Dual Use Research Articles

Association of conventional cigarette smoking, heated tobacco product use, and dual use with hearing loss: A working population-based study.

Although conventional cigarette smoking has been linked to an increased risk of hearing loss, the association between heated tobacco products (HTPs) and hearing loss is unknown. The objective of this study was to investigate the association between cigarette and HTP use and hearing loss. This cross-sectional study examined the data of 7769 employees from five companies (Study I) and 34404 employees from a large company (Study II), all participants in the Japan Epidemiology Collaboration on Occupational Health Study. The participants were categorized into five groups based on their self-reported tobacco use: never smokers, former smokers, exclusive cigarette smokers, exclusive users of HTPs, and those who used both cigarettes and HTPs. Hearing levels were measured using pure-tone audiometry at 1 and 4 kHz frequencies. Separate analyses were carried out for each study, and the results were then combined using fixed-effect models to pool the estimates. The analysis included 42173 participants, with a prevalence of 12.9% for exclusive cigarette smoking, 9.8% for exclusive HTP use, and 5.5% for dual use. The pooled adjusted odds ratios with 95% confidence intervals for unilateral hearing loss at 4 kHz were 1.21 (95% CI: 1.10-1.33) for former smokers, 1.83 (95% CI: 1.64-2.05) for exclusive cigarette smokers,1.46 (95% CI: 1.28-1.67) for exclusive HTP users, and 1.66 (95% CI: 1.41-1.96) for dual users, compared to never smokers. Additionally, the adjusted odds ratios for hearing loss at 4 kHz among exclusive cigarette smokers, exclusive HTP users, and dual users increased with the intensity of cigarette/HTP consumption (all p for trend <0.001). No significant associations were found between exclusive HTP use, dual use, and hearing loss at 1 kHz, apart from exclusive cigarette smoking. In this cross-sectional study, associations were found between exclusive cigarette smoking, exclusive HTP use, dual use, and hearing loss, particularly at 4 kHz. Further research is needed to confirm these findings.

E-cigarette use in pregnancy in Australia: A cross-sectional survey of public antenatal clinic attendees.

E-cigarette use has rapidly increased amongst young people in Australia, however the prevalence of use amongst pregnant people is not known. The aim of this study was to examine the prevalence of e-cigarette use and dual use of e-cigarettes and tobacco cigarettes, characteristics associated with use and reasons for use amongst a sample of pregnant Australian people attending public antenatal clinics. A cross-sectional survey was conducted with 4024 pregnant people attending antenatal appointments, between July 2021 and December 2022, in one local health district in New South Wales, Australia. Main outcome measures were current use of e-cigarettes, dual use with tobacco cigarettes, participant characteristics associated with use and reasons for use. 1.24% of pregnant people used e-cigarettes, 34% of these were dual smokers. Being a current smoker (OR 39.49; 95% CI 9.99-156.21) or ex-smoker (OR 29.86; 95% CI 8.75-101.95) were associated with e-cigarette use. Quitting smoking was the most reported reason for use (52%). This study is the first to report on the prevalence of e-cigarette use amongst pregnant people in Australia. We found that a small proportion of pregnant people use e-cigarettes and that many are dual users or ex-smokers. E-cigarette use and rates of dual use in pregnancy in Australia appear lower than internationally, however they are similarly being used as a smoking-cessation aid by many. As regulatory environments relating to e-cigarette access change in Australia, large-scale studies are required to continue to monitor e-cigarette use and dual use in pregnancy.

Prevalence of Cigarette Smoking, E-cigarette Use, and Dual Use Among Urban and Rural Women During the Peripartum Period, PRAMS 2015-2020.

Evidence has emerged on the health dangers of electronic cigarette (e-cigarette) use among pregnant women and neonates. We examined whether rural residence is a risk factor for smoking and e-cigarette use among women during the peripartum period in the United States. This study was based on pooled cross-sectional 2015-2020 data from the Pregnancy Risk Assessment Monitoring System. The outcome was exclusive smoking, exclusive e-cigarette use, and use of both products (ie, dual use) versus use of neither tobacco product by women with live infants aged 2 to 6 months. We examined rural-urban differences in outcome by using univariate and multivariable multinomial logistic regressions with post hoc contrasts and marginal analyses, adjusting for complex survey design and nonresponse. During the peripartum period, 5.0% of women were smoking combustible cigarettes, 5.0% were using e-cigarettes, and 1.9% were using both tobacco products. The crude prevalence of e-cigarette use was 1.1 percentage point higher, and the adjusted prevalence was 0.8 percentage points lower for rural versus urban women (P < .001 for both). Among rural women, 6.7% (95% CI, 6.3%-7.1%) smoked combustible cigarettes exclusively and 2.6% (95% CI, 2.3%-2.8%) used both products, as compared with 4.5% (95% CI, 4.4%-4.8%) and 1.7% (95% CI, 1.6%-1.8%) of urban women, respectively, adjusting for sociodemographic and health-related characteristics. Maternal sociodemographic and health-related characteristics differed by combustible smoking versus e-cigarette use during the peripartum period. The effect of residence on e-cigarette use was significantly confounded by sociodemographic and health-related characteristics, resulting in clinically comparable prevalence of e-cigarette use in rural and urban mothers with live infants aged 2 to 6 months.

#530 Cardiorenal effects of dual blockade with ACE inhibitors and ARBs among people with CKD: emulation of a reference trial (ONTARGET) using CPRD

Abstract Background and Aims Cardiovascular disease (CVD) is a leading cause of death globally, and individuals with chronic kidney disease (CKD) are at increased risk. Results from the ONTARGET trial, in conjunction with the ALTITUDE and VA-Nephron-D studies, led to an end of recommendations for dual ACE inhibitor and ARB therapy due to an increase in acute kidney injury. However, these studies had low power to address long-term kidney outcomes and there remains uncertainty about whether dual therapy could be effective at reducing adverse cardiovascular and renal outcomes in patients with CKD. Observational data provides an opportunity to explore such hypotheses in subgroups underrepresented in trials and with power and follow-up enabling estimation of risk of rare outcomes. We aimed to use ONTARGET to perform a reference trial emulation analysis, before extending analysis to explore treatment effectiveness of dual ARB and ACEi use vs ACEi alone in preventing cardiovascular and renal outcomes among those with CKD. Method Using routinely-collected data from the UK Clinical Practice Research Datalink (CPRD) Aurum linked with Hospital Episode Statistics secondary care data, we applied the ONTARGET trial eligibility criteria to patients prescribed an ARB/ACE inhibitor between 1/1/2001-31/7/2019. As the number of patients receiving prescriptions for both medications on the same day was likely to be small in routine care, we used an operational definition to capture dual users. Outcomes included ONTARGET primary cardiovascular composite outcome of cardiovascular-related death, myocardial infarction, stroke, or hospitalisation for heart failure and a composite renal outcome of ≥50% reduction in GFR or end-stage kidney disease (ESKD). Within the trial-eligible cohort, outcomes of interest were compared between groups prescribed dual therapy vs ACE inhibitors alone using a propensity-score—weighted time-to-event analysis using a Cox proportional hazards model. Conditional on successfully benchmarking results against the ONTARGET trial, we explored treatment effect heterogeneity by chronic kidney disease (CKD) at baseline, with CKD defined as estimated glomerular rate (eGFR) &amp;lt; 60 ml/min/1.73 m2. Results 412,406 trial-eligible patients in CPRD were included in analysis. Among those with non-missing eGFR at baseline, 37% had CKD (Table 1). We found similar effectiveness of dual therapy and ACE inhibitors in reducing the risk of the primary composite cardiovascular outcome (HR 0.98 (95% CI: 0.93, 1.03), consistent with the ONTARGET trial results (HR 0.99 (95% CI: 0.92, 1.07), with no evidence of heterogeneity by CKD (P-value for interaction = 0.14). However, dual therapy use was associated with a greater risk for the composite renal outcome compared to ACE inhibitor, HR 1.24 (95% CI: 1.14, 1.35), with no evidence of heterogeneity by CKD (P = 0.93) (Fig. 1). Analysing components of the composite renal outcome separately gave consistent results (≥50% reduction in GFR: HR 1.22 (95% CI: 1.12, 1.33); ESKD: HR 1.34 (95% CI: 1.24, 1.57)), as did a post-hoc sensitivity analysis by proteinuria status (no proteinuria: HR 1.28 (95% CI: 1.03, 1.59); proteinuria: 1.27 (95% CI: 1.08, 1.49)). Conclusion We found evidence that dual therapy use was associated with increased risk of renal outcomes in both those with and without CKD at baseline. Applying a reference trial emulation approach and successfully benchmarking findings against ONTARGET, where confounding was not present due to randomisation, provides confidence in the validity of these results.

Agrivoltaics Over Berries in Chile: Potential for Clean Energy Generation and Climate Change Adaption

Agrivoltaics (AV), the concept of installing photovoltaic (PV) panels on agricultural land, enabling a dual use of the surface, has the potential to foster renewable energy expansion without land use conflict and to protect water from evapotranspiration. Although there is growing interest in AV, there has been no structured analysis of its potential for clean energy generation and climate change adaptation in Chile. In this paper, we provide the first national-level estimate of the AV potential over blueberries, using a combination of filtered geo-datasets and meteorological data to quantify PV yields and impact on evapotranspiration. We find a theoretical potential of 13.4 GWp for AV over blueberries, predominantly in the central and southern regions. The derived potential for AV could provide 22% of the current national electricity generation while lowering irrigation demand by nearly 18 million m³ per year. Finally, we identify about 8,000 GWh of current annual conventional electricity generation that could be regionally replaced by AV, showing the potential to contribute significantly to the decentralization and decarbonization of the Chilean electricity mix. Further research on the agronomic and economic aspects of AV implementation should be carried out to enable synergetic development.

Pleasure and Satisfaction as Predictors of Future Cigarette and E-cigarette Use: A Novel Two-Stage Modeling Approach.

Subjective experience of e-cigarettes may be an important factor in helping people who use combustible cigarettes switch completely to e-cigarettes to reduce harm from smoking. This paper describes a novel two-stage analysis using pleasure and satisfaction responses from ecological momentary assessments (EMA) of both cigarette and e-cigarette use to predict future cigarette and e-cigarette tobacco use. This observational study included adult users of cigarettes and e-cigarettes who provided 7 days of EMA, capturing cigarette and e-cigarette use, followed by biweekly reports of cigarette and e-cigarette use over 1 year. Participants were 279 adults who provided both cigarette and e-cigarette responses during the EMA. We employed a two-stage analytic approach in which EMA data were used to predict subsequent levels of cigarette and e-cigarette use. In the first stage, EMA responses to cigarette and e-cigarette events were modeled via a mixed-effects location scale model to yield summaries of participants' means and variability on event-related ratings of pleasure and satisfaction. These EMA summaries served as predictors in the second stage analysis of the biweekly post-EMA longitudinal cigarette and e-cigarette use data. EMA pleasure and satisfaction ratings were similar for both products and predicted both longitudinal cigarette and e-cigarette use, even after controlling for baseline cigarette and e-cigarette dependence. Relatively higher levels of satisfaction with e-cigarettes were associated with greater decreases in cigarette use over time. Pleasure and satisfaction are important predictors of subsequent cigarette and e-cigarette use. Experienced subjective pleasure and satisfaction from e-cigarettes relative to cigarettes may be an important factor in helping individuals who smoke to switch completely to e-cigarettes as a harm reduction approach. In order to help sustain complete product switching and reduce dual use or relapse to smoking, e-cigarettes may need to deliver more satisfaction to the user compared to that experienced from cigarettes.

Heated tobacco product marketing: a mixed-methods study examining exposure and perceptions among US and Israeli adults.

The marketing of heated tobacco products (HTPs), like IQOS, influences consumers' perceptions. This mixed-methods study analyzed (i) survey data (2021) of 2222 US and Israeli adults comparing perceptions of 7 IQOS attributes (design, technology, colors, customization, flavors, cost and maintenance) and 10 marketing messages (e.g. 'Go smoke-free…') across tobacco use subgroups and (ii) qualitative interviews (n = 84) regarding IQOS perceptions. In initial bivariate analyses, those never using HTPs (86.2%) reported the least overall appeal; those currently using HTPs (7.7%) reported the greatest appeal. Notably, almost all (94.8%) currently using HTPs also currently used cigarettes (82.0%) and/or e-cigarettes (64.0%). Thus, multivariable linear regression accounted for current cigarette/e-cigarette use subgroup and HTP use separately; compared to neither cigarette/e-cigarette use (62.8%), cigarette/no e-cigarette use (17.1%) and e-cigarette/no cigarette use (6.5%), those with dual use (13.5%) indicated greater overall IQOS appeal (per composite index score); current HTP use was not associated. Qualitative data indicated varied perceptions regarding advantages (e.g. harm, addiction and complexity) of IQOS versus cigarettes and e-cigarettes, and perceived target markets included young people, those looking for cigarette alternatives and females. Given the perceived target markets and particular appeal to dual cigarette/e-cigarette use groups, IQOS marketing and population impact warrant ongoing monitoring to inform regulation.

Non-tobacco nicotine E-cigarette use and flavored E-cigarette use among young adults in the United States

BackgroundE-cigarette flavors can create sensations of sweetness and coolness while masking the aversiveness of nicotine. Recently, non-tobacco nicotine (NTN) products were introduced to the market, but little is known about flavors in NTN e-cigarette use. We examined associations between flavors (i.e., sweet, mint/menthol) and susceptibility to and use of NTN e-cigarettes. Methods1239 US young adults (18–25 years) completed an anonymous, online survey in Fall 2021. The analytic sample included 520 participants who had used e-cigarettes and heard of NTN. Multinomial logistic regression models analyzed associations of flavored e-cigarette use (sweet and mint/menthol) with NTN e-cigarette use status (i.e., current [past-month] use, past [ever but not current] use, susceptible to use, and non-susceptible to use [reference]). ResultsOverall, 46.2% of participants reported current NTN use, 14.8% reported past use, 16.7% were susceptible to use, and 22.3% reported no susceptibility. Participants reported dual-use of sweet and mint/menthol NTN e-cigarette flavors (56.5%), sweet flavors use (24.8%), and mint/menthol flavor use (1.7%). Ever dual use of sweet and mint/menthol flavors was associated with current (OR = 9.64, 95%CI: 3.21–28.98) and past NTN e-cigarette use (8.30, [2.10–32.80]). Ever sweet flavor use was associated with current NTN use (3.80, 95%CI: 1.44–10.03) and susceptibility to future use (4.25, [1.53–11.81]). Similar findings were observed for mint/menthol flavors (current: 5.03, [1.41–17.99]; susceptible: 5.65, [1.64–19.51]). ConclusionThe use of sweet and mint/menthol flavors was significantly associated with NTN e-cigarette use among US young adults, highlighting the need for ongoing surveillance of flavored NTN e-cigarettes and appropriate regulations to discourage use.

No Difference in Revision Rates or Patient-Reported Outcome Measures Between Surgical Approaches for Total Hip Arthroplasty Performed for Femoral Neck Fracture: An Analysis of 5,025 Primary Total Hip Arthroplasties From the New Zealand Joint Registry

BackgroundTotal hip arthroplasty (THA) for femoral neck fracture (FNF) can be performed through different surgical approaches. This study compared the revision rates and patient-reported outcome measures by surgical approach. MethodsData from the New Zealand Joint Registry were analyzed for patients undergoing primary THA for FNF from January 2000 to December 2021. A total of 5,025 THAs were performed for FNF; the lateral approach was used in 2,499 (49.7%), the posterior in 2,255 (44.9%), and the anterior in 271 (4.3%). The primary outcome measure was the all-cause revision rate. Secondary outcome measures included revision rates for: dislocation, aseptic femoral component loosening, periprosthetic fracture, and infection. Oxford Hip Scores (OHS) were also collected. Age, sex, body mass index, American Society of Anesthesiologists score, femoral head size, dual mobility use, femoral fixation, and surgeon experience were assessed as potential confounding variables. ResultsThere was no difference in the revision rates between lateral and posterior (P = .156), lateral and anterior (P = .680), or posterior and anterior (P = .714) approaches. There was no difference in the reasons for revision between the lateral and posterior approaches or 6-month OHS (P = .712). There was insufficient data to compare the anterior approach. ConclusionsThere is no difference in the overall revision rates, reasons for revision, or OHS between the lateral and posterior surgical approaches for THA performed for FNF. Insufficient data on the anterior approach is available for an accurate comparison. Level of EvidenceLevel III.

Adolescent’s explicit and implicit cigarette cognitions predict experimentation with both cigarettes and e-cigarettes

ABSTRACT Background: Past year, month, and lifetime adolescent e-cigarette use rates remain persistently high, despite falling cigarette use rates. Previous investigations have noted a strong relationship between an individual’s positive and negative cognitions related to a behavior, and subsequent initiation of that behavior. Objective: This investigation was conducted to determine the impact positive and negative explicit and implicit cigarette-related cognitions may have on the use of cigarettes and e-cigarettes among at-risk, cigarette-naive adolescents. Methods: A three-year longitudinal investigation evaluated the relationship between cigarette-related cognitions and subsequent cigarette and e-cigarette use among 586 alternative high school students (female: 50.8%; mean age: 17.4 years; Hispanic/Latino: 75.0%) who had never smoked cigarettes at the baseline assessment. Multilevel logistic regression models were used to generate demographics-adjusted odds ratios (OR) and 95% confidence intervals (95% CI). Results: Students with higher positive explicit cigarette cognitions at the baseline had greater odds of subsequent cigarette use (OR = 1.72, 95% CI 1.11–2.68). If students also reported an increase over time in positive (OR = 3.45, 95% CI 2.10–5.68) or negative (OR = 1.93, 95% CI 1.03–3.61) explicit cigarette cognitions, the odds of cigarette use increased. The odds of dual use of cigarettes and e-cigarettes were greater among students who had higher negative implicit cigarette cognitions at the baseline (OR = 2.07, 95% CI 1.03–4.17) compared to those with lower levels of negative implicit cognitions. Conclusion: Prevention programming that focuses on decreasing positive cognitions related to nicotine and tobacco use may have greater overall effect on decreasing use compared to programs that only focus on increasing negative cognitions individuals form surrounding cigarette or e-cigarettes.

Development and Psychometric Evaluation of a Novel Measure of Nicotine E-cigarette Withdrawal for use with Adolescents and Young Adults.

Nicotine withdrawal is a well-established construct that prompts continued nicotine product use and contributes to failed cessation efforts. Despite ongoing public health concerns about nicotine e-cigarette use in adolescents and young adults (AYAs), no psychometrically-sound measure of nicotine e-cigarette withdrawal exists for this population. A mixed methods approach comprising a literature review to identify existing nicotine withdrawal items; subject matter expert feedback on existing items and novel item generation; cognitive interviews assessing the measure's instructions, items, and response options; and a large quantitative validation survey (N = 997) was employed to develop the novel retrospective measure of nicotine e-cigarette withdrawal. A 25-item solution comprising four subscales - Negative Affect, Negative Physical Symptoms, Craving, and Appetite/Food - and an Overall Withdrawal score was supported. Internal reliability was excellent (mean alpha = 0.91), and scalar measurement invariance was reached for all subgroups tested (e.g., sex, age, exclusive e-cigarette use versus dual tobacco product use, daily versus non-daily nicotine vaping). Overall Withdrawal and its subscales evidenced concurrent validity with time to first vape in the morning, e-cigarette dependence, and previous vaping cessation attempts, although not each subscale was associated with each outcome. Importantly, cross-sectional incremental validity analyses indicated that retrospective withdrawal accounted for variance in each outcome above and beyond e-cigarette dependence. The novel retrospective AYA Nicotine E-cigarette Withdrawal Scale (AYA NEWS) evidenced strong psychometric properties for use in this population. Future research can determine whether the AYA NEWS can be used to assess acute e-cigarette nicotine withdrawal. While e-cigarette use remains the most prevalent form of nicotine product use among adolescents and young adults, there are limited options for psychometrically-sound measures of e-cigarette-related constructs in this population. Withdrawal from nicotine is associated with failed cessation attempts and continued use of nicotine-containing products, making it a critical construct within tobacco-related research. This study outlines the development and preliminary psychometric evaluation of a novel, retrospective measure of nicotine e-cigarette withdrawal. Study findings support using the Adolescent and Young Adult Nicotine E-cigarette Withdrawal Scale (AYA NEWS) to assess retrospective withdrawal from nicotine e-cigarettes in young people.

Overcoming Delays in the Progress against Cancer: Identifying Tobacco Use among Cancer Patients Enrolled in Clinical Trials.

Though smoking causes adverse cancer treatment outcomes and smoking cessation can improve survival, prior literature demonstrates deficits in collecting tobacco use information in clinical trials. Results by Streck and colleagues represent a thorough structured assessment of tobacco use and alternative tobacco product use in patients enrolled in cooperative group trials. Among patients with predominantly non-tobacco related cancers, observations demonstrate that approximately 27% of patients reported using one or more forms of tobacco use after diagnosis. Alternative tobacco use was reported by many patients, including patterns of dual use. Results demonstrate the feasibility of collecting comprehensive structured tobacco use information, and further support the need to address tobacco and cessation even among patients with non-tobacco related cancers. See related article by Streck and colleagues, Cancer Epidemiol Biomarkers Prev 2023;32:1552-57.

Respiratory symptoms and outcomes among cigar smokers: findings from the Population Assessment of Tobacco and Health (PATH) study waves 2–5 (2014–2019)

BackgroundThe mechanisms by which cigarette smoking increases the risk of respiratory disease have been studied. However, less is known about risks of respiratory symptoms and outcomes associated with smoking cigars, and risks by cigar types have not been previously explored. The aim of this study was to examine associations between cigar use, including traditional cigars, cigarillos, filtered cigars, and dual cigar and cigarette use, and functionally important respiratory symptoms (FIRS), lifetime asthma diagnosis, uncontrolled asthma, and new cases of FIRS.MethodsData from Waves 2–5 (2014–19) of the Population Assessment of Tobacco and Health (PATH) Study, a nationally representative longitudinal study, were analyzed in two ways. For cross-sectional analysis, the analytic sample included adults 18 and older at each wave, resulting in 44,040 observations. Separately, longitudinal analyses were assessed among adults 18 and older at Wave 2, resulting in 7,930 individuals. Both analyses excluded adults with chronic obstructive pulmonary disease (COPD) or non-asthma respiratory disease.ResultsCurrent established cigarillo smokers had higher odds of having FIRS (Adjusted odds ratio (AOR): 1.72; 95% CI: 1.08, 2.74) compared to never smokers of cigarillos and cigarettes, after adjusting for covariates. Current established filtered cigar smokers had higher odds of asthma diagnosis (AOR: 1.35; 95% CI: 1.10, 1.66) while current established dual smokers of filtered cigars and cigarettes had higher odds of uncontrolled asthma (AOR: 5.13; 95% CI: 1.75, 15.02) compared to never smokers of filtered cigars or cigarettes. Both current established cigar smokers and current established dual smokers of cigarettes and cigars had higher odds of new FIRS compared to never cigar or cigarette smokers (AORs: 1.62; 95% CI: 1.02, 2.60 for exclusive cigars and 2.55; 95% CI 1.57, 4.14 for dual smokers).ConclusionsThis study provides evidence that cigar smokers or dual smokers of cigars and cigarettes have greater odds of FIRS, asthma, and uncontrolled asthma and that new incidence of FIRS is higher among any cigar smokers compared to never cigar or cigarette smokers. Understanding health impacts associated with cigar use provides information for supporting policy development, as well as for designing clinical interventions focused on smoking cessation for cigars.

Perceptions of Heated Tobacco Products (HTPs) Versus Cigarettes and e-Cigarettes in Relation to Likelihood of Trying HTPs or Suggesting HTPs to Those who Smoke Cigarettes.

Heated tobacco products (HTPs), like IQOS, are marketed as innovative, stylish, harm-reduction products distinct from cigarettes and e-cigarettes. Research is needed to better understand how adults who are newly introduced to HTPs perceive them relative to cigarettes and e-cigarettes, and the impact of these perceptions on use outcomes. We analyzed 2021 cross-sectional survey data from 1914 adults who never used HTPs from the United States and Israel, two countries where IQOS has unique histories and markets. Exploratory factor analysis examined perceptions of HTPs (vs. cigarettes and e-cigarettes) across 12 perception measures (eg, innovative, trendy, harmful, addictive). Multivariable linear regression examined these factors in relation to self-reported likelihood to: (1) "try HTPs in the next year" (1 = not-7 = extremely) and (2) "suggest IQOS to a friend who smokes cigarettes" (1 = not-5 = very), controlling for demographics and past-month cigarette and e-cigarette use (10.1% dual use, 15.4% cigarette-only, 5.7% e-cigarette-only, 68.8% neither). Four factors were identified: HTPs' health and utility ("health-utility") and design and appeal ("design-appeal") versus cigarettes and versus e-cigarettes, separately. More favorable perceptions of HTP versus e-cigarette design-appeal (B = 0.30, 95% CI = 0.18, 0.41) were associated with greater likelihood to try HTPs. More favorable perceptions of HTP versus cigarette design-appeal (B = 0.38, 95% CI = 0.26, 0.51) and health-utility (B = 0.25, 95% CI = 0.13, 0.36), and HTP versus e-cigarette design-appeal (B = 0.32, 95% CI = 0.20, 0.45) were associated with greater likelihood to suggest HTPs to smokers. Monitoring perceptions of HTPs versus cigarettes and e-cigarettes is critical given the role of such perceptions in HTP use and their population-level impact. This study examined the relationship of perceptions of HTPs relative to cigarettes and e-cigarettes, with regard to adults' self-reported likelihood to use HTP or to suggest HTPs to those who smoke cigarettes. Favorable perceptions of HTPs' design and appeal versus e-cigarettes correlated with greater likelihood to try HTPs. Favorable perceptions of HTPs' design and appeal, as well as health and utility, versus cigarettes and e-cigarettes correlated with greater likelihood to suggest HTPs to those who smoke. Findings underscore the need for ongoing surveillance of HTP marketing and consumer perceptions to inform regulatory efforts and estimate the population-level impact of HTPs and other tobacco products.

Steel Arch and Rock Bolt Support in Terms of the Gateroad Stability Maintaining behind the Longwall Face

The longwall system is an extraction system commonly used in coal mining in many countries, including Poland. One of the methods for reducing extraction costs is the dual use of the gateroad. In the first instance, the gateroad serves as the tailgate, and during the exploitation of the second coal panel, it functions as the headgate. Such a situation requires maintenance of the roadway behind the longwall face, which is typically challenging, due to significant stress-related loads on the support and its substantial deformation. The support design for this kind of roadway should take into consideration the dual impact of exploitation pressure and the caved zone influence behind the longwall face. This article presents the results of in-situ research conducted on two roadways behind the longwall face. In both roadways, the effectiveness of specially designed steel arch frames and rock bolt patterns were examined to minimize roadway deformations and maintain their functionality. The research project was comprised of several stages. Initially, mining and laboratory studies were conducted to determine the geomechanical parameters of the rocks. Subsequently, excavation stability and functionality forecasts were performed based on the authors’ empirical indicators. Then, numerical analyses were carried out to design support schemes (steel arches and rock bolt) in both roadways. A fully automated monitoring system with programmed data loggers was designed to check the behaviour of a specific rock mass and the support elements. The load on the steel arch support was measured with the help of load cells, while the load on the rock bolt support was carried out with the help of measurement bolts. Behind the longwall face, the loads on the wooden cribs set from the goaf side were also monitored. Additionally, the measurement station was equipped with extensometers to monitor the movement of roof layers and stress meters to determine changes in rock mass stress. Laser scanning or traditional surveying methods were also used to verify the support schemes through roadway convergence measurements. The obtained results allowed us to draw conclusions regarding the optimization of support schemes and to give recommendations for the practical application of specific reinforcements in excavations maintained behind the longwall face.

Qualitative content analysis of actionable advice in information security policies – introducing the keyword loss of specificity metric

Purpose This paper aims to investigate how congruent keywords are used in information security policies (ISPs) to pinpoint and guide clear actionable advice and suggest a metric for measuring the quality of keyword use in ISPs. Design/methodology/approach A qualitative content analysis of 15 ISPs from public agencies in Sweden was conducted with the aid of Orange Data Mining Software. The authors extracted 890 sentences from these ISPs that included one or more of the analyzed keywords. These sentences were analyzed using the new metric – keyword loss of specificity – to assess to what extent the selected keywords were used for pinpointing and guiding actionable advice. Thus, the authors classified the extracted sentences as either actionable advice or other information, depending on the type of information conveyed. Findings The results show a significant keyword loss of specificity in relation to pieces of actionable advice in ISPs provided by Swedish public agencies. About two-thirds of the sentences in which the analyzed keywords were used focused on information other than actionable advice. Such dual use of keywords reduces the possibility of pinpointing and communicating clear, actionable advice. Research limitations/implications The suggested metric provides a means to assess the quality of how keywords are used in ISPs for different purposes. The results show that more research is needed on how keywords are used in ISPs. Practical implications The authors recommended that ISP designers exercise caution when using keywords in ISPs and maintain coherency in their use of keywords. ISP designers can use the suggested metrics to assess the quality of actionable advice in their ISPs. Originality/value The keyword loss of specificity metric adds to the few quantitative metrics available to assess ISP quality. To the best of the authors’ knowledge, applying this metric is a first attempt to measure the quality of actionable advice in ISPs.

Sustainability of dual exploitation (fry and adults) of the fish Semaprochilodus laticeps (Characiformes: Prochilodontidae) in Colombia

Introduction: Semaprochilodus laticeps is a freshwater fish species native to the Orinoco Basin that is exploited in Colombia at two different stages of its life cycle: fry (for the ornamental trade) and adults (for the consumer market). This double exploitation of juveniles and adults raises concerns about the population stability of the species. Objective: To evaluate the sustainability of the exploitation of the species in these two life stages. Methods: 1 277 specimens of S. laticeps were sampled between June and December 2017. Population parameters were estimated from length-frequency data using ELEFAN 1 routine of the FISAT II package. Length at first maturity (Lm) and length at maximum yield (Lopt) were determined using the Froese and Binohlan equations. Virtual population analysis was performed based on Jones length cohort analysis. Results: Population parameters were as follows: K = 0.75, L∞ = 53.1 cm LE, Z = 2.92 yr-1, M = 1.24 yr-1 and F = 1.68. Lm was estimated to be 29.6 cm SL and Lopt at 33.4 cm SL. Of note, 96.3 % of the fish caught in the consumer fishery exceeded Lm and 80 % exceeded Lopt. The results of the virtual population analysis suggested that a very low proportion (0.85 %) of the population was caught as fry, possibly due to natural mortality. Conclusions: Based on the results, as no indicators of overexploitation were identified, it is recommended to continue with the dual use of S. laticeps. It is recommended to maintain the existing conservation measures, such as the closed season during the reproductive period, to ensure sustainable fishery exploitation. The results obtained can serve as a reference to analyze the situation of other species currently fished for both the ornamental (fry) and food (adult) markets.

Use of and Beliefs toward Novel Tobacco and Nicotine Products among Portuguese University Students: A Pandemic Survey.

Over the last decade, novel tobacco and nicotine product experimentation and use have dramatically increased among the youth, even in countries with strong tobacco control and anti-smoking social norms. We performed an online questionnaire-based cross-sectional study in March-June 2021, targeting students from the University of Beira Interior, Portugal. The aim was to assess the experimentation and use of tobacco and nicotine products and students' beliefs towards these products. Of the 452 participants, 67.0% were female; the mean age was 21.9 ± 3 years. Most students (60.4%) reported experimenting with tobacco/nicotine products; 31.2% were current users; polyconsumption was common. Of the current users, all used cigarettes, 41.1% used heated tobacco, 20.6% e-cigarettes, and 14.9% used water pipes. Our multivariate analysis showed that being male, being in the third year of study, and cohabiting or socializing with smokers were strongly associated with tobacco/nicotine use. While most students agree that heated tobacco and e-cigarettes are addictive, that they are not less harmful than cigarettes, and that second-hand exposure may cause health problems, few tobacco/nicotine users are ready to quit, and few students support a smoke-free university campus. These findings indicate high experimentation and the regular dual use of novel tobacco and nicotine products and suggest a pro-smoking social norm among university students.

The association between single and dual use of cannabis and alcohol and driving under the influence and riding with an impaired driver in a large sample of Canadian adolescents

Objective Dual use of cannabis and alcohol has increased in adolescents, but limited research has examined how it relates to impaired driving or riding with an impaired driver (IDR) compared to single substance use. This study aimed to examine the odds of alcohol- and/or cannabis-IDR among adolescents based on their use of alcohol and/or cannabis, and whether associations differed by gender and age. Methods Cross-sectional survey data were used from a sample of 69,621 students attending 182 Canadian secondary schools in the 2021/22 school year. Multilevel logistic regression estimated the odds of exclusive alcohol-IDR, exclusive cannabis-IDR, and both alcohol and cannabis IDR (alcohol-cannabis-IDR). Substance use interactions with gender and age were tested. Results Overall, 14.7% of participants reported IDR; 7.5% reported exclusive alcohol-IDR, 3.2% reported exclusive cannabis-IDR, 4.0% reported alcohol-cannabis-IDR, and 7.4% were unsure if they had experienced IDR. The prevalence of IDR varied across substance use groups, 8.0% among nonuse, 21.9% among alcohol-only use, 35.9% among cannabis-only use, and 49.6% among dual use groups. Gender diverse, older, and students with lower socioeconomic status exhibited a higher likelihood of reporting alcohol-cannabis-IDR. Dual use was significantly associated with 9.5 times higher odds of alcohol-cannabis-IDR compared to alcohol-only use, and 3.0 times higher odds compared to cannabis-only use. Dual use was also associated with an increased likelihood of either alcohol- or cannabis-IDR. Conclusions This study highlights that all students, regardless of substance use, are at risk of IDR, but students engaged in dual use of alcohol and cannabis face an elevated risk compared to both peers who do not use substances and those who use only a single substance. These findings emphasize the importance of targeted interventions that address the risks associated with IDR.

Hox gene–specific cellular targeting using split intein Trojan exons

The Trojan exon method, which makes use of intronically inserted T2A-Gal4 cassettes, has been widely used in Drosophila to create thousands of gene-specific Gal4 driver lines. These dual-purpose lines provide genetic access to specific cell types based on their expression of a native gene while simultaneously mutating one allele of the gene to enable loss-of-function analysis in homozygous animals. While this dual use is often an advantage, the truncation mutations produced by Trojan exons are sometimes deleterious in heterozygotes, perhaps by creating translation products with dominant negative effects. Such mutagenic effects can cause developmental lethality as has been observed with genes encoding essential transcription factors. Given the importance of transcription factors in specifying cell type, alternative techniques for generating specific Gal4 lines that target them are required. Here, we introduce a modified Trojan exon method that retains the targeting fidelity and plug-and-play modularity of the original method but mitigates its mutagenic effects by exploiting the self-splicing capabilities of split inteins. "Split Intein Trojan exons" (siTrojans) ensure that the two truncation products generated from the interrupted allele of the native gene are trans-spliced to create a full-length native protein. We demonstrate the efficacy of siTrojans by generating a comprehensive toolkit of Gal4 and Split Gal4 lines for the segmentally expressed Hox transcription factors and illustrate their use in neural circuit mapping by targeting neurons according to their position along the anterior-posterior axis. Both the method and the Hox gene-specific toolkit introduced here should be broadly useful.