Knowing which vaccines older adults should get and hearing a clear recommendation from their health care provider about why a particular vaccine is important strongly motivated them to get vaccinated. That’s a key finding in a recent study I co-authored in the journal Open Forum Infectious Diseases.
Adults over 65 have a higher risk of severe infections, but they receive routine vaccinations at lower rates than do other groups. My colleagues and I collaborated with six primary care clinics across the U.S. to test two approaches for increasing vaccination rates for older adults.
In all, 249 patients who were visiting their primary care providers participated in the study. Of these, 116 patients received a two-page vaccine discussion guide to read in the waiting room before their visit. Another 133 patients received invitations to attend a one-hour education session after their visit.
The guide, which we created for the study, was designed to help people start a conversation about vaccines with their providers. It included checkboxes for marking what made it hard for them to get vaccinated and which vaccines they want to know more about, as well as space to write down any questions they have. The guide also featured a chart listing recommended vaccines for older adults, with boxes where people could check off ones they had already received.
In the sessions, providers shared in-depth information about vaccines and vaccine-preventable diseases and facilitated a discussion to address vaccine hesitancy.
In a follow-up survey two months later, patients reported that the most significant barriers they faced were knowing when they should receive a particular vaccine, having concerns about side effects and securing transportation to a vaccination appointment.
The percentage of patients who said they wanted to get a vaccine increased from 68% to 79% after using the vaccine guide. Following each intervention, 80% of patients reported they discussed vaccines more in that visit than they had in prior visits.
Of the 14 health care providers who completed the follow-up survey, 57% reported increased vaccination rates following each approach. Half of the providers felt that the use of the vaccine guide was an effective strategy in guiding conversations with their patients.
A pamphlet at the doctor’s office can empower older patients to ask about vaccines.
My research shows that strategies that equip older adults with personalized information about vaccines empower them to start the conversation about vaccines with their clinicians and enable them to be active participants in their health care.
What’s next
In the future, we will explore whether engaging patients on this topic earlier is even more helpful than doing so in the waiting room before their visit.
My research team plans to conduct a pilot study that tests this approach. We hope to learn whether reaching out to these patients before their clinic visits and helping them think through their vaccination status, which vaccines their provider recommends and what barriers they face in getting vaccinated will improve vaccination rates for this population.
The Research Brief is a short take on interesting academic work.
Throughout history, when pioneers set out across uncharted territory to settle in distant lands, they carried with them only the essentials: tools, seeds and clothing. Anything else would have to come from their new environment.
So they built shelter from local timber, rocks and sod; foraged for food and cultivated the soil beneath their feet; and fabricated tools from whatever they could scrounge up. It was difficult, but ultimately the successful ones made everything they needed to survive.
Something similar will take place when humanity leaves Earth for destinations such as the Moon and Mars – although astronauts will face even greater challenges than, for example, the Vikings did when they reached Greenland and Newfoundland. Not only will the astronauts have limited supplies and the need to live off the land; they won’t even be able to breathe the air.
Instead of axes and plows, however, today’s space pioneers will bring 3D printers. As an engineer and professor who is developing technologies to extend the human presence beyond Earth, I focus my work and research on these remarkable machines.
3D printers will make the tools, structures and habitats space pioneers need to survive in a hostile alien environment. They will enable long-term human presence on the Moon and Mars.
NASA astronaut Barry Wilmore holds a 3D-printed wrench made aboard the International Space Station. NASA
From hammers to habitats
On Earth, 3D printing can fabricate, layer by layer, thousands of things, from replacement hips to hammers to homes. These devices take raw materials, such as plastic, concrete or metal, and deposit it on a computerized programmed path to build a part. It’s often called “additive manufacturing,” because you keep adding material to make the part, rather than removing material, as is done in conventional machining.
For now, the print materials are mostly hauled up from Earth. But NASA has also begun recycling some of those materials, such as waste plastic, to make new parts with the Refabricator, an advanced 3D printer installed in 2019.
Manufacturing in space
You may be wondering why space explorers can’t simply bring everything they need with them. After all, that’s how the International Space Station was built decades ago – by hauling tons of prefabricated components from Earth.
But that’s impractical for building habitats on other worlds. Launching materials into space is incredibly expensive. Right now, every pound launched aboard a rocket just to get to low Earth orbit costs thousands of dollars. To get materials to the Moon, NASA estimates the initial cost at around US$500,000 per pound.
Still, manufacturing things in space is a challenge. In the microgravity of space, or the reduced gravity of the Moon or Mars, materials behave differently than they do on Earth. Decrease or remove gravity, and materials cool and recrystallize differently. The Moon has one-sixth the gravity of Earth; Mars, about two-fifths. Engineers and scientists are working now to adapt 3D printers to function in these conditions.
On alien worlds, rather than plastic or metal, 3D printers will use the natural resources found in these environments. But finding the right raw materials is not easy. Habitats on the Moon and Mars must protect astronauts from the lack of air, extreme temperatures, micrometeorite impacts and radiation.
Regolith, the fine, dusty, sandlike particles that cover both the lunar and Martian surfaces, could be a primary ingredient to make these dwellings. Think of the regolith on both worlds as alien dirt – unlike Earth soil, it contains few nutrients, and as far as we know, no living organisms. But it might be a good raw material for 3D printing.
My colleagues began researching this possibility by first examining how regular cement behaves in space. I am now joining them to develop techniques for turning regolith into a printable material and to eventually test these on the Moon.
But obtaining otherworldly regolith is a problem. The regolith samples returned from the Moon during the Apollo missions in the 1960s and 70s are precious, difficult if not impossible to access for research purposes. So scientists are using regolith simulants to test ideas. Actual regolith may react quite differently than our simulants. We just don’t know.
What’s more, the regolith on the Moon is very different from what’s found on Mars. Martian regolith contains iron oxide –that’s what gives it a reddish color – but Moon regolith is mostly silicates; it’s much finer and more angular. Researchers will need to learn how to use both types in a 3D printer.
See models of otherworldly habitats.
Applications on Earth
NASA’s Moon-to-Mars Planetary Autonomous Construction Technology program, also known as MMPACT, is advancing the technology needed to print these habitats on alien worlds.
Among the approaches scientists are now exploring: a regolith-based concrete made in part from surface ice; melting the regolith at high temperatures, and then using molds to form it while it’s a liquid; and sintering, which means heating the regolith with concentrated sunlight, lasers or microwaves to fuse particles together without the need for binders.
Along those lines, my colleagues and I developed a Martian concrete we call MarsCrete, a material we used to 3D-print a small test structure for NASA in 2017.
Then, in May 2019, using another type of special concrete, we 3D-printed a one-third scale prototype Mars habitat that could support everything astronauts would need for long-term survival, including living, sleeping, research and food-production modules.
That prototype showcased the potential, and the challenges, of building housing on the red planet. But many of these technologies will benefit people on Earth too.
In the same way astronauts will make sustainable products from natural resources, homebuilders could make concretes from binders and aggregates found locally, and maybe even from recycled construction debris. Engineers are already adapting the techniques that could print Martian habitats to address housing shortages here at home. Indeed, 3D-printed homes are already on the market.
Meanwhile, the move continues toward establishing a human presence outside the Earth. Artemis III, now scheduled for liftoff in 2027, will be the first human Moon landing since 1972. A NASA trip to Mars could happen as early as 2035.
But wherever people go, and whenever they get there, I’m certain that 3D printers will be one of the primary tools to let human beings live off alien land.
Sven Bilén, Professor of Engineering Design, Electrical Engineering and Aerospace Engineering, Penn State
Before they go too far trying to run the government like a business, Trump and his advisors may want to consider the very different example of the nation’s first chief executive while he was in office.
Elon Musk, left, and Donald Trump have undertaken an effort both describe as seeking to run government more like a business. Andrew Harnik/Getty Images
Above all, Washington was a farmer. On his Mount Vernon estate, in northern Virginia, he grew tobacco and wheat and operated a gristmill. After his second term as president, he built a profitable distillery. At the time of his death, he owned nearly 8,000 acres of productive farm and woodland, almost four times his original inheritance.
Much of Washington’s wealth was based on slave labor. In his will, he freed 123 of the 300 enslaved African Americans who had made his successful business possible, but while he lived, he expected his workers to do as he said.
President Washington and Congress
If Washington the businessman and plantation owner was accustomed to being obeyed, he knew that being president was another matter.
In early 1790, near the end of his first year in office, he reflected on the difference in a letter to the English historian Catharine Macaulay. Macaulay had visited Mount Vernon several years before. She was eager to hear the president’s thoughts about what, in his reply, he described as “the last great experiment for promoting human happiness by reasonable compact.”
As head of the executive branch, his own powers were limited. In the months since the inauguration, he had learned that “much was to be done by prudence, much by conciliation, much by firmness. Few, who are not philosophical Spectators,” he told his friend, “can realise the difficult and delicate part which a man in my situation (has) to act.”
Although Washington did not say why his situation was delicate, he didn’t need to. Congress, as everyone knew, was the most powerful branch of government, not the president.
The previous spring, Congress had shown just how powerful it was when it debated whether the president, who needed Senate confirmation to appoint heads of executive departments, could remove such officers without the same body’s approval. In the so-called Decision of 1789, Congress determined that the president did have that power, but only after Vice President John Adams broke the deadlock in the upper house.
The meaning of Congress’ vote was clear. On matters where the Constitution is ambiguous, Congress would decide what powers the president can legally exercise and what powers he – or, someday, she – cannot.
When it created a “sinking fund” in 1790 to manage the national debt, Congress showed just how far it could constrain presidential power.
Although the fund was part of the Treasury Department, whose secretary served at the president’s pleasure, the commission that oversaw it served for fixed terms set by Congress. The president could neither remove them nor tell them what to do.
Inefficient efficiency
William Humphrey, a member of the Federal Trade Commission, was unconstitutionally fired by Franklin Roosevelt in 1933. Library of Congress
By limiting Washington’s power over the Sinking Fund Commission, Congress set a precedent that still holds, notably in the 1935 Supreme Court case of Humphrey’s Executor v. U.S.
To the displeasure of those, including Trump, who promote the novel “unitary executive” theory of an all-powerful president, the court ruled that President Franklin D. Roosevelt could not dismiss a member of the Federal Trade Commission before his term was up – even if, as Roosevelt said, his administration’s goals would be “carried out most effectively with personnel of my own selection.”
Like the businessman who currently occupies the White House, Washington did not always like having to share power with Congress. Its members were headstrong and independent-minded. They rarely did what they were told.
But he realized working with Congress was the only way to create a federal government that really was efficient, with each branch carrying out its defined powers, as the founders intended. Because of the Constitution’s checks and balances, the United States was – and is – a government based on compromise between the three branches. No one, not even the president, is exempt.
To his credit, Washington was quick to learn that lesson.
The U.S. educational landscape has been drastically transformed since the COVID-19 pandemic shuttered school campuses five years ago.
Access to high-quality teachers and curriculum developed by teachers is shrinking, for example. Likewise, there has been a loss of emotional support for students and a decline in the school use of technology and social media.
Schools have tried to adapt by expanding class sizes and hiring substitute teachers. They have also increased use of video conferencing to Zoom teachers into classrooms.
When teachers leave, often in the middle of the school year, it can require their colleagues to step in and cover extra classes. This means teachers who stay are overworked and possibly not teaching in their area of certification.
This, in turn, leads to burnout. It also increases the likelihood that students will not have highly qualified teachers in some hard-to-fill positions like physical science and English.
2. Increase in scripted curriculum
As of fall 2024, 40 states and Washington had passed science of reading laws, which mandate evidence-based reading instruction rooted in phonics and other foundational skills.
While the laws don’t necessarily lead to scripted curriculum, most states have chosen to mandate reading programs that require teachers to adhere to strict pacing. They also instruct teachers not to deviate from the teachers’ manual.
Many of these reading programs came under scrutiny by curricular evaluators from New York University in 2022. They found the most common elementary reading programs were culturally destructive or culturally insufficient – meaning they reinforce stereotypes and portray people of color in inferior and destructive ways that reinforce stereotypes.
This leaves teachers to try to navigate the mandated curriculum alongside the needs of their students, many of whom are culturally and linguistically diverse. They either have to ignore the mandated script or ignore their students. Neither method allows teachers to be effective.
This form of de-professionalization is a leading cause of teacher shortages. Teachers are most effective, research shows, when they feel a sense of agency, something that is undermined by scripted teaching.
3. Improvements in teen mental health, but there’s more to do
Many of the narratives surrounding adolescent mental health, particularly since the pandemic, paint a doomscape of mindless social media use and isolation.
4. Crackdown on students’ technology use in schools
COVID-19 prompted schools to make an abrupt switch to educational technology, and many schools have kept many of these policies in place.
For example, Google Classroom and other learning management systems are commonly used in many schools, particularly in middle school and high school.
These platforms can help parents engage with their children’s coursework. That facilitates conversations and parental awareness.
But this reliance on screens has also come under fire for privacy issues – the sharing of personal information and sensitive photos – and increasing screen time.
And with academia’s use of technology on the rise, cellphone usage has also increased among U.S. teens, garnering support for school cellphone bans.
A student attends an online class at the Crenshaw Family YMCA on Feb. 17, 2021, in Los Angeles during the COVID-19 pandemic. Patrick T. Fallon/AFP via Getty Images
But banning these devices in schools may not help teens, as smartphone use is nearly universal in the U.S. Teens need support from educators to support them as they learn to navigate the complex digital world safely, efficiently and with balance.
In light of data surrounding adolescent mental health and online isolation – and the potential for connection through digital spaces – it’s also important that teens are aware of positive support networks that are available online.
Though these spaces can provide social supports, it is important for teens to understand the strengths and limitations of technology and receive authentic guidance from adults that a technology ban may prohibit.
5. Students and adults need social emotional support
Students returned to in-person schooling with a mix of skill levels and with a variety of social and emotional needs.
Social and emotional learning includes self-awareness, self-management, social awareness, relational skills and decision-making.
These skills are vital for academic success and social relationships.
While some of this social and emotional teaching came under fire from lawmakers and parents, this was due to confusion about what it actually entailed. These skills do not constitute a set of values or beliefs that parents may not agree with. Rather, they allow students to self-regulate and navigate social situations by explicitly teaching students about feelings and behaviors.
A teacher provides instruction to a student at Freedom Preparatory Academy on Feb. 10, 2021, in Provo, Utah. George Frey/Getty Images
One area where students may need support is with cognitive flexibility, or the ability to adapt to current situations and keep an open mind. Classroom instruction that engages students in varied tasks and authentic teaching strategies rooted in real-life scenarios can strengthen this ability in students.
Besides allowing students to be engaged members of a school community, cognitive flexibility is important because it supports the skill development that is part of many state English language arts and social studies standards.
Due to vague or confusing state policies, many schools have stopped teaching social and emotional learning skills, or minimized their use.
This, coupled with teacher stress and burnout, means that both adults and children in schools are often not getting their social and emotional needs met.
Message of mistrust
While we described five shifts since the start of the pandemic, the overall trend in K-12 schools is one of mistrust.
We feel that the message – from districts, state legislators and parents – is that teachers cannot be trusted to make choices.
We believe in teacher autonomy and professionalism, and we hope this list can help Americans reflect on the direction of the past five years. If society wants a different outcome in the next five years, it starts with trust.
