Led by Sarah Lowe, a professor of public health in social behavioral and sciences at the School of Public Health, in collaboration with researchers from the Harvard T.H. Chan School of Public Health, the University of Chicago and Oxford University, the researchers reviewed the scientific literature on the connection between chronic climate change and mental health issues. The study reported that the existing research is sparse — and scientists ought to do much more to help inform specific public health interventions. 

“Climate change is already harming human health, including growing mental health impacts,” Anthony Leiserowitz, the director of the Yale Program on Climate Change Communication, who was not involved in the study, wrote in an email to the News. “This paper underscores the critical need for more research on these impacts and investments in providing mental health support for individuals and communities struggling with the issue of climate change and the aftermath of climate change disasters.”

There is substantial evidence that natural disasters caused by climate change, such as hurricanes — which many scientists consider to be acute climate change — can directly impact mental health.

During a recent Climate Change and Trauma Webinar with the International Society for Traumatic Stress Studies, Betty Lai, a professor in counseling psychology at Boston College who was not involved in the study, highlighted this connection. 

“Disasters are directly linked to potential mental health distress symptoms,” Lai said.

Lai said that climate disasters especially affect children, recalling one study that demonstrated that one in four children who witnessed Hurricane Ike in 2008 were still reporting anxiety and PTSD symptoms 15 months later. 

In the webinar, Lowe noted that much of her research typically centers on the long-term mental health consequences of traumatic events. Her doctorate began with a study on how Hurricane Katrina exacerbated socioeconomic and racial disparities. 

However, after joining the School of Public Health in 2019, Lowe said, she realized that the bulk of research on climate change and mental health focuses only on acute climate change and not on the effects of long-term climate change. 

“[I]t seemed obvious that climate change could influence mental health in other ways, and I was hearing a lot from young people and in the media about how the threat of climate change escalation was leading to significant anxiety,” Lowe wrote in an email to the News. “We decided to embark on this systematic review to see what work had been done on the topic, knowing that there was likely to be research outside of our specialties.”

In the study, the researchers analyzed qualitative, quantitative and mixed-methods studies that examined the effects of slow-onset climate change on mental health indicators, which, according to Lowe, ended up being a “huge undertaking.” After screening over 10,000 abstracts, they included only 57 in the final review. 

They found that there is a lack of research on the specific link between chronic climate change and PTSD and post-traumatic stress symptoms. Most studies, they claimed, tended to focus on how the climate affects anxiety and depression symptoms and negative emotions, such as sadness, fear and anger. In addition, they noted that low and middle-income countries, the places most likely to feel the effects of chronic climate change, have less research output.

Lowe said she was especially surprised by how small the body of literature is on chronic climate change and mental health.

“As a point of comparison, I conducted a review of studies published in 2018 on PTSD and depression symptoms after disasters; in that single year, without using gold-standard systematic review methodologies, and focusing on only two outcomes, my colleagues and I identified 100 peer-reviewed articles on the topic,” Lowe wrote. 

For Lowe, because this body of research is so small, it is too early to determine the main differences between chronic climate change and acute climate change. Still, the preliminary evidence suggests that acute natural disasters may have more consistent negative impacts and are more likely to cause PTSD-related symptoms. 

Lowe emphasized the importance of conducting more qualitative and quantitative research across different disciplines to clarify the effects of chronic climate change. She also noted that longitudinal cohort studies, combined with interviews and focus groups, could help researchers learn more clearly how climate change affects overall well-being. 

Joan Monin, a professor of public health at the School of Public Health, who was not involved with the study, praised the call for more climate change research, noting how it could impact future policy. 

“This work is so important because it suggests that policymakers can implement changes to mitigate the effects of climate change,” Monin wrote in an email to the News. “This can have far-reaching effects on the mental health of large communities.”

According to the National Institute of Mental Health, it is estimated that one in five adults in the United States live with a mental illness. 

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From 2017 to 2019, Congress awarded $30 million in funding to the CDC and NIH to study firearm injury prevention. But from 2020 to 2022, the federal legislature reappropriated federal funds and awarded the agencies approximately $150 million. The study, led by researchers from the School of Public Health, the School of Medicine, the University of Pennsylvania Perelman School of Medicine and Brown University, found that the number of clinical trials and research publications concerned with firearm prevention from the past three years increased by 90 percent compared to the previous period.

“This study brings light to the significant historical gap in funding for firearm injury prevention research, and the impact that a relatively small amount of federal funding can provide,” James Doddington, a professor of pediatrics and emergency medicine at the School of Medicine who did not participate in the study, wrote in an email to the News.“Importantly, it is studies like this that can assist policymakers in building the case for consistent federal funding and building national data infrastructure for understanding firearm injury over the lifespan.”

Megan Ranney, the current dean at the School of Public Health, was the senior author of this study, and Guangyu Tong, an assistant professor of cardiovascular medicine at the School of Medicine, was a contributing author.

According to Tong, a “drought” in federal funding for gun violence research began in 1996 following the passing of the Dickey Amendment, which stated that “none of the funds made available for injury prevention and control at the Centers for Disease Control and Prevention (CDC) may be used to advocate or promote gun control.”

Spearheaded by Republican congressman Jay Dickey, this legislation was passed in response to growing concerns from gun rights activists that this funding could finance research that would advocate for more stringent gun control.

However, Tong said that the interpretation of this provision drastically changed after the shooting at Sandy Hook Elementary School in December 2013.

“There was a clarion call for action, which led to a reevaluation of the Amendment,” Tong wrote. “The Obama administration clarified that the Amendment did not prohibit research into gun violence itself, just the advocacy of gun control. This clarification aimed to reignite scholarly inquiry into this pressing public health issue, albeit within the constraints of not using federal funds to advocate for policy changes.”

Nevertheless, the impact of the Dickey amendment persisted even after that clarification since, according to Tong, government funding for gun violence research remained significantly lower than other public health issues. 

In 2020, this changed. Congress reappropriated more funding to the NIH and CDC specifically for gun violence research. According to Ranney, the change was the “result of the years of work by the public health and healthcare community, medical organizations, and by the [gun violence] survivor community,” who lobbied for more federal funding for gun violence research.

Ranney also credits the reappropriation of funding to the #thisisourlane social media campaign, in which she and other researchers discussed how gun violence is a public health issue that should receive more funding.

Ranney noted that their study only examined the number of gun violence studies conducted after funding reapportionment. She emphasized that researchers must conduct more studies to analyze the quality and impact of these studies on preventing injury from gun violence.

According to Kirsten Betchel, a professor of pediatrics and emergency medicine at the School of Medicine, increased research for gun violence is critical, as the landscape of gun violence in the United States has changed drastically over the past few years. Since the beginning of the COVID-19 pandemic in 2020, more Americans have bought firearms. In turn, there have been more injuries from firearm violence, particularly ones involving children. Betchel argued that it is necessary to conduct more gun violence research to help unpack these trends.

“We need to understand why [more] people bought firearms in the first place, and that requires a lot of time, effort and resources,” Betchel said. “It matters that funding be commensurate with that sort of effort to understand these questions so that we can prevent these injuries.”

Betchel explained that before the reapportionment of funds, Congress gave out more funding to study rare diseases than for firearm injury, even though more people in the United States are affected by firearm injury. It was only recently that the proportion of federal funding moved closer to the actual “burden of injury” of gun violence in the United States.

Yong also emphasized the importance of federal funding to incentivize gun violence studies, explaining that more studies on gun violence are critical in shaping policy to prevent gun violence.

“When it comes to implementing policies, we must leverage the insights gained from this research to enact measures that tangibly reduce gun violence,” Yong wrote. “This approach ensures that policy decisions are informed by solid evidence, paving the way for safer communities.”

In 2023, more than 40,000 people were killed by gun violence in the United States.

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“Tripledemic” refers to the three illnesses — respiratory syncytial virus, or RSV; the flu; and COVID-19 — that spike every winter and fall.

Scott Roberts, an infectious diseases specialist and associate medical director at the School of Medicine, said he believes multiple indicators show that levels of all three respiratory illnesses have already peaked in Connecticut.

“Caseloads across the state, wastewater data and current hospitalizations are now showing slight decreases in all three viruses,” Roberts wrote in an email to the News. “I always take these [post-holiday break] weeks with a grain of salt because often there is decreased testing due to the holidays, but regardless, I am enthusiastic the downward trend will continue.” 

Roberts said he doesn’t believe we will see a resurgence of COVID-19 this season since there is “no new concerning variant on the horizon.” However, he suspects that there could be a second wave of flu infections due to the influenza B viral variant, which frequently circulates later in the season. 

According to Madeline Wilson, an assistant professor at the School of Medicine and the chief campus health officer at Yale, there is currently an increase in respiratory virus activity among students on campus due to classes resuming and students returning to campus after the holiday break. Still, given the national and local outlook, she does not expect this trend to last for long. 

“We fully expect cases on campus to wane over the next several weeks,” Wilson wrote in an email to the News.

According to Roberts, the 2023-24 flu season looks very similar to last year’s, although cases this year seem to be peaking later, around New Year’s instead of early December. 

Further, this year’s and last year’s flu seasons remain much worse than the 2020-21 and 2021-22 flu seasons, likely due to the loosening of COVID-19 restrictions since then.

“[W]e saw this last year especially,” Roberts said. “Since no one encountered flu for a prolonged period, there was likely waning immunity that resulted in a more severe flu season than usual since so many people were newly seeing flu again and had lost some of their baseline immunity.” 

Roberts noted that while the COVID-19 pandemic may have increased the severity of the past two flu seasons, it may have also brought about some positive changes to flu season. The pre-COVID-19 pandemic 2019-20 flu season was comparable to the 2022-23 flu season due to very high levels of influenza B variant in 2019. However, during the COVID-19 pandemic, the Yamagata strain of influenza B has become extinct, which Roberts said is “remarkable.” Today, this strain is no longer included in flu vaccinations.

According to Thomas Murray, a pediatric infectious diseases physician and associate medical director at the School of Medicine, flu season has returned to pre-pandemic patterns, even with the introduction of COVID-19. Nevertheless, he notes that it is important to test for COVID-19 if you have symptoms.

“It is very difficult to tell the difference clinically between these different viruses,” Murray wrote in an email to the News. “To help contain spread if you have signs and symptoms of respiratory disease I would recommend a COVID-19 test and possibly an influenza test, as both can spread easily in populations that spend a lot of time together in congregate indoor settings.”

Roberts also recommended that students implement the “tried and true” strategies for preventing illness and its spread to others, such as hand washing, good ventilation, masking in high-risk settings, staying home when they are sick and keeping up with vaccinations. He encouraged students to remain up to date on CDC guidelines for vaccination since there have been several changes this year, including a new RSV vaccine and an updated COVID-19 vaccine. 

Flu and COVID-19 shots can be scheduled online for free for all Yale Health members, Yale University employees and Yale University students.

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Since Russia’s full-scale invasion of Ukraine, according to the report, at least 2,422 Ukrainian children between the ages of six and seventeen have been taken to 13 different facilities in Belarus.

“This report shows the Lukashenka regime of Belarus and Vladimir Putin’s government working together hand in hand to create a network for identifying, transporting, indoctrinating and in some cases, engaging in military training [of Ukrainian children],” Nathaniel Raymond, the executive director of HRL, told the News.

As part of the State Department-funded Conflict Observatory initiative, Raymond and the HRL first documented Russian efforts to relocate thousands of Ukrainian children in February, releasing a widely circulated report that found evidence of a network of 43 re-education and adoption facilities stretching from Crimea to Siberia. 

Raymond emphasized that many of these Ukrainian children involved come from “very vulnerable contexts;” many are orphaned, disabled, from low-income families or have parents fighting in the war.

The researchers found that children were subject to pro-regime “re-education” in at least eight of the 13 facilities described in the report, including promotion of political, cultural and social messages that serve the political interests of Belarus and Russia. 

According to David Simon, the assistant dean for graduate education at the Jackson School of Global Affairs, the deportation and re-education of Ukrainian children would likely be considered war crimes by the International Criminal Court.

“Clause 2(e) of the Genocide Convention stipulates that ‘the forcible transfer of children from one group to another’ is an act of genocide if undertaken with an intent to destroy a nation, racial, ethnic, or religious group in whole or in part,” Simon wrote in an email to the News. “The pairing of the program to relocate Ukrainian children from Ukraine to Russia and Belarus with programs to replace Ukrainian language with Russian (or Belarusian) language while ladling out heavy doses of the patriotic propaganda mandated by Belarusian law could be construed as precisely that.”

The report also found that at least six of the 13 facilities subjected the children to military training, and at least 67 children in total have been transported to hospitals for unknown medical treatments, which Belarusian officials refer to as “rehabilitation.”

The report details that Lukashenka has directly overseen Belarus’ efforts in relocating children by approving state and non-state organizations to transport Ukrainian children to Belarus, financing their relocation through the joint Russia-Belarus Union State budget and even visiting some of the children on multiple occasions.

Russia’s Investigative Committee and the Ministry of Education of the former Luhansk People’s Republic and Donetsk People’s Republic have helped to identify and target children to be sent to facilities in Belarus.

 Besides government officials, Raymond said that there is also a “unique constellation” of individuals and regime-aligned organizations involved in the transportation and “re-education” of Ukrainian Children. Some of these include a Belarusian Republican Youth Union group, pro-Russia ultranationalist militant motorcycle clubs based in Belarus and a Donetsk-based organization called the “Dolphins” that provides swim lessons to disabled children.

The researchers primarily used open-source information to gather evidence, and they verified all their claims in accordance with ethical standards established by guidelines like the Berkeley Protocol on Digital Open Source Investigations. These measures included aggregating and cross-validating multiple sources of information to identify the number of children transported to each facility and the activities going on at the facilities. 

In the process, the Humanitarian Research Lab team primarily used statements and documentation directly from the Russia and the Belarusian Lukashenka regimes. They also relied on social media posts from those who were directly affected by the re-education and transport, including children and their parents.

For Raymond, social media has been a crucial source of information since the Russia-Ukraine war began.

“Since we started monitoring the war in Ukraine in late winter or spring of last year, we have seen the amount of social media from individuals and from state organizations engage in violations of international law,” Raymond said. “We have seen the volume of social media produced from them about their acts on a level that we have never seen in any other conflict … The primary source of confirmation has been the statements, photos and posts of the perpetrators themselves.”

Raymond noted that opposition groups in Belarus have delivered evidence related to this case to the International Criminal Court. Additionally, Sviatlana Tsikhanouskaya, the exiled opposition leader of Belarus, has called for an international court indictment against Lukashenka.

In an email to the News, Daria Valska ’26, the current president of Ukraine House at Yale, said the report of Belarus’ involvement was “sickening.”

“On behalf of Ukraine House at Yale, I thank Yale HRL for shedding light on Belarus’ and Russia’s illegal deportations and all other work they do for my country…” Valska wrote. “This report shows just a part of the systematically-imposed terror Ukrainians from occupied territories suffer from. People at Yale and beyond should understand that the only way to end the genocide Russia commits is to help Ukraine win the war and regain sovereignty over all of its territory.”

On Nov. 16, the U.S. Department of State published a press release on the report, affirming that the United States will “continue to pursue accountability for actors involved in abuses connected with Russia’s war against Ukraine.”

The Conflict Observatory program was announced by the State Department on May 17, 2022.

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The HPSA program is a federal program that designates specific geographic areas, populations or facilities with a shortage of primary, dental or mental healthcare providers. The researchers found that 73 percent of the regions the program designated as high-need areas still experienced healthcare shortages ten years after their original designation, despite the HPSA’s efforts to mitigate disparities.

“[This study] demonstrates the inability of [a] well-intentioned health policy to achieve its goals,” Leslie Curry, a professor of public health at the School of Public Health, wrote in an email to the News. “Physician shortages and the associated impacts on mortality have not improved even after a decade of policy implementation. Clearly the HPSA program needs to be refined, and hopefully, this study compels action. This is another excellent example of why it is essential to work at the intersection of evidence generation and policy development.”

The study was led by Justin Markowski GRD ’24, a doctoral candidate studying health policy and management, Jacob Wallace, an assistant professor of public health, and Chima Ndumele, an associate professor of public health who also works for the Institute for Social and Policy Studies.

According to Markowski, the HPSA incentive program was founded in the 1960s, and it has continued expanding through the subsequent decades. Underserved areas petition on the state level to be identified as HPSAs. The program then offers various incentives, such as student loan forgiveness and medicare reimbursement, to encourage physicians to continue practicing in these areas. 

“[The HPSA program is] a critical part of the healthcare safety net, and it amplifies a federal approach to identify and mark need and underserved communities across the country,” Markowski told the News.

Though the program’s primary goal is to reduce physician shortages in these underserved areas, Markowski noted that there has been little research on whether the program is having its intended effect. To test the program’s effectiveness, Markowski and the other researchers identified the number of physicians and mortality rates in different areas around the country. Then, they compared HPSA-designated areas with “control counties,” areas that had similar demographics to HPSA counties but never petitioned for HPSA designation. 

After this analysis, they found that there was little difference in physician density or mortality rates between HSPA counties and the controls. 

“We believe that the program is really great at identifying and characterizing a salient problem … [but] it just has been ineffective at ameliorating that need,” Markowski said. “We believe that this is due to incentives that are not tuned appropriately or targeted or sufficiently targeting the right areas.”

The study then identifies two alternative strategies to improve the program’s effectiveness. First, they suggested that the program should expand some of its incentives, such as giving providers in underserved areas greater autonomy.

Second, the researchers suggested that the program use incentives aimed at recent medical school graduates rather than current physicians. Markowski said that this strategy may be effective because many physicians tend to stay in a certain area once they establish a panel of patients, and many of these HPSA areas don’t have any physicians at all.

“It’s important to discuss and think critically about and the other incentive is definitely looking at the actual mechanisms of healthcare practitioner decisions,” Markowski said. “The idea is that maybe if we think really carefully about attracting young physicians and really helping them make the decision and shift that burden toward wanting to practice in an underserved area.”

Markowski believes it is important for the program to think of more creative solutions and incentives to mitigate physician shortages and health disparities. Overall, the team said that researchers should conduct future studies to examine whether these solutions are effective. 

Jess Graham GRD ’28 praised the researchers for questioning the impact of current health policies. 

“I think that it’s a good thing that researchers at the School of Public Health are trying to determine whether current health policy is effective,” Graham said. “I think it’s important to stop and assess whether current policies are having their intended actions and if they are not, figure out effective methods to mitigate these health disparities.”

The School of Public Health was founded in 1915. 

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The money, which was announced during the school’s centennial celebration kick-off event on Sept. 21, will help offer students full-tuition scholarships as part of the YSN Community Scholars program. The program currently provides scholarships covering full tuition, fees, health insurance and an additional stipend of $20,000 for the six selected students each year.

Gail McCulloch, the nursing school’s associate dean for development and alumni affairs, said that the new donation will be instrumental in providing many deserving students with the opportunity to attend nursing school without going into significant debt. 

“Yale nurses and midwives often graduate with six figures of debt, a prohibitive burden to many talented people who would be incredible assets to the nation’s most trusted profession,” McCulloch wrote in an email to the News. “This gift makes it possible to welcome a cohort of future nurse leaders regardless of their ability to pay … They will be able to bring their advanced practice skills to healthcare deserts in rural areas, underserved communities and structurally marginalized populations.”

At the nursing school, the two nursing tracks for master’s students include the Master of Science in Nursing, which is for students with a bachelor of science in nursing, and the Graduate Entry Pre-Specialty in Nursing program, which is meant for those with no nursing experience. Students in either program are eligible to submit an application to the Community Scholars program. 

Students who apply are selected based on academic achievement, financial need and their demonstrated commitment to working with underserved communities and reducing health disparities.

According to the American Association of Colleges of Nursing, there will be a shortage of registered nurses in the U.S. by 2030. The AACN fact sheet on their website claims that the shortage may be due to the increased need for healthcare as the Baby Boomer generation ages, as well as the increased number of nurses leaving the workforce in the past two years, likely due to stress caused by the pandemic. 

According to Azita Emami, dean of the nursing school, the school’s Community Scholars Program aims to help address this shortage by making education more accessible for students from historically underserved communities. 

“YSN’s mission is better health for all people, and the Community Scholars Program is a signature effort toward making health equity a reality for all the populations we serve,” Emani wrote in a press release. “Our students, our faculty, and our school refuse to accept that the status quo of longstanding and shameful health disparities is inevitable and unchangeable.”

Emani said she expects Community Scholar students to act as “multipliers” once they graduate, helping to advance health equity and healthcare accessibility in their practice.

Carolyn Stewart NUR ’25 is a second-year student in the MSN program specializing in psychiatric and mental health. She praised the historic donation as well as the Community Scholars program for helping current and future nursing students. 

“It’s a beautiful thing to create opportunities for people to enter the nursing and advanced practice registered nurses [APRN] space, especially given the provider shortage our country is facing,” Stewart wrote in an email to the News. “It is encouraging and inspiring to think about how this gift will impact future YSN students. I am confident that the students receiving these scholarships will embody YSN’s mission of better health for all people, and I am sure they will go on to do great work in their respective specialties.”

In addition, according to the press release, the University will match the donation as part of its For Humanity fundraising campaign, making the total donation $22.2 million. The campaign, which was launched in fall 2021, aims to raise $1.2 billion for scholarships and fellowships across different University programs. 

Ekaterina Ginzburg, assistant dean of teaching and learning at the nursing school, spoke in an interview with the News about the overall importance of such a donation to the nursing profession.

“This is a very exciting event for the school,” Ginzburg said. “The nursing profession helps everybody in the most difficult times of their lives. This gift is a tremendous recognition of the importance of the nursing profession and nursing education.”

The Yale School of Nursing was founded in 1923. 

Correction, Nov. 29: The article was updated to include the correct term for an abbreviation.

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The study was primarily led by Emma Mew GRD ’25, a doctoral candidate studying chronic disease epidemiology, in tandem with her faculty advisor Nicola Hawley, an associate professor of epidemiology and an affiliated faculty member at the Yale Institute for Global Health. Mew and Hawley worked in collaboration with Jueta McCutchan-Tofaeono, a clinical psychologist in American Samoa.

McCutchan-Tofaeono praised the study for its cultural sensitivity to American Samoan culture.

“Being a Samoan mental health professional who was trained in the US, I was always struck by the extremely limited disaggregate data on Pacific Islanders,” McCutchan-Tofaeono wrote in an email to the News. “Even articles that included the term ‘Pacific Islanders’ enumerated little if anything at all on the unique needs of Native Hawaiian/Pacific Islanders … Rather than taking traditional Western models, normed on Western values, and attempting to make them fit, this research allows us to start from the ground up, to really understand the unique needs of our own people.”

“To our knowledge, this is the first scientific study published on youth mental health in a Samoan context,” Mew wrote in an email to the News. “This study took a community-directed approach that gathered perspectives from local leaders … [and] showed that mental health is a major health issue among youth — including a high suspected prevalence of suicidality, depression, anxiety, trauma and stressor-related disorders.”

Hawley, whose research lab is entitled the “Samoan Obesity, Lifestyle and Genetic Adaptations Study Group,” has researched topics on American Samoa for over ten years. While her research typically focuses on treating and preventing obesity and diabetes in resource-poor and low-income populations, the idea for this particular study came about with the realization that effective interventions for diabetes and obesity also require a foundational understanding of the population’s mental health. 

When conducting the study, the researchers followed a Samoan framework of research called Fa’afaletui, which researchers from the University of Auckland translated as ‘‘‘ways of’ [fa’a] ‘weaving together’ [tui] deliberations of different groups or ‘houses’ [fale].’’ 

This research framework aims to be more culturally sensitive than many North American and Anglo-European research models, allowing researchers to hear the perspectives of different groups in the society of interest to minimize their own cultural biases before drawing final conclusions. 

Keeping the ideas of Fa’afaletui in mind, the researchers conducted 28 in-depth interviews with adults living in American Samoa. Each interview began with the same question: “Can you tell me about your thoughts on the state of mental health among adolescents in American Samoa?” The conversations often revolved around common mental health problems observed in American-Samoan youth, including depression and anxiety, alongside stressor-related psychiatric disorders.

The researchers acknowledged that while most adolescents seemed to excel in their work, faith and communities, many still struggled with mental health issues, including suicidal ideation. In addition, many participants noted that mood disorders, substance use and non-suicidal injury are also common. 

Additionally, many interviewees expressed their frustration with existing services that treat adolescent mental health issues. In response, the researchers identified multiple common needs and policy proposals that need to be addressed.  

The researchers recommended adding more mental health professionals and strengthening case identification to bolster existing mental health services, reducing barriers for adolescents needing treatment and maintaining consistent funding to increase the sustainability of the project. Ultimately, the researchers called for increased collaboration and communication between local leadership on adolescent mental health challenges. 

Hawley acknowledged that the most challenging part of the study was hearing about how a community she cares so deeply about is affected by mental health issues. Still, Hawley praised the American Samoan community for their efforts and dedication to improving mental health services for adolescents.

“[T]he biggest takeaway for me was the incredible strengths that lie in the community organizations supporting mental health in American Samoa,” Hawley wrote in an email to the News. “They are already achieving remarkable things with very few resources, but with consistent funding and political support, [they] could do much more.”

Pew also noted that it was difficult to ensure that the study adequately featured the locals’ voices, given the paper’s limited word count. Nevertheless, she said that the process of conducting these interviews was extremely rewarding, as it allowed her to hear many different perspectives and build diverse connections with members of the American Samoan community. 

Sarah Lowe, a clinical psychologist and an associate professor of public health in social and behavioral sciences, helped develop interview questions related to mental health and interpreting data from the interviews. Lowe hopes that the themes they gathered in the interviews will encourage other researchers and policy workers to brainstorm models for mental health treatment.

“We have surveyed existing interventions and have come to the conclusion that none fully meets the community needs,” Lowe wrote to the News. “We are therefore hoping to culturally adapt an intervention that would include parents and children, with the goal of improving family wellbeing and decreasing youth’s mental health symptoms.”

According to the United States Census Bureau in 2020, American Samoa has a population of 49,170.

Update, Feb. 12: The article was updated to include quotes from Jueta Mccutchan-Tofaeono.

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According to Daniel Carrion, an assistant professor of epidemiology at the School of Public Health who was not affiliated with the study, the link between asthmatic patients and air quality found in the study is an important example of how climate change and pollution can directly impact human health.

“This work is both important and unsurprising,” Carrion wrote in an email to the News.  “Long-standing research shows that air pollution causes asthmatic exacerbations and mounting research shows that wildfire incidence is increasing with climate change. This timely study helps to highlight that poor air quality days from distant wildfires aren’t simply a nuisance, but they result in real-world health impacts.”

The study was led by Kai Chen, a professor of epidemiology at the School of Public Health and the Director of Research at the Yale Center on Climate Change, alongside Yiqun Ma GRD ’25, a doctoral student studying environmental health science at the School of Public Health and Michelle Bell, a professor of environmental health. 

When the wildfire smoke covered cities including New Haven and New York in early June, Chen said he was immediately interested in studying its potential health effects. He told the News that the images of New York’s orange sky reminded him of the pollution he often saw in Nanjing while completing his doctorate, sparking his interest in further analyzing the pollution’s direct health effects. 

“Among the air pollutants, one particular pollutant is called fine particulate matter [PM_2.5]…” Chen said. “We have learned that these smaller particles can penetrate into the blood system and generate impacts on the cardiovascular system, respiratory illness, and many other health organ systems.”

Chen said that researchers have found that PM_2.5 is a major concern when it comes to wildfire polution. This worry, Chen said, led researchers to the “natural question” of what the smoke waves’ immediate health impacts looked like.

To determine how many emergency department visits during the June smoke wave were due to asthma, the researchers used New York City’s syndromic surveillance system. The surveillance system records information with the details of a patient’s visit, their age and their residential zip code in all emergency departments across New York City’s five boroughs. Then, researchers used a text processing algorithm that analyzed the descriptions from each visit and counted the number of visits that included mentions of asthma, wheezing or chronic obstructive pulmonary disease. 

Researchers also determined PM_2.5 conditions using 10 local monitoring stations in New York City from the United States Environmental Protection Agency, which defined the days of the “wildfire smoke wave” in New York City to be from June 6 to June 8. On these days, the PM_2.5 levels exceeded the maximum level of PM_2.5 during a previous baseline period, according to the study. Chen said that one of the most interesting parts of the study was using real-time analysis as the researchers examined the data in late June and early July following the wave. 

The researchers found that both PM_2.5 levels and asthma-related emergency department visits peaked on June 7. Visits climbed to 261 total, roughly 80 cases higher than normal, the study reported. PM_2.5 levels peaked at 100 micrograms per cubic meter of air.  During a baseline period, PM_2.5 levels only peaked at 9.0 ug/m³. The researchers determined that this trend occurred across all five boroughs among patients ages five to 64. 

Ma, the doctoral researcher, made several recommendations to help prevent asthma-related emergency department visits when there are elevated PM_2.5 levels. Ma told the News that during smoke waves, people should stay indoors when possible, wear a mask outdoors, use air purifiers at home and consider further protective measures and health monitoring if individuals have pre-existing respiratory conditions. 

Additionally, Ma said that this study illustrates the different ways climate change can affect human health.

“It’s not just the direct effects from rising temperatures, but also the consequential increase in extreme weather events, like droughts and heatwaves,” Ma wrote in an email to the News. “Such conditions increase the occurrence and severity of other catastrophic events, such as wildfires. As wildfires intensify, they significantly decrease air quality, introducing harmful pollutants like PM_2.5, which further threaten human health.”

Ma said she hopes to conduct further research by broadening the scope of the study to include the entire U.S., examining a larger range of health outcomes. With this work, she said she is looking to determine which populations might be especially vulnerable to adverse health effects. 

Robert Dubrow, a professor of epidemiology and faculty director at the Yale Center on Climate Change and Health, said that this study serves as a warning for the effects of pollution and climate change. 

“Unfortunately, with the climate crisis worsening, we can anticipate more of these poor air quality events caused by distant wildfires to occur in the East and in other parts of the United States,” Dubrow wrote to the News. “The June 2023 episode, along with the unprecedented heat and floods that occurred during the summer of 2023, should represent a wake-up call for serious action to accelerate the transition from fossil fuels to carbon-free energy.”

The School of Public Health is located at 60 College Street. 

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The study is being led by Harlan Krumholz, a professor at the School of Medicine, and Akiko Iwasaki, a professor of immunobiology and molecular, cellular and developmental biology. The Yale Paxlovid for Long COVID trial aims to research whether consistent use of the antiviral medication can help improve the lives and symptoms of long COVID patients. 

Krumholz, who primarily researches cardiovascular diseases, said that he was drawn to the project not only because of its potential impact on many patients, but also for its innovative methods in conducting clinical research. 

“It was becoming clear to me that it was an opportunity both to try to make a contribution to those who were suffering, but also to innovate around how we pursued research … in a way that was digital, decentralized, democratized and was breaking new grounds in the ways that we were participating with people in our studies” Krumholz said. “[W]e could set an example to others how we could re-engineer the way we are doing studies.”

Iwasaki emphasized that because the study is decentralized, it is easier for people from across the country to participate. 

“Participants do not have to travel anywhere to get their biospecimen collected or obtain the medicine,” Iwasaki wrote to the News. “Everything is delivered to them. People living in Alabama to Wyoming can participate in the trial … this is particularly important for people with long COVID, who may be too ill to drive to a study site.”

Long COVID is defined in the study as a condition in which participants with prior COVID-19 infection developed symptoms of within four weeks of their initial infection. Those symptoms, according to the study’s definition, have persisted for at least three months. The study aims to test whether long COVID is caused by the persistence of the COVID-19 virus in patients. 

“[D]ifferent mechanisms may be going on in different people,” Erica Spatz, an associate professor of cardiology and one of the early organizers of the study, wrote. “One of these mechanisms is the persistence of coronavirus in the system. In fact, I have had some patients become reinfected with COVID and suddenly their Long COVID symptoms go away, potentially because their body was able to mount an effective immune response to residual virus. This study of Paxlovid is tapping into some of these theories, namely that there is persistent virus leading to symptoms of Long COVID.”

Paxlovid is an antiviral medication typically given to patients for five days during their infectious period. It works to inhibit a key enzyme that the COVID-19 virus uses to replicate itself. The researchers hypothesized that taking this medication for a longer period of time can help clear the remaining virus and alleviate patients of their long COVID symptoms. 

Interested participants take a pre-screening survey online to determine their eligibility. If they meet the qualifications, the patients compile their medical records in a secure cloud-based account and send them to the researchers, who then determine whether the patient should qualify for the study. 

Participants are randomly sorted, either receiving ritonavir-boosted nirmatrelvir — the generic name for Paxlovid — or a placebo to be taken orally for 15 days. The participants will complete a daily diary cataloging their symptoms alongside other surveys that the researchers will use to create an overall “summary score.” According to Krumholz, the summary score standardizes differences in symptoms between patients, since long COVID patients tend to have a large variety of symptoms. The overall score helps the researchers gauge whether the patients’ quality of life was generally improved by taking the medication despite the differences between patients. 

Beyond the questionnaires and summary score, blood and saliva samples will be taken from participants before and after treatment. These samples will go through an immunophenotyping analysis in the Iwasaki lab.

“They are measuring thousands of components of the immune system trying to characterize what is active, what is not, what levels are high and what levels are low, what immune antibodies may exist within the course of treatment and how it correlates with people’s response,” Krumholz said. “Even if the results are negative, it may be that we can identify the signatures of people who are responders and help us understand whether there are subsets of people that might benefit.”

Participants will continue to be followed after the 15 days of treatment to see whether the improvement of symptoms is sustained long term. 

Rohan Khera, assistant professor of medicine and biostatistics, is leading the analytic side of the project. In particular, Khera is working on decentralized data analysis in the trial. While this study is a good start, Khera said that there is still more research to be done regarding long COVID.

“There is a lot being done, and I think the biggest value will come from research that helps better characterize what symptom constellation defines Long COVID and whether there are disease subtypes representing different pathophysiologies,” Khera wrote to the News. “The treatment could then be targeted to the mechanisms causing the symptoms and challenges to patients.”

There are currently patients enrolled from 43 states, and Krumholz said they are aiming to include participants from the 48 contiguous states. As of September, roughly one third of the study is full. The researchers are still screening participants for eligibility. Krumholz hopes to be done enrolling participants by the end of this year and to get results sometime during the spring of 2024, although it would take additional time for the FDA to approve the use of Paxlovid for long COVID.

The School of Public Health is located at 60 College St.

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According to David Fiellin, an author on the study and professor of general medicine, emergency medicine and public health at YSM, this result came as a surprise. Many clinicians and patients are hesitant to prescribe or use the drug, he said, due to the concern that precipitate withdrawal may be common in patients taking this drug who also have used fentanyl, a common and potent synthetic opioid.

Kathryn Hawk — co-author, emergency physician at YSM and addiction researcher — explained that precipitate withdrawal is a “function of the pharmacology of buprenorphine.” Both buprenorphine and fentanyl bind and activate the mu receptors, which are located in different areas of the brain and work to modulate various physiological functions. Buprenorphine helps treat patients with a substance use disorder by preventing other opioids from occupying these mu receptors. 

However, if buprenorphine is administered too soon after the consumption of fentanyl, this can lead to precipitate withdrawal. 

“Buprenoprhine is very effective at treating opioid withdrawal, but if given to an individual with opioid use disorder while opioids are still on the mu receptors, the buprenorphine can displace the opioids and cause a significant increase in opioid withdrawal symptoms,” Hawk wrote. “Precipitated withdrawal is an unpleasant experience for the patient and the provider and has the potential to reduce both patient and clinician willingness to initiate treatment with the medication.”

According to Fiellin, some symptoms of precipitate withdrawal include acute nausea, vomiting, diarrhea, pain, agitation, anxiety and insomnia.

For this reason, many clinicians were concerned when the Biden administration loosened regulations on buprenorphine, eliminating the requirement for medical providers to obtain waivers before prescribing buprenorphine. These clinicians feared that the removal of those restrictions could lead to more incidences of precipitate withdrawal in patients.  

The YSPH study — led by Hawk, Fiellin and Gail D’Onofrio, an Albert E. Kent Professor of Emergency Medicine at YSM, in collaboration with researchers from the University of Pennsylvania, University of Kentucky College of Medicine and Highland Hospital Oakland — looked at the rate of precipitate withdrawal in approximately 1,200 patients across eight emergency departments with a high prevalence of patients using fentanyl. 

When patients were initiated buprenorphine with the standard initiation process, the researchers found that only 0.76 percent of patients experienced precipitate withdrawal. 

According to Fiellin, this study was unique because the researchers objectively defined metrics for precipitate withdrawal, and external experts adjudicated the research findings. 

“The findings are novel and have important implications for clinicians and patients who may shy away from buprenorphine initiation in patients using fentanyl,” Fiellin wrote. “Given the ongoing overdose death crisis and since we know that buprenorphine … treat[s] opioid use disorder and can substantially decrease mortality, we believed it was important to get these findings out quickly.”

This data for this paper came out of a larger and ongoing study led by D’Onofrio and Fiellin called ED INNOVATION, which looks at the extended-release of buprenorphine in patients receiving the medication via injection for seven days. 

The researchers hypothesized in this larger study that more patients will successfully reach formal addiction treatment if they receive the extended-release of buprenorphine. 

While the ED INNOVATION study is currently still ongoing, D’Onofrio explained that it was important for the researchers to publish these results on buprenorphine separately and as soon as possible, since buprenorphine is one of the few safe, unrestricted options available to treat patients with opioid use disorder. 

Edel Aron GRD ’24 applauds the YSPH researchers for exploring the side effects of medications like buprenorphine.

“It is important to do large, well-designed and well-conducted peer-reviewed studies to ensure that patients are getting the best possible treatment,” Aron wrote. “Hopefully work like this will be helpful in fighting the opioid epidemic.”

Currently, it is estimated that 2.1 million Americans suffer an opioid use disorder. The free and confidential treatment referral hotline for addiction is 1-800-662-HELP.

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