Connecticut’s Anxiety Above National Average, Analysis of Google Searches Shows

High anxiety.  It is apparently as American as apple pie.  At least that is what an analysis of Google searches is showing.  And Connecticut is above average, although less anxious than the rest of New England. In a state-by-state comparison of anxiety levels based on Google searches, topping the list was Maine, 21 percent above the national average.  At the other end of the spectrum was Oregon, 26 percent below the U.S. average. 

The states with the highest percentages of Google searches for “anxious” and related terms include Maine, New Hampshire, Vermont, Massachusetts, Rhode Island, Pennsylvania, West Virginia and North Dakota.  The least anxious:  Oregon, Nevada, Virginia, Kansas, Alaska and Hawaii.

The New York Times reports that Google’s measure of anxiety includes a broad range of searches, including “anxiety help,” “anxious” and “anxiety symptoms.”

“While Google searches may not be a perfect measure of anxiety,” a Times columnist reports, “there is increasing evidence that searches on a health condition highly correlate with the number of people suffering from that condition.” The rates of Google searches for anxiety in a state also correlate with survey measures of anxiety, explained Seth Stephens-Davidowitz, an economist and a contributing opinion writer for the Times.

Nationwide over the past eight years, Google search rates for anxiety have more than doubled. They are higher this year than they have been in any year since Google searches were first tracked in 2004, according to Stephens-Davidowitz.  Anxiety, however, is not uniquely American.  A review of online searches in the United Kingdom in 2014 found that 'What is anxiety?' was one of the top 10 most searched for questions.

Among the leading searches this year in the U.S. are driving anxiety, travel anxiety, separation anxiety, anxiety at work, anxiety at school and anxiety at home. Connecticut is the only New England state where the rate of Google searches for anxiety is not more than 10 percent above the national average.  The analysis indicates that “Americans anxieties are up 150 percent compared with 2004, based on internet searches.”  And still climbing.

The two leading drivers, according to the analysis:

• Poverty, and/or a major recession. States that were more deeply affected by the Great Recession saw bigger increases in anxiety during and after the recession. The estimate is that each percentage point increase in unemployment is associated with a 1.4 percent increase in anxiety. Google searches for anxiety tend to be higher in places with lower levels of education, lower median incomes and a larger part of the population living in rural areas, the analysis discovered.
• High opiate prescription rates — and high search rates for opiate withdrawal — are among the places with the highest search rates for panic attacks. These areas include Appalachia and the South. During years in which many people complained of opiate withdrawal, many people also complained about panic attacks. Searches for opiate withdrawal consistently start high at the beginning of the year. They mostly drop through the year, although they rise in the summer and then surge around Christmas.

Some have raised questions about the inferences in the analysis, wondering if opiate usage, for example, is a cause or effect reflected in the Google searches.  Others have suggested that merely the act of using Google to investigate real or perceived symptoms can make an individual more anxious, and more likely to search Google again, and the pattern could then repeat, leading to more frequent searches.

Travelers Initiative Aims to Predict Chronic Pain from Workplace Injuries

Can chronic pain, often the lingering result of a workplace injury, be predicted? The Travelers Companies, Inc. believes the answer is yes.  The company has developed what it describes as the first predictive model designed to reverse a sharp rise in chronic pain caused by workplace injuries.

The Travelers Early Severity Predictor (patent pending) identifies the likelihood of an injured employee developing chronic pain so that they can avoid it in recovery and reduce the need to use opioids or other painkillers.

“Millions of American workers are injured on the job each year, and the number of cases in which chronic pain interferes with an employee’s recovery has risen from less than 10 percent a decade ago to more than half of all serious injuries today,” said Dr. Adam Seidner, the National Medical Director at Travelers, when the initiative was announced in April.

According to A.M. Best, Travelers is the largest workers compensation carrier in the United States. The company manages more than 250,000 workplace injury claims and 3.5 billion medical treatments per year.

“When someone develops chronic pain, they are prescribed opioids or other painkillers more than 90 percent of the time. Our goal is to work with injured employees and their doctors to eliminate or substantially reduce the need for painkillers that can slow their recovery or lead to devastating long-term addiction.”

The Travelers Early Severity Predictor has been applied in more than 20,000 cases since early 2015. Of those, more than 9,000 injured employees were identified as being at risk of developing chronic pain. These employees received a customized, sports medicine-like regimen of treatment precisely sequenced to aid and accelerate their recovery, the company explained.

Injured employees who participated in the program in the past year have, on average, recovered and returned to work more quickly, the company said. They were also far less likely to receive a prescription for opioids, and when they did, it was typically a lower dosage or only for short-term use. At the same time, medical expenses, which cost American employers an average of nearly $40,000 per injury, were reduced by as much as 50 percent.

In 2014, there were 107.1 cases of nonfatal occupational injuries or illnesses requiring an employee to miss work for every 100,000 full-time American workers, according to the U.S. Bureau of Labor Statistics (BLS), the website IPWatchdog reported. Although this represented a decline from 2013’s workplace injury numbers, it still resulted in 1,157,410 days away from work among private, state government and local government employees. BLS statistics show that workplace injury incidence rates were highest in the industries of transportation and warehousing as well as health care and social assistance, according to the website.

Two patent applications published this year by the U.S. Patent and Trademark Office cover technologies associated with the Early Severity Predictor project, IP Watchdog reported.

The Centers for Disease Control issued a guideline earlier this year, the Insurance Journal reported, for primary care physicians for treating chronic pain. The new CDC guideline aims to lessen opioid use disorder and overdose. When opioids are used, doctors should prescribe lowest possible effective dosage, according to the guideline. The CDC guideline also suggests increasing the use of other effective treatments available for chronic pain, such as non-opioid medications or non-pharmacologic therapies.

According to research into physician dispensing of opioids, the Workers Compensation Research Institute (WCRI) noted that three out of four injured workers with pain are prescribed opiods, with the amount per claim varying by state, the Insurance Journal reported.  Nearly 1 in 12 injured workers given narcotics are still on them 3 to 6 months later as few doctors appear to be following recommended treatment guidelines to prevent abuse, according to WCRI research in 2012.

A 2012 study in the Journal of Occupational & Environmental Medicine found that when long-acting opioid painkillers are prescribed, workers’ compensation claims are nearly four times more likely to turn into catastrophic claims with costs tallying more than $100,000.

“Helping employees avoid chronic pain and the slippery slope to possible opioid dependency is critical to reversing this disturbing and costly health crisis,” Seidner emphasized.

The Travelers Companies, Inc. is a leading provider of property casualty insurance for auto, home and business. The company’s main offices are in New York, Hartford and St. Paul.  A component of the Dow Jones Industrial Average, Travelers has approximately 30,000 employees and generated revenues of approximately $27 billion in 2015.

E-Cigarettes Remain Controversial as New Federal Law, Yale Academic Study Weigh In

Even as new federal rules restricting the sale of e-cigarettes take effect, advocates in Connecticut continue to urge state lawmakers to impose tougher restrictions on electronic cigarettes and vapor products when they reconvene next year.  They warn that a growing number of young people are using these electronic delivery systems to "smoke" what could be harmful and addictive substances. The U.S. Food and Drug Administration announced rules earlier this year that will forbid e-cigarette shops nationwide from selling the products to people younger than 18 and will require staff to ask for identification that proves customers are old enough to buy.  The rules – which take effect this month - would also extend long-standing restrictions on traditional cigarettes to a host of other products, including e-cigarettes, hookah, pipe tobacco and nicotine gels. Minors would be banned from buying the products.

Teens who initially tried e-cigarettes because of their low cost had significantly stepped up their use of e-cigarettes by the time researchers checked in six months later, according to a study that senior researcher Suchitra Krishnan-Sarin, a professor of psychiatry at Yale University School of Medicine, told WebMD in an article published last week.  The low cost of the devices and the promise they can help teens quit smoking tobacco are the two strong predictors of continued use, she said.

In addition, teens who tried e-cigarettes to quit smoking were more than 14 times more likely to keep using e-cigarettes than those who did not consider this a reason to try the devices, the findings showed.  However, e-cigarettes didn't seem to help the kids quit. Four out of five teens who tried e-cigarettes to quit smoking were still puffing regular cigarettes six months later, the investigators found.

"Even though they said they were using e-cigarettes to quit smoking, it doesn't appear to have necessarily helped them," Krishnan-Sarin said.

Jennifer DeWitt, executive director of the Central Naugatuck Valley Regional Action Council, told members of the General Assembly's Public Health Committee this spring that every principal in the 12-town region her organization covers "has a desk drawer of these items that were confiscated from teens this year," including some retrofitted to smoke marijuana, the Associated Press reported.

"Tobacco is a success story for us in the overall picture of prevention. However, we will take a back-slide if electronic nicotine delivery devices continue to be available in the ways that they are currently," DeWitt said.  She said 7.2 percent of Connecticut high school students are e-cigarette users, marking a higher usage rate than all tobacco products combined.

According to the CDC, nationally, 7 out of 10 middle and high school students who currently use tobacco have used a flavored product. In addition:

• 63% of students who currently use e-cigarettes have used flavored e-cigarettes (1.6 million)
• 61% of students who currently use hookah have used flavored hookah (1 million)
• 64% of students who currently use cigars have used flavored cigars (910,000)

Beginning this month, retailers are prohibited from selling the tobacco products to those under 18, placing them in vending machines or distributing free samples, under the new FDA rules. While nearly all states already ban sales of e-cigarettes to minors, federal officials said they will be able to impose stiffer penalties and deploy more resources to enforce the law. The FDA action comes five years after the agency first announced its intent to regulate e-cigarettes and more than two years after it floated its initial proposal, according to published reports.

“Millions of kids are being introduced to nicotine every year, a new generation hooked on a highly addictive chemical” Health and Human Services Secretary Sylvia Burwell said. “We cannot let the enormous progress we’ve made toward a tobacco-free generation be undermined by products that impact our health and economy in this way.”

The CDC indicated that in 2013, more than a quarter million middle and high school students who had never smoked regular cigarettes had used e-cigarettes, a number that had grown three-fold in just two years. A high proportion of middle and high school students saw e-cigarette advertisements (in 2014) from one or more of the following four sources: retail, Internet, TV/movies, and Magazines/newspapers. Overall, 66% of Middle School Students and 71% of High School Student.

The New Haven Register reported that Dr. Roy Herbst, chief of medical oncology at the Yale Cancer Center and Smilow Cancer Hospital, said state and federal policy-makers should do more to rein in the spread of the devices.

“It didn’t go as far as we would’ve liked but it’s a good step in the positive direction and allows for more research,” Herbst said of the new federal rule. “I think now that we finally have this regulation, it will begin to stem the rapid use of e-cigarette use that is running rampant in the United States and around the world.”

New Documentary, Travelers Championship Heighten Attention to ALS, Sports is Once Again Common Theme

Public awareness of ALS - amyotrophic lateral sclerosis – has been intertwined with sports since Lou Gehrig played with the New York Yankees, and saw his career and his life, tragically shortened by the neurodegenerative disease eight decades ago.  Gehrig’s Yankee Stadium speech in 1939 has endured as one of the century’s most memorable. Earlier this month, the Travelers Championship on the PGA Tour raised more money for charity than in any previous year, when $2.8 million was raised with ALS as the primary charity.  Travelers Executive Chairman of the Board Jay Fishman announced in August 2015 that he had been diagnosed with ALS.

And now, a new motion picture documentary telling the story of a former NFL player afflicted with ALS is reaching theaters across the country, including Connecticut.  The film, Gleason, goes inside the life of Steve Gleason, the former New Orleans Saints defensive back who, at the age of 34, was diagnosed with ALS and given a life expectancy of two to five years. Gleason played for the Saints from 2000-2008.

The primary beneficiary for the 2016 Travelers tournament was the ALS Clinic at the Hospital for Special Care (HSC) in New Britain. Each year, HSC cares for more than 250 Connecticut residents with amyotrophic lateral sclerosis (ALS). HSC is the only facility in Connecticut that is part of the ALS Association’s national network of Certified Treatment Centers of Excellence and is certified by the Muscular Dystrophy Association for ALS care.

According to the ALS Association, amyotrophic lateral sclerosis is a progressive neurodegenerative disease that affects nerve cells in the brain and the spinal cord. When a muscle has no nourishment, it "atrophies" or wastes away. "Lateral" identifies the areas in a person's spinal cord where portions of the nerve cells that signal and control the muscles are located. As this area degenerates it leads to scarring or hardening ("sclerosis") in the region.  Motor neurons reach from the brain to the spinal cord and from the spinal cord to the muscles throughout the body. The progressive degeneration of the motor neurons in ALS eventually leads to their demise.

ALS burst back into the public conversation during the 2014 ALS Ice Bucket Challenge, as millions of people started talking about ALS. Recently, there have been some indications that the money raised during that social media explosion may have helped to advance research into ALS.

As the movie tells it, just weeks after his diagnosis, Gleason found out his wife, Michel, was expecting their first child. A video journal that began as a gift for his unborn son expands to chronicle Steve’s determination to get his relationships in order, build a foundation to provide other ALS patients with purpose, and adapt to his declining physical condition—utilizing medical technologies that offer the means to live as fully as possible, according to the movie synopsis appearing on the film’s website. The documentary was highly regarded at the 2016 Sundance Film Festival, and is making its Connecticut debut at Cinema City at the Palace 17 in Hartford.

ALS usually strikes people between the ages of 40 and 70, and approximately 20,000 Americans can have the disease at any given time (although this number fluctuates), the ALS Association reports. For unknown reasons, military veterans are approximately twice as likely to be diagnosed with the disease than the general public.

The Greater Hartford Walk to Defeat ALS will take place on September 25 in East Hartford.  The New Haven Walk will be held on October 2 in New Haven.

https://youtu.be/WgkQU32XSFQ

CCMC Study Brings Attention to Dramatic Increase in Trampoline Injuries Nationwide

As trampoline parks are becoming more common in Connecticut and across the United States, so are emergency department visits for injuries that occur at these facilities, a new national study led by physician researchers at Connecticut Children’s Medical Center (CCMC), has found. The study published this month in the journal Pediatrics, co-authored by CCMC emergency physicians Steven Rogers, MD, and Jesse Sturm, MD, and pediatric emergency medicine fellow Kathryn Kasmire, MD, came about after the physicians began noticing a sharp increase in trampoline injuries, including some that were serious.

For the study, the CCMC physicians analyzed emergency room reports from a national database to estimate the total number of trampoline-related injuries both from parks and trampolines at home. From 2010 to 2014, the average annual number of Emergency Department visits for trampoline injuries was close to 92,000.

The vast majority happened at home - but injuries at trampoline parks surged more than 10-fold during the study period. The study found that emergency room visits related to injuries at trampoline parks grew from 581 in 2010 to 6,932 in 2014, which was the latest year represented in the study. Patients injured at trampoline parks were more likely to be males, with an average age of 13.

The study concluded that “trampoline park injury patterns differed significantly from home trampoline injuries. Trampoline park injuries are an emerging concern; additional investigation and strategies are needed to prevent injury at trampoline parks.”

The number of trampoline parks in the United States also increased during that time frame from around 40 in 2011 to 280 in 2014. It is now estimated that nationwide, five to six new parks open each month. Over the last year alone, it is estimated that more than 50 million people visited trampoline parks in North America, according to the International Association of Trampoline Parks.

In Connecticut, trampoline parks are up and running in communities including Hartford, New Britain, Trumbull, Bethel, Stamford, Norwalk, Manchester, Milford, Danbury, New Milford, Ridgefield, Brookfield, Wallingford.  Another is expected soon in East Haven.

The state’s official tourism website, www.ctvisit.com, includes six trampoline parks among the places highlighted for “safe, family-friendly indoor recreation.”  The “Connecticut – Still Revolutionary” site features information about, and links to, Launch Trampoline Park in Hartford, Sky Zone in Bethel and Norwalk, Chelsea Piers in Stamford, Rockin’ Jump Trampoline Park in Trumbull and Flight Trampoline Park in New Britain.

The study found that the majority of trampoline-related accidents occur at home — rather than at a park — and these accidents did not increase significantly from 2010 to 2014, nor did overall trampoline injuries.

The International Association of Trampoline Parks (IATP) said the rise in injuries should be expected because of more parks in recent years. "We believe that the positives of youth recreational sports far outweigh the negatives, and we are actively engaged in programs aimed at promoting the safety and well-being of jumpers who visit our member parks," the organization said following publication of the study.

"I don't think trampoline park injuries are increasing because they are especially dangerous compared to home trampolines, but rather because of their growing popularity and the increasing number/availability of these facilities," said Kasmire, indicating that 1 in 11 children or young adults who went to the emergency room for park injuries was admitted to the hospital.

Most of the injuries were leg injuries, including strains and fractures. Children injured at trampoline parks were less likely to have head injuries than those injured on trampolines at home, but the severity of park-related injuries was concerning, the authors said.

In a published report, Kasmire said that parks generally have done a good job of ensuring that youngsters do not fall off trampolines, reducing the likelihood of head injuries, because the floors are covered with a bouncy surface. This floor, though, can increase the risk of other injuries if a person lands between two trampolines, she said.

The American Academy of Pediatrics advises against trampoline use for all children but says if children do use them, they should not do flips or have more than one jumper at a time on a trampoline. The academy said adult supervision is needed and that trampolines should also have proper padding.

The IATP indicated that the organization “welcomes studies like the one published” because they “provide a deeper understanding of safety issues and provide data on our sport allowing us to better educate parents, jumpers and parks so all can fully enjoy indoor trampoline park facilities.”

The trade organization also noted that “if the study reported Trampoline Park Injuries (TPIs) as a percentage, rather than a total, a more accurate industry picture would develop. As a point of reference, high school football players experience injuries at a rate of 3.87 per 1,000 exposures. The rate of reportable injury at a typical trampoline park is less than one per 10,000 jumpers.  Therefore, the rate at which injuries occur is a much more meaningful statistic than total number of injuries.”

The study in Pediatrics notes “adult supervision has been proposed to reduce trampoline injuries in children, although trampoline injuries often occur despite adult supervision.”  The study also states that “although only a fraction of trampoline-related injuries occurred at trampoline parks (11% in 2014), the trend is alarming.”

CT Has 3rd Lowest Teen Birth Rate in U.S.

Connecticut has the third lowest teen birth rate in the nation, and ranks among the states with the lowest incidence of low birthweight babies, preterm birth rate and percent of births to unmarried mothers, according to data from the National Center for Health Statistics of the Centers for Disease Control and Prevention. The data, reflecting statistics from calendar year 2014, indicate that Connecticut ranked  32^nd in Percent of Births to Unmarried Mothers, 30th among the states in Low Birthweight Rate, and 28^th in Preterm Birth Rate.  The state ranked 48^th in Teen Birth Rate, third lowest in the U.S.

The NCHS data also ranked Connecticut 12^th in the Cesarean Delivery Rate.

The Teen Birth Rate, determined by the number of births per 1,000 females age 15-19, was 24.2 nationally.  In Connecticut, it was 11.5.  The only states with a lower rate were Massachusetts at 10.6 and New Hampshire at 11.0.  Among the other states with low teen birth rates, well below the national average, were New Jersey, Vermont, Minnesota, Rhode Island, New York, Maine and Maryland.

The highest rates were in Arkansas (39.5), Oklahoma (38.5), Mississippi (38.), Texas (37.8) and New Mexico (37.8).

Regarding the percentage of babies born to unmarried mothers, a statistic long tracked by federal health officials, three states saw more than half the children born in that category.  The highest percentages were in Mississippi (54.0%), Louisiana (52.7) and New Mexico (51.3%).

Connecticut ranked 32^nd, at 37.1 percent, slightly lower than the national average of 40.2 percent.  The state with the lowest rate was Utah, at 18.6 percent, followed by Colorado (22.4%), Idaho (27.8%), Washington (32.1%) and Minnesota (32.3%).

Public Health National, Statewide Conferences Reflect Greater Attention to Field

With concerns about the Zika virus reaching the United States as reflected in the recent report of four cases in Florida and state public health monitoring now reaching Connecticut, public awareness of the role of public health officials, here and across the country, is likely to increase in the coming weeks and months. That coincides with the National Conference of the National Association of Local Boards of Health next week in St. Louis, and the Annual Meeting of the Connecticut Public Health Association slated for November in New Haven.  The statewide organization is marking its hundredth anniversary this year, and the theme of the conference will be "Back to the Future- 100 years of Public Health in CT and Beyond."

For the past century, the Connecticut Public Health Association has been “committed to improving the quality of the public health profession and advocating for policies and programs that promote health and prevent disease.” The association’s members, representing a wide variety of disciplines, “are united in the goal of protecting and promoting the public's health.”

The CPHA has invested its advocacy and education resources in key areas of public health such as public health infrastructure, racial and ethnic health disparities, health literacy, universal health care, environmental health, and disease prevention. The organization’s president is Brittany Allen, staff attorney with the state Department of Public Health.

Among those from Connecticut expected to attend the National Association of Local Boards of Health session in Missouri will be the Secretary on the national organization’s Board of Directors, Judith Sartucci of Rocky Hill and the Central Connecticut Health District which serves the towns of Berlin, Newington, Rocky Hill and Wethersfield.   The National Conference is scheduled to focus on ways to improve community heath, the Flint (MI) financial and water crisis “through a board of health lens,” and collaborative governance in an era of population health management.  The public health threats identified by the national Centers for Disease Control and Prevention will also be highlighted, as will Zika, according to Association Director Jamie Michael.

The mission of the Connecticut Public Health Association is to “represent and unite the diverse expertise of Connecticut's public health professionals, to ameliorate the most pressing public health issues in the state, and to promote health and safe living for the people of Connecticut.” CPHA works to promote and protect the public's health through advocacy; education; program, professional and workforce development; and networking among the public health community.

The CPHA website points out that “today, more than ever, the value of public health in saving lives and reducing health care costs is at the forefront of public policy. Being a part of this movement is exciting for practitioners and organizations alike.”

Among the learning objectives anticipated at the state conference in November, where 300 public health officials from across the state are expected, “attendees will be able to:

• Describe how policies, systems, and environmental changes can be applied to improve the public’s health.
• Identify evidence-based strategies that engage communities to improve health outcomes and explain how they work and are applied effectively.
• Explain how collaboration with nontraditional partners supports the improvement of population health and wellness.
• Promote the formation of collegial professional networks and the exchange of ideas among members of the public health community.

The keynote address will be provided by Camara P. Jones, MD, MPH, PhD, research director on social determinants of health and equity in the Division of Adult and Community Health, National Center for Chronic Disease Prevention and Health Promotion and President of the American Public Health Association (APHA).

Dr. Jones is a family physician and epidemiologist whose work focuses on the impact of racism on the health and well-being of the nation. She seeks to broaden the national health debate to include not only universal access to high quality health care but also attention to the social determinants of health (including poverty) and the social determinants of equity (including racism).

Her biography points out that:

• As a methodologist, she has developed new ways for comparing full distributions of data (rather than means or proportions) in order to investigate population-level risk factors and propose population-level interventions.
• As a social epidemiologist, her work on race-associated differences in health outcomes goes beyond documenting those differences to vigorously investigating the structural causes of the differences.
• As a teacher, her allegories on race and racism illuminate topics that are otherwise difficult for many Americans to understand or discuss.

Dr. Jones was an assistant professor at the Harvard School of Public Health from 1994 to 2000, is a member of the World Health Organization’s Scientific Resource Group on Equity and Health.

LED Street Lights Being Installed in CT Towns Even As Health Concerns Are Raised

The American Medical Association’s new policy stand “against light pollution and public awareness of the adverse health and environmental effects of pervasive nighttime lighting,” comes as municipalities across Connecticut and the nation are replacing longstanding lighting systems with LED lights in an effort to save money and improve safety.  The AMA however, is warning that the rapid pace of change could bring long-term detrimental health and safety effects. The AMA has noted that “it is estimated that white LED lamps have five times greater impact on circadian sleep rhythms than conventional street lamps. Recent large surveys found that brighter residential nighttime lighting is associated with reduced sleep times, dissatisfaction with sleep quality, excessive sleepiness, impaired daytime functioning and obesity.”

The organization noted earlier this month that “approximately 10 percent of existing U.S. street lighting has been converted to solid state LED technology, with efforts underway to accelerate this conversion.” The AMA’s Report of the Council on Science and Public Health on “Human and Environmental Effects of Light Emitting Diode (LED) Community Lighting” cautioned that “white LED street lighting patterns also could contribute to the risk of chronic disease in the populations of cities in which they have been installed. Measurements at street level from white LED street lamps are needed to more accurately assess the potential circadian impact of evening/nighttime exposure to these lights.

The AMA recommendations were developed to “assist in advising communities on selecting among LED lighting options in order to minimize potentially harmful human health and environmental effects”:

• an intensity threshold for optimal LED lighting that minimizes blue-rich light
• all LED lighting should be properly shielded to minimize glare and detrimental human health and environmental effects,
• consideration should be given to utilize the ability of LED lighting to be dimmed for off-peak time periods.

The concerns are not new, but they are receiving greater attention in the wake of the AMA’s formal community guidance and policy position, adopted at the organization’s annual conference in Chicago in mid-June.

Communities in Connecticut that have taken steps to switch to LED lighting include New London, Berlin, Plainville, East Hartford, Rocky Hill, Stamford, Southington, and Cheshire, according to published reports.  An article authored by UConn professor of Community Medicine and Health Care Richard G. Stevens, highlights red flags being raised by the AMA regarding the safety of LED lighting being installed in cities around the country.  The article first appeared on an international website, theconversation.com, and has since appeared on sites including CNN.  Stevens, an expert on the health impact of electric lighting, has raised concerns for more than a decade.

The Illuminating Engineering Society, founded in 1906 and based in New York, noted in a position statement that “exposure to optical radiation affects human physiology and behavior, both directly (acute effects including melatonin suppression, elevated cortisol production, increased core temperature) and indirectly (resetting the internal circadian body clock). There is no confirmation that typical exposures to exterior lighting after sunset lead to cancer or other life‐threatening conditions.” The Illuminating Engineering Society of North America (IES) is described as “the recognized technical authority on illumination.” The IES website indicates that the organization was “not represented in the deliberations leading to [the AMA document]. We intend to contact the AMA and work with them to ensure that any lighting related recommendations include some discussion with the IES.”

ANSES, the French Agency for Food, Environmental and Occupational Health & Safety, has published a report entitled (in English): " Lighting systems using light-emitting diodes: health issues to be considered," which focuses squarely on potential problems caused by LED lighting.  The LEDs Magazine website indicates that the full report is available in French only, but the report summary (in English) says that risks have been identified concerning the use of certain LED lamps, raising potential health concerns for the general population and professionals.

"The issues of most concern identified by the Agency concern the eye due to the toxic effect of blue light and the risk of glare," says the report, adding that the blue light necessary to obtain white LEDs causes "toxic stress" to the retina.

Back in 2011, a comprehensive report by Carnegie Mellon University’s Remaking Cities Institute (RCI) on the city of Pittsburgh’s transition to LED street lighting indicated that “Glare is an issue with LED street lighting. The RCI research team’s literature review and interviews with manufacturers and municipal agencies in cities with LED replacement projects indicate that the emphasis is being placed almost entirely on energy savings, to the exclusion of visual quality issues. The substantial glare caused by LEDs is not typically included as a measurable criteria in evaluation processes, and when it is, the tools of measurement are inadequate. As a result, glare persists as an issue.”

That report also noted that “the public is informed that LEDs save energy told that they are better in quality (often false) and that more accurate in color (often false).” In addition, the 113-page report indicated that “While the use of bright lights is believed to reduce accidents, it actually creates dangerous conditions for drivers, especially when night vision is affected by sharp differences in illumination. Bright lights are particularly hazardous for older persons because the human eye’s accommodation reflex slows with age.”

Regarding health concerns that have been raised, the report indicates that “Bright white light suppresses melatonin, the hormone that regulates tumors. Blue light wavelengths are to blame, because they ‘reset’ the circadian clocks of humans, animals, and plants even at very low levels of blue light. This might account for the significantly higher rates (30-60%) of breast and colorectal cancer in night shift workers.”

Some have compared the growing controversy regarding LED lighting to the ongoing debate in towns around the country regarding the use of crumb rubber from recycled tires as fill for sports turf fields.  Federal, state, and municipal governments have weighed in on the discussion, but even as health concerns continue to be raised, fields using the materials continue to be installed and used by youth in Connecticut and across the country.  The U.S. Environmental Protection Agency recently launched a research project aimed at providing better answers on that safety question.

Former UConn QB Cochran Says Football Puts Players in Harm’s Way, Urges End to "Cycle of Silence"

Former UConn quarterback Casey Cochran, who retired from the sport at age 20 after suffering his 13^th concussion, said this week that “There are problems with the game that need to be addressed. As it is played right now, tackle football — with its pads and helmets — puts players in harm’s way, all of the time, regardless of age and ability.” Cochran, writing a first-person story about his experiences with football and concussions in The Players’ Tribune, an online site founded by Derek Jeter, issued an alert to others who’ve journeyed through the sport, or continue to compete:

“I want to say to all former, current and future athletes who have or will suffer a concussion: Do not hide it. Tell your coaches, medical staff, parents, friends and teammates. Get treatment. The cycle of silence hurts more and more people each year.”

Cochran, from Monroe, explained that in the 18 months since his decision, after suffering a concussion on the last play of the first game of UConn’s 2014 season, against Brigham Young University, “I still feel the lingering effects from my many concussions. Life is a balancing act now. Some days it’s hard to wake up before noon. Sometimes I don’t want to leave my bed at all. In high school, I had a 3.9 GPA. Now I have trouble focusing and performing well in my graduate-school classes.”

He warned that “Those who play football, particularly those who begin in their youth, are given a glamorized version of the sport – one where camaraderie, discipline, toughness and leadership are highlighted and the wretchedness is ignored and swept under the rug. As a result, we fall in love with and value the good and push aside the bad.”

Cochran recalled that “I probably should have stopped playing football in eighth grade after my third concussion, but I was afraid to speak up. Afraid of disappointing people who had invested in my career. Afraid of who was I was without football. I wish I hadn’t hid the three concussions I had in one week during my junior year of high school, but I was afraid that college recruiters would find out.”

Even with increasing awareness of the risks of concussions, Cochran said the near and long-term effects haven’t led to enough changes.  “The only word I know to describe the first few moments after a concussion is limbo — there are a few moments between the world that you were just a part of and your new brain-injured reality,” Cochran explained.  “My head was seized with tremendous pressure, and that same awful, familiar depression from previous head injuries came over me — like a dark, heavy blanket, swallowing me up.”

With it all, he retains optimism: “There is life outside of the white lines. A lot of life. Stepping away from football was one of the scariest things I’ve ever had to do. I felt lost for a long time. For a little over a year, I felt like I was somewhere, deep in the ocean, being pulled by the currents. But what pulled me back from the depths was hope. Hope that things would get better.”

He now finds purpose in being an advocate for player safety, speaking to audiences, doing interviews and writing a book about his experiences.  To those going through what he did, during his 14 years of playing football, he says “If you feel alone, you aren’t. Chances are, there are a lot of people out there who have some idea of what you’re going through. Just keep looking. Reach out.”

Added Cochran: “Sometimes it’s nice to admit that things aren’t O.K.: ‘Hello, my name is Casey, and I have anxiety and depression.’ It may be permanent. It may be just the beginning. I don’t know what the future has in store for me and it will be some time before the medical field can paint a clearer picture for me. I may have CTE right now. I might have dementia at 50. My entire future is uncertain.”

AMA Policy, UConn Professor Raise Concerns About Municipal Conversions to LED Lighting

An article authored by UConn professor of Community Medicine and Health Care Richard G. Stevens, which highlights red flags being raised by the American Medical Association regarding the safety of LED lighting being installed in cities around the country, is gaining notice.  The article first appeared on an international website, theconversation.com, which features articles researched and written by college faculty from the U.S. and around the world.  The site’s tagline, “Academic rigor, journalistic flair,” reflects its approach.  The article has since been re-published on the CNN website, and it gaining traction on dozens of other internet sites. The article revolves around a policy statement issued by the AMA this month that suggests “conversions to improper LED technology can have adverse consequences.” Stevens, who has written about the health risks of electric lighting for more than two decades,  indicates that the policy statement comes "in response to the rise of new LED street lighting sweeping the country.” 

The new "white" LED street lighting which is rapidly being retrofitted in cities throughout the country has two problems, according to the AMA, Stevens highlights. “The first is discomfort and glare. Because LED light is so concentrated and has high blue content, it can cause severe glare, resulting in pupillary constriction in the eyes. Blue light scatters more in the human eye than the longer wavelengths of yellow and red, and sufficient levels can damage the retina. This can cause problems seeing clearly for safe driving or walking at night.” The AMA goes on to point out that blue-rich LED lighting can decrease visual acuity and safety, resulting in concerns and creating a road hazard.

In addition to its impact on drivers, the AMA notes that blue-rich LED streetlights operate at a wavelength that most adversely suppresses melatonin during night. It is estimated that white LED lamps have five times greater impact on circadian sleep rhythms than conventional street lamps, the AMA indicated. Recent large surveys, according to the AMA, found that brighter residential nighttime lighting is associated with reduced sleep times, dissatisfaction with sleep quality, excessive sleepiness, impaired daytime functioning and obesity.

The AMA points out that “converting conventional street light to energy efficient LED lighting leads to cost and energy savings, and a lower reliance on fossil-based fuels. Approximately 10 percent of existing U.S. street lighting has been converted to solid state LED technology, with efforts underway to accelerate this conversion.”

Although no comprehensive list is available, among the communities in Connecticut making the switch to LED lighting are Stamford, Plainville, East Hartford, Southington, and Berlin, according to published reports. Cheshire launched a streetlight replacement program earlier this year, indicating that “the new LED fixtures will provide the appropriate amount of lighting for locations across the town and will focus light directly downward on the sidewalks and roadway.  The fixtures have a ten-year product warranty, but are anticipated to have a much longer life. The project is expected to be completed in July 2016.”

"Despite the energy efficiency benefits, some LED lights are harmful when used as street lighting," AMA Board Member Maya A. Babu, M.D., M.B.A. "The new AMA guidance encourages proper attention to optimal design and engineering features when converting to LED lighting that minimize detrimental health and environmental effects."

The AMA encourages communities to minimize and control blue-rich environmental lighting by using the lowest emission of blue light possible to reduce glare. Stevens, however, says that “the AMA's recommendation for CCT below 3000K is not quite enough to be sure that blue light is minimized. The actual spectral irradiance of the LED -- the relative amounts of each of the colors produced -- should be considered, as well.”

Stevens concludes that “there is almost never a completely satisfactory solution to a complex problem. We must have lighting at night, not only in our homes and businesses, but also outdoors on our streets. The need for energy efficiency is serious, but so too is minimizing human risk from bad lighting, both due to glare and to circadian disruption. LED technology can optimize both when properly designed.”

The Hartford Courant reported last year that ESCO Energy Services is working with the Connecticut Conference of Municipalities to implement its municipal Street Light LED Conversion Program to buy the current streetlights from utilities and replace them with more efficient LED fixtures.

Stevens proposed in 1987 what was then seen as a radical new theory that use of electric lighting, resulting in lighted nights, might produce "circadian disruption" causing changes in the hormones relevant to breast cancer risk, according to the UConn Health website. Accumulating evidence has generally supported the idea, the site indicates, and it has received wide scientific and public attention. For example, his work has been featured on the covers of the popular weekly Science News (October 17, 1998) and the scientific journal Cancer Research (July 15, 1996). His most recent paper, “Shift work as a harbinger of the toll taken by electric lighting,” was published in Chronobiology International, The Journal of Biological and Medical Rhythm Research, in January 2016.

The Conversation website is a collaboration between editors and academics to provide "informed news analysis and commentary that’s free to read and republish." It launched as a pilot project in the U.S. in October 2014 after starting in Australia in March 2011 and​ the UK in May 2013. Boston University’s College of Communication is are hosting the operation in the U.S.

PHOTO:  Traditional street lighting (left) vs. LED lighting (right).