Boston Area Research Articles

Disparities in joint exposure to environmental and social stressors in urban households in Greater Boston

ObjectivesUnderstanding how environmental and social stressors cluster is critical to explaining and addressing health disparities. It remains unclear how these stressors cluster at fine spatial resolution in low to medium-income, urban households. We explored patterns of environmental and social exposures at the household-level and potential predictors of these joint exposures in two environmental justice communities in the Greater Boston area. MethodsWe recruited 150 households in Chelsea, MA and the Dorchester neighborhood of Boston, MA, between 2016 and 2019 and collected data on two domains: environmental and social stressor. For each domain, we fit Latent Class Analysis (LCA) models to exposure data to assess intra-domain variability, and cross-classified the resultant classes to identify joint exposure profiles. We compared differences in the distribution of these profiles by participants' demographic and household characteristics using χ2, Fisher's exact, Analysis of Variance, and Kruskal-Wallis tests. ResultsWe identified two latent classes in each domain: High environmental (n = 90; 60.4%), Low environmental (n = 59; 39.6%), High Social (n = 31; 20.8%), and Low Social (n = 118; 79.2%). Cross-classification yielded four joint exposure profiles: Both Low (n = 46, 30.9%); Both High (n = 18, 12.1%); High environmental-Low Social (n = 72, 48.3%); and Low environmental-High Social (n = 13, 8.7%). Significant group differences were found by housing type (e.g., single-family vs. multi-family) (Fisher's exact p = 0.0016), housing tenure (p = 0.0007), and study site (p < 0.0001). We also observed differences by race/ethnicity, income, and education: households that were Hispanic/Latinx, below the poverty level, and with lower education were more likely to be in the Both High group. ConclusionsOur analyses confirmed that environmental and social stressors cluster in socially disadvantaged households. Housing type, housing tenure, and location of the residence were also strong predictors of cluster membership, with renter and multi-family residents at risk of high exposures to environmental and social stressors.

Cities in Transition and Urban Innovation Ecosystems: Place and Innovation Dynamics in the Case of Boston and Cambridge (USA)

Urban transition is gaining relevance in the academic and policy debate for rethinking urban development strategies toward resilience and sustainability. The transformative power of innovation and knowledge is called upon to speed up the process. In this paper, we address the issue of urban transition by exploring how the urban innovation ecosystem is a crucial factor in operationalizing city transition strategies. For this scope, we propose a methodological approach to identify the city-level innovation ecosystem by connecting innovation dynamics with urban transformation. The objective is to highlight how transition dynamics are spurred by the urban innovation ecosystem in its maturity stage. Therefore, the paper proposes a case study of the Boston area (the cities of Boston and Cambridge, USA) where it is possible to detect a mature urban innovation ecosystem. The case analysis unveiled the urban characterizing factors of the innovation ecosystem. Here, the concentration of innovation activities stimulates the demand for urban transformations, which are managed through urban planning and zoning and specific supportive policy-planning initiatives.

Pandemic Response and Mutual Aid as Climate Resilience: Learning From Community Responses in the Boston Area

Abstract Community responses to the impacts of COVID-19 in working-class communities of color in the Boston area are examples of resilience in action. Building climate resilience is not just about hardening physical infrastructure but also about strengthening social and civic infrastructure to reach and protect the most vulnerable. This article explores the lessons learned from the pandemic for more equitable approaches to climate resilience. We find that community-based organizations and networks are building social capital through mutual aid networks rooted in solidarity, care, and reciprocity and forging new collaborations with government, funders, and service providers. These social capacities have saved lives and can also help transform the systems that produce vulnerabilities and inequities in the first place. Our overarching conclusion is that resilience is rooted in our abilities to work together, mobilize resources, and take care of one another.

HEAR US: a qualitative study of racial discrimination in Boston's Chinatown and empowering change from within the community.

To qualitatively explore the impact of anti-Asian racism in a Chinese community in the greater Boston area. Individual semi-structured interviews (n = 27) were conducted between June and September 2021. Eligible participants were ethnic Chinese immigrants living in the Boston area, who were recruited through a community-based organization and by word-of-mouth. Interviews were conducted in Mandarin and Cantonese and translated into English. Data were coded and analyzed using a directed approach to content analysis. The majority of participants reported personal experiences of anti-Asian racism, ranging from microaggressions to violent attacks. Although lockdown and isolation during COVID-19 affected all communities, the Chinese community suffered unique and prolonged trauma stemming from the fear of violent attacks against Asians. The older person/people, in particular, were severely isolated due to fear of exposure to anti-Asian hate crimes. Participants reported a variety of emotional, mental, and physical health effects associated with feelings of fear, anxiety, isolation, and powerlessness. Many preferred to engage in self-protective behavior changes rather than relying on external resources. Participants advocated for more education, community, and governmental support, and increased allyship between communities of color. These findings provide cultural context on the trauma this population faces and can inform further actions to address the wide range of reported health effects.

Long-term exposure to ambient fine particulate components and leukocyte epigenome-wide DNA Methylation in older men: the Normative Aging Study

BackgroundEpigenome-wide association studies of ambient fine particulate matter (PM2.5) have been reported. However, few have examined PM2.5 components (PMCs) and sources or included repeated measures. The lack of high-resolution exposure measurements is the key limitation. We hypothesized that significant changes in DNA methylation might vary by PMCs and the sources.MethodsWe predicted the annual average of 14 PMCs using novel high-resolution exposure models across the contiguous U.S., between 2000–2018. The resolution was 50 m × 50 m in the Greater Boston Area. We also identified PM2.5 sources using positive matrix factorization. We repeatedly collected blood samples and measured leukocyte DNAm with the Illumina HumanMethylation450K BeadChip in the Normative Aging Study. We then used median regression with subject-specific intercepts to estimate the associations between long-term (one-year) exposure to PMCs / PM2.5 sources and DNA methylation at individual cytosine-phosphate-guanine CpG sites. Significant probes were identified by the number of independent degrees of freedom approach, using the number of principal components explaining > 95% of the variation of the DNA methylation data. We also performed regional and pathway analyses to identify significant regions and pathways.ResultsWe included 669 men with 1,178 visits between 2000–2013. The subjects had a mean age of 75 years. The identified probes, regions, and pathways varied by PMCs and their sources. For example, iron was associated with 6 probes and 6 regions, whereas nitrate was associated with 15 probes and 3 regions. The identified pathways from biomass burning, coal burning, and heavy fuel oil combustion sources were associated with cancer, inflammation, and cardiovascular diseases, whereas there were no pathways associated with all traffic.ConclusionsOur findings showed that the effects of PM2.5 on DNAm varied by its PMCs and sources.

Examining the interactions between working from home, travel behavior and change in car ownership due to the impact of COVID-19

COVID-19 has disrupted society and changed how people learn, work and live. The availability of vaccines in the spring of 2021, however, led to a gradual return of many pre-pandemic activities in Massachusetts in the fall of 2021. Leveraging data that were collected using a map-based survey tool in the Greater Boston area in the fall of 2021, this study explores changes in travel behavior due to COVID-19 and investigates the underlying factors contributing to these changes. First, a structural equation modeling technique is developed to capture the interactions between various travel choices, including working from home, travel mode use and change in car ownership. Moreover, attitudinal factors such as risk perceptions and attitudes towards WFH are incorporated into the framework to explain behavior changes. Second, a discrete choice modeling approach is taken to study shifts in commuting mode choices in the fall of 2021. The results show that in the fall of 2021, people became more likely to use their cars to commute, and for those who bought cars during the pandemic, they tended to work on-site more. Our findings can provide planners and policymakers with information upon which to base travel demand management decisions in the post-pandemic era.

The effect of historic redlining on firearm violence

BackgroundFirearm homicides disproportionately affect young Black men, which in turn have lasting impact of communities of color as a whole. Previous cross-sectional studies have highlighted the role of discriminatory housing policies on the incidence of urban firearm violence. We sought to estimate the effects of racist housing policies on firearm incidence. MethodsFirearm incident data were obtained from the Boston Police Department and point locations spatially joined with vector files outlining the original 1930 Home Owner Loan Corporation (HOLC) Redlining maps. A regression discontinuity design was used to assess the increased rate of firearm violence crossing from historically “desirable” neighborhoods (Green) to historically “hazardous” neighborhoods (Red and Yellow) based on HOLC definitions. Linear regression models were fit on either side of the geographic boundaries with firearm incidents graphed at varying distances and the regression coefficient calculated at the boundary. ResultsCrossing from desirable to Red hazardous designation there was a significant discontinuity with an increase of 4.1 firearm incidents per 1,000 people (95% CI 0.68,7.55). Similarly, when crossing from desirable areas to the Yellow hazardous designation there was a significant discontinuity and increase of 5.9 firearm incidents per 1,000 people (95% CI 1.85,9.86). There was no significant discontinuity between the two hazardous HOLC designations (coefficient -0.93, 95% CI -5.71, 3.85). ConclusionsThere is a significant increase in firearm incidents in historically redlined areas of Boston. This suggests that interventions should focus on downstream socioeconomic, demographic, and neighborhood detriments of historically discriminatory housing policies in order to address firearm homicides.

579-P: Exercise Upregulates Extracellular Vesicles (EVs) Proteins Involved in Immunomodulatory and Mitochondrial Pathways in Human Subjects

Emerging data suggest that single bouts of exercise increase circulating hormones, cytokines, and EVs, and that these circulating factors may play a fundamental role in the beneficial effects of exercise on health. Here, we identify circulating factors in response to both acute exercise and exercise training and determine the effects of nutritional status on these responses. Blood samples were first collected before and immediately after an acute bout of maximal exercise in healthy, lean subjects (N=8, 3M/5F; age=27±2, V̇O2peak=28.4±1.2ml/kg/min). Subjects then completed a 10 wk moderate-intensity aerobic exercise training program (up to 65-70% VO2peak, 4x/week) with the same post-training sample collection. Proteomics (SOMAscan) quantified 1,310 circulating factors. In the untrained state, acute exercise upregulated 196 proteins and after training exercise upregulated only 65 proteins, with 47 proteins simultaneously upregulated in both the untrained and trained state. Interestingly, cellular component analysis showed that 1/3 of these shared proteins are localized in EVs. Next, we determined the baseline effects of exercise training in the fed and fasted state in the absence of acute exercise. Training upregulated 220 and 178 proteins in fed and fasted state, respectively. Exercise training commonly upregulated 120 proteins in the fed and fasted state with 1/3 localized in EVs. Integration using Vesiclepedia of the upregulated proteins in all 4 comparison groups showed 3 upregulated proteins in both acute exercise and training regardless of nutritional status: PPIF, PTPN6, and CLEC1B. These proteins are found in macrophages and neutrophils, and mediate immunomodulatory effects, promote tissue remodeling, and mitochondrial function. As EVs deliver molecules to cells altering their metabolism, they may play an important role in mediating the beneficial effects of exercise and warrant further mechanistic studies. Disclosure M.Vamvini: None. P.Nigro: None. L.Goodyear: None. R.J.W.Middelbeek: Research Support; Novo Nordisk. Funding Daiichi Sankyo; National Institutes of Health (R01DK099511 to L.G.), (5P30DK36836), (F32DK126432), (K23DK114550 to R.J.W.M.); Joslin Diabetes Center (to M.V.); Boston Area Diabetes Endocrinology Research Center (to R.J.W.M.)

Implications of Sea Breezes on Air Quality Monitoring in a Coastal Urban Environment: Evidence From High Resolution Modeling of NO2 and O3

AbstractCoastal urban environments face unique challenges associated with air quality‐meteorology interactions. In this study, high resolution chemical transport modeling over the Greater Boston area was performed to improve our understanding of sea breezes impacts on the spatiotemporal variability of primary and secondary pollutants. We perform WRF‐Chem simulations at 3 km resolution over June 22 to 10 July 2019 (a period that included 10 sea breeze occurrences), and use Pandora tropospheric NO2 column, surface air quality monitoring, and vertical meteorological aircraft profiles for evaluation. The model generally reproduces observed spatiotemporal variability of air pollution during sea breezes well. Tropospheric columns of NO2 predicted by the model and observed by the Pandora instrument show that sea breezes are associated with rapid increases and steep gradients in tropospheric NO2 and confirm accumulation of local primary emissions. Spatial heterogeneity in tropospheric NO2 is strongly governed by inland penetration lengths of the sea breeze front. Process diagnostics show that three sea‐breeze days where O3 observations recorded hourly concentrations &gt;70 ppb have both efficient net chemical O3 production in the boundary layer (&gt;10 ppb/hr) and rapid O3 convergence in the near‐surface convergence zone (&gt;20 ppb/hr). During sea breezes, interactions between photochemistry, the convergence zone inland penetration, and urban NOx titration effects, contribute to strong heterogeneity and high O3 inland that is not captured by the current monitoring network. We discuss monitoring needs and model applications for the sea breeze scenarios, with broad implications for air quality monitoring in coastal urban environments.

Encouraging Improvements to Opioid and Substance Use Disorder Care Quality in Nursing Homes

Encouraging Improvements to Opioid and Substance Use Disorder Care Quality in Nursing Homes

0948 End-to-End utility of the Cardiopulmonary Coupling Sleep Spectrogram in Sleep Medicine

Abstract Introduction Technology has improved the diagnosis and therapeutic tracking of sleep disorders, but remains fragmented. For example, the laboratory polysomnogram and home sleep apnea test is disconnected from the data available from therapy devices. Remote patient monitoring has focused more on apnea metrics rather than sleep quality. There is some value to a device or system which can be used for diagnosis, risk stratification, and tracking of clinical outcomes across different sleep disorders. Methods A method which offers the potential of end-to-end utility in sleep medicine is the cardiopulmonary coupling (CPC) spectrogram. Originally an ECG-base device, the current form is that of a Ring oximeter (finger) with an integrated activity monitor. The oximeter data is processed via Bluetooth in a smartphone, and then transferred to a Cloud-based analysis (www.sleepimage.com). The CPC analysis integrates heart rate variability and ECG or photoplethysmography-derived respiration. Outputs include a Sleep Quality Index and percentage of stable sleep (high frequency coupling which covaries with delta power on the electroencephalogram and is associated with blood pressure dipping), unstable sleep (low frequency coupling), an apnea-hypopnea index, oxygen desaturation index, heart rate profile across the night (dipping or non-dipping heart rate), total sleep time and sleep efficiency. Data from two clinical systems were used: Empower Sleep (an Internet-based “digital sleep clinic”) and Sleep Continuum (a sleep tracking service offered by Neurocare, Inc, in the Boston area). Results Data from over 500 patients across a range of sleep disorders show end-to-end utility of the SleepImage system. These include diagnosis of sleep apnea including multi-night recording, sleep apnea phenotyping (high loop gain and sleep fragmentation), remote patient monitoring during CPAP or oral appliance use, supportive information for diagnosis of hypersomnia, tracking medication effects (sodium oxybate, sedative-hypnotics, acetazolamide), sleep-wake instability in mood disorders and Long-Covid, impaired sleep quality in chronic fatigue syndrome and restless legs syndrome, off-label therapies for central sleep apnea (oxygen, acetazolamide, buspirone), and sleep fragmentation in Long-Covid and parasomnia. Examples from each of these clinical use cases will be shown. Conclusion The CPC-based SleepImage Ring system can provide complete diagnostic, phenotyping, and tracking functions. Support (if any) The Institute for Personalized Sleep Health, BIDMC, Empower Sleep

Longer Times to Delivery of Otolaryngology Care for Patients With Limited English Proficiency.

Limited English proficiency (LEP) is known to contribute to poorer health outcomes and delays in management. However, to our knowledge, no other studies have explored the impact of LEP on delays to care within otolaryngology. This study aims to investigate the relationship between LEP and the time to delivery of otolaryngology care. We retrospectively reviewed 1125 electronic referrals to an otolaryngologist from primary care providers at 2health centers in the greater Boston area, between January 2015 and December 2019. Multivariable logistic regression analyses were conducted to determine if patient LEP status (preferred language non-English and language interpreter use) has an impact on total time to appointment (TTTA). Patients with non-English preferred languages were 2.6 times more likely to experience extended TTTA (odds ratio [OR] = 2.61, 95% confidence interval [CI] = 1.99-3.42, p < .001) relative to English-speaking patients. Patients who required interpreter use were 2.4 times more likely to experience extended TTTA (OR = 2.42, 95% CI = 1.84-3.18, p < .001) relative to patients who did not require an interpreter. There was no difference in age, sex, insurance type, education level, or marital status. TTTA did not vary by diagnosis category (p = .09). LEP is an important factor that influences the time to appointment in our cohort. Notably, the impact of LEP on appointment wait times was independent of diagnosis. Clinicians should recognize LEP as a factor that can impact the overall delivery of care in otolaryngology. Specifically, mechanisms to streamline care for LEP patients should be considered.

Building resilient partnerships: How businesses and nonprofits create the capacity for responsiveness.

Increasingly, businesses are eager to partner with nonprofit organizations to benefit their communities. In spite of good intentions, differences between nonprofit and business organizations can limit the ability of potential partnerships to respond to a changing economic and public health landscape. Using a retrospective, multiple-case study, we sought to investigate the managerial behaviors that enabled businesses and nonprofits to be themselves together in sustainable partnerships. We recruited four nonprofit-business partnerships in the Boston area to serve as cases for our study. Each was designed to address social determinants of health. We thematically analyzed qualitative data from 113 semi-structured interviews, 9 focus groups and 29.5 h of direct observations to identify organizational capacities that build resilient partnerships. Although it is common to emphasize the similarities between partners, we found that it was the acknowledgement of difference that set partnerships up for success. This acknowledgement introduced substantial uncertainty that made managers uncomfortable. Organizations that built the internal capacity to be responsive to, but not control, one another were able to derive value from their unique assets.

Current and legacy effects of precipitation treatments on growth and nutrition in contrasting crops

Changing patterns of precipitation are causing moisture stress in ways that alters crop growth and nutrition. Moisture stress not only directly impacts plant physiology but also indirectly affects plant growth by altering soil conditions. While the direct effects of moisture stress on growth and physiology are well studied, outcomes are often examined only as a consequence of current water stress within a single growing season, without consideration of accumulated moisture-induced changes in soil properties that accrue over many seasons (legacy effects). Moreover, our understanding of the impacts of current and legacy effects on both crop growth and nutrition are lacking. To explore these connections, the infrastructure of the Boston Area Climate Experiment (BACE) was leveraged to examine the responses of kale (Brassica oleracea), oat (Avena sativa) and bean (Phaseolus vulgaris) to three levels of precipitation (ambient, 75 % of ambient, and 50 % of ambient) when grown in legacy soils obtained from 10 years of differential precipitation inputs (high, medium, or low water). Plant growth was measured weekly, and nutritional differences within the edible portions of each crop were assessed at the end of the season. We found that differences in current precipitation affects both growth and nutrients, while legacy effects more strongly affect bionutrient levels than plant growth.

Tribalism [MicroBusiness

Many of us enjoy watching and participating in sports. Team sports, amateur and professional, let us associate with a group—a surrogate tribe. I live in the Boston area, which we like to refer to as <italic xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink">title town</i> , and we are fanatical about our Red Sox, Bruins, Celtics, and Patriots. These teams play games that take the place of battles between tribes. We relish our victories against the “evil” teams representing New York. These games excite and energize us. In some ways, they are emotional substitutes for real battles. Occasionally, passions boil over and result in real violence on the field and off.

A Federated Platform Enabling a Systematic Collaboration Among Devices, Data and Functions for Smart Mobility

Through the vast adoption and application of emerging technologies, the intelligence and autonomy of smart mobility can be substantially elevated to address more diversified demands and supplies. Along with this trend, a systematic collaboration among three essential elements of smart mobility services, namely devices, data and functions, is being studied to comprehensively break down the intrinsic barriers that existed in current solutions, to support the integration of connectable devices, the fusion of heterogeneous data, the composability of reusable functions, and the flexibility in their cooperations. To enable such a collaboration, this paper proposes a federated platform, called Future Mobility Sensing Advisor (FMSA), which can 1) manage the three elements through standardized interfaces separately and uniformly; 2) create a fully connected knowledge graph to orchestrate the three elements efficiently and effectively; 3) support the client-server interaction in centralized and federated modes to handle service requests and edge resources with various availability and accessibilities jointly and adaptively; and 4) accommodate various mobility services to foster harmonious and sustainable mobility tenderly and invisibly. Moreover, the efficiency and effectiveness of the platform are also tested through a performance evaluation, and a pilot supported at the Great Boston Area, respectively. As a result, it shows that FMSA can 1) achieve high performance by using the two interaction modes selectively, and 2) renovate smart mobility towards sustainability through personalized services that can measure user preferences and system objectives mutually.

Personal and community-level exposure to air pollution and daily changes in respiratory symptoms and oxygen saturation among adults with COPD

BackgroundAir pollution exposure is associated with hospital admissions for Chronic Obstructive Pulmonary Disease (COPD). Few studies have investigated whether daily personal exposure to air pollutants affects respiratory symptoms and oxygenation among COPD patients. MethodologyWe followed 30 former smokers with COPD for up to 4 non-consecutive 30-day periods in different seasons. Participants recorded worsening of respiratory symptoms (sub-categorized as breathing or bronchitis symptoms) by daily questionnaire, and oxygen saturation by pulse oximeter. Personal and community-level exposure to fine particulate matter (PM2.5), nitrogen dioxide (NO2), and ozone (O3) were measured by portable air quality monitors and stationary monitors in the Boston area. We used generalized and multi-level linear mixed-effects models to estimate associations of the 24-hour average of each pollutant in the previous day with changes in respiratory symptoms and oxygen saturation. ResultsHigher community-level exposure to air pollutants was associated with worsening respiratory symptoms. An interquartile range (IQR) higher community-level O3 was associated with a 1.35 (95%CI: 1.07–1.70) higher odds of worsening respiratory symptoms. The corresponding ORs for community-level PM2.5 and NO2 were 1.18 (95%CI: 1.02–1.37) and 1.06 (95%CI: 0.90–1.25), respectively. Community-level NO2 was associated with worsening bronchitis symptoms (OR=1.25, 95%CI: 1.00–1.56), but not breathing symptoms. Personal PM2.5 exposure was associated with lower odds of worsening respiratory symptoms (OR=0.91; 95%CI: 0.81–1.01). Personal exposure to NO2 was associated with 0.11% lower oxygen saturation (95%CI: -0.22, 0.00) per IQR. ConclusionsIn this COPD population, there was a pattern of worsening respiratory symptoms associated with community-level exposure to O3 and PM2.5, and worsening oxygenation associated with personal exposure to NO2.

Association Between Ghrelin and Body Weight Trajectory in Individuals With Anorexia Nervosa

Individuals with anorexia nervosa maintain extremely low body weights despite elevations in the circulating orexigenic hormone ghrelin. Whether circulating levels of endogenous ghrelin are associated with weight gain in anorexia nervosa is unknown. To examine the association between baseline ghrelin and future weight change in individuals with anorexia nervosa. This prospective cohort study was conducted between April 1, 2014, and March 31, 2020, in the US. Girls and women aged 10 to 22 years were recruited from the greater Boston area from community and area treatment centers, enrolled, and followed up for 18 months. Statistical analyses were performed between January and August 2022. Presence or absence of anorexia nervosa and elevations in endogenous ghrelin. Changes in age- and sex-standardized body mass index percentiles from baseline to 9- and 18-month follow-up were the main outcomes of interest. A total of 68 girls and young women (11 [16%] Asian, 4 [6%] Hispanic or Latina, 51 [75%] White [non-Hispanic or Latina], and 2 [3%] other race or ethnicity), including 35 with anorexia nervosa and 33 healthy controls of similar Tanner stage, were included in this study. Anorexia nervosa and healthy control groups were not statistically different by race and ethnicity, Tanner stage, number completing follow-up visits, and the duration between baseline and follow-up visits. At baseline, individuals with anorexia nervosa were slightly older (median [IQR], 20.1 [18.5-21.0] vs 18.7 [14.7-19.4] years; P = .005), had lower body mass index percentiles (median [IQR], 2.4 [0.3-4.7] vs 52.9 [40.4-68.3]; P < .001), and had elevated circulating ghrelin area under the curve composite index (median [IQR], 1389.4 [1082.5-1646.4] vs 958.5 [743.0-1234.5] pg/mL; P = .003) compared with healthy individuals. In linear mixed-effects regression analyses, baseline ghrelin was associated with prospective weight gain after adjusting for diagnosis, age, race, and duration of follow-up (odds ratio, 2.35; 95% CI, 1.43-3.73; P = .004). In this cohort study, endogenous ghrelin was associated with longitudinal weight gain in individuals with anorexia nervosa. Further studies are warranted to confirm this result and examine its potential clinical utility in treatment development.

A randomized controlled trial of varenicline and brief behavioral counseling delivered by lay counselors for adolescent vaping cessation: Study protocol.

Approximately one-fifth of high-school seniors and college students currently vape nicotine. Adolescents express a desire to quit vaping, and case reports have shown promise for e-cigarette tapering with dual behavioral and pharmacologic therapies. However, there are no published clinical trials to date that test these intervention approaches for adolescent nicotine vaping cessation. In this three-arm randomized, placebo-controlled, parallel-group study, we aim to assess the efficacy of varenicline in combination with brief behavioral counseling and texting support on vaping cessation in adolescents dependent on vaped nicotine. The study will enroll 300 individuals between the ages of 16-25 with daily or near-daily nicotine vaping who reside in the Greater Boston area. Participants will be randomly assigned in a 1:1:1 ratio in blocks of six to one of the three arms: (1) a 12-week course of varenicline titrated to 1 mg bid, brief behavioral counseling delivered by a lay counselor, and an introduction to This is Quitting (TIQ) texting support created by the Truth Initiative; (2) a 12-week course of placebo, brief behavioral counseling, and TIQ; and (3) 12 weeks of enhanced usual care, consisting of advice to quit and an introduction to TIQ. The primary outcome will be biochemically verified continuous vaping abstinence at the end of the treatment (week 12). Secondary outcomes include continuous abstinence at follow-up (week 24), 7-day point prevalence abstinence at weeks 12 and 24, safety and tolerability of varenicline in an adolescent vaping population, as well as change in mood and nicotine withdrawal symptoms across the intervention period. Exploratory outcomes include change in comorbid substance use behaviors and nicotine dependence. Analysis will be intent-to-treat, with multiple imputation sensitivity analyses for participants with missing or incomplete outcome data. This is the first study to evaluate varenicline in combination with a novel, brief, lay counselor delivered vaping cessation program for adolescents who vape nicotine. Results will inform clinicians on the effectiveness and acceptability of this promising, but not yet tested intervention.Clinical trial registration: ClinicalTrials.gov, identifier NCT05367492.

Op-Ed: A Country of Immigrants, but not in Their Favor

Since 2016 the general American public has become more aware of immigration as a political issue. This Op-Ed’s goal is to share the author’s observations about the U.S.’s asylum process as a caseworker and advocate for asylum seekers. The author has volunteered as a trained caseworker at a Pro-Bono immigration non-profit organization in the Greater Boston Area for nearly four years, working with immigrants from around the world and in very different circumstances. The article concludes by highlighting areas of failure in the asylum system and making resource suggestions for those wishing to learn more.