YSPH research advances: Alcohol use drugs underutilized, air pollution linked to health concerns

The majority of mental health treatment facilities in the United States don’t offer medications for alcohol use disorder (MAUD) despite their proven effectiveness and the large number of people who struggle with both mental illness and alcohol misuse. For patients with these co-occurring disorders, research has shown that remission from both conditions is more likely if each condition is treated.

This significant gap in care is reported in a new national study led by researchers at the Yale School of Public Health (YSPH). The researchers looked at the care provided by more than 6,500 mental health treatment facilities across the U.S. and found that while 74% offered some form of substance use treatment, only 10% provided MAUD. Even among clinics that primarily treated both mental health and substance use, fewer than half (41.5%) provide access to the medications.

“Medications for alcohol use disorder are one of the most evidence-based treatments we have, but they remain drastically underused,” said Dr. Susan Busch, PhD, the paper’s first author and the Susan Dwight Bliss Professor of Public Health at YSPH. “These results suggest a missed opportunity to improve outcomes for people with co-occurring mental health and alcohol use disorders.”

The study identified multiple reasons for the treatment discrepancies. Some facilities may lack a prescribing clinician on site due to the cost or workforce shortages, the researchers said. Although the study found that while prescriptions for MAUD were more likely in facilities that had prescribing clinicians on site, availability of the medications remained low. Limited training among physicians also appeared to be a factor along with institutional environment, the researchers said. The study also identified concerns among addiction specialists about the efficacy of MAUD, adverse side effects, and costs of the drugs.

The researchers emphasized the importance of integrated care and the need for expanded training opportunities, given the prevalence of these co-occurring disorders nationwide. Among adults with mental illness in the U.S., 18.9% or 11 million have co-occurring alcohol use disorder. Yet only 8% of these individuals receive treatment, the researchers said, and less than 2% receive MAUD.

Authors: Susan H. Busch, PhD, David A. Fiellin, MD, Kaede Iida, BA, BS, Kim Gannon, PhD, Melissa B. Weimer, DO, MCR, and Jason Hockenberry, PhD.

Study: Alcohol Use Disorder Treatment Availability at Mental Health Treatment Facilities

Journal: Jama Network Open, published online on July 14, 2025. A related commentary, Improving Access to Medications for Alcohol Use Disorder in Mental Health Treatment, also appears in the journal.

• Arya Desai

Long-term exposure to surface-level ozone significantly increases respiratory mortality in the U.S., including deaths from COVID-19, according to a new study co-authored by Dr. Xi Chen, PhD, an associate professor of public health (health policy) at Yale School of Public Health and an affiliated faculty member with the Yale Center on Climate Change and Health.

Working in tandem with Assistant Professor Ziheng Liu of Zhejiang University and Assistant Professor Qinan Lu of Renmin University of China, Chen and his colleagues were able to show that a 10% reduction in ozone over five years could prevent more than 11,000 deaths annually. The researchers employed a novel instrumental variable statistical analysis based on ozone transmission from upwind counties to estimate the causal effects of long-term ozone exposure. The researchers said the findings underscore the urgent need for stronger ozone regulation and greater public awareness of this invisible yet dangerous air pollutant.

Authors: Ziheng Liu, PhD, Xi Chen, PhD, Qinan Lu, PhD.

Study: Blowin’ in the wind of an invisible killer: Long-term exposure to ozone and respiratory mortality in the USA

Journal: Journal of Population Economics, published on June 11, 2025

• Alix Rachman

A new study co-authored by Yale School of Public Health’s Dr. Xi Chen, PhD, presents some of the first causal evidence that exposure to fine particulate matter (PM2.5) air pollution significantly increases the risk of suicidal ideation among school-age children.

Chen, an associate professor of public health (health policy), and colleagues from several research institutions in China, analyzed data from 55,000 students across 273 schools in China, matching their survey responses on mental health and risk behaviors with real-time air pollution and weather data tied to each school's location and date. To identify the true impact of air quality, the study used changes in local wind direction to isolate pollution exposure from other factors—a method that helped to ensure the results reflected a causal link, not just a correlation.

The key finding: a 1% drop in daily PM2.5 levels was associated with a 0.36% decrease in the likelihood of suicidal ideation. The effect was especially pronounced for younger boys, students with poor academic performance, and those from less-educated families.

Authors: Xin Zhang, PhD, Xi Chen, PhD, Hong Sun, PhD, Yuanjian Yang, PhD.

Study: Blowin’ in the wind: Smog and suicidal ideation among school-age children

Journal: China Economic Review, published online on June 11, 2025