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Taking a Community-Based Approach to Youth Substance Abuse Prevention

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Credit: LaJoy Photography, Atlanta

As a child born and raised in a low-income, urban neighborhood of Jersey City, NJ, Ijeoma Opara counted herself lucky. She had strong support from her parents, both college-educated Nigerian immigrants. But she also saw firsthand the devastating effects that gang violence, crime, drugs, and alcohol were having on too many young people in her community. When she was in high school, her family bought their first house about 20 miles away in the middle-class, suburban neighborhood of Roselle, NJ. The dramatic differences between these two worlds drove home for her how significant a zip code can be in determining a child’s outlook and opportunities.

Today, inspired by this childhood moment of truth, Opara, an assistant professor of social work at The State University Stony Brook University, NY, is the recipient of an NIH Director’s Early Independence Award, tackling the complex relationships between neighborhoods, substance use, and mental health among urban youth. She’s focusing her efforts on Paterson, NJ, a city of about 150,000 people where the rates of substance abuse are among the highest in the country. She hopes to develop community engagement models that will work not only in Paterson, but in struggling urban communities across the United States.

Opara first explored the streets of Paterson, which is located about 20 miles west of New York City, and ultimately fell in love with the place as a PhD fellow studying substance abuse and mental health services. She got to know the youth of Paterson and heard from them directly about what their community was lacking to help them build a brighter future.

She also fell in love with community-based participatory research (CBPR). In this approach, researchers immerse themselves in a community and work as partners with community members, leaders, and organizations to understand the issues that matter, gather essential information and data, and translate them into efforts needed for a community and its youth to thrive.

When Opara decided to apply for the high-risk, high-reward Early Independence Award, she knew her proposal must be innovative and creative. Ultimately, though, Opara realized she needed to propose an idea about which she was passionate.

Opara remembered her love for Paterson and decided to go back there, focusing her attention on filling the many gaps in that community to prevent substance abuse among young people. True to her CBPR approach to research, she also spent weeks meeting with the people of Paterson to ensure that her work would address the community’s most-critical needs and strongest desires from day one.

Opara’s first aim is to look at neighborhoods across the city of Paterson and their relationship to substance abuse and mental health symptoms, including anxiety and depression among its youth. Her work will factor in access to safe housing, healthy food, parks, and playgrounds.

She’ll also recruit young people, including those who are most at risk, to get their take on their community including the prevalence of drug use. Opara won’t just be checking with kids at school. She’ll also spend lots of time with them on basketball courts, in grocery store parking lots, or wherever they like to congregate. What she learns will help her craft evidence-based and community-driven substance abuse interventions for young people at risk. She’ll then work with her partners in the community to help put the interventions to the test.

She recognizes that many consider urban youth too hard to reach. In her view, that’s simply not true. It’s her job to meet these young people where they hang out, learn to engage them, and listen to their needs.

In Paterson, she wants to build vibrant neighborhood models that will enrich the community and help more of its children get ahead. Most of all, she wants to change the way substance abuse and mental health work is done in urban communities like Paterson, and see to it that more resources for youth are put into place.

Opara hopes one day to inhabit a world where urban kids have access to the emotional and mental health resources that they need to cope with the many challenges that confront them. She also wants to inhabit a world where young girls growing up in the inner-city, as she did not so long ago, will be nurtured to move upward and onward as leaders. Her efforts and the strength of her example are certainly a push in the right direction.

Links:

Ijeoma Opara (The State University Stony Brook University, NY)

The Substance Abuse and Sexual Health Lab (Stony Brook)

Opara Project Information (NIH RePORTER)

NIH Director’s Early Independence Award

NIH Support: Common Fund


Masks Save Lives

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Masks save lives

Reminding others that “masks save lives” isn’t just sound advice. It’s a scientific fact that wearing one in public can help to slow the spread of SARS-CoV-2, the virus responsible for the coronavirus disease 2019 (COVID-19) pandemic.

I’m very careful to wear a mask outside my home whenever I’m out and about. I do it not necessarily to protect myself, but to protect others. If by chance I’ve been exposed to the virus and am currently incubating it, I wouldn’t want to spread it to other people. And any of us could be an unknowing superspreader. We owe it to everyone we encounter, especially those who are more vulnerable, to protect them. As my NIH colleague Tony Fauci recently demonstrated, it’s possible to wear your mask even while you’re outside exercising.

But there are still skeptics around. So, just how much does a facial covering protect those around you? Quite a bit, according to researchers who created a sophisticated mathematical model to take a more detailed look [1]. Their model shows that even if a community universally adopted a crude cloth covering that’s far less than 100 percent protective against the virus, this measure alone could significantly help to reduce deaths.

These findings, funded partly by NIH, were published recently in Nature Communications. They come from Colin Worby, Broad Institute of MIT and Harvard, Cambridge, MA, and Hsiao-Han Chang, National Tsing Hua University, Taiwan.

The researchers noted several months ago that recommendations on wearing a mask varied across the United States and around the world. To help guide policymakers, the researchers simulated outbreaks in a closed, randomly interacting population in which the supply and effectiveness of crude cloth or disposable, medical-grade masks varied.

Under different outbreak scenarios and mask usages, the researchers calculated the total numbers of expected SARS-CoV-2 infections and deaths from COVID-19. Not surprisingly, they found that the total number of deaths and infections declined as the availability and effectiveness of face masks increased.

The researchers’ model primarily considered the distribution of medical-grade, surgical masks. But because such masks are currently available in limited supply, they must be prioritized for use by health care workers and others at high risk. The researchers go on to note that the World Health Organization and others now recommend wearing homemade face coverings in public, especially in places where the virus is spreading. While it’s true the ability of these face coverings to contain the virus is more limited than medical-grade masks, they can help and will lead to many fewer deaths.

Another recent paper also suggests that while wearing a mask is primarily intended to prevent the wearer from infecting others, it may also help lower the dose, or inoculum, of SARS-CoV-2 that the wearer might receive from others, resulting in milder or asymptomatic infections [2]. If correct, that’s another great reason to wear a mask.

Already, more than 175,000 people in the United States have died from COVID-19. The latest estimates [3] from the Institute for Health Metrics and Evaluation (IHME) at the University of Washington’s School of Medicine, Seattle, predict that the COVID-19 death toll in the U.S. may reach nearly 300,000 by December 1.

But that doesn’t have to happen. As this new study shows, face coverings—even those that are far from perfect—really can and do save lives. In fact, IHME data also show that consistent mask-wearing—starting today—could save close to 70,000 lives in the months to come. Saving those lives is up to all of us. Don’t leave home without your mask.

References:

[1] Face mask use in the general population and optimal resource allocation during the COVID-19 pandemic. Worby CJ, Chang HH. Nat Commun. 2020 Aug 13;11(1):4049.

[2] Masks Do More Than Protect Others During COVID-19: Reducing the Inoculum of SARS-CoV-2 to Protect the Wearer. Gandhi M, Beyrer C, Goosby E. J Gen Intern Med. 2020 Jul 31.

[3] New IHME COVID-19 forecasts see nearly 300,000 deaths by December 1. Institute for Health Metrics and Evaluation. August 6, 2020.

Links:

Coronavirus (COVID-19) (NIH)

Colin Worby (Broad Institute of MIT and Harvard, Cambridge, MA)

Hsiao-Han Chang (National Tsing Hua University, Taiwan)

NIH Support: National Institute of Allergy and Infectious Diseases


For HIV, Treatment is Prevention

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U=U

For almost four decades, researchers have worked tirelessly to find a cure for the human immunodeficiency virus (HIV), which causes AIDS. There’s still more work to do, but a recent commentary published in JAMA [1] by Anthony Fauci, director of NIH’s National Institute of Allergy and Infectious Diseases, and his colleagues serves as a reminder of just how far we’ve come. Today, thanks to scientific advances, especially the development of effective antiretroviral therapy (ART), most people living with HIV can live full and productive lives. These developments have started to change how our society views HIV infection.

In their commentary, the NIH scientists describe the painstaking research that has now firmly established that people who take ART daily as prescribed, and who achieve and maintain an undetectable viral load (the amount of HIV in the blood), cannot sexually transmit the virus to others. To put it simply: Undetectable = Untransmittable (U=U).

The U=U message was introduced in 2016 by the Prevention Access Campaign, an international health equity initiative that aims to help end the HIV epidemic and HIV-related social stigma. The major breakthrough in combination ART regimens, which successfully reduced viral loads for many HIV patients, came over 20 years ago. But their importance for HIV prevention wasn’t immediately apparent.

There’d been some hints of U=U, but it was the results of the NIH-funded HIV Prevention Trials Network (HPTN) 052, published in The New England Journal of Medicine [2] in 2011, that offered the first rigorous clinical evidence. Among heterosexual couples in the randomized clinical trial, no HIV transmissions to an uninfected partner were observed when ART consistently, durably suppressed the virus in the partner living with HIV.

The data provided convincing evidence that ART not only treats HIV but also prevents the sexual transmission of HIV infection. The public health implications of what’s sometimes referred to as “treatment as prevention” were obvious and exciting. In fact, the discovery made Science’s 2011 list of top 10 Breakthroughs of the Year .

Three subsequent studies, known as PARTNER 1 and 2 and Opposites Attract, confirmed and extended the findings of the HPTN 052 study. All three showed that people with HIV taking ART, who had undetectable HIV levels in their blood, had essentially no risk of passing the virus on to their HIV-negative partners.

Of course, the success of U=U depends on people with HIV having the needed access to health care and taking their medications as prescribed every day of their lives [3]. ART works by preventing the virus from making more copies of itself. It’s important to note that achieving an undetectable viral load with treatment can take time—up to 6 months. Viral load testing should be performed on a regular basis to ensure that the virus remains at undetectable levels. If treatment is stopped, the virus typically rebounds within a matter of weeks. So, strict adherence to ART over the long term is absolutely essential.

Practically speaking, though, ART alone won’t be enough to end the spread of HIV, and other methods of HIV prevention are still needed. In fact, we’re now at a critical juncture in HIV research as work continues on preventive vaccines that could one day bring about a durable end to the pandemic.

But for now, there are more than 35 million people worldwide who are HIV positive [4]. With currently available interventions, experts have predicted that about 50 million people around the world will become HIV positive from 2015 to 2035 [5]. Work is proceeding actively on the vaccine, and also on ways to totally eradicate the virus from infected individuals (a “cure”), but that is proving to be extremely challenging.

Meanwhile, with continued advances, including improved accessibility to testing, adherence to existing medications, and use of pre-exposure prophylaxis (PrEP) in high risk individuals, the goal is to reduce greatly the number of new cases of HIV/AIDS.

References:

[1] HIV Viral Load and Transmissibility of HIV Infection: Undetectable Equals Untransmittable. Eisinger RW, Dieffenbach CW, Fauci AS. JAMA. 2019 Jan 10.

[2] Prevention of HIV-1 infection with early antiretroviral therapy. Cohen MS, Chen YQ, McCauley M, Gamble T, Hosseinipour MC, Kumarasamy N, Hakim JG, Kumwenda J, Grinsztejn B, Pilotto JH, Godbole SV, Mehendale S, Chariyalertsak S, Santos BR, Mayer KH, Hoffman IF, Eshleman SH, Piwowar-Manning E, Wang L, Makhema J, Mills LA, de Bruyn G, Sanne I, Eron J, Gallant J, Havlir D, Swindells S, Ribaudo H, Elharrar V, Burns D, Taha TE, Nielsen-Saines K, Celentano D, Essex M, Fleming TR; HPTN 052 Study Team. N Engl J Med. 2011 Aug 11;365(6):493-505.

[3] HIV Treatment (U.S. Department of Health and Human Services)

[4] HIV/AIDS (World Health Organization)

[5] Effectiveness of UNAIDS targets and HIV vaccination across 127 countries. Medlock J, Pandey A, Parpia AS, Tang A, Skrip LA, Galvani AP. Proc Natl Acad Sci U S A. 2017 Apr 11;114(15):4017-4022.

Links:

HIV/AIDS (National Institute of Allergy and Infectious Diseases/NIH)

Treatment as HIV Prevention (NIAID)

Prevention Access Campaign

Anthony S. Fauci (NIAID)

HIV Prevention Trials Network (Durham, NC)


An Aspirin a Day for Older People Doesn’t Prolong Healthy Lifespan

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Hands holding a pill and a glass of water

Credit: iStock/thodonal

Many older people who’ve survived a heart attack or stroke take low-dose aspirin every day to help prevent further cardiovascular problems [1]. There is compelling evidence that this works. But should perfectly healthy older folks follow suit?

Most of us would have guessed “yes”—but the answer appears to be “no” when you consider the latest scientific evidence.  Recently, a large, international study of older people without a history of cardiovascular disease found that those who took a low-dose aspirin daily over more than 4 years weren’t any healthier than those who didn’t. What’s more, there were some unexpected indications that low-dose aspirin might even boost the risk of death.


Precision Medicine: Who Benefits from Aspirin to Prevent Colorectal Cancer?

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Aspirin and DNA StethoscopeIn recent years, scientific evidence has begun to accumulate that indicates taking aspirin or other non-steroidal anti-inflammatory drugs (NSAIDs) on a daily basis may lower the risk of developing colorectal cancer. Now, a new study provides more precise information on who might benefit from this particular prevention strategy, as well as who might not.

Published in the journal JAMA, the latest work shows that, for the majority of people studied, regular use of aspirin or NSAIDs was associated with about a one-third lower risk of developing colorectal cancer. But the international research team, partly funded by NIH, also found that not all regular users of aspirin/NSAIDs reaped such benefits—about 9 percent experienced no reduction in colorectal cancer risk and 4 percent actually appeared to have an increased risk [1]. Was this just coincidence, or might there be a biological explanation?