatment.
• Other hallucinogens, which affect different brain functions and can cause psychedelic and potentially dissociative effects, include:
  • MDMA, or ecstasy, is a synthetic drug that’s a stimulant and hallucinogen. It is a Schedule 1 drug. It has been given the Breakthrough Therapy designation from the FDA for the treatment of PTSD.
  • Salvia is an herb in the mint family that has hallucinogenic effects. It is not a federally controlled drug, but it is controlled in some states, according to the DEA.
  • Ibogaine is derived from the root bark of a West African shrub and is a stimulant and hallucinogen. It is a Schedule 1 drug.

Research on psychedelics

There was a wave of studies on psychedelics, particularly LSD, in the 1950s and 1960s, but they came to a halt when the U.S. declared a “War on Drugs” in 1971 and tightened pharmaceutical regulations. There was little research activity until the early 1990s when studies on drugs such as MDMA and DMT began to emerge.

In 2006, researchers at Johns Hopkins University published a seminal double-blind study in which two-thirds of participants — who had never taken psychedelics previously — said their psychedelic sessions were among the most meaningful experiences of their lives.

“These studies, among others, renewed scientific interest in psychedelics and, accordingly, research into their effects has continued to grow since,” Jacob S. Aday and colleagues write in a 2019 study published in Drug Science, Policy and Law.

In their paper, Aday and colleagues argue that 2018 may be remembered as the true turning point in psychedelic research due to “advances within science, increased public interest, and regulatory changes,” such as psilocybin receiving the “breakthrough therapy” status from the FDA.

Today, there are numerous ongoing clinical trials on the therapeutic potential of psychedelics for different conditions, including substance use disorders and mental health conditions such as depression, anxiety and post-traumatic stress disorder.

Given the growing number of studies on psychedelics, the Food and Drug Administration issued a draft guidance in June 2023 for clinical trials with psychedelic drugs, aiming to help researchers design studies that will yield more reliable results for drug development.

The systematic reviews highlighted below show that there’s a lack of robust study designs in many psychedelic clinical trials. Some have small sample sizes. Some include participants who have used psychedelics before, so when they participate in a randomized controlled clinical trial, they know whether they are receiving psychedelic treatment or a placebo. Or, some include participants who may have certain expectations due to positive coverage in the lay media, hence creating bias in the results.

If you’re covering a study about psychedelics…

It’s important for journalists to pay close attention to study design and speak with an expert who is not involved in the study.

In a February 2024 blog post from Harvard Law School’s Petrie-Flom Center, Leiden University professors Eiko I. Fried and Michiel van Elk share several challenges in psychedelic research:

• “Conclusions are dramatically overstated in many studies. This ranges from conclusions in the results sections, abstracts, and even titles of papers not consistent with the reported results.”
• “There is emerging evidence that adverse events resulting from psychedelic substances are both common and underreported.”
• Some studies don’t have control groups, which can create problems for interpreting results, “because treatments like psychedelics need to be compared against a placebo or other treatment to conclude that they work beyond the placebo effect or already existing, readily available treatments.”
• “Participants in psychedelic studies usually know if they are in the treatment or control group, which artificially increases the apparent efficacies of psychedelics in clinical studies.”
• Small sample sizes can affect the statistical power and generalizability of the findings. “Small samples also mean that results are not representative. For example, participants with severe or comorbid mental health problems are commonly excluded from psychedelic studies, and therefore results may look better in these studies than in real-world psychiatric settings.”
• Many studies do not include long-term follow-ups of participants. “Studying how these people are feeling a few days or weeks after they receive treatment is not sufficient to establish that they are indeed cured from depression.”

Fried and van Elk also have a useful checklist for assessing the quality and scientific rigor of psychedelic research in their 2023 study “History Repeating: Guidelines to Address Common Problems in Psychedelic Science,” published in the journal Therapeutic Advances in Psychopharmacology.

Journalists should also remind their audiences that the drugs are still illegal under federal law and can pose a danger to health.

In California, the number of emergency room visits involving the use of hallucinogens increased by 54% between 2016 and 2022, according to a January 2024 study published in Addiction. Meanwhile, the law enforcement seizure of psychedelic mushrooms has risen dramatically, increasing nearly four-fold between 2017 and 2022, according to a February 2024 study published in the journal Drug and Alcohol Dependence.

Below, we have curated and summarized five recent studies, mostly systematic reviews and meta-analyses, which examine various aspects of psychedelic drugs, including legislative reform; long-term effects; efficacy and safety for the treatment of anxiety, depression and PTSD; and participation of older adults in clinical trials. The research summaries are followed by recommended reading.

Research roundup

Psychedelic Drug Legislative Reform and Legalization in the US
Joshua S. Siegel, James E. Daily, Demetrius A. Perry and Ginger E. Nicol. JAMA Psychiatry, December 2022.

The study: Most psychedelics are Schedule I drugs federally, but state legislative reforms are changing the prospects of the drugs’ availability for treatment and their illegal status. For a better understanding of the legislative reform landscape around Schedule I psychedelic drugs, researchers collected all bills and ballot initiatives related to psychedelic drugs that were introduced into state legislatures between 2019 and September 2022. They used publicly available sources, including BillTrack50, Ballotpedia and LexisNexis.

The findings: In total, 25 states considered 74 bills, although the bills varied widely in their framework. A majority proposed decriminalization but only a few would require medical oversight and some would not even require training or licensure, the authors write. Ten of those bills became law in seven states — Colorado, Connecticut, Hawaii, New Jersey, Oregon, Texas and Washington. As of August 1, 2022, 32 bills were dead and 32 remained active.

The majority of the bills — 67 of them — referred to psilocybin; 27 included both psilocybin and MDMA; 43 proposed decriminalization of psychedelic drugs.

To predict the future legalization of psychedelics, the authors also created two models based on existing medical and recreational marijuana reform. Using 2020 as the year of the first psychedelic decriminalization in Oregon, their models predict that 26 states will legalize psychedelics between 2033 and 2037.

In the authors’ words: “Despite the relative rapidity with which some have embraced psychedelics as legitimate medical treatments, critical questions about the mechanism of action, dosing and dose frequency, durability of response to repeated treatments, drug-drug interactions, and the role psychotherapy plays in therapeutic efficacy remain unanswered. This last point is critical, as a significant safety concern associated with drugs like psilocybin, MDMA, or LSD is the suggestibility and vulnerability of the patient while under the influence of the drug. Thus, training and clinical oversight is necessary to ensure safety and also therapeutic efficacy for this divergent class of treatments.”

Who Are You After Psychedelics? A Systematic Review and a Meta-Analysis of the Magnitude of Long-Term Effects of Serotonergic Psychedelics on Cognition/Creativity, Emotional Processing and Personality
Ivana Solaja, et al. Neuroscience & Behavioral Reviews, March 2024.

The study: Many anecdotal reports and observational studies have reported that psychedelics, even at microdoses, which are roughly one-tenth of a typical recreational dose, may enhance certain aspects of cognition and/or creativity, including coming up with new, useful ideas. Cognition is a “range of intellectual functions and processes involved in our ability to perceive, process, comprehend, store and react to information,” the authors explain. There are established relationships between impaired cognitive functioning and mental health disorders.

Due to limitations such as a lack of rigorous study designs, various populations in the studies and lack of documented dosage, it’s difficult to draw any conclusions about changes that last at least one week as a result of consuming psychedelics.

The authors screened 821 studies and based on the criteria they had set, found 10 to be eligible for the review and meta-analysis. The drugs in the studies include psilocybin, ayahuasca and LSD.

The findings: Overall, there was little evidence that these psychedelics have lasting effects on creativity. Also, there was not sufficient evidence to determine if this group of psychedelics enhances cognition and creativity in healthy populations or improves cognitive deficits in the study populations.

Pooled data from three studies showed lasting improvement in emotional processing — perceiving, expressing and managing emotions.

The studies offered little evidence suggesting lasting effects of psychedelics on personality traits.

In the authors’ words: “Results from this study showed very limited evidence for any lasting beneficial effects across these three psychological constructs. However, preliminary meta-analytic evidence suggested that these drugs may have the potential to cause lasting improvement in emotional recognition time. Future studies investigating these constructs should employ larger sample sizes, better control conditions, standardized and validated measures and longer-term follow-ups.”

The Impact of Psychedelics on Patients with Alcohol Use Disorder: A Systematic Review with Meta-Analysis
Dakota Sicignano, et al. Current Medical Research and Opinion, December 2023.

The study: Researchers are exploring the psychedelics’ potential for the treatment of alcohol use disorder, which affected nearly 30 million Americans in 2022. The authors of this study searched PubMed from 1960 to September 2023 for studies on the use of psychedelics to treat alcohol use disorder. Out of 174 English-language studies, they selected six studies that met the criteria for their analysis.

The findings: LSD and psilocybin are promising therapies for alcohol use disorder, the authors report. However, five of the six trials were conducted in the 1960s and 1970s and may not reflect the current treatment views. Also, four of the six studies included patients who had used psychedelics before participating in the study, increasing the risk of bias.

In the authors’ words: “Despite the existence of several clinical trials showing relatively consistent benefits of psychedelic therapy in treating alcohol use disorder, there are important limitations in the dataset that must be appreciated and that preclude a conclusive determination of its value for patient care at this time.”

Older Adults in Psychedelic-Assisted Therapy Trials: A Systematic Review
Lisa Bouchet, et al. Journal of Psychopharmacology, January 2024.

The study: People 65 years and older have been underrepresented in clinical trials involving psychedelics, including the use of psilocybin for the treatment of depression and anxiety. About 15% of adults older than 60 suffer from mental health issues, the authors note. They wanted to quantify the prevalence of older adults enrolled in psychedelic clinical trials and explore safety data in this population. They searched for English-language studies in peer-reviewed journals from January 1950 to September 2023. Of 4,376 studies, the authors selected 36. The studies involved psilocybin, MDMA, LSD, ayahuasca, and DPT (dipropyltryptamine), which is a less-studied synthetic hallucinogen.

The findings: Of the 1,400 patients participating in the selected studies, only 19 were 65 and older. Eighteen received psychedelics for distress related to cancer or other life-threatening illnesses. In a trial of MDMA-assisted therapy for PTSD, only one older adult was included. Adverse reactions to the drugs among older patients, including heart and gastrointestinal issues were resolved within two days and didn’t have a long-lasting impact.

In the authors’ words: “Although existing data in older adults is limited, it does provide preliminary evidence for the safety and tolerability of [psychedelic-assisted therapy] in older patients, and as such, should be more rigorously studied in future clinical trials.”

Efficacy and Safety of Four Psychedelic-Assisted Therapies for Adults with Symptoms of Depression, Anxiety, and Posttraumatic Stress Disorder: A Systematic Review and Meta-Analysis
Anees Bahji, Isis Lunsky, Gilmar Gutierrez and Gustavo Vazquez. Journal of Psychoactive Drugs, November 2023.

The study: LSD, psilocybin, ayahuasca and MDMA have been approved for clinical trials on psychedelic-assisted therapy of mental health conditions in Canada and the U.S. However, major medical associations, including the American Psychiatric Association, have argued that there is insufficient scientific evidence to endorse these drugs for treating mental health disorders. To better understand the current evidence, researchers reviewed 18 blinded, randomized controlled trials, spanning 2008 through 2023. Most studies were conducted in the U.S. or Switzerland.

The findings: The studies overall suggest preliminary evidence that psychedelic drugs are mostly well-tolerated. Psilocybin and MDMA therapies may offer relief from depression and PTSD symptoms for at least a year. Most studies also used therapy and psychological support along with psychedelics.

In the authors’ words: “Despite the promising evidence presented by our study and previous reviews in the field, the evidence base remains limited and underpowered. Long-term efficacy and safety data are lacking,” the authors write. “Future steps should encourage and highlight the need for more robust larger scale randomized controlled trials with longer follow-up periods, and efforts to address regulatory and legal barriers through the collaborations between researchers, healthcare professionals, regulatory bodies, and policymakers.”

Additional reading

Therapeutic Potential of Psychedelics: History, Advancements, and Unexplored Frontiers
Juliana Marino Maia, Bruna Stefane Alves de Oliveira, Luiz G.S. Branco and Renato Nery Soriano. Progress in Neuro-Psychopharmacology and Biological Psychiatry, April 2024.

Aggressive Behaviours Associated with MDMA and Psychedelics: A Narrative Review
Negar Sayrafizadeh, Nicole Ledwos, M. Ishrat Husain and David J. Castle. Acta Neuropsychiatrica, February 2024.

MDMA-Assisted Psychotherapy for PTSD: Growing Evidence for Memory Effects Mediating Treatment Efficacy
Mesud Sarmanlu, Kim P.C. Kuypers, Patrick Vizeli, Timo L. Kvamme. Progress in Neuro-Psychopharmacology and Biological Psychiatry, January 2024

Psychedelic Therapies Reconsidered: Compounds, Clinical Indications, and Cautious Optimism
Jennifer M. Mitchell and Brian T. Anderson. Neuropsychopharmacology, July 2023.

Psychedelics as Therapeutics: Gaps, Challenges and Opportunities
An NIH workshop with video recordings. January 2022.

Trends in MDMA-Related Mortality Across Four Countries
Amanda Roxburgh, et al. Addiction, March 2021.

The Therapeutic Potential of Psychedelic Drugs: Past, Present, and Future
Robin L. Carhart-Harris and Guy M. Goodwin. Neuropsychopharmacology, October 2017.

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Winter holidays bring celebrations, family traditions, light decorations, special foods and delicacies, and indoor and outdoor activities.

But they can also bring injuries and health problems. Research shows a range of injuries in kids and adults stemming from swallowing Christmas ornaments and decorations, falling from a ladder when putting up lights — or falling from Santa’s lap, suffering burns from touching the candles on a menorah or from biting into a hot deep-fried donut. In some, binging on alcoholic drinks can induce atrial fibrillation, leading to a condition known as “holiday heart syndrome.”

Each year, nearly 18,400 people visit emergency rooms because of accidents with Christmas decorations, according to USAFacts, a non-profit organization that provides U.S. data and reports, using data from the Consumer Product Safety Commission. The peak of those injuries is usually the Sunday after Thanksgiving.

To be sure, compared with other holidays such as Memorial Day, Fourth of July and Halloween, Christmas has a lower number of injuries, a 2010 study found. But seasonal holiday injuries and health issues make headlines each year.

Earlier this month, a Michigan woman suffered significant burns after her robe caught fire at a church’s Christmas event, reported Hometown Life, a Gannett-owned publication. “Someone put a candle in the wrong place,” the fire chief told the news outlet. A 9-year-old boy suffered injuries after falling from a float in the West Alabama Christmas Parade, according to WVUA 23 News. And ABC News ran an explainer about holiday heart syndrome.

For journalists looking to inform their audiences about health-related holiday topics, we’ve gathered several studies. They’re listed in order of publication date.

Research roundup

Enjoy the Holiday Spirit, Not the Holiday Heart
Ali Syed, Benjamin D. Seadler, David L. Joyce. The Journal of Thoracic and Cardiovascular Surgery, January 2023.

Alcohol is typically part of holiday celebrations and gatherings in Western society. Short-term alcohol use in excess and binge drinking are linked with memory loss, impaired judgment, unintentional injury, violence and driving under the influence.

But a less commonly known consequence of binge drinking is alcohol-induced atrial arrhythmia, known as “Holiday Heart Syndrome,” which was first described in the 1970s, the authors write. (In the United States, 5% to 10% of new atrial fibrillation diagnoses are related to alcohol abuse.)

Symptoms include palpitations, shortness of breath, anxiety, weakness and chest pain.

The authors note that the exact biochemistry of the syndrome is unknown, but the correlation between atrial fibrillation and binge drinking is “undeniable.”

Avoiding A Crisis at Christmas: A Systematic Review of Adverse Health Effects of ‘Chrishaps’ Caused by Traditional Hazard Sources and COVID-19
Ursula Wild, David M. Shaw, Thomas C. Erren. Australian and New Zealand Journal of Public Health, February 2022.

This study aims to find out “which hazards have been scientifically associated with old Christmas essentials such as decoration, gifts, menus, and Santa himself, as well as new challenges associated with COVID‐19?”

The authors examined the findings of 30 studies, most of which were case reports or retrospective analyses, which are types of studies that examine data collected in the past.

The various hazards of Christmas included allergic reactions to poinsettias, Christmas trees and candles; swallowing of Christmas decorations; and falling from ladders, roofs and furniture. In one case, a patient had a supposed case of cyanosis — a condition where the skin, lips and nails turn blue — after receiving a blue bed linen as a Christmas gift.

Christmas dinners can also pose risks, such as higher cholesterol levels and weight gain, the authors write. Also, “two other risks from eating were documented: abdominal pain after eating without chewing and eating a piece of Christmas cake together with a plastic robin,” which was part of the cake decoration, they write.

Pediatric Ingestions of Christmas Past, Present, and Future: A Review of Holiday Trends, 1997 to 2015
Patrick T. Reeves, Jayasree Krishnamurthy, Eric A. Pasman and Cade M. Nylund. Clinical Pediatrics, February 2019.

The authors use National Electronic Injury Surveillance System data from 1997 to 2015, focusing exclusively on cases of children, up to 17 years old, who went to an emergency department due to ingesting Christmas decorations, including ornaments, bells and candles during December and January.

There were an estimated 22,224 such cases over the period studied. Children aged 2 and younger accounted for 84% of the cases. Almost 96% were either treated and released or examined and released without treatment.

The peak of such injuries occurred during the Christmas week.

 “Future advocacy efforts might focus on improving social awareness, parental education, or even federal oversight with regard to these possibly dangerous decorations,” the authors write.

“Oh the Weather Outside is Frightful”: Severe Injury Secondary to Falls While Installing Residential Christmas Lights
Michael R. Driedger, et al. Injury, January 2016.

The study examines the health outcomes of 40 patients in Canada who were admitted to a level 1 trauma center from 2002 to 2012 with severe injuries suffered due to falling while installing Christmas lights. The researchers found this activity can result in life-altering injuries.

In total, 95% of the patients were men with a mean age of 55. Most of the falls (65%) were from ladders and 30% of the patients fell from a roof.

The most common injury was to the head and torso. About 43% of the patients had spine injuries.

“Given the heights associated with this activity, as well as the often hazardous weather conditions, adherence to safety precautions is essential,” the authors write.

Seasonal Foreign Bodies: The Dangers of Winter Holiday Ornamentation
Andrew T. Trout and Alexander J. Towbin. Pediatric Radiology, October 2014.

Children can suffer minor or severe injuries if they swallow winter holiday decorations and ornaments. These injuries mostly occur in children under 5.

In this “pictorial essay,” the authors provide radiology images of a wide range of holiday ornaments they’ve seen in children, including whole glass baubles, large and small, metal hooks used to hang ornaments on trees, small plastic ornaments, individual Christmas lights and Hanukkah decorations, including spinning tops and foil-wrapped coins.

Radiologists play a key role in identifying these foreign bodies in children, the authors write.

“Around the winter holidays, ornaments and decorations can become a source of foreign bodies for pediatric patients, and familiarity with the appearance of these seasonal foreign bodies can be helpful in their identification,” they write.

Jewish Holidays and Their Associated Medical Risks
Jacob Urkin and Sody Naimer. Journal of Community Health, June 2014.

This study summarizes the findings from the existing literature regarding the health hazards related to celebrating Jewish holidays, including Rosh Hashana, Yom Kippur, Passover, Sukkot, Purim and Hanukkah.

The authors highlight several injuries related to Hanukkah, which lasts eight days — starting in late November or in December — and is observed by lighting candles on a candelabrum called a menorah.

“Most of the injuries in Hanukkah are related to burns in children who were carelessly handling lighted candles,” the authors note.

Children often receive foil-wrapped chocolate coins, or gelt, during Hanukkah. Another source of injury is children ingesting the foil covering gelt.

The most popular sweet during Hanukkah — deep-fried donuts called sufganiyot — can be a source of burns in the mouth.

“We assume that the reason for these injuries is that the fluid cream, jam or caramel at the center of the pastry tends to heat much quicker than the surrounding baked dough, especially when heated in the microwave oven. Then, without sensing its extreme heat at the center, the hungry subject will bite into burning hot fluid,” the authors write.

Epidemiology of Pediatric Holiday-Related Injuries Presenting to U.S. Emergency Departments
Anthony D’Ippolito, Christy L. Collins and R. Dawn Comstock. Pediatrics, May 2010.

The study investigates eight major holidays in the U.S. and finds that among children younger than 19, approximately 500,000 holiday-related injuries were treated at emergency departments between 1997 and 2006.

Labor Day, Memorial Day, Fourth of July and Halloween were the holidays with the highest number of injuries per year overall. Christmas, in fact, had the least number of injuries.

Among the study’s other findings:

• Overall, boys sustained 62% of the injuries.
• Nearly 30% of injuries were in children younger than 5.
• The most common injuries were cuts, bruises, fractures and sprains.
• Nearly 66% of the cuts were to the face.
• The greatest proportion of deaths occurred around the Fourth of July and New Year’s.

“Parents should closely supervise children who are younger than 5 years on Thanksgiving and Christmas when the proportions of injuries were significantly greater among these younger children compared with the other age groups,” the authors write. “On New Year’s, those aged 15 to 19 years had a significantly greater proportion of injuries compared with all other holidays.”

The BMJ Christmas issue

The BMJ, a prestigious medical journal, has a well-established annual Christmas issue that includes a mix of light-hearted features and peer-reviewed research. Below are highlights from this year’s issue:

• One study makes the case for the Barbie doll to expand her range of medical and scientific professions.
• Another study draws a link between a new Doctor Who episode shown during the holidays, especially Christmas Day, and lower death rates in the following year across the UK.
• To the relief of coffee drinkers, a study finds that coffee machines are not responsible for spreading disease in hospitals.
• A small study finds putting a chair beside a patient’s bed in the hospital room nudged physicians to sit during the visit, which in turn resulted in higher patient satisfaction.
• If you’re a fan of the Great British Baking Show, you’ll appreciate this study, which examines the health benefits and harms of Christmas recipes on the show. Results: you can have your cake and eat it too.
• And if you’re popping the cork on a sparkling wine bottle on New Year’s Eve, be careful, because cork eye injuries can be significant, according to this study. It takes 0.05 seconds for the cork to travel from the bottle to your eye, the authors write. They also share a useful guide for opening a bottle of sparkling wine.

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Silicosis is a progressive, debilitating and sometimes fatal lung disease caused by breathing silica dust from cutting, drilling, chipping or grinding materials such as granite, sandstone, slate or artificial stone. The dust gets trapped in the lung tissue, causing inflammation, scarring and permanent damage.

Silicosis is a job-related lung disease and has no cure. The disease mostly affects workers in construction, stone countertop fabrication, mining, and even those who sandblast and stonewash denim jeans to create a ‘worn out’ look.

Silica is one of the most common minerals in nature. About 59% of the Earth’s crust is made of silica, found in quartz, granite, sandstone, slate and sand. Historically, people at the highest risk for the disease have worked in natural environments — mining, digging tunnels or doing quarry work. The disease was first documented by the Greek physician Hippocrates, who in 430 B.C. described breathing disorders in metal diggers.

But in recent decades there’s been renewed attention to the disease due to its more rapid progression and severity among younger workers. Research has shown that the culprit is artificial stone mostly used for countertops for kitchens and bathrooms, which has a very high silica content.

The new generation of coal miners is also at an increased risk of silicosis, in addition to black lung, because layers of coal have become thinner, forcing them to dig deeper into rock, as explained in a joint investigation by the Pittsburgh Post-Gazette and the Medill Investigative Lab at Northwestern University published on Dec. 4. CBS Sunday Morning also had a report on the same issue among West Virginia coal miners, aired as part of its Dec. 10 episode.

Silicosis in modern industries

Artificial, or engineered, stone used for countertops, also known as “quartz,” is formed from finely crushed rocks mixed with resin. Quartz is a natural mineral, but man-made products like many quartz countertops consist of not just quartz, but also resin, colors and other materials that are used to style and strengthen them.

The silica content of artificial stone is about 90%, compared with the 3% silica content of natural marble and 30% silica content in granite stones, according to the authors of a 2019 systematic review published in the International Journal of Environmental Research and Public Health.

The first reported case of silicosis associated with working with artificial stone was from Italy in 2010, according to a 2020 study published in Allergy. Since then, more studies have documented the growing number of cases among artificial stone workers, many of whom are from marginalized populations, such as immigrants.

A July 2023 study published in JAMA Internal Medicine found that in California, the disease mainly occurred among young Latino immigrant men. The disease was severe in most men by the time they sought care.

An August 2022 study, published in Occupational & Environmental Medicine, analyzing the Global Silicosis Registry, with workers in Israel, Spain, Australia and the U.S., found “a substantial emerging population of workers worldwide with severe and irreversible silica-associated diseases,” due to exposure from silica dust from engineered stone.

Other modern occupations such as denim sandblasting, work on dental prostheses, manufacturing of electrical cables and working on jewelry and semi-precious stones also put workers at risk of silicosis.

In the wake of modern-day silicosis cases, researchers have called for larger studies to better understand the disease and the discovery of effective treatments.

In the U.S. about 2.3 million workers are exposed to silica dust on the job, according to the American Lung Association. Other estimates show approximately 10 million workers in India, 3.2 million in the European Union and 2 million in Brazil work with material containing silica.

However, “the reporting system for occupational injuries and illnesses in the United States fails to capture many cases, leading to a poor understanding of silicosis incidence and prevalence,” writes Ryan F. Hoy, who has published extensively on the topic, in a June 2022 article in Respirology.

A 2015 study in the Morbidity & Mortality Weekly Report found the annual number of silicosis deaths declined from 185 people in 1999 to 111 in 2013, but the decline appeared to have leveled off between 2010 and 2013, the authors write. Another 2015 study in MMWR, examining silicosis deaths between 2001 and 2010, found the death rate from silicosis was significantly higher among Black people compared with whites and other races. Men also have a significantly higher death rate from silicosis than women.

The 2019 Global Burden of Disease Study estimates that more than 12,900 people worldwide die from silicosis each year.

Silicosis has no cure, but it’s preventable when workers have access to proper respiratory protection and are educated on safe practices set by regulatory bodies such as the U.S. National Institute for Occupational Safety and Health. The European Network on Silica also has guidelines on handling and using materials containing silica. A March 2023 study published in Environmental Science and Pollution Research International finds that “education, training, and marketing strategies improve respirator use, while training and education motivate workers to use dust control measures.”

Silicosis symptoms and treatment

Symptoms of silicosis include cough, fatigue, shortness of breath and chest pain. There’s no specific test for silicosis. The first signs may show in an abnormal chest X-ray and a slowly developing cough, according to the American Lung Association.

Silicosis symptoms don’t appear right away in most cases, usually taking several years to develop working with silica dust. However, studies indicate that symptoms of silicosis due to exposure to artificial stone appear quicker than exposure to natural silica sources, potentially due to the higher concentration of silica in artificial stone.

There are three types of silicosis: acute (most commonly caused by working with artificial stone), accelerated and chronic, depending on the level of exposure to silica dust, according to the Centers for Disease Control and Prevention, which explains the severity of each type on its website.

Complications from silicosis can include tuberculosis, lung cancer, chronic bronchitis, kidney disease and autoimmune disorders. In some cases, silicosis can cause severe scarring of the lung tissue, leading to a condition called progressive massive fibrosis, or PMF. Some patients may require a lung transplant.

Lung damage from silicosis is irreversible, so treatment of silicosis is aimed at slowing down the disease and relieving its symptoms.

In 1995, the World Health Organization called for the elimination of silicosis by 2030, but research studies and news stories show it remains a threat to many workers.

Below, we have gathered several studies on the topic to help journalists bolster their reporting with academic research.

Research roundup

Artificial Stone Associated Silicosis: A Systematic Review
Veruscka Leso, et al. International Journal of Environmental Research and Public Health, February 2019.

This systematic review aims to verify the association between exposure to silica dust in artificial stone and the development of silicosis.

Researchers narrowed down their selection from 75 papers to seven studies that met their inclusion criteria. The seven studies were from Australia, Israel and Spain. Most of the studies are observational and impede a definite association between exposure to silica while working with artificial stone and developing silicosis, the authors note.

However, “the unusually high incidence of the disease that was reported over short periods of investigations, and the comparable occupational histories of affected workers, all being involved in the manufacture and manipulation of engineered stones, may indicate a cause-effect relationship of this type.”

The review of studies reveals a lack of basic preventive measures such as lack of access to disposable masks; lack of information and training on the dangers of silica dust; and lack of periodic medical examinations, including a chest X-ray, among workers. There was limited environmental monitoring of dust levels at the workplace. Also, there was no dust suppression system, such as the use of water when polishing the stones, or effective ventilation. Machinery and tools weren’t properly set up and didn’t undergo routine checks, the authors write.

The authors recommend environmental monitoring for assessing silica levels in the workplace and verifying the effectiveness of personal protections. They also recommend the health surveillance of workers exposed to silica dust.

“Stakeholders, manufacturers, occupational risk prevention services, insurance companies for occupational accidents and diseases, business owners, occupational health physicians, general practitioners, and also employees should be engaged, not only in designing/planning processes and operational working environments, but also in assessing the global applicability of proactive preventive and protective measures to identify and control crystalline silica exposure, especially in new and unexpected exposure scenarios, the full extent of which cannot yet be accurately predicted,” they write.

Silica-Related Diseases in the Modern World
Ryan F. Hoy and Daniel C. Chambers. Allergy, November 2020.

The study is a review of the mineralogy of silica, epidemiology, clinical and radiological features of the various forms of silicosis and other diseases associated with exposure to silica.

The primary factor associated with the development of silicosis is the intensity and duration of cumulative exposure to silica dust. Most countries regulate silica dust occupational exposure limits, generally in the range of 0.05 mg/m³ to 0.1 mg/m³, although the risk of dust exposure to workers still remains high at those levels.

The study provides a list of activities that could expose workers to silica dust. They include abrasive blasting of sand and sandstone; cement and brick manufacturing; mixing, glazing or sculpting of china, ceramic and pottery; construction involving bricklaying, concrete cutting, paving and demolition; sandblasting denim jeans; working with and polishing dental materials; mining and related milling; handling raw material during paint manufacturing; road and highway construction and repair; soap and cosmetic production; blasting and drilling tunnels; and waste incineration.

“Despite the large number of workers in the construction sector, there have been few studies of [silica dust] exposure in this industry,” the authors note.

Other than silicosis, conditions associated with silica exposure include sarcoidosis, an inflammatory disease that commonly affects the lungs and lymph nodes, autoimmune disease, lung cancer and pulmonary infections.

“Recent outbreaks of silica-associated disease highlight the need for constant vigilance to identify and control new and well-established sources of silica exposure. While there are currently no effective treatments for silicosis, it is a completely preventable lung disease,” the authors write.

A Systematic Review of the Effectiveness of Dust Control Measures Adopted to Reduce Workplace Exposure
Frederick Anlimah, Vinod Gopaldasani, Catherine MacPhail and Brian Davies. Environmental Science and Pollution Research International, March 2023.

This study provides an overview of various interventions and their effectiveness in preventing exposure to silica dust based on a review of 133 studies from 16 countries, including the U.S., Canada, China, India, Taiwan and Australia, and published between 2010 and 2020.

These dust control measures range from simple work practices such as the use of respirators to more sophisticated technologies, such as water and air curtains and foam technology, the authors note.

The review finds increasing research interest in dust reduction, mainly in China. But overall, regulatory influence remains inadequate in preventing miners’ exposure to silica dust.

“Results from the review suggest that adopted interventions increase knowledge, awareness, and attitudes about respirator usage and generate positive perceptions about respirator usage while reducing misconceptions,” the authors write. “Interventions can increase the use, proper use, and frequency of use of respirators and the adoption readiness for dust controls but may not provide sustained motivation in workers for the continual use of dust controls or [personal protective equipment.]”

Notes from the Field: Surveillance of Silicosis Using Electronic Case Reporting — California, December 2022–July 2023
Jennifer Flattery, et al. Morbidity and Mortality Weekly Report, November 2023.

This study examines the use of electronic case reporting to identify silicosis cases in California. Electronic case reporting, or eCR, is the automated, real-time exchange of case report information between electronic health records at health facilities at state and local public health agencies in the U.S. It is a joint effort between the Association of Public Health Laboratories, the Council of State and Territorial Epidemiologists, and the CDC. Currently, 208 health conditions can be reported using eCR. All 50 states and other U.S.-affiliated jurisdictions are connected to eCR. Once a public health agency receives a case report, it reaches out to the patient for contact tracing or other actions.

From October 2022 to July 2023, the California Department of Public Health received initial silicosis case reports for 41 individuals. A review of medical records confirmed 19 cases and 16 probable cases. Six of the 41 cases were considered unlikely to be silicosis after a review of medical records.

Notably, engineered stone countertop fabrication was a significant source of exposure, especially among Hispanic and Latino workers.

At least seven of the 19 confirmed cases were associated with the fabrication of engineered stone — quartz — countertops. The 19 patients’ ages ranged from 33 to 51 and all were Hispanic or Latino. One patient died and two had both lungs replaced. One was evaluated for a lung transplant.

The median age of the 35 patients with probable or confirmed silicosis was 65, ranging from 33 to 89 years, and 91% were men.

“It is important that health care providers routinely ask patients about their work as an important determinant of health,” the authors write. “Being aware of the risks associated with work exposures, as well as the regulations, medical monitoring, and prevention strategies that address those risks can help guide patient care.”

Additional research

Understanding the Pathogenesis of Engineered Stone-Associated Silicosis: The Effect of Particle Chemistry on the Lung Cell Response
Chandnee Ramkissoon, et al. Respirology, December 2023.

Silicosis, Tuberculosis and Silica Exposure Among Artisanal and Small-Scale Miners: A Systematic Review and Modelling Paper
Patrick Howlett, et al. PLOS Global Public Health, September 2023.

Silicosis Among Immigrant Engineered Stone (Quartz) Countertop Fabrication Workers in California
Jane C. Fazio, et al. JAMA Internal Medicine, July 2023.

Silicosis and Tuberculosis: A Systematic Review and Meta-Analysis
P. Jamshidi, et al. Pulmonology, June 2023.

From Basic Research to Clinical Practice: Considerations for Treatment Drugs for Silicosis
Rou Li, Huimin Kang and Shi Chen. International Journal of Molecular Science, May 2023.

Silicosis After Short-Term Exposure
J. Nowak-Pasternak, A. Lipińska-Ojrzanowska and B. Świątkowska. Occupational Medicine, January 2023.

Occupational Silica Exposure and Dose-Response for Related Disorders—Silicosis, Pulmonary TB, AIDs and Renal Diseases: Results of a 15-Year Israeli Surveillance
Rachel Raanan, et al. International Journal of Environmental Research and Public Health, November 2022.

Demographic, Exposure and Clinical Characteristics in a Multinational Registry of Engineered Stone Workers with Silicosis
Jeremy Tang Hua, et al. Occupational & Environmental Medicine, August 2022.

Current Global Perspectives on Silicosis — Convergence of Old and Newly Emergent Hazards
Ryan F. Hoy, et al. Respirology, March 2022.

The Association Between Silica Exposure, Silicosis and Tuberculosis: A systematic Review and Metal-Analysis
Rodney Ehrlich, Paula Akugizibwe, Nandi Siegfried and David Rees. BMC Public Health, May 2021.

Silicosis, Progressive Massive Fibrosis and Silico-Tuberculosis Among Workers with Occupational Exposure to Silica Dusts in Sandstone Mines of Rajasthan State
Subroto Nandi, Sarang Dhatrak, Kamalesh Sarkar. Journal of Family Medicine and Primary Care, February 2021.

Artificial Stone Silicosis: Rapid Progression Following Exposure Cessation
Antonio León-Jiménez, et al. Chest, September 2020.

Silica-Associated Lung Disease: An Old-World Exposure in Modern Industries
Hayley Barnes, Nicole S.L. Goh, Tracy L. Leong and Ryan Hoy. Respirology, September 2019.

Australia Reports on Audit of Silicosis for Stonecutters
Tony Kirby. The Lancet, March 2019.

Artificial Stone-Associated Silicosis: A Rapidly Emerging Occupational Lung Disease
Ryan F. Hoy, et al. Occupational & Environmental Medicine, December 2017.

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Each year, there are an estimated 16 million cases of acute gastrointestinal illness in the U.S. stemming from contaminants in community water systems.

New research in The Review of Economics and Statistics finds quick notification of water problems can help keep households healthy, avoiding millions of dollars in lost job earnings and direct health care costs.

The research shows that timing matters: Households noticeably change their behavior by purchasing bottled water, but only when notified immediately of potential problems with their tap water.

“People tend to think that the water coming out of their tap is treated and clean and safe to drink,” says author Michelle Marcus, a health and environmental economist at Vanderbilt University. “But it’s actually fairly surprising how often these health-based drinking water violations occur even in the U.S., where we have pretty good water quality.”

In November, for example, residents of Millwood, Washington, faced a boil water order for nearly a week after samples showed elevated levels of coliform bacteria.

In October, water at an elementary school in Honolulu tested positive for coliforms following several nearby water main breaks.

In September, residents in west Baltimore were told to boil water after officials there found coliform contamination, including E. coli, in samples.

While coliform bacteria are generally not harmful to humans, according to the U.S. Environmental Protection Agency, federal regulators long maintained that coliforms are a bellwether for disease-causing viruses, parasites and bacteria.

The Environmental Protection Agency requires that community water systems, which can be public or privately owned, conduct regular tests for coliforms.

The public must be notified within 24 hours of acute violations. Acute violations happen when public health is immediately at risk — for example, if a water system detects thermotolerant coliforms such as E. coli, which can grow at relatively high temperatures and often indicate water contaminated with human or animal feces.

E. coli live naturally in the intestines, but certain strains can cause gastrointestinal illness, ranging from mild diarrhea to nausea and vomiting, with the risk of kidney failure in rare cases in very young and older people.

Federal regulations allow local water officials to use a variety of methods to issue public violations, including the news media or postal mail.

Until 2016, federal rules also required that most community water systems notify residents within 30 days when 5% of their monthly samples tested positive for total coliforms.

“Total coliforms are a group of closely related bacteria that are natural and common inhabitants of soil and surface waters,” according to a 2015 Environmental Protection Agency guidance document for community water systems serving under 1,000 people.

As of 2016, the federal government no longer requires that water systems of any size notify residents of coliform violations stemming from regular sampling — so long as any indications of fecal contaminants fall below prescribed levels and the water system identifies and fixes the problem.

In its final rule, which was published in 2013 but did not go into effect until 2016, Environmental Protection Agency officials maintain that the mere presence of coliforms “by themselves do not indicate a health threat.”

But the recent research shows that when the public is not notified of coliform violations in a timely way, there can still be costly consequences related to purchases of over-the-counter remedies, hospital stays and lost time at work.

Immediate notification, less sickness

Waterborne pathogens that cause gastrointestinal illness account for $160 million in direct healthcare costs each year in the U.S., according to research published in January 2021 in the journal Emerging Infectious Diseases. The authors estimate an additional $2.39 billion in direct healthcare costs when people get sick from breathing contaminated water droplets — at a hot tub or spa, for example.

The new paper in The Review of Economics and Statistics explores how the timing of public notifications related to water quality issues affects household behavior.

Marcus focuses on coliform violations from 2004 to 2015 in North Carolina, because of the quality and detail of data available for the state. This period covers roughly the decade before the federal rule went into effect that made it so community water systems no longer had to tell the public about certain types of contamination identified during routine testing.

Acute violations — those arising from testing indicating an immediate health risk and requiring 24-hour public notice — led households in affected areas to increase bottled water purchases by roughly 78%, on average, during the month the violation occurred, Marcus finds.

Less severe violations related to routine testing — those requiring public notice within 30 days rather than 24 hours — did not, on the whole, affect bottled water purchases.

Marcus finds 60% of community water systems in North Carolina notified households of those less severe violations within one week. Yet for water systems that notified households within one day of less severe violations, bottled water sales increased 40% on average. Notifications sent beyond the first day did not affect bottled water purchases.

While the notification timing was available for North Carolina, the method of communication was “not systematically recorded,” Marcus says. But the research shows early notification of water problems can meaningfully change household behavior.

“The timing of information to the public really matters,” Marcus says. “That’s something that can broadly apply to many different violations for drinking water, and even violations for different types of pollution.”

Although most coliforms do not affect human health, Marcus notably links less severe violations — those that water systems typically took longer to communicate to the public — with more purchases of over-the-counter medicines for stomach distress.

That relationship was not evident for acute violations, indicating the uptick in purchases of clean bottled water following quick notifications helped people avoid sickness.

Hospital admissions were also linked to monthly violations, especially for school-aged children. Likewise, monthly violations were linked to school absences, especially for elementary school students.

Costs of delayed notification

Marcus figures the dollar costs related to immediate warnings about potentially harmful water compared with warnings that come later. If the public had been notified within 24 hours of all testing violations — even those that only required notification within 30 days — Marcus estimates bottled water purchases would have been $365,000 higher in North Carolina during the decade studied.

Marcus also estimates how much the violations that water systems were slower to communicate to the public cost residents in terms of medication purchases, hospital visits and time lost at work.

• Some $441,000 worth of over-the-counter gastrointestinal medicines were purchased due to coliform violations in North Carolina.
• Emergency department visits cost another $422,000.
• Assuming an average wage of $25 per hour and assuming one parent missed one work day for each day a student was absent from school, there were nearly $7 million in lost earnings over the decade.

These are, to be sure, “back-of-the-envelope” calculations, as Marcus writes in the paper. Considering the wages-lost estimate, for example, some parents will have paid time off and won’t have foregone earnings because their child missed school. Others might have nearby relatives to help.

Still, the rough total estimate of costs related to monthly coliform violations that were not immediately communicated to the public comes out to $7.7 million — well above the several hundred thousand dollars’ worth of bottled water that would have been purchased if the public had been immediately notified about every violation.

“The jury’s still out,” Marcus says, referring to the long-term effects of the Environmental Protection Agency’s decision to no longer require public notifications for less severe coliform violations. But, she adds, her research “does indicate that previous to that revision, we were observing health effects for even that monthly coliform violation, which was thought not to matter very much in terms of health.”

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This research roundup about monkeypox was updated on Sept. 19, 2022, with a new study added under the “Additional research” subhead.

Human monkeypox, an infectious disease caused by the monkeypox virus, was first discovered 70 years ago. The virus has been present in parts of Central and West Africa, as a result of animal-to-human and human-to-human transmission.

In recent years, a handful of researchers who study the virus tried to notify the international community about a brewing problem, but their reports went mostly unnoticed until an outbreak in the United Kingdom this May.

The outbreak has now spread to more than 90 countries.

“This virus has been spreading in marginalized and vulnerable populations [in Africa] for decades, and we’ve done nothing about it,” Dr. Anne Rimoin, a University of California, Los Angeles epidemiology professor, told NPR in July.

In a July 2022 comment article in Nature Reviews Microbiology, two researchers at American University of Nigeria in Yola write that the current outbreak of monkeypox in countries where the virus transmission hasn’t been endemic is likely “a consequence of the failure to curtail the spread of the disease in endemic regions of Africa despite decades of constant outbreaks.”

A study about monkeypox infections between April and June this year, published in the New England Journal of Medicine, notes that although “monkeypox virus has circulated for decades in regions where it has traditionally been endemic, research into monkeypox has been neglected and underfunded.”

As of August 23, more than 41,000 monkeypox cases and at least a dozen deaths have been reported in 94 countries, 87 of which have not had a monkeypox outbreak before. The U.S. has reported more than 14,100 cases and no deaths, according to the U.S. Centers for Disease Control and Prevention.

On July 23, nearly two months after the U.K. reported its first Monkeypox case, the World Health Organization declared monkeypox a global health emergency — also called Public Health Emergency of International Concern, or PHEIC — which signals the need of an international response to ramp up available testing, medications and vaccines.

The first monkeypox case in the U.S. was identified on May 18 in Massachusetts. On Aug. 4, the U.S. declared a public health emergency, which allows the administration to use federal funds to respond to the outbreak.

To help journalists with their continued reporting of the outbreak, we’ve gathered several key facts and peer-reviewed studies on monkeypox. As you will see in the collection of studies below, scientists have been sounding the alarm for years leading up to the current outbreak, calling for more research and better surveillance. We’ll update this piece regularly as new information and research comes to light.

First, let’s begin with the basics.

A brief history: Monkeypox was first discovered in 1958 in monkeys that were shipped from Singapore to Copenhagen, Denmark, for polio vaccine research. At the time, researchers called it a pox-like disease. Despite being named “monkeypox” in the following years, the source of the disease remains unknown, according to the CDC. African rodents and non-human primates like monkeys might harbor the virus and infect people. The first case of human monkeypox was found in 1970 in the Democratic Republic of Congo in a 9-month-old boy.

The virus: The monkeypox virus is a member of Orthopoxvirus genus, from the family Poxviridae, and is related to smallpox and cowpox viruses. Monkeypox is less contagious than smallpox and causes less severe illness. (Smallpox was declared eradicated worldwide in 1980. Chickenpox is from a different virus family called Herpesviridae.)

History of outbreaks in the U.S.: The first monkeypox outbreak outside of Africa was documented in the U.S. in 2003. Eighty-one cases in Illinois, Indiana, Kansas, Missouri, Ohio and Wisconsin were reported during the outbreak. The outbreak was linked to a shipment of animals from Ghana. In 2021, one instance of the infection was documented in a U.S. resident who had returned from Nigeria.

Transmission: Researchers still don’t know in which host the monkeypox virus naturally lives and reproduces, but several animal species are susceptible to the virus, including rope and tree squirrels, Gambian pouched rats, rodents named dormice and non-human primates (monkeys).

Animal-to-human transmission of the virus — also called zoonotic transmission — can occur from direct contact with the blood, bodily fluids or lesions of infected animals. Human-to-human transmission can result from close contact with respiratory secretions like droplets, skin lesions of an infected person or objects like bedsheets used by someone who has monkeypox. Transmission can also occur via placenta from mother to fetus or during birth.

Transmission via respiratory droplets usually requires prolonged face-to-face contact. This puts health workers, household members and other close contacts of active cases at greater risk.

So far, data suggest that gay men, bisexual men and men who have sex with men make up the majority of monkeypox cases in the outbreaks in the U.S. and other countries. But anyone, regardless of sexual orientation or gender identity, who has been in close, personal contact with someone who has monkeypox is at risk, according to the CDC.

Symptoms: The symptoms of the current monkeypox outbreak include a rash that could be on or near the genitals or anus. It can also be on hands, feet, mouth, face and chest. Other symptoms are fever, chills, exhaustion, muscle aches, headaches and sore throat. The illness lasts between two to four weeks.

Death rate: Over the decades, the death rate from monkeypox infection has ranged from 0% to 11%, but researchers estimate the death rate from the current outbreak is about 0.03%.

Treatment: There is no specific treatment for monkeypox, but antivirals such as tecovirimat (TPOXX) may be recommended for people who are more likely to get severely ill, like patients with weak immune systems, according to the CDC.

Vaccines: Vaccination against smallpox has been shown to be 85% effective in preventing monkeypox. JYNNEOS, manufactured by Bavarian Nordic A/S, is currently the only FDA-licensed vaccine in the U.S. to prevent the infection. The vaccine was first approved in 2019 in the U.S. for the prevention of smallpox and monkeypox. People exposed to the virus can also get vaccinated. The CDC recommends vaccination within four days from the date of exposure. ACAM2000 is another vaccine that’s FDA-licensed to prevent smallpox, but it is associated with higher risk of adverse reactions compared with JYNNEOS. For more on monkeypox vaccine availability, read the August 17 monkeypox outbreak alert by Johns Hopkins University’s Center for Health Security. This Vox piece by Keren Landman is also a good explainer about why ACAM2000 isn’t currently used. And Monkeypox Vaccine 101 by epidemiologist Katelyn Jetelina is a good overview.

A July 2022 report by the Kaiser Family Foundation explores at the local level whether jurisdictions are requesting the vaccines allocated to them. It finds that jurisdiction request rates for JYNNEOS vary widely. While most jurisdictions have requested their full supply of the vaccine, some have requested a percentage of their allocation. Ten states — Washington, Missouri, Kansas, Georgia, Nevada, Montana, South Dakota, Oklahoma, Kentucky, and Arkansas — had requested 50% or less of their share when the report was published.

Renaming the virus: The World Health Organization is in the process of renaming the virus, after calls by many groups, including a letter signed by 22 scientists in June.

“The prevailing perception in the international media and scientific literature is that MPXV [monkeypox virus] is endemic in people in some African countries,” the group writes. “However, it is well established that nearly all MPXV outbreaks in Africa prior to the 2022 outbreak, have been the result of spillover from animals to humans and only rarely have there been reports of sustained human-to-human transmissions. In the context of the current global outbreak, continued reference to, and nomenclature of this virus being African is not only inaccurate but is also discriminatory and stigmatizing.”

WHO has already renamed two variants of the virus. The former Congo Basin variant was renamed Clade one (I) and the West African variant is now Clade two (II). Clade is a scientific term for a group of organisms that have evolved from a common ancestor.

Research roundup

High-Contact Object and Surface Contamination in a Household of Persons with Monkeypox Virus Infection — Utah, June 2022
Jack Pfeiffer; et al. CDC’s Morbidity and Mortality Weekly Report, August 2022.

The report is based on testing the surfaces of the household of two monkeypox patients in May 2022. When Salt Lake County Health Department officials went to the home, the patients had already isolated themselves for 20 days. They told officials that they had cleaned and disinfected areas of their home where they spent a lot of time. The monkeypox virus DNA was found in many of the 30 samples collected, but there was no viable virus. This suggests “that virus viability might have decayed over time or through chemical or environmental inactivation,” the authors write.

“Monkeypox virus primarily spreads through close, personal, often skin-to-skin contact with the rash, scabs, lesions, body fluids, or respiratory secretions of a person with monkeypox; transmission via contaminated objects or surfaces (i.e., fomites) is also possible,” the authors write. “Persons living in or visiting the home of someone with monkeypox should follow appropriate precautions against indirect exposure and transmission by wearing a well-fitting mask, avoiding touching possibly contaminated surfaces, maintaining appropriate hand hygiene, avoiding sharing eating utensils, clothing, bedding, or towels, and following home disinfection recommendations.”

Epidemiologic and Clinical Characteristics of Monkeypox Cases — United States, May 17–July 22, 2022
David Philpott; et al. CDC’s Morbidity and Mortality Weekly Report, August 2022.

The report describes the characteristics of 1,195 human monkeypox case reports in the U.S. between May 17, when the first U.S. case related to the 2022 outbreak was identified, and July 22. Of those, 99% were men and 94% reported male-to-male sexual or intimate contact during the three weeks before symptoms began. About 41% were white, 28% were Hispanic or Latino, 26% were Black and 5% Asian. Genital rash, although reported in fewer than half of cases, was common; 36% of persons developed rash in four or more body regions, the authors report. About 41% of patients were living with HIV.

“A substantial proportion of monkeypox cases have been reported among persons with HIV infection, and efforts are underway to characterize monkeypox clinical outcomes among these persons,” the authors write. “Clinicians and health officials implementing monkeypox education, testing, and prevention efforts should also incorporate recommended interventions for other conditions occurring among gay and bisexual men, including HIV infection, sexually transmitted infections, substance use, and viral hepatitis.”

Epidemiology of Early Monkeypox Virus Transmission in Sexual Networks of Gay and Bisexual Men, England, 2022
Amoolya Vusirikala; et al. CDC’s Emerging Infectious Diseases Journal, August 2022.

Published by researchers at the U.K. Health Security Agency in London, the study is based on phone interviews with 45 patients with monkeypox and was conducted between May 25 and 30, 2022. All but one person identified as gay or bisexual. About a quarter reported living with HIV and were receiving treatment. Sixty-four percent of patients reported attending sex-on-premises venues, such as bathhouses, or festivals, private sex parties or cruising grounds, in the three weeks before developing symptoms. The authors define cruising as sexual activity with anonymous people in public spaces. However, 36% didn’t report any of those activities. Instead, they had had sexual activity with new partners or had met via dating apps.

“Our findings suggest that sustained domestic MPXV [monkeypox virus] transmission in sexual networks of GBMSM [gay, bisexual men, and men who have sex with men] in England has been occurring since at least April 2022, with potential importations and exportations from other countries in Europe,” the authors write. “To achieve outbreak control, targeted interventions for venues and their users are vital, including supporting enhanced cleaning of venues to prevent transmission via fomites, targeted health promotion to build awareness and inform risk management, and innovative approaches to support contact tracing of venue attendees.”

Two related studies: “Demographic and Clinical Characteristics of Confirmed Human Monkeypox Virus Cases in Individuals Attending a Sexual Health Centre in London, UK: An Observational Analysis,” by Nicolò Girometti; et al., published in The Lancet Infectious Diseases in July 2022. And “Clinical features and novel presentations of human monkeypox in a central London centre during the 2022 outbreak: descriptive case series,” by Aatish Patel; et al., published in The BMJ in July 2022.

Tecovirimat and the Treatment of Monkeypox — Past, Present, and Future Considerations
Drs. Adam Sherwat, John Brooks, Debra Birnkrant and Peter Kim. NEJM, August 2022.

The perspective article discusses the nuances in use of antiviral drug tecovirimat (TPOXX), which has been approved for the treatment of smallpox under a regulation known as the “Animal Rule” and raises a conundrum: “How to manage compassionate access to a drug whose safety and efficacy in humans have not been established.”

Technical Report: Multi-National Monkeypox Outbreak, United States, 2022
U.S. Centers for Disease Control and Prevention, July 2022.

The report provides an overview of monkeypox cases in the U.S. as of July 25, 2022, including 3,487 cases in 45 states, the District of Columbia and Puerto Rico. The median patient age was 35. Of the 1,383 patients with information on sex assigned at birth, 99% were men. Of the 624 with information on sexual activity, 99% reported male to male sexual contact. Race and ethnicity data were missing for a large number of cases, but the available information showed that 38% were white, 32% were Hispanic and 26% were Black.

Many of the initial patients reported international travel in the 21 days before symptoms appears, visiting countries where monkeypox was not endemic. Many reported participating in large festivals and other activities where close, personal, skin-to-skin contact likely occurred.

The technical report lists several priority research questions, including what medical interventions can be effective, how the virus is transmitted and how best to monitor mis- and disinformation and counter them.

Frequent Detection of Monkeypox Virus DNA in Saliva, Semen, and Other Clinical Samples from 12 Patients, Barcelona, Spain, May to June 2022
Aida Peiró-Mestres; et al. Eurosurveillance, July 2022.

Analysis of 147 clinical samples collected at different times from 12 patients revealed that the monkeypox virus was present in saliva from all cases. It was also frequently present in rectal swab, nose swabs, semen, urine and feces.

“Our results contribute to an improved understanding of a likely complex transmission puzzle and underline other immediate areas for research such as the infectivity of bodily fluids, the frequency of secondary and asymptomatic cases or the impact of social and behavioral factors affecting viral transmission,” the authors write.

The Changing Epidemiology of Human Monkeypox — A Potential Threat? A Systematic Review
Eveline Bunge; et al. PLOS Neglected Tropical Diseases, February 2022.

Published shortly before the current outbreak, this systematic review of existing literature was one of several papers sounding the alarm about the public health implications of the international community ignoring monkeypox.

“The waning population immunity associated with discontinuation of smallpox vaccination has established the landscape for the resurgence of monkeypox,” the authors write. “In light of the current environment for pandemic threats, the public health importance of monkeypox disease should not be underestimated. International support for increased surveillance and detection of monkeypox cases are essential tools for understanding the continuously changing epidemiology of this resurging disease.”

Human Monkeypox — After 40 Years, An Unintended Consequence of Smallpox Eradication
Karl Simpson; et al. Vaccine, July 2020.

The report notes that since the eradication of smallpox in 1980, about 70% of the world’s population is no longer protected against smallpox and that monkeypox, which is from the same family of viruses, is now a re-emerging disease.

“Monkeypox has been viewed as ‘just another neglected disease.’ Global travel and easy access to remote and potentially monkeypox-endemic regions are a cause for increasing global vigilance,” the authors write. “As monkeypox is no longer a rare disease, there is need for more rigorous epidemiological studies, with particular reference to zoonotic hosts, transmission potential and human case severity.”

Human Monkeypox: Epidemiologic and Clinical Characteristics, Diagnosis, and Prevention
Dr. Eskild Petersen; et al., Infectious Disease Clinics of North America, December 2019.

The study provides an overview of monkeypox and related outbreaks over the decades and stresses that monkeypox is “no longer ‘a rare viral zoonotic disease that occurs primarily in remote parts of Central and West Africa, near tropical rainforests.’”

A Systematic Review of the Epidemiology of Human Monkeypox Outbreaks and Implications for Outbreak Strategy
Ellen Beer and V. Bhargavi Rao. PLOS Neglected Tropical Diseases, October 2019.

The report reviews 71 documents, including situation reports, investigations and case reports published between 1972 and 2018. The study provides a detailed analysis of available data.

The authors note that few studies based on virus samples were available. “Overall, samples are seldom taken, and very few cases are laboratory-confirmed,” they write. “Significant improvements in the quality and quantity of outbreak data collection are urgently needed to improve the monkeypox research portfolio to inform appropriate case management and public health response.”

The 2017 human monkeypox outbreak in Nigeria — Report of outbreak experience and response in the Niger Delta University Teaching Hospital, Bayelsa State, Nigeria
Dimie Ogoina; et al. PLOS One, April 2019.

The study investigates the 2017 monkeypox outbreak in Nigeria. While Nigeria reported three monkeypox cases between 1970 and 2017, it had a large outbreak with 228 suspected cases in 2017. Researchers reviewed clinical characteristics of 21 cases at Niger Delta University Teaching Hospital, between September and December 2017. The median age was 29, ranging from 6 to 45 years. About 80% were male.

Most patients expressed fear and anxiety over facing stigma and discrimination from hospital staff, members of the community and family members, the authors write.

The most prominent challenge in hospital response was delay in testing because none of the labs in Nigeria could test for the infection when the outbreak began.

“The Nigeria outbreak was characterized by predominant infection among young adult males and significant person-to-person secondary transmission,” the authors write. “These findings differ from previous reports … of human monkeypox where children below 10 years of age comprised 83% of the cases and secondary transmission was observed to be rare.”

The authors define secondary transmission as person-to-person transmission via respiratory droplets, direct contact with infected secretions of patients or from contact with contaminated patient environment, like bedding.

The authors also note that a substantial number of young adults had genital ulcers, which was less common in previously reported cases. “The role of genital secretions in transmission of human monkeypox, however deserves further studies,” they write.

Extended Human-to-Human Transmission during a Monkeypox Outbreak in the Democratic Republic of the Congo
Leisha Diane Nolen; et al. CDC’s Emerging Infectious Diseases Journal, June 2016.

The study reports a notable increase in monkeypox cases in the Democratic Republic of Congo, where the infection is endemic. The report includes 104 suspected cases between July and December 2013, compared with 13 cases in 2012 and 17 cases in 2011. In 50% of the cases the virus was spread among the people in the household. The median age of patients was 10 with an age range between 4 months and 68 years. About 57% were male. There were 10 deaths. The infections were likely caused by exposure to wild animals or an infected individual.

“The high attack rate and transmission observed in this study reinforce the importance of surveillance and rapid identification of monkeypox cases,” the authors write. “Community education and training are needed to prevent transmission of MPXV infection during outbreaks.”

Additional research

“Health Care Personnel Exposures to Subsequently Laboratory-Confirmed Monkeypox Patients — Colorado, 2022,” by Kristen E. Marshall; et al., published in September 2022 in CDC’s Morbidity and Mortality Weekly Report, finds that none of the 313 Colorado health care providers exposed to patients with monkeypox acquired the infection. Also, the use of recommended personal protective equipment and vaccination was low among the providers.

“HIV and Sexually Transmitted Infections Among Persons with Monkeypox — Eight U.S. Jurisdictions, May 17–July 22, 2022,” by Kathryn G. Curran; et al., published in CDC’s Morbidity and Mortality Weekly Report in September 2022, finds that among 1,969 people with monkeypox in the U.S., 38% had HIV infection and 41% had a sexually transmitted infection in the prior year. Hospitalization was more common among those with HIV infection.

More recommended reading

• What You Need to Know About the History of Monkeypox, by Simar Bajaj, published in the Smithsonian Magazine in June 2022, delves into the history of monkeypox.
• What Scientists Know — and Don’t Know — About How Monkeypox Spreads, by Megan Molteni, published in STAT in August 2022, explains in detail what’s known and unknown about the routes of virus transmission. “What’s clear from the epidemiological evidence so far is that the current monkeypox epidemic is being driven overwhelmingly by the first of these [direct skin-to-skin contact] — in particular, close intimate contact between sexual partners,” she writes.
• Why the Monkeypox Outbreak is Mostly Affecting Men Who Have Sex with Men, by Kai Kupferschmidt, published in Science Magazine in June 2022, explains how interconnected sexual networks within the community of men who have sex with me may give the virus the ability to spread in ways that it can’t in the general population.
• He Discovered the Origin of the Monkeypox Outbreak — and Tried to Warn the World, by Michaeleen Doucleff for NPR, published in July 2022, tells the story of Dr. Dimie Ogoina, who diagnosed the first known case of the current international monkeypox outbreak in an 11 year-old-boy in 2017.
• How is Monkeypox Spread? is a good explainer published in August 2022 by epidemiologist Katelyn Jetelina in her Substack.
• Fighting Monkeypox, Sexual Health Clinics Are Underfunded and Ill-Equipped, by Liz Szabo and Lauren Weber for Kaiser Health News, published in July 2022, notes, “Sexual health clinics have been stretched so thin that many lack the staff to perform such basic duties as contacting and treating the partners of infected patients.”
• New Data From Several States Show Racial Disparities in Monkeypox Infections, by Usha Lee McFarling, Katherine Gilyard and Akila Muthukumar, published in STAT in August 2022, highlights extreme racial disparities in monkeypox cases in some states, compounded by lack of access to vaccine.
• What Does It Mean to Declare Monkeypox a PHEIC? by Talha Burki, published in Lancet Infectious Diseases in August 2020, explains what a public health emergency declaration by WHO does and doesn’t do. In another article, Monkeypox as a PHEIC: Implications for Global Health Governance, published in August 2022 in The Lancet, Clare Wenham and Mark Eccleston-Turner also explore the implications of the declaration.

Resources for journalists

• Several journals, including JAMA, The Lancet journals, Nature journals, BMC journals and Annals of Internal Medicine have been providing free public access to their monkeypox content.
• You can find WHO’s main page for monkeypox here and the CDC’s here. And here’s CDC’s guidance for schools. Here’s CDC’s monkeypox case and trend data.
• WHO has weekly reports on emergency situations updates for monkeypox.
• CDC’s “2022 Monkeypox Outbreak Global Map” keeps track of confirmed cases and deaths. WHO also keeps track of reported cases on its Health Emergency Dashboard. Our World in Data is another source for numbers and reports 7-day averages and weekly trends.
• Johns Hopkins University’s Center for Health Security has a weekly outbreak alert for monkeypox and provides a comprehensive overview of the latest developments and research in the U.S. and around the world.
• Special Advisory: Covering Monkeypox by the Association of LGTBQ Journalists provides guidance to journalists and newsrooms on the language they use when covering monkeypox. How to Talk About Monkeypox Effectively, Without Stigmatizing Gay Men, published on NPR’s All Things Considered in August 2022, is also a good guide. And CNN’s Sara Ashley O’Brien has sage advice about choosing images for your monkeypox stories.
• Reducing Stigma in Monkeypox Communication and Community Engagement, a document by the CDC, discusses how the agency is framing communication around monkeypox to avoid marginalizing stigmatizing groups that may be at increased risk of the infection.
• How to Cover Health Inequities in U.S. Monkeypox Data Trends, by Margarita Birnbaum and Bara Vaida, published on Association of Health Care Journalists’ blog Covering Health in August 2022, is a tip sheet to help journalists shed light on the disparities in monkeypox infections. This August 2022 report by the Kaiser Family Foundation has data on monkeypox vaccinations in the U.S. by race and ethnicity.
• FDA Monkeypox Response explains the role of FDA in the current public health emergency.
• If you’re curious about monkeypox strains, check Nextstrain, an open-source project that provides a view of publicly-available data along visualizations for use by anyone.
• In Monkeypox Experts to Follow on Social Media, also published on the Covering Health blog, Bara Vaida shares her Twitter list of monkeypox experts.

Free multimedia collections for news stories

• The CDC has these graphics, images and videos about monkeypox. It also has b-roll of the agency’s buildings.
• WHO has a large collection of photos, including people getting vaccinated and patients with monkeypox.
• This WHO graphic on recovering from monkeypox at home shows what steps individuals should take.
• SciLine, a free service for journalists based at the American Association for Advancement of Science, has several video clips of expert interview, which you can embed in your stories.

The post Monkeypox: An explainer and research roundup appeared first on The Journalist's Resource.

Health misinformation is not a new phenomenon, but modern-day factors such as social media, in addition to politicization of health and science and the fast pace of scientific development during the pandemic have all made it easier for misinformation and disinformation to spread.

People who spread misinformation are not just fringe groups. Some politicians, public officials and a handful of physicians are now spreading misinformation. The growing trend highlights the increasingly important role of journalists in debunking misinformation, whether it’s presented at a press conference or as comments in an interview.

“In cases where public officials are spreading misinformation, the journalist’s responsibility is straightforward — either don’t report it; or report it while pointing out that it’s misinformation clearly, explicitly, and early, and telling people what the truth actually is,” Ed Yong, a Pulitzer Prize winning science journalist at The Atlantic, wrote in an email to The Journalist’s Resource. “I cannot stress enough that simply writing down what officials say is not journalism; you have to analyze, critique, and contextualize those comments, or you’re nothing more than an RSS feed with hands.”

The problem of misinformation has risen to a level that in November, the U.S. surgeon general issued a 22-page advisory titled “Confronting Health Misinformation,” dedicating a page to six tips for journalists and media organizations.

The report calls for training programs for journalists on how to recognize, correct and avoid amplifying misinformation. It also asks journalists to give more consideration to headlines and images they choose for their stories.

“If a headline is designed to fact-check a rumor, where possible, lead with the truth instead of simply repeating details of the rumor,” Surgeon General Dr. Vivek Murthy recommends in the advisory. “Images are often shared on social media alongside headlines and can be easily manipulated and used out of context.”

The Kaiser Family Foundation’s COVID-19 Vaccine Monitor report in November, focused on media and misinformation, shows how widespread is belief in pandemic-related misinformation. About 78% of the U.S. adults surveyed in October 2021 said they have heard at least one false statement about COVID-19 and that they believe it to be true or are unsure if it is true or false.

As a quick reminder, misinformation is information that is false, inaccurate or misleading according to the best available evidence at the time, regardless of intent to mislead. Disinformation is misinformation that is deliberately disseminated to mislead.

Brandy Zadrozny, a journalist and research fellow at the Technology and Social Change Project at Harvard Kennedy School’s Shorenstein Center on Media, Politics and Public Policy, who covers online extremism and disinformation, urges journalists to be brave and call disinformation what it is.

“I don’t think that we should sort of censor ourselves from facts because it’s a political issue and we don’t want to be seen as taking sides, when [in fact] there is one clear side,” she says.

In addition to Yong and Zadrozny, we spoke to several academics and researchers for advice on how to report on public officials and politicians who spread misinformation. Below are 7 tips gathered from those conversations.

Tip 1: Quickly correct the misinformation

If an official or politician is spreading misinformation, be quick to point it out. Instead of quoting them directly and amplifying it, provide the information that is correct, and report what the official has said is not grounded in evidence, advises Rebekah Nagler, a health communication researcher and an associate professor in the Hubbard School of Journalism and Mass Communication at the University of Minnesota.

“I think that we can agree that the correction ought not to be buried way below the lead,” says Nagler. “Because that’s basically doing what we’ve seen in the social media space, where that information is allowed to sort of hang without immediate correction. And the longer that happens, we know those beliefs and perceptions can become more entrenched.”

You can also use the “truth sandwich” method: Start with the truth. Indicate the lie. Return to the truth. “Always repeat truths more than lies,” advises Roy Peter Clark of the Poynter Institute in a 2020 post.

Be quick to point out to your audiences when an official is speaking outside of the scientific consensus and contrary to proven data, advises Jessica Malaty Rivera, an infectious disease research fellow at Boston Children’s Hospital.

“There’s a responsibility here to say he said this and it’s wrong,” says Malaty Rivera.

Scientific consensus is when the majority of researchers and scientists in a field have reached an agreement based on the available scientific evidence. This tip sheet about scientific consensus has a list of resources to help you point your audience to documents that show scientific consensus.

I cannot stress enough that simply writing down what officials say is not journalism; you have to analyze, critique, and contextualize those comments, or you’re nothing more than an RSS feed with hands.

Ed Yong

This is how Dr. Anthony Fauci, the nation’s top infectious disease expert, responded to an unfounded claim made by a politician. In a recent interview, MSNBC host Joy Reid asked Fauci for comments about a false claim made by Republican Congressman Ronny Jackson, a physician from Texas, about the omicron variant.

“What do you say to somebody who is a doctor who is telling people publicly as a member of Congress that this is all made up, that this is all just an election strategy?” Reid asked.

Fauci replied: “I would just say without being pejorative against him that he is at odds in his feelings and his beliefs with virtually everybody who knows anything about virology, including the [World Health Organization] and all the other health ministers throughout the country and throughout the world.”

Be aware that sometimes, officials may not directly spread misinformation but raise questions about issues that are already backed by data and scientific consensus. 

“Disinformation agents try to make a topic uncertain and debatable. … It may be settled science, such as measles vaccines,” says Dr. Wen-Ying Sylvia Chou, program director of the Health Communication and Informatics Research Branch at the National Cancer Institute. “But now it becomes debatable and that suddenly opens up the topic for all kinds of problems.”

Tip 2: Avoid false balance

Journalists often strive to be fair and objective, but in aiming to present both sides of an issues, they might end up creating “false balance” or “false equivalency,” which is “when one tries to treat two opposing positions as equally valid when they are simply not,” writes David Robert Grimes, a scientist and author, in his 2019 article “A dangerous balancing act,” published in EMBO Reports. 

“If one position is supported by an abundance of evidence while another is entirely bereft of it, it is profoundly misguided to afford equal air‐time and coverage to both positions,” writes Grimes. 

False balance is dangerous because it can amplify misinformation and lies and give them credibility. So even if the misinformation comes from a public official or politician, avoid giving it equal weight or credence. Instead, be quick to debunk the misinformation.

I don’t think that we should censor ourselves from facts because it’s a political issue and we don’t want to be seen as taking sides, when [in fact] there is one clear side. It’s the factual side of the overwhelming scientific community. We just have to be a little braver in reporting facts.

Brandy Zadrozny

Thomas Patterson, Bradlee Professor of Government and the Press at Harvard Kennedy School and one of the founders of The Journalist’s Resource, gave the following advice in a 2019 article: If one side is making erroneous claims or twisting the facts, journalists should say so in their coverage. Make it clear when claims are demonstrably untrue. Patterson says that a failure to do so increases the likelihood that the public will accept such claims as true.

In a 2016 article for the Association of Health Care Journalists, Tara Haelle writes that journalists “should only report scientifically outlier positions if solid evidence supports it, not just because someone is shouting it from their own tiny molehill.”

Also, if you’re quoting an official who’s spreading misinformation — for instance, that vaccines may not be safe — don’t call the scientific community, which overwhelmingly agrees that vaccines are safe, “critics.”

“It’s not just critics who are saying that,” says Zadrozny. “It’s the whole of public health. It’s the whole of science. What you have to do there is to say that the whole of public health disagrees and find the stance dangerous.”

Tip 3: Pick your words carefully for headlines and leads

“We have to be so discerning with what we choose to have in our headlines and what we choose to have in our leads,” says Malaty Rivera. “Because what often happens is logical fallacies. People will read a headline and assume total comprehension of a topic based on a handful of words. And that is most often the case when it comes to things like treatments or vaccines or events that cause something.”

Ask yourself what the audience will take away from your piece if they were to read just the headline, a tweet, a short post on social media or just the first few paragraphs of the article. Is there a conclusion that you don’t want them to come up with? “If the answer is maybe or yes, then rewrite it or get some scientists to give you feedback,” advises Malaty Rivera.

In “5 Lessons for Reporting in an Age of Disinformation,” Claire Wardle of First Draft, a nonprofit organization aiming to protect communities from harmful misinformation, writes: “It doesn’t matter if the 850 word article provides all the context and explanation to debunk or explain why a narrative or claim is false, if the 80 character version of that context is misleading, it’s all for nothing.”

Tip 4: Be leery of charts

Just because an official uses a chart or graph, it doesn’t mean that it’s an accurate one. Ask for the data behind it.

“At this point now, snake oil salespeople and people with bad intentions know how to sound scientific. So, they just science it up,” says Malaty Rivera. “People are very, very persuaded by data visualization, even if it’s bullshit. If it looks like a fancy chart with fancy color schemes and legends, people automatically assume that somebody smart made that. But you can put any number into an Excel spreadsheet, turn it into a graph and publish it and people [would say], ‘Oh, man, look at this research.’”

Tip 5: Be aware of the small group of physicians who spread misinformation

“Science is a very collaborative and evolving process,” says Malaty Rivera. “Many times, people say, ‘Well, I heard from this one doctor.’ and I’m like, OK, so one doctor is saying this one thing, when you have so many others with data to back it up saying something else. Think critically about that outlier.”

The American Medical Association’s House of Delegates adopted a policy in November to combat public health disinformation disseminated by health professionals, in all forms of media, and address disinformation that undermines public health initiatives. The association is also going to research disinformation disseminated by health professionals and its impact on public health and develop a comprehensive strategy to address it.

“Physicians are among the most trusted sources of information and advice for patients and the public at large, which is why it’s so dangerous when a physician or other health care professional spreads disinformation,” said AMA Board Member Dr. Jesse Ehrenfeld, in a news release.

The Center for Countering Digital Hate, an international nonprofit organization, which seeks to disrupt online hate and misinformation, has compiled a list of 12 doctors known for spreading disinformation with examples of how they are doing it.

Tip 6: Dig deeper into why an official or doctor is spreading misinformation

“Look at motivations and tactics used for spreading misinformation,” says Chou. “[Are they] using a topic and politicizing it or weaponizing it for political purposes? Sometimes there are financial incentives, or stoking fear. Fear mongering itself can be a powerful communication tool.”

Dig deeper to find out if the person has a business making money off a product they’re trying to peddle as an alternative to proven treatments or vaccines.

Zadronzy, who has reported on fringe doctor groups that have spread misinformation about COVID-19 and vaccines, suggests explaining why an official or physician’s statement is known to be false — and then exploring the motives of the fringe belief. “For instance, is there a financial or political motive?” Zadronzy says. “Say where the lie comes from and why you’re seeing it.”

Vet the people you talk to. It can be something as quick and simple as looking them up on Google or looking at their social media posts, advises Zadrozny.

Tip 7: Explain how misinformation and disinformation can lead to harm

“Misinformation damages society in a number of ways,” according to The Debunking Handbook 2020, written by a team of 22 scholars of misinformation, representing the current consensus on the science of debunking. “If parents withhold vaccinations from their children based on mistaken beliefs, public health suffers. If people fall for conspiracy theories surrounding COVID-19, they are less likely to comply with government guidelines to manage the pandemic, thereby imperiling all of us.”

Explain how people get COVID or are dying from it because they’ve come to believe that vaccines cause harm, or are turning to dangerous treatments, Zadrozny says. 

“Don’t make the bad guys the centerpiece but [instead] people who are harmed,” she advises.

Additional reading

• Expert Tips for Digging Out the Roots of Disinformation. Maurice Oniang’o. Global Investigative Journalism Network, November 2021.
• It’s Not Misinformation. It’s Amplified Propaganda. Renée DiResta. The Atlantic, October 2021.
• 9 Ways to Know if Health Info Is Actually Junk Science. Timothy Caulfield. Men’s Health, October 2021.
• Five tactics used to spread vaccine misinformation in the wellness community, and why they work. Allyson Chiu and Razzan Nakhlawi. The Washington Post, October 2021.
• Misinformation online is bad in English. But it’s far worse in Spanish. Stephanie Valencia. The Washington Post, October 2021.
• The Swiss cheese model for mitigating online misinformation. Leticia Bode and Emily Vraga. Bulletin of Atomic Scientists, May 2021.
• Five rules for evidence communication. Michael Blastland; et al. Nature, November 2020
• 5 Lessons for Reporting in an Age of Disinformation. Claire Wardle. First Draft, December 2018.
• Covering scientific consensus: What to avoid and how to get it right. Denise-Marie Ordway. The Journalist’s Resource, November 2021
• Covering scientific consensus: What to avoid and how to get it right. Denise-Marie Ordway. The Journalist’s Resource. November 2021.

Resources

• The Debunking Handbook 2020 summarizes the current state of the science of misinformation and strategies for debunking it. It was written by a team of 22 scholars of misinformation and it represents the current consensus on the science of debunking for citizens, policymakers, journalists and other practitioners.
• First Draft is a nonprofit organization aiming to protect communities from harmful misinformation. Its Misinformation Monitor keeps track of the latest and most important misinformation narratives.
• Center for Countering Digital Hate, an international nonprofit organization, with offices in London and Washington, D.C., seeks to disrupt online hate and misinformation. One of the center’s recent reports is “Pandemic Profiteers: The business of anti-vaxx.”
• Harvard Kennedy School’s Misinformation Review is a peer-reviewed publication with content produced by misinformation scientists and scholars and geared toward real-world implications.
• The Media Manipulation Casebook is a digital research platform and a resource for researchers, journalists, educators and others who want to learn about detecting, documenting, describing and debunking misinformation, disinformation and media manipulation.

Our interview sources

• Dr. Wen-Ying Sylvia Chou, program director of the Health Communication and Informatics Research Branch at the National Cancer Institute.
• Jessica Malaty Rivera; infectious disease research fellow at Boston Children’s Hospital. Malaty Rivera has a strong following on social media, where she answers questions via her Instagram stories and helps dispel misinformation.
• Rebekah Nagler, a health communication researcher and Beverly and Richard Fink Professor in Liberal Arts and an associate professor at the Hubbard School of Journalism and Mass Communication at the University of Minnesota, and co-author of the 2020 study “The Emergence of COVID-19 in the US: A Public Health and Political Communication Crisis,” published in the Journal of Health Politics, Policy and Law.
• Sarah Gollust, associate professor at the Division of Health Policy and Management at the University of Minnesota and co-author of 2020 study “The Emergence of COVID-19 in the US: A Public Health and Political Communication Crisis.”
• Jennifer Nilsen, a research fellow at the Technology and Social Change Project at the Shorenstein Center, who researches misinformation and has worked on the Media Manipulation Casebook. Her latest publication is “Ebola and the U.S. Border: Spreading Virus Rumors to Build the Wall.” 
• Brandy Zadrozny, a journalist and research fellow at the Technology and Social Change Project at the Shorenstein Center. 
• Ed Yong, a Pulitzer Prize-winning science journalist at The Atlantic. 

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A federal government database of doctors who provide medication-assisted treatment for opioid use disorder is rife with inaccurate information, making it difficult for people seeking help to schedule appointments, shows new research in the Journal of Psychiatric Practice.

Researchers combed the Substance Abuse and Mental Health Services Administration’s database of buprenorphine providers to verify the accuracy of phone numbers and confirm whether the provider was in fact prescribing buprenorphine and accepting new patients. SAMHSA is an agency of the U.S. Department of Health and Human Services.

Buprenorphine, sold under the brand name Subutex, and a component of the drug sold under the brand name Suboxone, is a drug commonly prescribed to treat opioid use disorder.

Researchers called SAMHSA-listed buprenorphine providers in the 10 states with the highest drug overdose death rates according to 2015 Centers for Disease Control and Prevention (CDC) drug overdose death data — West Virginia, New Hampshire, Kentucky, Ohio, Rhode Island, Pennsylvania, Massachusetts, New Mexico, Utah and Tennessee. They then focused on providers listed as practicing within a 25-mile radius of the county with the highest drug-related death rates in 2017, narrowing down the list to 505 providers.

The researchers secured appointments with just 28% — 140 — of providers contacted. In most cases, nobody answered the phone or returned the call, or the phone number listed was incorrect.

Over one quarter — 27.1% — of the numbers listed were incorrect, the researchers report. A similar percentage — 25.9% — of phone numbers corresponded to providers who did not offer buprenorphine.

“Someone who has opioid use disorder, if they try to use the federal database to locate someone to get medication-assisted treatment from, they’re going to find out that the database is full of wrong numbers and practices that aren’t even prescribing buprenorphine,” says author J. Wesley Boyd, an associate professor of psychiatry at Harvard Medical School.

Researchers made two attempts at contact during normal weekday business hours and left voice messages with a callback phone number when given the option. Calls were made over the span of two months. If the researchers made contact with the provider or office staff, they asked whether the provider currently prescribed buprenorphine. If yes, the researchers followed up by asking which insurance they accepted, including Medicaid, whether they were accepting new patients, and when their first available appointment was.

“One of the clinics that I called said to me, ‘Oh, Dr. Wartenberg hasn’t been in this clinic for over 12 years,’” Boyd recalls.

An evidence-based approach

Medication-assisted treatment is an evidence-based treatment for opioid use disorder. It has been shown to reduce the risk of overdose death for people who use opioids. These medications reduce symptoms of craving and withdrawal.

A study of 151,983 adults in England treated for opioid dependence between 2005 and 2009, published in Addiction, found the risk of fatal drug overdose more than doubled for individuals who received only psychotherapy compared with those who received medication-assisted treatment.

An April 2017 systematic review and meta-analysis published in The BMJ found that people receiving medication-assisted treatment were less likely to die of an overdose or other causes than peers with opioid use disorder who did not receive such treatment.

And a March 2015 review of randomized controlled trials in the Harvard Review of Psychiatry compared medication-assisted treatment of opioid use disorder with placebo or no medication and found that medication-assisted treatment “at least doubles rates of opioid-abstinence outcomes.”

Long waits and potential solutions

The researchers of the new paper verified that 310 of the 505 phone listings in their sample — 61.4% — listed correct numbers. Of all the providers who supposedly offered buprenorphine according to the database, only 195, or 38.6% actually did.

The researchers were able to ask 173 of these providers whether they accepted private insurance, and most — 75.7% — did. And more than half of the buprenorphine providers who were asked about whether they accepted Medicaid did — 62.9%.

“To me it was the one pleasant surprise of our findings, namely, that a decent chunk of the practices or individuals that we called did accept Medicaid,” Boyd notes.

But appointments typically required a wait — the average wait was 16.8 days, and the range spanned from 1 to 120 days. “Sixteen days is obviously a dangerous amount of time. Because as far as I’m concerned, every single time you use [opioids], you’re putting your life in jeopardy,” Boyd says.

Boyd notes that an underlying contributor to issues of access to buprenorphine is the relative scarcity of buprenorphine providers due to prescribing restrictions. Under the Drug Addiction Treatment Act of 2000, physicians must complete a training program if they want to prescribe medication-assisted therapy outside of an opioid treatment program.

“In order for people to be able to prescribe buprenorphine, the requirement for them to do additional training is, I think, obsolete and not necessary,” Boyd says. “So one thing is just to eliminate the requirement for specialized training over and above the training that one gets in order to be able to prescribe medications generally.”

Boyd suggests that SAMHSA might shore up the database through mass mailings to listed providers. He acknowledges that people can find medication-assisted treatment other than through the SAMHSA database, but as a provider listed in the database himself, he says he gets calls “infrequently, but regularly” about buprenorphine that likely stem from the listing.

“We were trying to replicate the experience of an opioid user looking for help,” Boyd says. “And this was the best way we thought that we could explore that issue.”

Boyd has conducted similar research on the issue of availability of mental health care. For more on the opioid epidemic, check out our long read.

The image on this page, obtained from Wikimedia Commons, is being used under a Creative Commons license. No changes were made.

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On Jan. 2, the Trump administration announced a ban on most flavored e-cigarette cartridges, except for menthol and tobacco flavors. The ban is aimed at reducing the uptake of vaping among young people.

Whether it will prove effective remains to be seen. History, however, may provide some insight.

The new policy banning most flavored e-cigarette cartridges echoes prior regulation of the tobacco industry. The Family Smoking Prevention and Tobacco Control Act, passed by Congress in 2009, banned the sale of flavored cigarette products — except for menthol.

The menthol exemption has garnered heavy criticism from public health advocates. They argue that any flavored product may encourage smoking and vaping among youth. Research shows that menthol cigarette use is disproportionately high among young smokers.

“Menthol – which is an ingredient in both mint and menthol flavored products – provides a cooling sensation that masks the harsh taste of nicotine, making it easier for children to get hooked,” said American Academy of Pediatrics President Sally Goza, in a statement following last week’s partial flavored vape ban. “The idea that menthol is an adult flavor is just plain wrong.”

In fact, compared with all other age groups, youth between the ages of 12 and 17 are the most likely to use menthol cigarettes, according to a 2016 study in Tobacco Control, which tracked the prevalence of the product in the U.S. over the course of a decade. While overall smoking rates among youth declined from 2004 through 2014, the proportion of youth smokers who use menthol cigarettes increased. Nearly 40% of surveyed youth smokers reported using menthol cigarettes from 2012 to 2014, compared with 35% from 2008 to 2010.

A 2006 study in Nicotine and Tobacco Research finds that menthol cigarettes are a “starter product” for youth smokers; data from the National Youth Tobacco Survey indicate that menthol cigarette use “was significantly more common among newer, younger smokers.”

“There’s been a lot of research done on correlates and consequences of menthol cigarette smoking, particularly among younger individuals,” says Amy Cohn, associate professor in the department of pediatrics at the University of Oklahoma College of Medicine, who studies tobacco use and regulation. “It’s been linked to progression to regular smoking among younger individuals. It’s been linked to greater nicotine dependence compared to non-menthol cigarette smoking, and greater difficulty quitting smoking among adult smokers.”

A 2019 study published in the American Journal of Preventive Medicine provides further detail on these trends. The study looks at data collected in 2013 and 2014 through the Population Assessment of Tobacco and Health Study, a nationally representative study of smoking habits that includes a sample of 13,651 U.S. kids between the ages of 12 and 17.

Of the respondents who had ever smoked a cigarette, more than 2 out of 5 — 43.2% — said the first cigarette they smoked was menthol. And 42% of respondents named a menthol brand as their regular brand. Youth who smoked menthol cigarettes in the past month were more likely to report that those cigarettes were easier to smoke than youth who smoked non-menthol cigarettes in the past month.

“It’s not as if only five or 10 percent of young people who started smoking start with a menthol cigarette, it’s almost half of them,” says Cohn, who was lead author of the study. “One of the reasons hypothesized for why menthol is so appealing to young people is that it’s been proposed to, quote-unquote, ‘help the medicine go down.’ The minty cooling sensation is supposed to mask the harshness of inhaled cigarette smoke.”

Additionally, kids who reported smoking menthols in the past month were more likely to have smoked six to ten cigarettes per day and less likely to have smoked between one and five cigarettes per day than kids who reported smoking non-menthol cigarettes in the past month.

Breaking the findings down further, the researchers found that youth respondents who began smoking with a menthol cigarette and who stated a preference for a menthol cigarette brand were more likely to be black, to have started smoking at a relatively older age and to have smoked menthol cigarettes in the past month.

Targeted marketing

Research shows that menthol cigarettes in particular have been marketed toward black youth.

“A lot of research suggests that this marketing has something to do with the uptake of menthol [cigarettes], specifically in this group of individuals,” Cohn says.

For example, a 2012 study published in Nicotine and Tobacco Research examined cigarette advertising in 407 stores within walking distance of 91 California schools, located in neighborhoods of varying racial demographics. Among the findings: “For each 10 percentage point increase in the proportion of black students, the proportion of menthol advertising increased by 5.9 percentage points.”

A 2011 study in Tobacco Control examined 953 tobacco industry documents from the 1930s through 2000s to examine various research questions, including whether menthol cigarettes were marketed to specific populations. The study finds that menthol cigarettes “were marketed as, and are perceived by consumers to be, healthier than non-menthol cigarettes. Menthol cigarettes are also marketed toward specific social and demographic groups, including African Americans, young people and women, and are perceived by consumers to signal social group belonging.”

About 80% of African American smokers smoke menthol cigarettes, Cohn notes, suggesting that peer use may also influence on why menthol cigarette smoking is higher among African Americans.

The patterns, she says, raise concerns about health equity. For this reason, and others, Cohn says it’s important to keep combustible tobacco products in the public eye even as e-cigarettes draw increasing media attention.

“I think that there’s a lot of focus on e-cigarettes and vaporized products. And what I think that does for the tobacco industry is that it takes the focus off of cigarettes and things like menthol cigarettes that have been around for a long time. And I think it’s important that we keep the focus on menthol cigarettes,” Cohn says. “The FDA has been saying we need more information, we need more data on the impact of menthol cigarettes on smoking and indicators of abuse liability…. I think there’s a lot of research to make the decision.”

The image on this page, obtained from Wikimedia Commons, is being used under a Creative Commons license. No changes were made.

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Efforts to shape public perceptions of a given issue — also known as agenda-setting — are a mainstay of the tobacco industry, researchers show. Robert Proctor, a professor of the history of science at Stanford University, details the tactics industry executives deployed over more than a century to promote their products and cast doubt on the science documenting tobacco-related health risks in his 2011 book Golden Holocaust: Origins of the Cigarette Catastrophe and the Case for Abolition.

“What kinds of strategies are used to manufacture doubt?” Proctor writes in the book. A few tactics used: “Hire journalists to write industry-sympathetic articles in the popular press and pressure media organs to ignore or suppress reports unfavorable to the industry. Threaten to withhold advertising from magazines that give too much attention to tobacco-disease links.” Other strategies: Divert. Distract. Deny.

“People tend to include or exclude from their cognitions what the media include or exclude from their content,” writes media scholar Donald L. Shaw in an influential 1979 paper on agenda-setting in mass communication. “People also tend to assign an importance to what they [the news media] include that closely resembles the emphasis given to events, issues and persons from the mass media.” Accordingly, the tobacco industry’s influence on the media in turn shapes public perceptions of the issues.

One example of agenda-setting that plays out through the media is found in its coverage of corporate social responsibility (CSR) initiatives. Tobacco industry CSR initiatives are projects — philanthropic or otherwise — undertaken “to shape public and policymaker understandings about tobacco control and the industry,” according to the authors of a 2018 study on the topic.

The study looks at 649 U.S. news reports about tobacco industry CSR initiatives published in newspapers, online and in television and radio broadcasts between 1998 and 2014. The news coverage was predominately positive, and rarely quoted tobacco control advocates, researchers found.

To what extent does news coverage still reflect tobacco industry efforts to agenda-set? How has the introduction of e-cigarettes complicated the issue? How has agenda-setting influenced public perceptions of tobacco control and, more recently, vaping?

This research roundup aims to answer those questions by examining studies published in the past five years on media coverage of tobacco and e-cigarettes. We hope to help journalists understand some of the forces that might shape their coverage as well as raise awareness about how the nature and tone of news stories have affected public perception and public policy.

Vaping in the news

Content Analysis of US News Stories About E-Cigarettes in 2015
Wackowski, Olivia A.; et al. Nicotine & Tobacco Research, August 2018.

This paper analyzes news coverage of e-cigarettes provided in 2015 by a variety of U.S. news organizations — four newswires, four online news outlets and the 30 newspapers with the largest circulations. In total, the researchers analyzed 295 articles. They found that 45.1% of stories focused on policy or regulatory issues around vaping. The next most common topics were health effects (appearing in 21.7% of studied articles) and e-cigarette prevalence (featured in 21% of articles). Articles frequently mentioned the following concerns: youth e-cigarette use (45.4%), e-cigarettes as a potential gateway to smoking (33.9%) and the appeal of flavors (22.9%). Articles that focused on Food and Drug Administration regulation of e-cigarettes more frequently mentioned youth prevalence of vaping (61%) than adult prevalence (13.5%).

“News articles more frequently discussed potential e-cigarette risks or concerns (80%) than benefits (45.4%), such as smoking harm-reduction,” the authors write. Similarly, when expert sources such as doctors, researchers and government officials were quoted, they were more likely to cite risks associated with e-cigarettes than benefits, such as avoiding the tar in traditional cigarettes. The researchers conclude, “While such coverage may inform the public about potential e-cigarette risks, they may also contribute to increasing perceptions that e-cigarettes are as harmful as tobacco cigarettes.” 

Youth and Young Adult Exposure to and Perceptions of News Media Coverage about E-Cigarettes in the United States, Canada and England
Wackowski, Olivia A.; Sontag, Jennah M.; Hammond, David. Preventive Medicine, April 2019.

This study analyzes what teens think about e-cigarettes. It looks at online survey data collected from 12,064 teenagers ages 16 to 19 in the U.S., Canada and England. The survey was conducted in July and August of 2017. It asked respondents about their exposure to news about e-cigarettes and their beliefs about the content of these stories. Respondents also answered questions about their perceptions of the harmfulness of e-cigarettes and their intention to use or stop using them. Nearly one-fifth, or 17.1% of respondents, reported encountering e-cigarette news at least “sometimes” over the past month. Most respondents thought the content was either mostly negative (35.7%) or mixed (34.8%). Only 19% viewed the coverage as mostly positive. White respondents were more likely to see negative e-cigarette news than their non-white peers.

“Participants exposed to mostly negative e-cigarette news were more likely to perceive that e-cigarettes cause at least some harm and, among past 30 day users, have intentions to quit e-cigarettes in the next month,” the authors write. Teens who reported seeing mostly positive news were more likely to report curiosity about trying e-cigarettes than peers who encountered mixed or mostly negative coverage. “E-cigarette news exposure may shape e-cigarette harm perceptions and use intentions, as well as reflect existing beliefs and product interest,” the authors conclude. 

To Vape or Not to Vape? Effects of Exposure to Conflicting News Headlines on Beliefs about Harms and Benefits of Electronic Cigarette Use: Results from a Randomized Controlled Experiment
Tan, Andy S. L.; et al. Preventive Medicine, December 2017.

This randomized, controlled experiment provides a complementary perspective to the more common observational research on the topic of news coverage of tobacco products. In this study, 2,056 U.S. adults between the ages of 18 and 85 responded to an online survey after viewing headlines about the safety of e-cigarettes. Each was assigned to one of four groups, reading headlines reflecting one of four of the following messages about the safety e-cigarettes: positive, negative, conflicting, or no message. Participants focused solely on the headlines and then answered questions about their beliefs about the harms and benefits of using e-cigarettes. The researchers found that participants who read negative headlines reported increased beliefs about harms and decreased beliefs of benefits, compared with participants who viewed positive headlines. These differences held when the researchers further analyzed the responses of only participants who had never used e-cigarettes. Adults who had never used e-cigarettes and read headlines with conflicting messages about e-cigarettes reported lower belief in the benefits of e-cigarettes than those who viewed positive headlines. The researchers suggest these findings demonstrate the link between the tone of news coverage of e-cigarettes and public beliefs about the product.

Tobacco control and industry in the news

A Multi-Year Study of Tobacco Control in Newspaper Editorials Using Community Characteristic Data and Content Analysis Findings
Stanfield, Kellie; Rodgers, Shelly. Health Communication, July 2018.

This study looks at the content of 1,473 editorials published in all Missouri newspapers between 2005 and 2011. Researchers chose Missouri because it has one of the lowest tobacco excise taxes in the country and does not have a statewide indoor smoking ban. At the community level, however, there have been successful initiatives to adopt smoke-free policies, the authors explain.

The researchers found that most editorials were about tobacco restrictions or ordinances, used neutral language and were factual in nature. However, they discovered that most of the editorials that took a position against tobacco control were published in cities with no clean air ordinances and the highest rates of smoking. On the other hand, cities that had low smoking rates and smoke-free policies had the highest percentage of editorials with a positive slant toward tobacco control. “The results show an agenda-setting function at the editorial level and a potential selection bias in selecting editorials according to topic, slant, and tone,” the authors conclude. “Not only were positive tones nearly non-existent in editorials, the majority of negatively slanted editorials were published in cities with the highest rates of smoking and no ordinance.”

Characteristics of Community Newspaper Coverage of Tobacco Control and Its Relationship to the Passage of Tobacco Ordinances
Eckler, Petya; Rodgers, Shelly; Everett, Kevin. Journal of Community Health, October 2016.

This study also looks at Missouri newspaper coverage of tobacco issues, but focuses on articles and editorials. The researchers looked at content published by all 381 Missouri newspapers between September 2006 and November 2011. In total, they analyzed 4,711 tobacco news stories. The researchers found that most were about tobacco control and were positively slanted toward it. “Stories with a positive tobacco control slant had information about enforcement, emphasized the lack of negative economic consequences or the health and economic benefits of policies or worker protection,” the authors write. However, editorials tended to be more negative in tone — in both the headline and text — than news stories.

Newspapers in towns that had smoke-free ordinances ran more stories about tobacco control than those located in towns without smoke-free ordinances. The authors write that this implies a connection between media coverage of tobacco control and the passage of tobacco control policies. Towns without smoke-free ordinances had more “non-tobacco control stories,” including news stories about youth smoking.

“We conclude that the tobacco industry may have had success in impacting news stories in no-ordinance cities by diverting attention from tobacco control to secondary topics, such as youth smoking, which meant stories had fewer public health facts and fewer positive health benefits in towns that may have needed these details most,” the authors write.

Setting the Agenda for a Healthy Retail Environment: Content Analysis of US Newspaper Coverage of Tobacco Control Policies Affecting the Point of Sale, 2007–2014
Myers, Allison E.; et al. Tobacco Control, July 2017.

This study looks at media coverage of point-of-sale tobacco control policies — interventions targeted at the place where people purchase tobacco products. Some examples are requirements for tobacco retailers to acquire licenses, prohibitions on the redemption of coupons for tobacco purchases and restrictions on the sale of tobacco in pharmacies.

This study looked at 917 news articles on point-of-sale tobacco control policies published in 268 regional newspapers and five national newspapers between 2007 and 2014. Nearly half of these articles focused on tobacco retailer licensing. Just over half had a mixed, neutral or anti-tobacco control slant. Articles that were framed in terms of politics, rights, or regulation, or that quoted anti-tobacco control sources (e.g., tobacco industry sources, tobacco retailers or tobacco users) were much less likely to have a pro-tobacco-control slant.

Tobacco retailers were cited in 39.6% of the stories studied, second only to government sources (52.3%) and followed by tobacco industry sources (22.0%). On the other hand, stories that focused on health issues and featured research and sources in favor of tobacco control tended to support tobacco control.

Trends in US Newspaper and Television Coverage of Tobacco
Nelson, David E.; et al. Tobacco Control, January 2015.

This study looks at newspaper, newswire and television coverage of tobacco issues in the U.S. between 2004 and 2010. The researchers looked at data from the U.S. Centers for Disease Control and Prevention’s Office on Smoking and Health’s news media surveillance system. The CDC created this system in 2004 to track tobacco stories in the news. The system identifies tobacco news stories in 10 major newspapers, two major newswires and six national television networks. They found that, on average, there were three newspaper stories, four newswire stories and one television story on tobacco each day. Television stories tended to focus on addiction or health effects and were less likely to focus on secondhand smoke or tobacco regulation than newspaper and newswire stories. Newspaper and newswire coverage of tobacco issues varied more than television coverage. “Newspaper editors and television producers have an important agenda-setting role, serving as gatekeepers who make decisions about whether a topic or event is ‘newsworthy,’ and thus, reported at all,” the authors write. “Differences in tobacco themes among individual newspapers and newswire services also strongly suggest that news editors differ in whether and how they choose to report tobacco stories.”

US Media Coverage of Tobacco Industry Corporate Social Responsibility Initiatives
McDaniel, Patricia A.; Lown, E. Anne; Malone, Ruth E. Journal of Community Health, February 2018.

The tobacco industry’s corporate social responsibility (CSR) initiatives are projects meant “to shape public and policymaker understandings about tobacco control and the industry.” They include food aid, arts funding, youth smoking prevention programs, disaster relief, employee volunteer programs and research efforts.

This study looks at 649 U.S. news reports about tobacco industry CSR initiatives — including newspaper articles, online news stories and transcripts of television broadcasts and NPR broadcasts — available through online media databases. Publication dates ranged from 1998 through 2014. Tobacco industry CSR coverage was predominately positive, and rarely quoted tobacco control advocates. Local newspapers provided most of the coverage of tobacco industry CSR.

The most common initiatives featured were unrelated to tobacco and aided “non-controversial” beneficiaries such as students, the elderly and arts organizations. Positive coverage was more common in the South — where many tobacco companies are headquartered — than in the West. When tobacco control advocates were quoted, news coverage was less likely to have a positive slant.

“The absence of tobacco control advocates from media coverage represents a missed opportunity to influence opinion regarding the negative public health implications of tobacco industry CSR,” the authors conclude. “Countering the media narrative of virtuous companies doing good deeds could be particularly beneficial in the South, where the burdens of tobacco-caused disease are greatest, and coverage of tobacco companies more positive.”

Read more: Teen vaping: Is it really a gateway to cigarette smoking?; ‘Causes’ vs. ‘contributes to’: Strong causal language on product warning labels more effective; E-cigarettes aren’t better at helping smokers quit than other strategies

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Health warning labels that use strong causal language deter consumers more than labels with weaker language, a new study in the American Journal of Public Health finds.

The findings lend support to the U.S. Food and Drug Administration’s proposed cigarette warning labels, issued August 15, 2019, which feature illustrations of health risks associated with smoking and strong causal language such as “smoking causes head and neck cancer.”

Frequent readers of Journalist’s Resource might note that we’ve stressed again and again the importance of not implying causation when research merely suggests correlation. But that’s not the case here. A large body of research has shown that smoking does, in fact, cause cancer.

“We are very supportive of this kind of language that FDA is using, given that there’s a lot of strong epidemiological evidence supporting those causal links between smoking and the health effects,” explains the  study’s lead author Marissa Hall, an assistant professor in the department of health behavior at the University of North Carolina. “It’s justifiable based on the evidence, and it does actually matter in terms of how effective these are likely to be.”

The study surveyed 1,360 adults across the U.S. through Amazon Mechanical Turk about their responses to health warnings for cigarettes, sugar-sweetened beverages (SSBs) or alcohol. Participants took the survey online and viewed four warnings, listed here in descending order of strength: “causes,” “contributes to,” “can contribute to,” and “may contribute to.”

For example, cigarette warnings would substitute the variants into the following: “WARNING: Smoking cigarettes [____ __] lung cancer.” Sugar-sweetened beverage warnings cautioned about tooth decay, and alcohol warnings referred to liver disease.

Participants were then asked which warning would most discourage them from wanting to use the product, which would least discourage them, and which they most supported implementing. For each question, the respondents were presented again with the four variants of the warnings they had previously viewed.

“My background is mostly in tobacco control policy and warning labels. And what we’ve noticed is that there’s just a lot of variety in the kinds of causal language that’s used in different warnings across different products,” Hall says. “I had this real interest in understanding, what is the impact of different causal variations? Does that matter at all to the public? It’s possible that people don’t really care whether it says ‘causes’ versus ‘contributes to’ versus ‘may contribute to.’ But the study found that it really does actually matter, and is likely to change the impact of the warnings.”

The findings

The researchers found 76% of participants selected the warning that used the strongest language (“causes”) as the one that most discouraged potential use. It was also the language most participants (39%) supported using for a warning. The least discouraging warning label, according to 66% of participants, used the weakest causal language (“may contribute to”).

Across the products studied, there were small differences in the likelihood that participants would select “causes” as the most discouraging warning and as the label they would most likely support for use on the product. Participants were slightly less likely to favor the strongest causal language for warnings on alcohol and sugar-sweetened beverages than for cigarettes.

“Which isn’t surprising,” Hall adds, “given that people are used to seeing cigarette warnings, and there’s, more of a track record. For example, cigarette warnings have been required in the U.S. for several decades, where they’re not yet required for sugar-sweetened beverages. And alcohol warnings tend to be just one text warning that’s pretty small and hard to notice.”

In the U.S., cigarettes packages have a warning stating “Smoking causes lung cancer, heart disease, emphysema, and may complicate pregnancy.” Warning labels for cigarettes have been required in the U.S. since 1966.

The Alcoholic Beverage Labeling Act (ABLA) of the Anti-Drug Abuse Act of 1988, requires alcoholic beverages to warn:

“(1) According to the Surgeon General, women should not drink alcoholic beverages during pregnancy because of the risk of birth defects. (2) Consumption of alcoholic beverages impairs your ability to drive a car or operate machinery, and may cause health problems.”

There are no federal policies that require warning labels for sugar-sweetened beverages, though individual states, like California, are pursuing initiatives.

One limitation of the new study is that it only looks at survey responses, and not the real-life effects on customers’ consumption habits if they were to encounter the warnings in retail outlets. However, Hall notes that one of the questions they studied — which warning would most discourage wanting to use the product — is “highly predictive” of behavioral change, as shown by other studies.

“I would love for future studies to replicate these findings with behavioral outcomes. And I think that would be a logical next step,” Hall adds.

Moreover, she notes that there’s already clinical research suggesting another kind of warning — pictorial warning labels — on cigarettes have successfully deterred people with established smoking habits.

Usable info for policymakers and journalists

Hall notes that policymakers and journalists alike can use these findings in their work.

Journalists, she says, might consider discussing the risks of products like cigarettes, alcohol and sugar-sweetened beverages as a matter of course in their reporting, whether the coverage is critical or lifestyle-focused.

“The typical person is not going to be reading AJPH on a regular basis,” she says. “So, yeah, talking about the background, what are the risks, leading up to stories that you’re covering, that seems great.”

And policymakers can use the findings to inform labeling efforts. “I think that policymakers have to really look at the research to inform the way they’re designing warnings. And so this is one way that the research, I hope, can then inform policymakers who are trying to weigh the pros and cons of different types of warnings and causal language,” she says.

Legislators backing warning labels might face legal challenges related to the First Amendment issue. “The issue really rests on compelled commercial speech, which refers to the government’s ability to require companies to put language on their products,” Hall explains. “And so there are really high standards and very specific standards for what’s allowable.”

In 2015, for example, the city of San Francisco enacted a sugar-sweetened beverage warning ordinance, which required ads for sugar-sweetened beverages to convey the following — “WARNING: Drinking beverages with added sugar(s) contributes to obesity, diabetes, and tooth decay.”

It was subsequently challenged in court by the American Beverage Association, reaching the U.S. Court of Appeals for the Ninth Circuit. The court ruled in the Association’s favor. As a result, the city has proposed modified warning text, which reads: “Drinking beverages with added sugar(s) may contribute to obesity, type 2 diabetes, and tooth decay.”

The key changes are the softening of “contributes to” to “may contribute to,” as well as specifying that the risk for diabetes is restricted to type 2 diabetes.

“San Francisco’s compelled message is problematic because it suggests that sugar is always dangerous for diabetics. In fact, consuming sugar-sweetened beverages can be medically indicated for a type 1 diabetic when there are signs of hypoglycemia, a complication of type 1 diabetes, because drinking fruit juice or soda raises blood sugar levels quickly,” the court’s ruling reads.

But Hall is disappointed by the notion of softening the proposed warning with the word ‘may.’

“I have read the meta-analyses and systematic reviews of longitudinal cohort studies show that these linkages are very factual. So it’s quite surprising to me that they’ve been questioned, and I think that it’s clear that the warning is not saying that every single person who drinks an SSB will inherently get type two diabetes. That’s not what the warnings are saying,” Hall says. “It’s disappointing to see the courts moving in this direction. To me, that’s questioning strong scientific evidence that we have, and making us weasel-word our way around warnings and weaken their meaning.”

The image on this page, obtained from Wikimedia Commons, is being used under a Creative Commons license. No changes were made.

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Child and adolescent deaths have decreased 51.7% worldwide from 1990 to 2017. But inequality between poor and rich countries has increased, with wealthier nations accounting for an increasingly smaller proportion of deaths overall, according to new research in JAMA Pediatrics.

“Childhood and adolescence are vulnerable periods and a crucial window for adult health determination,” the authors write. “While improvements in the mortality rate of children younger than 5 years (the population often called under-5) have been undeniably dramatic and positive, the full story of child and adolescent health is more nuanced and heterogeneous, with a notably broader range of characteristics than can be told with a single summary statistic.”

To home in on more detailed information about child and adolescent health, this study looks at data collected between 1990 and 2017 on those under the age of 20 living in 195 countries and territories. The researchers compiled data from thousands of sources, which they have made accessible to the public through the Global Health Data Exchange.

The authors note the limitation that data availability poses on their analysis. Estimates might be out-of-date due to time lags in reporting data; estimates might not be accurate for countries in conflict, like Syria, Iraq and South Sudan, which might suffer “data deficiencies.”

The researchers were interested in changes in mortality rates over time, as well as trends in nonfatal illness and disability. They analyzed at 359 diseases and injuries as causes of death and disability.

Here’s what they found:

• In 1990, there were 13.77 million child and adolescent deaths. In 2017 there were 6.64 million.
• Over half of all child and adolescent deaths — 60.1% — occurred in babies less than one year old. Nearly half of these infants — 46.6% — were less than one week old.
• During the period studied, deaths decreased most rapidly for children between the ages of 1 and 4. This age group had a 61% reduction in premature mortality.
• In less-developed regions, decreases in deaths were attributed mostly to reductions in mortality due to infectious diseases, neonatal disorders and unintentional injuries. The authors write that these decreases are linked to gains in development and “improvements in vaccination, early childhood nutrition, sanitation, clean water, and targeted interventions for HIV/AIDS and malaria.”
• In more-developed regions, mortality decreased primarily because of reductions in mortality due to non-communicable diseases, such as birth defects and blood disorders.
• While the largest absolute declines in mortality occurred in African, low- and low-middle income countries still had relatively higher percentages of the global share of premature mortality — 82.2% of deaths in 2017, an increase from 70.9% in 1990.
• Overall, the countries that had the greatest improvements in child and adolescent mortality also had the greatest improvements in maternal mortality, too.
• However, eight countries had divergent trends between maternal mortality and child and adolescent health. American Samoa, Canada, Greece, Jamaica, St. Vincent and the Grenadines, the United States and Zimbabwe had increases in maternal mortality and decreases in child and adolescent mortality and disability rates.
• Total disability-adjusted life years (DALYs), which are the sum of years lived with a disability and years of life lost due to premature mortality, decreased by 46% from 1.31 billion in 1990 to 709 million in 2017.
• Globally, the top ten contributors to premature death and disability were anemia, neonatal disorders, lower respiratory infection, diarrhea, congenital birth defects, malaria, meningitis, road injuries, malnutrition and HIV/AIDS.
• In total, disability rates increased 4.7% from 1990 to 2017. The authors explain that the decline in premature mortality, coupled with the increase in years lived with a disability show that global health trends are shifting towards nonfatal health issues.

“Continued monitoring of the drivers of child and adolescent health loss is crucial to sustain the progress of the past 26 years,” the authors conclude. “Only then will we be able to accelerate progress to 2030 and beyond.”

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Eric Rimm, professor of epidemiology and nutrition at the Harvard T.H. Chan School of Public Health, wasn’t expecting to become a celebrity/villain overnight.

But you can’t go after french fries and not expect to catch a bit of flak.

In what some might consider an ad tuberosum attack, Rimm called the crispy, defenseless spuds “starch bombs” in an article by New York Times editor Christopher Mele. The piece focused on a study connecting fried potato consumption with increased premature mortality risk.

Rimm wasn’t an author on the study, but his comments got most of the attention in the media onslaught that followed, receiving coverage in outlets including Vox, the Huffington Post, USA Today, the Boston Globe, the New York Post and Fox News. To add fat to the fryer, the coverage was then shared widely on social media, drawing critiques from celebrities like Top Chef host Padma Lakshmi, whose quippy (or, if you prefer, chippy) take garnered over 27,000 retweets.

What really drew scrutiny and ire was Rimm’s suggestion that restaurants might offer an option for meals to come with a side salad and a smaller portion of french fries. Six, to be exact.

Experts quoted in the original New York Times article believe the specificity of the suggestion, combined with the deeply ingrained consumption habits of many Americans, might explain the super-sized response it received.

“The message was good, the reporting was good, but it [the conversation] clearly went from covering science to more about people’s opinions and people’s individual habits,” Rimm said.

Lindsay Moyer, a senior nutritionist at the Center for Science in the Public Interest, who also provided comment for the story, echoed Rimm’s sentiment.

In a call with Journalist’s Resource, she said that while not all of her comments made it into the article, the gist of what she told Mele was similar. In short: “many restaurants serve fries in oversize portions; a side of fries can have as many calories as the entrée itself… When you’re getting fries, you’re getting a big pile of starch soaked in oil. Nutritionally, we know it’s not a good choice.”

“I think it was this very specific recommendation that hit a nerve, and I think that’s why people reacted to it,” she added.

For his part, Nicola Veronese, the lead author of the study discussed in the New York Times story, said he was surprised by the reaction to his research. In a call with Journalist’s Resource, he suggested the response might have had something to do with the frequency with which Americans consume French fries as a side dish.

Moyer agreed. “I think maybe the strong response reflects how much the food industry has trained Americans from a very young age to think fries are a default side,” she said. “The restaurant industry has really warped expectations, so when you get to hear something that cuts that down, that’s really shocking.”

But what to make of these second-day stories? Rimm described a “falling-off point” in the coverage of his comments, which he said “came when people inappropriately or incorrectly interpreted [them].”

Sounds like a teachable moment for us here at Journalist’s Resource! Here are some of Rimm’s thoughts on his recent virality, with a focus on pointers for journalists on how and how not to cover research that’s already getting a lot of media attention, along with specific tips about interpreting nutrition research.

1. Know what the story actually is.

Per Rimm: “By the time I got to the second day, people were asking me to send them the study I had published… Obviously people weren’t even reading the New York Times article, because this was not about a recent study I published, it was just my comment on someone else’s study.”

Look beyond the headline of the original story and figure out the basics of it before hopping on the viral bandwagon. “People got sort of misdirected,” Rimm said. “I think it’s because their usual gut reaction is, there’s a headline out there, I have to go to the scientist who published the study and ask them about the study.”

2. A corollary: Ask yourself, is it worth a story?

After the New York Times article, much of the ensuing coverage focused on Rimm’s comments, and not the science highlighted in the original story. “If they want to do a story on my opinion, that’s fine,” Rimm said. That being said, “I don’t think my opinion’s worth a story,” he added.  “It was just sort of blown out of proportion, and I think it was egged along by Twitter.”

I don’t have time for this kind of negativity in my life right now https://t.co/zFCFvhKMD2

— Padma Lakshmi (@PadmaLakshmi) December 4, 2018

3. If you must engage, add some value.  

Rimm highlighted a few pieces that stood out from the rest (in a good way) in the media circus.

• Six French fries nutritional advice from the New York Times is … good?

This stands out from the rest of the incredulous coverage of Rimm’s comments, because though Slate’s Heather Schwedel was also incredulous, she actually tried eating just six fries. “The idea that I don’t have to eat all the fries seems like a very useful thing to keep in mind. They’re so bad for you, but they’re so easy to keep eating,” she writes.

• “Am I Really a Monster?” The Six-Fry Harvard Professor Speaks and Leave The Fries, Take The Salad: Harvard Professor Defends Fry Proposal

Rimm thought these pieces, published by Vanity Fair and WBUR, respectively, did a good job of contextualizing his comments. For example, in the Vanity Fair piece, Hilary Weaver clarifies: “All Rimm wants, he said, is the option of something smaller, regardless of whether you can limit yourself to six.”

4. Have a healthy dose of skepticism when evaluating nutrition research.

“The expectation shouldn’t be, oh a new study was published on some aspect of nutrition… that’s going to erase what we know from the last 40 years, because there have now been so many big, well-done studies,” Rimm said. “Have perspective, realize it takes three to four different types of studies to have people realize some aspect of a diet is good.”

Also, Rimm said that with the rise in the number of academic journals, some of which are pay-to-play, meaning authors’ work is accepted for publication conditional on the payment of a fee, there has been an “explosion in mediocre-to-bad science.” His tips for evaluating research include asking an outside expert about the work in question, and focusing on larger studies and papers published in higher-tier journals (like the American Journal of Clinical Nutrition, where Veronese’s French fry paper was published, and the New England Journal of Medicine).

5. Make sure to get the science right.

The response to Mele’s story “clearly illustrates the public’s appetite for coverage of nutrition,” Moyer said. “And it reflects why it’s important to get the science right, because there are going to be a lot of eyeballs on these stories,” she added. Moyer suggested speaking to qualified experts and referencing the advice of health authorities such as the American Heart Association. If you’re mentioning dietary guidelines in a nutrition story, make sure they are backed by evidence, Moyer said. “This is the responsible thing to do if you’re making recommendations that are going to be of interest to a large portion of the public.”

6. Beware of false balance.

“I’ve been asked this a thousand times, ‘Do you think there’s someone else we could talk to who has a different opinion about this?’ Almost like there’s got to be two sides to every story so let’s give equal weight both sides,” Rimm said. “I think that actually does the most injustice to the science as well as to the scientist, because then you’re essentially saying even though your science agrees with 99 percent of what’s out there, there’s still going to be some flake out there who’s got a crazy idea that’s going to disagree with you, and so if you put it in the same article it’s going to make everybody confused.

“It is true there are papers that come out that disagree with previous papers where both studies were good,” he noted. However, he said those differences can stem from factors such as different study populations and methodologies. Further, he believes the media sometimes plays up conflicting findings beyond what is warranted. “I think that’s doing more of a disservice to the population, because people essentially are giving up because they can’t trust what they’re reading, they don’t know how to interpret it.”

7. Systematic reviews of the literature aren’t all created equal.

Systematic reviews, which summarize findings from numerous, prior independent studies, can give a mistaken impression that “here’s a new study that’s taken all the published literature and now this is the final answer, because it’s summarized all the previous studies,” Rimm said. Often that’s not the case. “Sometimes they’re good and sometimes they’re bad. And a lot of systematic reviews were done by people who were not in the nutrition field,” he added. “If you’re not knowledgeable enough about the topic and you’re pulling summary estimates from 20 other papers, I guarantee you that when you summarize those 20 estimates, you’re going to be wrong, or even though the number might be right it will be inappropriately interpreted,” he said. “So I think systematic reviews should have less weight than journalists put on them.”

8. Know how research and researchers are being funded.

“You have every right to ask the scientist who funded this,” Rimm said. “Just because something’s funded by industry doesn’t automatically make it bad science. It makes it more likely the message will benefit the industry.”

For more on writing about research, Journalist’s Resource has a tip sheet with suggestions for covering health research responsibly, as well as a summary of a paper that underscores the importance of reading research carefully.

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New research suggests that people who know more about the benefits of physical activity spend more time doing it.

The paper, published in PLOS ONE in November 2018, looked at survey data from 615 adults in Australia. In a phone interview with Journalist’s Resource, author Stephanie Schoeppe, a research fellow in the Physical Activity Research Group at Central Queensland University, said that it was difficult to say whether the findings could be generalized to the U.S. population, but suggested it would be interesting to attempt to replicate the finding in other populations.

The sample Schoeppe studied was 75 percent women and 25 percent men. Participants ranged in age from 18 to 77. The respondents were asked to report the amount and kind of physical activity they did in the past week. They were also asked to answer questions about their knowledge of the relationship between physical activity and health.

Specifically, the participants were asked to estimate the increased risk of disease resulting from inactivity, name the diseases associated with physical inactivity, and indicate how much physical activity is recommended for health benefits.

What the researchers found is that most people know that physical activity offers health benefits – 99.6 percent strongly agreed that physical activity is good for health.

But 55.6 percent of the study’s participants did not know how much activity was recommended for health benefits per Australian national guidelines. (By the way, it’s 30 minutes of moderate intensity physical activity, like gentle swimming, five or more days per week.) And participants were able to name just 13.8 of the 22 diseases associated with physical inactivity, on average.

There were two main factors associated with some respondents being significantly more active than others: the ability to identify more diseases associated with inactivity, and an overestimation of the risks associated with inactivity.

In other words, people who know more about the kinds of diseases they might develop if they don’t exercise, and people who think the risks associated with inactivity are higher than they actually are, are more active.

Schoeppe said that the results illustrate that simply knowing physical activity is associated with health benefits doesn’t translate to meaningful action.

“You can’t just look at simple knowledge — you have to dig a little bit deeper into these different levels of knowledge,” she said. People who are aware of specific risks, such as the vast range of chronic diseases associated with physical inactivity — including type 2 diabetes, cardiovascular disease and colon cancer — are more active, she added.

“I do think that increasing the depth of knowledge in people would certainly help,” Schoeppe said.

She added that information alone might not encourage people to become more active. “Campaigns to improve knowledge of the risks of physical inactivity would have to be coupled with policy interventions, Schoeppe said: “That means changing our neighborhoods, our urban environments, in a way that doesn’t always favor cars — that also favors active commuting. It’s always tied to the individual with more education and, in this example, with more in-depth knowledge, but also targeting their natural environment and their social environment.”

The research does not prove causation. The link between knowledge about physical activity and the practice of physical activity is just an association; Schoeppe’s research does not demonstrate that knowing more about the risks of physical inactivity leads people to become more active. It’s possible that people who tend to be more active might later educate themselves about the benefits of their activity.

The study is also limited in that data is self-reported and the sample is comprised primarily of women. In addition, Schoeppe noted that other factors could influence an individual’s level of physical activity. She noted that this could be a fruitful area of further research: “It would be interesting to look at the reasons why people are active. We often think about why people are inactive,” she said.

For related research, check out our write-ups on the health benefits of standing and how targeted ads can shape health behaviors.

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For reporters looking to broaden their immigration coverage, journalist Maria Hinojosa has a recommendation: “I haven’t seen a lot of coverage of immigrant mental health issues for mainstream journalists,” Hinojosa, the executive producer of the long-running NPR show Latino USA, said in a recent interview with Journalist’s Resource.

As it turns out, many public health scholars have been researching the mental health effects of being an immigrant or refugee in America today.

“We don’t always acknowledge the sacrifices that migrants take in leaving their homelands — how they risk so much in terms of safety and stability and opportunity,” said Cindy Sangalang, an assistant professor of social work at California State University, in a phone interview with Journalist’s Resource. “Going on this journey can be at a cost to their mental health, and these things can potentially worsen as other stressors increase once they’re here in the United States.”

In the third week of November, public health professionals from across the country gathered in San Diego for the American Public Health Association’s annual meeting. Among the hundreds of research presentations were several that focused on immigrant mental health. Researchers presented published, peer-reviewed studies and working papers and gave reports on early stage research.

Journalist’s Resource contacted a few scholars presenting at the meeting on the topic of immigrant health. Here, we’ve summarized their research, which covers topics from mental health to participation in health and social services. We also highlight a new working paper on mental health among Muslim college students in the United States. Most of the research has not yet been published in peer-reviewed journals, but, where possible, we’ve linked to publicly accessible versions of the work.

“Trauma, Post-Migration Stress, and Mental Health: A Comparative Analysis of Refugees and Immigrants in the United States”
Sangalang, Cindy; et al. Journal of Immigrant and Minority Health, 2018.

In an interview with Journalist’s Resource, lead author Cindy Sangalang explained that her research was motivated by the “record high” number of displaced migrants around the world. She explained that U.S. legal definitions place distinctions between refugees and immigrants, but in reality now “boundaries are starting to blur.”

“In the context of what’s going on right now, a lot of migrants who might be seen as fleeing for economic reasons might be encountering violence,” Sangalang said, making reference to the fact that refugees are often labeled as such because they are fleeing conflict or persecution.

In light of this context, Sangalang was interested in comparing the experiences of Asian refugees and Latino immigrants both coming to the U.S. Do Latino immigrants report traumas and stresses similar to those experienced by refugees during migration and resettlement?

Analyzing survey and interview responses from over 3,200 respondents, the authors found that Asian refugees and Latino immigrants both experienced pre- and post-migration trauma and associated mental disorders and distress, including depressive disorders.

Further, discrimination increased the risk for mental disorders and distress among both groups. She added that current immigration policies contribute to a “broader climate that facilitates more experiences of discrimination,” which, in turn, could exacerbate mental health concerns.

Sangalang concluded that the findings indicate that pre- and post-migration trauma among immigrants, and Latino immigrants in particular, is more common than previously thought.

“How Does the Election of an Anti-Immigrant Presidential Candidate Affect Health and Social Service Utilization? Findings from Southeast Michigan”
Fleming, Paul J.; et al. University of Michigan School of Public Health working paper, 2018.

This study investigated the effects of the 2016 presidential election on health and social service utilization among immigrants in southeastern Michigan. To do so, the researchers conducted and analyzed 29 in-depth interviews with staff members at two Federally Qualified Health Centers – community health centers that provide care to all people, regardless of income or insurance status. These employees are familiar with the immigrant communities they serve and their concerns. The researchers found that in the weeks after the election, staff perceived a decrease in the number of immigrants using their services. In the year after the election, staff noted downturns that corresponded with immigration enforcement actions within the community. Staff also reported that clients asked about arranging for power of attorney and making plans for the care of their children in the event that they were deported.

In a phone call with Journalist’s Resource, lead author Paul Fleming, an assistant professor at the University of Michigan School of Public Health, suggested a few policy interventions to support immigrants’ access to health and social services. He suggested social service agencies and clinics that serve immigrants prioritize creating not only welcoming spaces, but also safe spaces, where protecting clients is the primary goal. Staff should know how to respond to immigration enforcement officers if they arrive at clinics, Fleming said. Further, he suggested, clinics should post signs with critical information in multiple languages and offer the services of interpreters. Fleming said that health and social service agencies should adapt to this new climate of fear by finding new ways to reach clients, including offering services over the phone or through video, using trusted community members at schools, churches or other organizations as a go-between, and expanding or providing transportation. (Allowing immigrants who have entered the country without permission to have driver’s licenses, so that they can drive themselves to critical appointments, is another policy suggestion Fleming made.)

Fleming also noted that clinicians and researchers can influence policy by offering public comment on legislation that could impact immigrant communities. This might involve sharing stories about the effects immigration policies have had on their clients.

“Rise in Mental Health Problems Among Muslim Young Adults in the United States Following the 2016 Election”
Abelson, Sara; et al. University of Michigan School of Public Health working paper, 2018.

This research looks at data collected from the Healthy Minds Study, the largest national study of college student mental health. The Healthy Minds Study has been distributed annually since 2007. It uses a number of standardized mental health questionnaires to measure depression, generalized anxiety and eating disorders. The researchers were interested in the number of responses that corresponded to a clinically moderate-to-severe diagnosis.

More than 107,000 students from 132 colleges and universities participated in the study. At schools with more than 4,000 students, the survey was sent to a random sample of students. At smaller schools, all students were invited to participate.

The data analyzed in this study spans the three semesters prior to and the three semesters following the 2016 presidential election. Author Sara Abelson and her colleagues were interested in changes in reported mental health symptoms for Muslim and non-Muslim college students before and after the election.

What they found was that regardless of religion, students reported significantly worse mental health after the election. However, the prevalence of students with a mental health concern increased more among Muslims than non-Muslims – there was an 11.5 percent increase among Muslims, and a 5.3 percent increase among non-Muslims.

While proving a causal link between the election and worse mental health outcomes among Muslim students is difficult, Abelson said in an interview that “we were not aware of other things happening in that time that would have uniquely driven up the rate among Muslim students.”

She added that more research is needed to understand the intervening mechanisms that have led to increases in mental health concerns among Muslim students. Among the outstanding questions: Is discrimination increasing? How is the climate on campus changing?

She noted that irrespective of the driving mechanism, for doctors, therapists and social workers on campus, this research identifies a key population for further outreach.

“White Privilege: Comparing Fear of Crime, Bullying, Detainment and Deportation between University Students of Color and White University Students”
Grinshteyn, Erin; Couture, Marie-Claude; Valencia-Garcia, Dellanira. APHA annual meeting presentation, 2018.

For this study, conducted in 2017, researchers asked 1,415 students at the University of San Francisco to rate their fear of 11 different crimes and aggressions, as well as bullying, detainment and deportation, on a scale of one to 10, with zero being no fear and 10 indicating maximum fear. They compared the responses of white students with those of students of color. They found that median fear scores were higher for students of color than for white students. For example, students of color were more afraid of hate crimes, hate speech, threats and physical assault. They also had higher median scores for aggregate fear of crime than white students. Proportionally, more students of color reported being afraid of bullying many times a day or every day than white students. A smaller proportion of students of color reported never being afraid of bullying on and off campus as compared with white students. Students of color were also more likely to feel worried about themselves, friends and family being detained and deported.

The research presented did not look at changes in fear over time. However, lead author Erin Grinshteyn, an assistant professor at the University of San Francisco, said in a phone call with Journalist’s Resource that national ratings of fear in general have remained fairly stable since 1980. Meanwhile, crime rates have decreased.

Grinshteyn said this merits further research and analysis to understand why people are afraid. But first and foremost, she believes that fear should be addressed as a public health issue. At present, fear remains something like a specter: felt but unaddressed, she said.

“Trends in Food Insecurity and SNAP Participation Among Immigrant Families of U.S. Born Young Children”
Bovell-Ammon, Allison; et al. APHA annual meeting presentation, 2018.

This research finds that despite their eligibility, many immigrant parents whose children are U.S. citizens do not participate in the federal Supplemental Nutrition Assistance Program (SNAP), commonly known as food stamps. . The study involved 35,207 mothers who were not born in the U.S. but have children who were.

The findings indicate a sharp decline in participation among immigrant families in the first six months of 2018. In a phone call with Journalist’s Resource, lead researcher Allison Bovell-Ammon said that the findings document a “chilling effect” in immigrant communities in which fear prevents immigrants from accessing social programs despite their continuing eligibility. This matches anecdotal reports from frontline providers, she added.

Bovell-Ammon’s research finds that among foreign-born mothers who had been in the United States for less than five years, SNAP participation stood at 43 percent in 2017. It then dropped to 34.8 percent in the first half of 2018. For families that had been in the U.S. for more than five years, SNAP participation grew to 44.7 percent in 2017 and then dropped to 42.7 percent in 2018.

Meanwhile, food insecurity grew among immigrant families who had been in the United States for less than five years from 9.9 percent in 2007 to 17.8 percent by 2017. It increased from 10.8 percent to 17.5 percent in the same time span among families who had been in the United States for more than five years.

Other research has documented similar effects: A 2018 working paper by Marcella Alsan of Stanford Medical School and Crystal Yang of Harvard Law School finds that enrollment in SNAP and the Affordable Care Act declined among Hispanic U.S. citizens after the Secure Communities immigration enforcement program took effect.

“Food insecurity is associated with poor health outcomes from the prenatal period all the way through old age,” Bovell-Ammon told Journalist’s Resource. “SNAP is effective at reducing food insecurity, which improves health,” she added.

“Undocumented Immigrant Youth are Denied Equitable Access to Higher Education, a Barrier to Better Long-Term Health Outcomes”
Diaz, Mayra; Reyes, Katherine; Cabuslay, Edith. APHA annual meeting presentation, 2018.

The San Mateo County, California Health System conducted focus groups with 55 individuals, most of whom identified as undocumented or preferred not to report their immigration status, in order to understand the impact of immigration laws and the rescinding of the federal Deferred Action for Childhood Arrivals (DACA) policy on education and health.

Those who participated in the focus groups reported signs of depression and anxiety among children in their community. In particular, they said that older children who previously would have qualified for DACA shared feelings of hopelessness and low self-esteem. Some children are so upset they “refuse to continue their studies,” according to the abstract.

The authors conclude that anti-immigration laws and the rescinding of DACA have had profound negative effects in San Mateo County. They also said lower educational attainment could have public health implications in the future.

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Over one-third of a sample of American soldiers who attempted suicide did not have a prior mental health diagnosis, a new study published in JAMA Psychiatry finds. But the risk factors that predict suicide attempts in these soldiers are largely the same as those for soldiers who previously have been diagnosed with a mental health issue.

Dr. Robert J. Ursano, a psychiatrist at the Uniformed Services University of the Health Sciences and lead author of the study, said this points to the importance of broad screening efforts.

“There are those at risk who never come into specialty care,” Ursano told Journalist’s Resource.

This research gets at how to better identify this population.

The study looked at administrative records belonging to a sample of 9,650 enlisted U.S. Army soldiers with a documented suicide attempt occurring between 2004 and 2009. Nearly three-quarters of the sample was male. The researchers looked at the risk factors among these soldiers, comparing the factors involved for those with and without a prior history of mental health concerns.

Veterans as a group are at a higher risk for suicide than civilian adults — 22 percent higher, according to a 2016 report from the U.S. Department of Veterans Affairs. Nationally, across the whole population, suicide rates are increasing, according to statistics issued by the U.S. Centers for Disease Control and Prevention.

In their analysis, the researchers found that the risk factors associated with suicide attempts among soldiers were similar irrespective of past mental health history.

Among soldiers who did and did not have a prior mental health diagnosis, those who attempted suicide were more likely to be female and have less than a high school education (GED or similar program). They also were more likely to have experienced job promotion delays or demotion in the past year. However, these risk factors increased the odds of a suicide attempt significantly more in soldiers without a record of past mental health issues than in those with a documented history.

Other risk factors for both groups included family violence, eight or more outpatient physical health care visits in the past two months, injuries in the past month, and previous combat injuries. (The researchers acknowledge in the study that “our injury variable may have captured injuries that were self-inflicted but unrecognized as such.”)

For both groups, soldiers who had married in the past month had lower odds of attempting suicide than those who were unmarried and those who had been married for four to 12 months.

Soldiers without a documented history of mental health concerns were much more likely to attempt suicide early in their service than those with a documented diagnosis history. Nearly 60 percent of the attempts among soldiers without a history occurred in their first year of service, compared with 20 percent for those with a history.

One risk factor unique to those without a mental health diagnosis history was enlisting at a young age – before age 21.

Ursano said the health care system can use this additional information about risk factors to identify and refer vulnerable individuals. He stressed that many of these individuals do come into contact with primary care providers, mentioning the risk factors of past-month injuries and multiple outpatient visits in the past two months. He suggested interventions that tie primary care and mental health care closer together, such as incorporating mental health screening into primary care.

The authors note a few limitations, including the fact that the records analyzed did not capture unreported suicide attempts and unreported or undiagnosed mental disorders. They also indicate that these findings might not generalize to other populations.

The project was part of the Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS), the largest mental health study ever conducted among military personnel.

Looking for more research? We covered a study testing an emergency room intervention plan that lowered the risk of subsequent suicide attempts amongst veterans. We also wrote about research that highlights recent trends in injury-related deaths.

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