Mental Health Courts Can Struggle to Fulfill Decades-Old Promise
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GAINESVILLE, Ga. — In early December, Donald Brown stood nervously in the Hall County Courthouse, concerned he’d be sent back to jail.
The 55-year-old struggles with depression, addiction, and suicidal thoughts. He worried a judge would terminate him from a special diversion program meant to keep people with mental illness from being incarcerated. He was failing to keep up with the program’s onerous work and community service requirements.
“I’m kind of scared. I feel kind of defeated,” Brown said.
Last year, Brown threatened to take his life with a gun and his family called 911 seeking help, he said. The police arrived, and Brown was arrested and charged with a felony of firearm possession.
After months in jail, Brown was offered access to the Health Empowerment Linkage and Possibilities, or HELP, Court. If he pleaded guilty, he’d be connected to services and avoid prison time. But if he didn’t complete the program, he’d possibly face incarceration.
“It’s almost like coercion,” Brown said. “‘Here, sign these papers and get out of jail.’ I feel like I could have been dealt with a lot better.”
Advocates, attorneys, clinicians, and researchers said courts such as the one Brown is navigating can struggle to live up to their promise. The diversion programs, they said, are often expensive and resource-intensive, and serve fewer than 1% of the more than 2 million people who have a serious mental illness and are booked into U.S. jails each year.
People can feel pressured to take plea deals and enter the courts, seeing the programs as the only route to get care or avoid prison time. The courts are selective, due in part to political pressures on elected judges and prosecutors. Participants must often meet strict requirements that critics say aren’t treatment-focused, such as regular hearings and drug screenings.
And there is a lack of conclusive evidence on whether the courts help participants long-term. Some legal experts, like Lea Johnston, a professor of law at the University of Florida, worry the programs distract from more meaningful investments in mental health resources.
Jails and prisons are not the place for individuals with mental disorders, she said. “But I’m also not sure that mental health court is the solution.”
The country’s first mental health court was established in Broward County, Florida, in 1997, “as a way to promote recovery and mental health wellness and avoid criminalizing mental health problems.” The model was replicated with millions in funding from such federal agencies as the Substance Abuse and Mental Health Services Administration and the Department of Justice.
More than 650 adult and juvenile mental health courts were operational as of 2022, according to the National Treatment Court Resource Center. There’s no set way to run them. Generally, participants receive treatment plans and get linked to services. Judges and mental health clinicians oversee their progress.
Researchers from the center found little evidence that the courts improve participants’ mental health or keep them out of the criminal justice system. “Few studies … assess longer-term impacts” of the programs “beyond one year after program exit,” said a 2022 policy brief on mental health courts.
The courts work best when paired with investments in services such as clinical treatment, recovery programs, and housing and employment opportunities, said Kristen DeVall, the center’s co-director.
“If all of these other supports aren’t invested in, then it’s kind of a wash,” she said.
The courts should be seen as “one intervention in that larger system,” DeVall said, not “the only resource to serve folks with mental health needs” who get caught up in the criminal justice system.
Resource limitations can also increase the pressures to apply for mental health court programs, said Lisa M. Wayne, executive director of the National Association of Criminal Defense Lawyers. People seeking help might not feel they have alternatives.
“It’s not going to be people who can afford mental health intervention. It’s poor people, marginalized folks,” she said.
Other court skeptics wonder about the larger costs of the programs.
In a study of a mental health court in Pennsylvania, Johnston and a University of Florida colleague found participants were sentenced to longer time under government supervision than if they’d gone through the regular criminal justice system.
“The bigger problem is they’re taking attention away from more important solutions that we should be investing in, like community mental health care,” Johnston said.
When Melissa Vergara’s oldest son, Mychael Difrancisco, was arrested on felony gun charges in Queens in May 2021, she thought he would be an ideal candidate for the New York City borough’s mental health court because of his diagnosis of autism spectrum disorder and other behavioral health conditions.
She estimated she spent tens of thousands of dollars to prepare Difrancisco’s case for consideration. Meanwhile, her son sat in jail on Rikers Island, where she said he was assaulted multiple times and had to get half a finger amputated after it was caught in a cell door.
In the end, his case was denied diversion into mental health court. Difrancisco, 22, is serving a prison sentence that could be as long as four years and six months.
“There’s no real urgency to help people with mental health struggles,” Vergara said.
Critics worry such high bars to entry can lead the programs to exclude people who could benefit the most. Some courts don’t allow those accused of violent or sexual crimes to participate. Prosecutors and judges can face pressure from constituents that may lead them to block individuals accused of high-profile offenses.
And judges often aren’t trained to make decisions about participants’ care, said Raji Edayathumangalam, senior policy social worker with New York County Defender Services.
“It’s inappropriate,” she said. “We’re all licensed to practice in our different professions for a reason. I can’t show up to do a hernia operation just because I read about it or sat next to a hernia surgeon.”
Mental health courts can be overly focused on requirements such as drug testing, medication compliance, and completing workbook assignments, rather than progress toward recovery and clinical improvement, Edayathumangalam said.
Completing the programs can leave some participants with clean criminal records. But failing to meet a program’s requirements can trigger penalties — including incarceration.
During a recent hearing in the Clayton County Behavioral Health Accountability Court in suburban Atlanta, one woman left the courtroom in tears when Judge Shana Rooks Malone ordered her to report to jail for a seven-day stay for “being dishonest” about whether she was taking court-required medication.
It was her sixth infraction in the program — previous consequences included written assignments and “bench duty,” in which participants must sit and think about their participation in the program.
“I don’t like to incarcerate,” Malone said. “That particular participant has had some challenges. I’m rooting for her. But all the smaller penalties haven’t worked.”
Still, other participants praised Malone and her program. And, in general, some say such diversion programs provide a much-needed lifeline.
Michael Hobby, 32, of Gainesville was addicted to heroin and fentanyl when he was arrested for drug possession in August 2021. After entry into the HELP Court program, he got sober, started taking medication for anxiety and depression, and built a stable life.
“I didn’t know where to reach out for help,” he said. “I got put in handcuffs, and it saved my life.”
Even as Donald Brown awaited his fate, he said he had started taking medication to manage his depression and has stayed sober because of HELP Court.
“I’ve learned a new way of life. Instead of getting high, I’m learning to feel things now,” he said.
Brown avoided jail that early December day. A hearing to decide his fate could happen in the next few weeks. But even if he’s allowed to remain in the program, Brown said, he’s worried it’s only a matter of time before he falls out of compliance.
“To try to improve myself and get locked up for it is just a kick in the gut,” he said. “I tried really hard.”
KFF Health News senior correspondent Fred Clasen-Kelly contributed to this report.
KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.
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From Painkillers To Hunger-Killers
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Here’s this week’s selection of health news discoveries, the science behind them, what they mean for you, and where you can go from there:
Killing more than pain
It’s well-known that overuse of opioids can lead to many problems, and here’s another one: messing with the endocrine system. This time, mostly well-evidenced in men—however, the researchers are keen to point out that absence of evidence is very much not evidence of absence, hence “the hidden effects” in the headline below. It’s not that the effects are hard to see—it’s that a lot of the research has yet to be done. For now, though, we know at the very least that there’s an association between opioid use and hyperprolactinemia in men. The same research also begins to shine a light on the effects of opioid use on the hypothalamic-pituitary system and bone health, too:
Read in full: The hidden effects of opioid use on the endocrine system
Related: The 7 Approaches To Pain Management
Gut microbiome dysbiosis may lead to slipping disks
These things sound quite unconnected, but the association is strong. The likely mechanism of action is that the gut dysbiosis influences systemic inflammation, and thus spinal health—because the gut-spine axis cannot really be disconnected (while you’re alive, at least). It’s especially likely if you’re over 50 and female:
Read in full: Are back problems influenced by your gut?
Related: Is Your Gut Leading You Into Osteoporosis?
The Internet is really really great (for brains)
It’s common to see many articles on the Internet telling us, paradoxically, that we should spend less time on the Internet. However… Remember when in the 90s, it was all about “the information superhighway”? It turns out, the fact that it’s more like “the information spaghetti junction” these days doesn’t change the fact that stimulation is good for our brains, and daily Internet use improves memory, because of the different way that we index and store information that came from a virtual source. While there are parts of your brain for “things at home” and “things at the local supermarket”, there are also parts for “things at 10almonds” and “things at Facebook” and so forth. You are, in effect, building a vast mental library as you surf:
Read in full: Daily internet use supercharges your memory!
Related: Make Social Media Work For Your Mental Health
Fall back
Around this time of year in many places in the Northern Hemisphere, the clocks go back an hour (it’s next weekend in the US and Canada, by the way, and this weekend in most of Europe). Many enjoy this as the potential for an extra hour’s sleep, but for night owls, it can be more of a nuisance than a benefit—throwing out what’s often an already difficult relationship with the clock, and presenting challenges both practical and physiological (different processing of melatonin, for instance). Here be science:
Read in full: Why night owls struggle more when the clocks go back
Related: Early Bird Or Night Owl? Genes vs Environment
Can you outrun your hunger?
It seems so, though benefits are strongest in women. We say “outrun”, though this study did use stationary cycling. To put it in few words, intense exercise (but not moderate exercise) significantly reduced acylated ghrelin (hunger hormone) levels, and subjective reports of hunger, especially in women:
Read in full: Study finds intense exercise may suppress appetite in healthy humans
Related: 3 Appetite Suppressants Better Than Ozempic
Take care!
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The Midlife Cyclist – by Phil Cavell
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Whether stationary cycling in your living room, or competing in the Tour de France, there’s a lot more to cycling than “push the pedals”—if you want to get good benefits and avoid injury, in any case.
This book explores the benefits of different kinds of cycling, the biomechanics of various body positions, and the physiology of different kinds of performance, and the impact these things have on everything from your joints to your heart to your telomeres.
The style is very much conversational, with science included, and a readiness to acknowledge in cases where the author is guessing or going with a hunch, rather than something being well-evidenced. This kind of honesty is always good to see, and it doesn’t detract from where the science is available and clear.
One downside for some readers will be that while Cavell does endeavour to cover sex differences in various aspects of how they relate to the anatomy and physiology (mostly: the physiology) of cycling, the book is written from a male perspective and the author clearly understands that side of things better. For other readers, of course, this will be a plus.
Bottom line: if you enjoy cycling, or you’re thinking of taking it up but it seems a bit daunting because what if you do it wrong and need a knee replacement in a few years or what if you hurt your spine or something, then this is the book to set your mind at ease, and put you on the right track.
Click here to check out The Midlife Cyclist, and enjoy the cycle of life!
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What Curiosity Really Kills
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Curiosity Kills The Neurodegeneration
Of the seven things that Leonardo da Vinci considered most important for developing and maintaining the mind, number one on his list was curiosity, and we’re going to be focussing on that today.
In case you are curious about what seven things made Leonardo’s* list, they were:
- Curiosità: an insatiably curious approach to life and an unrelenting quest for continuous learning
- Dimostrazione: a commitment to test knowledge through experience, persistence, and a willingness to learn from mistakes
- Sensazione: the continual refinement of the senses, especially sight, as a means to enliven experience
- Sfumato: (lit: “gone up in smoke”) a willingness to embrace ambiguity, paradox, and uncertainty
- Arte/Scienza: the curated balance of art and science, imagination and logic
- Corporalità: the cultivation of physical grace, ambidexterity, and fitness
- Connessione: a recognition of and appreciation for the interconnectedness of phenomena (systems-based thinking)
*In case you are curious why we wrote “Leonardo” and not “da Vinci” as per our usual convention of shortening names to last names, da Vinci is not technically a name, in much the same way as “of Nazareth” was not a name.
You can read more about all 7 of these in a book that we’ve reviewed previously:
How to Think Like Leonardo da Vinci: Seven Steps to Genius Every Day – by Michael J. Gelb
But for now, let’s take on “curiosity”!
If you need an extra reason to focus on growing and nurturing your curiosity, it was also #1 of Dr. Daniel Levitin’s list of…
The Five Keys Of Aging Healthily
…and that’s from a modern-day neuroscientist whose research focuses on aging, the brain, health, productivity, and creativity.
But how do we foster curiosity in the age of Google?
Curiosity is like a muscle: use it or lose it
While it’s true that many things can be Googled to satisfy one’s curiosity in an instant…
- do you? It’s only useful if you do use it
- is the top result on Google reliable?
- there are many things that aren’t available there
In short: douse “fast
foodinformation” sources, but don’t rely on them! Not just for the sake of having correct information, but also: for the actual brain benefits which is what we are aiming for here with today’s article.If you want the best brain benefits, dive in, and go deep
Here at 10almonds we often present superficial information, with links to deeper information (often: scholarly articles). We do this because a) there’s only so much we can fit in our articles and b) we know you only have so much time available, and/but may choose to dive deeper.
Think of it in layers, e.g:
- Collagen is good for joints and bones
- Collagen is a protein made of these amino acids that also requires these vitamins and minerals to be present in order to formulate it
- Those amino acids are needed in these quantities, of which this particular one is usually the weakest link that might need supplementing, and those vitamins and minerals need to be within this period of time, but not these ones at the exact same time, or else it will disrupt the process of collagen synthesis
(in case you’re curious, we covered this here and here and offered a very good, very in-depth book about it here)
Now, this doesn’t mean that to have a healthy brain you need to have the equivalent knowledge of an anatomy & physiology degree, but it is good to have that level of curiosity in at least some areas of your life—and the more, the better.
Top tips for developing a habit of curiosity
As you probably know, most of our endeavors as humans go best when they are habits:
How To Really Pick Up (And Keep!) Those Habits
And as for specifically building a habit of curiosity:
- Make a deal with yourself that when someone is excited to tell you what they know about something (no matter whether it is your grandkid, or the socially awkward nerd at a party, or whoever), listen and learn, no matter the topic.
- Learn at least one language other than your native language (presumably English for most of our readers). Not only does learning a language convey a lot of brain benefits of its own, but also, it is almost impossible to separate language learning from cultural learning, and so you will learn a lot about another culture too, and have whole new worlds opened up to you. Again, more is better, but one second language is already a lot better than none.
- Make a regular habit of going to your local library, and picking out a non-fiction book to take home and read. This has an advantage over a bookshop, by the way (and not just that the library is free): since library books must be returned, you will keep going back, and build a habit of taking out books.
- Pick a skill that you’d like to make into a fully-fledged hobby, and commit to continually learning as much about it as you can. We already covered language-learning above, but others might include: gardening (perhaps a specific kind), cooking (perhaps a specific kind), needlecraft (perhaps a specific kind), dance (perhaps a specific kind). You could learn a musical instrument. Or it could be something very directly useful, like learning to be a first responder in case of emergencies, and committing to continually learning more about it (because there is always more to learn).
And when it comes to the above choices… Pick things that excite you, regardless of how practical or not they are. Because that stimulation that keeps on driving you? That’s what keeps your brain active, healthy, and sharp.
Enjoy!
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Anti-Aging Myths This Dermatologist Wants You To Stop Believing
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Dermatologist Dr. Sam Ellis lays all bare:
Bare-faced lies?
Obviously, we are hearing from a dermatologist here, so the focus is on skin aging specifically. We may well also not want to age our brain, joints, etc, but that’s not what this one is about.
So, without further ado, here are the myths she wants to bust:
- “Medical grade skincare”: the term “medical grade” is a marketing term and does not indicate superior efficacy or better ingredients.
- “Expensive skincare is more effective”: price does not always correlate with effectiveness; some high-end products justify their cost, but many do not.
- “More products = better results”: using too many products can reduce effectiveness and cause irritation; a simple routine with sunscreen and a retinoid is key.
- “Drink more water for better skin”: if you’re dehydrated, then yes, hydrate—but drinking excessive water does not improve skin appearance beyond normal hydration levels.
- “You don’t need anti-aging products until you see signs of aging”: starting skincare early, especially sun protection, helps maintain youthful skin longer.
- “Wrinkles are the first signs of aging”: hyperpigmentation and sagging are often more significant early indicators of aging than wrinkles.
- “Skincare is all you need for anti-aging”: by “skincare” here she means creams, lotions, tonics, etc, and recommends other treatments such as laser treatment and even Botox*.
- “Non-prescription retinoids are a waste of time”: over-the-counter retinoids like retinol and retinal can still be effective alternatives to prescription retinoids.
- “You must use retinoids every night”: retinoids are effective even when used a few times per week, depending on individual tolerance.
*We’re not convinced about the Botox; we’ll have to do a deep-dive research review one of these days!
For more on each of these, enjoy:
Click Here If The Embedded Video Doesn’t Load Automatically!
Want to learn more?
You might also like:
Retinoids: Retinol vs Retinal vs Retinoic Acid vs..?
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More research shows COVID-19 vaccines are safe for young adults
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What you need to know
- Myocarditis, or inflammation of the heart muscle, is most commonly caused by a viral infection like COVID-19, not by vaccination.
- In line with previous research, a recent CDC study found no association between COVID-19 vaccination and sudden cardiac death in previously healthy young people.
- A COVID-19 infection is much more likely to cause inflammation of the heart muscle than a COVID-19 vaccine, and those cases are typically more severe.
Since the approval of the first COVID-19 vaccines, anti-vaccine advocates have raised concerns about heart muscle inflammation, also called myocarditis, after vaccination to suggest that vaccines are unsafe. They’ve also used concerns about myocarditis to spread false claims that vaccines cause sudden deaths, which is not true.
Research has consistently shown that cases of myocarditis after vaccination are extremely rare and usually mild, and a new study from the CDC found no association between sudden cardiac death and COVID-19 vaccination in young adults.
Read on to learn more about myocarditis and what the latest research says about COVID-19 vaccine safety.
What is myocarditis?
Myocarditis is inflammation of the myocardium, or the middle muscular layer of the heart wall. This inflammation weakens the heart’s ability to pump blood. Symptoms may include fatigue, shortness of breath, chest pain, rapid or irregular heartbeat, and flu-like symptoms.
Myocarditis may resolve on its own. In rare cases, it may lead to stroke, heart failure, heart attack, or death.
What causes myocarditis?
Myocarditis is typically caused by a viral infection like COVID-19. Bacteria, parasites, fungi, chemicals, and certain medications can also cause myocarditis.
In very rare cases, some people develop myocarditis after receiving a COVID-19 vaccine, but these cases are usually mild and resolve on their own. In contrast, a COVID-19 infection is much more likely to cause myocarditis, and those cases are typically more severe.
Staying up to date on vaccines reduces your risk of developing myocarditis from a COVID-19 infection.
Are COVID-19 vaccines safe for young people?
Yes. COVID-19 vaccines have been rigorously tested and monitored over the past three years and have been determined to be safe for everyone 6 months and older. A recent CDC study found no association between COVID-19 vaccination and sudden cardiac death in previously healthy young adults.
The benefits of vaccination outweigh any potential risks. Staying up to date on COVID-19 vaccines reduces your risk of severe illness, hospitalization, death, long COVID, and COVID-19-related complications, such as myocarditis.
The CDC recommends people 65 and older and immunocompromised people receive an additional dose of the updated COVID-19 vaccine this spring—if at least four months have passed since they received a COVID-19 vaccine.
For more information, talk to your health care provider.
This article first appeared on Public Good News and is republished here under a Creative Commons license.
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How influencers and content creators discuss birth control on social media: What research shows
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News articles in recent weeks have documented the spread of misinformation about hormonal birth control methods on popular social media platforms like TikTok, YouTube and X, formerly called Twitter. Influencers with large and small followings are sharing unsubstantiated claims about the side effects of contraceptives, while directly or indirectly encouraging others to stop using them.
This trend has not escaped researchers, who for several years have been investigating what people who can get pregnant are posting on social media platforms about hormonal and non-hormonal birth control methods. Understanding the drivers of these trends is important because they have implications for policy and patient care, according to researchers. Some worry that during the post-Dobbs era, when there are continued strikes against reproductive rights in the U.S., misinformation about birth control on social media could have a negative influence on contraceptive preferences — potentially leading to more unwanted pregnancies.
More than 90% of women of reproductive age have used at least one contraceptive method, according to a 2023 report by the U.S. National Center for Health Statistics. However, the report also finds that the use of male condoms and withdrawal methods increased between 2006 and 2019, while the use of the birth control pill decreased. Non-hormonal contraception methods, including condoms, spermicides, withdrawal and menstrual cycle tracking, are 10% or less effective than hormonal contraceptives. The only exceptions are surgical sterilization and the copper intrauterine device.
To be sure, not all birth control-related content posted on social media platforms is negative, studies show. Health care professionals are sharing educational material with a high rate of engagement and non-health care professional users share their positive experiences with the birth control methods they use.
But as you will see in the studies curated below, researchers also find that social media users, including influencers, share inaccurate information about hormonal contraceptives on various social media platforms, discuss their discontinuation of birth control in favor of non-hormonal methods and engage in unsubstantiated fear-mongering of hormonal contraceptives.
Researchers also have learned that the content posted on social media platforms has changed in tone over time, mirroring the shift in the national political discourse.
In a 2021 study published in the American Journal of Obstetrics & Gynecology, researchers analyzed more than 800,000 English-language tweets mentioning at least one contraceptive method between March 2006, when Twitter was founded, and December 2019. They coded the sentiment of tweets as positive, neutral or negative.
“What we found over time was that the number of neutral tweets went down for each and every one of the birth control methods, and people became more polarized with regards to how they talk on these social media platforms over those 13 years,” says study co-author Dr. Deborah Bartz, an OB-GYN at Brigham and Women’s Hospital with expertise in complex family planning and an associate professor at Harvard Medical School.
In a February 2024 commentary in the Journal of Women’s Health, University of Delaware researchers Emily Pfender and Leah Fowler argue that ongoing dialogue about contraception on social media provides “a glimpse into public sentiment about available options” to people who can get pregnant.
The authors also note that misinformation and disinformation about hormonal contraception may have a larger effect on health disparities, especially among historically marginalized groups who may already mistrust the medical establishment.
“This may contribute to unintended pregnancy and delayed care, further widening health disparities and hindering progress toward equitable reproductive health outcomes,” Pfender and Fowler write.
Side effects
There are known side effects to hormonal birth control methods, including headaches, nausea, sore breasts and spotting. Most are mild and disappear with continued use or with switching to another method. Among hormonal contraceptives, only the Depo-Provera injection has been linked with weight gain, studies show.
But some social media influencers have spread false claims about the potential side effects of hormonal birth control methods, ranging from infertility to abortion to unattractiveness. Despite these false claims, physicians and professional organizations such as the American College of Obstetricians and Gynecologists find today’s contraceptive options safe and very effective.
“They’re about the most low-risk prescription that I give,” says Dr. Megana Dwarakanath, an adolescent medicine physician in Pittsburgh. “I always joke that if something goes wrong in someone’s life, they’re within the reproductive years, it always gets blamed on birth control.”
Dwarakanath says her young patients are most worried about two side effects: weight gain and mood. “Those are the things that they will almost always attribute to their birth control at a time that their bodies are also changing very rapidly,” she says. “Things like mental health diagnoses or personality disorders also tend to crop up during the time young people have started or have been on birth control.”
Most research on the link between oral contraceptives and cancer risk comes from observational studies, according to the National Cancer Institute. Overall, the studies have consistently shown that the risks of breast and cervical cancer are slightly increased for women who use oral contraceptives, whereas the risk of endometrial, ovarian and colorectal cancers are reduced.
The use of hormonal birth control has also been associated with an increase in the risk of developing blood clots, studies show. But that risk is not universal for everyone who takes hormonal birth control. This risk is higher for women 35 and older, those who smoke, are very overweight or have a history of cardiovascular disease. Overall, 3 to 9 out of 10,000 women who take the pill are at risk of developing blood clots within a given year. The risk for women who don’t take the pill is 1 to 5 out of 10,000.
There is no association between the pill and mood disorders, according to a large body of research, including a 2021 cohort study of nearly 740,000 young women.
It’s worth noting the dearth of research into women’s reproductive health due to chronic underfunding of women’s health research. An analysis of funding by the U.S. National Institutes of Health finds that in nearly three-quarters of the cases where a disease affects mainly one gender, the institute’s funding pattern favored males. Either the disease affected more women and was underfunded, or the disease affected more men and was overfunded, according to the 2021 study published in the Journal of Women’s Health.
Aside from underfunding, conducting robust research into the long-term effects of birth control is complex.
“Historically, people haven’t felt that it’s ethically OK to randomize people to birth control methods in large part because the outcome of unintended pregnancy is greater,” for people who are given the placebo, Bartz says.
Research on birth control misinformation on social media
Social media use is widespread among young adults. More than 90% of Americans between 18 and 29 reported ever using YouTube, while 78% said they had used Instagram, 62% used TikTok and 42% used Twitter, according to a 2023 survey of 5,733 U.S. adults by Pew Research Center.
These years overlap with the demographic of people who are most likely to use birth control. And because the use of contraceptives is less stigmatized today, people are more likely to talk with one another about their questions and concerns or share that information online.
In addition to investigating the general landscape of social media posts about birth control, researchers are also interested in the type of content influencers, who typically have 20,000 or more followers, post, because of their persuasive power over their audiences.
“When influencers disclose personal experiences and beliefs about various topics, audience members tend to form similar attitudes especially when they feel connected to the influencer,” Pfender and M. Marie Devlin write in a 2023 study published in the journal Health Communication.
Below we have curated several studies published in recent years documenting the spread of birth control misinformation on social media. The roundup is followed by a quick reference guide on female contraceptives and their actual potential side effects.
Contraceptive Content Shared on Social Media: An Analysis of Twitter
Melody Huang, et al. Contraception and Reproductive Medicine, February 2024.The study: The authors explore how contraceptive information is shared on X and understand how those posts affect women’s decisions. They analyze a random 1% of publicly available English-language tweets about reversible prescription contraceptive methods, from January 2014 and December 2019. The 4,434 analyzed tweets included at least 200 tweets per birth control method — IUDs, implants, the pill, patch and ring.
The findings: 26.7% of tweets about contraceptive methods discussed decision-making and 20.5% discussed side effects, especially the side effects of IUDs and the depot medroxyprogesterone acetate (DMPA or Depo-Provera) shot. Discussions about the pill, patch or ring prompted more discussions on logistics and adherence. About 6% of tweets explicitly requested information. Tweets about IUDs were most popular in terms of likes.
More importantly, 50.6% of the tweets were posted by contraceptive users, while only 6% came from official health or news sources. Tweets from news or journalistic sources were more frequent than tweets from a health care professional or organization.
Some tweets contained misinformation represented as facts, such as the unsubstantiated claim that IUDs can cause fertility issues. Others were outwardly misogynistic, shaming women and claiming that they wouldn’t be able to have kids because of using hormonal birth control.
One takeaway: “While Twitter may provide valuable insight, with more tweets being created by personal contraceptive users than official healthcare sources, the available information may vary in reliability. Asking patients about information from social media can help reaffirm to patients the importance of social networks in contraceptive decision-making while also addressing misconceptions to improve contraceptive counseling,” the authors write.
What Do Social Media Influencers Say About Birth Control? A Content Analysis of YouTube Vlogs About Birth Control
Emily J. Pfender and M. Marie Devlin. Health Communication, January 2023.The study: To explore what social media influencers shared on YouTube about their experiences with hormonal and non-hormonal methods of birth control, the researchers analyzed 50 vlogs posted between December 2019 and December 2021. Most of the 50 influencers were categorized on YouTube as Lifestyle (72%) and Fitness (16%). They had between 20,000 and 2.2 million subscribers each.
The findings: In total, 74% of the influencers talked about discontinuing hormonal birth control. About 44% said the main reason they were discontinuing birth control was to be more natural, while 32% said they wanted to improve their mental health and 20% were concerned about weight gain.
Forty percent of influencers mentioned using non-hormonal birth control methods such as menstrual cycle tracking, condoms, non-hormonal IUDs and the pull-out method. Twenty percent reported switching from hormonal to non-hormonal methods.
One takeaway: “Our content analysis revealed that discontinuation of hormonal birth control is commonly discussed among [social media influencers] on YouTube and sexual health information from influencers might not provide accurate educational information and tools… this is especially concerning given that social media is young adults’ primary tool for sexual health information. Future research is needed to understand the effects of SMI birth control content on sexual health behaviors,” the authors write.
Hormonal Contraceptive Side Effects and Nonhormonal Alternatives on TikTok: A Content Analysis
Emily J. Pfender, Kate Tsiandoulas, Stephanie R. Morain and Leah R. Fowler. Health Promotion Practice, January 2024.The study: The authors analyzed the content of 100 TikTok videos that used the hashtags #birthcontrolsideeffects and #nonhormonalcontraception. Their goal was to understand the types of content about side effects of hormonal and non-hormonal contraceptives on TikTok.
The findings: The videos averaged about 1 minute and garnered an average of 27,795 likes, 251 comments and 623 shares. For #birthcontrolsideeffects, 80% of the audience was 18 to 24 years old and videos with that hashtag had 43 million views worldwide as of July 7, 2023.
Thirty-two percent of the videos were by regular users (non-influencers), 26 by clinicians, 13% by health coaches and 2% by companies. Only 3% had a sponsorship disclosure and 6% included a medical disclaimer, that the person was not a doctor or was not providing medical advice.
Most of the 100 videos (71%) mentioned hormonal contraception. Among them 51% discussed unspecific hormonal contraceptives, 31% talked about the pill and 11% about hormonal IUDs. Four of the 71 creators explicitly recommended against using hormonal contraceptives.
Claims about hormonal contraceptives were mostly based on personal experience. About 25% of the creators cited no basis for their claims, 23% included outside evidence, including unspecified studies or information from the FDA insert, and 11% used a combination of personal and outside evidence.
Almost half (49%) mentioned discontinuing their hormonal contraception, with negative side effects cited as the most common reason.
The creators talked about mental health issues, weight gain, headaches, and less common risks of various cancers or chronic illness, change in personality and blood clots. They were less likely to mention the positive aspects of birth control.
About 52% of videos mentioned non-hormonal contraception, including copper IUDs and cycle tracking.
Nine of the 100 creators expressed feeling dismissed, pressured, gaslit or insufficiently informed about contraception by medical providers.
One takeaway: “Our findings support earlier work suggesting social media may fuel ‘hormonophobia,’ or negative framing and scaremongering about hormonal contraception and that this phobia is largely driven by claims of personal experience rather than scientific evidence,” the authors write. “Within these hashtag categories, TikTok creators frame their provider interactions negatively. Many indicate feeling ignored or upset after medical appointments, not sufficiently informed about contraceptive options, and pressured to use hormonal contraceptives. This finding aligns with previous social media research and among the general population, suggesting opportunities for improvements in contraceptive counseling.”
Popular Contraception Videos on TikTok: An Assessment of Content Topics
Rachel E. Stoddard, et al. Contraception, January 2024.The study: Researchers analyzed 700 English-language TikTok videos related to hormonal contraception, with a total of 1.2 billion views and 1.5 million comments, posted between October 2019 and December 2021. Their aim was to explore the types of contraception content on TikTok and to understand how the platform influences the information patients take into birth control counseling visits.
The findings: More than half of the videos (52%) were about patient experiences and how to use contraceptives. Other common topics included side effects (35%) and pregnancy (39%).
Only 19% of the videos were created by health care professionals, including midwives, physician assistants and medical doctors, although those videos garnered 41% of the total views, indicating higher engagement. While 93% of health care providers shared educational content, 23% of non-health care providers shared educational content.
One takeaway: “Our findings show an exceptional opportunity for education around contraception for young reproductive-aged individuals, given the accessibility and popularity of these videos. This may also extend to other topics around sex education and family planning, including sexually transmitted infection prevention and treatment and procuring abortion care,” the authors write.
TikTok, #IUD, and User Experience With Intrauterine Devices Reported on Social Media
Jenny Wu, Esmé Trahair, Megan Happ and Jonas Swartz. Obstetrics & Gynecology, January 2023.The study: Researchers used a web-scraping application to collect the top 100 TikTok videos tagged #IUD on April 6, 2022, based on views, comments, likes and shares. Their aim was to understand the perspectives and experiences of people with IUDs shared on TikTok. The videos had a total of 471 million views, 32 million likes and 1 million shares. Their average length was 33 seconds.
The findings: Some 89% of the creators identified as female and nearly 90% were from the United States; 37% were health care professionals; and 78% were 21 years or older.
Video types included patients’ own experiences with IUD removal (32%), educational (30%) and humorous (25%). More videos (38%) had a negative tone compared with 19% with a positive tone. The videos that portrayed negative user experiences emphasized pain and distrust of health care professionals.
Half of the videos were very accurate, while nearly a quarter were inaccurate (the authors did not use the term misinformation).
One takeaway: “The most liked #IUD videos on TikTok portray negative experiences related to pain and informed consent. Awareness of this content can help health care professionals shape education given the high prevalence of TikTok use among patients,” the authors write. “TikTok differs from other platforms because users primarily engage with an algorithmically curated feed individualized to the user’s interests and demographics.”
Types of female birth control
Most female hormonal contraceptives contain the synthetic version of natural female hormones estrogen and progesterone. They affect women’s hormone levels, preventing mature eggs from being released by the ovaries, a process that’s known as ovulation, hence, preventing a possible pregnancy.
Of the two hormones, progesterone (called progestin in synthetic form) is primarily responsible for preventing pregnancy. In addition to playing a role in preventing ovulation, progesterone inhibits sperm from penetrating through the cervix. Estrogen inhibits the development of follicles in the ovaries.
The information below is sourced from the CDC, the National Library of Medicine, the Cleveland Clinic and the Mayo Clinic.
Intrauterine contraception
Also called Long-Acting Reversible Contraception, or LARC, this method works by thickening the cervical mucus so the sperm can’t reach an egg. There are two types of IUDs: hormonal and non-hormonal.
- Levonorgestrel intrauterine system is a T-shaped device that’s placed inside the uterus by a doctor. It releases a small amount of progestin daily to prevent pregnancy. It can stay in place for 3 to 8 years. Its failure rate is 0.1% to 0.4%.
- Copper T intrauterine device is also T-shaped and is placed inside the uterus by a doctor. It does not contain hormones and can stay in place for up to 10 years. Its failure rate is 0.8%.
- Side effects: Copper IUDs may cause more painful and heavy periods, while progestin IUDs may cause irregular bleeding. In the very rare cases of pregnancy while having an IUD, there’s a greater chance of an ectopic pregnancy, which is when a fertilized egg grows outside of the uterus.
Hormonal methods
- The implant is a single, thin rod that’s inserted under the skin of the upper arm. It releases progestin over 3 years. Its failure rate is 0.1%, making it the most effective form of contraception available.
- Side effects: The most common side effect of an implant is irregular bleeding.
- The injection Depo-Provera or “shot” or “Depo” delivers progestin in the buttocks or arms every three months at the doctor’s office. Its failure rate is 4%.
- Side effects: The shot may cause irregular bleeding. The shot is also the only contraceptive that may cause weight gain. It may also be more difficult to predict when fertility returns once the shot is stopped.
- Combined oral contraceptives or “the pill” contain estrogen and progestin. They’re prescribed by a doctor. The pill has to be taken at the same time daily. The pill is not recommended for people who are older than 35 and smoke, have a history of blood clots or breast cancer. Its failure rate is 7%. Among women aged 15 to 44 who use contraception, about 25% use the pill.
- The skin patch is worn on the lower abdomen, buttocks or upper body, releasing progestin and estrogen. It is prescribed by a doctor. A new patch is used once a week for three weeks. No patch is worn for the fourth week. Its failure rate is 7%.
- Hormonal vaginal contraceptive ring releases progestin and estrogen. It’s placed inside the vagina. It is worn for three weeks and taken out on the fourth week. Its typical failure rate is 7%.
- Side effects: Contraceptives with estrogen, including the pill, the patch and the ring, increase the risk of developing blood clots.
- Progestin-only pill or “mini-pill” only has progestin and is prescribed by a doctor. It has to be taken daily at the same time. It may be a good option for women who can’t take estrogen. Its typical failure rate is 7%.
- Opill is the first over-the-counter daily oral contraceptive in the U.S., approved by the Food and Drug Administration in 2023. Opill only has progestin and like other birth control pills, it has to be taken at the same time every day. It should not be used by those who have or have had breast cancer. Its failure rate is 7%.
- Side effects: The most common side effect of progestin-only pills is irregular bleeding, although the bleeding tends to be light.
Non-hormonal birth control methods include using barriers such as a diaphragm or sponge, condoms and spermicides, withdrawal, and menstrual cycle tracking. Emergency contraception, including emergency contraception pills (the morning-after pill), is not a regular method of birth control.
Additional research studies to consider
Population Attitudes Toward Contraceptive Methods Over Time on a Social Media Platform
Allison A. Merz, et al. American Journal of Obstetrics & Gynecology, December 2020.Social Media and the Intrauterine Device: A YouTube Content Analysis
Brian T. Nguyen and Allison J. Allen. BMJ Sexual and Reproductive Health, November 2017.This article first appeared on The Journalist’s Resource and is republished here under a Creative Commons license.
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