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Over half of adults unvaccinated for COVID-19 fear needles. Here’s what’s proven to help.
Photo by CDC on Unsplash

If you're among the 25% of Americans averse to needles, you're probably not surprised by the COVID-19 immunization stall. Even for those who want immunity, bribes with beer or lottery tickets may not be enough to override anxiety made worse by pervasive images of needles in the media.

As a physician specializing in pain management, I study the impact of pain on vaccination. Research-proven adult interventions for pain, fainting, panic and fear can make vaccination more tolerable. At a minimum, understanding the reasons needle fear has become common might make the embarrassment easier to bear.

Why needle anxiety has increased

Needle fear has increased dramatically since a landmark 1995 study by J.G. Hamilton reported that 10% of adults and 25% of children feared needles. In that paper, adult patients who remembered when their fear began described a stressful needle experience around age 5.

The childhood experiences of the patients usually related to an unexpected illness; at the time the Hamilton participants were in preschool, vaccines were scheduled only until age 2. For most people born after 1980, however, booster injections given between ages 4 to 6 years became a routine part of the vaccine experience. The timing of boosters maximizes and prolongs immunity, but unfortunately falls within the age window when phobias form. A 2012 Canadian study of 1,024 children found that 63% of those born in 2000 or later now fear needles. In a 2017 study, my colleagues and I confirmed this increase in prevalence: Half of preschoolers who got all their boosters on one day – often four or five injections at once – were still severely afraid of needles as preteens.


Unsurprisingly, needle fear affects how willing teens and adults are to get vaccinated. A 2016 study found needle fear to be the most common reason teens didn't get a second HPV vaccine. Health care workers are no exception: A 2018 study found that 27% of hospital employees dodged flu vaccines due to needle fear. And most recently, an April 2021 national survey of 600 not-yet-COVID-19-vaccinated U.S. adults found that 52% reported moderate to severe needle fear.

The shame accompanying needle fear can make it difficult to research among adults.CDC/Unsplash, CC BY


Potential solutions for adults

For children, evidence shows that addressing their fear and pain while distracting them from the procedure is most effective in reducing distress.

While adults are not just big children, combining these concepts with findings from available adult injection studies suggest a few potential interventions. For the many who want a vaccine but need some support, here's what we know:

1. Pain reduction

Relieving injection pain may reduce needle fear by giving patients a feeling of control. For example, a group of patients in New Zealand were repeatedly missing their monthly antibiotic injections for rheumatic heart disease. Their doctors created a special clinic, offering either anesthetics, a vibrating cold device or both during the shot. The interventions in 107 adults reduced pain and fear by 50% after three months. Six months later, half the patients still used the interventions, and the special "missed dose" clinic was no longer needed.

Specifically for vaccination, applying a vibrating cold device to the injection site a minute prior to injection, then pressing just above the site during injection, relieved pain and improved satisfaction for adults, and was most effective for those with needle fear. A horseshoe-shaped plastic device using sharp prongs to confuse the nerves also reduced injection pain but increased anxiety, possibly due to discomfort from the prongs themselves.

Cold spray doesn't help reduce vaccination pain for children, but has been shown to be more effective than topical anesthetics for adult injections.

2. Psychological therapy

Exposure-based therapy involves asking a patient to rank anxiety caused by parts of a procedure, like seeing a picture of a tourniquet or thinking about sharp things, and gradually exposing them to these parts in a controlled environment. Free self-guided resources are available for fears ranging from flying to spiders. However, none of the three studies testing this approach on adult needle fear showed long-term fear reduction.

One of the studies that taught techniques to reduce fainting, however, was considered a success. Fainting, or vasovagal syncope, and needle fear are often conflated. While passing out due to injections is more common with anxiety, it is often a genetic response. Tensing the stomach muscles increases the volume of blood the heart can pump, keeping blood in the brain to prevent lightheadedness during needle procedures.

Planning ahead can help make vaccine day more approachable.recep-bg/E+ via Getty Images

3. Distraction

Surprisingly, there are no studies on adults using distraction for injections. Two studies, however, have found that pretending to cough reduces pain from blood draws.

Dropping F-bombs could also help: A recent study found that swearing reduced pain by one-third compared to saying nonsense words. Distraction with virtual reality games or videos has been shown to be more effective in children, although there have been mixed results in adults.

Mentally engaging tasks may also help. A visual finding task given to children during intramuscular shots has been shown to reduce pain and fear, with 97% rating the experience more pleasant than previous blood draws. Adults may need a more complicated task, but a similar intervention could work for them as well.

Use multiple interventions and go in with a plan

To reduce needle fear, research suggests the more interventions, the better. A 2018 study summarizing research on vaccine pain concluded that patient-operated cold and vibration devices combined with distraction techniques were most effective. Canada has implemented a practical national needle fear intervention for their vaccine rollout, emphasizing preparing ahead to help make vaccine day more comfortable.

Adults who don't like needles are in the majority. Taking control of your vaccination experience may be the best way to combat needle anxiety.

Amy Baxter is a Clinical Associate Professor of Emergency Medicine at Augusta University.

This article previously appeared on The Conversation. You can read it here.


All images provided by Bombas

We can all be part of the giving movement

True

We all know that small acts of kindness can turn into something big, but does that apply to something as small as a pair of socks?

Yes, it turns out. More than you might think.

A fresh pair of socks is a simple comfort easily taken for granted for most, but for individuals experiencing homelessness—they are a rare commodity. Currently, more than 500,000 people in the U.S. are experiencing homelessness on any given night. Being unstably housed—whether that’s couch surfing, living on the streets, or somewhere in between—often means rarely taking your shoes off, walking for most if not all of the day, and having little access to laundry facilities. And since shelters are not able to provide pre-worn socks due to hygienic reasons, that very basic need is still not met, even if some help is provided. That’s why socks are the #1 most requested clothing item in shelters.

homelessness, bombasSocks are a simple comfort not everyone has access to

When the founders of Bombas, Dave Heath and Randy Goldberg, discovered this problem, they decided to be part of the solution. Using a One Purchased = One Donated business model, Bombas helps provide not only durable, high-quality socks, but also t-shirts and underwear (the top three most requested clothing items in shelters) to those in need nationwide. These meticulously designed donation products include added features intended to offer comfort, quality, and dignity to those experiencing homelessness.

Over the years, Bombas' mission has grown into an enormous movement, with more than 75 million items donated to date and a focus on providing support and visibility to the organizations and people that empower these donations. These are the incredible individuals who are doing the hard work to support those experiencing —or at risk of—homelessness in their communities every day.

Folks like Shirley Raines, creator of Beauty 2 The Streetz. Every Saturday, Raines and her team help those experiencing homelessness on Skid Row in Los Angeles “feel human” with free makeovers, haircuts, food, gift bags and (thanks to Bombas) fresh socks. 500 pairs, every week.

beauty 2 the streetz, skid row laRaines is out there helping people feel their beautiful best

Or Director of Step Forward David Pinson in Cincinnati, Ohio, who offers Bombas donations to those trying to recover from addiction. Launched in 2009, the Step Forward program encourages participation in community walking/running events in order to build confidence and discipline—two major keys to successful rehabilitation. For each marathon, runners are outfitted with special shirts, shoes—and yes, socks—to help make their goals more achievable.

step forward, helping homelessness, homeless non profitsRunning helps instill a sense of confidence and discipline—two key components of successful recovery

Help even reaches the Front Street Clinic of Juneau, Alaska, where Casey Ploof, APRN, and David Norris, RN give out free healthcare to those experiencing homelessness. Because it rains nearly 200 days a year there, it can be very common for people to get trench foot—a very serious condition that, when left untreated, can require amputation. Casey and Dave can help treat trench foot, but without fresh, clean socks, the condition returns. Luckily, their supply is abundant thanks to Bombas. As Casey shared, “people will walk across town and then walk from the valley just to come here to get more socks.”

step forward clinic, step forward alaska, homelessness alaskaWelcome to wild, beautiful and wet Alaska!

The Bombas Impact Report provides details on Bombas’s mission and is full of similar inspiring stories that show how the biggest acts of kindness can come from even the smallest packages. Since its inception in 2013, the company has built a network of over 3,500 Giving Partners in all 50 states, including shelters, nonprofits and community organizations dedicated to supporting our neighbors who are experiencing- or at risk- of homelessness.

Their success has proven that, yes, a simple pair of socks can be a helping hand, an important conversation starter and a link to humanity.

You can also be a part of the solution. Learn more and find the complete Bombas Impact Report by clicking here.

Pop Culture

TikTok star's surprising method for finding good Chinese food is blowing people's minds

Yelp can be a helpful tool for scoping out food joints, but maybe not in the way you think.

Photo by Debbie Tea on Unsplash

Different cultures view service differently.

Content creator Freddy Wong has a brilliantly easy way to find authentic Chinese food.

As he reveals in a mega viral video that’s racked up 9.4 million views on TikTok and 7.7 million views on Twitter, the trick (assuming you live in a major metropolitan area) is to “go on Yelp and look for restaurants with 3.5 stars, and exactly 3.5 stars." Not 3. Not 4. 3.5.

He then backs up his argument with some pretty undeniable photo evidence.

First, he pulls up an image of a Yelp page from P.F. Chang’s. With only 2.5 stars, one can tell the food is “obviously bad.” Alternatively, Din Tai Fung—a globally recognized Michelin-starred Chinese restaurant—has four stars.

Sounds good right? Wrong. In this case, “too many stars” means that “too many white people like it,” indicating that the restaurant is being judged on service rather than food quality. According to Wong, if “the service is too good, the food is not as good as it could be.”

He then pulls up the Yelp page for a couple of local Chinese restaurants, both of which have 3.5 stars. The waiters at these establishments might “not pay attention to you,” he admits, adding that they might even be “rude.” But, Wong attests, “it’s going to taste better.”

@rocketjump

Why I only go to Chinese restaurants with 3.5 star ratings

♬ original sound - RocketJump

"The dumplings here are better [than Din Tai Fung's]. I've been here," he says of the 3.5 star Shanghai Dumpling House. Considering his Twitter profile boasts a “James Beard Award winning KBBQ Gourmand'' title, it seems like he knows what he’s talking about.

So, why is this 3.5 rule the “sweet spot”? As Wong explains, it all comes down to different “cultural expectations.”

“In Asia, they’re not as proactive. They’re not going to come up to you, they’re not going to just proactively give you refills, you need to flag down the waiter,” he says, noting the different interpretations of service.

"People on Yelp are insufferable,” he continues, arguing that “they're dinging all these restaurants because the service is bad,” but the food is so good that it balances out the bad service. Hence, a 3.5-star rating. His reasoning is arguably sound—people do often give absurdly scathing reviews that in no way accurately reflect a restaurant’s food quality.

“A good Yelp review doesn’t mean it’s a good restaurant — it simply means the restaurant is good at doing things that won’t hurt their online rating,” Wong said in an interview with Today, adding that “highly rated Yelp restaurants are often those with counter service and limited menus, minimizing potential negative interaction with staff.”

He also added the caveat, “I don’t have anything against those places, but I think people who only eat at the ‘highest rated’ restaurants on online review sites are only eating at the most boring restaurants.”

A ton of people in the comments seem to back Wong’s theory.

best chinese food

100% accurate, some say

TikTok

Plus, the theory seems to not be limited to just Chinese restaurants, further implying that maybe there’s more of a cultural misunderstanding, rather than any real lack of quality.

thai food near me

No drink refills but the food is fire.

TikTok

yelp reviews, yelp

2.8 is the new 5

TikTok

One of the gifts that our modern world provides is the opportunity to truly experience and appreciate other cultures. Since food is easily one of the most accessible (and enjoyable) ways to do that, perhaps we should prioritize seeking authenticity, rather than rely on a flawed and superficial rating system.

As Wong told Today, “I hope it encourages people to go out and eat more food from not only Chinese restaurants, but restaurants representing the whole world of cultural cuisines.”

Education

How a 3,800-year-old stone tablet helped create modern legal systems

'Innocent until proven guilty' isn't that new of a concept.

Kind of looks like the Matrix code...

The modern justice system is certainly not without its flaws, however most can agree that the concept of “innocent until proven guilty” is one that (when not abused) stands as the foundation of what fair due process looks like. This principle, it turns out, isn’t so modern at all. It can actually be traced all the way back to nearly 3,800 years ago.

historyLady Justice, the image of impartial fairness. Photo by Tingey Injury Law Firm on Unsplash

English barrister Sir William Garrow is known for coining the "innocent until proven guilty" phrase between the 18th and 19th century, after insisting that evidence be provided by accusers and thoroughly tested in court. But this notion, as radical as it seemed at the time, can, in fact, be credited to an ancient Babylonian king who ruled Mesopotamia.

During his reign from 1792 to 1750 B.C., Hammurabi left behind a legacy of accomplishments as a ruler and a diplomat. His most influential contribution was a series of 282 laws and regulations that were painstakingly compiled after he sent legal experts throughout his kingdom to gather existing laws, then adapted or eliminated them in order to create a universal system.

Those laws were inscribed on a large, seven-foot stone monument, and they were known as the Code of Hammurabi.

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via UNSW

This article originally appeared on 07.10.21


Dr. Daniel Mansfield and his team at the University of New South Wales in Australia have just made an incredible discovery. While studying a 3,700-year-old tablet from the ancient civilization of Babylon, they found evidence that the Babylonians were doing something astounding: trigonometry!

Most historians have credited the Greeks with creating the study of triangles' sides and angles, but this tablet presents indisputable evidence that the Babylonians were using the technique 1,500 years before the Greeks ever were.


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