Social Media Warning Labels: How Teens Can Responsibly Engage in Social Media Use

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Have you heard of the Kia Challenge? This social media trend has exploded on TikTok, with less-than-positive outcomes. After a video went viral of a teen-led carjacking, there was a skyrocket in Kia and Hyundai thefts around the country. Through online platforms, teens encourage each other to engage in risky, illegal behavior. This begs the question: Should social media come with a warning label, similar to other health and safety risks like tobacco and alcohol?

Social media platforms like TikTok, Instagram and X are accessible to all age groups, including minors. Impressionable teens nationwide spend an average of almost five hours on these apps daily. Parents and mental health professionals support the U.S. Department of Health and Human Services’ Surgeon General’s call for warning labels on social media. By bringing awareness to the risks of social media, warning labels will help prevent adverse health outcomes for youth.

Through social media, peer pressure has taken a twist through engaging trends and the desire to fit in as a young person. Through online platforms, teens have access to inappropriate content for their age group, such as drug and alcohol promotions. Famous pop stars and internet influencers are using their pages to endorse and promote alcoholic products. Anyone can follow these accounts, regardless of age.

Furthermore, the American Psychological Association shows how problematic these promotions on social media are for teen alcohol and drug use. The study found that “adolescents who perceive that alcohol use is normative, as evidenced by Facebook profiles, are at higher risk for cognitions shown to predict alcohol use than adolescents who do not see alcohol use portrayed as frequently on Facebook.” This meta-analysis determined that social media is a health risk for underage users, and there should be public health interventions put in place. Warning labels on social media are a solution to educate teens and reduce alcohol and drug-related harms.

But do warning labels actually make a difference? Given the evidence from tobacco prevention and research, there may be hope for social media labels. After all, warning labels on cigarettes led to a decrease in the prevalence of people who smoke. A study on the association between cigarette graphic warning labels (GWL) and cigarette smoking consumption found that “countries with GWLs experienced a reduction of 230–287 sticks of per capita cigarette consumption compared to countries without GWLs.” If warning labels can reduce the number of tobacco users and reduce unhealthy outcomes, perhaps they can also mitigate health harms associated with teen social media use.

While social media has allowed teens to stay up to date on current events, it’s also a catalyst for spreading misinformation. Such examples are the much hyped, not-so-healthy diet trends that encourage viewers to lose weight to match an unattainable beauty standard. Due to the portrayal of body image and diet culture online, the pervasiveness of eating disorders and co-occurring mental health disorders is increasing in adolescent girls. Warning labels would better alert users to the risks of misinformation on social media and let users know when public health trends are accurate.

While social media provides a platform for youth to learn about and nurture their mental health, cyberbullying can easily undo any of those positive strides. Hiding behind a screen and an anonymous username is the easiest way to bully someone online. Users can report an account or delete comments. But by that time, the damage has already been done and a youth’s mental health takes a nosedive so severe that it can sometimes lead to teen suicide. With the help of age-specific warning labels, teens should be aware of the potential harms of cyberbullying during this crucial time in the development of self-identity and confidence.

Furthermore, social media algorithms and their addictive qualities make logging off difficult, especially for teens. Articles have shown that social media, like the effects of food or drugs, influence our reward pathways. When youth are addicted to their phones, it takes away from the daily activities of childhood, such as schoolwork, sports, and sleep, a lot of which teens are losing due to prolonged activity on social media. Warning labels would encourage youth and their parents to limit their social media consumption for their health and well-being.

To be clear, warning labels aren’t the only tool we could use to prevent the health risks posed by social media. It also takes the political will of social media platforms to create algorithms that strike the right balance between free speech and preventing health-related harms.

As consumers of social media, the responsibility is on us to embrace a little bit of skepticism by questioning the authenticity and truth of the content we’re seeing. It’s valuable to consider public health when we post, comment or share on social media. Warning labels will help teach younger generations how to use social media responsibly.

Author:
Hannah Cordeiro

Hannah Cordeiro is a Prevention Specialist at the Institute for Public Strategies and oversees the Young Advocates Program in San Diego County. 

Individualism and the Fall of Public Health

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How predatory businesses sabotaged America’s health

Americans are dying sooner than we should. Food and Drug Administration Commissioner Robert Califf calls the trend catastrophic, especially since youth are among the principle victims. But living shorter lives is only part of the story; we also have more injuries and illnesses than people in other high-income countries. Many explanations have been offered, but according to the Trust for America’s Health, the reason is the chronic underfunding of our system of public health.

To be sure, we have the best doctors, nurses and health care facilities in the world. We ought to; we spent some $4.7 trillion on them during the year, about $14,000 per capita. This is double what other large, wealthy countries spend. But our healthcare system is flawed, say researchers from Harvard University; it’s “rescue care,” designed just to address the patient’s immediate problem. To foster long-term health, we need more resources directed toward public health, currently allocated at only 4.4 percent of our annual healthcare budget.

It wasn’t always this way. At the turn of the twentieth century, during America’s Progressive Era, public health was a viable force. In the wake of the Industrial Revolution, business had expanded as never before, but there was also extreme poverty with masses of people living in squalid housing with poor sanitation and frequent disease epidemics. Such conditions called for reform, and America responded with a host of polices destined to transform the country. Among these were regulations to improve safety of factory workers, minimum wage laws for women, industrial accident insurance and restrictions on child labor.

For the most part, these changes were welcomed, but corporate interests opposed them, viewing them as a threat to profitability. A lot of money was at stake, and they needed an ideal powerful enough to forestall the impetus of social reform. So, they appealed to patriotism, arguing that interference in business stifled innovation and reduced productivity, things that made America great. Moreover, they claimed that protecting people only made them weaker and dependent on government, which ran counter to the American traditions of self-sufficiency and independence.

These ideas got a boost from the 1928 presidential campaign when Herbert Hoover coined the term “rugged individualism” to describe his philosophy of personal freedom rather than government intervention. Generating visions of the pioneer spirit of America during its westward expansion, the notion was highly popular and won Hoover the presidency. It also spawned individualism as a political movement based on the idea that to preserve our right of self-determination, we had to limit the power of government. This included its power to impose health and safety standards on individual businesses, which was supposedly a disruption to our system of free enterprise.

This notion was quick to gain support from several industry groups, especially those noted for undermining health. As early as 1910, the gun industry was sending out the message that guns didn’t kill people; individuals did. By mid-century, the alcohol industry followed suit, claiming that responsible drinking was the solution to alcohol-related problems, not government regulation. More recently tobacco companies used a similar approach to oppose smoke-free dining and other restrictive policies, arguing they violated smokers’ rights.

Over the years, such messages helped diminish support for public health and install individualism as a national value. Gaining momentum from the “Me” generation of the 1970s, the movement helped launch the era of globalization when business interests reigned supreme. In latter decades, when progressive ideals reemerged, opponents kept up the pressure, branding efforts to foster health and safety as coercion from the Nanny State. Things turned ugly during the COVID pandemic when public health officials were intimidated, harassed and even physically threatened for mandating prevention measures.

Adding insult to injury, politicians in many states passed laws to permanently weaken public health. Then on May 13, 2021, Rochelle Walensky, the director of the CDC, finally threw in the towel, announcing on her Twitter feed that “Your health is in your hands,” which is exactly what individualists wanted to hear. It may have taken over 100 years, but the incessant media campaigns from corporate sponsors, with support from their political surrogates, were ultimately successful, moving public health from a national priority to a matter of personal choice.

Of course, the real loser has been the American people. As the country divested in public health, we have become more subject to epidemics of disease, alcoholism, drug use, and gun violence. And while our current healthcare system does little to address these problems, its cost is projected to skyrocket in the coming years, reaching $7.2 trillion by 2031 when it will amount to about 1 in every 5 dollars spent by the American consumer.

We need to reverse course. Some experts suggest we treat public health as a matter of national security, providing it with a mandatory funding stream that would insulate it from the influence of special interest groups. But whatever we do, let’s not let them dupe us any longer with their slick media campaigns. In 2024, let’s put public health reform back on the national agenda.

Author:
Dan Skiles

Dan Skiles is an IPS associate. He has a master’s degree in clinical psychology and over 30 years of experience in alcohol and other drug prevention.

A Perfect Storm: When Climate Change, Racial Justice, and Mental Health Collide

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April is a busy month for mental health awareness: National Minority Health Month, Alcohol Awareness Month, and Stress Awareness Month. When you add in Earth Day, this is a good time to remember that stewardship of the planet goes hand in hand with safeguarding mental health. After all, clean air and water, safe neighborhoods, and intact social networks are part of the social determinants of health. But when they are compromised or destroyed by Mother Nature, it can cripple a community’s ability to cope. This can lead to stress, anxiety, depression, and self-medication through substance use.

Communities of color are most vulnerable to the effects of the 21st century’s biggest challenge – climate change. With fewer resources and systemic racism in post-disaster recovery, they disproportionately suffer from injustices brought on by droughts, intense storms, destructive wildfires, and catastrophic flooding.

Environmental Justice is Racial Justice

Junee Kim knows this all too well. She is a high school student in Montgomery County, MD, and a climate activist with the BIPOC Green New Deal Internship program.

“One of our environmental goals is to hold the school district accountable to their commitment to electric buses, but they have drifted away from that by buying more diesel ones,” said Junee, a sophomore at Watkins Mill High School in Gaithersburg, MD. “I’m worried for my generation and the ones after us,” she said. “Many of my peers are stressed about climate change, but there isn’t a whole lot of awareness of how climate change impacts mental health and how to deal with it.”

Junee describes climate change as especially scary for underprivileged people and people of color because they are the ones most affected. “Not only will Earth deteriorate, but the gap between the ‘haves’ and the ‘have nots’ will continue to widen.”

If there was one silver lining brought on by Hurricane Katrina in 2005, it was the urgency to address the racial disparities and social injustice brought on by climate change and natural disasters. Research continues to show that non-white neighborhoods are more likely to be impacted by flooding, as experienced by Black and Hispanic communities during Katrina and later by Hurricane Harvey in 2017.

Elevated temperatures from global warming also highlight the struggles of low-income, inner-city neighborhoods, which are mostly inhabited by people of color. These areas are often trapped in “heat islands” where temperatures are much higher than surrounding areas with more green space. Residents of these neighborhoods are less likely to have an air-conditioner or a car that they can take to a “cool zone” compared to a predominantly white neighborhood. Exposure to such intense heat increases the risk of heat stroke, heat exhaustion, and heart attacks. Alcohol, drugs, and heat just don’t mix. They exasperate the underlying physical conditions or lead to new ones.

The Intersection of Climate Change, Mental Health, and Substance Misuse

The trauma caused by Katrina caused many of the displaced disaster victims – mostly Black – to turn to substance use. In Houston, one in four Blacks said their mental health had gotten worse and 11% of Blacks report they increased their alcohol use as a result of Harvey.

The West Coast doesn’t fare much better with its climate challenges. In California, devastating wildfires resulted in an uptick in prescription pill use. Researchers from Columbia University Mailman School of Public Health recently found that hospital visits from alcohol and drugs increased as a result of rising temperatures due to climate change.

Policy Responses and Adaptation Strategies

Because climate change is a complex and divisive issue, solutions can be equally perplexing. It requires a multi-faceted approach that integrates public health, social justice, and environmental science and technology. Most importantly, it must be community-driven, with those most impacted having a seat at the table.

One crucial aspect of a policy response is to be proactive rather than reactive. This means prioritizing interventions that promote community resiliency in under-resourced neighborhoods and communities of color, both in terms of physical infrastructure and mental health by doing the following:

  • Prioritize households with residents who are low-income, elderly, disabled, or non-English speaking in evacuation plans.
  • Demystify the process of receiving post-disaster aid by increasing the health and financial literacy of community members.
  • Establish mental health services and community support systems well in advance of natural disasters that equip individuals with healthy coping mechanisms that do not involve substance use.
  • Incorporate programs into high schools that foster advocacy and build resiliency, such as a resident leadership academy or Mind Matters.
  • Build a network of ‘trusted messengers’ – the people who carry out public health strategies within their communities.

“The first step is just understanding the effects climate change has on mental health,” according to Junee. “And only then can we address the resiliency part.”

Author:

Meredith Gibson
Media/GIS Director, IPS

Meredith Gibson is the Media/GIS Director at the Institute for Public Strategies. She uses geographic information systems (GIS) and media advocacy to promote systems and policy changes that contribute to healthy, safe, vibrant, and equitable communities.

As 2024 Ushers in a New Silent Opioid Epidemic, Securing LGBTQ+ Spaces is the Answer

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As seen in WeHo Times

In the shadows of the ongoing opioid crisis that continues to grip our nation, a new silent epidemic has emerged that has gone virtually unnoticed. While the opioid epidemic has commanded national headlines and sparked urgent conversations about substance use disorders and treatment, the LGBTQ+ community continues to remain shrouded in silence – left in a battle to combat this crisis alone. Homophobia today contributes to more overdoses than ever before and our divisive politics stand in the way of saving the lives of our LGBTQ+ neighbors.

The tragic reality is that homophobia in our country continues to persist on a regular basis. The stigmatization and discrimination faced by LGBTQ+ individuals often leads them to adopt unhealthy behaviors to cope – many of which predisposes them to a long-term struggle with substance use disorders. In 2020, LGBTQ+ individuals were found to use substances at nearly double the rate of the overall population. Consequently, LGBTQ+ individuals often enter treatment with more severe substance use disorders when compared to their heterosexual counterparts. While schools and community organizations have attempted to foster safe spaces to curb this pattern, our challenging and divisive political climate has hindered progress.

Over these past few years, nationwide anti-gay policies and legislation have threatened the safety of LGBTQ+ individuals. In 2022, Florida Governor Ron DeSantis introduced the controversial “Don’t Say Gay” bill. Meanwhile, the University of Houston closed its campus’ only LGBTQ+ resource center in response to the passing of Senate Bill 17, which banned diversity, equity, and inclusion initiatives in higher education institutions. LGBTQ+ books across the US have been banned from libraries and schools with many believing that the art of drag poses a greater threat to our nation than deadly firearms.

Gay bars, which to many in the LGBTQ+ community are seen as safe havens for gathering, have been on a steady decline. A report by The Washington Post states “all gay bar listings declined by 37 percent between 2007 and 2019, the number of queer bars serving people of color declined by 59 percent, and bars for lesbians declined 52 percent.” Due to their decline, a large piece of safety and comfort is lost for many in the LGBTQ+ community. On top of that, those who are in the recovery community may want to avoid gay bars so as to not give in to pressures or temptations of alcohol.

With the unprecedented amount of vitriol the LGBTQ+ community is facing, now is the time to mobilize and unify efforts toward a positive paradigm shift. If our goal is to eliminate this new silent epidemic, we need to coalesce and diversify safe spaces for the LGBTQ+ community. While creating safe spaces is an arduous feat, history has also shown that unified efforts can achieve remarkable progress.

When HIV/AIDS was dubbed a silent epidemic during the 80s, The ACT UP coalition was formed to end misinformation, re-invigorate political action, and shift the public narrative surrounding the deadly disease. Founded by members of the LGBTQ+ community, they mobilized public awareness campaigns, staged demonstrations and most importantly, gathered members together to discuss the problems in an inclusive manner. The organization’s activism eventually propelled ACT UP to be an internationally recognized group, becoming a favorite choice for resources and information on HIV/AIDS for the LGBTQ+ community.

ACT UP was instrumental to the change in public perception of HIV/AIDS, paving the way for advancements in the social and scientific aspects of the silent epidemic. If we want to tackle this new silent opioid epidemic head-on, we must commit to mobilizing in a manner similar to ACT UP to end LGBTQ+ overdoses. One of our first steps should be creating more community spaces for LGBTQ+ people that are affirming and sober.

There is an urgent need for more LGBTQ+ spaces and events that do not have access to drugs and alcohol. Coffee shops, bookstores, and community centers should take initiative to host LGBTQ+ activities and become cornerstones for inclusive community building.

Cuties, a Los Angeles coffee shop that opened in 2017, was founded with the intention of providing a safe space for members of the LGBTQ+ community that was not focused around alcohol and substance use. They would host a variety of events at the cafe quickly becoming a hotspot for many of its patrons. Unfortunately, the brick and mortar coffee shop closed its doors in 2020 due to the COVID-19 pandemic, and its untimely closing has contributed to the dwindling presence of LGBTQ+ safe and sober spaces.

It is essential to support local LGBTQ+ meeting spaces. To be an ally to the LGBTQ+ community, reaching out to local school districts, chambers of commerce, and business owners to host LGBTQ+ nights is a first step in the right direction. For people who identify as LGBTQ+, the time is now to connect with our fellow LGBTQ+ neighbors and mobilize movements for safe and sober areas, which will pave the way for healthier,  and safer substance use practices. Even if these actions feel out of reach, simply talking to your families and neighbors about LGBTQ+ acceptance and sharing your own story of acceptance can move us toward a future where sexual identity does not put one at risk for an overdose.

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Darwin Rodriguez is a program manager at the Institute for Public Strategies and oversees the Safer WeHo Coalition in West Hollywood.

Is the Business of America Really Business? Or Should it Benefit All of Society?

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The business of America is business. That famous quote is attributed to President Calvin Coolidge and has held sway over our culture and our national policy for more than a century. Interrupted only by World War II and the Civil Rights movement of the 1960s, it picked up steam in the 1980s with globalization when the interests of corporate America once again became predominant. It left concerns about public health and social justice in the dust.

Certainly, some have benefited from this single-minded focus. But the truth is, most have not. For it has resulted in an ever-widening gap between rich and poor and a shrinking middle class. Since 1980, according to the Pew Research Center, the share of wealth owned by those in the upper-income level has increased from 60% to 79%, while the share owned by the middle and lower classes dropped from 32% to 17% and from 7% to 4%, respectively.

We need to understand something here. We’re not just talking about economics. Those on the wrong side of the wealth gap are suffering much more than a decline in prosperity. For them, it’s a matter of life and death. According to a study from Harvard University, poverty in America can mean substantial reductions in how long a person will live. The difference is much greater than “the two or three years you might expect,” the researchers say. It could be as many as 10 or 15 years. The average lifespan of the poorest Americans is equal to that in Sudan or Pakistan.

It’s well known that poverty affects physical health. Higher rates of heart disease, cancer, and diabetes are all leading causes of death that have been noted in low-income and minority communities. Infectious diseases are also more prevalent, as seen during the COVID-19 pandemic, with more victims living in poor or overcrowded housing. However, the impact such conditions have on mental health has proved to be even more devastating.

Imagine waking up daily in a neighborhood with dilapidated buildings, graffiti painted on every wall, trash strewn along the sidewalks, people hanging around street corners dealing drugs, and gunshots ringing out on a nightly basis. Often it would be a low-lying area, so there would be no breeze. On hot days, such as with our recent heat wave, the asphalt would soak up the sunlight, dramatically increasing the temperature. There would be no parks and little green space. Heavy industry would be nearby with pollutants lingering in the air. It would sometimes be hard to breathe. Healthcare facilities would be scarce. There would be no markets selling fresh fruits or vegetables, just convenience stores with inflated prices.

How would any of us feel living in such conditions? Angry? Frustrated? Depressed? Suicidal? The answer is all the above. According to mental health experts, inadequate housing, poor nutrition, exposure to violence and crime, and lack of healthcare are all linked to mental illness. Combined with environmental stresses such as pollution, temperature extremes, and challenging sleep environments, they inevitably lead to higher rates of depressive disorders, anxiety, psychological distress, and suicide.

Moreover, if nothing is done, the problem is likely to get worse. Studies on intergenerational wealth show that when wealth is concentrated at the top, there will be less economic mobility. This means that as the gap in wealth gets wider, low-income families will have less and less chance of pulling themselves out of poverty. So, you get a winner-take-all system in which the very few accumulate vast fortunes, and the rest are left behind, permanently stuck in a vicious cycle of hopelessness, ill health, and early death.

The good news is that it doesn’t have to be this way. In Europe both rich and poor enjoy a similar span of life, and each lives longer than their counterparts in America. The solutions are simple enough, and we are familiar with them all. They include increased access to better housing, health care, and education; financial literacy and job training; higher minimum wages and a host of other common-sense policies such as treating substance misuse as an illness rather than a crime.

First, we need to change our mindset. By buying into the zero-sum game of Corporate America, we have seen our country divided into winners and losers, a state of affairs that is neither fair nor sustainable. We need to adopt a new attitude, one that balances the interests of big business with our obligation to preserve the health and welfare of the general population. With this as a guiding principle, we should be able to retool our economic system so that it promotes widespread prosperity, benefiting all segments of society, not just the highest earners.

Author:

–IPS Editorial Board

Taxing Alcohol to Protect Public Health and Safety Is a Good Thing

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Most people cringe at the idea of paying more taxes, including on alcoholic products. But when weighed against the cost that alcohol puts on communities, healthcare, and society, a strong case exists that more taxing is necessary.

An alcohol tax is a type of excise tax that is applied to beer, wine and spirits at the time of purchase. Generally, these taxes are implemented for two purposes. First, the financial benefit to taxing the sales of controlled substances is obvious. As demonstrated through historically high sales of alcohol leading into and following the COVID-19 pandemic, as well as historical state revenue from these measures, taxes on controlled substances can represent a significant proportion of total tax dollars going to the state—despite making up a small percentage of total taxes.

Second, these taxes are intended to have a preventative effect on substance use by disincentivizing drinking—especially excessive drinking. As one of the major causes of acute and chronic disease and illnesses, alcohol consumption is a key concern for state public health officials by placing a tremendous financial and material strain on healthcare, emergency responders, and social services, as well as adjudication and workplace productivity costs. These costs are broadly passed on to residents and community members.

Rather than keeping up with the rising costs to public health and safety of alcohol, taxes on alcohol are either remaining stagnant or even being lowered. Essentially, alcohol is a commodity that generates $10.2 billion in revenue from taxes, yet results in a loss of $249 billion in costs to society. The disparity is stark.

Despite many states’ goals to reduce excessive and life-threatening alcohol consumption, several still fail to fully utilize taxes as a public health tool. California, for instance, languishes behind many other states in its alcohol excise taxes, charging pennies on the dollar for the sales of distilled spirits when viewed alongside comparable geographies—as much as ten times less than other states like Washington and Oregon.

One step that some states can take is to change regulations regarding alcohol taxation. One specific example is to categorize “alcopops”—pre-mixed boozy beverages like Four Loko and Mountain Dew Hard—as distilled spirits rather than malt beverages. This puts their sales prices much higher and is hypothesized to present a greater barrier to purchase, specifically for youths at risk of being enticed by marketing and packaging.

Increasing numbers of community members, prevention specialists, and lawmakers are understanding the damage alcohol causes and leading advocacy efforts to raise alcohol taxes. States like Illinois and Maryland, for example, have taken bold steps to increase alcohol taxes and have seen dramatic reductions in impaired driving and fatal alcohol-related motor vehicle crashes. It’s a steep climb for advocates of alcohol harm prevention to reverse decades of stagnant tax policy, but the benefits of increasing excise taxes on alcohol will become apparent to communities when issues like calls for police service, DUI crashes, and other alcohol-related harms are reduced.

For the families of the hundreds of thousands of men, women, and children who die each year from alcohol-related harms, it’s past time for lawmakers to acknowledge that alcohol excise tax rates and the public health costs of alcohol are dramatically out of alignment.

Author:

Michael Pesavento
Communications Specialist

Michael Pesavento is a Communications Specialist in the San Diego County office. He serves on the Binge and Underage Drinking Initiative that aims to reduce harms and responsibly regulate drug and alcohol usage in the San Diego area.

How the “Housing Theory of Everything” Can Help Explain Alcohol and Other Drug Problems

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Up until the 1980s, common knowledge held that preventing addiction to substances, be they narcotic drugs, tobacco, or alcohol, were issues to be dealt with at the individual level through education and grounded in a moralistic knowledge of what is right and wrong.

Since then, attitudes about how to prevent drug and alcohol misuse have been scaled up, no longer focusing on the individual, but instead, on the community, in what has come to be known as “upstream prevention.”

This strategy seeks solutions that address a plurality of root causes that lead to alcohol and drug disorders. A great example of such a pluralistic root cause for substance use disorders is an unfortunately common issue throughout the U.S.: housing insecurity.

The “housing theory of everything” is a phenomenon that implies the U.S.’ housing shortage contributes to a broad range of societal problems such as inequality, climate change, disease, and stagnant population growth. A case can also be made for throwing substance use disorders into the mix as a consequence of the nation’s housing shortage.

Housing as a basic need

Housing is a fundamental necessity of human health, fulfilling both physiological and safety needs. However, the U.S. is experiencing an unprecedented housing crisis, in large part because housing development hasn’t kept up at the same pace as population and job growth.

This is especially true in the nation’s largest metropolitan areas. Last year, approximately 20% of the U.S. population reported they were very likely facing foreclosure, and 14% likely facing eviction.

When individuals become unsheltered or are facing some type of housing insecurity, stress and anxiety can be dramatically exacerbated. This is due in part to the ripple effects of not having a stable and secure place to eat or sleep.

For example, individuals experiencing homelessness may find it difficult or near impossible to secure a job, as employers often require a stable address for employment. Similarly, things like physical and mental hygiene become difficult, if not impossible, to attend to when housing is not immediately available.

These compounding issues have a cascading effect on health and well-being and can lead to self-medication with drugs and alcohol.

“The Housing Theory of Everything”

Are substance use disorders a cause or an effect of housing insecurity? On this, experts disagree. But what we do know is that there is a strong association between housing insecurity and poor mental health, thus supporting the theory that one’s housing situation is determinative of a range of health outcomes.

Whether it is struggling with the anxiety of rising housing costs, an inability to pay rent, or uncertainty about where the next meal and place to sleep will be, many Americans are turning to common coping mechanisms: drugs and alcohol.

And as consumption of these substances increases, so do poor health outcomes as suggested by increases in healthcare costs to treat substance-related diseases, emergency department costs, alcohol-related traffic fatalities, and domestic violence.

This last fallout from alcohol and drugs – domestic violence – concerns many housing advocates. Approximately 80% of homeless mothers with children are victims of domestic violence. Many victims flee their abuser with scant economic resources, little family support, or no solid place to land.

Housing as a stabilizing factor toward mental health

Providing housing that is safe, clean, affordable, and accessible doesn’t completely solve the entire homelessness crisis, but is a good first start. When a basic need like housing is met, we can start to see a general decrease in self-medicating habits, as well as a greater community impact through less burdensome social services.

The State of California has enacted legislation that commits over half a billion dollars to housing and services for individuals struggling with mental health and substance use disorders. This effort is a fundamental starting point for addressing the link between housing and substance use, providing treatment beds for over 1,000 Californians experiencing homelessness.

However, programs like this fall short by treating housing insecurity as the result, rather than the cause, of substance misuse. Instead, we need to focus efforts toward programs aiming to thwart housing insecurity at its root. By providing stability and security, we can eliminate many of the anxieties that contribute to substance use disorders, and we can make a meaningful difference.

Author:

Michael Pesavento
Media Advocacy Specialist

Michael Pesavento is a Media Advocacy Specialist in the San Diego County office. He serves on the Binge and Underage Drinking Initiative that aims to reduce harms and responsibly regulate drug and alcohol usage in the San Diego area.

Group of community advocates banning together

Creating a Prevention Campaign That Works

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Lessons learned from tobacco control hold value for future efforts

In 1880, James Albert Bonsack filed a patent on an invention that would eventually pit industrial growth against public health.

Bonstack’s invention could roll hundreds of cigarettes a minute, revolutionizing the tobacco industry and creating a product that would see thousands of percentages of increases in use over just a few short decades.

Tobacco industrialists saw tremendous potential for profit in this new, portable and cheap cigarette. This signaled the beginning of what would become almost a century-long campaign to sell consumers a highly addictive, highly carcinogenic product. And it worked!

Over 100 years since Bonsack filed his original patent, communities everywhere are still subjected to the fallout of the “smoking boom” of the 1900s, and new smokers are created every day through products like flavored tobacco and e-cigarettes/vaporizers.

But all hope is not lost. In the decades since, public health professionals have advanced policy and enforcement measures around tobacco, and have learned important lessons in the process.

Many early attempts to create tobacco prevention campaigns framed much of the issue as one of personal choice. Most of those campaigns regarded the individual smoker as the important unit of change, believing that if you can change the thinking of an individual through education and appeals to reason, then you can halt a behavior in an entire population. However, we have since learned this narrow focus has a very limited effect.

Instead, modern prevention strategies have shifted the focus from individual knowledge, behavior and attitudes as the “unit of change” to acknowledging the role of policy, systems and “environmental factors” in shaping individual behavior. In this context, environmental factors include factors like the way a neighborhood is built, the types of businesses that exist there, the amenities and spaces available to residents and even transportation. In tobacco prevention, it also includes the devious marketing tactics of Big Tobacco.

When focusing on these environmental factors, modern prevention campaigns focus on influencing policy to produce community-level change. Democracy at any level, from the local city council all the way to state and federal jurisdictions, plays a role. Focusing on policy, rather than individuals, provides resources for enforcement and maintenance of policies.

Despite the understanding that smoking was already a population-level health hazard, smoking prevention in the 1970’s and 80’s approached it as an individual choice; something for people to stop doing on their own.

It wasn’t until studies began showing the effects of second and even thirdhand smoke exposure (especially on children) that conversations about prevention began to elevate on a national level. In 1990 the federal government instituted its ban on smoking in airplanes for U.S. domestic flights, a policy which expanded worldwide thereafter. In the early 2000s, many cities and local jurisdictions in the U.S. began implementing indoor smoking bans, and as of 2018 nearly 30 states had totally banned the smoking of cigarettes indoors. These broad policy changes reflect efforts at the federal, state and local levels by public health professionals and advocates to create evidence-informed changes that promote healthy decisions and reduce access and exposure to harmful substances like tobacco.

Even now, initiatives like IPS’ Smoke-Free Multi-Unit Housing (MUH) project aim to implement smoking restrictions in residential spaces where secondhand tobacco exposure can impact people’s health, with a goal to implement transformative, equitable policy strategies that keep residences free of harmful tobacco smoke and other carcinogens.

As prevention efforts continue to hone in on effective strategies, one element remains consistent: community. Involving community members and welcoming their input instantly elevates any campaign, and is absolutely vital to creating sustainable change after a campaign’s conclusion. Prevention professionals have learned that it is important to work with community members to develop a plan that meets them where they are, to create a shared language with residents that embraces policy and systems change, and to invest in the capacity of the communities so that residents can continue this important work.

Efforts to reduce smoking-related problems are far from over. Despite successes like California’s recent successful ballot measure that will ban flavored tobacco products, issues with nicotine and tobacco will persist. Youth access and second-hand exposure are likely issues that will take decades of work to address. However, through the efforts of dedicated public health professionals—and with a lot of patience—we can learn from our successes and failures to bring strong, coherent campaigns that truly influence population-level change.

Let’s not let those lessons go up in smoke.

 

Tobacco Prevention 2.0: Integrating Equity into Smoke-Free Multi-Unit Housing

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Protecting the health and safety of everyone requires a new approach to policy

When it comes to housing vulnerable populations, tobacco prevention is essential. Tens of millions of Americans live in multi-unit housing (apartment buildings, condominiums, and other tightly-clustered living arrangements). A significant percentage of this housing is subsidized by the government.

Smoke-free building policies, which cover roughly one-third of multi-unit housing residences in the U.S., are intended to protect tenants from exposure to secondhand smoke, which can travel through open windows and under doors, seep in between shared walls, and blow through shared ventilation systems. Owners and managers of smoke-free housing also benefit from reduced fire risk and legal liability safeguards, lower maintenance costs, and maintenance of property value.

Research shows there is no level of safe exposure to secondhand smoke. In adults, health impacts range from mild nasal irritation to more severe health risks to the coronary, pulmonary, and reproductive systems.

In children, secondhand smoke can cause middle ear disease, compromise respiratory function, and even result in sudden infant death syndrome (SIDS). Secondhand smoke is also responsible for triggering asthma. About 1 in 20 children suffer from asthma, and of those, about 1 in 6 are treated at emergency departments or hospitalized, resulting in high medical bills, missed school (and work) days, and decreased quality of life.

The lack of policy around secondhand smoke is particularly harmful to children, people with lower income, people with less education, residents of rental and multi-unit housing, people who live with someone who smokes inside the home, and people in traditionally “blue collar” occupations. The Black population, in particular, is exposed to more secondhand smoke than other racial and ethnic groups. According to the Centers for Disease Control and Prevention:

As of June 2021, of the ten U.S. states with the highest proportion of Black residents, only three of those states have comprehensive smoke-free laws that prohibit smoking in all workplaces and public places. Of the seven states that do not have comprehensive laws, two also prevent local communities from adopting comprehensive smoke-free laws.

Smoke-free multi-unit housing policies have therefore been well-intentioned efforts to protect tenants from unwanted tobacco smoke. They have also, however, forced building managers to grapple with serious issues of equity: While it is not fair or right to expose tenants to someone else’s tobacco smoke, it is also ethically unsound to evict smokers with no other housing options available, particularly considering the U.S.’s current housing crisis.

Demand for housing that is in short supply for both homeowners and renters is sharply driving up the cost of homeownership and rent. The consequences are dire: billions of dollars in lost earnings, increased debt, overcrowded homeless shelters, more people living in their car or on the streets, and physical and emotional distress. It is neither a prudent public health nor ethical policy to force people out of their homes.

These dynamics have recently inspired a new take on smoke-free building policies. Cities in California, for example, have created equity-forward solutions that are less punitive toward the tenant while holding the HOA and/or landlord accountable for enforcing the policy before more extreme measures like tenant fines and eviction are implemented.

Berkeley’s Municipal Code 12.70 is one such example. Importantly, Berkeley’s policy is specifically framed to protect smokers, and eviction is not the preferred form of regulation and enforcement. Tenants who smoke are provided with adequate notice, education, access to comprehensive cessation resources, and reasonable accommodations.

Community groups advocating for smoke-free MUH policies, too, are adopting an equity-forward approach, ensuring affected tenants, and even smokers themselves, are involved in the process by sharing lived experiences, advising on policy details, and meeting with elected officials.

Solutions like the Smoke-Free Multi-Unit Housing Initiative are vital to preserving the health and well-being of tenants, property managers/owners, and community members without contributing to the housing insecurity crisis. The project advocates for eliminating extreme remedial measures such as massive fines or eviction in favor of a graduated, multi-step process that doesn’t shame or further threaten the health and well-being of smokers while also protecting non-smokers.

The tension between the needs and wants of smokers and non-smokers has plagued housing units for decades, and there are no easy solutions. These new, equity-forward approaches recognize the complexity of the problem and attempt to do a better job ensuring everybody – smokers and non-smokers alike – can live in housing that is healthy and safe.

California’s New Composting Law Takes on Climate Change

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It’s no secret that the first to be impacted by the devastating effects of climate change are those who are already the most vulnerable. The startling and unprecedented changes to the natural world—caused, at least in part, by human activity—individuals that are already struggling are likely to bear the burden of environmental collapse. Already, researchers indicate that the impacts faced by these communities can be far more widespread and immediate than many might expect.

For example, an obvious impact of climate change is rising average temperatures; we feel it, summer after summer as the thermometer ticks ever upward. However, less expected are the secondary effects these changes might have—things like fewer opportunities for healthy outdoor time and worse mental health outcomes. These effects are exacerbated in communities where inequalities are most pronounced. For low-income communities where amenities like air-conditioning and insulation are fewer and further between, the effects of increased global warming will be felt most severely. 

That’s why it is important to look for “upstream” solutions to environmental issues. By addressing the root causes of a problem rather than its symptoms we can prevent harm, such as increased global temperatures, as well as its trickle-down effects, like impacted mental and physical health.

In that vein, California has recently begun to implement SB 1383—dubbed “California’s Short-Lived Climate Pollutant Reduction Strategy”—in earnest. This legislation was introduced in 2016 by then-Governor Jerry Brown, and broadly sets goals for the reduction of methane emissions in the state. 

Methane (CH4) is a leading contributor to atmospheric insulation, 25 times as potent a contributor as carbon dioxide (CO2). That ratio makes methane a major target for emission reductions, as pound-for-pound, methane accounts for much more atmospheric insulation—and thus, temperature increase—than do even pollutants from fossil fuels. That’s why bills like SB 1383 are working to reduce the amount of methane we release in California. 

One way to reduce methane emissions is by lowering the amount of organic waste being decomposed in municipal landfills. This entails creating proper composting sites for the separation of food and yard waste and redirecting organic matter that would otherwise end up creating methane into more productive areas. One such redirection is the distribution of the created compost to local farms, parks, and gardens.  

But what would this look like in practice?

We can look to state and local municipalities for examples of success in creating a buffer between vulnerable communities and climate effects. Often, these localities can address the specific needs of their community members more acutely than broad strokes approaches by other governing bodies.

For example, in 2018 the Institute for Public Strategies (IPS) partnered with San Bernardino County residents who were advocating for the City of Pomona to allow them to use a vacant city-owned property to create Pomona’s first urban farming project. The project—titled ECOFARM—focuses on composting to support climate change mitigation and alleviate environmental justice burdens on the immediate community. The city could not deny the efforts of the residents and voted unanimously in favor to allow the use of the vacant lot for the ECOFARM free of cost.  The ECOFARM was funded by a grant secured by residents from the California Environmental Protection Agency. Residents used the funds for basic infrastructure development, acquisition of tools and supplies, soil, irrigation, essential farm labor, as well as a variety of educational programming around nutrition and environmental justice. 

But the options for addressing both community and environmental issues at once are not limited to farming and gardening projects. Outside of SB 1383, California agencies are providing some direct assistance to local jurisdictions. Just this year the California Natural Resources Agency released millions in grants to local jurisdictions to use in environmental projects. Highlights from these grant releases include the agency’s Youth Community Access and Environmental Enhancement and Mitigation programs, each of which awarded over $10M for everything from greenspace cleanups to park improvements and youth outdoor programs.

Obviously, these programs are not the ultimate solution to climate change; that responsibility lies at the highest levels of government and industry and should be prosecuted with all the vigor we can muster. However, state and local level programs are an important push toward improving both environmental wellbeing and mental and physical health outcomes, especially for youth. Moreso, the push to reduce methane emissions—a high-level upstream initiative—made way for materially impactful local changes.

As the global climate faces significant changes in the immediate future, our adaptation to these new conditions must strategize prevention efforts that prioritize the health and safety of marginalized communities. Future regulations and policies can learn from this upstream approach to designing solutions. A world with less food waste is a world with fewer methane emissions; a world with working public transport is a world with fewer polluting cars; a world with more available, livable housing is a world with fewer children sleeping on our streets.

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Author:

Michael Pesavento
Media Advocacy Specialist, IPS

Michael Pesavento is a Media Advocacy Specialist in the San Diego County office.