Month: October 2022

A positive outlook has been linked to better heart health and a longer life. But is that true for Black Americans, whose average lifespan is about 72 years, compared with an average lifespan of 77 years for all Americans?

Recent findings from the nation’s largest and longest-running study of cardiovascular risk factors in Black Americans, the Jackson Heart Study, suggest that the answer is a qualified yes. Cardiovascular diseases, which give rise to heart attack and stroke, are the leading cause of death and disability worldwide. Perhaps not surprisingly, the association between optimism and longevity in Black Americans appears to be strongest among people with higher education or income levels, and those ages 55 and younger. It also proved stronger among men than among women.

Is optimism the only key to longevity in this study?

Probably not. There’s another possible explanation for the findings, says Dr. Rishi Wadhera, a cardiologist at Harvard-affiliated Beth Israel Deaconess Medical Center (BIDMC).

“Instead of optimism leading to better health, it’s possible that healthier individuals are simply more optimistic, or less healthy individuals are less optimistic,” he says. This so-called reverse causality — when cause and effect are the opposite of what one assumes — is always a possibility in observational studies, even when scientists take pains to control for possible confounding factors such as health conditions and behaviors, as they did in this study.

“Nonetheless, these findings contribute to a body of evidence that suggests that psychosocial resources, mood, and mental health are all associated with health,” says Dr. Wadhera, who is section head of health policy and equity research at the Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology at BIDMC.

Measuring optimism in the study

Led by researchers at the Harvard T.H. Chan School of Public Health, the study included 2,652 women and 1,444 men who were part of the Jackson Heart Study. Researchers measured optimism using the Life Orientation Test-Revised, which includes questions such as “In uncertain times, I usually expect the best.” Responses are scored on a scale of 0 (strongly disagree) to 4 (strongly agree). The researchers administered this test and others between 2000 and 2004, and tracked mortality among the study participants until 2018.

Optimism — the general belief that good things will happen — may be partly inherited, although genetic factors are thought to explain only about 20% to 30% of this trait. Some research suggests that people can enhance their feelings of optimism either through cognitive behavioral therapy or writing exercises that focus on imagining their “best possible future self.”

Looking forward

Still, optimism is but one of many intertwined social factors that influence how long people live. A better understanding of biological pathways that could potentially explain the outcomes observed in this study may help, says Dr. Wadhera.

“But to meaningfully address the alarming and ubiquitous health inequities that exist in our country, we need to tackle the unacceptable gaps in care and resources that exist between different racial and ethnic groups,” he adds. This includes disparities in health insurance coverage, access to health care, neighborhood factors such as access to green space and healthy foods, and environmental stressors such as pollution exposure. “Doing so may help people and communities from all backgrounds live happier and longer lives,” Dr. Wadhera says.

 

About the Author

Julie Corliss, Executive Editor, Harvard Heart Letter

Julie Corliss is the executive editor of the Harvard Heart Letter. Before working at Harvard, she was a medical writer and editor at HealthNews, a consumer newsletter affiliated with The New England Journal of Medicine. She … See Full Bio View all posts by Julie Corliss

We all want our child to have friends. We want them to be happy, and to build the social skills and connections that will help them now and in the future.

Sometimes, and for some children, making friends isn’t easy. This is particularly true after the COVID-19 pandemic. Because of isolation and remote school, many children either didn’t learn the skills they need to make friends — or those skills got rusty.

Here are some ways parents can help.

Start at home: Learning relationship skills

Making and keeping friends involves skills that are best learned at home with your family. Some of them include:

• Empathy. Make sure that everyone in the family treats each other fairly and with kindness. Sometimes we turn a blind eye to sibling fights, or feel justified in snapping at our partner when we have had a long day. No matter what we say, our children pay attention to what we do.
• Curiosity about others. Make a family habit of asking each other about their day, their interests, their thoughts.
• Communication skills. These days, devices endanger the development of those skills. Shut off the devices. Have family dinners. Talk with each other.
• Cooperation. Do projects, play games, and do chores as a family. Work together. Help your child learn about taking turns and valuing the input of others.
• Regulating emotions. It’s normal to have strong feelings. When your child does, help them find ways to understand big emotions and manage them.
• Knowing when and how to apologize — and forgive. This really comes under empathy, but teach your child how to apologize for their mistakes, make amends, and forgive the mistakes of others.

All of these apply also to how you and your partner talk about — or with — other people in front of your children, too!

Be a good role model outside the home, too

When you are outside your home, be friendly! Strike up conversations, ask questions of people around you. Help your child learn confidence and strategies for talking to people they don’t know.

Make interactions easier

Conversations and interactions can be easier if they are organized around a common interest or activity. Here are some ways parents can help:

• Sign your child up for sports or other activities that involve their peers. Make sure it’s something they have at least some interest in doing.
• Get to know the parents of some of your child’s peers — and invite them all to an outing or meal. It could allow the children to get to know each other while taking some of the pressure off.
• When planning playdates, think about fun, cooperative activities — like baking cookies, or going to a park or museum.

Keep an eye on your child — but don’t hover

Ultimately, your child needs to learn to do this — and you don’t want to embarrass them, either. The two exceptions might be:

• If the children aren’t interacting at all, you might want to suggest some options for activities. Facilitate as necessary, and step back out again.
• If there is fighting or meanness on either side, you should step in and make it clear that such behavior isn’t okay.

Keep an open line of communication, and be supportive

Talk with your child regularly about their day, about their interactions, and how things made them feel. Listen more than you talk. Be positive and supportive. Remember that part of being supportive is understanding your child’s personality and seeing the world from their eyes. You can’t make your child someone they are not.

If your child keeps struggling with making friends, talk to your doctor

All parents need help sometimes — and sometimes there is more to the problem than meets the eye. This is particularly true if your child has ADHD or another diagnosis that could make interactions more challenging.

For information on supporting friendships at different ages, check out the advice from the American Academy of Pediatrics.

Follow me on Twitter @drClaire

About the Author

Claire McCarthy, MD, Senior Faculty Editor, Harvard Health Publishing

Claire McCarthy, MD, is a primary care pediatrician at Boston Children’s Hospital, and an assistant professor of pediatrics at Harvard Medical School. In addition to being a senior faculty editor for Harvard Health Publishing, Dr. McCarthy … See Full Bio View all posts by Claire McCarthy, MD

When caught early through routine screening, cervical cancer is curable. In the US, roughly 92% of women with early-stage cervical cancer survive five years or longer, compared with only 17% of women with late-stage cervical cancer. So recent research that shows a steep rise in new cases of advanced cervical cancer among white Southern women, and underscores the disproportionate burden of advanced cases among Black Southern women, is worrisome.

What factors might be at play, and how can people best protect themselves? Two Harvard experts share their insights.

Human papilloma virus and cervical cancer: What to know

Human papilloma virus (HPV) causes nine out of 10 cervical cancers. In 2023, 13,960 women in the US will be diagnosed with cervical cancer and 4,310 will die from it, according to American Cancer Society estimates.

Pap test screening can detect this cancer early, when it’s easiest to treat. And testing for HPV has been approved as an additional screening test for cervical cancer. It can be used alone or with a Pap test.

What did the research focus on and learn?

The study was published online in International Journal of Gynecological Cancer. Researchers combed through cervical cancer data submitted to the United States Cancer Statistics program between 2001 and 2018, and national survey findings on Pap screening and HPV vaccination. During this period, nearly 30,000 women were diagnosed with late-stage cervical cancer, which has spread to other parts of the abdomen and body.

Early-stage cervical cancer cases have been dropping for most groups in the US in recent years. But advanced cervical cancer cases have not declined within any US racial, ethnic, or age group over the last 18 years.

New diagnoses of advanced disease rose 1.3% annually during the study period. Southern white women ages 40 to 44 saw an annual rise of 4.5% in advanced cases. Southern Black women ages 55 to 59 were diagnosed nearly twice as often as white women with early and advanced cases.

What else is important to understand?

The new study showed that women living in the South are less likely to be vaccinated against HPV or screened for cervical cancer. But lower screening rates likely don’t fully explain the rise in late-stage cases in that region, says Dr. Ursula Matulonis, chief of the Division of Gynecologic Oncology at Dana-Farber Cancer Institute.

“Most cervical cancer cases continue to be diagnosed early,” Dr. Matulonis says. “These new findings suggest that cases involving a more aggressive cell type called adenocarcinoma are also increasing. Often found higher up in the cervical canal, this is harder to detect with a Pap smear.”

Older women are especially vulnerable. Rates of late-stage cervical cancer are higher — and survival is worse — among women 65 and older than among younger women, according to a study in California. One possible reason? They may not have received the recommended number of screening tests with normal results before they stopped having Pap smears, says Dr. Sarah Feldman, a gynecologic oncologist at Brigham and Women’s Hospital.

HPV vaccine protects against cervical cancer

The HPV vaccine is FDA-approved for use in females ages 9 through 26. The first group of vaccinated adolescents, now in their 20s, have clearly benefited: invasive cervical cancer rates among women 20 to 24 dropped by 3% each year from 1998 through 2012.

“That’s pretty impressive,” Dr. Matulonis says. “And those decreases span race and ethnicity, which isn’t always the case in women’s cancers.”

What steps can you take to protect against cervical cancer?

Dr. Feldman offers this guidance around cervical cancer prevention and detection.

• HPV vaccination. All children should be vaccinated against HPV between ages 9 and 12, well before sexual activity begins. “The most important thing for future generations in cervical cancer prevention is vaccinating that generation,” Dr. Feldman says.
• Routine screening. Regardless of vaccination status or whether they’re sexually active, women should begin having screening tests for cervical cancer in their 20s and continue through age 65. Discuss the right intervals with your doctor. Current screening guidelines take into account when you start screening and whether results of tests are normal:
  • If you start at 21: Have a Pap test every three years until 30.
  • If you start at 25: Seek an HPV test first.
  • At age 30: If all screening tests so far have been normal, have HPV testing every five years. Continue this screening until age 65.
  • Don’t stop screening at 65 unless all test results are normal, including at least two results in the last 10 years and one in the last five years.
  • If any testing led to abnormal results, you may need to continue screening beyond age 65.

An HPV infection, rather than sexual activity alone, is the factor that places people at risk, Dr. Feldman says.

“A lot of older women may have a new sexual partner in their 50s. A new HPV infection raises risk for cervical cancer roughly 20 years later,” Dr. Feldman says. “If HPV test results are persistently negative through age 65, the risk of developing cervical cancer in your 70s is low.”

About the Author

Maureen Salamon, Executive Editor, Harvard Women's Health Watch

Maureen Salamon is executive editor of Harvard Women’s Health Watch. She began her career as a newspaper reporter and later covered health and medicine for a wide variety of websites, magazines, and hospitals. Her work has … See Full Bio View all posts by Maureen Salamon

About the Reviewer

Howard E. LeWine, MD, Chief Medical Editor, Harvard Health Publishing

Howard LeWine, M.D., is a practicing internist at Brigham and Women’s Hospital in Boston, Chief Medical Editor at Harvard Health Publishing, and editor in chief of Harvard Men’s Health Watch. See Full Bio View all posts by Howard E. LeWine, MD

Understandably, the sensitive topic of weight in children and teens often focuses on the health costs of overweight and obesity. Sometimes, though, a child needs to gain some weight. And while there are lots of ways to make that happen, not all of them are healthy.

What to do if your child seems underweight

If you are worried about whether your child needs to gain weight, it’s very important to check with your doctor before getting to work on fattening them up. It’s entirely possible that your child’s weight is absolutely fine. Given that one in five children in the US is obese and another one in six is overweight, it’s easy to see how a parent might think their child is too thin in comparison. One way to find out if your child’s weight is healthy is to check their body mass index, a calculation using height and weight that is used for children ages 2 and up.

Losing weight or being underweight can be a sign of a medical or emotional problem, so be sure to let your doctor know about your concerns. They may want to see your child to help decide if any evaluations are needed. If your child is less than 2 years old, it’s particularly important that you check in with your doctor about weight concerns, and follow their advice exactly.

Choosing healthy foods when a child needs to gain weight

If your child is older than 2 and the doctor agrees that gaining weight is a good idea, the best way to approach it is by using healthy foods and healthy habits.

Three ways to help encourage healthy weight gain:

• Give your child three meals (breakfast, lunch, and dinner) and two healthy snacks (mid-morning and mid-afternoon). If your child eats dinner early, you could consider a small snack before bedtime. Try to avoid snacks in between or drinking anything other than some water; you want them to be hungry when you give them food.
• Offer healthy high-calorie foods. Think in terms of healthy fats and protein. Some examples are:
  • nuts and nut butters, as well as seeds like pumpkin or sunflower seeds
  • full-fat dairy, such as whole milk, heavy cream, cream cheese, and other cheeses
  • avocados
  • hummus
  • olive oil and other vegetable oils
  • whole grains, such as whole-wheat bread or granola (look for granola sweetened with juice or fruit rather than sugar)
  • meat if your diet includes it
• Every time you prepare a meal or snack, think about how you might add some calories to it. For example, you could add some extra oil, butter, or cheese to pasta — or some nut butter on a slice of apple or piece of toast.

Three traps to avoid:

• Giving your child more sweets or junk food. It’s tempting, as children generally want to eat sweets and junk food, and both have calories. But they aren’t healthy foods, and it’s not a good idea to build a sweets and junk food habit.
• Giving your child unlimited access to food. This, too, is tempting — after all, you want them to eat! But not only does that make it hard to be sure that what they are eating is healthy, snacking can make them less hungry when it’s time for an actual meal.
• Letting your child fill up on milk and other drinks — including nutritional supplement drinks. This, too, makes it less likely that they will eat at mealtime, and they are unlikely to get all the nutrients they need. Don’t give your child nutritional supplements unless your doctor advises you to do so.

Be sure you schedule regular check-ins with your doctor to monitor your child’s progress. Hopefully your child will soon be at a healthier weight that helps them to thrive as they grow.

Follow me on Twitter @drClaire

About the Author

Claire McCarthy, MD, Senior Faculty Editor, Harvard Health Publishing

Claire McCarthy, MD, is a primary care pediatrician at Boston Children’s Hospital, and an assistant professor of pediatrics at Harvard Medical School. In addition to being a senior faculty editor for Harvard Health Publishing, Dr. McCarthy … See Full Bio View all posts by Claire McCarthy, MD