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SMASHED: Changing the way we talk about underaged drinking

Smashed, which was launched in the Philippines through a collaboration between Diageo Philippines and PETA Plus in partnership with UK-based company Collingwood Learning. It is a groundbreaking global program that is a pillar of Diageo’s Society 2030: Spirit of Progress commitment to tackle underage drinking.

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Every parent knows you can shout at the top of your voice until you’re blue in the face, but you can’t always make children listen. Especially if what you are shouting about is something that is potentially dangerous, but their peers more commonly believe is “cool”.

It doesn’t matter if you’re right or wrong, it doesn’t matter if you have their best interests at heart, it doesn’t matter that you might have lived through the very same thing that they are and are trying to help them not make your mistakes. After kids hit a certain age, adults become the enemy.

So how do you get an important message through to adolescents? By using one of the most powerful communication tools known to man: storytelling.

Neil Gaiman, wildly successful author and graphic novelist, tells us that stories “teach us how the world is put together and the rules of living in the world, and they come in an attractive enough package that we take pleasure from them and want to help them propagate.”

Invention born of necessity

It is given that youths of today will experiment with many things as they grow older, regardless of the environment and socio-economic conditions they grew up in.

Unfortunately, this means that the vast majority of young people all across the world will come across the chance to sample substances: nicotine, alcohol, or even illegal drugs.

Smashed, which was launched in the Philippines through a collaboration between Diageo Philippines and PETA Plus in partnership with UK-based company Collingwood Learning. It is a groundbreaking global program that is a pillar of Diageo’s Society 2030: Spirit of Progress commitment to tackle underage drinking.

Chris Simes, the Managing Director for Collingwood Learning, recognizes that in order to nip the problem in the bud, one has to take a completely different approach other than lecturing the youth. “This is a real change from the usual approach to alcohol education in schools and one that makes the risks of underage drinking impossible to forget. We understand that because of the pandemic, both teachers and students are still adjusting to the current normal. But we want to help carry the learning forward by providing high-quality teaching resources for use, despite the pandemic. We’re thrilled to be working with PETA Plus and the Department of Education in the Philippines to produce new innovative online learning solutions to supplement the highly successful live approach.”

Inevitably, kids who start drinking at an early age do not have minds and bodies that are able to process alcoholic beverages. They get lured into it by seeing it as a rite of passage, a means of escape, or a social requirement.

On its second run, Smashed utilizes a novel approach, with additional features designed for more interaction with its target audience.

Conceptualized during the time when education was adapting to the new constraints of being unable to hold physical classes, the Smashed Philippine project initially launched in September 2021. It was an interactive website (online.smashedproject.org) that sought to empower Filipino teens and preteens to make better choices by harnessing their critical thinking skills.

Smashed utilized an online platform featuring a gripping story with three main characters and even has a feature that makes the viewer feel like they are actually on video calls with the characters as they follow along.

What’s the problem?

It’s easy to ignore a problem you don’t see. Teens learn how to drink from adults. They think it’s okay because they see it everyday, and sometimes, they are even encouraged to drink, especially males. Adults will sometimes allow their children to drink inside their homes with their friends because it is ‘safer’, saying, “mas okay nang dito ka mag-inom sa bahay kesa sa labas”.

But the Philippines does have an underage drinking culture. If you’re ever in doubt about this fact, just ask the kids.

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Ashley Mae Torres, a tenth-grade student from Quirino High School, points out, “Bilang kabataan, mas marami akong nakikitang proud maging alcoholic.” That’s a worrying statement indeed, but she also credits Smashed, seeing the potential good in the program. “Salamat at dahil sa Smashed mas lumawak ang aking kaalaman sa mga panganib ng alcohol,” says Ashley. “Mas magandang piliin ang tama kasya sa udyok ng ibang tao.”

The Philippines, which has a thriving drinking culture, reports that 70% of the population has consumed alcohol before the age of 14, despite it being illegal for stores and restaurants to sell or serve the substance to minors. This could be a problem.

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Sometimes the adults in the lives of young drinkers are the problem. In a scathing insight, the winner of the Smashed essay writing contest notes, “Ang problem po sa underage drinking sa bansa natin ay ine-encourage pa ng ibang family na ‘uy uminom ka’. Diyan din ako nagsimula ayaw ko pang uminom pero kinalaunan umiinom na rin ako tapos na-enjoy ko na rin.” Angel Borda, from Don Alejandro Roces Sr. Science-Technology High School emphasizes that the relatability of the situations of the characters was especially helpful in this case. “Pero ‘yun po yung mali talaga. We have to break that mindset. Napansin ko po yung kay Miko and kay Jella na yung pinagdadaanan po nila sa buhay nila, sa personal life nila is yun po yung ineexplain po nun kung bakit sila may addiction sa drinking pero it’s not an excuse sa behavior na pinapakita nila. Yung pagiging iresponsable nila, yung kawalan nila ng respeto sa ibang tao, kumbaga hindi sila main character sa buhay na ito at hindi lang sila ang maapektuhan sa buhay na ginagawa nila.”

The American-based National Institute on Alcohol Abuse and Alcoholism (NIAA) has published research that has found that those who get into the habit of alcohol consumption earlier in life may suffer more from it than those who learn to drink at an appropriate age. It states that “youthful patterns of alcohol use can mark the start of a developmental pathway that may lead to abuse and dependence”, and that continued drinking may lead to physiological reactions, such as depression or anxiety disorders, triggering an even greater reliance on the substance to alleviate the symptoms of these disorders. That’s already discounting the immediate effects of alcohol on young minds, which could lead to poor decision-making, patterns of antisocial behavior, and impaired motor skills. Finally, there is also the detrimental effect of extensive alcohol exposure on developing vital organs such as the liver and brain.

Lofty goals and marked successes

During its initial rollout in the Philippines in 2021, Smashed was supported by 120 schools in 17 regions and managed to get up in front of an audience of 17,700 young people. With the Department of Education and other academic institutions serving as partners, Smashed Online was able to equip educators and young leaders with workshops and training.

For 2023, the program’s goal is to be able to get its message through to over 25,000 students, partnering with schools and educators all over the Philippines. It is the program’s target to reach 300,000 Filipino youths by 2030 by working in close collaboration with the Department of Education.

“We are proud to support an important program to address the dangers associated with underage drinking like Smashed in the Philippines. This is part of our Society 2030: Spirit of Progress at Diageo, and we are confident that we can make a positive impact with the Filipino youths in making informed choices about alcohol and combat alcohol related harm for generations to come”, comments Shanahan Chua, Corporate Relations Director of Diageo Philippines.

According to the Philippines’ Smashed Online project manager, Gold Villar-Lim, in 2022, 93% of the total participants surveyed reported a marked attitudinal change. “Overall, the project is not only a big step in advocating for alcohol education and youth empowerment, but also in promoting applied theater and drama-in-education as effective teaching tools in the Philippines,” says Villar-Lim.

It isn’t just about making a connection with the participants, either. Smashed tries to melt the resistance that most children seem to have towards reaching out to adults to help in case they find themselves in a sticky spot due to alcohol, especially their parents. And it seems that the message is getting through.

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Even educators are impressed. “Highly recommended talaga ang Smashed PH kasi na-to-touch niya yung mga buhay at talagang nangyayari araw araw sa mga mag-aaral, says Russel Radaza, a department head at President Sergio Osmeña High School Manila. “Mas maganda kung mas maraming schools ang ma-rereach out ng Smashed PH para sila ay mag-enjoy at mas matuto about alcoholic beverages.”

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This sentiment is echoed by Jennifer Rances, a teacher at Sipocot National High School in Camarines Sur. Sa akin naman, talagang napakalaking tulong po nito na sa mga young learners lalo na ngayon iba na ang gusto nilang gawin hindi na sila nakafocus,” she says, emphasizing the lack of connection between a child’s attention span and traditional methods of education. She goes on to stress that “with these kinds of projects, talagang magiging focus nila ay […] ano ba talaga yung nangyayari sa society at ano ba talaga yung realidad. With this kind of project that Smashed Ph has, talagang sa tingin ko sobrang positive ako na madedevelop ang mga bata rito. Lahat madedevelop including their skills, pati yung mga talents nila at yung focus din even leadership skills.”

Could this change in the approach to the conversation create lasting effects in the way we approach underage drinking? Will it create deliberate and productive conversations between children at risk and the adults who are in the position to guide them? Evidence points to the possibility of both, and although only time will tell, Smashed Ph is definitely taking the necessary steps in the right direction.

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NewsMakers

Popular prescription weight loss drugs linked to uncommon blinding condition

Patients prescribed semaglutide (as Ozempic or Wegovy) for diabetes or weight loss had a higher risk of having a potentially blinding eye condition called NAION than similar patients who had not been prescribed these drugs.

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A new study led by investigators from Mass Eye and Ear found that patients prescribed semaglutide (as Ozempic or Wegovy) for diabetes or weight loss had a higher risk of having a potentially blinding eye condition called NAION than similar patients who had not been prescribed these drugs.

Notably, the study found people with diabetes who had been prescribed semaglutide by their physician and then filled the prescription were more than four times more likely to be diagnosed with NAION. Those who were overweight or had obesity and prescribed this drug were more than seventimes more likely to get the diagnosis.

The study, which was led by Joseph Rizzo, MD, director of the Neuro-Ophthalmology Service at Mass Eye and Ear and the Simmons Lessell Professor of Ophthalmology at Harvard Medical School,  published July 3rd in JAMA Ophthalmology.

“The use of these drugs has exploded throughout industrialized countries and they have provided very significant benefits in many ways, but future discussions between a patient and their physician should include NAION as a potential risk,” said Rizzo, the study’s corresponding author. “It is important to appreciate, however, that the increased risk relates to a disorder that is relatively uncommon.” 

NAION is relatively rare, occurring up to 10 out of 100,000 people in the general population. NAION is the second-leading cause of optic nerve blindness (second only to glaucoma) and it is the most common cause of sudden optic nerve blindness. NAION is thought to be caused by reduced blood flow to the optic nerve head, with the consequence of permanent visual loss in one eye. According to Rizzo, the visual loss caused by NAION is painless and may progresses over many days before stabilizing, and there is relatively little potential for improvement. There are currently no effective treatments for NAION. 

The impetus for the study occurred in the late summer of 2023 when Rizzo, a resident (study co-author Seyedeh Maryam Zekavat, MD, PhD) and other Mass Eye and Ear neuro-ophthalmologists noticed a disturbing trend — three patients in their practice had been diagnosed with vision loss from this relatively uncommon optic nerve disease in just one week. The physicians observed all three were taking semaglutide.

This anecdotal recognition led the Mass Eye and Ear research team to run a backward-looking analysis of their patient population to see if they could identify a link between this disease and these drugs, which had been surging in popularity.

Semaglutide was developed to treat type 2 diabetes. The drug encourages weight loss, and its use has snowballed since its launch as Ozempic for diabetes in 2017. The drug was also approved for weight management, branded as Wegovy, and released in 2021.

The researchers analyzed the records of more than 17,000 Mass Eye and Ear patients treated over the six years since Ozempic was released and divided the patients in those who were diagnosed with either diabetes or overweight/ obesity. The researchers compared patients who had received prescriptions for semaglutide compared to those taking other diabetes or weight loss drugs. Then, they analyzed the rate of NAION diagnoses in the groups, which revealed the significant risk increases.

There are several limitations to the study. Mass Eye and Ear sees an unusually high number of people with rare eye diseases, the study population is majority white, and the number of NAION cases seen over the six-year study period is relatively small. With small case numbers, statistics can change quickly, Rizzo noted. The researchers also couldn’t determine if the patients actually took their medication or if they started and then stopped taking semaglutide at some point and how this might have impacted their risk.  

Importantly, the study does not prove causality, and the researchers don’t know why or how this association exists, and why there was a difference reported in diabetic and overweight groups.

“Our findings should be viewed as being significant but tentative, as future studies are needed to examine these questions in a much larger and more diverse population,” Rizzo said. “This is information we did not have before and it should be included in discussions between patients and their doctors, especially if patients have other known optic nerve problems like glaucoma or if there is preexisting significant visual loss from other causes.”

Authorship: In addition to Rizzo and Zekavat, other Mass General Brigham co-authors include Jimena Tatiana Hathaway, MD, MPH (MEE); Madhura P. Shah, BS (MEE); David B. Hathaway, MD (BWH); Drenushe Krasniqi, BA (MEE); John W. Gittinger Jr, MD (MEE); Dean Cestari, MD (MEE); Robert Mallery, MD (MEE); Bardia Abbasi, MD (MEE); Marc Bouffard, MD (MEE); Bart K. Chwalisz, MD (MEE) and Tais Estrela, MD (MEE).

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New study confirms forever chemicals are absorbed through human skin

New research, published in Environment International proves for the first time that a wide range of PFAS (perfluoroalkyl substances) – chemicals which do not break down in nature – can permeate the skin barrier and reach the body’s bloodstream.

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A study of 17 commonly used synthetic ‘forever chemicals’ has shown that these toxic substances can readily be absorbed through human skin. 

New research, published in Environment International proves for the first time that a wide range of PFAS (perfluoroalkyl substances) – chemicals which do not break down in nature – can permeate the skin barrier and reach the body’s bloodstream.  

PFAS are used widely in industries and consumer products from school uniforms to personal care products because of their water and stain repellent properties. While some substances have been banned by government regulation, others are still widely used and their toxic effects have not yet been fully investigated. 

PFAS are already known to enter the body through other routes, for example being breathed in or ingested via food or drinking water, and they are known to cause adverse health effects such as a lowered immune response to vaccination, impaired liver function and decreased birth weight.  

It has commonly been thought that PFAS are unable to breach the skin barrier, although recent studies have shown links between the use of personal care products and PFAS concentrations in human blood and breast milk.  The new study is the most comprehensive assessment yet undertaken of the absorption of PFAS into human skin and confirms that most of them can enter the body via this route. 

Lead author of the study, Dr Oddný Ragnarsdóttir carried out the research while studying for her PhD at the University of Birmingham. She explained: “The ability of these chemicals to be absorbed through skin has previously been dismissed because the molecules are ionised. The electrical charge that gives them the ability to repel water and stains was thought to also make them incapable of crossing the skin membrane. 

“Our research shows that this theory does not always hold true and that, in fact, uptake through the skin could be a significant source of exposure to these harmful chemicals.” 

The researchers investigated 17 different PFAS. The compounds selected were among those most widely used, and most widely studied for their toxic effects and other ways through which humans might be exposed to them. Most significantly, they correspond to chemicals regulated by the EU’s Drinking Water Directive.   

In their experiments the team used 3D human skin equivalent models – multilayered laboratory grown tissues that mimic the properties of normal human skin, meaning the study could be carried out without using any animals. They applied samples of each chemical to measure what proportions were absorbed, unabsorbed, or retained within the models. 

Of the 17 PFAS tested, the team found 15 substances showed substantial dermal absorption – at least 5% of the exposure dose. At the exposure doses examined, absorption into the bloodstream of the most regulated PFAS (perfluoro octanoic acid (PFOA)) was 13.5% with a further 38% of the applied dose retained within the skin for potential longer-term uptake into the circulation.  

The amount absorbed seemed to correlate with the length of the carbon chain within the molecule. Substances with longer carbon chains showed lower levels of absorption, while compounds with shorter chains that were introduced to replace longer carbon chain PFAS like PFOA, were more easily absorbed. Absorption of perfluoro pentanoic acid for example was four times that of PFOA at 59%. 

Study co-author, Dr Mohamed Abdallah, said “our study provides first insight into significance of the dermal route as pathway of exposure to a wide range of forever chemicals.  Given the large number of existing PFAS, it is important that future studies aim to assess the risk of broad ranges of these toxic chemicals, rather than focusing on one chemical at a time.”  

Study co-author, Professor Stuart Harrad, of the University of Birmingham’s School of Geography, Earth and Environmental Sciences, added: “This study helps us to understand how important exposure to these chemicals via the skin might be and also which chemical structures might be most easily absorbed. This is important because we see a shift in industry towards chemicals with shorter chain lengths because these are believed to be less toxic – however the trade-off might be that we absorb more of them, so we need to know more about the risks involved.” 

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Chronic loneliness may increase stroke risk among older adults

When loneliness was assessed at baseline only, the participants considered lonely had a 25% higher risk of stroke than those not considered lonely. Among the participants who reported loneliness at two time points, those in the “consistently high” group had a 56% higher risk of stroke than those in the “consistently low” group, even after accounting for a broad range of other known risk factors.

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Chronic loneliness may significantly raise older adults’ risk of stroke, according to a new study led by Harvard T.H. Chan School of Public Health. 

“Loneliness is increasingly considered a major public health issue. Our findings further highlight why that is,” said lead author Yenee Soh, research associate in the Department of Social and Behavioral Sciences. “Especially when experienced chronically, our study suggests loneliness may play an important role in stroke incidence, which is already one of the leading causes of long-term disability and mortality worldwide.”

While previous research has linked loneliness to higher risk of developing cardiovascular diseases, few have examined the impact on stroke risk specifically. This study is one of the first to examine the association between loneliness changes and stroke risk over time.

Using 2006-2018 data from the Health and Retirement Study (HRS), the researchers assessed the association between changes in loneliness and stroke incidence over time. During 2006-2008, 12,161 participants—all adults ages 50 and above who never had a stroke—responded to questions on the Revised UCLA Loneliness Scale, from which the researchers created summary loneliness scores. Four years later (2010-2012), 8,936 participants who remained in the study responded to the same questions again. The researchers then placed the participants into one of four groups according to their loneliness scores across the two time points: “consistently low” (those who scored low on the loneliness scale at both baseline and follow-up); “remitting” (those who scored high at baseline and low at follow-up); “recent onset” (those who scored low at baseline and high at follow-up); and “consistently high” (those who scored high at both baseline and follow-up).

Among the participants whose loneliness was measured at baseline only, 1,237 strokes occurred during the follow-up period (2006-2018). Among the participants who provided two assessments of loneliness over time, 601 strokes occurred during the follow-up period (2010-2018). The researchers analyzed each group’s risk of stroke over the follow-up period in the context of their experiences with loneliness, controlling for other health and behavioral risk factors. These included social isolation and depressive symptoms, which are closely related but distinct from loneliness.

The findings showed a link between loneliness and higher risk of stroke and found that chronic loneliness heightened risk the most. When loneliness was assessed at baseline only, the participants considered lonely had a 25% higher risk of stroke than those not considered lonely. Among the participants who reported loneliness at two time points, those in the “consistently high” group had a 56% higher risk of stroke than those in the “consistently low” group, even after accounting for a broad range of other known risk factors. While the baseline analyses suggest loneliness at one time point was associated with higher risk, those who experienced remitting or recent onset loneliness did not show a clear pattern of increased risk of stroke—suggesting that loneliness’ impact on stroke risk occurs over the longer term.

“Repeat assessments of loneliness may help identify those who are chronically lonely and are therefore at a higher risk for stroke. If we fail to address their feelings of loneliness, on a micro and macro scale, there could be profound health consequences,” said Soh. “Importantly, these interventions must specifically target loneliness, which is a subjective perception and should not be conflated with social isolation.”

The authors noted that further research examining both nuanced changes in loneliness over the short-term, as well as loneliness patterns over a longer period of time, may help shed additional light on the loneliness-stroke association. They also noted that more research is needed to understand the potential underlying mechanisms, and that the study findings were limited to middle-aged and older adults and may not be generalizable to younger individuals.

Other Harvard Chan authors included Ichiro Kawachi, Laura Kubzansky, Lisa Berkman, and Henning Tiemeier.

Chronic Loneliness and the Risk of Incident Stroke in Middle and Late Adulthood: A Longitudinal Cohort Study of U.S. Older Adults” was written by Yenee Soh, Ichiro Kawachi, Laura D. Kubzansky, Lisa F. Berkman, Henning Tiemeier, and appeared in eClinicalMedicine.

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