Author Interviews, JAMA, Opiods, Pediatrics / 06.01.2020

MedicalResearch.com Interview with: Rachel H. Alinsky, MD, MPH Adolescent Medicine and Addiction Medicine Fellow Division of General Pediatrics and Adolescent Medicine Johns Hopkins University School of Medicine MedicalResearch.com: What is the background for this study? Response: We know that over 4,000 adolescents and young adults between the ages of 15-24 are dying from an opioid overdose every year. Nonfatal opioid overdose has been identified as a potential touchpoint with the healthcare system when individuals can be drawn into treatment, yet very little is known about health care use following opioid overdose in youth. We were interested in figuring out the extent to which adolescents and young adults are receiving evidence-based treatment after an opioid overdose. (more…)
Author Interviews, Opiods, Surgical Research / 30.12.2019

MedicalResearch.com Interview with: Sunil Agarwal, MD Michigan Opioid Prescribing Engagement Network Ann Arbor, MI MedicalResearch.com: What is the background for this study? Response: Excess opioid prescribing after surgery often leads to misuse and diversion into the community. To prevent excessive prescribing for acute pain, 31 states have implemented legislation that limits the duration of opioid prescriptions. Our study examined the effect of prescribing limits and postoperative opioid prescribing on surgical patients in Massachusetts and Connecticut, the first two states to implement opioid prescribing limits for acute pain after the CDC guidelines were released.  (more…)
Author Interviews, Critical Care - Intensive Care - ICUs, Mental Health Research, Opiods, Pediatrics / 23.12.2019

MedicalResearch.com Interview with: Megan Land, MD, PGY 6 Pediatric Critical Care Medicine Fellowship Emory University School of Medicine MedicalResearch.com: What is the background for this study?
  • Much of the research on the opioid crisis has focused on the impact to adults; however, children and adolescents in the US are also negatively affected by the opioid epidemic.
  • The percentage of children admitted to a pediatric intensive care unit increased over the study period as the clinical effects of the opioid ingestions increased in severity.
  • The primary intent of opioid ingestions was suspected suicide attempts in adolescents resulting in increasing admissions to a psychiatric hospital.
  • Opioids associated with the highest odds of needing an intervention in an intensive care unit were methadone, fentanyl, and heroin. 
(more…)
Author Interviews, JAMA, Opiods, Pediatrics, University of Michigan / 19.12.2019

MedicalResearch.com Interview with: Kao-Ping Chua, MD PhD Assistant Professor, Department of Pediatrics Susan B. Meister Child Health Evaluation and Research Center University of Michigan MedicalResearch.com: What is the background for this study? Response: Opioids are frequently prescribed to adolescents and young adults aged 12-21 years – in a recent study, 1 in 8 patients in this population were prescribed opioids during the year. At the same time, almost 30% of the 3000 opioid-related overdose deaths in 2016 among adolescents and young adults involved prescription opioids. Given the frequency of opioid prescribing and the risk of overdose, it is important to understand how to prescribe opioids safely to adolescents and young adults. However, there have been few studies that examine which opioid prescribing patterns are associated with prescription opioid overdose in adolescents and young adults. Prior studies examining these patterns have focused on older adults, particularly U.S. Veterans, so the generalizability of these findings to younger populations is unclear. (more…)
Addiction, Author Interviews, Opiods, Technology / 10.12.2019

MedicalResearch.com Interview with: Anna Konova, PhD Assistant Professor, Dept. of Psychiatry & UBHC Core Faculty, Brain Health Institute Rutgers University - New Brunswick MedicalResearch.com: What is the background for this study? Response: Opioid reuse and relapse are common outcomes even when a person is seeking treatment for their addiction. These reuse events pose many health risks, as well as risk for treatment failure. We currently lack the much needed tools to understand and predict this reuse vulnerability. In this study, we used computer games that assess a person's decision making process, to get at psychological processes related to how people make decisions involving risks, when they transitioned between lower and higher reuse vulnerability states during the first few months of opioid treatment. (more…)
Author Interviews, OBGYNE, Opiods / 05.12.2019

MedicalResearch.com Interview with: Dr. Rupa Radhakrishnan, MD Assistant professor of Radiology and Imaging Sciences Indiana University School of Medicine MedicalResearch.com: What is the background for this study? Response: Opioid use in pregnancy is a major public health crisis. Opioids adversely impact maternal, fetal and infant health. Infants who were exposed to opioids in the womb, can have withdrawal symptoms soon after birth, and are also at risk for poor long term neurodevelopment outcomes. Our group studied the changes in brain function in infants exposed to opioids in the womb, to understand how opioids affect the developing brain. We used resting state functional MRI to study these infants.  (more…)
Aging, Author Interviews, JAMA, Opiods / 27.11.2019

MedicalResearch.com Interview with: Yong-Fang Kuo, PhD Professor and Director, Office of Biostatistics Don W. and Frances Powell Professor in Aging Research Mukaila Raji, MD, MS, FACP Professor & Director Edgar Gnitzinger Distinguished Professorship in Aging Preventive Medicine and Population Health UTMB Health MedicalResearch.com: What is the background for this study? Response: Medicare beneficiaries who qualified because of disability constitute a growing population of patients hospitalized for opioid/heroin overdose. Although the CDC regularly generates reports of opioid overdose deaths by demographics and states, studies on policy actionable predictors of overdose mortality (e.g., clusters of medical and psychiatric conditions, types of disabling conditions) are lacking in this population.  (more…)
Author Interviews, JAMA, Opiods / 27.11.2019

MedicalResearch.com Interview with: Steven H. Woolf, MD, MPH Director Emeritus and Senior Advisor, Center on Society and Health Professor, Department of Family Medicine and Population Health C. Kenneth and Dianne Wright Distinguished Chair in Population Health and Health Equity Virginia Commonwealth University School of Medicine Richmond, Virginia 23298-0212 MedicalResearch.com: What is the background for this study? What are the main findings? Response: Life expectancy in the US has decreased for three years in a row, the first time this has occurred in this country since the Spanish flu epidemic a century ago. Meanwhile, life expectancy in other countries continues to climb. Our study found that the trend is being driven by an increase in death rates among working-age adults (ages 25-64 years), which began as early as the 1990s. The increase has involved deaths from drug overdoses—a major contributor—but also from alcoholism, suicides, and a long list of organ diseases. We found increases in 35 causes of death. We analyzed the trends across the 50 states and discovered that the trend is concentrated in certain regions, especially the Industrial Midwest (Rust Belt) and Appalachia, whereas other regions like the Pacific states were least affected. Increases in midlife mortality in four Ohio Valley states (Ohio, Pennsylvania, Indiana and Kentucky) accounted for one third of the excess deaths between 2010 and 2017. (more…)
Author Interviews, Opiods, Rheumatology / 12.11.2019

MedicalResearch.com Interview with: Raveendhara R. Bannuru MD, PhD, FAGE Director, Center for Treatment Comparison and Integrative Analysis (CTCIA) Deputy Director, Center for Complementary and Integrative Medicine (CCIM) Asst Professor of Medicine, Tufts University School of Medicine Asst Professor of Clinical & Translational Science, Sackler School of Graduate Biomedical Sciences Division of Rheumatology, Tufts Medical Center Boston, MA MedicalResearch.com: What is the background for this study? Response: Given the current controversy regarding the use of opioids in chronic pain, we wanted to delve deeper into the efficacy and safety profiles of oral opioid drugs in osteoarthritis patients. Temporal assessments like ours can reveal peak periods of efficacy, and can provide clinicians with a blueprint for optimal durations of treatment regimens. With respect to subgroup analyses based on strength of opioid binding affinity, we sought to explore currently held paradigms that strong opioids may be useful for the treatment of severe pain, and to specifically assess their relevance in OA populations. Knowledge of the relative efficacy and safety profiles of strong versus weak opioids can give clinicians the information they need to weigh benefits and harms of specific subgroups of opioids. (more…)
Author Interviews, JAMA, Opiods, Primary Care / 30.08.2019

MedicalResearch.com Interview with: Dr. Hannah T. Neprash, PhD Assistant Professor, Division of Health Policy and Management School of Public Health University of Minnesota  MedicalResearch.com: What is the background for this study? Response: Physicians play a pivotal role in the opioid epidemic and it's important to understand what factors that drive opioid prescribing. Variation in opioid prescribing across physicians has been well-documented, but there’s very little research on variation within physicians…which is surprising, given the widespread concern about time pressure and cognitive fatigue having a potentially detrimental effect on the quality of care provided by physicians. (more…)
Author Interviews, Education, JAMA, Opiods, Social Issues / 28.08.2019

MedicalResearch.com Interview with: Isaac Sasson, PhD Department of Sociology and Anthropology and the Herczeg Institute on Aging Tel Aviv University Tel Aviv, Israel MedicalResearch.com: What is the background for this study? Response: Life expectancy at birth in the United States has been declining steadily since 2014, which is very unusual for a high-income country in times of peace. In fact, the last time that life expectancy declined in the US was in the early 1990s, and only briefly. Studies from the past few years have shown that the rise in mortality is concentrated among middle-aged Americans and particularly the lower socioeconomic classes. Our study analyzed over 4.6 million death records in 2010 and 2017 to understand which causes of death account for the rise in mortality among white and black non-Hispanic US adults. In addition, given the substantial socioeconomic inequality in health in the US, we broke down our results by level of education, which is a good proxy for socioeconomic status. Essentially, our goal was to measure how many years of life were lost, on average, to each cause of death across different social groups.  (more…)
Addiction, Alcohol, Author Interviews, Cannabis, Cocaine, Methamphetamine, Opiods / 21.08.2019

MedicalResearch.com Interview with: Greg Midgette, PhD Assistant Professor Department of Criminology and Criminal Justice University of Maryland MedicalResearch.com: What is the background for this study? Response: This report estimates marijuana, cocaine, heroin, and methamphetamine use in the U.S. between 2006 and 2016 on three dimensions: the number of past-month chronic users per year, where "chronic" has previously been defined as consuming the drug at least four days in the past month, expenditure per drug among those users, and consumption of each drug. These measures are meant to aid the public and policy makers' understanding of changes in drug use, outcomes, and policies.   (more…)
Author Interviews, Opiods, Pediatrics, Surgical Research / 09.08.2019

MedicalResearch.com Interview with: Kao-Ping Chua, M.D., Ph.D. Assistant Professor, Department of Pediatrics and Communicable Diseases Susan B. Meister Child Health Evaluation and Research Center University of Michigan Ann Arbor, Michigan MedicalResearch.com: What is the background for this study?   Response: Tonsillectomy is one of the most common surgeries performed in children. It is also one of the most common reasons children are prescribed opioids, even though randomized trials suggest that non-opioids like ibuprofen are equally effective for pain control. We were interested in understanding whether it is possible to safely reduce opioid exposure after tonsillectomy in children without increasing the risk of complications such as emergency department visits for uncontrolled throat pain, which could lead to dehydration. (more…)
Author Interviews, CDC, Opiods / 09.08.2019

MedicalResearch.com Interview with: Gery P. Guy Jr., PhD, MPH Senior Health Economist Division of Unintentional Injury Prevention CDC  MedicalResearch.com: What is the background for this study? Response: In 2017, among the 70,237 drug overdose deaths in the United States, 47,600 (67.8%) involved prescription or illicit opioids. Distribution of the opioid receptor antagonist naloxone to reverse overdose is a key part of the public health response to the opioid overdose epidemic. The 2016 CDC Guideline for Prescribing Opioids for Chronic Pain recommended clinicians consider offering naloxone when overdose risk factors, such as history of overdose or opioid use disorder, higher opioid dosages, or concurrent benzodiazepine use, are present. However, recent analyses examining pharmacy-based naloxone dispensing are lacking. To address this gap and to inform future overdose prevention and response efforts, CDC examined trends and characteristics of naloxone dispensed from retail pharmacies at the national and county level in the United States. (more…)
Addiction, Author Interviews, Opiods / 08.08.2019

MedicalResearch.com Interview with: Brian J Piper, PhD MS Department of Medical Education Geisinger Commonwealth School of Medicine Scranton, Pennsylvania  MedicalResearch.com: What is the background for this study? Response: All states have a Prescription Monitoring Program to collect data about controlled substance prescriptions. Maine also had a Diversion Alert Program to obtain information about arrests involving prescription and illicit drugs. Buprenorphine is a treatment for an opioid use disorder. Naloxone is an opioid antagonist. Prior pharmacoepidemiology research found that buprenorphine accounted for half of prescriptions for males in their twenties in Maine.1 This study examined the current status of the opioid crisis using three complementary data sources: 1) Arrests as reported to the Diversion Alert Program; 2) Medical opioid use as reported by the Drug Enforcement Administration; and 3) Overdoses as reported to the medical examiner. (more…)
Author Interviews, Brigham & Women's - Harvard, Opiods / 06.08.2019

MedicalResearch.com Interview with: Lauren A. Hoffman, Ph.D. Research Fellow Recovery Research Institute Center for Addiction Medicine Massachusetts General Hospital Harvard Medical School MedicalResearch.com: What is the background for this study?   Response: In 2017, an estimated 11.4 million Americans reported past-year opioid misuse1 and opioid-related overdose accounted for more than 47,000 deaths2. Prior research has helped further our understanding of the prevalence and consequences of opioid misuse, but we know substantially less about recovery from opioid use problems. Recovery-focused research conducted to-date has largely focused on alcohol use disorder, the most common type of substance use disorder. Characterizing recovery from opioid use problems and the pathways that individuals take to resolve such problems can ultimately help identify effective ways to address opioid misuse. Using data from the first national probability-based sample of US adults who have resolved a significant substance use problem (National Recovery Survey3), we provide the first national prevalence estimate of opioid recovery, and characterize treatment/recovery service use and psychological well-being in individuals who resolved a primary problem with opioids, relative to individuals who resolved a primary alcohol problem. We focused our cross-sectional investigation of service use and well-being on 2 time-horizons associated with continued vulnerability: <1 year since problem resolution (early-recovery) and 1 – 5 years since problem resolution (mid-recovery). (more…)
Author Interviews, Global Health, Opiods, Pain Research, Primary Care / 26.07.2019

MedicalResearch.com Interview with: Marisha Burden, MD, FACP, SFHM Associate Professor of Medicine Division Head of Hospital Medicine University of Colorado School of Medicine MedicalResearch.com: What is the background for this study? Response: The United States has seen a marked increase in opioid prescribing since 2000 and while there has been a slight decline in prescribing since 2012, prescription rates for opioids still remain much higher than in the late 1990’s and are considerably higher when compared to other countries. The US continues to see opioid-related complications such as overdoses, hospitalizations, and deaths. Hospitalized patients frequently experience pain and opioid medications are often the mainstay for treatment of pain. Studies have suggested that receipt of opioid prescriptions at the time of hospital discharge may increase risk for long-term use. (more…)
Author Interviews, Cancer Research, Dental Research, Opiods / 23.07.2019

MedicalResearch.com Interview with: Praveen Arany, DDS, PhD Department of Oral Biology School of Dental Medicine University of Buffalo MedicalResearch.com: What is the background for this study? How is the light treatment delivered? Response: Cancers are usually treated with chemotherapy and/or radiation to destroy the tumor cells. However, an unfortunate side-effect of these treatments is pain and ulcers in the mouth due to breakdown of normal protective responses. Light has various applications in human health and normal physiology. Two good examples are vision and sunlight-Vitamin D for bone and health. The use of low dose light to alleviate pain or inflammation and promote tissue healing is termed Photobiomodulation (PBM) Therapy. This treatment can be provided with lasers or LED devices at specific wavelength (color) and dose (power). This treatment is currently being provided by a health care provider - usually a laser - either nurse or dentist prior or during the cancer treatments. There are several exciting innovation where take-home, self-use devices are becoming available. (more…)
Addiction, Author Interviews, Cannabis, Columbia, JAMA, Opiods / 18.07.2019

MedicalResearch.com Interview with: Silvia S. Martins, MD, PHD Associate Professor of Epidemiology Department of Epidemiology Mailman School Of Public Health Columbia University  MedicalResearch.com: What is the background for this study? Response: Prior studies have suggested t6hat medical marijuana legalization might play a role in decreasing opioid use. We aimed to test this hypothesis using individual level data on nonmedical use of prescription opioids and opioid use disorder  from the US National Survey on Drug Use and Health.  (more…)
Author Interviews, JAMA, Opiods, Pediatrics, UCSD / 17.07.2019

MedicalResearch.com Interview with: Lorraine Kelley-Quon, MD, MSHS, FAAP Assistant Professor | Division of Pediatric Surgery Children's Hospital Los Angeles Department of Surgery & Preventive Medicine Keck School of Medicine of USC  MedicalResearch.com: What is the background for this study? What are the main findings?  Response: Prescription opioids are pharmacologically similar to heroin, and previous research has shown an association between nonmedical opioid use and heroin use. This is the first study to follow a group of teenagers through all 4 years of high school and identify an association between nonmedical prescription opioid use and later heroin use. (more…)
Author Interviews, Lifestyle & Health, Mental Health Research, Opiods, University of Pennsylvania / 15.07.2019

MedicalResearch.com Interview with: Samuel Preston, Ph.D. Professor of Sociology University of Pennsylvania MedicalResearch.com: What is the background for this study? What are the main findings?  Response: Life expectancy at birth in the United States is low by international standards and has been declining in recent years. Our study aimed to identify how these trends differed by age, sex, cause of death, metropolitan status, and region. We found that, over the period 2009-11 to 2014-16, mortality rose at ages 25-44 in large metropolitan areas and their suburbs as well as in smaller metropolitan areas and non-metropolitan areas. Mortality at ages 45-64 also rose in all of these areas except large metropolitan areas. These were the ages responsible for declining life expectancy. Changes in life expectancy were particularly adverse for non-metropolitan areas and for women. The metropolitan distinctions in mortality changes were similar from region to region. The cause of death contributing most strongly to mortality declines was drug overdose for males and mental and nervous system disorders for women. (more…)
Author Interviews, Dental Research, Opiods, Pain Research / 05.07.2019

MedicalResearch.com Interview with: Dr. Stuart Lieblich, DMD Oral and maxillofacial surgeon  Avon, CT MedicalResearch.com: What is the background for this study? How does EXPAREL® differ from other pain medication for dental work or other short-term procedures? Response: This study analyzed the use of opioids and non-opioid options for postsurgical pain following third molar extraction (wisdom teeth removal). Our research team reviewed data from 600 patients who underwent third molar extraction, with 300 patients having received non-opioid option EXPAREL (bupivacaine liposome injectable suspension) and 300 patients that did not receive an infiltration of EXPAREL. The study aimed to show that reducing opioid prescriptions following this procedure may decrease opioid-related adverse events and the risk of opioid dependence. (more…)
Addiction, Author Interviews, JAMA, Opiods, University of Michigan / 30.06.2019

MedicalResearch.com Interview with: Rebecca L. Haffajee, J.D., Ph.D., M.P.H. Assistant Professor Department of Health Management & Policy umichsphumichsph MedicalResearch.com: What is the background for this study? What are the main findings?  Response: Evidence suggests that the availability of medications to treat opioid use disorder (OUD) has been slow to expand, particularly in rural areas, despite the efficacy and effectiveness of these medications in reducing overdose deaths and other adverse life outcomes. We were interested in understanding the characteristics of counties both with high need (as measured by above-national rates in opioid overdose deaths) AND low provider capacity to deliver medications to treat OUD in 2017. We found that such "opioid high-risk" counties were likely to be in the East North Central (e.g., Michigan, Ohio, Illinois, Indiana), South Atlantic (e.g., North Carolina, South Carolina, Virginia, West Virginia), and Mountain (e.g., New Mexico, Arizona, Nevada) regions. We also found that these opioid high-risk counties were more likely to have higher rates of unemployment and less likely to have fewer primary care clinicians or be micropolitan (more…)
Author Interviews, Opiods / 26.06.2019

MedicalResearch.com Interview with: John Holaday, PhD Chairman and CEO of DisposeRx Dr. Holaday discusses the recentannouncement that Walgreen's has added DisposeRx to its safe medication drop off kiosks.  MedicalResearch.com: What is the background for this study? How big is the problem of unused risky medications leftover after the need or indication period has passed? Response: Keeping leftover medications in the home significantly increases the risk of accidental poisonings as well as diversion, which can lead to addiction, overdoses and death. According to the Centers for Disease Control & Prevention (CDC), accidental medicine poisonings send nearly 60,000 children under 5 years old to emergency rooms annually. And, a study by the National Institute on Drug Abuse found that the first opioid used by 70% of individuals with heroin-use disorder was a prescription pain medication, often remaining in their medicine cabinet well after the pain subsided and then a remaining temptation for abuse. This is a pervasive problem across the country. In an independent survey DisposeRx sponsored, it was found that 4 out of 10 Americans are keeping leftover prescriptions—including opioids – in their medicine cabinets. Other results of the survey include: 62% of respondents who said they stored medications in case a condition returns; and 37% said they save prescription drugs in case a friend or family member needs them. Walgreens sees value in adding DisposeRx at-home solution to its comprehensive medication management and opioid stewardship programs These consumers need to be educated about all the potential harm resulting from saving leftover medications. Leading pharmacy chains such as Walgreens are committed, as responsible corporate citizens, to making DisposeRx available upon request for their customers and to educate them about its use in getting rid of leftover drugs before they cause harm. Walgreens sees value in adding DisposeRx at-home solution to its comprehensive medication management and opioid stewardship programs as an additional method to reduce risks and exposure. (more…)
Author Interviews, Opiods, Pediatrics / 25.06.2019

MedicalResearch.com Interview with: Jennifer N. Cooper, PhD Principal Investigator Center for Innovation in Pediatric Practice The Research Institute at Nationwide Children's Hospital, Research Assistant Professor of Pediatrics The Ohio State University College of Medicine MedicalResearch.com: What is the background for this study? What are the main findings? Response: Although postoperative opioid prescribing has decreased in recent years due to an increased awareness of the risks of excess opioid prescribing, many patients are still prescribed more opioids than they need after surgery. In the pediatric population, most opioids are prescribed after surgical and dental procedures. Although patients are often prescribed more opioids than they need after surgery, previous studies have found that excess opioids left unused after surgery are rarely properly disposed. These leftover opioids can be misused or accidentally ingested by young children. Previous studies have targeted the problem of non-disposal of opioids leftover after surgery by providing patients and families with educational materials describing proper methods of postoperative opioid disposal. However, these studies have had mixed results with some finding an increase in opioid disposal after education and others finding no effect of such education. In addition to education, another means of facilitating postoperative opioid disposal is the provision of drug disposal products. These products contain compounds that irreversible adsorb or oxidize medications, enabling them to be safely disposed of in the home garbage. (more…)
Annals Internal Medicine, Author Interviews, Opiods, University of Pittsburgh / 18.06.2019

MedicalResearch.com Interview with: Dr. Julie Donohue, Ph.D. Professor, Department of Health Policy and Management Vice Chair for Research Graduate School of Public Health University of Pittsburgh MedicalResearch.com: What is the background for this study? Response: The opioid epidemic is exacting a significant burden on families, communities and health systems across the U.S. Prescription and illicit opioids are responsible for the highest drug overdose mortality rates ever recorded. We know from previous studies that some surgical and medical patients who fill opioid prescriptions immediately after leaving the hospital go on to have chronic opioid use. Until our study, however, little was known about how and if those patients were being introduced to the opioids while in the hospital. My colleagues and I reviewed the electronic health records of 191,249 hospital admissions of patients who had not been prescribed opioids in the prior year and were admitted to a community or academic hospital in Pennsylvania between 2010 and 2014. Opioids were prescribed in 48% of the admissions, with those patients being given opioids for a little more than two-thirds of their hospital stay, on average. (more…)
Author Interviews, Education, Opiods, Social Issues / 16.06.2019

MedicalResearch.com Interview with: Arline T. Geronimus Sc.D Professor, Health Behavior and Health Education School of Public Health Research Professor Population Studies Center Institute for Social Research University of Michigan Member, National Academy of Medicine  MedicalResearch.com: What is the background for this study? Response: The gap in life expectancy between less and more educated Americans grew over the last 30 years, a deeply troubling fact. We are alone among western nations in these trends. We aimed to determine what causes of death account for this growing educational gap in life expectancy and whether the gap has continued to grow in the most recent years. Disturbingly, we found the educational gap in life expectancy has continued to grow. Why? A common theory is that this growing inequality is due to the opioid epidemic. Some even speculate that the less educated are dying from a composite of what they call “deaths of despair” – opioid and other drug overdose, suicide and alcoholic liver disease – with the theory being that as less educated and working class Americans have faced job loss and stagnating wages, they experience hopelessness and despair and turn to drugs, alcohol, or even suicide to ease or end their pain and feelings of hopelessness. However, while opioid, suicide and alcoholic liver disease deaths have increased among white youth and young adults and is cause for concern, this does not imply that these deaths should be grouped together as “deaths of despair” (DOD) or that they explain the growing educational gaps in life expectancy across all groups – men, women, whites, blacks, or older as well as younger adults. (more…)