Three Things Thursday highlights three things I am paying attention to as an epidemiologist each week. This week we are taking a break from news about measles, though case counts continue to rise and according to a ProMED report, Russia is "burning with measles,” and flu/cold/COVID/RSV season.
This week we are turning our attention to the surge in syphilis cases in the US. A substantial increase in the number of premature births in the United States. And the hearings on Capitol Hill discussing the challenges of preventing harm to children who are on social media.
The public health headlines are not positive or encouraging. The health threats we are facing at the moment are coming from a multitude of directions — underfunding of sexually transmitted infections prevention, structural racism, health inequalities, inadequate access to healthcare, stigma, substance abuse, and more.
I want to remind each of you that (in the words of Will McAvoy from The Newsroom, which I have quoted often) —
“The first step in solving any problem is recognizing there is one.”
Hoping this post helps to educate and empower you
to be healthy and create healthy communities.
Surge in Syphilis Cases
On Tuesday, the CDC reported that syphilis cases have increased by 80% between 2018-2022. The number of cases in 2022 has not been that high since the 1950s. Increases are occurring across all age groups — from newborns to senior citizens and in all regions of the country. There were 3755 cases of congenital syphilis (infection passed from pregnant person to fetus), an increase of 937% from a decade ago.
These HUGE increases are unsettling and concerning.
At the beginning of the 21st century, public health experts thought the disease was on the verge of elimination. Now, we are facing an epidemic of syphilis… And we have, according to Dr. Ina Park, “an entire generation of physicians who barely saw it, and don’t really know how to recognize it.”
Syphilis is a sexually transmitted infection (STI) caused by a bacterium, Treponema pallidum, that can cause serious health problems and death if left untreated. Oscar Wilde and Al Capone all died of syphilis, along with hundreds of black men and women who were mistreated and unethically recruited into the U.S. Public Health Service Study of Untreated Syphilis.
Syphilis is spread through direct contact with a syphilis sore during vaginal, anal, or oral sex. Syphilis can also pass from a pregnant individual to a fetus. You CANNOT get syphilis through casual contact with an object, such as a toilet seat or hot tub.
Syphilis is often called The Great Imitator because early on in the course of the disease, the signs and symptoms of syphilis mimic those of other diseases. The disease presents in three stages — primary syphilis, where an individual has a painless, but highly infectious sore (or two) on their genitals; secondary syphilis, which is characterized by a skin rash; and tertiary syphilis (that can occur 10-30 YEARS after the first sore appears) causes damage to your internal organ (including the brain).
The huge increase in syphilis cases has likely been caused by several factors — decreased condom use, increased substance abuse (which is linked to unsafe sex), and (most importantly) a lack of funding to prevent, treat, diagnose, screen, and provide education about syphilis.
According to Admiral Rachel Levine, assistant secretary for health and chair of the National Syphilis and Congenital Syphilis Syndemic Federal Task Force (and public health royalty!) —
"Addressing the resurgence of syphilis and congenital syphilis requires a concerted effort. We can collectively work towards reducing the incidence of syphilis and its devastating consequences, and we will turn the tide on the syphilis epidemic."
Increase in the Rate of Premature Births in the US
The rate of babies born prematurely — before 37 weeks gestation — increased by 12% from 2014-2022, according to a new report published by the National Center for Health Statistics this week. This data adds to the mountain of evidence that shows that the US has the worst maternal health outcomes among all developed countries.
Not good. Not good. At all.
The report highlighted that —
Black mothers were nearly twice as likely as white mothers to give birth to premature babies.
Women over 40 had a greater risk of preterm birth compared to those in their 20s.
Premature birth is the leading cause of death and other adverse health outcomes, including breathing problems, feeding problems, cerebral palsy, developmental delays, and vision and hearing problems, for infants and children. The earlier a baby is born, the risk of death, health complications, and disabilities increases.
The exact cause of premature birth is NOT known.
However, we know that teenagers and older individuals are more at risk of having a premature birth. Additionally, alcohol and substance abuse during pregnancy can increase the risk.
To prevent premature births, we need to all know the signs of preterm labor, which include contractions, vaginal discharge, pelvic pressure, low/dull backaches, cramps, and diarrhea.
Additionally, we should be working to enhance sex education in our schools; encouraging programs that discuss how to prevent pregnancy. And we all need to recognize that addiction is a disease and that individuals — pregnant or not — who are addicted need our compassion and help.
These are just the first steps. They are a starting point…
Social Media Hearings on Capitol Hill & Public Health
Yesterday the CEOs of Meta, TikTok, Snapchat, Discord, and X were on Capitol Hill to testify (discuss and answer some hard questions) about protecting children who are using social media. At the center of the discussion is a proposed bill — the Kids Online Safety Act — which is designed (according to its authors) to prevent harm to children. However, there are a lot of people who argue that it violates First Amendment free speech rights.
While the proposed bill brought everyone together, it was Meta CEO Mark Zuckerberg’s apology to parents in the audience that monopolized the headlines.
After hearing testimony from parents whose children have been harmed online, Zuckerberg addressed them directly —
“I’m sorry for everything you have all been through. No one should have to go through the things that your families have suffered, and this is why we invested so much.”
While we are nowhere near a law that will both protect children online and protect free speech, it is important to remember the impacts social media has on the health of our kids. In May, the Surgeon General published an Advisory on Social Media & Youth Mental Health.
According to the Advisory, up to 95% of youth ages 13-17 report using social media. More than one-third of those report that they use social media “almost constantly.” These statistics combined with the fact that adolescence is an important period for brain development are the root of the report.
The Advisory noted that there are benefits to social media use. Youth have found positive communities and connections via social media platforms. And social media has promoted health-seeking behaviors among youth struggling with mental health issues.
HOWEVER —
Research shows that 8th and 10th graders spend (on average) 3.5 hours per day on social media.
Social media is associated with an increased risk of depression and anxiety among adolescents. Specifically, the risk of cyberbullying-related depression has increased as a result of social media use.
Social media platforms are also sites for predatory behaviors and interactions with adults who target kids and adolescents.
We have A LOT left to learn —
There are so many unanswered questions about the relationship between social media and mental health. There is a HUGE need for independent researchers and technology companies/social media platforms to work together to rapidly increase our understanding of the social media impacts on the mental health of youth and adolescents.
BUT we cannot wait until we have all the answers. We MUST act now —
The youth mental health crisis is occurring now. We must act NOW.
We need age-appropriate health and safety standards.
We need a social media literacy curriculum in schools.
Families need to create a social media plan that includes boundaries and rules.
Screen time limits are needed.
Families should also encourage in-person friendships.
As parents, we need to set a good example for our children. And we need to work with other parents to establish shared boundaries and norms for our teenage children.
Additionally, we need to define and prohibit online bullying. And we MUST make sure that our kids do NOT keep online harassment or abuse a secret.
Open, in-person communications are needed.
Have questions? or comments?
And be sure to share this post & all the others with your friends and family —