TTHealthWatch is a weekly podcast from Texas Tech. In it, Elizabeth Tracey, director of electronic media for Johns Hopkins Medicine in Baltimore, and Rick Lange, MD, president of Texas Tech Health El Paso, look at the top medical stories of the week.
This week’s topics include lifetime stress and racial disparities in mortality, tobacco companies’ adherence to regulations, statin discontinuation during pregnancy, and impact on kids of parental injury due to firearms
Program notes:
0:45 Impact on kids of parental firearm injury or death
1:46 Eight additional psychiatric diagnoses per 1,000
2:39 Lifetime stress, inflammation, and racial disparities in mortality
3:40 Black individuals had shorter survival
4:40 Precise number is difficult to understand
5:40 Self-report
6:45 If a woman has known cardiovascular disease (CVD), can she discontinue statins in pregnancy?
7:45 No difference in woman’s health
8:45 Over a 14-year period
9:00 Policy compliance in leading tobacco brands
10:00 Instagram, Federal Trade Commission (FTC), and FDA policies
11:00 Cut across all types of nicotine products
12:59 End
Transcript:
Elizabeth: Can cumulative lifetime stress and inflammation explain racial disparities in mortality?
Rick: What happened to the mental health of children whose parents have had a firearm injury?
Elizabeth: Are tobacco companies adhering to FDA and FTC regulations?
Rick: And for women with cardiovascular disease who become pregnant, is it safe to stop their statin?
Elizabeth: That’s what we’re talking about this week on TTHealthWatch, your weekly look at the medical headlines from Texas Tech University Health Sciences Center in El Paso. I’m Elizabeth Tracey, a Baltimore-based medical journalist.
Rick: And I’m Rick Lange, president of Texas Tech Health El Paso.
Elizabeth: Rick, in view of the recent gunshot fatalities that are really capturing the nation’s attention, why don’t we turn first to the New England Journal of Medicine and take a look at what happens to kids when one of their parents has a firearm injury?
Rick: Very few studies have actually looked at this, and we have about 20,000 youths each year that lose a parent to a firearm in the United States, and then we have many more that have nonfatal firearm injuries. What happens to the kids after that happens?
These investigators used commercial health insurance claims data in 2007 to 2022. They identified youths that are age 1 to 19 years of age whose parents had received treatment for a firearm injury, and then they matched those kids to five other control youths based on the same year, who did not have a similar circumstance.
What was the primary outcome? Psychiatric disorders among the youths. Did it increase things like medication use for psychiatric disorders or substance use disorders? They examined almost 3,800 youths and the mean age of these youths was just about 11 years.
Once a parental firearm injury occurred, it was associated with eight additional psychiatric diagnoses per 1,000 youths and 23 additional mental health visits per 1,000 youths compared to the control. When they looked at what the most common disorders were, they were mostly trauma-related disorders, including PTSD [post-traumatic stress disorder]. There weren’t changes in other diagnoses, medical encounters, procedure services, or medical spending. It all had to do with the child’s mental health.
Elizabeth: If you were the king of the forest, how would you address this problem outside of awareness and intervention with the children when such circumstances arise?
Rick: Well, Elizabeth, I think that’s exactly what we need to do. We don’t follow up with the children frequently after that, and so this awareness that this is an issue means that we need to address it proactively and make sure that we’re attentive, and provide the psychiatric and behavioral health care that the children need.
Elizabeth: Very sobering issue. Let’s turn from there to another sobering issue in JAMA Network Open, and this is looking at cumulative lifespan stress, inflammation, and racial disparities in mortality between Black and white adults here in the U.S.
This looks at data from a cohort that’s called the St. Louis Personality and Aging Network, which has recruited participants from 2007 to 2011 from the St. Louis, Missouri metropolitan area. They decided to query this stress metric by looking at C-reactive protein [CRP] and interleukin-6 [IL-6], which were measured from serum collected between 2014 to 2019. From that, they developed a CRP-IL-6 composite score that indicated stress. They also looked at mortality and cause of death from CDC data and National Death Index data queried in December 2023.
Among their 1,554 participants, they found that Black individuals had shorter survival times than white individuals. This cumulative lifetime stress and their index measure were each higher among Black compared with white individuals. And when they looked at these associations, they said that this metric accounted for almost 50%, so 49.3% of these racial disparities in mortality data that they collected.
Rick: Elizabeth, this was an interesting article in several ways. One is there’s 12 authors on this in the Journal of the American Medical Association and not a single MD. This is primarily a statistical analysis. The data are pretty clear that inflammation does contribute to chronic disease, increased mortality, and decreased survival. Being able to attach a certain specific percentage, I just find very difficult. I would entirely agree that life stress and inflammation does affect overall disease outcome. But being able to give an exact percentage, I just find that very difficult, even after reading this paper. Your thoughts?
Elizabeth: We’ve talked about before these things are associations and so I think it’s really difficult to put a number on it in that way. And it’d be interesting to hear the authors talk about how they actually created that particular number.
I did think that this cumulative stress index, or the assessment of that, what they did was query them on assessments of childhood maltreatment, adult trauma exposure. They did verify stressful life events, discrimination, and indices of socioeconomic status, including annual household income and highest level of education of participants and their parents. Clearly, a lot of these factors have already been both separately and collectively identified in the past as contributing to the overall stress score, if you will. In some respects, I’m not really surprised by it. The self-report part of it is also something that probably needs to be looked at a little bit more carefully.
Rick: Yep. And I agree with all of that. They’re trying to put some face on why there’s a disparity between Blacks and whites. And this certainly can be one of the explanations. There’s no question about it. Their use, by the way, of using some serum markers, CRP and interleukin, that may be due to stress, it could be due to any type of chronic disease. I do think the message is clear, is that chronic inflammation, and chronic stress, by the way, does affect health deleteriously.
Elizabeth: I agree. And I would just say that in the chaplain role, whenever I have exposures to patients and they tell me their stories, and they tell me what it is that they’re in the hospital for, it’s abundantly clear that their exposures to stressful life events cause their conditions to be exacerbated and increase the number of hospitalizations. People of all ages, too.
Rick: Yep. And as you know, people respond differently. The same stress can elicit a different response from different individuals. Do I think it accounts for some of the disparity? Absolutely.
Elizabeth: A factor that’s well worth trying to get our arms around, I think.
Rick: Absolutely.
Elizabeth: Let’s turn to Circulation.
Rick: If a woman has known cardiovascular disease or is at high risk for it, let’s say she has had a heart attack or had a stroke or has high cholesterol and is on statin therapy, if she discontinues it during pregnancy because of concerns that it may somehow affect the baby, does that deleteriously affect her health as well, either during the pregnancy or over the next several years?
It was a national cohort study conducted in South Korea from their National Health Insurance Database from 2009 to 2023. They looked at women that had been taking statins and then compared those who continue statin therapy throughout pregnancy to those who stopped. If they stop it, do they have an increased risk of heart attack or stroke, or coronary revascularization, or cardiovascular death? And then they look at gestational outcomes.
And what they discovered is that among over 13,000 women who had statin use preconception, about 56% continued statin use and then 44% discontinued it. And when they compared their outcomes, there was no difference at all.
With regard to those who continue statin use, there was not an increase in congenital malformations in the baby. But when they stopped the statins, it was associated with a lower risk of non-live birth, about 11% risk of that, and a low birth weight risk, about a 12% decreased risk of that. This study would suggest that they can stop it without any deleterious effects on the woman’s health.
Elizabeth: I think I would go a little further than that and say it sounds like to me that they ought to stop it.
Rick: That’s what I would conclude as well. The authors have a very nuanced thing and they say talk to your doctor before you do that. There are some whose risk is mildly elevated. There may be some whose risk is significantly elevated and you’d want to have that conversation with your physician before you did that.
Elizabeth: I’m interested in the indications for statins in somebody who’s that age, the age where you would be getting pregnant.
Rick: Mm-hmm. Some of these women may have had a stroke, known cardiovascular disease, believe it or not, they’ve had coronary revascularization. Some of them have a very elevated cholesterol at baseline. But it’s interesting, Elizabeth, as you mentioned. This is over a 14-year period and there were only 13,000 women in Korea taking a statin. So it’s relatively uncommon.
Elizabeth: Let’s finally then turn to The BMJ and this is a look at evaluating policy compliance among leading tobacco brands on Instagram. Clearly, we know that tobacco companies are vested in trying to hook as many users as possible. One of the platforms that they can use for this is social media, is Instagram, and Instagram, of course, targeted largely to younger people.
This study looked at compliance with platform-specific and federal tobacco control policies among leading tobacco brands on Instagram. They examined 1,654 posts between October 2022 and September 2024. They looked at their main page and tagged sections of six leading tobacco brand accounts, those including Vuse, Lost Mary, Zyn, Velo, Lucky Strike, and Winston. They coded them for compliance with Instagram’s, FTC’s, and FDA policies, including age-gating, financial disclosure, and the presence of health warnings and restricted URLs.
They found that almost 70% of their posts contain URL links, unrestricted access to tobacco content that is without any age issue, almost 50%. They had influencers or celebrities appearing in almost 20% of their posts, and of those, almost 42% did not disclose the financial relationship between the brand and that person, the influencer or the celebrity. While 73% of their posts did have a health warning label, only 41% had an age warning label. These leading tobacco brands, both legacy brands and newer types of tobacco products, are not complying very much at all.
Rick: They cut across e-cigarettes, nicotine pouches, which are frequently used among kids as well, and cigarettes. This is extremely disappointing. We have these policies for a reason. We don’t want to take impressionable kids and addict them to nicotine at a young age. The FTC and FDA has regulations. In my opinion, Instagram has social responsibility. The major tobacco companies are using social media to get around these policies and the social responsibility.
Elizabeth: I thought that the legacy brands, the Lucky Strike and the Winston, sure, they were also complicit in all of this. This brand, I’m not familiar with, Lost Mary, also turns out to target things that are especially appealing to youth, including flavored products and their use of bright colors in their ads.
Rick: That Lost Mary is one of the nicotine pouch products. Obviously, we have the policies, but we need to enforce them. And then I think we need to pressure Instagram and other related social media outlets to be responsible.
Elizabeth: The good news here, though, that the authors start out with is that in 2024 about 2.25 million middle and high school students in the U.S. reported a tobacco or nicotine product use in the previous 30 days. And that compares to a 2.8 million in 2023. So the number is going down. And I think with more scrutiny and more visibility, hopefully it will continue to do so.
Rick: Yeah. A reduction of over half a million fewer youth tobacco users in 2024 is a good story. It’s still disappointing that 2.25 million kids, middle and high school students, reported using tobacco in the last month.
Elizabeth: On that note, then, that’s a look at this week’s medical headlines from Texas Tech. I’m Elizabeth Tracey.
Rick: And I’m Rick Lange. Y’all listen up and make healthy choices.
