As King County seeks to reach its goal of “” — ultimately eliminating the practice of juvenile detention in the county —91̽�� researchers are working to help address major systemic challenges in how young people engage with health care.

With a strategic plan to close the juvenile detention center by 2025, King County needs an increasingly robust system to ensure youth are getting consistent and accessible services, including health care. This is especially true upon release from juvenile detention, the researchers say.��

“For many youth involved in the criminal legal system, their first health care experience as an adolescent is in a setting of confinement and trauma,” said Sarah Gimbel, a professor of child, family and population health nursing in the 91̽��School of Nursing. “So, while juvenile detention is a less than ideal setting for getting physical and mental health care, it is also critical that we are meeting kids where they are today, addressing their needs, and improving the chances that they will continue to engage in health care services in the community.”

While King County guides investments and creates policies that support families and prevent youth involvement in the legal system, Gimbel explains, improving support for youth who are already detained is critical, especially as they reenter their communities from detention.��

“You think about the resources and money that we put into incarcerating kids, and yet so little is put on the back end to help them move back into their communities,” Gimbel said. “We’ve been working for over a year in the juvenile detention clinic with some really amazing frontline health workers, but they are struggling in a system that is scheduled to close down without a concrete plan for what that looks like.”

Gimbel has been co-leading a team of 91̽��experts in an to build a system for managing health care for youth who are detained. The team, which includes advisers and experts from the local organizations and , in addition to Harborview Medical Center, are improving the quality of care in the clinic at the King County Children and Family Justice Center to better serve and track the health needs of young people.

“Prior to young people engaging with the criminal legal system, they’re often coming from neighborhoods that are under-resourced and under-supported,” said Sean Goode, executive director of CHOOSE180. “The data tells us that a large percentage of the children who are living incarcerated are coming from neighborhoods that are farthest away from economic justice, health justice, educational justice, and so the sheer amount of disproportionate injustices they’ve experienced prior to walking into a courtroom are extraordinary. Then they end up incarcerated, living in these facilities, and for likely the first or second time in their lives, they begin to be asked questions about their health and well-being.”

The 91̽��team’s systems-building effort has funding from various state and foundation sources, but in the spring Gimbel made a pitch at the 91̽��School of Nursing’s “Dawg Tank” grant competition. She won the $15,000 award with a plan to augment the systems approach with the creation of a nurse navigation position to help young people manage their healthcare that will be outside of the justice center’s clinic. The nurse will work closely with CHOOSE180.��

“Navigating our health care system is very difficult,” said Addy Borges, a 91̽��graduate student working on the systems project. “When a young person is involved in the criminal legal system, there are usually many other competing priorities and stressors facing them and their families, so navigating health care can be particularly challenging.”

The idea to try the nurse-navigation project came from conversations with community members and service providers about the effects of detention and how to make health care accessible for youth and families who have been marginalized by the current systems.��

“Our hope is that this nurse navigation pilot can be part of the movement toward a community-based system that does not involve detention,” Borges said. “It is an evolving concept that will be guided by community organizations that have deep experience in this space.”��

Goode adds that these youth are faced with a confluence of challenges, including that when they leave incarceration, they are also leaving the care plans that may have been introduced for the first time within those walls.��

“And for the young people who have been forced to live incarcerated inside those facilities, we have to figure out how we make sure they have care when they exit back into the community,” Goode said. “That’s where this conversation around nurse navigation comes into play. It’s an opportunity to imagine a world where young people more immediately have access to a continuation of care that allows them to continue their journey toward wellness and wholeness.”

The 91̽��group has found that inefficiencies in health care services in juvenile detention centers, exacerbated by communication and coordination barriers, result in missed opportunities to address the individual health needs of youth. The group aims to break down walls between siloed services in order to improve communication and make providers work synergistically.

“My work sits at the intersection of nursing (and health care in general) and systems engineering,” Gimbel said. “I focus on helping frontline health workers do their work better with whatever resources they have. And right now, addressing the complex health needs of youth engaged in the criminal legal system has the potential to improve their well-being, as well as prevent recidivism and support King County’s goal of zero youth detention.”

“We know with certainty that young people, when they’re engaged in their healing journey, are far less likely to cause harm,” said Goode, “which allows us all to live in the community we dream of, a community where all young people have the opportunity to thrive, live and love.”

For more information, contact Sarah Gimbel at sgimbel@uw.edu.��

When schools closed during the first year of the pandemic, an immediate and potentially devastating problem surfaced: How would millions of children in struggling families get the school meals many of them depended on?

The U.S. Congress responded by authorizing the Department of Agriculture to roll out two major programs. It launched the “grab and go school meals,” which helped schools provide prepared meals for off-site consumption and distributed funding for the state-operated Pandemic EBT (P-EBT) program, which gave parents debit cards so they could purchase groceries from food retailers.

A new study led by the Harvard and 91̽�� schools of public health found that the programs reached more than 30 million children and either directly provided meals or, through the P-EBT program, cash for nearly 1.5 billion meals a month in 2020.

In the new study , the researchers found:

• The P-EBT program reached 26.9 million of the 30 million children whose families qualified because of low income at a cost of $6.46 per meal, providing access to 1.1 billion meals a month.
• The grab-and-go program reached 8 million children not eligible for P-EBT at a cost of $8.07 per meal, providing 429 million meals a month.

“When schools had to close across the country during the spring of 2020 due to COVID-19, kids all of a sudden lost access to school lunches and breakfasts. From a public health and nutrition security��perspective, this was an urgent concern, given that these meals are critical for students at risk of food insecurity and are also an essential source of nutrition for millions of children,” said , study lead author and assistant professor of public health nutrition at Harvard.

Kenney said when these programs began, no one really knew how effectively they would reach kids who needed them and at what cost per meal. So the researchers set out to try to answer how these two major policy responses to the loss of regular school meal access worked.

“This study suggests that, in many states, P-EBT can reach the most eligible children at relatively low cost to the government, while a meal distribution model such as grab-and-go school meals can also ensure families directly receive meals and reach children beyond those who are P-EBT-eligible,” said , senior author and clinical professor of health systems and population health in the 91̽��School of Public Health.

Now, Krieger said, extensions of these two key projects are being debated in Congress. On July 27, the House Education and Labor Committee sent its 2022 Child Nutrition Reauthorization bill (H.R. 8450), the ““ to the House floor.

In the following Q&A, Krieger and Kenney discuss what their findings mean for this or similar policy.

What would the new “kids act” do?

Krieger: The act proposes a comprehensive, science-driven reauthorization of federal child nutrition programs that meets the needs of children and families. It includes many familiar and essential programs, such as school meals and the WIC program. It would address food insecurity among children during the summer, when schools are closed, by significantly expanding access to summer meals and creating a nationwide Summer-EBT program. The Summer-EBT program would operate similarly to P-EBT in many ways and provide $75 per month per household on an electronic debit card. It supports school efforts to increase access to summer meals using methods that worked in the grab-and-go school meals program during COVID school closures.

Based on your findings, what should Congress do for kids?

Krieger: Our study offers evidence that these components of the proposed act — an EBT program to distribute the value of school meals, similar to the proposed summer-EBT program, combined with expanded distribution of meals in the community, similar to the expanded summer meals program— were effective in feeding millions of children when schools were closed due to COVID and suggests that they will also likely be effective in delivering food to children during school summer recess. Including both programs in the act would help to assure food access when schools are closed during summer breaks.

Kenney: An important takeaway from our study that may be relevant for the conversation about the Healthy Meals, Healthy Kids Act is that these should be considered together, as a two-pronged strategy. The two approaches complement one another: P-EBT can help make sure that at least the cash value of those missed meals can get out to low-income families efficiently, and grab-and-go meals can ensure that families who may be struggling but may not have a low-enough income to qualify for P-EBT can still get meals. They can also ensure that families who may have more difficulty preparing food — like families experiencing homelessness or with limited kitchen facilities, or even just with limited time — can access nutritionally adequate meals.

What else should Congress consider?

Krieger: The federal government should be investigating strategies for optimizing the cost-effectiveness of grab-and-go school meals. It should also expand the P-EBT program or its equivalent to cover 60 meals per month instead of 40 to match the grab-and-go school meals benefit level. And, it should work to optimize the nutritional quality of the foods provided.

Co-authors include Lina Pinero Walkinshaw and Jessica Jones-Smith, 91̽��Department of Health Systems and Population Health; Ye Shen and Sara Bleich, Harvard T.H. Chan School of Public Health; and Sheila E. Fleischhacker of the Georgetown University Law Center. This research was funded by the Robert Wood Johnson Foundation.

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For more information, contact Kenney at ekenney@hsph.harvard.edu or Krieger at jkrieger@hfamerica.org.

Since it first launched in 2019, Washington state’s has been used to help decisionmakers and government agencies engage with overburdened communities to clean up contamination, improve buildings and electric grids, plant trees and many other projects.

Using a complex matrix of data, this open-access, interactive map ranks Washington’s nearly 1,500 U.S. census tracts by health risks due to environmental degradation and economic and health disparities. It acts as a guide for state agencies and the legislature to improve environmental and economic justice and is included in the state’s .

Now the 91̽��, one of the original partners in the creation of the map, is helping the Department of Health launch a new version, updating the data and methodology for how the map ranks vulnerable areas. The newly updated map went live on July 28.

“The original request for this map tool came from community members who felt that researchers and government programs were looking at either air or water quality, treating them as separate. But communities experience them together, and so they wanted to know if there was a better tool that could communicate the cumulative impact of pollution,” said , a 91̽��researcher who led the creation of the original map as well as its updated data and methods.

That was in the fall of 2016. At that time, , an environmental justice coalition of organizations rooted in communities of color, several state agencies and the 91̽�� formed a working group that eventually published the first version of the map.

“It brings together not just the harms to communities from pollution through an environmental health lens, but also shows a community’s vulnerability — what makes certain communities less resilient to environmental degradations,” said Min, a clinical assistant professor of environmental and occupational health sciences in the 91̽��School of Public Health. “The map does a really good job of framing that and communicating that.”

Map users can create data visualizations to see environmental health risks and compare census tracts based on dozens of factors, such as existing levels of pollution that include ozone concentration, PM_2.5, diesel emissions, lead risks in homes, proximity to heavilytrafficked roads, industrial or waste treatment facilities and Superfund sites. Included also are socioeconomic factors such as English proficiency, education levels, housing affordability and employment statistics, birthweights and prevalence of cardiovascular disease.

“The Environmental Health Disparities map is our most popular data product, used by organizations — big and small — across the state,” said Jennifer Sabel, manager of the Washington Tracking Network, which publishes the map. “With this version release, the data will be updated to reflect the changes that have happened since we first launched the map. This will lead to better-informed decisions that support health and environmental equity in our state.”

, the map has already been used as a guide by state agencies, such as the Departments of Ecology, Commerce and Natural Resources, when issuing grants or funding projects with the goal of improving health and the environment in an equitable manner. Examples include grants for investigating and cleaning up contaminated sites, funding for waste management projects, programs for clean energy buildings and solar and electrical grid modernization, as well as urban and community forestry programs.

In addition, Min said, “community groups are using the map for their own advocacy, saying ‘Look, our communities not only struggle with air pollution, but also here are all the other things that we really need to work on to eliminate disparities.’”

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For more information, contact Min at estmin@uw.edu. Contact the Washington Department of Health at DOH-PIO@doh.wa.gov.

Air pollution is not just a problem for lungs. Increasingly, research suggests air pollution can influence childhood behavioral problems and even IQ. A new study led by the 91̽�� has added evidence showing that both prenatal and postnatal exposure to air pollution can harm kids.

The study, , found that children whose mothers experienced higher nitrogen dioxide��(NO₂) exposure during pregnancy, particularly in the first and second trimester, were more likely to have behavioral problems.

Researchers also reported that higher exposures to small-particle air pollution (PM_2.5) when children were 2 to 4 years old was associated with poorer child behavioral functioning and cognitive performance.

“Even in cities like Seattle or San Francisco, which have a lot of traffic but where the pollution levels are still relatively low, we found that children with higher prenatal NO₂ exposure had more behavioral problems, especially with NO_2��exposure in the first and second trimester,” said , lead author and a postdoctoral scholar in the Department of Environmental & Occupational Health Sciences.

The study involved data gathered from 1,967 mothers recruited during pregnancy from six cities: Memphis, Tennessee; Minneapolis; Rochester, N.Y.; San Francisco; and two in Washington, Seattle and Yakima. Originally, these participants were enrolled as part of three separate studies: , and . The three studies have been combined under a major NIH initiative called ECHO, which brings together multiple pregnancy cohorts to address key child health concerns. These three combined cohorts are known as the consortium.

The study employed a state-of-the-art model of air pollution levels in the United States over time and space that was developed at the 91̽��. Using participant address information, the researchers were able to estimate each mother and child’s exposures during the pregnancy period and early childhood.

Exposure to NO₂ and PM_2.5 pollution in early life is important to understand, Ni said, because “there are known biological mechanisms that can link a mother’s inhalation of these pollutants to effects on placenta and fetal brain development.”

Furthermore, once the child is born, the first few years are a critical time of ongoing brain development as the number of neural connections explodes and the brain reaches 90% of its future adult size, the researchers write. For young children, inhaled pollutants that invade deep in the lung and enter the central nervous system can cause damage in areas relevant for behavioral and cognitive function.

“This study reinforces the unique vulnerability of children to air pollution — both in fetal life where major organ development and function occurs as well as into childhood when those processes continue. These early life perturbations can have lasting impacts on lifelong brain function. This study underscores the importance of air pollution as a preventable risk factor for healthy child neurodevelopment,” said senior author��Dr.��, a professor in the 91̽��School of Public Health and School of Medicine.

More specifically, the researchers found that exposure to PM_2.5 pollution was generally associated with more behavioral problems in girls than in boys, and that the adverse effect of PM_2.5 exposure in the second trimester on IQ was stronger in boys.

“We hope the evidence from this study will contribute to informed policymaking in the future,” Ni said. “In terms of reducing air pollution, the U.S. has gone a long way under the Clean Air Act, but there are threats to continued improvement in the nation’s air quality. The evidence suggests there is reason to bring the level of air pollution down even further as we better understand the vulnerability of pregnant women and children.”

Co-authors include Christine Loftus, Michael Young and Marnie Hazlehurst, 91̽��Department of Environmental and Occupational Health Sciences; Sheela Sathyanarayana, 91̽��School of Public Health and School of Medicine; Adam Szpiro, 91̽��Department of Biostatistics; Laura Murphy, Frances Tylavsky and W. Alex Mason, University of Tennessee; Kaja LeWinn and Nicole Bush, University of California San Francisco; and Emily Barrett, Rutgers University. This research was funded by the National Institutes of Health through the ECHO-PATHWAYS consortium.

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For more information, contact Yu Ni at niyu@uw.edu.

Opioid use disorder is an addiction crisis in the United States that has become increasingly during the COVID-19 pandemic. To preserve access to life-saving treatment during the pandemic, federal drug agencies loosened requirements on physicians for treating these patients, including moving patient evaluations away from in-person exams to telemedicine.

This federal policy change , a highly effective treatment for opioid use disorder and one that is much less onerous and stigmatizing than methadone, the other most common but heavily monitored treatment.

With a $2.5 million National Institutes of Health grant, researchers at the 91̽�� will explore one of the most important questions related to this emergency policy change: whether those changes helped with another opioid-related crisis — the unequal access experienced by Black and Latinx patients to buprenorphine.

“There are a lot of clinical champions these days who think buprenorphine should be offered routinely in primary care to people who have opioid use disorder, and this policy change helps that,” said , professor of health systems and population health in 91̽��School of Public Health. “However, we’ve seen systematically that Black and Latinx patients were much less likely to get the less-stigmatized buprenorphine than white patients.”

Williams and co-principal investigator , assistant professor of psychiatry and behavioral sciences at the 91̽��School of Medicine, want to find out if this inequity remained, improved or potentially got worse under the new policies since telemedicine itself can be a barrier to access. The researchers, who also have appointments at the , will use national data from U.S. Veterans Affairs to explore this question.

“I work primarily in a chronic pain clinic. We’ve known for a long time that pain is undertreated among certain racial minority populations. That’s really clear,” said Chen. “And what is becoming increasingly obvious to us as a country is that opioid use disorder is a huge epidemic, and what I am seeing is that the life-saving treatments we have for opioid use disorder are also being under-received by patients of color and other minoritized groups.”

To understand how and why these disparities exist, the researchers will undertake a unique study effort to use critical race theory and its related public health praxis to “examine the structural mechanisms of disparities” in treating opioid use disorder, the researchers stated in their grant application.

“This situation provides an excellent opportunity to begin applying critical race theory and the practice of ‘centering the margins’ into a research design that focuses on the lived experiences of marginalized populations,” Williams said. “A lot of research focuses on what is happening for minoritized groups relative to white people and then figuring out those mechanisms. But when we center the margins, we’re caring specifically about what’s happening to these minoritized groups that are not getting what they need.”

The researchers plan to conduct phone interviews with Black and Latinx patients for this part of the study. They intend to look beyond the health care system and into patients’ communities to learn more about the policies society has enacted that affect them. For example, the is a policy initiated by President Nixon in 1971 that has differentially impacted minoritized communities, including in ways that serve as barriers to adequate substance use treatment.

“One of the key variables we are looking at is differential police presence in communities as one of the things that might modify community members’ ability to access buprenorphine versus methadone,” said Chen. “The more that any specific behavior is criminalized, the more that we expect that people will go through the court system and a treatment pathway that involves a lot of monitoring, as methadone does. Then of course that treatment itself becomes more disruptive of the person’s life, which then has impacts for family, as well as economic and occupational opportunities.”

The researchers hope their findings will show who benefited from easier access to buprenorphine and whether those temporary policy changes to access should be made permanent. They also hope to encourage the larger health care system to review and change the social policies that have such a big impact on individual outcomes.

“There are just so many horrible and sad ways that our society is structured to limit access to resources for some groups and to privilege others,” Williams said, “And the way that trickles into health care and in particular care for stigmatized conditions like opioid use disorder is, for me, heartbreaking.”

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For more information, contact Williams at emwilli@uw.edu and Chen at chenj4@uw.edu.

All forest fire smoke is bad for people, but not all fires in forests are bad.

This is the conundrum faced by experts in forest management and public health: Climate change and decades of fire suppression that have increased fuels are contributing to larger and more intense wildfires and, in order to improve forest health and reduce these explosive fires, prescribed and managed fire is necessary.

These intentional fires — some deliberately set and others unintended but allowed to burn under control — will reduce the intensity of wildfire smoke in the long run, but they are still creating health-impacting smoke, often hitting populations least protected from exposure to smoke.

To find consensus on how to deal with the impacts of all fires on dry Western forests, the 91̽�� and The Nature Conservancy led a series of conversations involving roughly 60 experts charged with keeping forests and people healthy. The led the organization of these discussions.

On May 2, more than two dozen of those participants that is part review of current scientific understanding of the issues and health impacts and part consensus report on how to deal with them.

“It started as a conversation between experts who think about fire from really different angles in order to find how we can address fire through an interdisciplinary lens,” said lead author , a postdoctoral fellow in UW’s Department of Environmental & Occupational Health Sciences. “It took a little bit to get to the fact that it was really smoke that brought us all together. We kind of had to set a baseline for what peoples’ starting points were — all smoke is bad smoke from a public health perspective, but we can’t do fire management without more fire.”

That working group — comprised of scientists, practitioners and managers who specialize in areas of forest and fire ecology, fire safety, air quality, health care and public health — agreed on six statements and recommendations as part of its “interdisciplinary approach” to the issues.

“The Nature Conservancy is dedicated to an evidence-based approach to forest and fire management practices that supports the health of both nature and people. These consensus statements aim to serve as guideposts for forest health and public health professionals to work together to promote healthy and resilient forests and communities,” said , co-author and director of conservation science for The Nature Conservancy in Oregon.

The first consensus statement addresses the issue of the long-running effort to suppress all forest fires versus the historic practices of Indigenous peoples:

“We recognize the need to listen to and integrate a diversity of perspectives, in particular those embodied by Indigenous peoples who have successfully used fire as an ecological tool for thousands of years,” the authors wrote.

“I’ve often heard from Tribal leaders how controlled burns were one of many tools they employed historically to steward healthy ecosystems,” said , co-author and executive director of the Tribal Healthy Homes��Network. “This Tribal knowledge has been overlooked, perilously, during decades of European colonization, and federal land management practices. It is only in recent years, as forest ecosystems decline in health, that Western science has begun to recognize and learn from the innate sensibility and sustainability of traditional Tribal burning practices.”

Here are the other five consensus statements:

• Prescribed fires in addition to managed fires for resource benefit are both necessary management techniques to keep forests resilient and to lessen the negative ecological and public health impacts of wildfires.
• Certain regions of the Western U.S. will experience more smoke days with heightened use of prescribed and managed fire; however, we expect the impacts of smoke exposure to be reduced over the long term in comparison with untreated land burned by wildfires. With these techniques, exposure in affected communities can be planned and lessened.
• No degree of smoke exposure is without risk. However, additional investment in advance preparation for affected populations can lower associated health risks. A smoke-resilient community is resilient to smoke from any type of fire.
• We must work to promote both equity in process (e.g., who has a say in decision-making) and equity in outcomes (e.g., who gets exposed to the smoke) within those communities and populations experiencing disproportionate impacts from smoke.
• We are missing opportunities for positive impact by working as separate disciplines. We recommend that further and intentional integration of forest/fire and health disciplines (including the practitioners, tools and resources) needs to occur to lessen the human health effects of smoke exposure due to prescribed and managed fires.

In their conclusion, the authors point out that when all stakeholders work together to “combat this climate and public health crisis,” communities will be more able to meet these goals, both during and outside of wildfire season.

“Extra attention must be given to people who have more smoke exposure, are more likely to experience health problems from smoke, and who don’t have enough support to anticipate, adapt, respond or recover from smoke,” added��, senior author and associate professor of environmental and occupational health sciences in the 91̽��School of Public Health. “These disproportionately affected populations must be included in decision-making to address inequities in smoke health impacts.”

D’Evelyn hopes the paper will inspire more interagency and cross-disciplinary efforts and funding for research and preparation.

“There are really wonderful community organizations working to make sure that people have access to clean air. And, there are really wonderful organizations working to do as much prescribed burning as they’re allowed to lessen the smoke or lessen the severity of wildfires when they come through,” D’Evelyn said. “But there are gaps where communities, organizations and researchers could be collaborating to have an even bigger impact on preparedness.”

Other co-authors are Jihoon Jung, Ernesto Alvarado, Jill Baumgartner, Pete��Caligiuri, R. Keala Hagmann, Sarah Henderson, Paul Hessburg, Sean Hopkins, Edward Kasner, Meg Krawchuk, Jennifer Krenz, Jamie Lydersen, Miriam E. Marlier, Yuta J. Masuda, Kerry Metlen, Susan Prichard, Claire Schollaert, Edward Smith, Jens Stevens, Christopher Tessum, Carolyn Reeb-Whitaker, Joseph Wilkins, Nicholas Wolff, Leah Wood.

For author affiliations, please see the publication.

This research was funded by Science for Nature and People Partnerships, The Nature Conservancy and CDC’s National Institute for Occupational Safety and Health.

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For more information, contact D’Evelyn at sdevelyn@uw.edu.

Your immune system’s ability to combat COVID-19, like any infection, largely depends on its ability to replicate the immune cells effective at destroying the SARS-CoV-2 virus that causes the disease. These cloned immune cells cannot be infinitely created, and a key hypothesis of a new 91̽�� study is that the body’s ability to create these cloned cells falls off significantly in old age.

According to a model created by 91̽��research professor , this genetically predetermined limit on your immune system may be the key to why COVID-19 has such a devastating effect on the elderly. Anderson is the lead author of a paper detailing this modeled link between aging, COVID-19 and mortality.

“When DNA split in cell division, the end cap — called a telomere — gets a little shorter with each division,” explains Anderson, who is a modeler of biological systems in the School of Aquatic and Fishery Sciences. “After a series of replications of a cell, it gets too short and stops further division. Not all cells or all animals have this limit, but immune cells in humans have this cell life.”

The average person’s immune system coasts along pretty good despite this limit until about 50 years old. That’s when enough core immune cells, called T cells, have shortened telomeres and cannot quickly clone themselves through cellular division in big enough numbers to attack and clear the COVID-19 virus, which has the trait of sharply reducing immune cell numbers, Anderson said. Importantly, he added, telomere lengths are inherited from your parents. Consequently, there are some differences in these lengths between people at every age as well as how old a person becomes before these lengths are mostly used up.

Anderson said the key difference between this understanding of aging, which has a threshold for when your immune system has run out of collective telomere length, and the idea that we all age consistently over time is the “most exciting” discovery of his research.

“Depending on your parents and very little on how you live, your longevity or, as our paper claims, your response to COVID-19 is a function of who you were when you were born,” he said, “which is kind of a big deal.”

To build this model the researchers used publicly available data on COVID-19 mortality from the Center for Disease Control and US Census Bureau and studies on telomeres, many of which were published by the co-authors over the past two decades.

Assembling telomere length information about a person or specific demographic, he said, could help doctors know who was less susceptible. And then they could allocate resources, such as booster shots, according to which populations and individuals may be more susceptible to COVID-19.

“I’m a modeler and see things through mathematical equations that I am interpreting by working with biologists, but the biologists need to look at the information through the model to guide their research questions,” Anderson said, admitting that “the dream of a modeler is to be able to actually influence the great biologists into thinking like modelers. That’s more difficult.”

One caution Anderson has about this model is that it might explain too much.

“There’s a lot of data supporting every parameter of the model and there is a nice logical train of thought for how you get from the data to the model,” he said of the model’s power. “But it is so simple and so intuitively appealing that we should be suspicious of it too. As a scientist, my hope is that we begin to understand further the immune system and population responses as a part of natural selection.”

Co-authors include Ezra Susser, Mailman School of Public Health, Columbia University; Konstantin Arbeev and Anatoliy Yashin, Social Science Research Institute, Duke University; Daniel Levy, National Heart, Lung, and Blood Institute, National Institutes of Health; Simon Verhulst, University of Groningen, Netherlands; Abraham Aviv, New Jersey Medical School, Rutgers University.

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For more information, contact Anderson at jjand@uw.edu.

Two 91̽�� nursing and midwife experts in maternal health have provided the following quotes on the issue of restricting abortion or making it illegal — seen as increasingly likely due to the Supreme Court draft opinion, leaked to Politico on Monday.

is an assistant professor in the 91̽��School of Nursing and nurse midwife, whose scientific research focuses on respectful and equitable care during pregnancy and childbirth.

is associate professor and Director of Nursing at 91̽��Bothell School of Nursing and Health Studies. Eagen-Torkko a nurse midwife with a continuing practice at Public Health Seattle-King County, where her practice specializes in family planning and women’s health.

“Restricting, and in many states, making abortion illegal will not change the need for abortion, but not having safe and accessible abortion services available will have tremendous impact. In fact, lack of access to abortion services has been shown to increase the risk of maternal mortality, both through restricted funds to family planning and through abortion restriction legislation, with the highest impact seen with racially minoritized communities,” said Altman.

“Outside of maternal mortality, the impacts on health care will be enormous: We can expect to see mismanagement of miscarriage and complicated pregnancies due to provider fear of being accused of providing abortions. We will see people not accessing necessary care for early pregnancy complications due to fear that providers will report them. We will see significant negative mental health impacts from people being forced to carry unwanted pregnancies,” said Eagen-Torkko.

Said Altman: “We will also see increased birth rates and associated increased poverty given our country does not provide adequate resources for childbearing families. Bottom line is that abortion is necessary health care. Abortion is public health. And the impacts of removing this crucial health care service will be monumental.”

As the most serious type of skin cancer, a melanoma diagnosis carries emotional, financial and medical consequences. That’s why recent studies finding that there is an overdiagnosis of melanoma are a significant cause for concern.

“Overdiagnosis is the diagnosis of disease that will not harm a person in their lifetime. If melanoma is being overdiagnosed, it means that too many people are getting the scary news that they have cancer, and receiving and paying for unnecessary treatment,” said , professor of biostatistics in the 91̽��School of Public Health.

Kerr recently of a study involving more than 100 dermatopathologists — pathologists who specialize in skin diseases and who diagnose melanoma — to find out if they believe that melanoma overdiagnosis is a public health issue in the U.S. and whether that belief affects their own conclusions. The pathologists were given biopsy slides to diagnose and were surveyed on their perceptions of overdiagnosis.

Kerr discussed the results of this study, published April 20 in JAMA Dermatology, in the following Q&A with 91̽��News:

How can you know if a disease is being overdiagnosed?

Kathleen Kerr: Overdiagnosis is often studied by looking at population-level data rather than individual cases. Melanoma diagnoses have been rising in the U.S. If there were truly an epidemic of melanoma, we would expect that deaths from melanoma to show a corresponding rise, since there hasn’t been a major breakthrough in treatment during this time. Yet melanoma deaths have been remarkably constant. This suggests that the rise in melanoma diagnoses is largely due to overdiagnosis.

Why does this happen when it comes to melanoma?

Kerr: The problem is multifaceted. Most of us who aren’t doctors think that if we have something on our skin that could possibly be cancer, and we get it biopsied, then the pathologist’s diagnosis after examining the skin tissue under a microscope is definitive. Reality is more complicated.

Skin abnormalities are some of the most challenging cases for pathologists to diagnose. Previous research has shown that different pathologists who examine the same skin biopsy will sometimes give different diagnoses — to a very surprising degree. The same pathologist examining the same case on two different occasions might even give two substantially different diagnoses.

While advanced melanoma is fairly easy for pathologists to diagnose, difficulties arise for cases where the biopsy shows some kind of abnormality that doesn’t appear to be melanoma but might be a precursor to melanoma. These are the instances where pathologists show the most diagnostic variability, and the cases that raise the possibility of overdiagnosis.

What did find in your study?

Kerr: The first component of our recent paper was a survey of practicing dermatopathologists’ perceptions about overdiagnosis. About half perceive that noninvasive melanoma is over-diagnosed and one-third perceive that invasive melanoma is overdiagnosed. Also, a majority of dermatopathologists agree that they see cases that should not have been biopsied in the first place. This points to overdiagnosis as a system-wide issue — a problem that may be rooted in too many skin biopsies.

The second component of our study was looking for relationships between pathologists’ perceptions on overdiagnosis and how they diagnosed actual skin biopsies. We thought that those who think is overdiagnosed might be more reserved in making this diagnosis, but this was not true. In fact, those who think invasive melanoma is overdiagnosed were slightly more likely to diagnose invasive melanoma compared to other dermatopathologists examining the identical cases.

What do you think is the importance of this finding?

Kerr: Overdiagnosis is a really challenging problem because both doctors and patients are wary of missing a cancer, which is understandable. Our study shows there is widespread recognition of melanoma overdiagnosis among dermatopathologists. We also show that awareness of overdiagnosis may not be enough to reduce overdiagnosis. It isn’t surprising that such a complicated problem won’t have a simple solution. Reducing overdiagnosis will need to involve patients and primary care doctors having more restraint with obtaining skin biopsies, and pathologists exercising restraint in diagnosing cases as melanoma.

Co-authors are Megan Eguchi and Joann Elmore, University of California, Los Angeles, David Geffen School of Medicine; Michael Piepkorn, Division of Dermatology, 91̽��School of Medicine, and Dermatopathology Northwest, Bellevue; Andrea Radick, Lisa Reisch and Hannah Shucard, Department of Biostatistics, 91̽��School of Public Health; Stevan Knezevich, Pathology Associates, California; Raymond Barnhill, Institut Curie, Paris Sciences and Lettres Research University and University of Paris, France; David Elder, Department of Pathology and Laboratory Medicine, Hospital of the University of Pennsylvania. This research was funded by the National Institutes of Health.

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For more information, contact Kerr at katiek@uw.edu.

The first of research led by the 91̽�� into handgun carrying by young people growing up in rural areas has found six distinct patterns for when and how often these individuals carry a handgun.

The patterns, or “longitudinal trajectories,” suggest that youths in rural areas differ in some ways from their urban counterparts when it comes to handgun carrying and provide information for programs designed to help prevent firearm violence and injury.

“Because firearms in many rural areas are such an integral part of a robust gun culture, understanding how youth engage with firearms in those settings is incredibly important,” said principal investigator and senior author��, a 91̽��professor of epidemiology and the 91̽��Bartley Dobb Professor for the Study and Prevention of Violence. “Strikingly, until now there has been almost no research into the longitudinal patterns of handgun carrying in rural areas.”

In these communities, young people carry handguns at nearly twice the rate as in urban settings, the researchers point out. And urban youths and rural youths do not necessarily have the same cultural context, motivations and use of firearms.

“A key takeaway of our study is that about one in three youth in rural areas report carrying a handgun by age 26,” said , lead author and acting assistant professor of pediatrics at the 91̽��School of Medicine who holds a doctorate in economics. “So, this is a prevalent behavior among these youth during adolescence and early adulthood. For those who carry, about half say they did so only one time, but another portion is carrying quite frequently, 40 times or more a year.”

Funded by the Centers for Disease Control and Prevention, this study of handgun carrying among youth in rural areas is based on interviews with roughly 2,000 young people who started answering survey questionnaires in the sixth grade. Participants took repeated surveys over a roughly 15-year period, 2005 to 2019, as part of the UW’s��. That larger study is designed to evaluate the university’s����program, which helps communities take a broad approach to preventing youth problem behaviors.

These study results are the first in a series of related 91̽��studies that are funded by the CDC and part of a wider range of focusing on firearm violence and injury prevention. Investigators at the 91̽��Social Development Research Group, Washington State University, Seattle Children’s Research Institute and Arizona State University collaborated on the current 91̽��study.

The researchers identified these six patterns, which are based on 10 chronological waves of survey data (click on each image for a description):

The researchers add that in these patterns of carrying that emerged over the 10 nearly annual waves of surveys, some participants reported first carrying at an early age, as young as 12 years old. Consequently, they said, educating young adolescents about firearms, firearm violence, injury and conflict resolution may be suitable, especially if it connects to the firearm culture of that community.

“Certainly this behavior is very episodic, but adolescence is the age when other behaviors such as bullying and physical violence emerge,” said Ellyson, who is also a principal investigator at Seattle Children’s Research Institute . “Carrying a handgun concurrently with bullying or physical violence may increase the risk, and those behaviors could escalate into more severe violence. More research is needed to measure the potential consequences and health risks of handgun carrying.”

The study emphasizes that nearly all current interventions focused on handgun carrying are related to crime, which may not work for most youth in rural settings, where handgun carrying may occur with different motivations, circumstances and consequences.

“Before this study, we knew that there is a certain fraction of youth in rural areas who carry handguns,” said Rowhani-Rahbar, co-director of the at the Harborview Injury Prevention & Research Center. “But with this study, we provided evidence that there are distinctive and different patterns of handgun carrying. The discovery of these patterns in rural areas is the first step toward prevention, because knowing when this behavior starts as well as its frequency and duration may provide important points of intervention for injury prevention.”

In 2020, for the first time in nearly 30 years, the CDC����$7.8 million in funding for more than a dozen national studies to understand and prevent firearm violence. The UW’s proposal to study handgun carrying among rural adolescents was awarded roughly $1.5 million. The current study is one of four areas of focus in the UW’s proposal and involved surveys from 12 communities across 7 states: Colorado, Illinois, Kansas, Maine, Oregon, Utah and Washington.

Next, the 91̽��researchers will focus on improving understanding of the cultural context of handgun carrying among young people in rural areas. What are the reasons they pick up a handgun? What are the settings in which they do? What does “carrying” a handgun mean to them? After that, the researchers hope to examine what happened before a person carried and what happened after. What were the consequences? Finally, they hope to test the effectiveness of the Communities That Care prevention program.

“There is a very strong safety culture around the use of firearms in rural areas, and some of these young people are very well exposed to and trained in the safe use and handling of firearms, but some of them are not,” said Rowhani-Rahbar. “This type of research really sheds light on the fact that you have to think about context, you have to think about setting, you need to consider community-based factors that should drive and inform the prevention efforts that you design.”

Co-authors are Emma Gause and Julia Schleimer, with the Firearm Injury and Policy Research Program, 91̽��Harborview Injury Prevention and Research Center; Vivian Lyons, with the 91̽��Harborview Injury Prevention and Research Center and the Department of Health Behavior and Health Education, University of Michigan; Schleimer, also Department of Epidemiology, 91̽��School of Public Health; Margaret Kuklinski, John Briney and Kevin Haggerty, Social Development Research Group, 91̽��School of Social Work; Sabrina Oesterle, Southwest Interdisciplinary Research Center, School of Social Work, Arizona State University; and Elizabeth Weybright, Department of Human Development, Washington State University.

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For more information, contact Rowhani-Rahbar at rowhani@uw.edu.

Brian Donohue, public information editor at 91̽��School of Medicine, contributed to this story.