US Surgeon General Research Articles

The effect of social media use on mental health of college students during the pandemic.

Social media is viewed to be a key contributor to worsening mental health in adolescents, as most recently reflected in a public health advisory by the US Surgeon General. We provide new evidence on the causal effects of social media on mental health of college students during the Covid-19 pandemic, exploiting unique, longitudinal data collected before the Covid-19 pandemic began and at two points during the pandemic. We find small insignificant effects of social media 4months into the pandemic during a period of social distancing, but large statistically significant negative effects 18months into the pandemic when colleges were mostly back to normal operations. Using rich data on substance use, exercise, sleep, stress, and social support, we find some evidence of substitution away from activities that better support mental health at later stages of the pandemic but not at early stages. We find that the negative effects of social media are mostly concentrated among socially-isolated students. Both social support and resilience protect students from the negative effects of social media use. Policy implications include regulating social media while also bolstering social support and resilience as important protective factors.

Factors associated with loneliness, depression, and anxiety during the early stages of the COVID-19 pandemic.

The COVID-19 pandemic was an unparalleled stressor that enhanced isolation. Loneliness has been identified as an epidemic by the US Surgeon General. This study aimed to: (1) characterize longitudinal trajectories of loneliness during the acute phase of the COVID-19 pandemic; (2) identify longitudinal mediators of the relationship of loneliness with anxiety and depression; and (3) examine how loneliness naturally clusters and identify factors associated with high loneliness. Two hundred and twenty-nine adults (78% female; mean age=39.5±13.8) completed an abbreviated version of the UCLA Loneliness Scale, Perceived Stress Scale, Emotion Regulation Questionnaire, State Anxiety Inventory, and Patient Health Questionnaire-8 longitudinally between April 2020 and 2021. Trajectory analyses demonstrated relatively stable loneliness over time, while anxiety and depression symptoms declined. Longitudinal analyses indicated that loneliness effects on anxiety and depression were both partially mediated by perceived stress, while emotion regulation capacity only mediated effects on anxiety. Three stable clusters of loneliness trajectories emerged (high, moderate, and low). The odds of moderate or high loneliness cluster membership were positively associated with higher perceived stress and negatively associated with greater cognitive reappraisal use. Our results demonstrate the important interconnections between loneliness and facets of mental health throughout the early phases of the pandemic and may inform targeted future interventions for loneliness work.

Digital Detox and Well-Being.

In a May 2023 advisory, the US Surgeon General raised concerns about the effects of social media use on well-being. One implied strategy to reduce its impact is abstaining from digital media use. This state-of-the-art review summarizes the most recent studies on reducing or abstaining from digital media use, including social media (ie, "digital detox") and its effect on well-being to inform parents, educators, schools, policymakers, and the public when taking action. In June 2023, we conducted a literature search in Google Scholar, PubMed, and ScienceDirect. We included reviews and original research articles (1) focusing on interventions to reduce screen time/social media time and (2) its impact on/association with well-being. We summarized the key points of the 2 published reviews and 6 articles (published between 2013 and 2023), including 139 articles in total. Our main findings are: there is no clear definition of digital detox and no consistency in the assessment of interventions' effectiveness;reducing social media/smartphone time rather than promoting total abstinence showed more beneficial effects on well-being;the effect of the interventions and their duration varies depending on the type of outcome; andthe effects are influenced by gender, age, and contextual factors. Available evidence on interventions aiming at reducing social media use on well-being is limited, leaving no clear implications for policymaking at this point. More empirical, high-quality research is needed to understand the circumstances under which digital detox interventions are helpful and for whom.

Integrating firearm storage and safety devices into health care.

Millions of US children and adolescents live in homes with loaded firearms, with only half of these homes securing their guns. Firearm-related deaths among youth have doubled over the past decade, making firearms the leading cause of death for children and adolescents in the United States. The recent advisory by the US Surgeon General, identifying firearm violence as a public health crisis, underscores the urgent need for responsible firearm ownership, including safe firearm storage. However, the healthcare community currently lacks durable medical equipment (DME) codes for firearm storage devices, limiting the ability of healthcare providers to support responsible gun ownership. We propose the establishment of DME codes for firearm storage and safety devices, which would facilitate insurance coverage of these vital prevention measures. Durable medical equipment codes would empower physicians and other healthcare providers to integrate anticipatory guidance and lethal means counseling of firearm safety into routine care and support hospital- and community-based efforts to prevent firearm-related injuries and deaths among children and adolescents.

Looking Toward the Future of Integrated Care: History, Developments, and Opportunities

For almost five decades, the development and implementation of integrated care—the simultaneous combination of primary care with mental health and substance use care—has been a major challenge for the behavioral health care field. Integrated care is exceptionally important because many people with behavioral health conditions also have chronic physical health conditions. Early research findings in the mid-1980s showed that persons with mental illness are likely to develop chronic physical conditions earlier and more severely than other people. These findings precipitated efforts to understand this problem and to develop further appropriate integrated care solutions. Subsequently, the US Surgeon General made care integration a major focus of his landmark 1999 Report on Mental Health, as did the 2008 Mental Health Parity and Addiction Equity Act and the 2010 Patient Protection and Affordable Care Act. However, it was not until 2014, and later, that integrated care actually began to be implemented more broadly. This article reviews these major developmental milestones, examines current activities, and explores likely developments over the next several years. Major current issues include the response to the COVID-19 pandemic, adjusting to its effects on the behavioral health care workforce, and the growing realization that behavioral health care must address the social determinants of life. Likely developments over the next several years will include devising ways to address our workforce crisis, developing effective community interventions, and implementing population health management strategies; implementing the CMS Innovation in Behavioral Health Model; improving reimbursement practices; and exploring the potential of AI for integrated care. Implications for future service organization and training of behavioral health care providers also are discussed. Granted the severity of the current workforce crisis in behavioral health care, urgent efforts are needed to advance the deployment of integrated care in the short-term future.

What’s Moral Distress Got to Do With It? How to Avoid Burnout and Optimize Patient Care

Burnout, estimated to affect between 40-80% of healthcare professionals, is a complex issue encompassing emotional exhaustion, depersonalization, and a decreased sense of personal accomplishment. The Stanford Model of Professional Fulfillment considers both individual and system-level factors with three main elements of efficiency of practice, personal resilience, and culture of wellness. Dr. Finkelstein’s alternate model for burnout reimagines the Stanford Model with three main factors contributing to burnout: inevitable suffering, moral distress, and “extra junk.” In Dr. Finkelstein’s alternate model, inevitable suffering arises from the emotional toll of providing patient care. While interventions like coaching, therapy, and mindfulness are beneficial, they must be offered genuinely, not as profit-driven schemes. “Extra junk” refers to administrative burdens that take away from patient care. Some initiatives aim to alleviate these burdens, but their effectiveness needs critical evaluation. Finally, moral distress occurs when external constraints hinder an individual’s ethical actions. Burnout affects not just individual professionals but also the entire healthcare system, leading to early retirements, lower quality care, and worsening health outcomes. Recognizing this, the US Surgeon General has outlined an approach to address burnout that requires cultural changes at all levels of the healthcare ecosystem. Healthcare professionals are resilient, and part of the solution lies in individual recognition of burnout, work-life balance, and finding joy in work. However, larger cultural shifts towards justice and equity, both within healthcare and broader society, are needed. This includes prioritizing workforce diversity, humane sick and maternity leave policies, and reducing unnecessary administrative burdens. Academic institutions also have a role in promoting mentorship, recognizing the contributions of underrepresented groups, and supporting burnout research. Addressing burnout effectively requires a comprehensive approach that considers individual and system-level factors, advocating for systemic reforms, and prioritizing justice and equity within the healthcare ecosystem.

Technology-supported cooperative learning as a universal mental health intervention in middle and high school.

Adolescent mental health issues are a major public health concern, highlighted by the US Surgeon General as a crisis. Traditional school-based interventions show inconsistent success, creating a demand for effective solutions. This study evaluates the impact of technology-supported cooperative learning (CL) on adolescent mental health, focusing on positive peer relations and peer victimization. Participants included 813 adolescents (50.2% female; 70.7% White) from 12 middle and high schools in the Pacific Northwest. The study used hierarchical linear modelling (HLM) to assess the effectiveness of CL facilitated via PeerLearning.net. Implementing CL led to significant improvements in peer relations and reductions in victimization and mental health problems, with moderate-to-large effect sizes observed across different demographics. Positive peer relations significantly predicted lower victimization and improved mental health. The findings highlight the potential of technology-supported CL in addressing adolescent mental health by enhancing protective factors and reducing risks. Such interventions offer a scalable and sustainable approach for schools to address mental health challenges. Technology-supported cooperative learning offers a promising strategy for improving adolescent mental health, demonstrating significant benefits in peer relations and reducing victimization. This approach provides schools with an accessible and effective tool to tackle the mental health crisis among students.

Former US Surgeon General Criticizing $5,000 Emergency Room Bill

No abstract available. Article truncated after 150 words. Business Insider is reporting that Dr. Jerome Adams, US surgeon general from 2017-2021, is complaining about the $5,000 bill after treatment at the Mayo Clinic Arizona emergency room (ER) for dehydration (1). Local media has been slow to pick up on this story with none of the local television, radio, or newspaper sources reporting on the former surgeon general’s ER visit. Adams first shared his experience on X (formerly Twitter) in a post that went viral. In an interview conducted February 26 with Business Insider, Adams said he was taken by ambulance to the ER in January after becoming lightheaded while hiking. He had labs drawn, received 3 bags of intravenous fluid and was discharged. The shock came when he received the bill. He decided to fight and has been spending hours on the phone with hospital billing reps to get a clearer picture of why he was charged so …

The Role of Primary Care in the Social Isolation and Loneliness Epidemic.

The United States is facing a social isolation and loneliness crisis. In response, the US Surgeon General issued an advisory in May 2023 recommending actions that health care, community programs, and social services can take to collaboratively improve social connection. Primary care has a critical role to play in implementing the Surgeon General's recommendations. We present social isolation and loneliness as medical issues and highlight next steps for the primary care sector to combat this epidemic.Annals Early Access article.

Literature Review on Nicotine’s Role in Human Health

Summary Background Next generation of nicotine/tobacco products (NGPs) include electronic cigarettes (ECs), heated tobacco products (HTPs), oral nicotine pouches (NPs) and smokeless tobacco (SLT) products (in particular snus). These products commonly contain nicotine and are intended to replace combustible cigarettes (CCs) and thus can be regarded as tobacco harm reduction products. To fulfill this role, it is essential that nicotine, which has well established addictive properties, is not causally related to health risks upon chronic use. Objectives The purpose of this review is to evaluate the scientific literature to answer the question, whether nicotine is involved in the development of any diseases or disorders associated with the acute, short, mid- and long-term use of NGPs. Appropriate results from studies with nicotine replacement therapy (NRT) products (gum, patches, inhalers, lozenges) are included as reference basis for inferring the health effects of NGPs. Furthermore, suggestions for filling identified gaps and for avoiding or minimizing limitations and weaknesses in study design are provided. Methods Literature databases such as MEDLINE, Google Scholar and an in-house ABF library (containing about 180,000 articles) were searched for relevant articles. Furthermore, pertinent monographs (such as the US Surgeon General Reports) and recent reviews were screened for further publications. Inclusion criteria were: all human studies investigating the association between use (preferably chronic use) of the nicotine/tobacco products mentioned above and health effects, including diseases, disorders, changes in biomarkers of biological effect (BOBEs). In vivo (animal) and in vitro studies were also considered, provided effects of NGPs in the presence and absence of nicotine or in relation to the nicotine exposure dose were reported. Also, reference lists of recent suitable articles were screened. In total, about 500 articles were retrieved by this approach. The role of nicotine was evaluated by considering the article authors’ statements and their cited references as well as by own judgement of reported results. Human studies are presented in a standardized table format. Results In total, 183 human studies were evaluated, with cardiovascular diseases (CVD) ranking highest (N = 75 studies), followed by respiratory diseases (43), oral health disorders (23), cancer (10), metabolic syndrome (7), reproduction disorders (5) and several other diseases (< 5). The majority of studies do not provide evidence for a participation of nicotine in the pathogenesis. Some (weak) evidence was found that nicotine might be involved in some CVD-related effects and metabolic syndrome. This would be also supported by results from animal and in vitro studies. Discussion Human studies showed some severe limitations and weaknesses with respect to the study design and time of availability of NGPs on the market. A severe flaw is the insufficient consideration of dual use (NGP + CC), particularly in studies on chronic use, which could have led to erroneously increased risks for NGPs with direct consequences also for the role of nicotine. Additionally, prior effects from using CC have an impact. Both circumstances could have led to inaccurate conclusions in terms of elevated risk levels, which require changes in method designs. Suggestions for methodological improvements are provided for future studies. Conclusions A final evaluation of the role of nicotine in disease development in NGP users is currently not possible because use durations are too short. Chronic studies often suffer from insufficient separation between NGP only and dual use together with CCs, which may falsely increase the observed health risk. There is some limited evidence that nicotine may be involved in CVD-related effects, which, however, has to be verified in well controlled long-term studies. The potential involvement of nicotine in other patho-mechanisms also requires further research.

Artificial Intelligence in Medicine: A Caution About Good Intentions and Where It May Lead.

Implementing Artificial Intelligence in medicine is revolutionizing how medicine is practiced. It has much promise in bringing about improved clinical outcomes and efficiency while decreasing costs. There are also concerns and unintended consequences that are being realized and significant efforts to consider ethical principles in the implementation of Artificial Intelligence in medicine. One potential consequence may be the loss of what has been described as the soul of medicine: the physician-patient relationship. This relationship is especially precious in the context of what the US Surgeon General Vivek H. Murthy MD has called an "Epidemic of Loneliness and Isolation." This commentary describes considerations and potential steps to protect this vital relationship while implementing Artificial Intelligence approaches to improving patient care. If not vigilant, Artificial Intelligence may unintentionally erode the physician-patient relationship resulting in physician/patient isolation.

IGNITE: Operationalizing The US Surgeon General's Framework for Workplace Mental Health and Well-Being

Workplaces have been called to action by The US Surgeon General's Framework for Workplace Mental Health and Well-Being. Educating the workforce on the five essentials anchored to ten human needs can be a way to create a shared vocabulary about the elements of work design that foster healthy workplaces. Through socializing the Framework, workplaces enable workers to be constructive partners in creating better environments. In addition, there is an urgent need to counter professional isolation and enhance social connection among the entire health care workforce. This article shares the rationale and process of creating a novel program called IGNITE (Inspiring Growth, Networking, Improvement, Togetherness, and Engagement) that operationalizes the Framework. This initiative accomplishes the dual purpose of enhancing individual and organizational resilience through learning about the Framework, while creating space for our entire workforce to build stronger communities and teams. [ Psychiatr Ann . 2024;54(1):e9–e13.]

Cigarette Smoking, Mental Health, Depression, Maryland Behavioral Risk Factor Surveillance System Survey, 2020.

Smoking cessation is linked to improved mental health that encompasses the overall well-being and psychological functioning of an individual. Examine relationships between smoking, mental health, and social connectedness among adults in Maryland, US in 2020. This cross-sectional study used data from the Maryland 2020 Behavioral Risk Factor Surveillance System Survey of adults during the onset of COVID-19. Primary outcomes measured include demographics, depression, and number of not good mental health days among individuals with current and former smoking statuses compared to those who have never smoked. Compared to those who never smoked, individuals who currently smoked had an increased relative risk of reporting 14 or more days of not good mental health (RRR = 1.63, 95% CI: 1.35-1.97, P < .001) and a history of depression (RRR = 1.99, 95% CI: 1.69-2.35, P < .001). Individuals with former smoking status also showed elevated risk, with RRR = 1.24 (95% CI: 1.06-1.45, P = .006) for 14 or more days of not good mental health and RRR = 1.46 (95% CI: 1.28-1.66, P < .001) for a history of depression. Widowed, separated, or divorced; unemployed or unable to work; without a high school diploma; or recent physical exam were inclined to have a current or former smoking status. We identify critical subpopulations vulnerable to life-long smoking behaviors amid the COVID-19 pandemic including adults under 35years old, and those suffering from depression, a lack of social connectedness due to unemployment, changes in marital status, and outdated physical exams. The US Surgeon General's 2023 Advisory on the epidemic of loneliness and the 2021 Youth Mental Health Report emphasize the mental health crises among the young in which these findings serve as a compelling call to action for innovating targeted public health interventions.

Smoking cessation interventions and implementations across multiple settings in Japan: a scoping review and supplemental survey

BackgroundSmoking is the leading risk factor for death worldwide. In Japan, although several evidence-based interventions (EBIs) for smoking cessation have been disseminated or adopted, there is a gap between scientific evidence and the actual implementation. This scoping review aimed to describe the knowledge gaps in local-level smoking cessation interventions in Japan, their implementation outcomes, implementation barriers and facilitators, and the use of implementation strategies.MethodsThis study comprised two approaches: (1) a comprehensive scoping review of primary and grey literature, and (2) a supplemental survey of organizations in the grey literature. For the scoping review, we included original studies or reports on smoking cessation interventions targeting adults aged 18 years and older, or providers of cessation support at various settings (community, workplace, school, and clinical settings) in Japan. The extracted data included basic characteristics, intervention categories, implementation outcomes, factors influencing implementation, and implementation strategies for each intervention. Responses to the supplemental survey were extracted same used for the scoping review. To gain a deeper understanding, semi-structured interviews were conducted with some of the organizations in the survey.ResultsA total of 600 interventions with 691 intervention components, based on EBIs in the 2020 US Surgeon General Report, from 498 articles were included in the data extraction; 32 of the 88 organizations responded to the survey. Regarding the overall knowledge about smoking cessation intervention components, behavioral counseling, and cessation medication in clinical settings were mostly reported (34.7%). Implementation outcomes were measured in 18 articles (3.0%) and penetration was mostly reported. Regarding influential factors, “available resources,” and “knowledge and beliefs about the intervention” for barriers, and “relative priority” for facilitators were mostly reported. Implementation strategies were measured in 29 articles (4.8%), and “Train and educate stakeholders” was mostly reported.ConclusionsMost EBIs reported in the Japanese literature included smoking cessation treatments in clinical settings. While a few articles focused on the implementation indicators in Japan, significant knowledge and experience were extracted from the grey literature, especially in the workplace and community settings. Future research should focus more on implementation to reduce the knowledge gap regarding smoking cessation interventions.

The impact of social media use on depression, anxiety, and well-being for teens/young people: using hypnosis to build a strong sense of self

ABSTRACT The national conversation continues to focus on the negative impact of social media on teens/young people. The lingering effects of the pandemic revealed sharp increases in the common practice of “compare and despair” as well as higher rates of loneliness, isolation, depression, and self-harming behaviors. In May 2023, the US Surgeon General warned that social media “is the defining public issue of our time” and is driving the teen mental health crisis. These concerns for the mental health of humans across the globe are real and dramatic. Social media’s impact on young people can be neutral, negative, positive or shades of each. The hypnosis community has an opportunity to be a more vital presence in helping young people navigate, manage, and reduce negative social media impact and to harness social media’s very positive contributions, many of which are well documented. This article focuses on assessing social media use in teens and young adults, identifying developmental tasks being practiced on social media, and how factors such as time spent on social media and social media experiences have promoted trauma, stress, depression and anxiety. In addition, it will consider some of the ways in which the isolating effects of COVID-19 have further impacted well-being. Finally, the article will discuss how hypnotherapists can leverage social media to foster stronger ego strengthening using therapeutic interventions that employ hypnosis, hypnotherapy techniques and interventions, hypnotic scripts, and social media to lower mental health risks in teens/young adults.

Stress, anxiety, and illness perception in patients experiencing delay in operative care due to the COVID-19 pandemic

BackgroundAmid the height of the COVID-19 pandemic in the US, the US Surgeon General ordered hospitals and healthcare systems to stop all elective surgical procedures. The aim of our study was to evaluate the additional mental health impact of surgical delay on patients awaiting surgery for benign, pre-malignant and malignant conditions within the context of the COVID-19 pandemic. Study designAll patients over the age of 18 awaiting surgery for benign, pre-malignant or malignant conditions within the gynecologic oncology, surgical oncology and colorectal services across Northwell Health were eligible for participation. Upon successful enrollment, participants completed a baseline questionnaire consisting of the Generalized Anxiety Disorder Questionnaire, the Penn State Worry Questionnaire, and Brief-Illness Patient Questionnaire. ResultsThe surgical delay was considered moderately to extremely concerning by 72 % of survey respondents, with one third indicating the highest (10/10) level of concern. Fifty-five percent of patients with a pre-operatively suspected/confirmed cancer or pre-malignant condition demonstrated mild to severe anxiety in their completion of the GAD-7 scale. The average time awaiting surgery was 117 days (range 8–292); and 63 % of respondents indicated that the delay had a moderate to severe impact on their daily life. ConclusionsPatients awaiting surgery for confirmed, suspected or pre-malignant conditions expressed decreased sense of control and increased levels of distress compared to patients awaiting procedures for benign conditions (p < 0.05, 95 % CI [-2.65, -0.08]). Future research will focus on the effects of COVID-19 related delays in operative care on clinical outcomes, including cancer morbidity and mortality.

Anti‐LGBTQ+ sex education laws: The effects on students and implications for schools and school practitioners

AbstractAnti‐Lesbian, Gay, Bisexual, Trans, and/or Queer (LGBTQ+) education laws are defined as laws that prohibit or limit schools from discussing same‐sex relationships, broader sexuality, and gender issues in their sexual education curriculum. This study presents a historical context of anti‐LGBTQ+ sex education laws, examines the extant literature on the possible impact of these laws, and suggests recommendations for schools and school practitioners. Anti‐LGBTQ+ sex education laws may impact school climate and have been associated with poorer well‐being for LGBTQ+ students and cisgender heterosexual allies that encompass a range of sexual orientations and gender identities. With an Executive Order from the US president outlining the need to support LGBTQ+ youth in schools and the US Surgeon General's Advisory to highlight the urgent need to address the nation's youths' mental health, it is imperative to support LGBTQ+ students. We offer strategies that may be used to address anti‐LGBTQ+ sex education laws by school administrators and practitioners in a call for advocacy to make changes in sex education policy to improve the well‐being of students, particularly LGBTQ+ youth.

Perceived Impact of Affect Labeling and Social Sharing in Healthcare: Insights from a Pilot Study and Opportunities for Future Investigation

Perceived Impact of Affect Labeling and Social Sharing in Healthcare: Insights from a Pilot Study and Opportunities for Future Investigation

HEALing Our Nation - Health Equity Achieved Through Lifestyle Medicine Capturing Highlights From the "HEALing Our Nation" Session at LM2023 and Outlining the Important Work of the HEAL Initiative.

Since the COVID-19 pandemic, health equity has been placed front and center in the conversations surrounding healthcare as well other fields. This conversation has also been occurring in the field of lifestyle medicine with an intentional focus on developing solutions at the intersection of lifestyle medicine and health equity. Initiated by a call to action by ACLM Past President Dexter Shurney at the 2019 Lifestyle Medicine conference, the HEAL Initiative was created with that intention, to address health disparities and advance health equity through lifestyle medicine. Since 2019, the HEAL initiative has grown considerably in its work and impact, creating solutions aligned with the AMA strategic planning recommendations as well developing projects that are examples of community engaged-lifestyle medicine. The work of the HEAL initiative culminated in a full circle moment at the 2023 Lifestyle Medicine Conference which featured an interview (facilitated by Dr. Dexter Shurney) with former US Surgeon General Dr. Jerome Adams and review of HEAL's work over the past 3years. This article will capture the key highlights of the HEALing our Nation opening session and the cumulative work of HEAL Initiative.

Editors in Chief of Public Health Reports, 1878-2022: Men and Women Who Shaped the Discussion of Public Health Practice From 1918 Influenza to COVID-19.

Public Health Reports (PHR), the official journal of the Office of the US Surgeon General and US Public Health Service, is the oldest public health journal in the United States. Considering its heritage through the eyes of its past editors in chief (EICs), many of whom have been influential public health figures, can provide a fresh point of view on US public health history, of which the journal has been an integral part. Here, we reconstruct the timeline of past PHR EICs and identify women among them. We reconstructed the PHR EIC timeline by reviewing the journal's previous mastheads and its articles describing leadership transitions. For each EIC, we identified dates in office, concurrent job titles, key contributions, and other important developments. PHR had 25 EIC transitions in 109 years of its history, during which a single individual in charge of the journal could be identified. Only 5 identifiable EICs were women, who served as EIC for approximately one-quarter of the journal's traceable history (28 of 109 years). PHR's longest-serving EIC was a woman named Marian P. Tebben (1974-1994). PHR history revealed frequent EIC transitions and a low representation of women among its EICs. Mapping the timeline of past EICs of a historic public health journal can yield valuable insights into the workings of US public health, especially in the area of building a research evidence base.