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Tag: JAMA Network Open

  • Does science agree it’s better to give than receive? A doctor explains

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    (CNN) — The holidays are here, which means you’re probably thinking about gifts — what to buy, whom to give to and how much to spend. Gift-giving is often framed as a source of stress and obligation, but a growing body of research suggests there may also be something beneficial about giving itself.

    I have wondered if science supports the idea that it’s better to give than receive, and if so, are there measurable health effects? Does it matter how you give, such as money versus time and big gestures versus small ones? And can giving ever backfire?

    I turned to CNN wellness expert Dr. Leana Wen, counting on her for some good advice. Wen is an emergency physician and adjunct associate professor at George Washington University who previously was Baltimore’s health commissioner. She is done with her holiday shopping for her family and friends.

    CNN: Does science really back up the idea that it’s better to give than receive?

    Dr. Leana Wen: Science does support that idea, with some key caveats. Research from psychology, neuroscience and public health shows that prosocial behaviors such as giving time, money or support to others are associated with benefits to well-being.

    That doesn’t mean that giving is always beneficial or that people should give at the expense of their own needs. But taken together, the evidence suggests that generosity can be good for both emotional and physical health.

    CNN: What kinds of health benefits have researchers found?

    Wen: A wealth of research links giving and helping behaviors to better mental well-being, including lower rates of depression and anxiety and higher life satisfaction. Surprisingly, the effects also go beyond mental health: Researchers have found associations between prosocial behavior and lower stress hormones, reduced inflammation, better cardiovascular outcomes and longer lifespan.

    Notably, a large 2023 JAMA Network Open review looked at 30 studies involving prosocial interventions, which include acts of kindness, charitable giving, community volunteering and helping behaviors. Researchers found improvements in mental well-being, lower depression scores, physical activity and even blood test results

    Giving time and effort, such as volunteering at a food bank, often produces stronger benefits than giving money alone. Credit: Drazen Zigic/iStockphoto / Getty Images via CNN Newsource

    CNN: How does giving affect the brain and body?

    Wen: Giving activates reward pathways in the brain in areas linked to pleasure, motivation and social bonding. These actions trigger the release of chemicals such as dopamine and endorphins, which are associated with positive feelings.

    Another key hormone is oxytocin, which plays a role in stress regulation. Oxytocin can lower blood pressure, reduce stress responses and promote feelings of social connection. Over time, repeated activation of these pathways may help explain why generosity is linked to better health, especially in conditions influenced by chronic stress, such as depression and heart disease.

    CNN: Is this just correlation, or is there evidence that giving actually causes these benefits?

    Wen: That’s an important distinction. Some early research was observational, which means it’s possible that perhaps healthier or happier people were simply more likely to give. But more recent studies include experimental designs that strengthen the case for causation.

    For instance, randomized trials have asked participants to perform acts of kindness or generosity and compared them with control activities. These studies have shown short-term reductions in stress hormones like cortisol, along with improvements in mood and emotional well-being. While it is harder to prove long-term causation, the consistency across experimental, biological and population-level data makes a strong case that giving itself plays a role.

    CNN: Does it matter how people give, whether it’s money, time, small gifts or expensive ones?

    Wen: Yes, the type and context of giving matter a great deal. Research suggests that voluntary, meaningful giving is more beneficial than giving that feels obligatory or stressful. Giving time and effort, such as volunteering or helping someone directly, often produces stronger benefits than giving money alone.

    Meaning also matters. Giving that aligns with personal values or strengthens social connection is likely to be more beneficial than something that is impersonal or transactional. All this means that small acts such as writing a thoughtful note, helping a neighbor or spending time with someone who is lonely can have meaningful effects.

    CNN: Can giving ever be harmful?

    Wen: Absolutely. Giving is not universally beneficial. When giving leads to financial strain, exhaustion, resentment or neglect of one’s own health, the benefits disappear and can even reverse. Caregiver burnout is a clear example. People who give extensively without adequate support often experience worse physical and mental health.

    The key is balance. In the ideal circumstances, giving should be voluntary. People should not feel pressure to give beyond their means or capacity, especially during the holidays, when expectations can be high.

    CNN: Who benefits most from giving?

    Wen: Benefits have been observed across age groups, but some populations appear to gain particular advantages. Older adults who volunteer often show better physical functioning and lower mortality risk. People who feel socially isolated may also have significant benefit because giving strengthens social ties and provides a sense of purpose.

    There is also growing evidence that adolescents and young adults benefit from prosocial behavior, with improved mental well-being. Researchers are studying whether structured kindness or volunteering programs can support health across the lifespan.

    CNN: How should people think about gift-giving during the holidays?

    Wen: The holidays can be a good time to rethink what giving means. Instead of focusing on cost or quantity, people might consider gifts that foster connection or shared experience. Time, attention and thoughtfulness matter more than price.

    It’s also important to set boundaries. Giving should not come with guilt or pressure. Choosing to give in ways that feel meaningful and opting out of expectations that cause stress is consistent with what the science suggests about healthy generosity.

    CNN: What’s the takeaway this holiday season?

    Wen: Giving can be good for health, but only when it is done thoughtfully and within one’s means. Science supports the idea that generosity can reduce stress, strengthen social bonds and improve both mental and physical well-being. The holidays offer an opportunity to practice generosity in ways that are healthy, sustainable, meaningful and connected to what matters most.

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    Katia Hetter and CNN

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  • Women face a much higher risk of homicide, especially from guns, during pregnancy

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    (CNN) — On April 9, 2020, after Shirley Scarborough made her daily call to a prayer line, she went to work and got another call: from the police department in Richmond, Virginia. Her youngest daughter, Francesca Harris-Scarborough, had been killed the night before.

    Police had found the 31-year-old’s car still idling. Scarborough’s daughter, who was three months pregnant, had been shot twice in the heart.

    “I wasn’t ready for it. I lost control of everything,” Scarborough said. “Everything went blank.”

    Francesca was part of a terrible trend in the United States: Homicide is the No. 1 way pregnant women die, research has showed, but a new study finds that they are even more vulnerable than other women of childbearing age when there’s a gun involved.

    The study, published Monday in the journal JAMA Network Open, looked at more than 7,000 homicides of women of childbearing age between 2018 and 2021. Pregnant women were found to have a 37% higher firearm homicide rate than women who weren’t pregnant, and more than two-thirds of pregnancy-associated homicides involved firearms.

    The presence of a firearm is known to be a key risk factor of intimate partner homicide. The new study showed that every 1% increase in state-level firearm ownership was associated with a 6% increase in all-cause homicide and an 8% increase in the firearm-specific homicide rate in pregnant women, even after adjusting for other factors.

    “Even incremental increases in firearm availability may contribute to measurable increases in homicide risk in pregnant women,” the researchers wrote.

    Shirley Scarborough, left, is shown with her daughter, Francesca Harris-Scarborough. In 2020, Francesca was found shot to death in her car. Credit: Shirley Scarborough via CNN Newsource

    “It was really not surprising, if you think about it, that if firearms are more available, then that certainly it does increase your risk of homicide in general,” said study co-author Dr. Lois Lee, a senior faculty adviser in the Office and Health Equity & Inclusion and an associate professor of pediatrics and emergency medicine at Harvard Medical School. “So you could imagine, if you take away or at least decrease the number of firearms, then there would likely be many fewer deaths during pregnancy.”

    “And unlike medical conditions, which, yes, we do have many medical advances and can save many lives, but in some ways, those conditions are much less preventable, like eclampsia and sepsis,” Lee added. “This is predictable and potentially preventable.”

    The highest proportion of homicides in pregnant women was among those 20 to 24 years old. Among women who weren’t pregnant, it was ages 25 to 29. Most homicide victims were Black, whether they were pregnant or not.

    “Those findings suggest that these risks of homicide during pregnancy are shaped not just by individual factors but by broader systems of inequity and structural racism,” Lee said. “So it’s not just a solution at the individual level that’s needed, but there needs to be urgent change at a policy level, as well.”

    The study authors recommend safe storage laws and domestic violence firearm prohibitions.

    Although most states prohibit people with final protective orders from purchasing or possessing firearms, such laws should be expanded to require people to surrender their firearms even when there’s an emergency protective order on the books, said Dr. Kelly Roskam, director of law and policy at the Johns Hopkins Center for Gun Violence Solutions, who was not involved with the new research.

    “Usually, the first stage of that order process is often the most dangerous time for individuals experiencing intimate partner or family violence, since it is usually the first indication that an individual is going to be separating from an abuser,” Roskam said.

    Roskam said the most successful gun surrender laws also have strong follow-up. She points to a program in King County, Washington, that created a multidisciplinary team of prosecutors, law enforcement and court administrators who serve on a regional domestic violence firearm unit. It scours court documents and databases to make sure every individual involved in a domestic violence offense gives up every firearm.

    According to King County, firearms are used in domestic violence homicides more than all other weapons combined in Washington state.

    “They really show respondents that they are very serious about ensuring this firearm relinquishment compliance. And since they have started doing this, they have been recovering a much larger number of firearms from these protective orders,” Roskam said.

    Scarborough has been working on her own programs so more women are spared her daughter’s fate. She created a nonprofit called Cry Loud, Spare Not, Speak Up that’s dedicated to empowering women affected by domestic violence and abuse in Virginia.

    In reading her daughter’s journals after her death, Scarborough said, she realized that although her daughter was successful and seemed happy, she had confidence issues that began when she was younger. Scarborough also started a program for girls ages 12 and up to cultivate self-esteem and grow their confidence. Scarborough also wrote about her own experience in her memoir “Shattered But Not Destroyed A Mother’s Journey from Heartbreak to Hope.” She said she hopes it can help readers find strength and purpose, even when life is at its most difficult.

    Each year, near the anniversary of Francesca’s death, Scarborough hosts another empowerment program for girls and women called “I Am Enough, I Know My Worth.”

    “This way she will never die. We can always try to help somebody,” Scarborough said. “Her death has really been my teacher. It’s changed my life. It will never be the same.”

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    Jen Christensen and CNN

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  • With CDC signoff, CVS says Covid-19 vaccines will be available nationwide without a prescription

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    (CNN) — The US Centers for Disease Control and Prevention signed off on a recommendation that patients must consult a health care provider to get a Covid-19 vaccine, although they don’t necessarily need a prescription.

    The updated CDC recommendation — made by a new panel of vaccine advisers chosen by US Health and Human Services Secretary Robert F. Kennedy Jr. — shifted away from a broader push in past years for most people to get an updated Covid-19 vaccine. It became final with signoff from Acting CDC Director Jim O’Neill.

    The new recommendations mean people ages 6 months and older can get Covid-19 vaccines after consulting with a qualified health care provider, which keeps the shots available but may also create more barriers to access than in past years.

    Before the finalized recommendation this year, access to Covid-19 shots has differed from state to state as pharmacies and providers navigated new federal vaccine policies. CVS, which had previously limited access to Covid-19 shots in some places, said Monday that it was “updating our systems to be able to offer the updated COVID-19 vaccines to patients nationwide” and that “prescriptions from outside prescribers will no longer be required in any states.”

    The signoff is also coming later than usual for the fall respiratory virus season. With the recommendation, the government can finally distribute Covid-19 vaccines through its Vaccines for Children program, which provides free inoculations to about half of US children.

    The CDC’s independent vaccine advisers, the Advisory Committee on Immunization Practices, voted unanimously last month that people who want a Covid-19 vaccine should consult with a health care provider, a process called shared clinical decision-making. However, they narrowly voted down a recommendation that a prescription should be required to get the shot.

    In August, the US Food and Drug Administration moved to limit approval of Covid-19 vaccines to adults 65 and older as well as younger people who are at higher risk of severe illness because of other health conditions.

    A study published last month in the journal JAMA Network Open found that a universal Covid-19 vaccine recommendation — as had been in place for the US in recent years — could save thousands more lives than limiting the recommendation to high-risk groups.

    Experts said that even requiring shared clinical decision-making could make Covid-19 shots harder to get.

    The recommendation “assumes health care and insurance,” said Dr. Demetre Daskalakis, who recently resigned as head of the CDC’s National Center for Immunization and Respiratory Diseases. “We do not have universal health care in this country, and we know millions of people are losing insurance.”

    HHS said it was bringing back “informed consent” ahead of vaccination.

    “CDC’s 2022 blanket recommendation for perpetual COVID-19 boosters deterred health care providers from talking about the risks and benefits of vaccination for the individual patient or parent. That changes today,” O’Neill, who is also the deputy secretary of HHS, said in a statement.

    Another new recommendation will mean toddlers get their first vaccines against measles and chickenpox separately, around their first birthdays. In this case, the ACIP guidance formalizes an existing recommendation, which is designed to reduce a very rare, slightly elevated risk of seizures when the two shots are combined into a single injection.

    The CDC advisers said that the single-dose measles, mumps, rubella and varicella vaccine was not recommended before age 4 and that younger kids should get the varicella vaccine, which protects against chickenpox, separately from the shot that protects against measles, mumps and rubella.

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    Brenda Goodman, Katherine Dillinger and CNN

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