Author: Futurity (National Geo)

People experiencing a miscarriage in states with restrictive abortion policies may be less likely to receive optimal care than those in states with supportive abortion policies.

The new study, published in the journal Women’s Health Issues, was conducted prior to the Supreme Court’s decision last June to overturn Roe v. Wade when lead author Elana Tal was a fellow at Washington University School of Medicine in St. Louis.

Tal, now a clinical assistant professor in the obstetrics and gynecology department in the Jacobs School of Medicine and Biomedical Sciences at the University at Buffalo, had concerns about how restrictive abortion policies affect care for people experiencing spontaneous pregnancy loss.

“I had a hunch that restricting abortion means less ideal care for people experiencing miscarriage,” says Tal, who focuses on complex family planning.

“Too often, when we talk about abortion the conversation becomes about the morality of ending a pregnancy and not about how restricting abortion affects reproductive health in general,” she says. “We know abortion restrictions correlate with higher rates of maternal mortality, so it follows that other aspects of health care would be affected, especially miscarriage care, which so closely mirrors abortion care. I wanted to find out if that was true.”

Spontaneous pregnancy loss, i.e. miscarriage, in the first trimester occurs in about 10% of all clinically recognized pregnancies, and 25% of all people capable of becoming pregnant will experience a miscarriage in their lifetime.

This study is among the first to explore how miscarriages are managed in light of evidence-based, patient-centered guidelines issued in recent years by the American College of Obstetricians and Gynecologists (ACOG).

Those guidelines, and the research they were based on, found that for managing early pregnancy loss, optimal care includes uterine aspiration in the physician’s office and the prescribing of both mifepristone and misoprostol, which block hormones that are necessary for pregnancy and help clear the uterus.

Because these methods are also used to terminate a pregnancy, Tal and her coauthors wanted to see if access to these methods is compromised for those experiencing a miscarriage.

The researchers found that in states with restrictive abortion policies, physicians managing early pregnancy loss were less likely than physicians in supportive states (40.8% vs. 67.5%) to offer mifepristone alone and less likely to offer both mifepristone and office uterine aspiration (33.2% vs. 51.3%). They also found, however, that there was no significant difference in the proportion offering uterine aspiration between physicians in restrictive states and those in supportive states.

In addition, physicians in restrictive states were less likely to report having received abortion training (67.3% vs. 89.6%), and less likely to report perceived institutional support for abortion care (49% vs. 85%).

“Our study is consistent with the notion that general pregnancy care suffers where abortion is restricted,” says Tal. “That would apply to routine early miscarriage, more complicated miscarriage like second trimester fetal demise, and abortion for life-threatening situations.

“Clinicians should be aware of the potential deficiencies in their ability to provide miscarriage care if they train or practice in states with restrictive laws,” she says.

In addition to surveying the impact of a state’s policies on access to reproductive care, the survey was also aimed at determining how a physician’s perception of their institution’s support for abortion care, or lack of it, might influence access to reproductive care generally.

The survey was sent to more than 1,500 members of ACOG. Respondents were deemed eligible to respond if they were an attending physician with an academic medical center who provided obstetric and/or gynecologic care and had provided early pregnancy loss care in the past year.

Eligible responses were received from 350 physicians from every region in the US, representing half of academic medicine centers.

Tal notes that the end of Roe v. Wade is expected to even more strongly affect access to care for those experiencing miscarriage.

“At the time of our study, access to abortion was constitutionally protected, and we still saw disparities in the management of miscarriage, a very common reproductive health issue,” she says. “We would expect the disparities we outlined in our study to get worse since the overturning of Roe v. Wade.

“We should recognize that people experiencing miscarriage are at risk of collateral damage from abortion restrictions. We need to actively work to destigmatize abortions, be outspoken in support for abortion care, and promote universal access to excellent miscarriage care.”

Additional coauthors are from Washington University in St. Louis School of Medicine. The Society for Family Planning Research Fund supported the work.

Source: University at Buffalo

An ultrasoft “skin-like” material that’s both breathable and stretchable could be used in the development of an on-skin, wearable bioelectronic device for health monitoring.

Cancer, diabetes, and heart disease are among the leading causes of disability and death in the United States. a long-term, in-home health monitoring solution could detect these chronic diseases early and lead to timely interventions.

The new material could pave way for devices that track multiple vital signs such as blood pressure, electrical heart activity, and skin hydration.

“Our overall goal is to help improve the long-term biocompatibility and the long-lasting accuracy of wearable bioelectronics through the innovation of this fundamental porous material which has many novel properties,” says Zheng Yan, an assistant professor in the chemical and biomedical engineering department and the mechanical and aerospace engineering department at the University of Missouri.

Made from a liquid-metal elastomer composite, the material’s key feature is its skin-like soft properties.

“It is ultrasoft and ultra-stretchable, so when the device is worn on the human body, it will be mechanically imperceptible to the user,” Yan says. “You cannot feel it, and you will likely forget about it. This is because people can feel about 20 kilopascals or more of pressure when something is stretched on their skin, and this material creates less pressure than that.”

Its integrated antibacterial and antiviral properties can also help prevent harmful pathogens from forming on the surface of the skin underneath the device during extended use.

“We call it a mechanical and electrical decoupling, so when the material is stretched, there is only a small change in the electrical performance during human motion, and the device can still record high-quality biological signals from the human body,” Yan says.

While other researchers have worked on similar designs for liquid-metal elastomer composites, Yan says the University of Missouri team has a novel approach because the breathable “porous” material they developed can prevent the liquid metal from leaking out when the material is stretched as the human body moves.

The work builds on the team’s existing proof of concept, as demonstrated by their previous work including a heart monitor currently under development. In the future, Yan hopes the biological data gathered by the device could be wirelessly transmitted to smartphone or similar electronics for future sharing with medical professionals.

The research, which appears in the journal Science Advances, received support from the National Science Foundation, the Office of Naval Research, the National Institute of General Medical Sciences, the National Institute of Arthritis and Musculoskeletal and Skin Diseases, and the Air Force Office of Scientific Research.

The content is solely the responsibility of the authors and does not necessarily represent the official views of the funding agencies.

Source: University of Missouri

Researchers are finding new clues to how the olfactory sensory system aids in threat assessment and have found neurons that “learn” if a smell is a threat.

Whether conscious of it or not, when entering a new space, we use our sense of smell to assess whether it is safe or a threat. In fact, for much of the animal kingdom, this ability is necessary for survival and reproduction.

“We are trying to understand how animals interact with smell and how that influences their behavior in threatening social and non-social contexts,” says senior author Julian Meeks, principal investigator of the Chemosensation and Social Learning Laboratory at the Del Monte Institute for Neuroscience at the University of Rochester.

“Our recent research gives us valuable tools to use in our future work and connects specific sets of neurons in our olfactory system to the memory of threatening smells.”

Sniffing out threats

Smell may guide how the brain responds to a social threat. In mice, the researchers identified a specific set of neurons in the accessory olfactory system that can learn the scent of another mouse that is a potential threat. The research appears in the Journal of Neuroscience.

“We knew that territorial aggression increases in a resident male mouse when it is repeatedly introduced to the same male,” says Kelsey Zuk, first author of the research.

“Previous research has shown this behavior is guided by social smells—our research takes what we know one step further. It identifies where in the olfactory system this is happening. We now know plasticity is happening between the neurons, and the aggression between the male mice may be driven by the memory formed by smell.”

The researchers found that “inhibitory” neurons (nerve cells that act by silencing their synaptic partners) in an area of the brain responsible for interpreting social smells become highly active and change their function when males repeatedly meet and increase their territorial aggression.

By disrupting the neurons associated with neuroplasticity—learning—in the accessory olfactory bulb, the researchers revealed that territorial aggression decreased, linking changes to cellular function in the pheromone-sensing circuity of the brain to changes in behavioral responses to social threats.

“It abolished the ramping aggression that is typically exhibited,” says Zuk. “It indicates that this early sensory inhibitory neuron population plays a critical role in regulating the behavioral response to social smells.”

Unknown smells

Threat assessment also comes when an animal navigates unknown smells. For example, the smell of a predator it has never encountered. In a second paper in eNeuro, researchers found that a novel predator smell, i.e. the smell of a snake to a mouse, caused the animal to engage in a threat assessment behavior—neither acting “fearful” nor “safe.”

“This offers clues into how chemical odors given off by predators stimulate threat assessment in the brain,” says Jinxin Wang, first author of a paper. “Identifying changes in patterns of animal behavior helps us better understand how threatening smells are processed in the brain.”

The researchers used video tracking to observe the movement and posture of mice exploring familiar environments with different odors—like other mice and snakes. Wang and colleagues developed a hybrid machine learning approach that helped them to uncover that mice respond to novel predator odors in ways that were unique and distinguishable from how mice reacted to non-predator odors. These behaviors were neither fearful nor safe but rather a state of assessment.

“These findings offer new clues into how smells impact social behavior and what it may mean for survival, but this study also offers new tools that will propel this science forward,” says Meeks.

“We combined methods that had known limitations to improve the accuracy, information depth, and human-interpretability of the collected data. We think this approach will be valuable for future research into how the blends of chemical odorants given off by predators stimulate threat assessment in the brain.”

Additional coauthors of the Journal of Neuroscience research are from the University of Rochester and the University of Florida. Support for the research came from the National Institutes of Health.

Additional coauthors of the eNeuro research are from the University of Texas Southwestern Medical Center. Support for the research came from the National Institute on Deafness and Other Communication Disorders.

Source: University of Rochester

Researchers have identified a new genetic pathway involved in regulating sleep from fruit flies to humans.

The findings could pave the way for new treatments for insomnia and other sleep-related disorders.

“There have been enormous amounts of effort to use human genomic studies to find sleep genes,” says Alex Keene, a geneticist and evolutionary biologist at Texas A&M University.

“Some studies have hundreds of thousands of individuals. But validation and testing in animal models is critical to understanding function. We have achieved this here, largely because we each bring a different area of expertise that allowed for this collaboration’s ultimate effectiveness.”

Keene says the most exciting thing about the team’s work is that they developed a pipeline starting not with a model organism, but with actual human genomics data.

“There is an abundance of human genome-wide association studies (GWAS) that identify genetic variants associated with sleep in humans,” Keene says. “However, validating them has been an enormous challenge. Our team used a genomics approach called variant-to-gene mapping to predict the genes impacted by each genetic variant. Then we screened the effect of these genes in fruit flies.

“Our studies found that mutations in the gene Pig-Q, which is required for the biosynthesis of a modifier of protein function, increased sleep. We then tested this in a vertebrate model, zebrafish, and found a similar effect. Therefore, in humans, flies, and zebrafish, Pig-Q is associated with sleep regulation.”

Keene says the team’s next step is to study the role of a common protein modification, GPI-anchor biosynthesis, on sleep regulation. In addition, he notes that the human-to-fruit flies-to-zebrafish pipeline the team developed will allow them to functionally assess not only sleep genes but also other traits commonly studied using human GWAS, including neurodegeneration, aging, and memory.

“Understanding how genes regulate sleep and the role of this pathway in sleep regulation can help unlock future findings on sleep and sleep disorders, such as insomnia,” says Philip Gehrman, an associate professor of clinical psychology in psychiatry at the University of Pennsylvania and a clinical psychologist with the Penn Chronobiology and Sleep Institute.

“Moving forward, we will continue to use and study this system to identify more genes regulating sleep, which could point in the direction of new treatments for sleep disorders.”

Keene’s research within his Center for Biological Clocks Research-affiliated laboratory lies at the intersection of evolution and neuroscience, with primary focus on understanding the neural mechanisms and evolutionary underpinnings of sleep, memory formation, and other behavioral functions in fly and fish models.

Specifically, he studies fruit flies (Drosophila melanogaster) and Mexican cavefish that have lost both their eyesight and ability to sleep with the goal of identifying the genetic basis of behavioral choices which factor into human disease, including obesity, diabetes, and heart disease.

The research appears in Science Advances. Additional researchers from the University of Pennsylvania and Children’s Hospital of Philadelphia’s contributed to the work.

Funding came from the National Institutes of Health.

Source: Texas A&M University

Some ants move much more methodically than previously thought, a new study shows.

When strolling through an unfamiliar grocery store, you may find yourself methodically walking down each aisle to ensure you find everything you need without crossing the same path twice. At times, you’ll stray from this orderly process, such as when you see a vibrant “sale” sign from across the store or realize that you forgot something.

According to the study in the journal iScience, some ants go about their search for food and shelter in a similar manner.

The researchers found that when a colony of rock ants is placed in an unfamiliar environment in a lab, the ants wander in a way that’s not as random as previously thought. The ants follow a systematic meandering pattern combined with some random movement—a method with the potential to optimize exploration in their natural environment.

“Previously, researchers in the field assumed that ants move in a pure random walk when searching for targets of which they don’t know their location,” says Stefan Popp, lead author of the paper and a graduate student in the ecology and evolutionary biology department at the University of Arizona. “We found that rock ants show a striking, regular meandering pattern when exploring the area around their nests.”

In Arizona, these ants can be found nesting between or under rocks in areas above elevations of 7,000 feet. These slow-moving critters are only about half the length of a medium grain of rice.

The study finds that the ants’ meandering, or zigzag, walking pattern may make their search more efficient than a purely random search. This is because the ants can explore a large area in less time, as they cross their own paths less frequently.

“These ants don’t form obvious foraging trails like many ants we are familiar with,” Popp says. “Instead, the colony depends on individual foragers finding resources, making their search strategy a crucial part of colony success.”

According to the researchers, the evolutionary advantage of meandering found in these rock ants could have possibly evolved in other species of insects and animals as well. The researchers also say that the ants’ movement could someday be used to inform the design of autonomous swarms of robots that perform search and rescue missions in disaster areas or explore landscapes on other worlds.

Because it is difficult to track ants in their natural environment, Popp and his team collected rock ant colonies from atop and around Mount Lemmon, just north of Tucson. The team then moved the ants to the lab, placing them in an enclosed arena with a paper floor. The enclosure measured 2 by 3 meters—giant compared to the tiny scurrying ants. After being introduced to a new home, the ants were eager to explore.

“These ants may have been patrolling the area for other competitor ants,” Popp says, explaining that there is a selective pressure to keep other ants from intruding on their nest. “They may have also been searching for food and new nest sites.”

The researchers soon noticed the meandering pattern of the ants as they walked around. It raised an immediate question: Were these patterns just random squiggles, or were the ants moving in a methodical, non-random way?

To address this question, the researchers set up cameras and used automatic-tracking software, coupled with manual corrections, to track the individual paths of each marching insect over the course of five hours. The ants’ journeys were then compared to simulated ants walking in a random fashion.

“We looked at whether the direction in which an ant was moving in some way depended on the direction that it was moving before,” says coauthor Anna Dornhaus, a professor in in the ecology and evolutionary biology department. “These methods helped us realize that the ants’ search behavior was not completely random, as biologists had previously thought.”

The researchers used statistics to determine that the direction an ant turned was directly correlated to the turns it had taken previously.

“Our research showed that the ants smoothly alternate left and right turns on a relatively regular length scale of roughly three body lengths,” Popp says, “For some ants, the meandering-like search pattern was even more extreme than others, kind of like a meandering river in the Amazon basin. I am fascinated by this and wonder how the ants ensure that they don’t cross their own path again and again, while still doing extreme turns and loops.”

Popp and Dornhaus note that they don’t know how this search behavior changes across an ant’s lifetime, or even if individual ants are aware of it.

Regardless, the combination of meandering and randomness may be optimal for searching for resources in an unknown environment. The systematic approach can keep an ant close to its nest without crossing back and forth on previously explored ground. The added randomness accounts for obstacles that come with an unpredictable, natural environment.

“Until now, the widespread assumption was that free-searching animals are incapable of searching for new resources methodically,” Popp says. “Most of the previous research on search behavior only focused on situations where the animal is already familiar with where it’s going, such as going back to the nest entrance or going back to a memorable food source.”

“Based on these results, many animals may be using complex combinations of random and systematic search that optimize efficiency and robustness in real and complex habitats,” Dornhaus says. “This discovery opens up a whole new way of looking at all animal movement.”

The researchers believe their discovery has the potential to unify different fields of science, including biology and robotics. The wanderings of these ants may have applications for real environments where a completely systematic search would fail when faced with an obstacle.

“This discovery could possibly lead to applications for roboticists as they program robots to be able to find their way around or search for something,” Dornhaus says. “In this way, they can make their algorithms more robust, so they don’t immediately fail as soon as the robot loses track of its exact location.”

Source: Kylianne Chadwick for University of Arizona

Researchers are identifying how scammers target victims on dating apps.

As Valentine’s Day approaches, the use of dating apps by people looking to make new connections ramps up. Unfortunately, as people are looking for love, scammers are looking for ways to steal their money.

The new research in the American Journal of Criminal Justice exposes the tactics used by scammers to gain users’ trust and make them vulnerable to cybercrime.

The phenomenon known as “romance fraud” is both often underreported and understudied, says Volkan Topalli, a professor of criminal justice and criminology and an associate with Georgia State University’s Evidence-Based Cybersecurity Research Group.

“We have this explosion of crime taking place online. In the physical world, maybe you can scam one or two people at a time. But thanks to social media and technology, a scammer can send an email or chat message to hundreds of people at once, just trawling for victims,” Topalli says.

“The scammers are effective because they are experts in extracting funds from people, and they’re also experts in identifying a vulnerable target.”

A cybercrime report published by the FBI in 2021 found that online romance fraud losses have skyrocketed in recent years, reaching almost $956 million. That makes it the third-ranked cybercrime overall in terms of losses.

The goal of the research was to identify risk and protective factors for those targeted by so-called romance scammers in order to develop a model for victim vulnerability and resilience, says primary author Fangzhou Wang, a doctoral student in the criminal justice and criminology department.

“We really wanted to take advantage of open intelligence data sources to find out what these fraudsters were doing that was so effective. The purpose is to identify patterns and uncover strategies that users can adopt to protect themselves,” Wang says.

The researchers gathered data from online testimonials on websites where victims share stories and warn others, including stop-scammers.com and male-scammers.com, where they were able to review nearly 10,000 vetted reports.

Using data analysis software, they created a romance fraud victim database using testimonials as a basis for analysis. They then analyzed the victims’ stories to identify overarching themes.

The testimonials included those from victims who were approached on social networks like Facebook and Twitter, or on dating sites, including Tinder, Ashley Madison, and OkCupid.

The researchers identified a number of techniques and forms of deception that were most common and most successful for scammers. They include things like using visceral, emotional triggers or influences; manufacturing a crisis; exploiting likability and similarity; or eliciting the victim’s sense of guilt.

Another common tactic used by scammers is to quickly ask their victims to migrate the relationship away from the app to a private email or messaging format (like WhatsApp or Google Hangout) in order to isolate them. Often, scammers will also pressure the victim to make quick decisions.

Other red flags include online suitors refusing to have conversations on the phone, or not sending recent photographs. Of course, the biggest warning sign is that someone is asking you to part with your money. Topalli recommends checking any new online relationship against a third party, like a trusted friend or family member.

The researchers also identify common risk factors for potential victims. They include a lack of familiarity with technology, which is often seen in older people. Young people are also vulnerable because they may be overconfident or inexperienced with initiating a relationship online. Unsurprisingly, others who make a good mark for scammers are those who have been through broken relationships and are simply looking for companionship.

The research team says it’s likely that the number of victims is vastly underrepresented, taking into consideration things like victim shame or even self-incrimination. Sometimes victims won’t event accept that they’ve been scammed when confronted with evidence.

“They’re sort of hoping against hope that it’s a real thing. There are numerous stories of people who just say, ‘No, I love this person, you’ve got it wrong’ and then they will continue in the relationship,” says Topalli. “It’s painful to hear the stories.”

Wang says that since fraudsters tend to use very similar linguistic cues to deceive victims, online service providers could develop algorithm-based predictive tools to detect fraudulent attempts against potential victims that can be built into the dating and social media sites.

“Potentially, dating and social networking sites can draw from the information from our study to launch educational or awareness programs for those who were previously victims, and those who may be potential victims,” Wang says.

Romance fraud often results in not only financial loss but also long-lasting psychological trauma. The research indicates that victims of online romance scams undergo a traumatic psychological aftermath similar to victims of domestic violence. Wang says she plans to explore further research utilizing surveys and interviews to dive deeper into the mindsets of offenders and victims in the cyber world.

“There’s nothing wrong with starting a relationship online. But you’re basically putting yourself out in the Wild West,” Topalli says. “You always want to keep in mind what we call ‘cyber hygiene,’ which means really looking at your interactions online and the apps that you use and being very cognizant of protecting yourself.”

Source: Georgia State University

Labels made with inexpensive photonic fibers could improve clothing recycling, researchers report.

Less than 15% of the 92 million tons of clothing and other textiles discarded annually are recycled—in part because they are so difficult to sort.

“It’s like a barcode that’s woven directly into the fabric of a garment,” says Max Shtein, a professor of materials science and engineering at the University of Michigan and corresponding author of the study in Advanced Materials Technologies.

“We can customize the photonic properties of the fibers to make them visible to the naked eye, readable only under near-infrared light or any combination.”

Ordinary tags often don’t make it to the end of a garment’s life—they may be cut away or washed until illegible, and tagless information can wear off. Recycling could be more effective if a tag was woven into the fabric, invisible until it needs to be read. This is what the new fiber could do.

Recyclers already use near-infrared sorting systems that identify different materials according to their naturally occurring optical signatures—the PET plastic in a water bottle, for example, looks different under near-infrared light than the HDPE plastic in a milk jug.

Different fabrics also have different optical signatures, but those signatures are of limited use to recyclers because of the prevalence of blended fabrics, explains lead author Brian Iezzi, a postdoctoral researcher in Shtein’s lab.

“For a truly circular recycling system to work, it’s important to know the precise composition of a fabric—a cotton recycler doesn’t want to pay for a garment that’s made of 70% polyester,” Iezzi says. “Natural optical signatures can’t provide that level of precision, but our photonic fibers can.”

To develop the technology, the team combined Iezzi and Shtein’s photonic expertise—usually applied to products like displays, solar cells, and optical filters—with the advanced textile capabilities at MIT’s Lincoln Lab. The lab worked to incorporate the photonic properties into a process that would be compatible with large-scale production.

They accomplished the task by starting with a preform—a plastic feedstock that comprises dozens of alternating layers. In this case, they used acrylic and polycarbonate. While each individual layer is clear, the combination of two materials bends and refracts light to create optical effects that can look like color. It’s the same basic phenomenon that gives butterfly wings their shimmer.

The preform is heated and then mechanically pulled—a bit like taffy—into a hair-thin strand of fiber. While the manufacturing process method differs from the extrusion technique used to make conventional synthetic fibers like polyester, it can produce the same miles-long strands of fiber. Those strands can then be processed with the same equipment already used by textile makers.

By adjusting the mix of materials and the speed at which the preform is pulled, the researchers tuned the fiber to create the desired optical properties and ensure recyclability. While the photonic fiber is more expensive than traditional textiles, the researchers estimate that it will only result in a small increase in the cost of finished goods.

“The photonic fibers only need to make up a small percentage—as little as 1% of a finished garment,” Iezzi says. “That might increase the cost of the finished product by around 25 cents—similar to the cost of those use-and-care tags we’re all familiar with.”

In addition to making recycling easier, the photonic labeling could be used to tell consumers where and how goods are made, and even to verify the authenticity of brand-name products, Shtein says. It could be a way to add important value for customers.

“As electronic devices like cell phones become more sophisticated, they could potentially have the ability to read this kind of photonic labeling,” Shtein says. “So I could imagine a future where woven-in labels are a useful feature for consumers as well as recyclers.”

The team has applied for patent protection and is evaluating ways to move forward with the commercialization of the technology.

The National Science Foundation and the Under Secretary of Defense for Research and Engineering funded the work.

Source: University of Michigan

Black children are over-reported as suspected victims of child abuse when they have traumatic injuries, even after accounting for poverty, according to new research.

The study, which drew on a national database of nearly 800,000 traumatic injuries in children, also found evidence that injuries in white children are under-reported as suspected abuse.

The study highlights the potential for bias in doctors’ and nurses’ decisions about which injuries should be reported to Child Protective Services, according to the researchers. Medical caregivers are mandated reporters, obligated to report to CPS any situations in which they think children may be victims of abuse.

Because caregivers rarely admit to injuring their children, such reports rely in part on providers’ gut feelings, making them susceptible to unconscious, systemic bias.

Bias can harm both Black and white children, says senior study author Stephanie Chao, assistant professor of surgery at Stanford Medicine.

“If you over-identify cases of suspected child abuse, you’re separating children unnecessarily from their families and creating stress that lasts a lifetime,” Chao says. “But child abuse is extremely deadly, and if you miss one event—maybe a well-to-do Caucasian child where you think, ‘No way’—you may send that child back unprotected to a very dangerous environment. The consequences are really sad and devastating on both sides.”

Child abuse and poverty

Racial disparities in reporting child abuse have been documented before, but prior studies have not controlled well for poverty, which is a risk factor for abuse. Some experts argue that disproportionate reporting of injured Black children as possible abuse victims reflects only that their families tend to have lower incomes, not that medical professionals are subject to bias. Chao’s team wanted to clarify the debate.

The new study drew on data from the National Trauma Data Bank, which is maintained by the American College of Surgeons. The researchers studied records of nearly 800,000 traumatic injuries that occurred in children ages 1 to 17 from 2010 to 2014 and from 2016 to 2017. Of these injuries, 1% were suspected to be caused by abuse, based on medical codes used to report different types of abuse. The researchers controlled their findings for whether children had public or private insurance as a marker for family income.

Suspected victims of child abuse were younger (a median age of 2 versus 10 years), more likely to have public insurance (77% versus 43%), and more likely to be admitted to the intensive care unit (68% versus 48%) than the general population of children with traumatic injuries.

Suspected child abuse victims also were 10 times as likely as the general population of children with traumatic injuries to die of their injuries in the hospital, with 8.2% of suspected abuse victims versus 0.84% of all children with traumatic injuries dying during hospitalization.

Similar proportions of children in the suspected child abuse group and in the general population of injured children were of Asian, Native Hawaiian/Pacific Islander, American Indian, and “other” races, and similar proportions of both groups were of Hispanic or Latino ethnicity.

However, Black patients were over-represented among suspected child abuse victims, comprising 33% of suspected child abuse victims and 18% of the general population of injured children. White children comprised 51% of suspected child abuse victims and 66% of the general population of injured children.

“Even when we control for income—in this case, via insurance type—African American children are still significantly over-represented as suspected victims of child abuse,” says Chao. “In addition, they were reported with lower injury severity scores, meaning there was more suspicion for children with less-severe injuries in one particular racial group.”

In general, the researchers found medical professionals had a higher threshold for suspecting white families of abuse and a lower threshold for suspecting Black families. For example, white children in the suspected abuse group were more likely than Black children to have worse injuries, and they were more likely to have been admitted to the intensive care unit.

Dire consequences of getting it wrong

Chao and her colleagues are designing more equitable ways to screen injured children for possible abuse. An important element, she says, is to make the screening universal so evaluation for possible abuse is not initiated primarily by medical providers’ gut feelings.

Chao created a universal screening system, in use at Stanford Medicine Children’s Health since 2019, in which every time a child younger than 6 years old is evaluated for an injury sustained in a private home, the electronic medical record automatically sends an alert to the organization’s child abuse team.

Composed of pediatricians and social workers with specialized training in abuse detection, the team checks the medical record for other indications of abuse. In most cases, no such signals are found, and the entire process occurs behind the scenes. However, if the medical record shows any red flags, the medical staff who admitted the patient to the emergency department or hospital can be alerted for further consideration of whether further work-up or a CPS report is warranted.

Chao is also now working with Epic, the nation’s largest electronic medical record company, to include an automated child abuse screening tool in its system. The screening tool will be tested at several medical institutions later this year.

Chao hopes the work will improve the accuracy of CPS reports, especially when it comes to reducing the impact of medical providers’ unconscious bias.

“Everyone means well here, but the consequences of getting these reports wrong are pretty dire in either direction,” she says. “If we don’t recognize bias and always chalk it up to something else, we can’t fix the problem in a thoughtful way. Now, I hope we can recognize it and work toward a solution.”

The study appears in the Journal of Pediatric Surgery.

The National Center for Advancing Translational Sciences funded the work.

Source: Stanford University

More US high school seniors reported vaping cannabis in states where it is legal only for medical purposes than states where all adult use is permitted, according to a new study.

About 27% of 12th graders in medical marijuana states reported vaping cannabis compared to 19% in states that prohibited cannabis or allowed it for adult use.

“More than a quarter of our youth in medical states were vaping cannabis. That’s a lot,” says Christian Maynard, a sociology PhD student at Washington State University and first author of the study published in the journal Drug and Alcohol Dependence Reports.

“We were expecting medical and adult use states would be more similar. Instead, we didn’t find any statistical difference between prohibited and adult use states.”

“It’s possible the context of saying cannabis is for medical reasons is contributing to the fact that youth view it as less risky.”

For the study, Maynard and Jennifer Schwartz, his advising professor and a sociologist, analyzed responses from 3,770 high school seniors to the 2020 Monitoring the Future survey, a project which has surveyed US youth since 1975.

The researchers also analyzed a subset of 556 participants who had also answered questions about access to cannabis vaping products and risk perceptions. They found that 62% of the high school seniors in medical marijuana states reported very easy access to cannabis vaping cartridges or “carts,” and only 31% saw regular cannabis use as a great risk.

In both prohibited and adult use states, fewer high school seniors, 52%, reported easy access to cartridges. More also felt regular cannabis use was risky: 40% in prohibited states and 36% in adult use states.

The study could not identify exact reasons for the high rates of teen vaping in medical marijuana states, but Maynard suspects there may be a couple factors at play.

“It’s possible the context of saying cannabis is for medical reasons is contributing to the fact that youth view it as less risky,” says Maynard. “The difference in availability may also be that adult use states are providing legal cannabis to a wider range of people, which may in turn tamp down on the illegal market, and an adolescent can’t go to a dispensary.”

More research needs to be done to get to the reasons behind this difference, Maynard emphasizes.

While cannabis and tobacco use among teens has been decreasing overall, vaping has bucked that trend. Among high school seniors, cannabis vaping during the past 30 days made the second the biggest single-year jump in 2019 for any substance in the 45-year history of the Monitoring the Future study. It was only second to nicotine vaping.

Vaping remains popular even after crisis of related lung injuries in 2019 and 2020 that led to more than 2,000 hospitalizations including 68 deaths. Many of the cases were connected to cartridges sold outside of stores that contained Vitamin E, according to the Centers for Disease Control and Prevention.

The rise in cannabis vaping among teens highlights the need for parents and educators to help inform youth of the dangers, Maynard says.

“Like it or not, cannabis legalization seems to be happening across the country,” he says. “It’s very important to talk with adolescents. We know that at a younger age, when the brain is developing that cannabis is associated with harmful side effects. It’s also not safe to buy cannabis carts off the streets. You don’t know what they’re putting in those unregulated carts.”

Source: Washington State