They say that parenting is the greatest — and the most challenging — job that many of us will ever land. Life can be tough for kids too, especially when they go through emotionally trying times.

What can parents do to help their kids manage episodes of anger, sadness, or anxiety triggered by school, siblings, and daily living? Whether you are a parent to an elementary-age child, a tweener ages 8 to 12, or a teenager, practicing two skills can help both you and your child: validation and coping.

Practicing validation

Validation teaches your children that feeling and expressing their emotions is okay.

“When parents use validation, they are affirming to their child that it’s fine to feel emotions and they should not be suppressed,” says Dr. Chase Samsel with the Department of Psychiatry and Behavioral Sciences at Harvard-affiliated Boston Children’s Hospital. “It shows them you understand their feelings and point of view, and it establishes trust. This, in turn, can help a child feel supported and open to discussing solutions.”

Start with acknowledgement

Acknowledge their emotions with comments like, “It sounds like you are frustrated or angry,” or “I can see that you’ve had a tough day at school.”

But which emotion — or emotions — is your child feeling? “It can be difficult for parents to recognize the genuine emotion their child is battling,” says Dr. Samsel. “Many times, kids have an emotional reaction but can’t explain what’s going on, or don’t want to, or express various emotions at once.”

Other times, different emotions lie underneath the one being shown. This is especially common among teenagers where they display anger, but often the real emotion is fear, anxiety, or sadness. “In these incidences, just recognizing they are going through something difficult is enough,” says Dr. Samsel.

Practice validation often

A child may not respond to validation at first — they may not want to talk about their emotions or may ignore your interest. But consistent validation will eventually pay off.

“By repeating validation when emotional crises arise, the child soon will become more comfortable expressing their emotion,” says Dr. Samsel. “Once they recognize that their parents welcome this and will not be reprimanded, they will be open to sharing details.”

Building a coping skills toolbox

Coping skills are ways parents can teach their children to manage emotional problems when they arise.

Try a breathing exercise together

Breathing exercises are a popular strategy, as they are easy to learn and quick to use. Dr. Samsel recommends any of the following: three-part breathing, ujjayi breathing, and belly breathing.

Other coping skills include guided meditation, visualization, squeezing a ball for stress relief, taking a walk or playing outside, and reading together (ideal for preschool and elementary-age children).

“Sometimes just giving children alone time in their room or “taking space” works well,” says Dr. Samsel.

Tap into coping skills yourself

It’s also vital for parents to adopt these strategies when dealing with their own emotions, says Dr. Samsel. Not only will this help you feel calmer, but it’s a great way to model that coping skills help everyone — adults, too!

For example, try telling your kids when you feel upset or frustrated about something that happens during your day. Announce that you plan to take a walk to de-stress or do a breathing exercise. Later, share your strategies for problem-solving.

“Kids watch what their parents do and will often mimic their behavior,” says Dr. Samsel. “If they see you constructively working through your emotions, they will be more open to doing the same.”

Be flexible

Never insist on having older kids use a coping mechanism, even when situations call for it. That could feel like punishment and trigger an automatic resistance.

Instead, Dr. Samsel suggests parents expose their children to different types of coping skills and then let them decide which ones they want to try. “They may need to experiment to find techniques they can easily follow and that work for them,” says Dr. Samsel.

About the Author

Matthew Solan, Executive Editor, Harvard Men's Health Watch

Matthew Solan is the executive editor of Harvard Men’s Health Watch. He previously served as executive editor for UCLA Health’s Healthy Years and as a contributor to Duke Medicine’s Health News and Weill Cornell Medical College’s … See Full Bio View all posts by Matthew Solan

About the Reviewer

Howard E. LeWine, MD, Chief Medical Editor, Harvard Health Publishing

Dr. Howard LeWine is a practicing internist at Brigham and Women’s Hospital in Boston, Chief Medical Editor at Harvard Health Publishing, and editor in chief of Harvard Men’s Health Watch. See Full Bio View all posts by Howard E. LeWine, MD

Ever heard of mpox? Wondering why it’s back in the news?

Many of us first learned about mpox (formerly called monkeypox) in 2022, when the largest known outbreak spread to nearly 100,000 people in more than 100 countries. While mpox often circulates in central and western Africa, the 2022 outbreak quickly spread from the Democratic Republic of the Congo (DRC) to places it had never been detected before. In the US alone, it caused more than 32,000 infections and 58 deaths.

Now, a new outbreak of mpox has put it back in the news. What should you know — and do — about this latest international health emergency? What are your risks? Are vaccines available? If you get mpox, how can you avoid spreading it?

What’s different about the 2024 mpox outbreak?

This time, a new strain of the virus (called Clade 1b) is spreading quickly. That’s why the World Health Organization (WHO) declared a second mpox global health emergency in August 2024.

Already, more than 15,600 cases and 500 deaths have been reported, mostly in the DRC. And mpox has been found in countries that previously hadn’t identified any cases, including Burundi, Kenya, Rwanda, and Uganda. Recent cases diagnosed in Sweden and Thailand have public health officials bracing for additional international spread, including to Asia, Europe, and the US.

6 things to know about mpox

What is mpox and how does it spread?

Mpox is a viral infection caused by the same family of viruses as smallpox. In central and western Africa it’s common in certain animals, including squirrels and rats. People can become infected after contact with infected animals. Mpox can spread from person to person through close physical contact, including sex.

What are the symptoms of mpox?

Mpox causes flulike symptoms, fever, headache, enlarged lymph nodes, and a unique rash. The rash usually begins a few days into the illness as small flat spots. The spots evolve over a week or two to become small fluid-filled bumps (vesicles) similar to chickenpox, and then larger pus-filled blisters. Over another week or two, the blisters scab over and heal. Once that happens, a person is no longer contagious.

Although the disease is usually mild, some people develop complications. Serious complications include pneumonia, vision loss due to eye infection, and sepsis, a life-threatening infection.

What is your risk of getting mpox?

Location and activities factor into your risk for developing mpox.

Risk increases if you

• have close physical contact with an infected animal or person
• have contact with bedding, clothes, or other objects or surfaces touched by an infected person
• live in or visit a place where the mpox virus is endemic — that means present in the environment, such as in the soil or infected animals or people
• are a man who has sex with men
• have many sexual partners.

When people get mpox, risk factors for experiencing more severe disease or complications like pneumonia include:

• pregnancy
• young age (especially children younger than age 1)
• having a weakened immune system
• having eczema (because this weakens the protective skin barrier).

Why is the new mpox outbreak so worrisome?

The new outbreak of mpox is especially worrisome because the strain of the virus is deadlier than in 2022. The virus is spreading more quickly and reaching places where mpox had not previously been found.

In addition, the new outbreak has disproportionately affected kids and teens in resource-poor countries. Many are already suffering with malnutrition, or other infections such as cholera.

It’s worth noting that the strain of mpox from the 2022 outbreak (Clade 1) is still circulating at a low level in the US. Right now, fewer than 15 people a week are diagnosed with it and treatment is available.

Are there mpox vaccines and treatments?

There are two vaccines available to prevent mpox in the US:

• Jynneos is approved to prevent mpox and smallpox. It requires two doses four weeks apart.
• A vaccine called ACAM2000 is approved for preventing smallpox and is considered effective for mpox. It could be made available if needed, but its potential side effects make it a second choice.

Resource-poor countries in Africa, Asia, and elsewhere have had limited access to vaccines. Even in resource-rich countries like Europe and the US, vaccine hesitancy has been an obstacle to containing the outbreak. In one study, only half of a vulnerable population in Illinois received the initial dose of the mpox vaccine, and only a quarter received both recommended doses.

An antiviral drug called tecovirimat is approved to treat smallpox. Animal studies suggest it may be effective in treating mpox as well. Now being investigated as an mpox treatment, the drug may be available by enrolling in a study. A 2024 study found tecovirimat did not reduce the length of time adults and children with Clade 1 mpox had symptoms. However, the death rate (1.7%) was half of what was expected. But it’s unclear whether the low death rate was actually due to drug treatment.

How can someone with mpox avoid spreading it?

If you are diagnosed with mpox, it’s important to take these measures to avoid infecting others:

• Avoid close contact with others until your skin lesions have healed.
• Wear a well-fitting medical mask while near others; those visiting you should wear a mask as well.
• Stay several feet or more away from others.
• Use a separate bedroom and bathroom.
• Clean all surfaces you’ve touched.
• Don’t share eating utensils, towels, or bedding with others.
• Increase room ventilation by opening windows or using a high-efficiency particulate air (HEPA) purifier.

Some experts recommend avoiding contact with pets or other animals because they could become infected and spread the disease to new animal species in new places.

The bottom line

Will mpox be the next pandemic? That’s unlikely. The virus that causes mpox spreads mainly by direct contact — unlike the virus that causes COVID-19, which spreads through small respiratory droplets that are easily breathed in. Also, people with mpox who are contagious typically have obvious symptoms, so they can take steps to avoid spread.

Currently, the risk mpox poses to most people in the US appears to be quite low. To help make sure it stays that way and to help countries where mpox is common, US public health officials are working with their counterparts in other countries to contain the outbreak. To be successful, we’ll need a robust. well-coordinated international effort, including financial support to resource-poor countries to fund educational programs, vaccination, testing, and treatment.

About the Author

Robert H. Shmerling, MD, Senior Faculty Editor, Harvard Health Publishing; Editorial Advisory Board Member, Harvard Health Publishing

Dr. Robert H. Shmerling is the former clinical chief of the division of rheumatology at Beth Israel Deaconess Medical Center (BIDMC), and is a current member of the corresponding faculty in medicine at Harvard Medical School. … See Full Bio View all posts by Robert H. Shmerling, MD

Need another jolt of motivation to shore up a resolution to shed weight, sleep more soundly, boost nutrition or exercise levels, or cut back on alcohol? Then you'll be pleased to learn that any (and all) of these efforts can also add up to better brain health.

An international study led by researchers at the McCance Center for Brain Health at Massachusetts General Hospital devised and validated a Brain Care Score (BCS) card that makes it easy to total up what you're doing well and where you might do better. The prize is a healthier brain — specifically a lower risk for dementia and strokes.

Designed to predict how current habits might impact future brain health, the user-friendly scorecard is apparently the first of its kind, says Dr. Andrew Budson, a lecturer in neurology at Harvard Medical School.

"It's a real service that the researchers have developed a scale like this and completed the first study to determine if scoring worse on this scale raises your risk for dementia and stroke," says Dr. Budson, who wasn't involved in the analysis. "On one hand, no one's done something quite like this before. On the other, however, it's really wrapping together health factors everyone has known for a number of years in new packaging."

What's included on the scorecard?

Called the McCance Brain Care Score, the card tallies points from 12 physical, lifestyle, and social-emotional domains.

Physical components relate to

• blood pressure
• blood sugar
• cholesterol
• body mass index (BMI).

Lifestyle components include

• nutrition
• alcohol intake
• smoking
• aerobic activities
• sleep.

Social-emotional factors inquire about

• stress management
• social relationships
• meaning in life.

Each response is given a score of 0, 1, or 2, with the highest possible score totaling 21. Higher scores suggest better brain care.

"All these physical and lifestyle factors can contribute to the risk of dementia to some extent through strokes," Dr. Budson says. "Those that aren't a risk through strokes are usually related to the fact that a healthy brain is a brain that's using all of its parts. Engaging in healthy relationships and meaningful activities helps us maintain good brain structure and function."

What did the analysis involve?

The study was published online in Frontiers of Neurology in December 2023. It involved nearly 399,000 adults ages 40 through 69 (average age 57; 54% women) who contributed personal health information to the UK Biobank.

During an average follow-up period of 12.5 years, participants recorded 5,354 new cases of dementia and 7,259 strokes. Researchers found that participants with higher Brain Care Scores at the study's start had lower risks of developing dementia or strokes over time.

These threats to health and independence take a stunning — and growing — toll on people in the US. Dementia affects one in seven Americans, a rate expected to triple by 2050. Meanwhile, more than 795,000 people in the United States suffer a stroke each year, according to the CDC.

What did the study find?

Each five-point step higher in the BCS rating assigned when the study began was linked to significantly lower risks of dementia and stroke, with those odds varying by age group:

• Participants younger than 50 at the study's start were 59% less likely to develop dementia and 48% less likely to have a stroke with each five-point higher score on BCS.
• Participants 50 through 59 at the study's start were 32% less likely to develop dementia and 52% less likely to have a stroke with each five-point higher score on BCS.

But those brain disease benefits appeared to diminish for those older than 59 at the study's start. This group experienced only 8% lower odds of dementia and a 33% lower risk of stroke with each five-point higher score on BCS. Study authors theorized that some of these participants may have already been experiencing early dementia, which is difficult to detect until it progresses.

"I feel very comfortable that the study's conclusions are entirely correct, because all the factors that go into its BCS are well-known things people can do to reduce their risk of stroke and dementia," Dr. Budson says.

What are the study's limitations?

However, Dr. Budson notes that the study did have a couple of limitations,. The UK Biobank fell just short of collecting all the components of the BCS in its dataset, lacking meaning-of-life questions. So its scores ranged from 0 to 19, not up to 21. "It's a practical limitation, but it should be acknowledged that so far, there have been no studies to validate the actual 21-point scale they're recommending we use," he says.

The analysis also evaluated participants' scores at just one point in time instead of several, Dr. Budson says. Future research should determine whether people can lower their stroke and dementia risk by improving their BCS over time with behavior and lifestyle changes.

How can you play this game at home?

While better brain health may be the clear prize of a higher score, it's far from the only benefit. That's because improving any health component of the BCS also benefits our overall well-being.

"By improving these factors, not only will people help their brain, but they'll also help their heart and reduce their risk of cancer," Dr. Budson adds. "These factors will absolutely also improve your psychological health, which is certainly an important part of brain health."

The scale's simple breakdown of health factors also makes it easy to focus on tweaking one or two without getting overwhelmed.

"Let's say someone's nutrition isn't perfect — and they know it — but they're not willing to change their diet. Fine. They can then decide to do more aerobic exercise, for example, or to stop drinking, or to get the sleep their body needs," he says.

What one change could put you on a path to better brain health?

If he had to choose just one factor to improve brain health, Dr. Budson would focus on meaning of life, "which means you generally feel your life has meaning or purpose," he says. To do that, he suggests giving deep, quiet thought to what you wish your life's purpose to be, whether you expect to live a long time or just a few years.

"Once you have a purpose, then you have a reason to follow through with assessing all the other items on the BCS scale and seeing what you can do so you'll be around longer, and be competent and capable longer, to help fulfill the meaning and purpose of your life," he says.

About the Author

Maureen Salamon, Executive Editor, Harvard Women's Health Watch

Maureen Salamon is executive editor of Harvard Women’s Health Watch. She began her career as a newspaper reporter and later covered health and medicine for a wide variety of websites, magazines, and hospitals. Her work has … See Full Bio View all posts by Maureen Salamon

About the Reviewer

Howard E. LeWine, MD, Chief Medical Editor, Harvard Health Publishing

Dr. Howard LeWine is a practicing internist at Brigham and Women’s Hospital in Boston, Chief Medical Editor at Harvard Health Publishing, and editor in chief of Harvard Men’s Health Watch. See Full Bio View all posts by Howard E. LeWine, MD

You’re huffing and puffing and starting to sweat — and that’s just from walking across the parking lot in blistering heat and humidity. This summer has left us all struggling to stay cool.

“The last 13 months have been the hottest on record. We’re seeing increased levels of heat-related illness, and it started earlier in the season we’re used to,” says Dr. Tess Wiskel, a climate change and human health fellow at the Center for Climate, Health, and the Global Environment, and an emergency physician at Beth Israel Deaconess Medical Center.

Don’t wait until you’re overheated to figure out how to cool down. Be wary of high temperature risks throughout your day and practice ways to avoid them. Here are 14 ideas to get you started.

Cover the basics

• Become a weather expert. Use a weather app on your smartphone and pay attention to the hourly temperatures, not just daily highs and lows. Note the hottest points of the day and plan your schedule around them.
• Stay hydrated. One way the body cools down is by sweating. As moisture on the skin evaporates, it takes heat with it. That’s called evaporative heat loss. But you must replace the fluids you lose through a combination of drinks and water-rich foods. Generally, the National Academy of Medicine recommends totals of about 11 cups (88 ounces) per day for women and 15 cups (120 ounces) per day for men. If you spend a lot of time outdoors or are sweating a lot, you’ll need even more fluids.
• Seek air-conditioned environments. As much as possible, hang out in air-conditioned indoor spaces during the hottest points of the day. If you don’t have AC, go to a shopping mall, public library, movie theater, or a community cooling center.
• Use fans correctly. Another way the body cools down is by channeling blood and body heat to vessels near the skin’s surface, where heat escapes. A fan can blow that heat away from your body and keep you cool, but not if the surrounding air is hot. “In that case, wet your skin, even with a spray bottle or a wet wipe. The fan will promote evaporative heat loss,” Dr. Wiskel says.
• Take breaks. Pace yourself when doing outdoor activity. “Physical work produces its own heat at the same time you’re being heated from outside,” Dr. Wiskel says. “Be active for short periods and rest in between.”

Pack and dress for heat

• Bring cool-downs with you. Any time you leave your home, bring plenty of water. Even better: bring a handheld fan, wet wipes, and ice packs. That way you’re prepared if you get stuck outside.
• Wear loose clothing. Lightweight, loose-fitting garments allow air to get to your skin, promoting evaporative heat loss to keep you cool when you sweat.
• Try high-tech clothes. Consider wearing clothes with cooling technology (such as tops, bottoms, hats, or neck gaiters). They work in various ways. For example, a garment might be made of a special fabric that’s activated with water and stays damp for a long period, continually pulling heat from your body.

Try DIY cool downs

• Make a DIY cooling garment. Dunk a kitchen towel or cotton T-shirt in cold water, wear it on your head, neck, or torso, and then rewet the fabric as it dries. Or buy higher-tech versions made with fabrics and gels designed to stay cool longer.
• Eat or drink something cold. A cool glass of water, ice chips, or a popsicle help fight dehydration and might help lower your body’s core temperature. Just don’t ingest anything too quickly. Dr. Wiskel says it might cause gastrointestinal upset.
• Cool off with a shower or bath. Experts debate the best temperature for water to cool you down. Some maintain that cool water constricts blood vessels and sends heat back to the core, making you hot again. Others maintain that chilly water cools the blood vessels and sends cooled blood to the core. Dr. Wiskel’s take: “Immerse yourself in water that’s cooler than your body temperature. The water can be tepid. Once you’re out of the water, stand in front of a fan to promote evaporative heat loss.”
• Submerge your forearms. If you can’t take a shower or bath, try a trick used by the US Army: submerge your hands, forearms, and elbows in ice water for five minutes. This helps send cooled blood moving through blood vessels back to your core.
• Apply ice or cold packs. A water-free method to cool blood vessels involves placing ice packs in areas near large blood vessels such as the elbows, underarms, neck, or inside the legs near the groin area.

Know when to get help

If you’re not cooling down after trying numerous methods, Dr. Wiskel advises that you seek care. Call your doctor’s office or call 911 if you’re exhibiting signs of heat exhaustion, such as

• excessive sweating
• headache
• feeling faint or dizzy
• cold, clammy skin
• a fast or weak pulse
• extreme fatigue
• muscle cramps.

Pay extra attention to those symptoms, especially if you’re vulnerable to heat and aren’t able to regulate your temperature well.

“People at high risk include older adults, babies and children, those who are pregnant, people who take medications that make them less able to sweat, people who work outdoors, and people with certain health conditions, including cardiovascular disease,” Dr. Wiskel says. “And if you’re not high risk, check in on people who are.”

About the Author

Heidi Godman, Executive Editor, Harvard Health Letter

Heidi Godman is the executive editor of the Harvard Health Letter. Before coming to the Health Letter, she was an award-winning television news anchor and medical reporter for 25 years. Heidi was named a journalism fellow … See Full Bio View all posts by Heidi Godman

About the Reviewer

Howard E. LeWine, MD, Chief Medical Editor, Harvard Health Publishing

Dr. Howard LeWine is a practicing internist at Brigham and Women’s Hospital in Boston, Chief Medical Editor at Harvard Health Publishing, and editor in chief of Harvard Men’s Health Watch. See Full Bio View all posts by Howard E. LeWine, MD

Mosquitoes are not just a buzzing summertime nuisance; they can carry serious diseases like West Nile virus, malaria, and Zika. In recent months, the US has seen an unusual spike in the mosquito-borne illness dengue fever, also known as breakbone fever.

What is dengue, and where is it occurring in the US? How does it spread? And what steps can you take to protect against this and other mosquito-borne illnesses?

What is dengue and what are its symptoms?

Dengue is a viral disease caused by any of four closely-related viruses: dengue virus 1, 2, 3, and 4. Not everyone infected with dengue will become sick: only about one in four will experience symptoms that range from minimal discomfort to serious problems. A blood test is used to confirm the diagnosis.

When symptoms do occur, they tend to feel like the flu. The onset of feeling unwell usually begins within two to three days of being bitten by an infected mosquito but can take up to six to nine days, says Dr. Edward Ryan, director of global infectious diseases at Harvard-affiliated Massachusetts General Hospital.

Seek medical advice if you have recently traveled to an area with a risk of dengue and have a fever (101° F or higher) combined with any of these symptoms:

• aches and pains (often headache or pain behind the eye or in muscles, joints, or bones)
• nausea and vomiting
• a rash (faint red blotches).

About one in 20 people who gets sick will develop severe dengue, which requires emergency care. Those at an increased risk for severe dengue include infants a year or younger, pregnant women, adults ages 65 years or older, and those with previous dengue infections.

Symptoms of severe dengue require immediate medical care. They include:

• feeling very weak and lightheaded from low blood pressure
• bleeding from the nose or gums
• stomach swelling
• vomiting
• extreme fatigue.

How is dengue treated?

Dengue is cause by a virus, and no specific medications are available to combat it. Milder dengue symptoms typically last two to seven days, according to the Centers for Disease Control and Prevention (CDC). The symptoms are managed supportively: plenty of fluids, over-the-counter pain medications, and rest.

Severe dengue usually requires treatment in a hospital with intravenous (IV) fluids. Patients are monitored until their fever breaks and symptoms begin to wane. This usually happens in about three to five days. Recovery at home can last many more days before a person’s strength returns.

“While there are reports of people dying from severe dengue fever, deaths from dengue cases in the US are rare,” says Dr. Ryan.

How does dengue spread?

The viruses that cause dengue do not directly spread from person to person. Aedes species mosquitoes can become infected with the dengue virus when they bite a person who has the virus. Infected mosquitoes then spread the virus to other people.

US visitors to high-risk countries may unknowingly bring the virus home with them, giving dengue infection a chance to spread further. For example, an infected person will have dengue virus circulating in their bloodstream for up to one week after being bitten. Let’s say the person returns to the US sooner than seven days, where they get bitten by a mosquito. That mosquito in the US now carries the virus and could bite someone else, thereby spreading the infection.

Where is dengue occurring in the US?

Most dengue transmission in the United States happens in areas where this illness is already common, such as Puerto Rico, American Samoa, and the US Virgin Islands.

At this writing, the CDC has reported nearly 3,000 dengue cases in the United States and US territories. States with the highest reported instances include Florida, New York, Massachusetts, and California. (Puerto Rico, which declared a public health emergency in March, had reported almost 1,500 cases by late June 2024.) While US cases are higher than in previous years, they are still low compared to the global incidence of dengue, which hit a record 9.7 million cases in North, Central, and South America during the first six months of 2024.

It’s not clear what has caused the sudden rise in dengue cases. Dr. Ryan says it could be due to several factors, such as higher seasonal travel, more people living closer together in urban settings, and the fact that there are more mosquitoes are carrying dengue.

Is there a dengue vaccine?

Currently, there is no widely available dengue vaccine for US travelers. One FDA-approved vaccine, Dengvaxia, protects children ages 9 to 16 from all four types of dengue. It is used only for children who have had a previous infection and who live in areas where dengue is common. However, the vaccine will be discontinued in September 2025, with the final doses expiring in September 2026.

What steps can you take to prevent dengue?

The best way to prevent dengue when visiting high-risk areas and after returning home is to protect yourself from mosquito bites. Here are some tips from the CDC:

• Use EPA-registered insect repellents with one of the following active ingredients: DEET; picaridin (known as KBR 3023 and icaridin outside the United States); IR3535; oil of lemon eucalyptus (OLE) or 2-undecanone (plant-derived ingredients); or para-menthane-diol (PMD).
• Wear loose-fitting, long-sleeved shirts and pants.
• Wear clothing and gear treated with permethrin (an insecticide that kills or repels mosquitoes).
• Place screens on windows and doors.
• When traveling, stay in places with air conditioning and screens. Use a bed net if air-conditioned or screened rooms are unavailable or if sleeping outdoors.
• To prevent mosquitoes from laying eggs in or near water around your home, empty and scrub, turn over, cover, or throw out outdoor items that hold water. This includes tires, buckets, toys, kid pools, birdbaths, flower pot saucers, or trash containers.

About the Author

Matthew Solan, Executive Editor, Harvard Men's Health Watch

Matthew Solan is the executive editor of Harvard Men’s Health Watch. He previously served as executive editor for UCLA Health’s Healthy Years and as a contributor to Duke Medicine’s Health News and Weill Cornell Medical College’s … See Full Bio View all posts by Matthew Solan

About the Reviewer

Howard E. LeWine, MD, Chief Medical Editor, Harvard Health Publishing

Dr. Howard LeWine is a practicing internist at Brigham and Women’s Hospital in Boston, Chief Medical Editor at Harvard Health Publishing, and editor in chief of Harvard Men’s Health Watch. See Full Bio View all posts by Howard E. LeWine, MD

Heavy rains and sea level rise contribute to major flooding events that are one effect of climate change. Surging water rushing into buildings often causes immediate harms, such as drowning deaths, injuries sustained while seeking shelter or fleeing, and hypothermia after exposure to cold waters with no shelter or heat.

But long after news trucks leave and public attention moves on, flooding continues to affect communities in visible and less visible ways. Among the less visible threats is a higher risk of respiratory health problems like asthma and allergic reactions. Fortunately, you can take steps to minimize or avoid flooding, or to reduce respiratory health risks after flooding occurs.

How does flooding trigger respiratory health issues?

Flooding may bring water contaminated with toxic chemicals, heavy metals, pesticides, biotoxins, sewage, and water-borne pathogens into buildings. Afterward, some toxic contaminants remain in dried sediments left behind. When disturbed through everyday actions like walking and cleaning, this turns into microscopic airborne dust. Anything in that dried flood sediment — the toxic chemicals, the metals, the biotoxins — is now in the air you breathe into your lungs, potentially affecting your respiratory health.

Buildings needn’t be submerged during flooding to spur respiratory problems. Many homes we studied after Hurricane Ida suffered water intrusion through roofs, windows, and ventilation ducts — and some were more than 100 miles away from coastal regions that bore the brunt of the storm.

The growth of mold can also affect health

Another common hazard is mold, a fungal growth that forms and spreads on damp or decaying organic matter. Indoor mold generally grows due to extensive dampness, and signals a problem with water or moisture. Damp materials inside buildings following a flood create perfect conditions for rapid mold growth.

Mold can be found indoors and outdoors in all climates. It spreads by making tiny spores that float through the air to land in other locations. No indoor space is entirely free from mold spores, but exposure to high concentrations is linked with respiratory complications such as asthma, allergic rhinitis, and sinusitis. Thus, flooding affects respiratory health by increasing the risk of exposure to higher concentrations of mold spores outdoors and indoors.

For example, after Hurricane Katrina in New Orleans in 2005, the average outdoor concentration of mold spores in flooded areas was roughly double that of non-flooded areas, and the highest concentrations of mold spores were measured indoors. A study on the aftermath of Hurricane Katrina and the flooding in the UK in 2007 showed that water damage accelerated mold growth and respiratory allergies.

Children are especially vulnerable to health problems triggered by mold. All respiratory symptoms — including asthma, bronchitis, eye irritation, and cough — occurred more often in homes reporting mold or dampness, according to a study on the respiratory health of young children in 30 Canadian communities. Other research demonstrates that mold contributes to development of asthma in children.

What can you do to protect against the health harms of flooding?

Our research in New Orleans, LA after Hurricane Ida in 2021 identified common factors — both in housing and flooding events — with great impact on respiratory health. Preliminary results suggest two deciding factors in whether substantial indoor mold appeared were the age of a building’s roof and how many precautionary measures people took after flooding from the hurricane. The impact on respiratory health also varied with flood water height, days per week spent at home, and how many precautionary measures were taken after Ida swept through.

Informed by this and other research, we offer the following tips — some to tackle before flooding or heavy rains, and some to take afterward. While you may not be able to entirely prevent flooding from hurricanes or major storms, taking these and other steps can help.

Before seasonal storms, flooding, or heavy rains start: Protect against water intrusion

• Repair the roof, clean gutters, and seal around skylights, vent pipes, and chimneys to prevent leaks. These are some of the most vulnerable components of a building during storms and hurricanes.
• Declutter drains and empty septic tanks.
• Construct barriers and seal cracks in outer walls and around windows, to prevent heavy rain and floodwater from entering.
• Install a sump pump to drain water from the basement, and backflow valves on sewer lines to prevent water from backing up into the home.

After flooding or major rainstorms: Move quickly to reduce dampness and mold growth

The Environmental Protection Agency recommends limiting contact with flood water, which may have electrical hazards and hazardous substances, including raw sewage. Additionally:

• Minimize your stay in flooded regions (particularly after hurricanes) or buildings until they are dry and safe.
• Check building for traces of water intrusion, dampness, and mold growth immediately after flooding.
• Drain floodwater and dispose of remaining sediment.
• Remove affected porous materials. If possible, dry them outdoors under sunlight.
• Increase the ventilation rate by leaving all windows and doors open, or use a large exhaust fan to dry out the building as fast as possible.
• Use dehumidifiers in damp spaces such as basements.
• Upgrade the air filters in your HVAC system to at least MERV 13, or use portable air cleaners with HEPA filters to reduce your exposure to airborne mold spores.

What to do if you spot mold growth

• Wear a well-fitted N95 face mask, gloves, and rubber boots to clean.
• Clean and disinfect anything that has been in contact with water using soap, detergents, and/or antibacterial cleaning products.
• Dispose of moldy materials in sealed heavy-duty plastic bags.

Taking steps like these — before and after a major storm — goes a long way toward protecting your respiratory health.

Read Flooding Brings Deep Trouble in Harvard Medicine magazine to learn more about the health hazards related to floods.

About the Authors

Parham Azimi, PhD, Contributor

Dr. Parham Azimi is a research associate in the department of environmental health at the Harvard T.H. Chan School of Public Health, investigating the indoor environment’s impact on occupant health and wellness and strategies to improve … See Full Bio View all posts by Parham Azimi, PhD

Joseph Allen, DSc, MPH, CIH, Contributor

Dr. Joseph Allen is an associate professor in the department of environmental health at the Harvard T.H. Chan School of Public Health, and the director of Harvard’s Healthy Buildings Program. He is the coauthor of Healthy … See Full Bio View all posts by Joseph Allen, DSc, MPH, CIH

Trees enhance life in a multitude of ways. They combat climate change by reducing greenhouse gases in the atmosphere. They muffle sound pollution and reduce air pollution, drawing in carbon dioxide and releasing oxygen. When rain pours from the skies, trees decrease stormwater runoff, preventing flooding and soil erosion. They also provide valuable habitats to support biodiversity in insects, birds, and other animals, and microorganisms. The list goes on.

Equally important is accumulating evidence that simply spending time around trees and green spaces uplifts our health and mood. Below are a few of the biggest benefits we reap.

Keeping it cool: Trees help prevent heat-related illness

Climate change is causing rising temperatures and more heat waves across the US. These effects are worse for those who live in neighborhoods known as urban heat islands, where asphalt and concrete soak up heat during the day and continue to radiate it at night. Temperatures can reach 7° F hotter than suburban, rural, or simply wealthier and leafier neighborhoods.

Trees and their leafy canopy provide shade that helps to prevent urban heat islands. What does that mean for individuals? It translates to fewer heat-related health illnesses, which strike outdoor workers and younger, older, and medically vulnerable people more often. A study published in The Lancet calculated that increasing tree canopy to 30% coverage in 93 European cities could prevent an estimated four in 10 premature heat-related deaths in adults in those cities.

How trees help children: Better mood, behavior, attention, and more

Spending more time in nature has been linked with better health outcomes like lower blood pressure, better sleep, and improvement in many chronic conditions in adults. These findings are prompting a growing interest in forest therapy, a guided outdoor healing practice that leads to overall improved well-being. But what’s also remarkable are the varied benefits of trees and nature for children.

One study of children 4 to 6 years old found that those who lived close to green space demonstrated less hyperactive behavior and scored more highly on attention and visual memory testing measures compared with children who did not.

Just seeing trees can have mental health benefits. In Michigan, a study of children between the ages of 7 and 9 demonstrated that students who could see trees from their school windows had fewer behavioral problems than those with limited views.

In Finland, researchers modified daycare outdoor playscape environments to mimic the forest undergrowth. These daycares were compared to control standard daycares and nature-oriented daycares where children made daily visits to nearby forests. At the end of 28 days, the children in the daycares with modified forest undergrowth playscapes harbored a healthier microbiome and had improved markers of their immune systems as compared to their counterparts.

How green space helps communities

Having green space in neighborhoods also does a lot to enrich the well-being of communities. A randomized trial in a US city planted and maintained grass and trees in previously vacant lots. Researchers then compared these green spaces to lots that were left alone.

In neighborhoods below the poverty line, there was a reduction in crime for areas with greened lots compared to untouched vacant lots. Meanwhile, residents who lived near lots that were greened reported feeling safer and increased their use of the outside space for relaxing and socializing.

How can you help?

Unfortunately, urban tree canopy cover has been declining over the years. To counter this decline, many towns and nonprofit organizations have programs that provide trees for planting.

A few examples in Massachusetts are Canopy Crew in Cambridge and Speak for the Trees in Boston. (Speak for the Trees also offers helpful information on selecting and caring for trees). Neighborhood Forest provides trees for schools and other youth organizations across the US. Look for a program near you!

Planting trees native to your region will better suit the local conditions, wildlife, and ecosystem. Contact your regional Native Plant Society for more information and guidance. If you are worried about seasonal allergies from tree pollen, many tree organizations or certified arborists can give you guidance on the best native tree selections.

If planting trees is not for you but you are interested in contributing to the mission, consider donating to organizations that support reforestation, like The Canopy Project and the Arbor Day Foundation.

About the Author

Wynne Armand, MD, Contributor

Dr. Wynne Armand is a physician at Massachusetts General Hospital (MGH), where she provides primary care; an assistant professor in medicine at Harvard Medical School; and associate director of the MGH Center for the Environment and … See Full Bio View all posts by Wynne Armand, MD

Cancer treatment can involve difficult tradeoffs, and that's also true of the testosterone-blocking drugs used in treating prostate cancer. These drugs work in two different ways. Androgen deprivation therapies (ADT) shut down the body's production of testosterone, a hormone that fuels prostate cancer growth. A newer class of drugs called androgen-receptor signaling inhibitors (ARSIs) block testosterone by deflecting the hormone from its cell receptor.

ADT can slow or control prostate cancer, and mounting evidence shows that adding ARSIs also improves survival when the disease is in advanced stages. This treatment combination is called intensified ADT. Researchers are now testing intensified ADT for some men with early-stage prostate cancer as well.

However, all drugs that block testosterone have challenging side effects, including metabolic changes that can compromise cardiovascular health. In June, British researchers reported that cardiovascular risks worsen when ADT and ARSIs are given together. The authors concluded that men who get intensified ADT should be counseled about the risks, and monitored for signs of heart disease before and after the treatment begins.

Study goals and results

The findings were derived from a systematic review of 24 clinical trials that assessed ADT and ARSI treatment for prostate cancer. Published between 2012 and 2024, the trials enrolled a combined total of 22,166 men ages 63 to 77. Their diagnoses ranged across the prostate cancer spectrum, from nonmetastatic cancer with aggressive features to metastatic prostate cancer that no longer responded to ADT by itself.

The goal of the systematic review was to compare ADT and intensified ADT with respect to cardiac events, including hypertension, cardiac arrhythmias (abnormal heartbeats), blood clots, or — in the worst case — heart attack or stroke.

Results showed that adding an ARSI to ADT approximately doubles the risk of a cardiac event across all prostate cancer states. Risks for severe "grade 3" events that can require hospitalization ranged between 7.8% and 15.6%. Notably, giving two ARSIs — abiraterone acetate and enzalutamide — led to a roughly fourfold increase in cardiac risk. Mounting evidence shows that combining abiraterone acetate and enzalutamide worsens side effects without improving prostate cancer survival. The use of that combination is now broadly discouraged by expert groups around the world.

The authors emphasize that intensified therapy is riskier for men with pre-existing cardiac conditions than it is for healthier men. In an accompanying editorial, Dr. Katelyn Atkins, a radiation oncologist at Cedars-Sinai Medical Center in Los Angeles, noted that cardiovascular disease is the second leading cause of death among men with prostate cancer.

Candidates for traditional or intensified ADT, Dr. Atkins wrote, should be assessed for atherosclerosis, fatty plaques in coronary arteries that can accumulate asymptomatically. Fortunately, cardiac risk factors are treatable by lowering blood pressure, eating a heart-healthy diet, exercising, and in some cases using a cholesterol-lowering drug called a statin.

Experts comment

"More and more research shows that intensive therapy prolongs survival, and may in some men even evoke a cure," said Dr. David Crawford, head of urologic oncology at the University of Colorado Anschutz Medical Campus who was not involved in the study. "We have learned time and again from the treatment of many cancers that it is not one drug followed by another and another that results in the best outcomes. Rather, it is combining drugs more effectively to treat the cancer.

"Still, we need to tackle the challenges of prostate cancer treatment and focus on preventing cardiovascular events and other side effects of ADT. As clinicians and in clinical studies, we have seen that men who maintain their weight, exercise, expand muscle mass, and maintain normal lipids and blood pressure do much better than men who gain weight and have a lot of cardiovascular risk factors."

"This important study re-emphasizes the necessity to keep a patient’s cardiovascular history front and center when treatment choices are made, " said Dr. Marc Garnick, the Gorman Brothers Professor of Medicine at Harvard Medical School and Beth Israel Deaconess Medical Center, and editor-in-chief of the Harvard Medical School Guide to Prostate Diseases.

"Intensification of treatment — that is, adding several drugs earlier and earlier in prostate cancer management — is to be both encouraged and cautioned. The caution is for physicians to consider and discuss pre-existing risk factors and how to modify them when deciding upon treatment programs. The ARSI class of drugs have greatly improved outcomes. The goal is to maximize the best outcomes while minimizing the side effects."

About the Author

Charlie Schmidt, Editor, Harvard Medical School Annual Report on Prostate Diseases

Charlie Schmidt is an award-winning freelance science writer based in Portland, Maine. In addition to writing for Harvard Health Publishing, Charlie has written for Science magazine, the Journal of the National Cancer Institute, Environmental Health Perspectives, … See Full Bio View all posts by Charlie Schmidt

About the Reviewer

Marc B. Garnick, MD, Editor in Chief, Harvard Medical School Annual Report on Prostate Diseases; Editorial Advisory Board Member, Harvard Health Publishing

Dr. Marc B. Garnick is an internationally renowned expert in medical oncology and urologic cancer. A clinical professor of medicine at Harvard Medical School, he also maintains an active clinical practice at Beth Israel Deaconess Medical … See Full Bio View all posts by Marc B. Garnick, MD

Dementia usually develops in people ages 65 years and older. So-called young-onset dementia, occurring in those younger than age 65, is uncommon. Now, a new study published in December 2023 in JAMA Neurology has identified 15 factors linked to a higher risk of young-onset dementia.

Let’s see what they found, and — most importantly — what you can do to reduce your own risks.

Are early dementia and young-onset dementia the same?

No. Experts think of early dementia as the first stage in dementia. Mild cognitive impairment and mild dementia are forms of early dementia. So, someone age 50, 65, or 88 could have early dementia.

Young-onset dementia refers to the age at which dementia is diagnosed. A person has young-onset dementia if symptoms and diagnosis occur before age 65.

What has previous research shown?

A previous study of men in Sweden identified some risk factors for young-onset dementia, including high blood pressure, stroke, depression, alcohol use disorder, vitamin D deficiency, drug use disorder, and overall cognitive function.

What to know about the new study

In the new study, a research team in the Netherlands and the United Kingdom looked at data from the UK Biobank. The biobank follows about half a million individuals in the United Kingdom who were 37 to 73 years old when they first joined the project between 2006 and 2010. Most participants identified as white (89%), and the remaining 11% were described only as “other.” Slightly more than half of the participants (54%) were women.

The researchers excluded anyone age 65 or older and people who already had dementia at the start of the study, leaving 356,052 participants for the analyses. Over roughly a decade, 485 participants developed young-onset dementia. The researchers compared participants who did and did not develop young-onset dementia to identify possible risk factors.

What did the researchers learn about risks for young-onset dementia?

In reviewing the results, I think it is helpful to group the risk factors into several categories, and then to examine each of them. These risks may act on the brain directly or indirectly.

Eight factors that we know or strongly suspect cause dementia:

• Genes: Carrying two apolipoprotein E (APOE) ε4 alleles is a major genetic risk factor for Alzheimer’s disease. The risk is thought to be caused by the APOE ε4 protein not clearing amyloid efficiently from the brain. This allows amyloid to accumulate and cause plaques, which starts the cascade to cell death and Alzheimer’s disease.
• Being diagnosed with alcohol use disorder (AUD) has been associated with damage to several parts of the brain, including the frontal lobes, which leads to trouble with executive function and working memory. When combined with poor nutrition, AUD also harms small regions connected to the hippocampus that are critical for forming new memories.
• Being socially isolated is a major risk factor for dementia. Although the exact mechanism is unknown, it may be because our brains evolved, in large part, for social interactions. Individuals with fewer social contacts have fewer social interactions, and simply don’t use their brains enough to keep them healthy.
• Not getting enough vitamin D can lead to more viral infections. A number of studies suggest that certain viral infections increase your risk of dementia.
• Not hearing well increases your risk for dementia, as I discussed in a prior post. This is likely because of reduced brain stimulation and reduced social interactions. Using hearing aids lessens that risk.
• Previously having had a stroke is a risk factor because strokes damage the brain directly, which can lead to vascular dementia.
• Having heart disease is a major risk factor for strokes, which can then lead to vascular dementia.
• Having diabetes if you’re a man can lead to dementia in many different ways. Why only if you’re a man? The researchers suggest that it is because middle-aged men are more likely to have a diabetes-related ministrokes than middle-aged women, which can, again, lead to vascular dementia.

Two factors that reduce cognitive reserve

Cognitive reserve can be described as our capacity to think, improvise, and problem-solve even as our brains change with age. These two risk factors make it more likely that dementia symptoms will show up at a younger age.

• Having less formal education may affect your familiarity with the items on the pencil-and-paper cognitive tests that are used to diagnose dementia.
• Having lower socioeconomic status may be related to lower-quality education.

Is every factor identified in the study a clear risk?

No, and here’s why not: Sometimes research turns up apparent risk factors that might be due to reverse causation. It’s possible, for example, that symptoms of impending dementia appear to be risk factors because they become noticeable before obvious dementia is diagnosed.

• Lower handgrip strength is a sign of frailty, which is often associated with dementia.
• No alcohol use is a risk factor because people may stop drinking when they develop memory loss (also known as the “healthy drinker effect” in dementia).
• Depression is a risk factor because many people get sad when they have trouble remembering or when they are worried about having dementia.

Lastly, there are risk factors that could be either a contributing cause or a result of the impending dementia.

• High C-reactive protein is a sign of inflammation.
• Orthostatic hypotension is an abnormal drop in blood pressure when a person stands up after lying down or sitting. While this condition can lead to brain damage and dementia, it can also be a result of some types of dementia, such as Parkinson’s disease dementia and dementia with Lewy bodies.

What can you do to prevent young-onset dementia?

Taking these five steps can reduce your risk for developing dementia before age 65:

• Don’t drink alcohol in excess.
• Seek opportunities to socialize with others regularly.
• Make sure that you’re getting enough vitamin D. You can make your own vitamin D if your skin (without sunblock) is exposed to sunlight. But in northern climates you might need to take a supplement, especially in the winter. Because vitamin D can interact with other medications, ask your doctor about this option.
• Make sure you are hearing well and use hearing aids if you are not.
• Exercise regularly, eat a healthy diet, maintain a healthy body weight, and work with your doctor to reduce your risk of strokes, heart disease, and diabetes.

About the Author

Andrew E. Budson, MD, Contributor; Editorial Advisory Board Member, Harvard Health Publishing

Dr. Andrew E. Budson is chief of cognitive & behavioral neurology at the Veterans Affairs Boston Healthcare System, lecturer in neurology at Harvard Medical School, and chair of the Science of Learning Innovation Group at the … See Full Bio View all posts by Andrew E. Budson, MD

All of us have an internal clock that regulates our circadian rhythms, including when we sleep and when we are awake. And light is the single most important factor that helps establish when we should feel wakeful (generally during the day) and when we should feel sleepy (typically at night).

So, let me ask you a personal question: just how dark is your bedroom? To find out why that matters — and whether sleeping in an eye mask is worthwhile — read on.

How is light related to sleep?

Our circadian system evolved well before the advent of artificial light. As anyone who has been to Times Square can confirm, just a few watts of power can trick the brain into believing that it is daytime at any time of night. So, what’s keeping your bedroom alight?

• A tablet used in bed at night to watch a movie is more than 100 times brighter than being outside when there is a full moon.
• Working on or watching a computer screen at night is about 10 times brighter than standing in a well-lit parking lot.

Light exposure at night affects the natural processes that help prepare the body for sleep. Specifically, your pineal gland produces melatonin in response to darkness. This hormone is integral for the circadian regulation of sleep.

What happens when we are exposed to light at night?

Being exposed to light at night suppresses melatonin production, changing our sleep patterns. Compared to sleeping without a night light, adults who slept next to a night light had shallower sleep and more frequent arousals. Even outdoor artificial light at night, such as street lamps, has been linked with getting less sleep.

But the impact of light at night is not limited to just sleep. It’s also associated with increased risk of developing depressive symptoms, obesity, diabetes, and high blood pressure. Light exposure misaligned with our circadian rhythms — that is, dark during the day and light at night — is one reason scientists believe that shift work puts people at higher risk for serious health problems.

Could sleeping with an eye mask help?

Researchers from Cardiff University in the United Kingdom conducted a series of experiments to see if wearing an eye mask while sleeping at night could improve certain measures of learning and alertness.

Roughly 90 healthy young adults, 18 to 35 years of age, alternated between sleeping while wearing an eye mask or being exposed to light at night. They recorded their sleep patterns in a sleep diary.

In the first part of the study, participants wore an intact eye mask for a week. Then during the next week, they wore an eye mask with a hole exposing each eye so that the mask didn't block the light.

After sleeping with no light exposure (wearing the intact eye mask) and with minimal light exposure (the eye mask with the holes), participants completed three cognitive tasks on days six and seven of each week:

• First was a paired-associate learning task. This helps show how effectively a person can learn new associations. Here the task was learning related word pairs. Participants performed better after wearing an intact eye mask during sleep in the days leading up to the test than after being exposed to light at night.
• Second, the researchers administered a psychomotor vigilance test, which assesses alertness. Blocking light at night also improved reaction times on this task.
• Finally, a motor skill learning test was given, which involved tapping a five-digit sequence in the correct order. For this task, there was no difference in performance whether participants had worn an intact eye mask or been exposed to light at night.

What else did the researchers learn?

No research study is ever perfect, so it is important to take the conclusions above with a grain of salt.

According to sleep diary data, there was no difference in the amount of sleep, nor in their perceptions of sleep quality, regardless of whether people wore an eye mask or not.

Further, in a second experiment with about 30 participants, the researchers tracked sleep objectively using a monitoring device called the Dreem headband. They found no changes to the structure of sleep — for example, how much time participants spent in REM sleep — when wearing an eye mask.

Should I rush out to buy an eye mask before an important meeting or exam?

If you decide to try using an eye mask, you probably don’t need to pay extra for overnight shipping. Instead, follow a chronobiologist’s rule of thumb: “bright days, dark nights.”

• During the daytime, get as much natural daylight as you possibly can: go out to pick up your morning bagel from a local bakery, take a short walk during your afternoon lull at work.
• In the evening, reduce your exposure to electronic devices such as your cell phone, and use the night-dimming modes on these devices. Make sure that you turn off all unnecessary lights. Finally, try to make your bedroom as dark as possible when you go to bed. This could mean turning the alarm clock next to your bed away from you or covering up the light on a humidifier.

Of course, you might decide a well-fitted, comfortable eye mask is a useful addition to your light hygiene toolkit. Most cost $10 to $20, so you may find yourself snoozing better and improving cognitive performance for the price of a few cups of coffee.

About the Author

Eric Zhou, PhD, Contributor

Eric Zhou, PhD, is an assistant professor at Harvard Medical School. His research focuses on how we can better understand and treat sleep disorders in both pediatric and adult populations, including those with chronic illnesses. Dr. … See Full Bio View all posts by Eric Zhou, PhD