Research Spotlights: October 2019

research spotlight

Stigmas can increase public health risks

Recently published research funded by NHGRI and the National Science Foundation used dynamic and game theory to explore the effects of infectious disease stigmas on public health. Stigmas have been a part of human societies dating back to prehistoric times. Some theories propose that stigmatization of infectious diseases may have been adaptive by reducing disease risk and prevalence. However, other theories contend that stigmatization has strong negative impacts on community health. Recently, it has been hypothesized that, in the past, stigmas had individual and group-evolutionary benefits but are now maladaptive because of changing societal factors. The impacts of stigma on public health are poorly understood since direct measurement and quantification are lacking. The researchers addressed this problem using mathematical modeling to directly estimate the effects of stigma from empirical data and to understand how infectious disease stigma transitions from advantageous to maladaptive.

The researchers proposed a theory based on a model of stigmatization that describes the probability of changes in an individual’s disease state and predicts for disease prevalence and community size under various societal conditions using demographic parameters, infection risks, and behavior. A person’s state was categorized into four mutually-exclusive possibilities: susceptible (risk of infection from infected community members or an external/environmental disease reservoir), cryptically infected (community is ignorant of their infection), infected and labeled (community is aware of the disease, but now they can access doctors, hospitals, and other medical resources publicly, however they can still transmit disease and are at risk for stigmatization), and infected and stigmatized (individual is ostracized resulting in less contact with noninfected community members).

Their results indicate that in pre-urban communities prior to curative or infection-controlling medicine, stigma and ostracism may have been evolutionarily advantageous by reducing infectious disease prevalence and risk. However, if the stigma does not lead to complete isolation of infectious individuals, but instead leads to infectious individuals concealing their disease and consequently reducing access to medical interventions, it can increase the lifetime infection risk in a community. An example of the negative impacts on stigma may be seen in the response to the AIDS epidemic in the 1980s where the stigma of AIDS likely influenced infected individuals to conceal their disease status and not seek help, which may have led to an increase in HIV/AIDS infections.

In summary, stigmas can be adaptive, but with good healthcare and leaky ostracism stigmas against chronic infectious disease can be maladaptive in modern urban societies. This quantitative theory of stigmatization of infected individuals and its effects on community health, provides a foundation for future mathematical and computational studies, that may lead to improved intervention designs and communications strategies for addressing infectious disease outbreaks.

Reluga TC, Smith RA, Hughes DP. 2019. Dynamic and game theory of infectious disease stigmas. J Theor Biol. 476:95-107.

High school students with stronger peer-to-adult networks have fewer suicide attempts

A recent publication funded by NIMH explores how relationships in high school students impact suicide attempt rates. The World Health Organization has reported that suicide is the second leading cause of death of adolescents worldwide. It will likely take a wide range of interventions to reduce suicide rates, however current interventions in adolescence primarily focus on individual‐level psychiatric risk factors and strategies to treat high‐risk youth. There is strong evidence that strong positive social bonds and improved social integration can reduce suicidal behavior. To examine social integration in this population, the researchers assessed the structural characteristics of school networks and if the network structures could predict school rates of suicidal behaviors.

The participants were (10,716) students from 38 U.S. high schools from counties within New York and North Dakota that had rates of suicide above the state’s past 5‐year average (2009–2011) (per 100,000, 24.40 in ND and 5.19 in NY). The participants were 48.9 percent female and from predominantly rural, small-town communities. Race/ethnicity distribution was 79 percent white, 8 percent Black, 4.6 percent Native American, 1.7 percent Asian, 5.3 percent other or mixed race, and 6.5 percent Hispanic/Latino. In order to construct the social networks, the students named up to seven of their closest friends and up to seven trusted-adults in their school. They then examined network characteristics identified in previous studies that map onto three empirically and theoretically informed domains of risk/protective processes: integrated versus thwarted relational needs, suicidal student influence, and group cohesion. Suicidal thoughts and behaviors were assessed using the Youth Risk Behavior Survey measure, as well as the following self‐report measures of constructs: depressive symptoms (Short Mood and Feelings Questionnaire), violence victimization (Add Health scale), and bully victimization (World Health Organization youth survey).  

Results showed that the rates of suicide attempts and ideation were higher in schools where students had less peer friendships. Notably, suicide attempts were higher in schools where students had fewer trusted-adults in their networks, indicating more isolation from adults. For each 10 percent increase in students who were more isolated from adults, there was a 20 percent increase in suicide attempts. In contrast, suicide attempts were lower in schools where students had both close peer-friendships and trusted-adults in their networks.

In conclusion, schoolwide peer and youth–adult relationship patterns influence suicide rates. Potentially, interventions that leverage or alter the student’s network may be useful in reducing suicide rates and create a more protective school environment by maximizing youth–adult connections schoolwide and increasing the influence of youth with healthy coping strategies.

Wyman PA, Pickering TA, Pisani AR, Rulison K, Schmeelk-Cone K, Hartley C, Gould M, Caine ED, LoMurray M, Brown CH, Valente TW . 2019. Peer‐adult network structure and suicide attempts in 38 high schools: implications for network‐informed suicide prevention, J Child Psychol Psychiatry DOI: 10.1111/jcpp.13102 [Epub ahead of print]

Tweets reveal symptoms of nicotine dependence in JUUL users

A recent publication supported by funding from the NCI and the National Science Foundation used messages on Twitter to investigate the effects of JUUL use on symptoms of nicotine dependence and withdrawal. JUUL is a popular electronic nicotine delivery system that has a high nicotine content with a rapid speed of absorption. However, many users may not know of the nicotine content nor expect the acute effects or potential for nicotine dependence. The researchers sought to systematically examine tweets mentioning JUUL, identify themes related to nicotine related symptoms, and contextualize the social conversation around JUUL nicotine effects and dependence-related terminology.

Data were collected from Twitter’s Filtered Streams interface from April 11, 2018 to June 16, 2018, by retrieving tweets matching the terms “juul,” “juuls,” and “juuling” (158,933 original tweets) that also used words consistent with nicotine effects, symptoms of dependence, and withdrawal. This process resulted in a matched set of 41,205 original tweets, which was further reduced to a random 5 percent subsample for feasibility of human coding while still being generalizable within the context of the full dataset. A random 5 percent subsample (n = 1986) was coded by two independent coders (Cohen’s κ for inter-rater reliability 0.62–1.00 for all coded variables). Tweets were assessed using a qualitative content analysis approach.

The results showed that 21.1 percent of tweets were related to dependence, acute nicotine effects, quitting JUUL, and/or withdrawal.  A total of 189 (9.5 percent) tweets mentioned themes related to nicotine symptoms, with almost 15 percent of these tweets describing physical effects, including feeling buzzed, experiencing dizziness or light-headedness, and feeling high. Additionally, 2.1 percent of tweets mentioned themes related to quitting JUUL and/or withdrawal from JUUL.

In conclusion, this self-report study showed that JUUL users experienced nicotine dependence or the physical effects nicotine exposure by using the using Twitter data. These results also support the use of Twitter to collect real-time data for research on timely health trends on a large scale. These results will add to the investigation the social conversation surrounding JUUL and its addictive properties.

Sidani JE, Colditz JB, Barrett EL, Shensa A, Chu KH, James AE, Primack BA. 2019. I wake up and hit the JUUL: Analyzing Twitter for JUUL Nicotine Effects and Dependence. Drug Alcohol Depend. 204:107500. doi:10.1016/j.drugalcdep.2019.06.005. [Epub ahead of print]