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By Ella Seo Introduction In an increasingly digital world, the mental health of adolescents can be reflected in their interactions on social networking sites (SNS). As adolescence represents a pivotal transitional period characterized by changing dynamics in social relationships, the transferal of in-person connections to online spheres in response to the COVID-19 pandemic has been a significant development in teen mental mental health.  While excessive social media use during the lockdowns led to an increase in cyberbullying (highlighted in Canada’s updated criminal code) and eating disorders (explored through mukbang , or ‘escapist eating’ in South Korea), the types of SNS interactions adolescents engage in—comparative social media use and more passive, autonomous enjoyment—are critical to identifying its positive and negative effects of social media on adolescent health. To examine the impact of social media usage on teen mental health during the pandemic , this study utilizes a comparative analysis of surveillance and harm within social media consumption in South Korea and Canada. For South Korean and Canadian adolescents, the distinction between active and passive social media use and the degree of online autonomy can define the level of harm to mental stability, emphasizing the importance of autonomous social media consumption in ‘safe digital spaces.’ In December 2019, an outbreak of pneumonia of an unknown origin was reported in Wuhan, Hubei Province, China (Ciotti et al., 2021). The World Health Organization   declared a pandemic on March 12, 2020, due to the airborne nature of SARS-CoV-2, its high level of worldwide transmission, and the thousands of deaths brought on by the coronavirus disease (COVID-19). Measures enacted during the COVID-19 pandemic included closing public recreation sites, shutting down schools and universities, implementing quarantine policies, and strictly enforcing "social distancing" to prevent any in-person interactions (Andrews et al., 2020). In addition to physical, economic and social implications, the pervasive psychological impacts of the pandemic remain key sociological factors. In a case study focusing upon youths aged 10 to 19, this article will examine the effects on the restrictions on in-person connectiviness held on adolescent mental health. Adolescent mental health is shaped by the transitional period between late childhood and early adulthood. As adolescence is characterized by an increase in group interactions and social relationships, and a decrease in parental control (Lerner and Steinberg, 2004), the independent connections adolescents form during this time period become highly important. Generation Z, commonly seen as “digital natives,” do not remember a time before the Internet existed (Ilaria et al., 2021), with digital consumption having a high relevance in their lives . Moreover, recent studies show that the brain goes through a remodeling process that facilitates the development of social cognitive skills during this period (Choudhury et al., 2006). In 2020, “social distancing” shifted the methods which teens interacted with, resulting in an explosion of an already-escalating adolescent social media use. Figure 1 (Ortiz-Ospina, 2019) depicts the social media landscape just before the pandemic.  Figure 1.  Number of People Using Social Media From 2004 Until the End of 2019 (2019). Even before COVID-19, mental illnesses were highly prevalent amongst South Korean and Canadian teens.  Hong (2011) observed that in 2011, 35.8% of South Korean adolescents experienced mental health issues, while Gallson (2019) revealed that 18% of Canadian adolescents suffered from a mental illness or substance abuse problem during pre-pandemic. Nevertheless, the COVID-19 pandemic introduced a period of “emotional crisis” (Lee et al., 2021, para. 19), with research finding that increased social media use during the lockdowns correlated with a rise in cyberbullying, eating disorders, and depression and anxiety (Kee, Al-Anesi, and Al-Anesi, 2022; Cooper et al., 2020; Magson et al., 2020). As well, scholars have differentiated between two types of social media engagement: active, comparative use, examples including obsessively counting likes, comparing profiles, and determining personal worth, and passive, autonomous enjoyment, including reviewing pleasing content, and connecting with friends. These separate forms of online consumption have been found to have generated distinct positive and negative impacts on teens. To detail the variation within adolescent mental health before, during, and after the pandemic, this study utilizes a comparative analysis of surveillance and harm within social media consumption in South Korea and Canada. For South Korean and Canadian adolescents, the distinction between active and passive social media use and the degree of online autonomy can define the level of harm to mental stability, emphasizing the importance of autonomous social media consumption in ‘safe digital spaces.’ Body Perception  Body Perception and Social Media Adolescents often face a disconnect between their self-image and actual image—this discrepancy is exacerbated on apps such as Instagram. According to Lupu (2012), society and its cultural offsets define a set criteria that differentiates an “ideal” body from a “not ideal” body (p. 771). Body perception has also been further skewed by social media, which encourages the use of image filters and editing to create unattainable standards.  Moreover, pro-anorexia and pro-bulimia content is common on platforms such as Twitter (although hidden in cryptic hashtags) (Ilaria et al., 2021), and can increase eating disordered behaviors via like-minded communities. Through social media use, the line between surveillance and self-harm amongst teenagers blurs, particularly when triggering existing eating disorders or eating disordered thoughts. However, experiences related to body perceptions can differ between adolescents, depending on their initial mental health state. Body Image in South Korea In South Korea, adolescent body standards are often shaped by media consumption. According to Yassin (2021), 10% of adolescents in Asia have eating disorders, much of which developed from active use of social media platforms, such as the Korean application Kakao. Common Kakao trends, like mukbang, provide voyeuristic entertainment for teens, depicting individuals filming themselves, eating massive quantities of food, creating an experience of "vicarious eating." This "escapist eating" could encourage behaviors such as binge eating, purging, or restricting, developing into eating disorders, which may be triggering content for those with existing symptoms or previous histories with such conditions. Body Perception in Canada Amongst Canadian adolescents, comparative viewing on social networking sites (SNS) can increase negative body perceptions. According to Santarossa and Woodruff (2017), social comparisons on Twitter, Instagram, and Facebook increase body image dissatisfaction; body image construction is linked to social media activities, such as commenting on other profiles or engaging with content. Where the type  of interactions on SNS (comparing profiles, likes, or comments, etc.) can shape their effect on adolescent body images, studies find that interactive social media use can be more harmful than passive use (Santarossa and Woodruff, 2017). Yet, as found by Alberga et al. (2018), prior to the pandemic, fitspiration , or positive, inspirational messages and/or images surrounding health and fitness became popular, as well. This shows that  the type of content that teens consume can be just as important as the kinds of interactions (passive or comparative) that adolescents practice. On SNS, the distinction between obsessive and more passive consumption defined the mental health experiences of Canadian adolescents during lockdowns. Cyberbullying  Cyberbullying and Social Media Cyberbullying is defined as harassment using communication technologies such as electronic mail, smartphones, short message devices, or social media platforms. Chatzakou et al. (2019) find that over half of younger social media users have experienced online harassment at some point. Cyberbullying's autonomous nature, as discussed by Hamm et al. (2015), can intensify its especially detrimental impacts on adolescents. The harmful nature of these attacks can initiate victims’ depression and/or anxiety. By violating safe online spaces, adolescents experiencing cyberbullying during the pandemic may have suffered more extreme consequences due to them being unable to separate their online and offline spheres. Cyberbullying in South Korea In South Korea, cyberbullying narratives often focus on the offline experiences of victims. According to Lee (2016), cyberbullying can be broken down into distinct methods:  “cyber moyok/bibang (insults); cyber myungye-hweson (defamation); cyberstalking ; cyber sungpokryuk (sexting); gaeinjungbo-youchul (personal information drain); cyber gangyo (coercion); and cyber ttadolim (exclusion), cyber gorophim (harassment), or cyber wang-ta ” (p. 151). In South Korea, the most common form of cyberbullying is “cyber sungpokryuk (sexting)” (Lee 2016, 155). Furthermore, Shin and Choi (2021) found that in the country, cyberbullying increased during the COVID-19 pandemic, and the resulting transition of social communication to online spaces. To protect the mental health of adolescent students, teachers should protect the autonomous interactions of students online and keep online spaces ‘safe spaces.’ Cyberbullying in Canada Canada’s Criminal Code, updated in 2021, outlines legal consequences to cyberbullying that violates online spaces. According to Espelage and Hong (2016), the suicides of two teenagers in 2013, Amanda Todd and Rehtaeh Parsons, sparked widespread attention to the public health issue. As both cases were linked to sexual assault and sexual abuse, Canada’s stance against cyberbullying speaks to a decision to separate the overlap between online and in-person harassment. In her Canadian study, Beran et al. (2017), the authors find that cyber-relationships parallel the dynamics of in-school peer interactions. Although Canada’s cyberbullying rates are comparable to the rest of the world (Beran et al., 2017), the criminalization of cyberbullying during the COVID-19 pandemic speaks to the necessity of viewing online interactions as a part of large sociological trends. And with increased anti-cyberbullying campaigns during the lockdowns, Canada acknowledges the intersection between online and offline dimensions during COVID-19.   Global Positive Aspects of Social Media Use  Given the risks associated with adolescent use of digital media, it is critical to examine aspects of SNS that contribute to adolescent mental health. Social media use can serve as humor and entertainment, identity exploration, and creative expression.Social connections are also crucial advantages of SNS; in Clark et al.’s (2018) international survey, 77% of adolescents reported that social media was important for keeping up with friends, and 69% stated that it allowed them to have meaningful conversations with close friends. While acknowledging the harmful associations between body image and SNS (Santarossa and Woodruff, 2017), it is also relevant to note that #ProRecovery hashtags dominate platforms such as Instagram, Twitter, and TikTok. While cyberbullying can exacerbate depression, anxiety, and suicidal tendencies, digital media algorithms can detect signals of mental illness, including depression, post-traumatic stress disorder, and even suicidal thoughts. To global adolescents, social media can be harmful or helpful—the degree of harm involved is dependent on varying ways adolescents engage in content; either from a lens of comparison or the desire to connect. Conclusion According to Uhls, Ellison, and Subrahmanyam (2017), “Identity exploration, or the search for a coherent sense of self, takes place online as well as offline (p. 68).”The adolescent social media landscapes in South Korea and Canada reflect crucial stages of cross-cultural identity formation. While obsessive, unwanted, or comparative behavior on SNS can lead to negative impacts on adolescent mental health, utilizing SNS to engage in meaningful content or social relationships can lead to the construction of positive, ‘safe online spaces’ during the instability of the COVID-19 pandemic. As this study examines the overlap between online and offline spheres through the lens of body image and cyberbullying, future researchers should further explore the intersection between mental illness and recovery on social-networking sites.. Works Cited  Alberga, A. S., Withnell, S.J., & Ranson, K.M. (2018). Fitspiration and thinspiration: a comparison across three social networking sites. Journal of Eating Disorders , 6 (39), 1-10.   https://doi.org/10.1186/s40337-018-0227-x . Andrews, J.L., Foulkes, L., & Blakemore, S.-J. (2020). Peer influence in adolescence: Public health implications for COVID-19. Trends in Cognitive Sciences , 24 (8), 585-587, https://doi.org/10.1016/j.tics.2020.05.001 .  Beran, T., Mishna, F., McInroy, L.B., & Shariff, S. (2017). Children's experiences of cyberbullying: A Canadian national study. Children & Children’s Schools , 37 (4), 207-2014.   https://doi.org/10.1093/cs/cdv024 .   Chatzakou, D., Leontiadis, I., Blackburn, J., De Cristofaro, E., Stringhini, G., Vakali, A., & Kourtellis, N. (2019). Detecting cyberbullying and cyberaggression in social media. ACM Transactions on the Web ,  13 (3), 1-51, https://doi.org/10.1145/3343484 . Choudhury, S., Blakemore, S.-J., & Charman, T. (2006). Social cognitive development during adolescence. Social Cognitive and Affective Neuroscience, 1 (3) 165–174,   https://doi.org/10.1093/scan/nsl024 . Ciotti, M., Ciccozzi, M., Terrinoni, A., Jiang, W.-C., Wang, C.-B., & Bernardini, S. (2020). The COVID-19 pandemic. Critical Reviews in Clinical Laboratory Sciences , 57(6), 365-388,   https://doi.org/10.1080/10408363.2020.1783198 . Clark, J.L., Algoe, S.B., & Green, M.C., (2018). Social network sites and well-being: The role of social connection. Current Directions in Psychological Science,   27 (1), 32-37,   https://doi.org/10.1177/0963721417730833 . Cooper, M., Reilly, E.E., Siegel, J.A., Coniglio, K., Sadeh-Sharvit, S., Pisetsky, E.M., & Anderson, L.M. (2020). Eating disorders during the COVID-19 pandemic and quarantine: an overview of risks and recommendations for treatment and early intervention. Eating Disorders , 30 (1), 54-76.   https://doi.org/10.1080/10640266.2020.1790271 Espelage, D. & Hong, J.S. (2016). Cyberbullying prevention and intervention efforts: Current knowledge and future directions. The Canadian Journal of Psychiatry.   https://doi.org/10.1177/0706743716684793 . Gallson, D. (2019). Mental illness and addiction in Canada . Mood Disorders Society of Canada.   https://mdsc.ca/docs/MDSC_Quick_Facts_4th_Edition_EN.pdf . Hamm, M.P., Newon, A.S., Crisholm, A., Shulhan, J., Milne, A., Sundar, P., Ennis, H., Scott, S., & Hartling, L. (2015). Prevalence and effect of cyberbullying on children and young people: A scoping review of social media studies. JAMA Pediatrics , 169 (8), 770-777.   https://doi.org/10.1001/jamapediatrics.2015.0944 Hong, C.H. (2011). Current health issues in Korean adolescents. Korean Journal of Pediatrics , 54 (10), 495-400.   https://www.doi.org/10.3345/kjp.2011.54.10.395 . Ilaria, C., Bruno, L., Michelle, N., Yee, J., & Gianluca, E. (2021). Social media usage and development of psychiatric disorders in childhood and adolescence: A Review. Frontiers in Psychiatry , 11 ,   https://doi.org/10.3389/fpsyt.2020.508595 . Kee, D.M.H., Al-Anesi M.A.L., & Al-Anesi, S.A.L (2022). Cyberbullying on social media under the influence of COVID‐19. Global Business and Organizational Excellence , 41 (6), 11-22.   https://doi.org/10.1002/joe.22175 . Kircabun, K., Yurdagul, C., Kuss, D., Emirtekin, E., & Griffiths, M.D. (2020). Problematic mukbang watching and its relationship to disordered eating and internet addiction: A pilot study among emerging adult mukbang watchers. International Journal of Mental Health and Addiction , 19 , 2160-2169. Lee, H., Noh, Y., Seo, J.Y., Park, S.H., Kim, M.H., & Won, S. (2021). Impact of the COVID-19 pandemic on the mental health of adolescent students in Daegu, Korea. Journal of Korean Medical Science , 36 (46), e321.   https://doi.org/10.3346/jkms.2021.36.e321 . Lee, S. H. (2016). Cyberbullying in eastern countries: Focusing on South Korea and other eastern cultures. In R. Navarro, S. Yubero, & E. Larranaga (Ed.)  Cyberbullying across the globe: Gender, family, and mental health . (149-168). Switzerland: Springer International Publishing. Lerner, R. M., & Steinberg, L. (Eds.). (2009). Handbook of adolescent psychology, volume 1: Individual bases of adolescent development (Vol. 1). John Wiley & Sons.  Lupu, D. (2012). Perception of self-image by pre-teens: The balance between real and ideal. Procedia: Social and Behavioral Sciences , 82 (3), 770-774.   https://doi.org/10.1016/j.sbspro.2013.06.346 . Magson N.R., Freeman, J.Y., Rapee, R.M., Richardson, C.E., Oar, E.L., & Fardouly, J. (2020). Risk and protective factors for prospective changes in adolescent mental health during the COVID-19 pandemic. Journal of Youth and Adolescence , 50 (1), 44-57.   https://doi.org/ 10.1007/s10964-020-01332-9 . Ortiz-Ospina, E. (2019, September 18). The rise of social media . Our World in Data.   https://ourworldindata.org/rise-of-social-media . Santarossa, S. & Woodruff, S.J. (2017). #SocialMedia: Exploring the relationship of social networking sites on body image, self-esteem, and eating disorders. Social Media + Society , 1-10.   https://doi.org/10.1177/2056305117704407 Shin, S.Y. & Choi, Y.-J. (2021) Comparison of cyberbullying before and after the COVID-19 pandemic in Korea.   International Journal of Environmental Research and Public Health , 18, 1-11.   https://doi.org/10.3390/ijerph181910085 . Uhls, Y.T., Ellison, N.B., & Subrahmanyam, K. (2017). Benefits and costs of social media in adolescence. Pediatrics , 140 (2), 67-70.   https://doi.org/10.1542/peds.2016-1758E . Yassin, F. (2021). Where barbie meets K-pop: The rise of eating disorders in Asia.  The Wave Clinic.   https://thewaveclinic.com/blog/where-barbie-meets-k-pop-the-rise-in-eating-disorders-in-asia/

By Joe Clark Photo Credit: The McGill International Review INTRO In August 1978, the CIA reported that “Iran is not in a revolutionary or even a ‘pre-revolutionary’ situation,” to President Jimmy Carter. Roughly six months later, the secular dictatorship that had ruled Iran had fallen and a new Islamic government was in power. The recent Iranian protest movement, like the Iranian Revolution of the past, has caught the world by surprise, leading many to wonder if the current government would suffer the same fate. The 2022 “Women, Life, Freedom” uprising was widely considered to be the most serious challenge the Islamic Republic had faced since its founding in 1979. For almost 50 years, Shia Ayatollahs have ruled Iran as a theocratic dictatorship with strictly enforced gender segregation and harsh repression against dissent. When other protest waves occurred in the past, they were generally focused on the short term or economic goals. These protests, on the other hand, challenged the country's foundations and pushed for the establishment of a democratic government, with many experts comparing them to the events of the 1979 Revolution which overthrew the US-backed Pahlavi Regime. While the 2022 uprising was ultimately crushed after roughly a year by brute force, the grievances that caused it have persisted and the continuation of passive resistance could mean further mass dissent could develop in the near future. This article will analyze the factors of the 1979 Revolution's success and to see if they occur in the present day. While the protests of 2022 were unlikely to recreate the success of the Iranian Revolution, they carry the potential to build networks that could challenge the government. IRANIAN REVOLUTION HISTORY Despite the murderous and oppressive reputation the Islamic Republic of Iran has gained since its founding, it was brought to power by a primarily peaceful mass movement – the Iranian Revolution. The revolution emerged as a response to a growing feeling of discontent towards the Shah of Iran for his economic and social liberalization projects, which led to economic ruin for many Iranians and were seen as foreign and un-Islamic by Iran’s Shia clerics. Although the Shah had suppressed nearly all forms of political organization, a network of mosques and bazaar merchants survived, serving as the catalyst for the rapid mobilization in the Revolution, led by exiled dissident Ayatollah Ruhollah Khomeini. The first protests began in 1977 and were organized by religious groups. The network was particularly effective in urban areas, as students, impoverished people, workers, bazaar merchants, and clerics all lived in close proximity. The demonstrations were accompanied by a general strike. The security forces cracked down on the demonstrators, which proved to be a grave mistake. In the Shia tradition, mourning ceremonies are held 40 days after a death, therefore protest followed a 40 day pattern in which the mourning of victims became a demonstration itself – one which was suppressed with force, producing more victims and the cycle repeating itself 40 days later. This process was glorified in Shia culture as it emphasized personal sacrifice and social justice. The cycle continued through 1978, with the demonstrations growing in size. While the Shah offered generous concessions in comparison to most autocrats facing resistance to their rule, continued repression meant continued rallies. As waves of strikes and demonstrations endured, tactical nonviolent strategies began to emerge. Cassette tapes of Khomeini’s speeches were smuggled, copied, and played in mosques across the nation. Khomeini emphasized methods such as strikes, tax boycotts, and stay-aways when faced with harsh repression, meaning the revolution could survive even as the regime attempted to provoke them into violence or suppress them on the streets. Workers from across different sectors, especially the oil industry which produced much of the nation’s revenue, were able to paralyze the country through strikes and also sabotage the Shah’s counter-efforts such as cutting off power during the Shah’s televised speeches. It wasn’t just the tactical genius of the revolutionaries that led to their victory, but the blunders of their enemies. The Shah made a fatal mistake in September 1978 when he allowed the Islamists to hold an Eid demonstration, only to crack down on protestors the next day. The Eid demonstration had created cross-cutting mobilization as more people felt it was safe to join the Islamists in protest. The crackdown on “Black Friday” nevertheless, produced a large number of casualties and led to the rebels switching to strike waves. Despite the Shah attempting to crush the revolution through martial law, it was impossible to enforce as there was not enough room in prisons to hold demonstrators, and the government could not adequately run the industries that workers had abandoned. The opposition did not attack security forces, insteading appealing for them to defect, setting up an organization to protect defecting soldiers and sending officers back into the armed forces to gather intelligence. Just before the declaration of neutrality, the army stated they were running at only half capacity. In January 1979, the Shah, dying of cancer, fled the country and Khomeini returned. He quickly set up a parallel government and called on officials from the monarchy to defect. When soldiers began to mutiny in February, demonstrators assisted and defended them from the rest of the military. Finally, on February 11th, 1979, the military declared neutrality in the dispute between the regime and the rebellion.The regime would soon surrender, giving Khomeini and the parallel government control of the country. BARRIERS TODAY As the current Islamist regime was established through a popular uprising, they have taken active steps to curtail the influence of activists, through the use of the Islamic Revolutionary Guard Corps (IRGC). The regular armed forces, a professional fighting force which has held strong nationalist sentiments throughout its existence, could support revolutionary causes if convinced. The IRGC on the other hand, has become fanatically loyal to the regime, through a lucrative network of economic patronage. The IRGC represents the militaristic fundamentalism that protesters opposed.  It is further augmented by the Basij, a civilian auxiliary group with membership in the hundreds of thousands which acts as a plainclothes militia in emergencies. The 2022 uprising was crushed by way of these two organizations, their fanatical fighters being far less likely to defect while on the frontlines. Revolutionaries as a result have been placed in a tough position, unable to encourage widespread desertion of security forces as seen in 1979. Nevertheless, there are still avenues which they could exploit. While the IRGC is better equipped and favored by the regime, the regular armed forces are much larger, have lower pay, face discrimination from the IRGC, and are primarily composed of conscripts. While not to the levels seen during the Revolution, these factors could be used to persuade soldiers to defect, weakening the position of the regime. Additionally, another factor has been the level of organization. The Mosque-Bazaar network that facilitated the 1979 Revolution had been a large political force in the country for decades beforehand (Rulers, Rebels and Rogues) and had facilitated previous revolts. Aside from that, Khomeini was able to establish himself as a clear leader of the network and unite its various rebel groups,  provide direction to the movement and ensure effective cooperation in countering the government. The 2022 protests lacked such networks. The clergy now rules, and while bazaars participated in the uprising, it has steadily lost public influence over the past few decades. A clear and powerful leader has not yet emerged either. The most likely candidate is Crown Prince Reza Pahlavi, the son of the deposed Shah which many Iranians pledged support to during the uprising. Despite his popularity, especially with the younger generation who seek a return to the relative freedom enjoyed under Pahlavi rule, he lacks the institutions and structures within the country to turn this support into action. Nevertheless, new tools, such as the internet, can supply Iranians a means to assemble. Although the regime has attempted to censor or cut off access to the web, protesters have been able to continue to communicate and coordinate using VPNs and satellite terminals. Also, organized labor continues to be a potent force sympathetic to the country’s opposition, potentially with the capability to bring down the national economy through mass strikes. Finally, while Iran’s clergy has been uncompromising, some lower-level religious leaders have been sympathetic to the demands of the protesters. These calls could spread through the establishment, encouraging it to take a more conciliatory position, or splinter it, reducing the religious legitimacy of the regime. Nevertheless, if the Islamic Republic falls or considerably changes its political structures, it holds significant ramifications for its interactions across the Middle East, especially with its vast networks of proxies. Ultimately, the current fight for Iranian protests has been an uphill battle, in a sociopolitical environment much different than in 1979. The theocratic government has taken steps to fortify its institutions, allowing it to break up dissent more so than the Shah ever could and has taken a more uncompromising approach towards the opposition than the Shah ever did. But a new method of building solidarity has emerged through internet communication, and has helped the opposition utilize existing mobilization networks, such as organized labor, to challenge the government. While a revolution is still unlikely, it is certainly not impossible. After all, the CIA didn’t believe that the 1979 Revolution had any chance of succeeding, perhaps the same will be true this time. Works Cited Afary, J. (2024, June 8). Iranian revolution. Encyclopædia Britannica. https://www.britannica.com/event/Iranian-Revolution Balzer, K. (2019, October 28). EXPEDITIONS WITH MCUP POLICY, PERCEPTION, AND MISPERCEPTION THE UNITED STATES AND THE FALL OF THE SHAH. Marine Corps University. https://www.usmcu.edu/Outreach/Marine-Corps-University-Press/Expeditions-with-MCUP-digital-journal/Policy-Perception-and-Misperception/ Browne, R. (2022, October 7). VPN use skyrockets in Iran as citizens navigate internet censorship under Tehran’s crackdown. CNBC. https://www.cnbc.com/2022/10/07/vpn-use-skyrockets-in-iran-as-citizens-navigate-internet-censorship.html Chenoweth, E. (2013). Why civil resistance works: The strategic logic of nonviolent conflict. Columbia University Press. Cole, B. (2022a, November 16). How Iran protests compare to the 1979 revolution. Newsweek. https://www.newsweek.com/iran-protests-revolution-1979-comparison-1760104 Cole, B. (2022b, November 16). How Iran protests compare to the 1979 revolution. Newsweek. https://www.newsweek.com/iran-protests-revolution-1979-comparison-1760104 Dagres, H. (2022, November 1). 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By Yasmin Tagijeva Photo Credit: Adobe Stock Images When addressing the problem of Islamist propaganda on the internet, the public and researchers tend to focus primarily on video and text material circulated on social media and chat platforms. This concern is well-warranted as a study conducted by the Institute for Strategic Dialogue in May 2023 indicates that “official Islamic State content is being repurposed for TikTok and is not only evading the platform’s moderation efforts but seemingly getting worse.’’ While these findings are alarming, they also show that video content is currently at the center of focus of research on online radicalization. However, certain forms of propaganda bypass social media content moderation while also evading the public's and researchers' attention. The purpose of this work is to highlight the gaps in the public’s understanding of the nature and sources of Islamist extremist material by examining radical anasheed, a less often recognised form of radical Islamist propaganda. Drawing attention to the under-detected types of radical content contributes to public awareness and allows users to recognize and report extremist messaging online, it also puts additional pressure on social media platforms to improve methods of content moderation. This work begins by defining the term nasheed, providing examples of non-radical religious text and contrasting it with lyrics of anasheed popular in jihadist circles. The paper then highlights the danger this content poses for young users on social media and shows the difficulty in tracking the source of this output. Lastly, this work highlights areas for improvement in social media content monitoring and provides examples of strategies efficiently utilized by other countries. Nasheed (plural: anasheed) is a chant usually performed a cappella with no instruments except the occasional use of percussion. Its lyrics are often verses of the Quran or stories of the prophets meant to praise God or the Prophet Mohammed (Lahoud 42). While schools of Islamic jurisprudence disagree on the permissibility of music in Islam, the vast majority view anasheed as an acceptable form of art due to the lack of instrumentation and its goal being the worship of God (Allam). The general approval from Islamic jurists makes anasheed a viable substitution for music for pious Muslims while also serving as an extension of worship to the general Muslim population. As such, the target audience of nasheed artists are people either already identifying or familiar with Islam. The target demographic is relevant in examining youth radicalisation through Islamist anasheed. However, it is important to understand that radical content constitutes a minority of this art form. Most anasheed are created to supplement religious practices such as prayer and do not contain violent or extremist narratives, as seen in an excerpt from “The Beauty of Existence,” one of the most popular anasheed translated from the original Arabic: The Beauty of existence is remembering Allah, Then life becomes pure with His guidance of light, And the soul becomes assured in His obedience, Then happiness reaches its utmost peak. (Al Muqit) From this sample, it is evident that this nasheed speaks to already believing Muslims. Its author, Muhammad Al Muqit, a Saudi nasheed artist, describes his works as aiming to “inspire and uplift listeners around the globe.” With over a million monthly listeners on Spotify and regular tours across the Muslim world, he is one of the most popular nasheed performers (Al Muqit). The Beauty of Existence paints a representative picture of the content of mainstream anasheed, its producers, and its audiences. This baseline understanding of the nature of anasheed is crucial to effectively compare and identify abnormal, radical messaging. The defining characteristic of an extremist nasheed is the substance of its lyrics. These reflect themes often used in radical Islamist propaganda such as antagonism towards the disbelievers, lamentation of oppression by Western secular powers, and glorification of martyrdom, calling believers to unite, stand up to oppressors, and die as martyrs. Martyrdom in the Islamic context refers to sacrificing one's life to protect the religion, profess one's faith or defend other Muslims. The noble interpretation of self-sacrifice emerged during the early history of Islam when Muslims contested for power in Arabia. Martyrdom does not inherently imply violent intent as those who die in natural disasters or accidents also achieve martyrdom, however, extremist content strongly emphasizes struggle and fight as means to achieve this status. (Chowdhury) Radical subtext will also often encourage forceful spread of Islam and violence against non-believers, as seen in an excerpt from a translation of “Madin Kas-Sayf” (Sharp As a Sword): So he [the occupier] built his strongholds in fear, he raised his walls in them,So he [the mujahid] blew himself up among them in anger; he fixed his nails in them,You see him as splinters of fire; a commando makes his raid,He did not slow down his pace until he carried out his decision in death. (Al-Tamimi) This nasheed directly calls for violence against the “occupiers,” whom it associates with the American forces in Afghanistan, as its first found usage was in a 2009 video recorded by a Somali offshoot of Al-Qaeda to pledge allegiance to Osama bin Laden (Al-Tamimi). It is also an example of the glorification of suicide bombing, martyrdom, and those who practice jihad (the mujahideen). These anasheed can present a starting point in radicalization, being easily accessible to non-extremist and non-Muslim audiences, of which young men are at the highest risk of radicalization. Although it falls outside of the scope of this paper, gender is a key component of the extremism literature, and several aspects of radical anasheed can be more impactful to men. Young men are susceptible to feelings of emasculation and disenfranchisement by society, which can prompt them to seek out radical ideologies to restore a sense of masculinity (Kimmel). For these young men, the image of a martyr, dedicated enough to die for his ideas and brave enough to stand up to subjugation while disregarding earthly pleasures, becomes an ideal they should emulate. The circulation of anasheed promoting martyrdom through violence on TikTok is difficult to monitor since this content is uploaded anonymously. Combating this type of propaganda effectively requires knowing the identity of the original authors and producers of these anasheed. The melody of the aforementioned “Madin Kas-Sayf” was composed by Abu Ali, a well-known Saudi artist who claims to have no connection to terrorist groups, despite it being attributed to him by jihadists and the general Muslim public (Lahoud 52). However, the same melody used in the nasheed is notably used in a different one titled “It Blew Like The Wind,” which bares no extremist messaging and only encourages followers to assist each other and to search for knowledge (Al-Tamimi). Therefore, Abu Ali may be the author of the melody of  “It Blew Like The Wind,” which was lyrically modified by Al-Qaeda to include a radical message. The unclarity of the authorship of anasheed is quite prevalent and has allowed for the co-optation of mainstream versions by jihadists. Al-Qaeda is a prime example of this since most of their propagandistic anasheed were not produced by their own media outlets, with lyrics often taken from authors not affiliated with the terrorist group and then modified to spread radical messages (Lahoud 53). This authorship confusion complicates monitoring and removing this content from the Internet. The radical “Madin Kas-Sayf,” which openly glorifies suicide bombers, is available on YouTube and Spotify, with the artist credited as Abu Ali even though he most likely did not write the text. This further complicates the attempts to censor such content as it cannot be traced to a specific source such as an artist on Spotify, or a channel on YouTube. Instead, the audios are uploaded to these platforms by multiple users, often in sped-up, slowed down or otherwise edited form to prevent the algorithm from deleting all these recordings in case one of them is flagged and removed. This has occurred on TikTok, where a section of  “Madin Kas-Sayf”' became especially popular amongst young male Muslims in 2020 as background audio for their videos (Ayad). While many who used the audio were unfamiliar with the lyrical content of the nasheed, as they were not Arabic speakers, and the portion of the chant used was not particularly radical, this incident showcases the need for better content moderation on social networking sites, to combat the spread of radical ideologies to Muslims and non-Muslims alike. Online propaganda such as radical anasheed often bypasses the established content moderation system by keeping the names of the recordings and the authors vague and non-problematic. Since the name of the track and its author are never directly linked to a terrorist group or a violent message, this content manages to pose as an inoffensive religious hymn. Therefore, it is necessary to dedicate more attention to the contents of these tracks, especially those popular on social media with a younger audience. The ability to recognize less common types of extremist propaganda plays a crucial role as individual users are less likely to engage with content if they deem it as radical. Moreover, knowledgeable users are more likely to report extremist material that was not detected by the built-in algorithm of the social media network. Public awareness helps prevent the spread of radical content and pressures social media networks and legislative authorities to adjust the regulations on producing media such as anasheed. An example of such a strategy is Saudi Arabia, whose Ministry of Information now prohibits independent media production companies from publishing anasheed to prevent potential jihadists from co-opting these works and influencing mainstream Muslim culture. (Lahoud 52) This decision was a result of public concern over the fact that many authors of radical anasheed proved to be Saudi citizens and shows that raising awareness for covert forms of extremist content can lead to positive legislative changes. Works Cited Al Muqit, Muhammad. “The Beauty of Existence .” YouTube, YouTube, 1 July 2016, www.youtube.com/watch?v=NrsCej6SVxM. Al Muqit, Muhammad. “YouTube Music Profile.” YouTube, YouTube, music.youtube.com/channel/UCI4Qvd1VU_M1cwbMB_UuPzA. Accessed 13 Feb. 2024. Allam, Shawki. “What Is the Ruling Concerning Music?” Egypt’s Dar Al Iftaa , 2013, www.dar-alifta.org/en/fatwa/details/4866/what-is-the-ruling-concerning-music. Al-Tamimi, Aymenn  Jawad. “Famous Anasheed: ‘Madin Kas-Sayf’ by Abu Ali.” Pundicity, 2013. Ayad, Moustafa. “Caliphatetok: TikTok Continues to Host Islamic State Propaganda.” ISD, 26 Sept. 2023, www.isdglobal.org/digital_dispatches/caliphatetok-tiktok-continues-to-host-islamic-state-propaganda/. Ayad, Moustafa. “Islamogram: Salafism and Alt-Right Online Subcultures.” Institute for Strategic Dialogue, 2021. Chowdhury, Rashed. “Martyrdom and Jihad - Carnegie Endowment for International Peace.” Carnegie Endowment, 1 Mar. 2004, carnegieendowment.org/2004/03/01/martyrdom-and-jihad-event-684. Kimmel, Michael. “Almost All Violent Extremists Share One Thing: Their Gender.” The Guardian, Guardian News and Media, 8 Apr. 2018, www.theguardian.com/world/2018/apr/08/violent-extremists-share-one-thing-gender-michael-kimmel. Lahoud, Nelly. “A Cappella Songs (Anashid) in Jihadi Culture.” Jihadi Culture: The Art and Social Practices of Militant Islamists. Ed. Thomas Hegghammer. Cambridge: Cambridge University Press, 2017. 42–62. Print. “Muhammad Al Muqit.” Spotify, open.spotify.com/artist/4kpoYPOSgCl2jYvCm6Cp05?si=mMkVt2CGTwSidWxILws25Q. Accessed 17 Apr. 2024.

By Camila Aragón Alfaro Photo Credit: John M Lund Photography Inc/Getty Images, Genetic Engineering & Biotechnology News Introduction In October of last year, the World Federation of Neurology reported that neurological disorders had become the second leading cause of death and the leading cause of disability worldwide. The presented study, performed by the Global Burden of Disease (GBD), determined that 40% of the global population currently suffer from neurological disorders, a number that is projected to double by 2050 (World Federation of Neurology). It is no surprise then, that scientists are developing new methods to study and treat these damaging conditions. The emerging field of nanotechnology offers one of the most promising possible treatments: nanoparticles. Nanoparticles (NPs) are materials that are between 1 and 100 nanometers in size—more than a thousand times smaller than the diameter of a single human hair. Nanoscale materials have already been used to tackle the toughest medical problems; the COVID-19 vaccine for example, contained them (Omberg). Because of their small size, nanoparticles can be extremely effective for therapeutic applications, like vaccines, as they can easily cross both bacterial and human cell membranes. Nanoparticles, however, face difficulties with reaching the brain, due to the extremely restrictive nature of the blood-brain barrier. While there have been significant advances made regarding the possible ways of transporting nanoparticles into the barrier, as well as ongoing research on the potential of different nanoparticles, there are still many challenges that need to be addressed before determining their therapeutic potential. Devising effective methods to cross the blood-brain barrier is one of the biggest challenges in nanoparticle research—as it could open the possibility of employing new drug-delivery methods that could directly treat even the most complicated neurological disorders. The Blood-Brain Barrier It’s no secret that the brain is one of the most fragile organs in our body. Significant protections for our  brains have evolved over time, most notably with our skull, in combination with the cushioning effect of cerebrospinal fluid (CSF), and the barrier of the meninges membrane, shielding it from physical injury.  But some of the biggest threats to our brain are not physical—multiple disease-causing organisms, or pathogens, can reach the brain through the bloodstream. In cases like these, the best line of defense is none other than the blood-brain barrier. The blood-brain barrier (BBB) is a selective semi-permeable membrane (Dotiwala et al.)—which allows for the passage of only certain substances between the brain’s small blood vessels, or capillaries, and the different components that make up brain tissue (Götz). The BBB is composed of a capillary basement membrane and three cellular elements: endothelial cells (ECs), which form a cell layer, the endothelium, that coats the interior wall of the blood vessels, pericytes (PCs), present along the walls of the capillaries and crucial for the maintenance of the BBB, and the end-feet of astrocytes, a subtype of glial cells, or non-neuronal cells in the nervous system that don't conduct electricity, and are shaped like stars (Wu et al., 2). What makes the BBB a near-impenetrable barrier are the endothelial tight junctions (TJs). The endothelial cells in the capillaries that form the BBB are so tightly packed that they only allow tiny molecules, fat-soluble molecules (due to cell membranes being lipid-based), and certain gasses. Larger or water-based molecules rely on transport proteins to traverse the barrier (Cleveland Clinic), allowing for the BBB to protect the brain from harmful pathogens and toxins, while still maintaining access and regulation of the hormonal, nutrient, and water levels in the organ. The Challenge While the blood-brain barrier is great at obstructing the entrance of potentially malignant organisms, its restrictive nature also makes it the biggest impediment to any neurological therapeutic approach. It is estimated that the BBB prevents more than 98% of all small-molecule drugs and nearly 100% of large-molecule neurotherapeutics from entering the brain (Pardridge, 3). Furthermore, the BBB’s endothelial cells contain ATP-binding cassette transporters, also known as ABC transporters. ABC transporters use the chemical energy present in adenosine triphosphate (ATP), the source of energy in cells’ phosphate bonds, which is released after ATP reacts with water to break down said bonds—a process known as hydrolysis. This allows for the transport of various substances across the membrane—but the expulsion of compounds that might cross the BBB back into the bloodstream, which further restricts the number of molecules that can be effectively transported into the brain (Ceña & Játiva, 1513). Various strategies have been devised to effectively penetrate the blood-brain barrier over the century since its discovery. These strategies can be classified into invasive techniques, such as opening or disrupting the BBB or injecting therapeutic proteins directly into the CSF, and non-invasive methods such as intranasal drug delivery or gene therapy (Bellettato & Scarpa, 3). All of these techniques however have several limitations. The temporary parting of the BBB’s tight junctions, be it by using osmotic pressure, microbubbles, or ultrasound, can damage the integrity of the barrier and cause an uncontrolled influx of unwanted molecules into the central nervous system (CNS) when the junctions open, potentially harming patients (Zhou et al., 291). Directly injecting enzymes—proteins that speed up chemical reactions—into the cerebrospinal fluid, while effective in both mice and dog models, is considered challenging to use in a clinical setting due to the short half-life of the enzymes. On the other hand, intranasal drug delivery is severely hampered by the limited concentration that can be achieved in the brain and spinal cord, the reduction of drug delivery efficiency as the drug’s molecular weight increases, and the variabilities in nasal absorption caused by irritation or nasal pathology (ie. the common cold). Finally, while effective in mice, gene therapy has encountered challenges with the human immune response, and difficulties from translating therapeutic approaches from small animal models to larger ones. (Bellettato & Scarpa, 6). The Potential of Nanoparticles Nanoparticle drug delivery methods offer several advantages over other strategies due to their reduced size, biocompatibility, prolonged blood-circulation, and non-toxicity (Teleanu et al., 5). Furthermore, nanoparticles offer other benefits such as minimal invasiveness, affordability, biodegradability, long-term stability, precise targeting ability, and excellent loading and releasing control through the BBB (Zhou et al., 291). While nanotechnology-based medications, such as Abraxane, Daunoxome, and Doxil have already been approved for cancer treatment by the FDA (Sahu et al., 5), there is still a long way to go in the development of brain-focused nanoparticle technology. Current nanotechnology-mediated drug delivery systems under investigation include both specific and non-specific mechanisms for targeting brain sites (Teleanu et al., 5). Viable nanoparticles must maintain stability and remain in the bloodstream for long periods of time, avoid clumping and uptake by the immune system, and have minimal impact on the drug molecules they will carry (Zhang et al., 220). The Development of Nanocarriers The nano-carriers currently in development can be divided into two types: those made out of organic nanomaterials, and those made out of inorganic ones. Organic nanomaterials, primarily carbon based, are what constitute polymeric nanoparticles, liposomes, dendrimers, and micelles. Inorganic nanomaterials constitute gold and silica nanoparticles, and carbon nanotubes. Polymeric nanoparticles, which are composed of very large molecules, or macromolecules, have shown potential for treating CNS diseases due to their attractive drug delivery properties—including controlled drug release, customizable structures, cellular targeting and uptake, and its ability to avoid being ingested and eliminated by the immune system (Wu et al., 13). Modification of polymeric nanoparticles with specific ions or molecules known as ligands allows for the targeting of the receptors on the ECs, while their polymeric matrix can be triggered for drug release, resulting in prolonged, protected, and particularized drug delivery. Recent studies using polyalkyl cyanoacrylates nanoparticles (PACA NPs) loaded with doxorubicin (a chemotherapy drug) have been tested in patients with refractory solid tumors (Vauthier, 3), while the same particles loaded with mitoxantrone (a cancer medicine) have been tested in patients with liver cancer (Wang et al., 97). On the other hand, PACA NPs can be potentially used for the treatment of Alzheimer’s Disease (AD). AD is linked to the abundance of the amyloid-β peptide, so having antibodies that can detect this peptide is important for AD recovery. In some studies, PACA NPs were decorated with anti-amyloid-β1-42 antibodies, leading to memory recovery in AD mouse models (Carradori et al., 610). However, further investigation on the applications of PACA NPs for CNS disorders is still needed. Liposomes are the best candidate to carry potential hydrophilic and hydrophobic molecules due to their lipid bilayer arrangement. These spherical vesicles are made of a double layer of lipid molecules, with the lipid’s hydrophobic (water repellent) tails facing the inside and the hydrophilic (water soluble) tails facing the outside, giving it amphiphilic properties and allowing it to transport many kinds of molecules. They have been shown to enhance drug solubility and controlled distribution, and their surface can be easily modified for targeted, prolonged, and sustained drug release. Currently, various liposomal drug delivery systems have been clinically approved for  treatment of cancer, fungal, and viral infections (Nsairat et al., 9–10), and they have also been used in gene therapy.  Multiple studies have reported the use of liposomal formulations for anti-cancer drugs, such as methotrexate, 5-fluorouracil, paclitaxel, doxorubicin, and erlotinib (Teleanu et al., 7). Dendrimers are a type of nano-sized, radially symmetric synthetic macromolecules, with a structure consisting of tree-like arms or branches. Their globular structure comprises a core, with multiple branching layers extending from the central core and active functional groups in the outermost layer. The advantages they provide have made them the newest class of macromolecular nano-scale delivery systems after their discovery in 1978 (Wang et al., 1), and it is emerging as a possible therapeutic agent for anticancer therapies and diagnostic imaging (Abbasi et al., 5). Dendrimers have been applied in treating brain cancer, neurodegenerative diseases, stroke, neuroinflammation and circulatory arrest; polyamidoamine dendrimers have become the most commonly studied dendrimers for treating brain disease (Teleanu et al., 8). Micelles are amphiphilic molecules - that is, a molecule that has both hydrophobic (nonpolar) and hydrophilic (polar) regions (Illustrated Glossary of Organic Chemistry). Their size ranges from 5 to 100 nanometers. Micelles can be used for the delivery of hydrophobic molecules, and can provide controlled and sustained release, chemical and physical drug stability, and improve drug bioavailability (Joseph et al., 145). There are several of nanomicelle-based drug delivery systems that allow it to gain edge over classical drug delivery methods: they can entrap hydrophobic drugs and increase their solubility, their ability to target specific portions of the CNS can lead to maximum efficiency in delivery and minimal side effects, they can release drugs when triggered by stimuli, such as pH or temperature, they have the capability to ensure a continuous supply of therapeutic agents, and their small size is well-suited for intravenous injection without risk of arterial blockage (Bose et al., 1–3). Recent studies have focused on curcumin delivery for targeting glioma, a common type of brain tumor, and Alzheimer’s disease through using micelles as nanocarriers; micelles with contrast agents are also being investigated for potential applications in magnetic resonance imaging of neuroinflammation and stroke injuries caused by clots in the brain (Teleanu et al., 9). Inorganic nanoparticles, while not very biodegradable, have been widely used in biomedical applications. Gold nanoparticles (AuNPs) could be potentially used for therapeutic applications for neurodegenerative disorders due to their anti-inflammatory and antioxidant properties (de Bem Silveira et al., 2425). These properties are theorized to contribute to their neuroprotective effects and ability to reduce oxidative stress—a critical factor in the pathogenesis of neurodegenerative disease. Because of these effects, AuNPs would be able to prevent further neuronal damage caused by excessive inflammation or lack of oxidation, reduce neuroinflammation-associated neurotoxicity, and to maintain stable conditions within cells through homeostasis. Additionally, AuNPs can enhance the secretion of neurotrophic factors— biomolecules that support neuron survival (Krieglstein, 843)—, which helps to maintain neuronal health and plasticity, and enhance connectivity between them. Most importantly, AuNPs may be able to reduce the clustering of misfolded proteins—a significant occurrence in many neurodegenerative disorders (Chiang et al., 2–3). Recent studies have shown AuNPs’ potential for treating Alzheimer’s, as it can protect neurons against toxicity induced by amyloid-β clustering, has high levels of inhibition efficency (Hou et al., 2), and assist in relieving memory impairment and neural damage (Sanati et al., 2305). AuNPs can also improve cognitive and antioxidant function, and reduce the hyperphosphorylation of the tau protein—a key feature of Alzheimer’s—, in which the biomolecule becomes tangled and misfolded (dos Santos Tramontin et al., 932). Additionally, research in mice using AuNPs to treat Parkinson’s disease (PD) has demonstrated outcomes such as reduction of oxidative stress, improvement of motor symptoms, and partial improvement of neurotrophic factors (da Silva Córneo et al., 8). Silica nanoparticles (SiNPs) are composed of silicon dioxide (silica), the most abundant element on earth. SiNPs can be easily hybridized with other inorganic nanoparticles and they possess uniform pore and controllable particle sizes, large surface areas, capacity to maintain stability, adaptable surfaces, and biocompatibility (Huang et al., 1), making them potential nano-vehicles for the delivery of drugs and imaging probes through the BBB. While their performance in clinical trials has been promising, there are still several hurdles to overcome before SiNPs’ can be implemented, including ensuring safety with prolonged exposure, determining long-term toxicity profiles from various administration methods, and exploring scale-up techniques, particularly in producing reliable batches of the macroparticle. Moreover, only solid SiNPs without pores or with small pores have been tested, which has a lower cargo-loading capacity compared to dendritic, virus-like, large-pore and mesoporous (that is, with pores with diameters from 2 to 50 nanometers) SiNPs, which have the capability to load multiple drugs and biologics (Janjua et al., 1072). Finally, carbon nanotubes (CNTs) are hollow graphite sheet tubes with a diameter in the nanometer range that present great promise in biomedical applications due to their ability to continue operating while containing chemical compounds that can alter their physical and biological properties. Carbon nanodots coated with polymers and chemically-altered carbon nanotubes with multiple walls have been used to transport drugs during brain cancer therapy, which has been found to have successfully penetrated the blood-brain barrier, enhancing the drugs’ uptake in tumors (Kafa et al., 228, Wang et al., 38). Another study that compared the absorption of the Alzheimer’s drug berberine in a control group where it was administered normally, to an experimental group where multi-walled CNTs had transported it, found the experimental groups had shown greater levels of brain absorption of the drug, and has a potential in reducing amyloid-β levels (Lohan et al., 277). Nevertheless, the possible toxicity of CNTs due to their nanostructure and biopersistence is of major concern, and further inquiry is needed on their impacts (Zhang et al., 7). The Transport Strategies There are four main possible mechanisms for nanoparticle transport across the blood-brain barrier, which can be divided into two categories: passive and active. Passive methods are energy independent, as they do not require ATP hydrolysis, and consist of simple molecules diffusion through endothelial cells (Zhou et al., 292). Nonetheless, it is difficult to get most biomolecules through using this process, with only the most lightweight lipid-soluble ones being able to do so effectively (Grabrucker et al., 2). Therefore, most research has focused on active transport mechanisms, such as carrier-mediated transport, receptor-mediated transcytosis, and adsorption-mediated transcytosis. Carrier-mediated transport (CMT) uses carrier systems for transportation, and it is best known for being the most common technique for small molecules that cannot passively diffuse through the brain due to their polarity, such as glucose. While efforts have been made to use CMT systems, only small peptides have been shown to be shipped through the brain effectively. Yet, CMT can best operate only in specific molecular configurations, which can be easily disrupted by small changes to the molecule, making CMT unideal in most cases (Lopes van den Broek, Shalgunov & Herth, 3). Receptor-mediated transcytosis (RMT) is currently the most studied mechanism for BBB nanomedicine transport, and the main pathway for macromolecules across this barrier. In RMT, nanoparticles are transported into the brain by binding to specific receptors on one side, then absorbed into small cellular containers called endosomes through a process called endocytosis, before being released to the other side through exocytosis. During RMT, substances get exposed to different environments—within the endosomes, the pH range changes from 7.0 to 7.4 outside the cell to 4.5 to 6.5 inside the cell—, meaning that nanoparticles would have to withstand rapid changes in conditions. Still, RMT has the potential to transport higher amounts of nanomedicines compared to CMT, and it has been proved to be more versatile, being used for liposomes, polymers, nanoparticles, and proteins, (Lopes van den Broek, Shalgunov & Herth, 4). Finally, in adsorption-mediated transcytosis (AMT) nanomolecules are transported across cellular barriers via electrostatic interactions between ligands in the bloodstream and the cell membrane, leading to their internalization (Xiao & Gan, 2). Nanomedicines, which tend to be positively charged, can easily interact with the negatively charged cell membrane. However, this method of crossing the BBB only seems to work in one direction—from blood to brain—and analysis over its effectiveness continues (Grabucker et al., 3). Moving Forward While nanoparticles are certainly a promising method for drug delivery across the brain—especially in recent studies—there is still a lot of research yet to be done. Despite advancements in nanoparticle engineering, targeting methodologies, and drug formulations, numerous challenges remain, including limited penetration, potential toxicity, and immune response activation. Continued interdisciplinary research efforts are paramount to advancing our understanding of blood-brain barrier biology and refining nanoparticle delivery systems. Integrating innovative approaches, such as being able to chemically attach ligands to the surface of nanoparticles, making nanoparticles responsive to environmental cues, and making them mimic natural biological systems, holds immense potential for enhancing the specificity, efficacy, and safety of nanoparticle-based therapies for even the most challenging of neurological diseases. 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By Gideon Gordon Photo Credit: Relief from the National Library of Ireland on The Commons In current conversations about the intersection of masculinity and imperial oppression, a proper progressive line views masculinity as part and parcel of a larger colonial structure. Colonization imposed new concepts of masculinity onto colonized people; to properly decolonize society, we need to identify the range of ways that masculinity can be performed and recognize that the norms we take for granted are in fact historically constructed and can be reconstructed in different ways. Colonization of non-European societies by European cultures produced distinctly new forms of masculinity, for both colonists and those displaced by them. Colonists became “real men” through colonization; Clive Moore notes how the process of colonization in Queensland, Australia created a mythology of masculine Australian men, with Queenslander manhood defined in contrast to recent arrivals from the British Isles, women, and the Aboriginal people of Australia (Moore 1998). The masculinity gained through colonization was by comparison to others: both native people of the region and the people of the colonist’s nation left behind at home. While colonization affirmed the masculinity of the colonizer, it also meant denigrating the “uncivilized” masculinity of the colonized. Brendan Hokowhitu, writing about his experience as a Māori man in academia, describes how colonial and racist institutions in New Zealand ultimately defined Māori men by their physical strength and “untamed” power, especially as expressed through sport (Hokowhitu 2004). The masculinity of the colonizer, because it was structured in contrast to “inferior masculinities,” requires this negative comparison; ultimately it is in contrast to the colonized “other” that a colonist becomes a “real” man. This paper does not challenge the substance of this academic literature. Instead, this paper will sound a note of caution regarding the uncritical acceptance of anti-colonial masculinities. I will do so through the lens of “Come Out, Ye Black and Tans,” an Irish rebel song. The chorus to the song begins: Come on out, ye Black and Tans — come and fight me like a man! It continues: Show your wife how you won medals down in Flanders Tell her how the IRA Made you run like hell away From the green and lovely lanes of Killeshandra. This tune crystallizes an anti-colonial form of masculinity. It mocks the manhood of the British “Black and Tans,” a counterinsurgent unit formed of World War I veterans who were deployed in Ireland to suppress the guerrilla attacks of the IRA (the original, active in the 1920s, not to be confused with the Provisional IRA which was active in Northern Ireland during the Troubles). Ultimately, former members of the “Black and Tans” would also be deployed to the Palestine Mandate in the 1920s and 1930s (Cahill 2009). However, the song was not written in the 1920s, but the 1950s or 1960s; the writer, Dominic Behan, became active as a songwriter in 1958. “Come Out, Ye Black and Tans” is thus a commemoration of a previous generation of nationalists not written by them. This context is important in understanding how it constructs anti-colonial masculinity through the symbolic resources of the 1920s insurgency. The song marks a very open challenge to the masculinity of British forces in Ireland: “Come and fight me, hand to hand, like real men do; you won’t.” (paraphrased quotation). In other words, as the British assert their manhood through the violence of colonial rule, the “real men” of Ireland puncture through these views by revealing them unwilling to “fight fair.” The presence of an audience — the wives of the British soldiers — makes their humiliation public. The “green” land itself seems to fight the British as they flee, whilst the Irish resistance forces the British to leave the (feminized) territory alone. The chorus thus brings together a number of strands: defiance against British soldiers’ manhood, invoking the soldiers’ emasculation in front of an audience, and its association with the protection of the lovely and feminine land of Ireland. The first two verses of the song sharpen the poetic bombardment of British and non-nationalist manhood and the elevation of Irish nationalist manhood. The first provides background framing of the song as one that the narrator heard from his father, who would get in fights with pro-British neighbors every night. This links the manhood of the narrator to the manhood of his father, putting his honor in relation to the historic honor of his family and ancestors. The second brings current British dishonor into the context of recent martyrs of the Irish nationalist cause: Charles Stewart Parnell and the sixteen executed leaders of the 1916 Easter Uprising. The third verse of the song explicitly places the British war in Ireland in the context of other contemporary colonial ventures: Come tell us how you slew Them ol' Arabs two by two Like the Zulus they had spears and bows and arrows How bravely you faced one With your sixteen pounder gun And you frightened them damn natives to their marrow. This verse is what moves “Come Out, Ye Black and Tans” from a specific tale of Irish nationalism to a broader narrative of anti-colonial masculinity. It mockingly asks the British to show the same minimal courage they displayed crushing Arab revolts in the Middle East, when they often used air power to bombard recalcitrant tribes (Omissi 22-23), and in the Anglo-Zulu Wars, where they wielded “sixteen pounder” artillery against Zulus who the singer asserts, were armed only with “spears and bows and arrows.” The implicit argument is that the mighty British empire cannot win an even fight; it must resort to heavy weaponry when fighting weaker parties. The appeal here is not unlike one used to challenge a bully. The call to “pick on someone your own size” is a powerful symbolic attack on the manhood of occupying armed forces, not necessarily restricted to the Irish context. Julie Peteet, an anthropologist present in the West Bank during the First Intifada, used Bourdieu’s analysis of “challenge” to understand how the Israeli army’s beatings of Palestinian youth became understood culturally to strengthen the masculinity of those youth, even though the beatings vividly illustrated their physical vulnerability (Peteet 1994). Peteet notes that, based on Bourdieu’s reading of challenge, masculinity, and honor (qtd. in Peteet 1994, 34), “a man dishonors himself when he challenges a man considered incapable of ‘taking up the challenge.’” The violence inflicted by a heavily armed Israeli soldier on a young Palestinian, which, in certain perspectives, revealed the Israeli army’s arbitrary power over Palestinian bodies, could thus be reinterpreted as a mark of the Israeli army’s lack of honorable masculinity. In other words, the very superiority of force which the ruling power enjoys also destroys its own claim to civilizational or moral superiority, within this framework. Helpfully, this symbolic attack is likely to be available essentially anywhere imperial power occurs, because massively overwhelming force is a necessity for colonization. But this verse also reveals the deeply-rooted problem with anti-colonial masculinity. While elevating Irish masculinity, it simultaneously reinforces ideas of Arabs and Zulus as weaker and more vulnerable to British rule. In the case of the Zulu War verse, this is explicitly linked to British technological advantages, which emasculates other victims of colonial rule as “damn natives” frightened “to the marrow” by British firepower, even as it emasculates the British for resorting to that firepower in the first place. Masculinity comes from facing the superior power of the British Empire fearlessly, as the narrator does. Thus, that the Arabs and Zulus are cowed by British artillery and air power implicitly makes them “lesser” men than the Irish. There is a racial element too: the Irishman singing the song never categorizes himself with the “damn natives.”. The role of anti-colonial masculinity in establishing a hierarchy of manhood also operates within the colonized society. While the explicit text of “Come Out, Ye Black And Tans” is about a confrontation with the British Empire, the subtext focuses on a slightly different set of enemies who the narrator’s father is calling out: Irish loyalists. An Irish journalist analyzing the song’s history notes that it is “textured by the [the writer’s family’s] bitterness about the way the Free State treated them after Irish freedom…” (Falvey 2019). The men emasculated by their failure in the song were not actually British soldiers, but fellow Irishmen who the narrator disagrees with politically in Dublin after independence. The masculinity of non-nationalists, unionists, or pro-British Irishmen can thus be called into question by linking it to the failed, emasculated British Empire, comparing as such to the heroic masculinity of Irish nationalists. This mirrors the hierarchy of manhood established by colonial masculinity, but with the colonists gone by the song’s time, the non-nationalists become identified with their weakness and cowardice. In this framework, the only possible response to colonial rule is to do the brave but suicidal thing: to call out the colonial forces and expose yourself to superior firepower. Surviving violence at the hands of occupying forces makes you a hero, as Peteet notes. Not surviving, also a very probable outcome, makes you a martyr. Masculinity here becomes a competition for honor through participation in the national struggle; to not oppose foreign influence wholeheartedly means to no longer be a man. “Come Out, Ye Black and Tans” remains a symbol of Irish nationalism decades later. In 2020, amid a controversy surrounding a possible event commemorating the Royal Irish Constabulary, a rendition of the song by the Wolfe Tones, an Irish band which often plays songs with nationalist themes, reached the top spot on Irish iTunes (“Come Out Ye Black And Tans Is Number 1”). And in the Irish general elections that same year, the Irish republican political party Sinn Fein, with branches in both the country and Northern Ireland, played the song as part of their campaign (McQuinn, “General Election 2020: The 10 Defining Moments”). Ultimately, “honorable” standup bouts of fisticuffs did not drive the British from Ireland. Instead, the Irish insurgents of the 1920s waged their war as secretly and “unfairly” as they could. Much of the time, the experience of battle for the insurgents was an exercise in waiting on lonely roads to stage ambushes, often to no avail (Catháin 2023). And the war ended not in a complete victory for either, but in a compromise solution via treaty, including an un-glamourous provisional administration, a gradual handover of power, and the continued inclusion of Northern Ireland in Great Britain. The compromise produced intense debates across Irish society, and it was only accepted by the revolutionary Irish parliament, the Dáil, by the narrow margin of 64 to 57 (“The Treaty In Context”). The Irish War of Independence was immediately followed by an uprising by opponents of the treaty, who felt that it sold out all that the war had been fought to achieve, and the resulting civil war occurring between 1922-23 cost over a thousand lives. Even after the provisional government defeated the anti-treaty faction, the ideological scars remained; the “Dublin street,” where the narrator was born, was one torn by continued controversies over the meaning of independence. “Come Out” participates in and reproduces wartime discourse a long time after the war. Thus, in practical terms, there is a massive gulf between the heroic masculinity nationalists promote, and the messy process of true national liberation. Anti-colonial masculinity detaches violence from political aims. The nameless narrator of “Come Out, Ye Black and Tans” does not have a specific aim in the fight he’s seeking. The fistfights with pro-British neighbors, “every night, when my Da would come home tight” is framed as a repetitive ritual of manhood, not as part of any long-term strategy. The goal of masculine anti-colonial violence is emotional catharsis — a rejection of colonial emasculation and an assertion of agency — not material improvement. And these structures of honor, shame, and hierarchy persist even once, supposedly, the war is won, as shown through the history of “Come Out, Ye Black and Tans.” Future research could explore the legacies of these anti-colonial masculinities in more detail: How memories, especially the mythologies constructed around wars of independence shape how we think about masculinity today; what gender performance looks after periods of anti-colonial warfare; and how nationalists reconstruct masculine heroism out of the messy reality of wars of independence. The anticolonial masculinity of “Come Out, Ye Black and Tans” is not an issue for the distant past; it remains alive, and the ethos of heroic violence it promotes continues to distort our thinking about how political change and social progress actually occur. Works Cited Bourdieu, Pierre. Outline of a Theory of Practice. Cambridge University Press, 1977. Cahill, Richard. “‘Going Beserk’: ‘Black and Tans’ in Palestine.” Jerusalem Quarterly, no. 38, Summer 2009, https://www.palestine-studies.org/en/node/78290. Catháin, Máirtín Seán Ó. “The War That Didn’t Happen: Waiting for Ambushes in the Irish War of Independence.” Contemporary European History, vol. 32, no. 4, Nov. 2023, pp. 532–50, https://doi.org/10.1017/S0960777322000819. “Come Out Ye Black And Tans Is Number 1 in Irish and UK ITunes Charts.” The Irish Times, https://www.irishtimes.com/culture/music/come-out-ye-black-and-tans-is-number-1-in-irish-and-uk-itunes-charts-1.4135091. Accessed 21 Mar. 2024. Falvey, Deidre. “Come Out Ye Black and Tans: Think You Know What It’s about? You Probably Don’t.” The Irish Times, https://www.irishtimes.com/culture/music/come-out-ye-black-and-tans-think-you-know-what-it-s-about-you-probably-don-t-1.3832601. Accessed 21 Mar. 2024. Hokowhitu, Brendan. “Tackling Māori Masculinity: A Colonial Genealogy of Savagery and Sport.” The Contemporary Pacific, vol. 16, no. 2, 2004, pp. 259–84, https://www.jstor.org/stable/23721783. Houses of the Oireachtas. The Treaty in Context – Houses of the Oireachtas. 11 Dec. 2021, https://www.oireachtas.ie/en/visit-and-learn/centenaries/treaty-debates/the-treaty-in-context. McQuinn, Cormac. “General Election 2020: The 10 Defining Moments.” Irish Independent, 8 Feb. 2020, https://www.independent.ie/irish-news/general-election-2020-the-10-defining-moments/38938282.html. Moore, Clive. “Colonial Manhood and Masculinities.” Journal of Australian Studies, vol. 22, no. 56, 1998, https://www.tandfonline.com/doi/pdf/10.1080/14443059809387359. Omissi, David E. Air Power and Colonial Control: The Royal Air Force, 1919–1939. Manchester University Press, 1990, https://archive.globalpolicy.org/component/content/article/169-history/36386-british-air-power-and-colonial-control-in-iraq-1920-1925.html#:~:text=The%20policing%20role%20of%20most,other%20populations%20under%20British%20sway. Peteet, Julie. “Male Gender and Rituals of Resistance in the Palestinian Intifada: A Cultural Politics of Violence.” American Ethnologist, vol. 21, no. 1, 1994, pp. 31–49, https://doi.org/10.1525/ae.1994.21.1.02a00020.

By Piper Sneed Photo Credit: CNN and Adobe Stock An Introduction to the Significance of Preterm Birth: Preterm birth, defined as live birth before 37 weeks gestation, is a major determinant of infant and maternal mortality and morbidity. While it is estimated that the incident number of cases of preterm birth has decreased worldwide, from 16.06 million in 1990 to 15.22 million in 2019, preterm birth remains a considerable problem affecting mothers and children around the globe. Complications that arise from preterm birth, such as impaired respiration, difficulty feeding, and a high risk of infection, are the leading cause of death among children under five years old worldwide (Cao et al.). Those that survive have an elevated risk of developing various diseases and disorders, some of which may be lifelong and debilitating. Preterm birth has been associated with an increased risk of neurodevelopmental disorders, coronary artery disease, stroke, type II diabetes mellitus, and obesity in adulthood (Vidal et al.). The burden of preterm birth is distributed unequally, with low income countries, especially those in Africa and Asia, having the highest prevalence. Systematic review and modeling analysis of data from 2014 showed that 80% of preterm births occurred in countries in sub-Saharan Africa and South Asia. Disparities in preterm birth rates are also seen within countries and regions in relation to differences in maternal education, race, ethnicity, and other sociodemographic characteristics. In the United States, for instance, the preterm birth rate in 2016 was 14% among African-American women but only 9% among white women (Walani). Research on the etiology of preterm birth is an important step in lowering the incidence of cases and improving perinatal care. A wealth of studies have focused on uncovering potential risk factors, and while there have been no definitive results as to specific causes, many significant associations have been made. Evidence suggests that having a history of preterm birth, becoming pregnant within 6 months of one’s last delivery, having multiple gestations, experiencing vaginal bleeding during pregnancy, and acquiring intrauterine or intra-amniotic infections are associated with an elevated risk of preterm birth. Other associations with preterm birth include a low or high pre-pregnancy body mass index (BMI - which is associated with nutritional deficiencies and conditions like hypertension and diabetes respectively), a large volume of amniotic fluid, maternal conditions like thyroid disease or asthma, receiving abdominal surgery or invasive procedures for cervical disorders, and cigarette and tobacco use (Goldenberg et al.). While all of these potential risk factors warrant our attention, the subject of this article will be an association with preterm birth that is often neglected: high levels of psychosocial stress. This article presents studies conducted over the past few decades that focus on the role that stress and related issues like depression and anxiety play in one’s risk for delivering preterm. In doing so, this article makes the case that more needs to be done to address the emotional and psychological needs of pregnant women both for the sake of the mother and her unborn child. As previously stated, preterm birth (PTB) is defined as live birth before 37 weeks gestation, a definition adopted by all of the studies that will be presented. Additionally, in all of the presented studies, preterm birth is categorized in three broad ways. The first is spontaneous preterm delivery, which is defined as a sudden, early onset of labor. The second is premature rupture of membranes, which is the premature rupture of the amniotic sac. Finally, there is medically indicated preterm delivery, which occurs when a doctor induces labor prematurely in a pregnant individual who is at risk of serious complications.  For most studies, only spontaneous preterm birth and premature rupture of membranes were included, as these represent the onset of preterm labor without medical intervention. Criteria for inclusion varied across studies, but common characteristics that barred potential subjects from participating were having multiple gestations, being under a certain age (usually under 18 years old), engaging in drug or alcohol use while pregnant, having active infections like HIV, or having a severe chronic illness. The way that stress levels were quantified varied from study to study, but in general, stress was measured in terms of a) whether participants are exposed to external events (stressors) that are thought to necessitate an inherent stress response and/or b) participants' subjective perception of whether or not they experience stress. Anxiety and depressive symptoms were also commonly used to assess participants’ overall stress levels, though in some cases, anxiety and depression were evaluated independently of stress. By discussing how stress may be related to an elevated risk of preterm birth, this article will elucidate the significance of a holistic approach to perinatal care that emphasizes not only physical wellbeing, but also mental and social wellbeing. The etiology of preterm birth is complex and as such, consideration of all potential factors- not just those that have a biological or physiological basis- is important for improving maternal and child health around the world. Stress and Preterm Birth: In light of the observation that stress can take a toll on one’s physical health, research on PTB over the past few decades has shifted its focus from purely examining the biological and physiological mechanisms underlying this problem to also considering how things like stress may impact one’s risk of delivering prematurely. Multiple studies have found a statistically significant association between PTB and stress, be it perceived stress or stress resulting from objectively stressful situations or circumstances in life. For instance, one study found that maternal stress was significantly greater in postpartum Thai women who delivered preterm compared with those who delivered at term. After adjusting for maternal stress levels, perceived stress scores, marital status, alcohol consumption, intent to get pregnant, undergoing a divorce or separation, and sustaining physical or psychological trauma during pregnancy, it was found that both stress and perceived stress were significant predictors of PTB (Tanpradit and Kaewkiattikun). Furthermore, another study observed that maternal stress during pregnancy was more prevalent among women who delivered preterm than those who delivered at term (Lilliecreutz et al.). These results are supported by a study conducted by Szegda et al., which found that elevated levels of perceived stress at the midpoint of pregnancy increased the risk of PTB. This study observed a linear trend, with women in the highest quartile of stress experiencing three times the risk of PTB compared with women in the lowest quartile. Interestingly, this study found that stress early on in pregnancy was not associated with PTB. This result was also found by Hoffman et al. in their study on the effect of cortisol on PTB. In this study, the researchers observed that women who delivered preterm had a higher mean second trimester hair cortisol concentration compared with those who delivered at term, a difference that was not seen for the first and third trimester. Additionally, at 16 weeks gestation (which falls in the second trimester), they observed a significant difference in perceived stress scores between women who delivered preterm and women who delivered at term. This, in combination with the study by Szegda et al., suggests that stress may have the highest impact on risk for PTB in the second trimester. Hoffman et al. propose two reasons for this. They cite that in the first trimester, there is a small placental volume, low placental blood flow, and low oxygen tension in the fetoplacental unit, which may partially shield the embryo from the mother’s psychobiological environment. Moreover, they note that although cortisol levels are at their highest during the third trimester, there is also an increase in the levels of cortisol metabolizing enzymes, which may result in a reduced maternal response to cortisol in preparation for delivery. There is a small subset of research that has found no statistically significant association between stress and PTB. In a study on the epigenetics linking stress and PTB, it was found that although high stress was moderately correlated with PTB, it was not associated with an elevated risk of PTB when compared to low levels of stress (Vidal et al.). The researchers note that this derivation from what the majority of the literature reports may be due to their use of a small, limited sample size. This study also focused primarily on stress in the first trimester. As previously established, evidence suggests that stress may not be correlated with PTB in the early and late stages of pregnancy. In evaluating this research, it is clear that the evidence which suggests an association between stress and PTB is much stronger than the limited evidence suggesting no relationship. Given that there is adequate data to suggest a relationship between stress and an elevated risk of PTB, medical professionals should do more to address their pregnant patients’ stress levels. Anxiety and Depression: Another possible contributing factor to PTB is anxiety. Anxiety may become worse during pregnancy, as women become familiar with the medical risks that accompany being pregnant. One study found that women with medium and high levels of pregnancy-related anxiety showed an increased risk of PTB, with the highest measures of pregnancy-related anxiety being associated with a twofold increase in risk. In this study, it was also found that women with higher pregnancy-related anxiety were at a higher risk of spontaneous PTB than of medically-indicated PTB (Dole et al.). In a similar vein, Kramer et al. reported that when adjustments were made for medical and obstetric risk, perception of pregnancy risk, and depression, pregnancy-related anxiety was the only factor significantly associated with an increased risk of PTB. The findings from both of these studies are further supported by research done by Orr et al., which found that women with higher levels of pregnancy-related anxiety had a significantly increased risk of spontaneous PTB. Non-pregnancy related anxiety has also been shown to impact the risk of PTB. Sanchez et al. observed that, when compared with women who had minimal anxiety, women with mild anxiety had a modest increase in the odds of PTB and women with moderate-severe anxiety had a considerable increase in the odds of PTB. Notably, women with moderate-severe anxiety were found to have a greater than two-fold odds of PTB when compared with women who had minimal anxiety (Sanchez et al.). Becker et al. reported similar results, observing that women who were determined to have high levels of anxiety were at an increased risk of PTB when compared with women who had low levels of anxiety. While there has been limited research on depression as a potential contributor to PTB, there is some evidence that suggests that depressive symptoms may be associated. Sanchez et al. found that mild and moderate-severe depressive symptoms were statistically significantly associated with increased odds of PTB compared with minimal depressive symptoms. They argue that depression is a biologically-plausible contributor to PTB, noting previously determined associations between psychiatric disorders and overactivation of the hypothalamic-adrenal-pituitary (HPA) axis, as well as the proposition that depression may increase the release of corticotropin-releasing hormone (CRH) from the placenta. However, while there is some research that supports the association between depression and PTB, evidence has been contradictory. Dole et al., for instance, found that negative life events, social support, and depression were not associated with PTB. Given the conflicting evidence on this topic, further research should be undertaken to deepen our understanding of the association between depression and PTB. The presence of studies that have found an association between PTB and/or depression and anxiety should not be ignored. By learning more about how these factors may be related to PTB, we can generate the evidence needed to implement initiatives to improve pregnancy outcomes by addressing pregnant patients’ mental health. Social Determinants of Health that May Impact PTB: As previously established, data shows that PTB is especially prevalent in developing countries and among individuals of a lower socioeconomic status. This points to the fact that one’s environment and circumstances in life may be related in some way to their risk of PTB. While research on this particular area is limited, there is some evidence that suggests social factors are linked to PTB. For example, Dole et al. observed that a high score on a standardized racial discrimination scale was associated with an increased risk of PTB. Moreover, they found that women with the highest scores on a gender discrimination scale, as well as those who had a high perception of living in an unsafe neighborhood, showed a slightly increased risk of PTB. Many studies have also found that being of a minority race or ethnicity (especially African American), coming from a low-income household, and having a low level of education are associated with PTB. For instance, one study found that being African American and having a low level of education was associated with PTB (Copper et al.). Another interesting subset of research on PTB has hypothesized that living in a stressful environment may make individuals more likely to engage in harmful behaviors, which can contribute to an elevated risk of PTB. Copper et al. found that stress was significantly associated with drug and tobacco use, two things that have been associated with a higher risk of PTB. Likewise, a similar study found that women who reported “feeling more depressed” on a standardized depression scale were more likely to smoke cigarettes or marijuana, consume alcohol, do cocaine, and/or experience unhealthy weight gain, all of which can contribute to negative gestational outcomes including PTB (Zuckerman et al.). While these are insightful studies, it should be noted that these results do not point to whether stress and depressive symptoms are a cause or an effect of negative health behaviors. Nonetheless, while some of these studies make it difficult to determine the direction of causality, there is a good deal of evidence which suggests that factors like socioeconomic status are in some way related to PTB. As such, social determinants of health cannot be completely ignored as possible contributors to an elevated risk of PTB. Limitations and Future Research: While the studies presented in this article are an important contribution to the discussion surrounding the etiology of preterm birth, they are not without limitations. One of the biggest restrictions is that the majority of studies presented here are observational, which presents the possibility of issues like residual confounding and recall bias. Additionally, many of the more niche studies, such as those on the relationship between stress and unhealthy behaviors, have not been replicated. While results of such studies may have been significant, repetition of these studies is needed to draw more concrete conclusions. A third limitation is that the subjects in many of the presented studies were primarily of a lower socioeconomic status. This does not invalidate the results of any of these studies, but it does mean that research involving subjects of other demographic characteristics must be conducted in order to generalize the results to a wider population. While the body of literature on the relationship between stress and preterm birth has grown significantly over the past few decades, additional research is needed to strengthen the current literature and bring the issue of stress to the attention of medical and public health professionals. Because the direct mechanisms responsible for preterm are physiological in nature, more research should focus on how the body’s response to stress may elevate one’s risk for premature delivery. Furthermore, it should be acknowledged that most of the current literature focuses on preterm birth in the United States. Given that the prevalence of preterm birth is highest in countries in Africa and Asia, more research should be done on these populations. As it stands, physical wellbeing remains the primary concern of prenatal care. While it cannot be understated that physical health is vital to a healthy pregnancy, research suggests that addressing the psychological needs of soon-to-be mothers is also incredibly important. From the available data, we see supporting evidence for a correlation between PTB and stress, anxiety, depression, and/or other psychosocial factors. Information generated by these studies demonstrates the need for a greater focus on mental and psychosocial health among pregnant patients. Furthermore, such research serves as a foundation for future research, which will further convince the medical community of the importance of evaluating the impact that stress and related issues may be having on those who are pregnant. By embracing the current literature and conducting further research on the relationship between psychosocial factors and preterm birth, we can begin to take initiatives to improve perinatal care and lower the incidence of preterm birth. Works Cited Becker, Martin, et al. “Deleterious and Protective Psychosocial and Stress-Related Factors Predict Risk of Spontaneous Preterm Birth.” American Journal of Perinatology, vol. 40, no. 01, Thieme Medical Publishers (Germany), May 2021, pp. 074–88, https://doi.org/10.1055/s-0041-1729162. Accessed 20 Mar. 2024. Cao, Guiying, et al. “Global, Regional, and National Incidence and Mortality of Neonatal Preterm Birth, 1990-2019.” JAMA Pediatrics, May 2022, https://doi.org/10.1001/jamapediatrics.2022.1622. Copper, Rachel L., et al. “The Preterm Prediction Study: Maternal Stress Is Associated with Spontaneous Preterm Birth at Less than Thirty-Five Weeks’ Gestation.” American Journal of Obstetrics and Gynecology, vol. 175, no. 5, Nov. 1996, pp. 1286–92, https://doi.org/10.1016/s0002-9378(96)70042-x. Dole, N. “Maternal Stress and Preterm Birth.” American Journal of Epidemiology, vol. 157, no. 1, Jan. 2003, pp. 14–24, https://doi.org/10.1093/aje/kwf176. Goldenberg, Robert L., et al. “Epidemiology and Causes of Preterm Birth.” Lancet (London, England), vol. 371, no. 9606, 2008, pp. 75–84, https://doi.org/10.1016/S0140-6736(08)60074-4. Hoffman, M. Camille, et al. “Measures of Maternal Stress and Mood in Relation to Preterm Birth.” Obstetrics & Gynecology, vol. 127, no. 3, Mar. 2016, pp. 545–52, https://doi.org/10.1097/aog.0000000000001287. Kramer, M. S., et al. “Stress Pathways to Spontaneous Preterm Birth: The Role of Stressors, Psychological Distress, and Stress Hormones.” American Journal of Epidemiology, vol. 169, no. 11, Apr. 2009, pp. 1319–26, https://doi.org/10.1093/aje/kwp061. Lilliecreutz, Caroline, et al. “Effect of Maternal Stress during Pregnancy on the Risk for Preterm Birth.” BMC Pregnancy and Childbirth, vol. 16, no. 1, Jan. 2016, https://doi.org/10.1186/s12884-015-0775-x. Orr, Suezanne T., et al. “Maternal Prenatal Pregnancy-Related Anxiety and Spontaneous Preterm Birth in Baltimore, Maryland.” Psychosomatic Medicine, vol. 69, no. 6, July 2007, pp. 566–70, https://doi.org/10.1097/psy.0b013e3180cac25d. Accessed 6 Mar. 2020. Sanchez, Sixto E., et al. “Risk of Spontaneous Preterm Birth in Relation to Maternal Depressive, Anxiety and Stress Symptoms.” The Journal of Reproductive Medicine, vol. 58, no. 0, 2013, pp. 25–33, www.ncbi.nlm.nih.gov/pmc/articles/PMC3662498/. Szegda, Kathleen, et al. “Prenatal Perceived Stress and Adverse Birth Outcomes among Puerto Rican Women.” Journal of Women’s Health, vol. 27, no. 5, May 2018, pp. 699–708, https://doi.org/10.1089/jwh.2016.6118. Tanpradit, Kittikhun, and Kasemsis Kaewkiattikun. “The Effect of Perceived Stress during Pregnancy on Preterm Birth.” International Journal of Women’s Health, vol. Volume 12, Apr. 2020, pp. 287–93, https://doi.org/10.2147/ijwh.s239138. Vidal, Adriana C., et al. “Maternal Stress, Preterm Birth, and DNA Methylation at Imprint Regulatory Sequences in Humans.” Genetics & Epigenetics, vol. 6, Jan. 2014, p. GEG.S18067, https://doi.org/10.4137/geg.s18067. Walani, Salimah R. “Global Burden of Preterm Birth.” International Journal of Gynecology and Obstetrics, vol. 150, no. 1, 2020, pp. 31–33, https://doi.org/10.1002/ijgo.13195. 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By: Joe Clark Photo Credit: Saudi Arabia Vision 2030 The Arab Spring was a monumental turning point in the history of the Middle East and North Africa. In late 2010, after decades of rising youth unemployment, diminishing economic opportunities, and growing resentment toward widely authoritarian and corrupt governments, protests erupted across the region. The ensuing wind of change upended its political order, with revolutions occurring in multiple states which either established democracies or devolved into civil war. Despite the mixed results of these mass uprisings, one country can claim to have not experienced any of its impacts at all: Saudi Arabia. The Kingdom only saw minor protests at the time, which were quickly crushed, an example of the not-so-hidden ways that the state has been able to placate Saudi society. The reason Saudi Arabia managed to escape the turmoil was not some hidden state secret. It was because the rules of society simply worked differently there. Saudi Arabia lacks the social contract of many states in which citizens pay taxes and expect the state to act in their interests. Instead, the state provides everything Saudi citizens need to survive and therefore they do not feel the need to be involved with their government, but this unique situation is unlikely to last. When it gained its independence from the Ottoman Empire following World War I, the Arabian Peninsula was considered to be a wasteland inhabited by poor and violent nomads, by Western observers. Different Bedouin tribes who followed different Islamic sects and adhered to tribalist monarchism, engaged in wars over land which was considered to be worthless. But shortly after the House of Saud managed to establish control over most of the peninsula in the 1930s, large quantities of oil were discovered under the sands. Overnight, Saudi Arabia became a primary player on the global stage, rising to become the world’s largest oil exporter, and allowing a unique social contract to form: Saudi citizens would support an Islamist Absolutist Monarchy with very few social freedoms, so long as the royal family gave them everything they financially needed. Saudi citizens pay few taxes and have most expenses subsidized by the government, including housing, healthcare, and education. This was funded through the operations of Aramco, the state-owned oil company. The Saudi economy did not Industrialize  and diversify when government investment was placed entirely on the oil sector, and political opponents could simply be bribed into submission. Saudi Arabia was able to maintain this political system as most of the world embraced democracy. The Saud family saw no problems with enforcing strict regulations such as outlawing movie theaters or banning women from driving or traveling without a male partner because there was no incentive to do otherwise. But in the mid 2000s, this all changed. Oil prices began to fluctuate and at times, ran too low for Aramco to make a profit, which the Saudi government realized would not be temporary. In recent years, the world has begun to shift away from oil as most major economies attempt to reach net-zero carbon emissions by 2050, and the price of renewable energy declines. Global oil demand is expected to decline by 71% that year, with its growth further anticipated to slow significantly in the next five years alone. Due to this, a 2015 assessment stated that by 2030, Saudi household income would drop by 20%, unemployment would nearly double and government assets would drop from $900 billion USD to negative $2 trillion. For these reasons, the Saudi government has recognized that a system that relies on a commodity for over 40% of its GDP is unsustainable and vulnerable. Currently, 63% of the Saudi population is under 30 years old, of which 65% remain unemployed with little economic opportunities. Roughly a quarter of the population lived in poverty when statistics were collected a decade ago.  Efforts to alleviate the situation have been hampered by corruption within the royal family and strict restrictions on women employment, which makes it significantly harder for female-led households to have a stable income. These conditions, similar to those experienced in other countries prior to the Arab Spring, could lead to resentment and revolt unless  the Saudi government implemented major reforms. The man who has chosen to undertake this task has been Mohammad Bin Salman. After coming to power as Crown Prince in 2016 through an internal coup, Salman has essentially ruled as de facto king. He quickly consolidated power by imprisoning his rivals in the Ritz- Carlton Hotel in Riyadh in 2017, during which billions of dollars were confiscated in a supposed anti-corruption operation. Most importantly in 2016, he unveiled  Vision 2030, a project seeking to overhaul the Saudi economy through incentivizing private investment through economic and  limited social reforms, pushing to rapidly diversify the economy. Salman amassed hundreds of billions of dollars worth of Saudi assets into a Public Investment Fund which he intended to spend on achieving this goal. It included launching a foreign tourism sector which required lifting movie theater bans and attracting music festivals, sporting events, and a planned Six Flags park. Women can now drive, leave the country without permission from male guardians, and dress more liberally under relaxed rules. The Saudi government has attempted to improve its public image around the world through sports leagues and other forms of global entertainment, and has abolished the radical Islamist doctrine once espoused and taught in schools, with the royal family distancing itself from other radical Islamists. Nevertheless, Saudi Arabia still remains a highly authoritarian state, with Salman himself greatly playing a role in the 2017 assassination of American journalist and government critic Jamal Kashoggi and a brutal war in Yemen which has left countless civilians dead. These stains on the Kingdom’s reputation has made investing in the country controversial, which coupled with continual royal infighting and harsh business restrictions has reduced the efficacy of Vision 2030. Case in point, the Saudi economy has vastly underperformed against the project’s targets, with. The percentage of GDP of the private sector and foreign direct investment (FDI) expected to reach 65% and 5.7% respectively from a start of 40% and 3.8% in 2016, but with the former only increasing by 2.7 points and the latter decreasing to 0.57% by 2021. Diversification has also not occurred at the pace needed with non-oil exports only reaching 22.4% of GDP in 2021 from a 2016 start of 16%, much away from a 2030 goal of 50%, and unemployment has grown by 0.1 points to 11.7% while the plans calls for a decrease to 7% within the next seven years. Saudi Arabia is facing a similar dilemma that the Soviet Union did in the late 1980s: the trade-offs that greater political liberalization may entail, between improved economic conditions or the encouragement of regime dissent or resistence. Current and proposed ideas, such as “The Line City” mega project are unlikely to fix this situation  and are likely to cause further problems due to their vulnerability to corruption. Saudi citizens are highly educated (58% have college degrees), and are disillusioned about the current state of affairs, recognizing that greater change will be needed to bring the economy into the 21st Century. Information and new ideas spread quickly throughout the highly digitized nation, and as citizens are compelled to pay a higher and higher tax burden, and may become increasingly hostile towards a royal family viewed as not carrying their fair share, calls for action could spread, and a full-out uprising might begin. One potential off-ramp that could be  used to avoid this confrontation is to replicate the “Chinese  Model” of economic liberalization without democratization. In the Chinese model, a diverse semi-free market economy is allowed to exist although control of the market is still centralized in the government and social liberalization such as civil rights and democratization does not occur. The Vision 2030 appears to push for a similar model albeit with some limited social reforms. In fact, after the failures of the post-Arab Spring democracies to alleviate economic grievances and to stabilize, their political elites turned towards this Model to maintain their dominance. But, in examining Chinese conditions, where economic growth has stalled in recent years, while citizens and corporations have only supported the current system due to its previous economic success, and are still quite open to democracy; this may not be fruitful for the Saudi regime to adopt. Forced between two paths, the Saudi royal family must choose to continue with the political and economic liberalization which would help it move beyond oil, or to stick with its autocratic structures and society. Nonetheless, the question is not whether Saudi Arabia’s theocratic monarchy will end but how, as current and future trends will place pressure for the regime to inevitably change. 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