Past Days Research Articles

Psychosocial determinants of pre-exposure prophylaxis use among pregnant adolescent girls and young women in Cape Town, South Africa: A qualitative study.

In South Africa, at least 7.5million people (age ≥15years) are living with Human Immunodeficiency Virus (HIV). In 2020, 220,000 new infections occurred, approximately one-third of which were among cisgender adolescent girls and women (age ≥15years). The perspectives of pregnant adolescent girls and young women (AGYW) as key, targeted end-users of pre-exposure prophylaxis (PrEP) in this setting are not well known. We purposively recruited participants enrolled in an ongoing cohort study at an urban antenatal clinic in Cape Town, South Africa for in-depth interviews between July-September 2020. We restricted our analysis to pregnant AGYW (age: 16-25years) who initiated daily oral PrEP (Tenofovir/Emtricitabine) antenatally and self-reported either high PrEP persistence (≥25days in the past 30days and no missed PrEP collection), or low PrEP persistence and/or discontinuation (missing >5days in the last 30days or missed PrEP collection). The findings were organized thematically, per the adapted Health Behavior Model (2000), using Nvivo-v.1.5. We interviewed 18 AGYW (mean age = 22years), at a mean of 14weeks postpartum. Higher self-esteem and high-quality study provider-client relationships, including empathic psychosocial support, facilitated PrEP continuation. Reported barriers included unstable social structure characteristics (i.e., financial hardship) and individual factors (i.e., unintended pregnancy, parental rejection, and inadequate peer- and [non-cohabiting] partner support). Participants self-perceived a need for PrEP, feeling susceptible to non-consensual, forced sex, or considering partners' (presumed) sexual risk-taking. Limited community awareness regarding PrEP availability and/or perceived complexity in navigating health system access to PrEP, impede continuation. PrEP-focused healthcare access pathways for pregnant and postpartum AGYW need to be simplified. Further research is needed on health system determinants (i.e., structural barriers, provider-client interactions, and related outcomes) of oral PrEP utilization. In 2022, South Africa announced regulatory approval of long-acting PrEP options (i.e., the dapivirine ring for non-pregnant women and injectable cabotegravir, respectively); these may mitigate implementation barriers reported in this study. However, the safety and efficacy of long-acting PrEP (e.g., injectables, implants) among pregnant or breastfeeding women, specifically, remains to be confirmed in this setting.

Development and Preliminary Validation of an Instrument to Measure Symptoms and Impacts in Patients with Proliferative Diabetic Retinopathy.

Following a review of patient-reported outcome (PRO) instruments in the literature, existing PRO instruments may not adequately capture the experience of receiving treatment for proliferative diabetic retinopathy (PDR). Therefore, this study aimed to develop a de novo instrument to comprehensively assess the patient experience of PDR. This qualitative, mixed-methods study comprised item generation for the Diabetic Retinopathy-Patient Experience Questionnaire (DR-PEQ), content validation in patients with PDR, and preliminary Rasch measurement theory (RMT) analyses. Adult patients with diabetes mellitus and PDR who received aflibercept and/or panretinal photocoagulation within 6months of study initiation were eligible for participation. The preliminary DR-PEQ comprised four scales: Daily Activities, Emotional Impact, Social Impact, and Vision Problems. DR-PEQ items were generated using existing knowledge of patient experiences in PDR and conceptual gaps identified from existing PRO instruments. Patients indicated the level of difficulty conducting daily activities and frequency experiencing emotional impacts, social impacts, and vision problems attributed to diabetic retinopathy and its treatment in the past 7days. Content validity was evaluated in two rounds of in-depth, semi-structured patient interviews. Measurement properties were investigated via RMT analyses. The preliminary DR-PEQ comprised 72 items. Overall, mean (SD) patient age was 53.7 (14.7) years. Forty patients completed the first interview; of these, 30 completed the second interview. Patients reported thatthe DR-PEQ was easily understood and relevant to their experience. Minor revisions, including removal of the Social Impact scale and addition of a Treatment Experience scale, were implemented to generate 85 items spanning four scales: Daily Activities, Emotional Impact, Vision Problems, and Treatment Experience. RMT analyses provided preliminary evidence that the DR-PEQ performed as intended. The DR-PEQ evaluated a broad spectrum of symptoms, functional impacts, and treatment experiences relevant to patients with PDR. Additional analyses are warranted to evaluate psychometric properties in a larger patient population.

Multilevel Risk and Protective Factors for Frequent and Nonfrequent Past-30-Day Marijuana Use: Findings From a Representative Sample of High School Youth.

Research has identified many factors associated with past-30-day (P30D) marijuana use among youth but has not assessed factors that may differentiate youth who use frequently from youth who do not. We took a multilevel approach to identify and compare risk and protective factors associated with frequent and nonfrequent P30D marijuana use among high school students. Individual-level data were obtained from the 2019 Nevada Youth Risk Behavior Survey (completed by 4,980 high school youth from 99 schools); school-level data were obtained from the state's Department of Education. A multinomial, multilevel model was used to estimate the association between risk and protective factors at the individual and school levels and a three-level frequency of use outcome: no P30D use (0 times), nonfrequent P30D use (1-19 times), and frequent P30D use (≥20 times). At the individual level, other P30D substance use, exposure to adverse childhood experiences (ACEs), perceived ease of access, and perceived risk were associated with both frequent and nonfrequent use, but the relationships were generally stronger for frequent use. P30D nonprescription drug use and school connectedness were associated with frequent use only. At the school level, number of students with individualized education programs, number of incidents involving possession of controlled substances, and school type were associated with frequent use only. Individual and school-based interventions designed to address the factors uniquely or strongly associated with frequent marijuana use may prevent escalation from occasional use to more frequent use among high school youth.

Screen Time Correlates of Bullying Perpetration and Victimization in Brazilian Adolescents.

This study is an investigation of the associations of time spent in different screen time activities with bullying among Brazilian adolescents. In this cross-sectional study, adolescents answered questions related to bullying in the past 30days and reported the weekly volume of screen time spent studying, working, watching videos, playing video games, and using social media applications. Multilevel logistic regression models were used. Our results indicate that higher social media use was associated with higher odds of bullying victimization among males but not females. Excessive use of screen time for work and social media purposes was associated with a higher likelihood of bullying victimization.

Perceived Stress, Religiosity, and Substance Use Among African American and Latinx College Students with Asthma in the USA.

This study examined associations among perceived stress, religiosity, and substance use in African American and Latinx college students with asthma. Participants included 194 college students with asthma (18-20years, 63.4% African American, 21.1% Latinx). Eligible students completed an online questionnaire that included measures of asthma control, perceived stress, religiosity, alcohol misuse, and last 30-day tobacco use and marijuana use. Over one-quarter (25.3%) of participants reported using tobacco and 31.9% reported using marijuana in the past 30days. Perceived stress and religiosity were each independently associated with multiple indicators of substance use. Asthma control moderated associations between religiosity and tobacco use in the past 30days (b = - .014, p = .002), such that the association between religiosity and tobacco use was stronger among those with better asthma control. Participant gender significantly moderated the association between perceived stress and alcohol misuse (b = - .099, p = .029); a stronger, positive association between stress and alcohol misuse was found among men. Students' perceived stress levels were associated with marijuana use in the past 30days and high alcohol misuse. Religiosity was inversely linked to substance use. There is a need for healthcare providers to recognize and focus on substance use prevention specifically among African American and Latinx college students with asthma.

Food Insecurity and Transmission Risks Among People with HIV Who Use Substances.

Food insecurity (FI) impacts people with HIV (PWH) and those who use substances (i.e. drugs and alcohol). We evaluated the longitudinal association between FI and HIV transmission risks (unprotected sexual contacts and shared needles/syringes). Among 351 PWH who use substances in Russia, 51.6% reported FI and 37.0% past month injection drug use. The mean number of unprotected sexual contacts in the past 90days was 13.4 (SD 30.1); 9.7% reported sharing needles/syringes in the past month. We did not find a significant association between mild/moderate FI (adjusted IRR = 0.87, 95% CI 0.47, 1.61) or severe FI (aIRR = 0.84, 95% CI 0.46, 1.54; global p = 0.85) and unprotected sexual contacts. We observed a significant association between severe FI and sharing needles/syringes in the past month (adjusted OR = 3.27, 95% CI 1.45, 7.39; p = 0.004), but not between mild/moderate FI and sharing needles/syringes in the past month (aOR = 1.40,95% CI 0.58, 3.38; p = 0.45). These findings suggest that severe FI could be a potential target for interventions to lower HIV transmission.

Methamphetamine use and illicit opioid use during buprenorphine treatment

IntroductionAlthough methamphetamine use is rising in the United States, its impacts on patient outcomes among persons undergoing treatment for opioid use disorder (OUD) remain unclear. This study aims to assess the association between baseline methamphetamine/amphetamine (MA/A) use and subsequent illicit opioid use among patients with OUD initiating buprenorphine in an office-based setting. MethodsWe conducted a secondary analysis of a pilot randomized controlled trial of a behavioral mobile health intervention for buprenorphine adherence conducted over a 12-week study period at two clinic sites. The study defined baseline MA/A use by a positive urine drug test (UDT) and/or self-report of use within the past 30-days. Separate Poisson regression models with robust standard errors evaluated associations between MA/A and: i) illicit opioid use measured by weekly UDT (primary) and ii) self-reported past 30-day use at end of study (secondary). Other secondary outcomes included buprenorphine positive UDTs throughout the study and retention in OUD treatment at both weeks 12 and 24 post-randomization. ResultsAt baseline, 28 (36 %) of the 78 participants had MA/A use and use was associated with a statistically significant increase in risk of testing positive for illicit opioids on UDT during the study follow-up period (adjusted relative risk (aRR) = 1.54; 95 % CI = 1.09–2.17; p = 0.015), as well as an increased risk for reported past 30-day illicit opioid use at week 12 (aRR = 3.86; 95 % CI = 1.47–10.18; P = 0.006). The study found no significant associations between MA/A use and buprenorphine positive UDT or retention in OUD treatment. ConclusionsIn this sample of patients initiating buprenorphine, methamphetamine/amphetamine use at baseline was associated with illicit opioid use over a 12-week period. These findings demonstrate how co-use of methamphetamine can impede attainment of ideal OUD treatment outcomes.

A high pan-immune-inflammation value before chemoradiotherapy indicates poor outcomes in patients with small-cell lung cancer.

Objectives: The objective of our study was to assess the prognostic significance of the Pan-Immune-Inflammation Value (PIV) before concurrent chemoradiation (C-CRT) and prophylactic cranial irradiation (PCI) in patients with limited-stage small-cell lung cancer (SCLC). Methods: The medical records of LS-SCLC patients who underwent C-CRT and PCI between January 2010 and December 2021 were retrospectively analyzed. PIV values were calculated using the peripheral blood samples obtained within the past 7days before the initiation of treatment: PIV = [neutrophils × platelets × monocytes] ÷ lymphocytes. Using receiver operating characteristic (ROC) curve analysis, the optimal pretreatment PIV cutoff values that can partition the study population into two groups with substantially distinct progression-free survival (PFS) and overall survival (OS) outcomes were determined. The relationship between PIV values and OS outcomes was the primary outcome measure. Results: Eighty-nine eligible patients were divided into two PIV groups at an optimal cutoff of 417 [Area under curve (AUC): 73.2%; sensitivity: 70.4%; specificity: 66.7%]: Group 1: PIV < 417 (N = 36) and Group 2: PIV ≥ 417 (N = 53). Comparative analyses revealed that patients with PIV < 417 had significantly longer OS (25.0 vs 14.0months, p < .001) and PFS (18.0 vs 8.9months, p = .004) compared to patients with PIV ≥ 417. The outcomes of the multivariate analysis have verified the independent significance of pretreatment PIV concerning PFS (p < .001) and OS (p < .001) outcomes. Conclusion: The findings of this retrospective study indicate that the pretreatment PIV is a reliable and independent prognostic biomarker for patients with LS-SCLC who were treated with C-CRT and PCI.

Assessment of energy poverty among rural households in Kwara State, Nigeria

ABSTRACT Energy poverty is a widespread phenomenon which is mostly attributed to the poor rural households in developing countries. This study was carried out to assess the energy poverty status and as well analyse the determinants of energy poverty among rural households in Kwara State of Nigeria thus providing information that may lead to improvement in the energy use efficiency of the rural households. A four-staged random sampling technique was used to select 150 rural households from Kwara State and were administered a well-structured questionnaire. The study employed the descriptive statistics, expenditure approach and logit regression model to identify the various energy used for cooking by the rural households, energy poverty status and the determinant of energy poverty in the study area, respectively. The result shows that the household stack the various types of energy with majority of them using the combination of modern and transitional energy types, with 59% using the traditional sources of energy and 49% using the modern sources in the past 7days. About 39% of the rural households were energy non poor, years of schooling, distance to energy source and household income significantly influence the energy poverty of the households. Although majority of the rural households spend above the energy benchmark for this study, however, majority of them uses the traditional sources of energy. The study therefore recommended necessity to establish regulatory frameworks for the protection of poor consumers to guarantee access to modern energy sources at affordable prices, which may involve the incorporation of subsidies.

An investigation of the prevalence of work-related musculoskeletal pain and related disability among poultry slaughterhouse workers: a cross-sectional study.

The poultry slaughterhouse workers (PSW) are at substantial risk of developing work-related musculoskeletal pain (WMSP) at workplace due to their work. This study investigated the prevalence rate of WMSP and related disability among the PSW. A cross-sectional descriptive study was conducted among 78 PSW (40 women and 38 men) in the region of northern Thailand. The prevalence rate of WMSP was evaluated using the Standardized Nordic Musculoskeletal Questionnaire (SNMQ). The disability related to the MSP was evaluated using a series of disability questionnaires. Descriptive statistics were used to evaluate the WMSP. Data on the disability were summarized in frequency, mean (M), standard deviation (SD) and percentage. The prevalence rate of WMSP in the past 7days were higher in the shoulder region (61.5%, N = 48) followed by wrists/hands (60.3%, N = 47), and lower back region (35.9%, N = 28). The WMSP over the past 12months was also high at the shoulder (61.5%, N = 48), wrists/hands (60.3%, N = 47), and neck region (37.1%, N = 29), respectively. The overall disability related to WMSP among PSW was found to be mild to moderate across different body regions. PSW had a high prevalence rate of WMSP in the shoulders, wrists/hands, lower back, and neck regions. However, the PSW with WMSP reported only mild to moderate disability in the work.

The Association of Outdoor Walking Per Week with Mental Health and Costs of Psychotropic Drugs in Adults.

Regular walking confers many physical health benefits, including a reduced risk of disease-specific and all-cause mortality and better physical fitness. However, less is known about its role in mental health. Thus, the aims of this study were to determine the associations of outdoor walking per week with costs of psychotropic drugs used and mental health in adults. 500 adults aged 18 to 64years in Hangzhou (China) reported sex, age, the name of the psychotropic drugs used and their dosage, and outdoor walking during the past 7days. The cost that a person spends on buying psychotropic drugs for a month was considered psychotropic drugs costs. Overall mental health was assessed using the Chinese Version of the 12-Item General Health Questionnaire. The levels of walking in participants taking psychotropic were significantly lower than participants who did not taking psychotropic (p = 0.002). There was a significant negative correlation between mental health scores and minutes of walking per week and a significant positive correlation between the number of psychotropic drugs used and walking per week (p < 0.05). However, no particular associations were found between costs of psychotropic drug used and walking per week. Outdoor walking is prospectively associated with better overall mental health in adults. Then, awareness should be raised about the possible positive effects of outdoor walking on the mental health of adults.

The association between recent cannabis use and urinary incontinence in women: a population-based analysis of the NHANES from 2009 to 2018.

In this study, we investigated the association between recent cannabis use and urinary incontinence(UI) among women using the 2009-2018 National Health and Nutrition Examination Survey. A total of 7889 women aged 20years and older were included in the study. Respondents were dichotomized as recent users or non-users if they had used or not used cannabis in the past 30days, respectively. Urinary incontinence (UI) was ascertained by self-report. Multivariablelogistic regressionmodelswereusedto adjust for sociodemographic and health-related covariates. Among 7889 women, 12.1% (n = 955) of subjects reported recent cannabis use. In the adjusted analysis, recent users were more likely than non-users to report stress, urge and mixed incontinence (OR 1.31, 95% CI 1.12-1.53, p < 0.001; OR 1.40, 95% CI 1.18-1.66, p < 0.001; and OR 1.29, 95% CI 1.12-1.53, p = 0.018). And, the association becomes more significant among heavy users (≥ 20 of the past 30days) (SUI: OR 1.63, 95% CI 1.26-2.09, p < 0.001; UUI: OR 1.72, 95% CI 1.32-2.24, p < 0.001; and MUI: OR 1.64, 95% CI 1.20-2.25, p = 0.0019). Recent cannabis use was associated with an increased likelihood of stress, urge and mixed incontinence in women.

Single-Center Experience on Growth in Infants Born With End-Stage Kidney Disease

Children with chronic kidney disease display poor growth that impacts health outcomes; data on infants with severe congenital anomalies of the kidney and urinary tract (CAKUT) are limited. We examined growth patterns in infants with CAKUT requiring dialysis in the first 30days. This study evaluated infants with severe CAKUT from 2014 to 2018 surviving past 30days. Somatic growth parameters as per standard infant curves and nutritional information were recorded. Twenty four infants met inclusion criteria. Seventeen infants received dialysis, demonstrating somatic growth disruption most profound at a 1-2months postnatal age. Growth trends were improved compared to infants with CAKUT who did not require dialysis. Linear growth failed to normalize by 1year of age. Infants with severe CAKUT are at high risk for early growth failure. Understanding of this deficit and impacts of early dialysis on growth and long-term outcomes are needed to identify targeted nutritional strategies.

Are state minimum jail laws associated with less frequent drunk-driving?

Objectives The current study investigated associations between minimum jail sentences included in state DUI laws and self-reported drunk-driving in the US. Scant existing research has been conducted on this topic. The current study is the first to use Behavioral Risk Factor Surveillance System (BRFSS) data to investigate associations between minimum jail sentences and frequency of self-reported drunk-driving among adults who report drunk-driving. Methods 2020 BRFSS data were used. Analyses were limited to participants aged 18 years and older who reported at least one episode of drunk-driving during the past 30-days. Participants missing data on age, gender, race, income, binge-drinking, or state of residence were excluded from analyses. The final sample size was 3,732. Websites from official state legislatures and/or data from state motor vehicle departments were used to gather current information on DUI minimum jail penalties. A dichotomous variable was created that categorized all 50 states and Washington D.C. as either (i) having a minimum jail sentence for first time DUI offense or (ii) having no minimum jail sentence for first time DUI offense. Multivariable negative binomial regression analyses were conducted using SAS® v9.4. The dependent variable was the number of self-reported drunk-driving episodes. Results Among the sample of adults who reported drunk-driving, residents of states with no minimum jail sentence for a first-time DUI offense had a 32% higher incidence rate of drunk-driving episodes [RR = 1.32,95% CI:0.98–1.77] compared to their counterparts residing in states with a minimum jail sentence for first time DUI offenses. Similar findings were observed in multiple sensitivity analyses conducted. Conclusion There was a marginally significant [p = 0.07] higher incidence rate of drunk-driving episodes among residents of states with no minimum jail sentence compared to those in states with a minimum jail sentence for the first time DUI. This was the first study to use BRFSS 2020 data to investigate this association and only among participants who self-reported drunk-driving. We therefore provide an important contribution to the literature on this association by using the most up to date data and among a valid sample of drunk drivers. Further studies that provide stronger causal inference are needed.

THE ASSOCIATED RISK FACTORS AND PSYCHOSOCIAL ADJUSTMENTS AMONG THE PEER VICTIMISED ADOLESCENTS IN MALAYSIA: A POPULATION-BASED NATIONWIDE STUDY

&#x0D; &#x0D; &#x0D; The objective of this study is to determine the prevalence of victimisation among Malaysian school-attending adolescents with the associated risk factors; and the psychosocial impacts among victims. All data was obtained from the Global School Health Survey Malaysia (GSHS-M), where 25,461 students aged 13-18 years and from 234 randomly selected schools were recruited using a two-stage cluster sampling design. Data were analysed descriptively and multivariable logistic regression using SPSS version 20.0. About one-fifth of the respondents reported being victimised at least once in the past 30-days. The most prevalent type of bullying is making fun of gender and body image. Multivariable logistic regression analysis substantiated that the likelihood of victimisation was higher among the boys, students of the lower secondary form, those without a close friend, and the obese respondents. In addition, victims without parental support were more likely to miss school (aOR 0.81, 95% CI 0.59-1.13), considered suicide (aOR 1.60, 95% CI 1.18-2.18), make a suicide plan (aOR 1.45, 95% CI 2.01-1.08), as well as attempted suicide at least once in the past 12 months (aOR 0.48, 95% CI 0.33-0.69). Overall, specially tailored intervention strategies are pivotal in addressing school bullying among secondary school-going adolescents, particularly to minimise the physical and psychosocial impact among the victims.&#x0D; &#x0D; &#x0D;

Prevalence and predictors of waterpipe smoking cessation among young adults in the US: Findings from a population-based study

BackgroundThe prevalence of waterpipe tobacco (WPT) smoking is 9.2 % among young adults aged 18–24 years in the United State (US). Adequate understanding of the factors predicting WPT smoking cessation among the young population is essential to tobacco control efforts. This study assessed the prevalence and predictors of WPT smoking cessation among young adults. MethodsThe population assessment of tobacco and health (PATH) study data (waves 1–5) was used for the study. A total sample of 561 young adults exclusively using WPT (past 30-days) was used for the analysis. The probability of WPT smoking cessation (no use in the past 12 months) was estimated using the Kaplan-Meier survival method, and the predictors were assessed using the Cox proportional hazards regression model. ResultsDuring the five waves, 25.1 % of the young adult WPT smokers quit smoking. Among them, 58.2 % were females and the remaining 41.8 % were males. The Hispanics (40.2 %) had the highest rate of cessation among the ethnic groups. Regret smoking (adjusted hazard ratio (aHR) = 2.33, 95 % confidence interval (CI) = 1.24–4.36), smoking restriction at home (aHR = 2.86, 95 % CI = 1.41–5.88), and living in Midwest geographical region (aHR = 2.11, 95 % CI = 1.16–3.84) increased the likelihood whereas alcohol use (aHR = 0.62, 95 % CI = 0.41–0.93) decreased the likelihood of cessation among the young adult WPT smokers. ConclusionsCommunicating the health and economic consequences associated with WPT smoking (e.g., pictorial health warning labels), involving smoker’s household members in WPT awareness campaigns, and closing regulatory loopholes related to WPT venues will increase the WPT smoking cessation rate among the young population in the US.

Novel Methods of Cannabis Use and Lower Sleep Duration Among High School Students.

The general use of cannabis in adolescence is associated with various sleep deficits. While traditional smoking remains the most common form of cannabis consumption amongst adolescents, novel methods of administration are becoming more popular and available due to legalization. The association of these novel methods of use with sleep in adolescence has yet to be studied and research is needed to inform public health initiatives. High school (9th-12th grade) students from the Healthy Kids Colorado Survey with current cannabis use (n= 4,637) reported on numerous demographic variables, method of cannabis use (flower, edibles, dabs, and vaporizers) and average sleep duration on weeknights. Logistic regression assessed the relationship between novel methods of use (edibles, dabs, and vaporizers) and sleep duration in comparison to cannabis flower. Use of any edible, dab, or vaporizer product in the past 30-days was associated with being male and current tobacco use. Reporting a novel method of use as the most common mode of cannabis use was associated with current tobacco use and higher mothers' education. Students who used any novel method products in the past 30 days or reported these products as the usual mode of cannabis use, were more likely to sleep 7 hours or fewer a night. Novel methods of cannabis administration such as edibles, dabs, and vaporizers are associated with getting less sleep than recommended (7 or less hours), in comparison to those who smoked flower. Sleep outcomes should be a focus of study for novel cannabis products amongst high school adolescents.

Predictors of E-cigarette and Cigarette Use Trajectory Classes from Early Adolescence to Emerging Adulthood Across Four Years (2013-2017) of the PATH Study.

This study examines predictors of trajectories of cigarette and e-cigarette use among a cohort of US adolescents transitioning into young adulthood. Comparing trajectories of each tobacco product is important to determine if different intervention targets are needed to prevent progression to daily use. Latent trajectory class analyses identified cigarette and e-cigarette use (never, ever excluding past 12-month, past 12-month (excluding past 30-day (P30D)), P30D 1-5 days, P30D 6+ days) trajectory classes, separately, among US youth (12-17; N = 10,086) using the first 4 waves (2013-2017) of data from the nationally representative PATH Study. Weighted descriptive analyses described the class characteristics. Weighted multinomial logistic regression analyses examined demographic, psychosocial, and behavioral predictors of class membership. Younger adolescents 12-15 years had lower tobacco use compared to 16-17 year olds and less stable classes. In the 16-17 year group, there were five unique trajectories of cigarette smoking, including a Persistent High Frequency class. Four e-cigarette use trajectories were identified; but not a persistent use class. Shared predictors of class membership for cigarettes and e-cigarettes included mental health problems, other tobacco use, marijuana use, and poorer academic achievement. Male sex and household tobacco use were unique e-cigarette trajectory class predictors. There was no evidence that initiation with e-cigarettes as the first product tried was associated with cigarette progression (nor cigarettes as first product and e-cigarette progression). Interventions should focus on well-established risk factors such as mental health and other substance use to prevent progression of use for both tobacco products. Using nationally representative data and definitions of use that take into account frequency and recency of use, longitudinal 4-year trajectories of e-cigarette and cigarette use among US adolescents transitioning into young adulthood were identified. Results among 16-17-year olds revealed a class of persistent high frequency cigarette smoking that was not identified for e-cigarette use. Cigarette use progression was not associated with e-cigarettes as the first product tried. Risk factors for progression of use of both products included mental health and other substance use, which are important prevention targets for both tobacco products.

If we build it, will they come? Perspectives on pharmacy-based naloxone among family and friends of people who use opioids: a mixed methods study

BackgroundExpanding access to the opioid antagonist naloxone to reduce overdose mortality is a public health priority in the United States. Naloxone standing orders (NSOs) have been established in many states to increase naloxone dispensing at pharmacies, but increased pharmacy access does not ensure optimal uptake among those likely to witness an overdose. In a prior statewide purchase trial, we documented high levels of naloxone access at Massachusetts pharmacies under a statewide NSO. In this study, we characterize barriers to pharmacy-based naloxone uptake among potential opioid overdose “bystanders” (friends or family of people who use opioids) that may be amenable to intervention.MethodsEligible bystanders were Massachusetts residents ≥ 18 years of age, did not use illicit opioids in the past 30 days, and knew someone who currently uses illicit opioids. We used a sequential mixed methods approach, in which a series of semi-structured qualitative interviews (N = 22) were conducted April-July 2018, to inform the development of a subsequent quantitative survey (N = 260), conducted February-July 2020.ResultsMost survey participants (77%) reported ever obtaining naloxone but few (21%) attempted to purchase it at a pharmacy. Qualitative participants revealed that barriers to utilizing the NSO included low perceived risk of overdose, which was rooted in misconceptions regarding the risks of prescription opioid misuse, denial about their loved one’s drug use, and drug use stereotypes; inaccurate beliefs about the impact of naloxone on riskier opioid use; and concerns regarding anticipated stigma and confidentiality. Many participants had engaged in mutual support groups, which served as a source of free naloxone for half (50%) of those who had ever obtained naloxone.ConclusionsDespite high levels of pharmacy naloxone access in Massachusetts, few bystanders in our study had attempted to obtain naloxone under the NSO. Low perceived risk of overdose, misinformation, stigma, and confidentiality were important barriers to pharmacy naloxone uptake, all of which are amenable to intervention. Support groups provided a setting for addressing stigma and misinformation and provided a discreet and comfortable setting for naloxone access. Where these groups do not exist and for bystanders who do not participate in such groups, pharmacies are well-positioned to fill gaps in naloxone availability.

Cigar Warning Noticing and Demographic and Usage Correlates: Analysis from the United States Population Assessment of Tobacco and Health Study, Wave 5.

Although cigars pose health risks similar to cigarettes, their packaging/marketing is not subject to commensurate regulation in the US. In a 2000 agreement with the Federal Trade Commission, seven major manufacturers agreed to use some form of cigar warning. In 2016, the Food and Drug Administration passed a rule requiring larger standardized warnings, but the requirement was successfully challenged in court. Here, we examined U.S. population-level trends in noticing existing cigarillo, traditional and filtered cigar warnings. We analyzed Wave 5 Population Assessment of Tobacco and Health adult data to assess prevalence of past-30 day warning noticing and associations with socio-demographic and tobacco use variables. Noticing was higher among current users of cigarillos (27%), filtered (34%) and traditional cigars (21%), than non-users (8% for each product, p < 0.0001), and among every-day vs. some-day users, established vs. experimental users, and past-30 day users vs. those without past-30 day use. Results varied by product, but generally indicated lower noticing among non-Hispanic Whites and dual cigarette users, but higher noticing among those purchasing cigars by the box/pack (vs. not purchasing for themselves). Low overall noticing but higher prevalence among frequent users underscores a need for a stronger, uniform cigar warning label policy in the US.