Many types of leisure time activities may lower risk of death for older adults

Older adults who participate weekly in many different types of leisure time activities, such as walking for exercise, jogging, swimming laps, or playing tennis, may have a lower risk of death from any cause, as well as death from cardiovascular disease and cancer, according to a new study led by researchers at the National Cancer Institute, part of the National Institutes of Health.

Photo credit: United Nations

The findings suggest that it’s important for older adults to engage in leisure time activities that they enjoy and can sustain, because many types of these activities may lower the risk of death, the authors wrote.

The findings appear Aug. 24 in JAMA Network Open.

Using data from 272,550 adults between ages 59 and 82 who had completed questionnaires about their leisure time activities as part of the NIH-AARP Diet and Health Study, the researchers looked at whether participating in equivalent amounts of seven different exercise and recreational activities—including running, cycling, swimming, other aerobic exercise, racquet sports, golf, and walking for exercise — was associated with lowered risk of death.

The researchers found that achieving the recommended amount of physical activity per week through any combination of these activities was associated with a 13% lower risk of death from any cause compared with no participation. When they looked at the role of each activity individually, playing racquet sports was associated with a 16% reduction in risk and running with a 15% reduction. However, all activities were similarly associated with lower risks of death.

The second edition of the Physical Activity Guidelines for Americans recommends that adults engage in 2.5 to 5 hours of moderate-intensity aerobic physical activity, or 1.25 to 2.5 hours of vigorous-intensity aerobic physical activity, each week.

The levels of activity by the most active individuals (those who exceeded the recommended levels of physical activity) were associated with even greater reductions in the risk of death, but there were diminishing returns as activity levels increased. Even people who did some recreational activity, though less than the recommended amount, had a 5% reduction in risk of death than those who did not participate in any of the activities studied.

These activities were also associated with a lower risk of death from cardiovascular disease and cancer. Playing racquet sports was associated with the greatest reduction in risk of cardiovascular deaths (27% reduction), while running was associated with the greatest reduction in risk of cancer deaths (19% reduction).

Tobacco smoking rates are decreasing in people with major depression and substance use disorder

Significant reductions in cigarette use were found among U.S. adults with major depression, substance use disorder, or both from 2006 to 2019, according to a new analysis of nationally representative survey data published today in JAMA. 

Smoking is a modifiable risk factor for cardiovascular disease and 73% of African American adults who smoke want to quit,

The study was conducted by researchers at the National Institute on Drug Abuse (NIDA), part of the National Institutes of Health, and the Substance Abuse and Mental Health Services Administration (SAMHSA).

These findings suggest that groups at higher risk of cigarette smoking can be reached by, and may have benefitted from, tobacco use prevention and cessation efforts that have led to significant declines in tobacco use in the general population. At the same time, the findings highlight remaining disparities, documenting higher smoking rates in people with psychiatric disorders than in those without.

“This study shows us that, at a population-level, reductions in tobacco use are achievable for people with psychiatric conditions, and smoking cessation should be prioritized along with treatments for substance use, depression, and other mental health disorders for people who experience them,” said Nora Volkow, M.D., director of NIDA and co-author of the study. “Therapies to help people stop smoking are safe, effective, and may even enhance the long-term success of concurrent treatments for more severe mental health symptoms in individuals with psychiatric disorders by lowering stress, anxiety, depression, and by improving overall mood and quality of life.”

Cigarette smoking, the leading preventable cause of disease, disability and death in the U.S., has been declining. Experts attribute this in part to increases in available treatments, insurance coverage of these treatments, cigarette prices, smoke-free and tobacco-free policies, mass media and educational campaigns and other evidence-based strategies to help people avoid or quit using cigarettes that have been implemented in recent decades.

Quitting cigarette smoking and tobacco use reduces the risk of cancer, heart disease, stroke and lung diseases. Studies have also found that smoking cessation in people with psychiatric disorders can help decrease anxiety, depression and stress; lower likelihood of a new-onset substance use disorder; and improve quality of life.

Past studies have documented that smoking rates remained essentially unchanged in people with substance use disorders, major depression or other psychiatric disorders. Now, analyzing data from more than 558,000 individuals aged 18 and older who participated in the 2006 to 2019 National Surveys on Drug Use and Health (NSDUH), researchers found that while people with major depression, substance use disorder or both were more likely to smoke cigarettes than people without these disorders; improvements in smoking cessation were seen among those with these psychiatric disorders during the 14-year period. The NSDUH, conducted annually by SAMHSA, provides nationally representative data on cigarette smoking, tobacco use, major depressive episode and substance (alcohol or drug) use disorders among the US civilian, non-institutionalized adult population. Among the population studied here, roughly 53% were women, 41% were aged 18 to 25 and 62% were non-Hispanic white.

After controlling for factors such as age, sex, race/ethnicity, education and family income, the researchers found that past-month smoking rates declined by 13.1% from 2006 to 2019 among adults with a past-year major depressive episode and by 8.2% from 2006 to 2019 among adults without. The difference in past-month cigarette smoking among those with versus without past-year major depressive episode significantly narrowed from 11.5% in 2006 to 6.6% in 2019.

Similarly, past-month cigarette smoking declined by 10.9% from 2006 to 2019 among adults with past-year substance use disorder and by 7.8% among adults without. For people with co-occurring substance use disorder and major depression, past-month smoking rates decreased by 13.7% during this 14-year period and by 7.6% among adults without these disorders.

“These declines tell a public health success story,” said Wilson Compton, M.D., NIDA’s Deputy Director and the senior author of the study. “However, there’s still a lot of work to be done to ensure tobacco use in patients with substance use disorder, depression, or other psychiatric conditions continue to decrease. It is crucial that healthcare providers treat all the health issues that a patient experiences, not just their depression or drug use disorder at a given point in time. To do this, smoking cessation therapies need to be integrated into existing behavioral health treatments. The result will be longer and healthier lives for all people.”

During 2006 to 2019, among adults with past-year major depressive episodes or substance use disorder, past-month cigarette smoking declined significantly across every examined age, sex, and racial and ethnic subgroup, except that among non-Hispanic American Indian or Alaska Native adults smoking rates did not decline. Given that American Indian and Alaska Native communities face the highest smoking and lowest quitting rates among racial and ethnic subgroups in the United States, this highlights the need to channel additional prevention and treatment efforts into these communities.

In future work, the researchers note the need to include data on certain populations at high risk of psychiatric disorders and cigarette smoking, such as institutionalized individuals or those experiencing homelessness without living in a shelter. More work is also needed to continue to monitor national trends in differences in tobacco use and nicotine vaping among adults with or without psychiatric conditions – including substance use disorder – during the COVID-19 pandemic.

Central African Republic: War Crimes Court’s First Trial

The opening of the first trial at the Central African Republic’s Special Criminal Court (SCC) on April 19, 2022 represents significant progress in the difficult effort to see justice for grave crimes committed in the country, Human Rights Watch said today. Human Rights Watch issued a question-and-answer document ahead of the SCC’s trial. 

The case involves war crimes and crimes against humanity committed in May 2019 in Koundjili and Lemouna allegedly by the suspects, Issa Sallet Adoum, Ousman Yaouba, and Tahir Mahamat, members of the “3R” rebel group. Human Rights Watch has documented the events.  

“The Special Criminal Court’s first trial is a landmark moment for victims in the Central African Republic who have repeatedly called for justice for heinous crimes committed during successive conflicts in the country,” said Esti Tambay, senior International Justice counsel at Human Rights Watch. “This novel court – which combines international and domestic experience to hold those responsible for grave crimes to account – could be an important justice model for other countries to consider.” 

The SCC became operational in 2018 to help limit widespread impunity for serious crimes in the Central African Republic. The court is staffed by both international and national judges and prosecutors, and benefits from international assistance. It has the authority to try grave crimes committed during the country’s armed conflicts since 2003.  

The SCC is conducting investigations in tandem with the ICC, the global permanent court of last resort, which currently has four suspects in custody regarding charges of crimes committed in the Central African Republic. The ICC can play an important role in pursuing cases involving more senior leadership, while the SCC seeks to conduct trials in a wider set of cases in the country’s capital, Bangui. 

“The courts should be strategic in their coordination to maximize their combined efforts at securing justice,” Tambay said. “All countries committed to justice have an important role to play in supporting these courts with much-needed funding and to carry out arrests.” 

Drug use severity in adolescence affects substance use disorder risk in adulthood

People who reported multiple symptoms consistent with severe substance use disorder at age 18 exhibited two or more of these symptoms in adulthood, according to a new analysis of a nationwide survey in the United States.

These individuals were also more likely, as adults, to use and misuse prescription medications, as well as self-treat with opioids, sedatives, or tranquillizers. Published today in JAMA Network Open, the study is funded by the National Institute on Drug Abuse (NIDA), part of the National Institutes of Health.

While use of alcohol, cannabis, or other drugs is common among adolescents, previous studies have suggested that most teens reduce or cease drug use as they enter adulthood. However, this study indicates that adolescents with multiple symptoms of substance use disorder – indicating higher severity – do not transition out of symptomatic substance use. 

“Screening adolescents for drug use is extremely important for early intervention and prevention of the development of substance use disorder,” said Nora Volkow, M.D., director of NIDA. “This is critical especially as the transition from adolescence to adulthood, when brain development is still in progress, appears to be a period of high risk for drug use initiation.” Dr. Volkow further discusses the findings and implications of this study in a related commentary(link is external).

Researchers in this study argue that key knowledge gaps currently hinder the initiation of screening, diagnosis, prevention, and treatment efforts for teens with substance use disorders. For example, previous methods evaluating persistence of substance use disorder tended to treat substance use disorder as one broad category, without looking at severity. They also failed to account for the possibility of polysubstance use, whereby individuals may use multiple drugs or switch the types of drugs they use as they grow older.

The NIDA-funded Monitoring the Future Panel study at the University of Michigan-Ann Arbor helped close this research gap by examining substance use behaviors and related attitudes among 12th graders through their adulthood in the United States. Since 1976, the study has surveyed panels of students for their drug use behaviors across three time periods: lifetime, past year, and past month. In this study, researchers looked primarily at a subgroup of 5,317 12th graders first evaluated between 1976 and 1986, who were followed with additional surveys at two-year, then five-year intervals for up to 32 years, until they reached age 50. Among the respondents, 51% were female and 78% were white.

The research team examined the relationship between substance use disorder symptom severity at age 18 and prescription drug use, prescription drug misuse, and substance use disorder symptoms up to age 50 in these individuals.

To measure severity of substance use disorder symptoms in adolescence, researchers recorded the number of substance use disorder symptoms that participants reported in response to initial survey questions. These questions were based on criteria for alcohol, cannabis, and “other drug” use disorders in the Diagnostic and Statistical Manual of Mental Disorders (DSM). The researchers categorized substance use disorder symptoms into five levels of severity: exhibiting no symptoms, one symptom, two to three symptoms, four to five symptoms, and six or more symptoms. Symptoms included, but were not limited to, substance use resulting in a failure to fulfill major role obligations and repeating substance use even when dangerous to health.

Approximately 12% of surveyed teens indicated “severe” substance use disorder, defined by this study as reporting six or more symptoms. Among this group, more than 60% exhibited at least two symptoms of substance use disorder in adulthood – an association found across alcohol, cannabis, and other drug use disorders. By comparison, roughly 54% of teens reporting two to three symptoms – indicative of “mild” substance use disorder – had two or more substance use disorder symptoms in adulthood.  Higher severity of substance use disorder symptoms at age 18 also predicted higher rates of prescription drug misuse in adulthood.  

Overall, more than 40% of surveyed 18-year-old individuals reported at least two substance use disorder symptoms (across all substances). More than half of the individuals who were prescribed and used opioids, sedatives, or tranquilizers as adults also reported two or more symptoms at age 18. This finding underlines the importance of strategies to increase safety and properly assess a potential history of substance use disorder symptoms when prescribing controlled medications to adults.

“Teens with substance use disorder will not necessarily mature out of their disorders, and it may be harmful to tell those with severe symptoms that they will,” said Dr. Sean Esteban McCabe, senior author of this study and director of the Center for the Study of Drugs, Alcohol, Smoking and Health at University of Michigan. “Our study shows us that severity matters when it comes to predicting risk decades later, and it’s crucial to educate and ensure that our messaging to teens with the most severe forms of substance use disorder is one that’s realistic. We want to minimize shame and sense of failure for these individuals.”

The authors note that more research is needed to uncover potential neurological mechanisms and other factors behind why adolescents with severe substance use disorder symptoms are at increased risk of drug addiction and misuse in adulthood. Characterizing possible causes of more severe substance use disorder could help improve understanding of vulnerability to chronic substance use and help make prevention and treatment strategies more effective.

Sudan: ICC Holds First Darfur Trial

 The International Criminal Court’s trial of Ali Kosheib, or Kushayb, will open on April 5, 2022, and offers the first opportunity to see a leader face prosecution for massive crimes committed in Darfur nearly 20 years ago, Human Rights Watch said.

Kosheib’s trial is a long-awaited chance for victims and communities terrorized by the notorious Janjaweed militia and government forces in Darfur to see a leader held to account

Human Rights Watch issued a question-and-answer document and a video ahead of the trial.  

“Kosheib’s trial is a long-awaited chance for victims and communities terrorized by the notorious Janjaweed militia and government forces in Darfur to see a leader held to account,” said Elise Keppler, associate international justice director at Human Rights Watch. “In the face of steep odds and no other credible options, the ICC is serving as the crucial court of last resort for Darfuris.”

The video focuses on the significance of the trial and on what else is needed by the Sudanese authorities to advance justice for atrocities committed in Darfur. The question-and-answer document covers:  

“For all these years, those implicated in serious crimes and other abuses in Darfur have largely suffered no consequences, and in some instances, have even been rewarded,” Keppler said. “Would-be abusers should take note that they can end up in court even if it is slow going. Now, Sudanese authorities should surrender the remaining fugitives, including former president Omar al-Bashir, so victims have the opportunity to also see them held to account.”

Ali Kosheib, or Kushayb, is the nom de guerre of Ali Mohammed Ali, identified by the International Criminal Court (ICC) as Ali Mohammed Ali Abd–Al-Rahman. Kosheib is believed to have been the principal leader of the Janjaweed militias in the Wadi Saleh area of West Darfur. He also held commanding positions in Sudanese government auxiliary forces, the Popular Defense Forces and Central Reserve Police.

In early 2003, the Janjaweed worked alongside the Sudanese government forces during its armed conflict with rebel groups to carry out a systematic campaign of “ethnic cleansing.” The campaign targeted civilians from African Fur, Masalit, and Zaghawa ethnic groups, from which the members of the rebel groups were drawn. Attacking from the air and land, Sudanese government forces and allied militias killed, raped, and forcibly displaced more than 2 million people from their homes and land. The Sudanese government recruited, armed, and trained the Janjaweed forces.

South African faith leaders today signed a declaration to end modern slavery

At a ceremony at Constitution Hill in Johannesburg on March 15, 2022, faith leaders in South Africa endorsed the Joint Declaration of Religious Leaders against Modern Slavery.

The signing in Johannesburg is the eleventh since 2014 when Pope Francis and Grand Ayatollah Taqi al-Modarresi joined other faith leaders from many of the world’s great religions in declaring that modern slavery must be eradicated.

The Global Freedom Network, which convened the signing, is the faith-based arm of Walk Free, an international human rights organization. The Network is building a coalition of faith leaders to accelerate the end of modern slavery. Walk Free believes faith leaders can be a bridge between victims and law enforcement, social workers, and victim support groups.

Modern slavery is an umbrella term that includes human trafficking, domestic servitude, the worst forms of child labor and forced and child marriage.

Franca Pellegrini, director of the Global Freedom Network, who presided over the ceremony, said faith leaders were in a unique position to see into the hearts of their communities.

“Faith leaders occupy a prominent position and are well placed to lead the fight against modern slavery in their communities”, said Ms. Pellegrini. “The philosophy of Global Freedom Network is built on interfaith collaboration.

Pellegrini said that the Global Freedom Network was “acutely aware that poverty and inequality were driving forces of many forms of modern slavery”.

She noted that Walk Free’s Global Slavery Index rated South Africa a B – the top rating in Africa, which is accorded to nine countries on the continent. Ten countries – mainly in Europe – are rated A. The most recent Global Slavery Index was published in 2018, with an updated index due for release later this year.

The signing event coincided with the launch of the Faith For Freedom smartphone app, which was developed in collaboration with faith leaders to help guide them to tackle modern slavery in their communities and congregations.

“This a practical tool designed for and developed by faith leaders to assist with their important work addressing modern slavery in their congregations and communities,” Ms. Pellegrini said. “We are using modern technology to address an age-old problem.”

HarvestPlus, World Food Programme Release Joint Brief on Biofortification

HarvestPlus and the World Food Programme (WFP) have released a joint brief that highlights the significant role of nutrient-enriched biofortified crops in improving global nutrition and food security, especially for the world’s most vulnerable households. 

The brief, Biofortification: A Food Systems Approach to Ensuring Healthy Diets Globally, comes as HarvestPlus and WFP are working to “leverage one another’s expertise, experience, and reach to improve nutrition and food security” and “increase the uptake of biofortified crops and foods,” writes Valerie N. Guarnieri, Assistant Executive Director for Programme and Policy Development at WFP, and Arun Baral, CEO of HarvestPlus, in the brief’s Forward. 

The document showcases examples of WFP/HarvestPlus collaborations in supporting country-level initiatives to scale up biofortified seeds, crops, and foods, and identifies opportunities to integrate biofortified crops and foods in the global agency’s procurement policies and in other relevant WFP programs.    

The brief provides basic information about biofortification and how it plays a central role in global efforts by the CGIAR (of which HarvestPlus is a part) to improve the nutrition and health of vulnerable populations in low- and middle-income countries. It highlights the robust evidence based on the agricultural benefits of biofortified crops, their acceptance by farmers and consumers, and the crops’ nutritional and health benefits. Drawing on this evidence, the brief shows how “nutrient-enriched crops can help sustainably transform food systems to deliver healthier diets.” 

Biofortified crops promoted by HarvestPlus are currently available in 30 countries and are benefiting nearly 10 million smallholder farming households who are growing, consuming, and trading in these crops. The crops promoted by HarvestPlus include vitamin A maize, sweet potato, and cassava; iron bean and pearl millet; and zinc wheat, rice, and maize.