Public Health Benefits Research Articles

Examination of patients presenting to the emergency department as "apparently drunk".

Alcohol, a significant public health concern, contributes to a substantial burden on emergency services. Identifying avoidable causes of Emergency Department (ED) presentations may reduce hospital overcrowding and benefit public health. This prevalence study aims to provide a detailed analysis of patients presenting to the ED at Mercy University Hospital (MUH) as "Apparently Drunk" in 2022 and 2023. Data were sourced from the Integrated Patient Management Information System at MUH. All patients recorded as "Apparently Drunk" were included. Data collected included demographics, associated injuries or complaints, mode of arrival, admission status, and discharge status. Descriptive statistics were used to summarise the data and trends were examined by comparing 2022 and 2023 data. A total of 1662 presentations were categorised as "Apparently Drunk," representing 3% of all ED visits. There was an 18% increase in such presentations from 2022 to 2023. The majority of patients were male (72%). The median age was 39years. Notably, 23% of the presentations involved people experiencing homelessness, and 81% were conveyed by ambulance. Significant associated injuries included head injuries (7%), falls/collapses (6%), mental health issues (5%), and assaults (4%). The findings indicate a growing trend in patients presenting to the ED as "Apparently Drunk". The high incidence among people experiencing homelessness and the substantial resource utilisation underscores the need for targeted public health interventions and integrated services. Policymakers should consider these findings in the context of potential legislative changes that may impact alcohol availability.

Knowledge and Use of Menthol-Mimicking Cigarettes Among Adults in the US

Cigarette companies have been introducing synthetic cooling agent menthol-mimicking cigarettes into the US marketplace as menthol cigarette bans are implemented. These cigarettes may reduce the public health benefits of menthol cigarette bans. To examine the epidemiology of the use of synthetic cooling agent menthol-mimicking cigarettes among adults in the US. This population-based cross-sectional survey study of adults in the US (≥21 years) with oversampling of Asian, American Indian or Alaska Native, Black or African American, and Hispanic or Latino peoples was conducted from March to May 2024. Participants were recruited from an online panel using a sample-matching approach to achieve national representation. Data were weighted to be nationally representative. Descriptive statistics were used to summarize the population characteristics. Weighted prevalence of awareness of, ever use (among those aware), current use (among ever used), susceptibility (among noncurrent use), and likely to switch to synthetic cooling agent menthol-mimicking cigarettes were estimated overall and by covariate. Sequential weighted logistic regression models were used to estimate the associations between covariates and synthetic cooling agent menthol-mimicking-related outcomes (awareness, ever use, current use, susceptibility). Statistical analysis was performed from July to September 2024. Demographics, state menthol cigarette ban, cigarette smoking, and disclosure of synthetic cooling agent. Awareness of, susceptibility to, ever and currently using synthetic cooling agent menthol-mimicking cigarettes and intention to switch to these cigarettes if a nationwide menthol cigarette ban were enacted. The study population included 3200 US adults (47.4% men; 0.8% American Indian or Alaska Native, 5.9% Asian, 12.0% Black or African American, 16.0% Hispanic or Latino, 63.6% White, and 1.9% other race; 34.8% with a college degree; and 36.7% with annual household income of ≥$75 000). Overall, 29.1% (95% CI, 27.0%-31.1%) of US adults were aware of synthetic cooling agent menthol-mimicking cigarettes, 36.9% (95% CI, 33.1%-40.8%) of those aware ever used these cigarettes, 24.7% (95% CI, 20.1%-29.3%) of those who ever used reported currently using these cigarettes, and 37.5% (95% CI, 33.4%-41.6%) of those not currently using were susceptible to using them. Black or African American (vs White), men (vs women), adults aged 60 years or younger (vs adults aged ≥61 years), adults who used menthol and nonmenthol cigarettes (vs adults who did not smoke cigarettes), and those who lived in states with a menthol cigarette ban (vs those who lived in states with no ban) had higher odds of awareness, ever use, current use, and/or susceptibility to these cigarettes. Considering a national menthol cigarette ban, 50.8% (95% CI, 42.8%-58.7%) of adults who smoked menthol cigarettes and were aware of menthol-mimicking cigarettes with a synthetic cooling agent reported likely to switch to these cigarettes. Ever using these cigarettes was associated with the likelihood of switching (adjusted odds ratio, 2.61 [95% CI, 1.20-5.68]). In this survey study of US adults, a substantial proportion were aware of and had already experimented with synthetic cooling agent menthol-mimicking cigarettes. These products may serve as a substitute for menthol cigarettes and reduce the public health benefits of a menthol cigarette ban in promoting smoking cessation.

Association between activity quotient and cause-specific mortality - A prospective cohort study of 0.5 million participants in Asia.

Regular physical activity (PA) is important for reducing the risk of chronic diseases and improving overall health. Activity Quotient (AQ) is a novel metric that translates heart rate during PA into a weekly score, providing an objective measure of an individual's PA. We prospectively examined the association of AQ with cancer and cardiovascular (CVD) mortality outcomes, the two major causes of death, in a Taiwanese population. A cohort of 515,608 healthy adults (52 % women) enrolled in a standard medical screening program was followed for mortality outcomes. The weekly AQ score of each participant was estimated based on self-reported PA intensity and weekly duration, and placed into six categories (0, ≤50, 51-99,100-149, 150-199, or ≥ 200 AQ per week). We used multivariable Cox proportional hazard models adjusted for potential confounders to estimate the hazard ratios (HR) and 95 % confidence intervals (CI). Higher weekly AQ scores were associated with lower risks of CVD, cancer, and all-cause mortalities. Compared with inactive individuals, HRs (CI) for the association of AQ scores of ≤50, 50-99, 100-149, 150-199, and ≥ 200 were 0.93 (0.89-0.97), 0.91 (0.85-0.96), 0.84 (0.77-0.91), 0.84 (0.74-0.96), and 0.81 (0.73-0.90) with cancer mortality; and 0.88 (0.83-0.93), 0.86 (0.80-0.93), 0.81 (0.73-0.90), 0.71 (0.60-0.85), and 0.73 (0.64-0.84) with CVD mortality, respectively. Subgroup analyses showed that meeting 50 AQ a week was associated with lower risk of disease specific mortality risk across age groups and among individuals with known risk factors. Higher weekly AQ scores were also associated with longer life expectancy, with the highest gains observed among those achieving 150-199 weekly AQ. Our findings show that AQ may be an objective tool for assessing and tracking PA and predicting mortality risks. Encouraging individuals to achieve ≥50 AQ a week could have substantial public health benefits, including lower mortality from major chronic diseases as well as prolonged health- and life expectancy.

Reducing Agricultural Land Use Through Plant-Based Diets: A Case Study of Romania.

Agricultural systems face increasing global pressure to address sustainability challenges, particularly regarding land use and environmental protection. In Romania, where traditional diets are heavily dependent on animal-based products, optimizing land use is critical. This study investigates the potential of plant-based diets to reduce agricultural land use, examining scenarios of partial and complete replacement of animal protein with plant protein sources (soy, peas, and potatoes). The research modeled three dietary transition scenarios-replacing 33%, 50%, and 100% of animal protein with plant-based protein-using data from the Romanian National Institute of Statistics, the FAO, and international sources. Land use was calculated for each scenario using formulas that take into account protein content and land use intensity for animal and plant protein sources. The simulations quantify the reduction in agricultural land use at the per capita and national levels. The study reveals significant land-saving potential across all scenarios. At the national level, land use reductions ranged from 84,020 hectares (33% replacement) to 1,067,443 hectares (100% replacement). High-impact products such as beef and dairy continue to dominate land use, even in partial replacement scenarios. Conversely, replacing pork and chicken proteins shows substantial savings. The findings highlight the inefficiency of animal-based protein production and the ecological benefits of transitioning to plant-based diets. A dietary shift towards plant-based protein in Romania could achieve significant reductions in agricultural land use, contributing to the Sustainable Development Goals. This transition not only supports environmental conservation and resource optimization, but also provides public health benefits by reducing consumption of red and processed meat. These results provide a basis for policies to promote sustainable and nutritionally balanced food systems.

Empowering India’s fight against cervical cancer: Harnessing routine HPV immunisation

ABSTRACT Cervical cancer, driven by human papillomavirus (HPV) infection, presents a significant health challenge in India, marked by high morbidity and mortality rates among women. This systemic review synthesises the latest research on HPV epidemiology in India, evaluates the effectiveness of existing vaccination programmes and compares India’s strategies with those of countries that have successfully mitigated cervical cancer burden. Despite available vaccines targeting high-risk HPV types, vaccine coverage remains suboptimal due to challenges, such as accessibility, vaccine hesitancy and socioeconomic barriers. Comparative analysis suggests that school-based and community engagement strategies could enhance vaccination efforts. Addressing India’s cervical cancer burden requires a multifaceted approach that includes expanding HPV vaccination coverage, implementing public awareness campaigns and adopting best practices from global successes. Economic analyses affirm the cost-effectiveness of such strategies, highlighting the potential for significant public health and financial benefits.

Expert perspectives on tuberculosis screening procedures for migrants.

To evaluate the perspectives of tuberculosis experts from different countries regarding national screening procedures. This was a qualitative descriptive study. Data were collected by using electronic, anonymized surveys with experts in tuberculosis in seven different countries within two World Health Organization regions (Europe and Africa). Thematic analysis was employed. The survey results indicate that there are varied perceptions of and experiences with national guidelines on screening for and treatment of tuberculosis (especially in the population tested), the appropriate timing of screening, types of tests, best practices, barriers, and limitations of the screening. The participants highlighted the importance of integrating health care services into the community to achieve people-centered health care. The study also sheds light on the importance of involving trained nurses and social workers in the screening process and of networks to ensure continuity of care. The overall perceptions of the respondents underscore the importance of standardized screening guidelines. The ongoing collaboration between public health services, the private sector, and the community is essential to reduce tuberculosis transmission, as well as to provide substantial public health and economic benefits.

Mapping of US tobacco industry: Companies, products, histories, and market shares.

Data visualization can communicate information clearly and effectively through graphical means. We developed an industry landscape map to help tobacco regulatory scientists and policymakers understand a high-level overview of the US tobacco industry. This kind of mapping of the market data and deep visualization of companies and their products benefits regulatory science and public health policy in supporting potential knowledge gaps in the regulated industry.

Epidemiology of norovirus disease in the first 2 years of life: A prospective multisite cohort study in Lima, Peru.

Norovirus is associated with 18% of acute gastroenteritis (AGE) cases worldwide. We aim to document the norovirus-related AGE incidence in peri-urban areas of Lima (Peru), evaluating the potential impact of a norovirus vaccine introduction. A prospective, community-based pediatric cohort study was established at two sites in Lima. Healthy children between 5 and 18 months were contacted weekly for AGE detection during a 6-month period. Stool samples from AGE cases were tested for norovirus by RT-PCR. Incidence and coinfection of norovirus-associated AGE were analyzed. All norovirus-positive samples were genotyped by Sanger DNA sequencing. Among 498 enrolled children, 461 (93%) completed the follow-up period. We detected 799 AGE cases, yielding 676 valid stool samples. Norovirus was detected in 216 samples (32%), with an incidence of 7.7 episodes per 100 child-months (95% CI: 6.7-8.8). Genotypes GII.4 (31%) and GII.6 (22%) were frequent. Campylobacter (43%) and Salmonella spp. (15%) were the most common coinfections with norovirus. Ninety-five percent of study children had received an oral rotavirus vaccine. Norovirus was the second most frequent cause of AGE in this Peruvian cohort with high rotavirus vaccine coverage. An effective norovirus vaccine would have an important public health benefit in this population.

Cost-effectiveness of nonavalent HPV vaccination in the Netherlands

ABSTRACT Background A bivalent human papillomavirus vaccine (2vHPV) is currently used in the Netherlands; a nonavalent vaccine (9vHPV) is also licensed. Research design and methods We compared the public health and economic benefits of 2vHPV- and 9vHPV-based vaccination strategies in the Netherlands over 100 years using a validated deterministic dynamic transmission metapopulation model. Results Compared to 2vHPV, the 9vHPV strategy averted an additional 3,245 cases of and 825 deaths from 9vHPV-strain-attributable cancers, 4,247 cases of and 190 deaths from recurrent respiratory papillomatosis (RRP), and 1,009,637 cases of anogenital warts (AGWs), with an incremental cost-effectiveness ratio (ICER) of €4,975 per quality-adjusted life year (QALY) gained. The ICER increased in a scenario with increased HPV vaccination coverage rates and was relatively robust to one-way deterministic sensitivity analyses, with variation in the disease utility parameter having the most impact. When catch-up vaccination for individuals ≤26 years of age was added to the model, vaccinating with 9vHPV averted additional cancers and AGWs compared to 2vHPV vaccination. Conclusion Our analyses predict that transitioning from a 2vHPV- to a 9vHPV-based vaccination strategy would be cost-effective in the Netherlands.

The Environmental and Public Health Benefits of Offshore Wind Power Deployment in China.

With the rapid decline in the levelized cost, offshore wind power offers a new option for the clean energy transition of the power sector in China's coastal areas. Here, we develop a power system capacity expansion and operation optimization model to simulate the penetration of offshore wind power in China and quantify the associated health effects. We find that offshore wind power has great potential in mitigating the negative impacts of existing coal-fired power emissions. By deploying cost-competitive offshore wind power, it is projected that by 2050, offshore wind power would contribute 2% to 5% (306-654 TWh) of China's total electricity generation, cumulatively reducing pollutants from the electricity sector by 3% and preventing 165,000 premature deaths. Notably, with the implementation of incentive policies, the scale of offshore wind power deployment expands two to three times, yielding public health benefits that far outweigh the costs of policy implementation.

Positive dementia caregiving in 30 days (PDC30): Study protocol of a randomized controlled trial of a self-guided automated online training program.

The Benefit-Finding Intervention, a face-to-face psychoeducation program with a focus on the positive meanings of caregiving, has been found to reduce depressive symptoms and burden in dementia caregivers. The program was revamped into a computer-delivered web-based program to enable 24/7 access without location restriction. This study evaluates the efficacy of this new online program called Positive Dementia Caregiving in 30 Days (PDC30). A 2-arm (PDC30 vs. waitlist control) parallel-group randomized controlled trial will be conducted. Target sample is 200 mildly depressed dementia family caregivers with internet access and fluency in English, who will be recruited globally through a YouTube video promoted on social media and through service agencies. The primary outcome is depressive symptoms whereas secondary outcomes are anxiety symptoms, burden, and positive gains, all collected at baseline and 1, 2, and 3months. The treatment x time (both linear and quadratic) interaction effects will be examined using mixed-effect regression. Additionally, possible therapeutic mechanisms via strengthened self-efficacy in controlling upsetting thoughts and positive reappraisal coping will be examined in a mediation path model. If positive treatment effects are found, the potential public health benefits, given the ease of access, universal availability, and flexible approach, of this online intervention are considerable.

Exploring the Relationship between Dietary Patterns and Mental Health

Dietary patterns play a crucial role in shaping mental health, as they influence the availability of essential nutrients that support brain function and emotional regulation. The high intake of antioxidants and healthy fats supports brain health, reducing the risk of cognitive decline and neurodegenerative diseases such as Alzheimer’s disease. For example, in patients with depression, markers of systemic inflammation are often significantly greater than in controls, which is indicative of immune system dysregulation. The potential importance of the relationship between dietary patterns or quality and mental health early in the life span. Prospective and intervention studies are now required to improve the level of evidence. Given that the average age of onset for anxiety and mood disorders is 6 years and 13 years, respectively, the potential for early intervention using strategies targeted at improving dietary intake at a population level may be of substantial public health benefit. However, this would require policy action to improve the global food environment. Diets high in processed foods, sugars, and unhealthy fats are linked to an increased risk of mental health disorders such as depression and anxiety. Prioritizing a balanced, nutritious diet can therefore play a crucial role in preventing mental health issues and enhancing overall well-being.

Are Genetically-Modified Foods Made for the Common Good? The Perspectives of the Victoria Islanders

This research investigated the depth of public knowledge on genetically modified food products, and further explored their understanding of the underlining socio-environmental and public health benefits of GM food products within the socio-demographic indices. To achieve this goal, 369 respondents were recruited through a convenience sampling method in Victoria Island, Lagos, Nigeria and data were gathered using a structured questionnaire. The target population for this study comprised "employed adults either residing or working" on Victoria Island, Lagos. The results showed that the majority of respondents (n=232, 62.9%) were knowledgeable about GM foods and their associated issues. However, many believed that people in their neighborhood or community were not well-informed on the topic. However, awareness on GM foods and associated concerns may be associated with sociodemographic factors such as marital status and education (P<0.01). The majority of respondents were well-informed and had an understanding of the environmental and health advantages of GM foods. In fact, about 61.8% believed that GM food production could sustainably decrease the reliance on chemical pesticides, fertilizers, and other energy inputs, along with their ecological impacts. Most respondents did not feel that purchasing or consuming GM foods conflicted with their beliefs or would affect their food choices. This study recommends that the government should actively educate the public on the ecological and health benefits of GM foods and address any safety concerns. Furthermore, the government should implement strict border controls and food labeling for GM products to safeguard consumer rights arising from the preference for the consumption of organic foods. Additionally, sufficient technical and financial assistance should be provided to farmers who subscribe to the organic seeds program for bolstering national food security.

Phylodynamics for HIV Prevention: A Miami-Dade Case Study.

To date, HIV molecular epidemiology (HIV ME) has been primarily used to identify clusters of related infections (cluster detection and response [CDR]) and then address interventions to these clusters. Community groups have raised concern regarding CDR regarding privacy and ethical concerns. Here we demonstrate how an alternative approach to HIV ME can provide public health benefit. A limited dataset for Miami-Dade County provided by the Florida Department of Public Health was curated and annotated by neighborhood health district (NBHD) and genetic linkage (using a genetic distance threshold of ≤ 0.5%) and phylodynamic analyses were performed. Phylodynamic analyses were used to infer viral transmissions into Miami-Dade County, and between NBHDs within the county. 7274 HIV sequences from unique persons collected between 1/1/2015 and 12/31/2021 were analyzed, including 50% of the 7894 new diagnoses during this period. The proportion of sequences in local clusters increased over time. Higher ratios of local introductions, compared to viral egress (i.e., source of local clusters in other NBHDs) were observed in three NBHDs in North Miami [range 1.9-2.5], suggesting earlier diagnosis, but high numbers of susceptible persons not on pre-exposure prophylaxis. South Dade/Homestead had a low ratio (0.3) of local introductions compared to egress, suggesting later diagnosis and less durable suppression. Phylodynamic and genetic linkage analyses can highlight populations and geographic regions that might benefit more from particular types of HIV prevention interventions. These findings will need to be explored by evaluating the impact of scaling up interventions informed by these analyses.

Detecting the role of urban green parks in thermal comfort and public health for sustainable urban planning in Delhi

Urbanization has significantly impacted the environment and urban life, with urban green spaces playing a crucial role in enhancing sustainability and public health. Urban Green Spaces (UGS) offer benefits such as temperature regulation, ecological services, and improved thermal comfort, while providing entertainment, culture, disaster avoidance, and ecological services. This study evaluates the cooling effects of UGS in mitigating the Urban Heat Islands (UHIs) phenomenon in Delhi, India, using satellite imagery to assess the Land Surface Temperature (LST) of 24 parks. We calculated the Park Cooling Intensity (PCI) by applying the mono-window algorithm. We found that parks larger than 1.55 hectares with dense vegetation and water bodies significantly reduced surrounding temperatures by up to 8.28 °C. The PCI effect was significantly influenced by park size, vegetation density, and the presence of water bodies, with larger parks and denser vegetation and water bodies demonstrating enhanced cooling capacity. These findings highlight the importance of integrating green spaces into urban planning as vital infrastructure for enhancing urban resilience, reducing heat-related health risks, and ensuring equitable access to public health benefits. The study also highlights the importance of addressing socio-economic disparities in park accessibility, which have significant implications for equitable urban development. This study emphasized the importance of formulating a strategic urban planning approach that focuses on green spaces' growth, conservation, and equitable allocation, thereby fostering eco-friendly, habitable, and robust urban environments.

Aggregation‐Driven Fluorescence Behavior of EuMOF for Aldehydes Detection

ABSTRACTThis research leverages the fluorescence properties of a europium metal–organic framework (EuMOF) to assess the presence of aldehydes in food. The EuMOF demonstrates three distinct excitation peaks, with an unusual change in fluorescence intensity attributed to the excessive aggregation observed in the initial two peaks. Aldehydes, specifically monoaldehyde compounds (MACs) and dialdehyde compounds (DACs), can engage with the amine groups on the surface of the EuMOF through a Schiff reaction. This interaction disrupts the accumulation process during dilution and allows for the quantification and differentiation of aldehyde compounds based on their unique fluorescence behaviors. By conducting a series of sample dilutions, the ratio between the first two fluorescence excitation peaks can be determined, leading to the creation of a data matrix. The quantitative evaluation of aldehyde‐derived compounds is enabled by deconstructing the original sample matrix using reference matrices of EuMOF and a reaction mixture containing the aldehyde standard. This innovative technique for monitoring aldehydes eliminates the need for sample pretreatment, aldehyde derivatization, and the use of hazardous chemicals in the detection process, offering significant economic and public health benefits.

What to Expect From a Low-Nicotine Product Standard for Cigarettes

This Viewpoint discusses the public health benefits that could be gained if the US Food and Drug Administration (FDA) were to mandate very low-nicotine-content cigarettes (VLNCs).

Taxing tobacco as a strategy to reduce consumption and increase public health benefits in Pakistan.

Tobacco consumption poses a significant challenge to global health and contributes to the increase in noncommunicable diseases and premature deaths. To investigate the potential impact of a 70% tobacco tax on consumption and government revenue in Pakistan. We analysed secondary data from 2011 to 2022 (after imposition of a 70% excise tax) from the Pakistan Bureau of Statistics, Pakistan Social and Living Standard Survey, financial yearbooks and Federal Board of Revenue reports for tobacco consumption and government revenue. Variables included tobacco price inflation, per capita income, cigarette price, federal excise duty, and government revenue. The higher taxes reduced tobacco production by PKR 3.72 billion (≈US$ 13.4 million). Price elasticity analysis indicated an inelastic demand for cigarettes, mostly among the rural populations. Imposition of excise duty of 70% of the retail price caused a decrease in government revenue by PKR 390 million (≈US$ 1.4 million). Implementing 70% taxation on tobacco products is beneficial, however, to fully realize its benefit, there is a need for strict regulation on brand shifting and illegal trade.

Development of a policy brief to reform waterpipe tobacco taxation in Egypt.

Waterpipe tobacco smoking is increasing in Egypt, although there are several interventions to reduce its use. To describe the development of a policy brief to reform waterpipe tobacco taxation in Egypt. During 2019-2022, we synthesized available literature evidence on waterpipe tobacco taxation in Egypt and other countries. We then held a policy dialogue to engage various stakeholders to discuss and finalize a draft policy brief for Egypt. The policy brief proposes 3 elements for improving waterpipe tobacco taxation in Egypt: establishing a public platform for national data on waterpipe tobacco economics; modelling the economic and public health benefits of an improved waterpipe tobacco taxation system; and raising waterpipe tobacco tax level and reforming the taxation structure. Application of the knowledge-to-policy translation framework was instrumental in bridging the gap between evidence synthesis and political framing for the policy brief. More effort should be made to strengthen evidence-informed policymaking, particularly in settings where tobacco control governance is fragmented and tax policies are applied inconsistently.

A comprehensive review on oral nicotine pouches: Available scientific evidence and future research needs.

Oral nicotine pouches (ONPs) are an emergent class of tobacco products that, unlike conventional oral smokeless tobacco products, contain a nicotine powder instead of tobacco leaves. This review synthesizes available data on ONPs in key research domains including survey studies, marketing/advertising studies, chemical characterization and in vitro studies, and clinical studies. Research findings relevant for ONP regulations are summarized, including who uses these products and why, how marketing tactics influence appeal and use intentions, what harmful and potentially harmful constituents they contain, and what acute effects they have on humans. Taken together, the current data suggest that ONPs likely produce less harm to individual users than conventional tobacco products (e.g., moist snuff, cigarettes) and can acutely suppress nicotine/tobacco withdrawal symptoms among current cigarette smokers. Thus, ONPs may be a viable harm reduction option for individuals who switch completely to using them from conventional products. However, randomized controlled trials are needed to determine if established tobacco users would use ONPs long term, and more independent academic research is needed given that most ONP studies to date are tobacco industry-funded. Additionally, ONPs have qualities (e.g., flavors, marketing claims of "tobacco free") that could increase appeal among youth and young adults, and these products can deliver nicotine at levels sufficient to cause dependence; widespread adoption of ONPs among otherwise nicotine-naive individuals may reduce their net public health benefit. This review concludes by suggesting future research directions necessary to increase scientific understanding of ONPs and inform regulations for these increasingly popular products. (PsycInfo Database Record (c) 2024 APA, all rights reserved).