How Location Affects Lifespan, The Barriers To Receiving Cognitive Behavioral Therapy

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• Location Can Affect People's Lifespan If They're Poor

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  A lot of factors determine where people settle in the U.S. — job opportunities, good school systems and public amenities, such as parks. For others, it’s proximity to family and deep roots in a community.

  But, a new study published in the Journal of the American Medical Association shows that where you live can have a profound impact on a person’s life, especially if they are poor. And that the health gap between the wealthiest and poorest Americans is significant.

  “The gaps are quite large,” said Michael Stepner, who is co-author of the study and a researcher at the Massachusetts Institute of Technology. “The gap for men — between the richest 1 percent the poorest 1 percent — is 15 years. And for women, that gap is 10 years.”

  The research shows that the lifespans of the richest Americans are going to be greater regardless of where they live. However, where the poorest Americans live can have the biggest impact on how long they live.

  Stepner said while the data doesn’t show the causal factors for why there’s such a significant gap between the lifespans of the rich and poor, looking at local factors can help explain what is happening at the national level. The study showed that poor Americans living in states like New York and California outlive people in the same economic bracket living in areas like Nevada, Michigan and Ohio.

  The places where the poor are living the longest tend to have better health practices, Stepner said.

  “They have low rates of smoking, low rates of obesity, and high rates of exercise,” he said. “And that’s just consistent across the board. Where the places where the poor have healthy behaviors also have high life expectancies.”

  He said the data also shows that poorer Americans living in affluent areas tend to live longer, but he cautions the data does not point to specific reasons why. However, Stepner said there are some potential scenarios leading to these findings. One hypothesis says where local governments impose more regulations could be leading to better health outcomes.

  “These are the places where you have indoor smoking bans, or you might have a trans-fat ban, or you might have high taxes on cigarettes,” he said. “These might be the places where the government is most involved.”

  In the end, Stepner said that there are a few policy shifts that could happen — both locally and nationally — that could reduce the lifespan gap in the U.S.

  First, he said while there have been conversations at the national level about health disparities, it warrants addressing them locally to affect positive change. Second, public health initiatives such as efforts to reduce smoking have the potential to close these gaps.

• New Guidelines For Insomnia Steer Patients Away From Sleeping Pills

  New guidelines issued on Tuesday by the American College of Physicians recommend doctors treat insomnia with cognitive behavioral therapy before writing sleeping pill prescriptions.

  The recommendation states that all adult patients receive cognitive behavioral therapy for insomnia as the initial treatment for chronic insomnia disorder and for clinicians to use a shared decision-making approach when deciding to add a pharmaceutical drug. Approximately 6 to 10 percent of adults suffer from insomnia disorder, according to research from the American College of Physicians. The disorder typically leads to fatigue, poor cognitive function and mood disturbances among other symptoms, and is more common in women and older adults.

  Dr. Roger Kathol, a professor in psychiatry at the University of Minnesota, said cognitive behavioral therapy is used for a wide variety of psychiatric conditions, including depression, anxiety and personality disorder.

  “It’s a form of cognitive and behavioral learning process that allows people that have chronic insomnia to identify the things that create the problem and to then systematically utilize techniques to overcome the problem,” Kathol said.

  Kathol said doctors often overlook insomnia, a dangerous proposition since it can be a contributor to other medical conditions to the heart, kidneys and lungs.

  “Identifying and effectively treating insomnia is an important thing, and doctors really just need to become more aware that this is an area that is important in people’s lives,” he said.

  Several barriers have prevented cognitive behavioral therapy from being more available to patients. Kathol said the stigmatization of mental health has led it to be segregated within medical practices, creating an accessibility issue to some patients.

  However, Kathol said a growing platform of digital apps are proving to be an effective alternative to insomnia patients who don’t have access to a therapist.

• New Research Shows Where You Live Can Affect Your Lifespan

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  According to new research, if you’re poor in the United States where you live can greatly affect if you live a short or a long life. Joining us to talk about the findings is Michael Stepner, a researcher from the Massachusetts Institute of Technology and the co-author of the study.

• The Barriers To Receiving Cognitive Behavioral Therapy–And How To Overcome Them

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  On Tuesday, the American College of Physicians released new guidelines for chronic insomnia. They’re now recommending cognitive behavioral therapy for insomnia as a first-line treatment…which means doctors would prescribe cognitive behavioral therapy before they write a prescription for a sleeping pill. We talk to an expert who just wrote an editorial on the barriers to receiving cognitive behavioral therapy. He explains the difficulty in getting this treatment and what needs to change to make cognitive behavioral therapy more accessible.