In 2020, firearm violence became the leading cause of death for American children and teens, a critical datapoint informing the 2024 U.S. Surgeon General's advisory on firearm violence. However, firearm violence has been a leading cause of death for Black youth-particularly, Black males-for decades, disproportionately impacting their morbidity and mortality. As the rights of Black youth to experience safety from firearm violence converge with the interests of white youth now increasingly impacted by it, it is imperative that prevention scientists critically interrogate what contributes to the national willfulness to see Black youth as perpetrators of violence deserving of punishment and a national reluctance to see Black youth as victims of violence deserving of healing and prevention? Guided by the Cycle of Dehumanization framework, we contend this pattern is symptomatic of racial dehumanization, a root cause of structural racism and violence. We argue that to successfully prevent youth firearm violence using a structural approach, we must disrupt dehumanizing narratives about Black male criminality and offer a viable solution through our visual storytelling and narrative change campaign, In All Ways Human. Using an adapted community engaged participatory action research approach and qualitative interviewing, our multimodal narrative change project captured 50 strategically disseminated (mural, billboards, kiosks, exhibits, digital galleries) portraits and stories that construct a counter-narrative with the power to prevent youth violence by transforming the ways in which Black males are seen, see one another, and see themselves. The impact and future directions of our narrative change effort are discussed.

Public Support for Warning Label Policies on Social Media Among U.S. Adults in 2024.

In 2021, US Surgeon General Vivek Murthy issued an advisory calling health misinformation a serious threat to public health and urging all Americans to help slow its spread. The public appears to agree; a 2023 KFF poll found that three-fourths viewed the spread of false and inaccurate health information as a major problem. Although health misinformation has gained significant attention since the COVID-19 pandemic, the public's understanding of complex health issues has long been a challenge. In this article, the authors reflect on more than 30 years of polling to offer perspectives on how the public accesses, evaluates, and uses health information and discuss what recent trends may suggest about the future of the health information (and misinformation) environment. They start by examining public knowledge gaps on health and the role of partisanship in national health debates. They then look at how sources of health information have changed over time alongside declines in trust of information from government health agencies. They end by examining the current era of health misinformation, focusing on widespread uncertainty among the public and how increasing use of social media and emergent technologies have the potential to further complicate the landscape of health information and trust.

In response to rising concerns about violence against health care workers, beginning in 2021, Penn Medicine implemented a high-tech weapons-detection system at hospital entrances. The prevalence of detected firearms represented an opportunity to engage with patients, families, community members, and hospital staff in efforts to promote firearm safety, not just at the hospital, but at homes within the community. In this article, the authors report on the development of a firearm-secure-storage program implemented in partnership with hospital security at an urban academic hospital in Philadelphia. Promoting secure storage among firearm owners is a key strategy to prevent injury and death and was highlighted as a community risk reduction and education strategy in the 2024 U.S. Surgeon General’s advisory on firearm violence. The authors describe a scalable design process, leading to the development of several firearm-related initiatives, including a firearm-storage-device distribution program that featured a pilot randomized controlled trial to compare self-reported secure storage adherence rates among those who accepted a free cable-lock device and those who received their choice of a free cable lock or lockbox (all chose the lockbox). After some development and iteration, phase 1 of the program evolved from free hospital-based cable lock distribution and on-site firearm storage to program participation via a QR-enabled poster at hospital security entrances. Interested visitors and patients could scan the QR code on the poster, respond to survey questions, and share shipping information to receive a free locking device. Findings suggest that the hospital setting provides a scalable platform for firearm-secure-storage programs; that recipients prefer lockboxes over cable locks; and that device distribution improves secure storage rates among firearm owners. This initiative highlights the potential for health systems to contribute to injury prevention through innovative partnerships with security staff and easy-to-adopt safety solutions embedded in routine hospital operations.

To estimate the attributable mortality to secondhand tobacco smoke (SHS) exposure among the population aged 35 years and older in Brazil and its 27 federal units in 2019. Attributable mortality analysis. A prevalence-dependent method was applied. Attributable mortality to SHS exposure was estimated under two scenarios. In scenario 1, attributable mortality from three causes (ischaemic heart disease, lung cancer and stroke) was calculated using the relative risks (RRs) reported by the Surgeon General. In scenario 2, attributable mortality from eight causes (ischaemic heart disease, lung cancer, stroke, chronic obstructive pulmonary disease, type 2 diabetes mellitus, asthma, lower respiratory tract infections and breast cancer) was calculated using RRs derived from a recent meta-analysis. Scenario 1: in 2019, SHS exposure caused 10 604 deaths in Brazil, 5451 of which were due to ischaemic heart disease, 830 to lung cancer and 4323 to stroke. The attributable mortality rate due to SHS exposure varied across federal units, ranging from 5.6 deaths per 100 000 inhabitants in Amazonas to 16.1 in Piauí. Scenario 2: exposure to SHS caused 20 292 deaths, 5258 of which were due to ischaemic heart disease. In scenario 2, mortality attributable to SHS exposure from lung cancer increased, while mortality from ischaemic heart disease and stroke decreased compared to Scenario 1. In Brazil, exposure to SHS is estimated to cause between 30 and 60 deaths per day. The mortality rates varied across federal units. Differences in the risk sources and the selection of health outcomes significantly influence mortality estimates. These findings underscore the importance of strengthening the enforcement of tobacco control policies by health authorities in Brazil.

Background: Loneliness is a growing public health concern. In 2022, the AHA identified it as a contributor to poor cardiovascular health, followed by a 2023 U.S. Surgeon General advisory declaring an “Epidemic of Loneliness and Isolation”. Although linked to mortality, its independent effect and generalizability across diverse groups remain understudied. With over half of U.S. adults reporting loneliness, understanding its role may be essential to improving cardiovascular outcomes. Research Questions/Hypothesis: We examined the association between loneliness and CVD mortality in a diverse national cohort. We hypothesized that loneliness would be associated with increased CVD mortality. Methods: The Reasons for Geographic and Racial Differences in Stroke (REGARDS) Study is a prospective cohort of 30,239 adults aged ≥45 years recruited from 2003-2007. We included those who completed a baseline loneliness item assessing feelings in the past week. Cox proportional hazards models estimated HRs and 95% CIs for the association between loneliness and time to CVD death. Models were sequentially adjusted for demographics (age, race, gender), SDOH (employment, education, income, insurance, region, poverty, health professional shortage, public health infrastructure), clinical factors (hypertension, diabetes, self-rated physical health, obesity, inflammation, cognition), health behaviors (smoking, activity, diet, medication adherence), and objective social health (partnership, social isolation, social support). Effect modification by age, race, and gender was assessed using interaction terms. Results: We included 29,387 participants with median follow-up of 13.1 years (IQR 7.3-16.1). Mean age was 65.0 years (SD 9.4); 41% identified as Non-Hispanic Black and 55% were women. Overall, 21% of participants reported loneliness in the past week, with 3,643 CVD deaths observed. Loneliness was associated with a 41% increased hazard of CVD mortality in unadjusted models (HR, 1.41; 95% CI, 1.31-1.53). The association attenuated but remained significant in the fully adjusted model (HR, 1.21; 95% CI, 1.03-1.41). No effect modification was observed. Conclusion: Loneliness was associated with increased CVD mortality risk, even after accounting for clinical, behavioral, and social factors. A one-time, self-reported loneliness measure may serve as a practical tool for identifying at-risk patients and inform efforts to reduce cardiovascular risk.

In September, the Office of the Surgeon General issued a clear warning about vaping and adolescents — cigarette smoking is going down, but vaping is going up.

On 27 February 1962, Surgeon General Luther Terry announced a new vaccine development program within the National Institute of Allergy and Infectious Diseases (NIAID). Initially, the plan had three components: (1) special laboratories and facilities for development of prototype vaccines; (2) pilot lot production facilities and preliminary vaccine trial sites; and (3) larger lot production capacity and expanded human testing. Respiratory viruses were targeted as the top priority for vaccine development. Over 5 decades, this program has evolved and expanded to include multiple academic vaccine evaluation sites within the network, now labeled as the Vaccine and Treatment Evaluation Units (VTEUs). The network has evaluated many different vaccines, with many shown to be safe, effective, and licensed for recommended use. This manuscript offers a historical perspective, crafted by early investigators from currently funded VTEUs, to showcase how some of the original VTEUs-both individually and collectively-advanced vaccine science and shaped the strategies and achievements that continue to impact public health today.

BackgroundPrimary care-based secure firearm storage programs are well-positioned to prevent firearm-related injury, the leading cause of death for young people in the United States. While recommended by the American Academy of Pediatrics and US Surgeon General, these programs have yet to become routine practice. Our cluster randomized hybrid effectiveness-implementation trial tested implementation strategies across 30 clinics in two large health systems for a universal evidence-based secure firearm storage program, S.A.F.E. Firearm (Suicide and Accident Prevention through Family Education). S.A.F.E. Firearm includes a brief discussion between a clinician and parent on secure firearm storage and an offer of free cable locks at pediatric well-child visits for youth ages 5–17. The ASPIRE trial demonstrated meaningful clinician behavior change, with S.A.F.E. Firearm delivered to a significantly higher percentage of patient families in the clinics that received both implementation strategies (49%) versus only one (22%). The present study qualitatively explores factors influencing the successful implementation of S.A.F.E. Firearm, centering healthcare worker (HCW) perspectives.MethodsSemi-structured qualitative interviews were conducted with leaders, clinic change agents, and clinicians involved in implementation from 2023–2024 (N = 38). The interview guide was informed by the original and updated Consolidated Framework for Implementation Research. Interviews were coded and analyzed using an abductive, integrated (i.e., deductive and inductive) approach. Inter-rater reliability (Kappa = 0.87) was strong.ResultsInterviews elucidated four interconnecting themes. HCWs unanimously expressed pediatric HCWs’ responsibility to promote firearm safety (role of pediatrics in firearm safety) across heterogeneous community and healthcare firearm cultures. By preserving families’ autonomy and privacy around firearms, S.A.F.E. Firearm’s nonjudgemental and universal approach promoted program acceptability and delivery. Consequently, HCWs’ understanding versus confusion around this universal, privacy-focused harm reduction approach was foundational to implementation.ConclusionsHealth systems can harness HCWs’ shared commitment to firearm safety by deploying brief programs that preserve recipient autonomy and privacy. To scale these evidence-based approaches, we recommend offering clear, simple trainings and collaboratively adapting programs to meet HCW and recipient needs.Trial registration:Registry: https://clinicaltrials.gov/study/NCT04844021, TRN: NCT04844021, first registered on April 14, 2021.

Abstract Measures of loneliness are usually individualistically worded and commonly refer to loneliness with respect to relationships with at most a group of friends or ambiguous “people”. In light of the current discussion of a collapse in community and an epidemic of loneliness (Office of the Surgeon General, 2023; Putnam, 2020a, 2020b), it is vital to develop a new and reliable way to measure collective loneliness. To this end, we started with scoping review of collective loneliness and related concepts to generate the items. The preliminary dimensions of the scale were 1) levels: small groups, community, society, and world, and 2) themes: perceived situation, direct loneliness, connectedness, otheredness, isolation, neededness, and need-fulfillment. Based on past literature and feedback from the qualitative interviews, 131 items were generated. The two group interviews and ten individual interviews additionally aided in evaluating the items (n = 15). The items were further evaluated in a pre-test (n = 34) to assess content and face validity, difficulty, ambiguity, and social desirability, and a pilot (n = 48) to preliminarily assess psychometric properties. These evaluations together with an expert review were used to reduce the scale to twelve items. Then the factor structure of the reduced scale was assessed in a sample of adults (n = 853). Finally, measurement invariance was tested among a sample of adolescents (n = 156) and psychometric properties assessed. Our results suggest that our new Collective Loneliness Scale is a valid scale that measures loneliness concerning collectives to complement current individualistic loneliness scales.

In 2023, then-US Surgeon General (SG) Vivek Murthy published a public health advisory, which describes “our epidemic of loneliness and isolation,” details the public health burden posed by these trends, and highlights some strategies for ameliorating it. SG Murthy’s report offers a thorough symptomology of the current crisis, and proposes six “pillars” to structure public-health responses to it, each of which is reasonable and important in its own right. As helpful as these are, there are arguably additional key causes of loneliness and social isolation that merit further attention, including median wage stagnation; the decline of childhood free play and independence; and the growing isolation of America’s elderly as households shrink. Moreover, some of the epidemic’s most damaging aspects, such as the decline of marriage and religious participation, likewise merit more detailed attention than they receive in the Advisory. The report’s six pillars could thus also be supplemented with several other urgently needed approaches as well, including reviving widely shared economic prosperity; restoring some of children’s lost independence; encouraging multi-generational households; and exploring public policy levers for promoting marriage and religious participation. Our aim in this review is to call attention to some of what is underemphasized in the SG’s report, in the hope of building on his important Advisory to develop a yet more comprehensive account of the drivers of the decline of belonging in contemporary America, and of a path back toward a richly connected society.

ObjectivesThe rise of smartphones and social media is widely seen as a pivotal societal shift that has fueled what the U.S. Surgeon General in 2023 described as “our epidemic of loneliness and isolation.” The evidence for an increase in social isolation, however, has not accounted for age and cohort effects – i.e., variation in time spent alone over the life course and across generations. This study leverages the latest breakthrough in Age-Period-Cohort (APC) modeling to disentangle age-specific effects, societal changes, and generational shifts that contribute to social isolation in the era of smartphones.MethodsWe analyze data from the 2003–2022 waves of the American Time Use Survey (ATUS), focusing on time spent alone in nonwork activities among individuals aged 15–79 (N = 240,576). Using a recent breakthrough in APC modeling, we identify net effects of age, period, and cohort separately for men and women.ResultsSocial isolation has increased over the past two decades for both women and men, with a notable acceleration in the mid-2010s, suggesting that societal shifts during this period may have intensified isolation. However, age and cohort effects play a much larger role in explaining the social isolation crisis of the 21st century. Gender differences are substantial, particularly in cohort trajectories and in age patterns after age 70.DiscussionWhile smartphone-era societal shifts have contributed to a general rise in isolation, aging and generational differences explain more of the variation. Public health efforts should prioritize mitigating isolation among older adults or earlier cohorts, with attention to gender-specific patterns.

The rise of smartphones and social media is widely seen as a pivotal societal shift that has fueled what the U.S. Surgeon General in 2023 described as "our epidemic of loneliness and isolation." The evidence for an increase in social isolation, however, has not accounted for age and cohort effects - i.e., variation in time spent alone over the life course and across generations. This study leverages the latest breakthrough in Age-Period-Cohort (APC) modeling to disentangle age-specific effects, societal changes, and generational shifts that contribute to social isolation in the era of smartphones. We analyze data from the 2003-2022 waves of the American Time Use Survey (ATUS), focusing on time spent alone in nonwork activities among individuals aged 15-79 (N = 240,576). Using a recent breakthrough in APC modeling, we identify net effects of age, period, and cohort separately for men and women. Social isolation has increased over the past two decades for both women and men, with a notable acceleration in the mid-2010s, suggesting that societal shifts during this period may have intensified isolation. However, age and cohort effects play a much larger role in explaining the social isolation crisis of the 21st century. Gender differences are substantial, particularly in cohort trajectories and in age patterns after age 70. While smartphone-era societal shifts have contributed to a general rise in isolation, aging and generational differences explain more of the variation. Public health efforts should prioritize mitigating isolation among older adults or earlier cohorts, with attention to gender-specific patterns.

Adolescent mental health issues have been increasing globally, with one in seven youth experiencing mental health disorders. While social connectedness traditionally serves as a protective factor, the widespread adoption of online platforms has fundamentally transformed how adolescents build and maintain social relationships. This systematic review aimed to synthesize existing literature on the relationship between online social connections and mental health among adolescents aged 10-18 years. The review specifically examined how the structure, function, and quality of online interactions influence mental health outcomes, guided by the U.S. Surgeon General's framework on social connection. A systematic search was conducted in January 2024 using PsycINFO, MEDLINE, PubMed, and Web of Science databases. Studies were included if they measured mental health outcomes, assessed online social connection, analyzed relationships between these variables, and focused on adolescents ages 10-18 years. From an initial search of 3,745 articles, 23 met inclusion criteria after screening. The review revealed complex, bidirectional relationships between online social connections and adolescent mental health. Online-only friendships demonstrated a protective function, particularly for vulnerable youth experiencing suicidal ideation. Social capital in online contexts significantly influenced well-being, with higher online social capital associated with positive outcomes, especially in gaming environments. Gender differences emerged in social media effects, with passive use negatively impacting girls. Online social connections present both opportunities and risks for adolescent mental health. While digital platforms can provide valuable support and self-expression opportunities, particularly for vulnerable youth, they also carry risks related to social comparison and inadequate support.

A narrative literature review: Community pharmacy technician well-being and its implications.

<b>Background:</b> In response to concerns over the health of United States of America's (USA) healthcare workers, the USA Office of the Surgeon General emphasized the importance of addressing burnout and poor workplace conditions. This paper presents the findings of the National Area Health Education Centers Organization preceptors’ survey 2024, which assessed the workplace mental health and well-being of USA healthcare preceptors.<br /> <b>Method: </b>The survey, conducted between November 2023 and February 2024, included 123 preceptors in the Area Health Education Centers program from 49 states.<br /> <b>Results: </b>The results revealed insights into the preceptor’s mental health challenges. Notably, 58.2% reported that precepting contributes to burnout, while 41.8% self-reported burnout, and 45.3% felt loneliness. Despite these challenges, 92.5% of respondents reported a high quality of life.<br /> <b>Conclusion: </b>These findings highlight the need for targeted interventions to enhance preceptors’ well-being. This survey identified the importance of supporting the mental health and well-being of healthcare preceptors.

In 2023, the US Surgeon General declared an "epidemic of loneliness and isolation." This study asks: (RQ1) Where do daily social connections come from? (RQ2) Can people find alternative sources of social connection when access from a location is unavailable? Using 10 years of data from the American Time Use Survey, I find that the home is the largest source of social connections in daily life, followed by the workplace and third places. More importantly, when people lack daily social connections at home (i.e., living alone), they have 3.8 h/day fewer connections than people who do not live alone. In contrast, when people lack daily social connections at work (i.e., through unemployment or retirement), they have 1.3 h/day fewer connections than employed people. This significant difference in effect size is explained by the compensation patterns of people lacking daily social connections at home vs. at work. Specifically, people who lack daily social connections at work can compensate for their loss by getting connections from home and third places, whereas people who live alone are not able or willing to find alternative sources of daily social connections from work or third places, highlighting the need to address social isolation at home.

BackgroundThere is growing global recognition that mental ill-health is the leading health and social challenge facing young people. Yet, access to care remains poorest for this age group, and the services available are often not fit for purpose, falling short in cultural relevance, developmental appropriateness, and overall quality. This has spawned a worldwide reform movement led by a blend of clinical research leaders and young people which is building new models of care which are versions of enhanced youth friendly primary care. This base camp is evolving and seeks to create a new space in the health system located between childhood and later adulthood, sensitive to the transitional needs and the force of morbidity that threatens the lives and futures of young people from puberty to independent adulthood.Aims & ObjectivesWe aimed to examine the evolving landscape of youth mental health and identify key contributing factors driving the rise in mental ill-health among young people globally. We also sought to explore emerging explanatory frameworks and assess their implications for prevention and intervention strategies.MethodWe conducted a narrative review to explore contributing factors such as family dynamics, educational pressures, climate change, social media, and socio-economic challenges potentially linked to neoliberal policies.ResultsWe documented mental health trends since the mid-1990s, focusing on mental and substance use disorders among young people and their current needs. Over the very period that youth mental health services focused on the 12–25 year age transition to adulthood began to be assembled, there has been an alarming rise in the incidence and prevalence of mental ill-health in young people. The recent Australian National Study of Mental Health and Wellbeing revealed that the prevalence of operationally defined mental disorders in 16–24-year-olds rose by 50%, from 26% in 2007 to 39% in 2021. The rise in young women was more marked than in young men, with rates reaching 48%. The Australian HILDA survey of 17 000 households/people confirmed a long-term decline in the mental health of this age group. This survey also captured the additional impact of the coronavirus disease 2019 (COVID-19) pandemic and its mitigation strategies. Similar alarming trends had been identified in many other high-income countries well before the COVID-19 pandemic. In 2021, in an advisory to the United States President and Congress, the US Surgeon General, responding to similar trends in the US, described the situation as a “youth mental health crisis.”Discussion & ConclusionsThese fndings suggested that youth mental health was a rapidly shifting and increasingly urgent issue. While new care platforms were being built, broader social megatrends, including rising inequality, digital saturation, and environmental stressors, continued to drive demand. Our review highlighted the importance of both recognising and addressing these deeper structural forces and reforming existing service systems in parallel.We need to focus on prevention and tackle the megatrends in society that are driving this crisis. In addition to new platforms of care there is an equally urgent need for new workforces and for existing disciplines to deepen and expand their expertise in youth mental health.

The National Depressive and Manic-Depressive Association (National DMDA) is the largest patient-directed, illness-specific organization in the United States, representing the millions of people living with mood disorders. Recent National DMDA surveys have shown that people with mood disorders often have incorrect information about their illnesses, that misdiagnoses are frequent, that a significant physician/patient communication gap exists, and that noncompliance is widespread. For optimal recovery to occur, it is important that individuals receive correct information about their symptoms and treatments, that physicians and other healthcare providers understand mood disorders from a patient perspective, and that doctors and patients communicate fully throughout the course of treatment about symptoms, side effects, and other concerns. National DMDA plays an important role in the management of mood disorders by urging those who are undiagnosed or untreated to seek treatment; by providing accurate, easy-to-understand information; and by facilitating support groups in which patients and their families can discuss treatment and management of their illnesses. The organization encourages patients to play active roles in their treatment plans and to attend support groups, which have been shown to increase patient compliance and decrease the incidence of psychiatric hospitalization. According to the US Surgeon General, stigma is the number one barrier to mental health care, and National DMDA’s evidence supports this. National DMDA works to combat stigma with education, advocacy, and patient self-help. Increased awareness and openness about mood disorders can lead to increased acceptance, which, in turn, can lead to more timely diagnosis and treatment. Psychopharmacology Bulletin. 2001;35(4):186-196

ABSTRACT The US FDA has authorized several modified risk tobacco products (MRTPs), permitting marketing claims around modified exposure (i.e. lower exposure to harmful substances compared to cigarettes). We propose that this FDA authorization may serve as a heuristic cue, influencing how people visually attend to the U.S. Surgeon General’s warning to discourage tobacco use and perceive MRTPs and their marketing messages among young tobacco users and non-users. We conducted a 3 (claims: FDA-authorized modified exposure claim vs. the claim only vs. no claim) ×2 (tobacco use status: users vs. non-users) between-subjects factorial experiment with 88 young adults. Eye-tracking and survey data were collected during and after showing a one-minute commercial video for an MRTP, which included the claim and the warning. Participants exposed to FDA-authorized modified exposure claims spent significantly less time looking at the warning and reported greater intent to try the product than the other conditions. While visual attention to the warning did not differ significantly between tobacco users and non-users, tobacco users reported higher interest and intent to try the product. Additionally, there was a significant interaction effect between the claim condition and tobacco use; tobacco users rated the risk of a MRTP significantly lower than non-users only when exposed to the FDA-authorized claim. Our findings support scholarly concerns about the negative impact of FDA-authorized marketing claims for newer tobacco products on young people. Modified exposure claims endorsed by the FDA can reduce attention to risk information, making young people more receptive to tobacco marketing.