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Jacobs W, Qin W, Riley TN, Parker ES, Owora AH, Leventhal A. Race/ethnic differences in the association of anxiety, depression, and discrimination with subsequent nicotine and cannabis use among young adults: A prospective longitudinal study. Addict Behav 2024; 153:107979. [PMID: 38394958 DOI: 10.1016/j.addbeh.2024.107979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 01/15/2024] [Accepted: 02/02/2024] [Indexed: 02/25/2024]
Abstract
INTRODUCTION The shifting patterns in nicotine and cannabis use among young adults is taking place at a time when there is also increased reports of psychosocial stressors such as anxiety, depression, and everyday discrimination. Although race/ethnicity has been found to moderate the impact of psychosocial stressors, there is limited research examining the association of anxiety, depression, and discrimination with patterns of nicotine and/or cannabis product use among diverse young adults. METHODS Data were from a longitudinal study of 2478 US young adults surveyed between 2019 and 2021. General estimating equation models were used to examine associations of self-reported psychological symptoms (depression, anxiety) and social stressors (discrimination) with substance use (any nicotine and cannabis product use; nicotine and cannabis vaping). RESULTS Young adults from different racial/ethnic groups differed significantly in their depression and discrimination scores with young adults of color having higher mean scores. Overall, higher depression and everyday discrimination score was associated with increased odds of past 6-month use of any nicotine/tobacco and cannabis products. Higher generalized anxiety score increased odds of any nicotine/tobacco and dual nicotine and cannabis product use. Higher everyday discrimination score was associated with increased odds nicotine and cannabis vaping overall. Stratified models showed variation in associations among different racial/ethnic groups. CONCLUSIONS Psychosocial stressors are associated with increased substance use odds among young adults. However, these stressors have a differential impact on substance use odds among young adults from different racial/ethnic contexts.
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Affiliation(s)
- Wura Jacobs
- Department of Applied Health Science, School of Public Health, Indiana University, United States.
| | - Weisiyu Qin
- Department of Applied Health Science, School of Public Health, Indiana University, United States.
| | - Tennisha N Riley
- Department of Counseling and Educational Psychology, Indiana University, United States.
| | - Erik S Parker
- Department of Epidemiology and Biostatistics, School of Public Health, Indiana University, United States.
| | - Arthur H Owora
- Department of Epidemiology and Biostatistics, School of Public Health, Indiana University, United States.
| | - Adam Leventhal
- Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States.
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Ray LA, Baskerville WA, Nieto SJ, Grodin E, Enders C, Kady A, Meredith L, Gillis A, Leventhal A, Ho D, Miotto K. A practice quit model to test early efficacy of medications for alcohol use disorder in a randomized clinical trial. Psychopharmacology (Berl) 2024; 241:543-553. [PMID: 38012333 DOI: 10.1007/s00213-023-06504-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 11/07/2023] [Indexed: 11/29/2023]
Abstract
RATIONALE Screening novel medications for alcohol use disorder (AUD) requires models that are both efficient and ecologically-valid. Ideally, such models would be associated with the outcomes of a given medication in clinical trials. OBJECTIVES To test a novel human laboratory model in which individuals with intrinsic motivation to change their drinking engage in a "practice quit" attempt consisting of 6 days of complete abstinence from alcohol. METHOD Individuals with current AUD completed a randomized, double-blind, placebo-controlled study of naltrexone (50 mg), varenicline (2 mg bid), or matched placebo. Participants were titrated onto the study medication for 1 week prior to starting the 6-day practice quit attempt. During the practice quit attempt, participants completed daily interviews with research staff. All participants completed an alcohol cue-exposure paradigm before starting the study medication and after 2 weeks of study medication. RESULTS There were no significant medication effect on drinks per drinking day (F(2,49) = 0.66, p = 0.52) or percent days abstinent (F(2,49) = 0.14, p = 0.87) during the 6-day practice quit period. There were no medication effects on alcohol cue-reactivity (F(2,44) = 0.80, p = 0.46). Notably, participants sharply reduced their drinking during the entire 13-day medication treatment period, as compared to reducing only during the 6-day practice quit period. During the total medication period, higher levels of motivation to change was associated with higher percent days abstinent (F(1,49) = 8.12, p < 0.01). CONCLUSIONS This study reports mostly null findings, which challenges us to decompose its nuanced design to consider model refinements. Possible changes to the model include considering the requirement for intrinsic motivation for change, including a longer practice quit period, encompassing the medication administration timeframe in the practice quit period, increasing the required sample size for signal detection, and examining a post COVID-19 pandemic cohort.
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Affiliation(s)
- Lara A Ray
- Department of Psychology, University of California at Los Angeles, 1285 Franz Hall, Box 951563, Los Angeles, CA, 90095-1563, USA.
- Department of Psychiatry and Biobehavioral Sciences, University of California at Los Angeles, Los Angeles, CA, USA.
- Brain Research Institute, University of California at Los Angeles, Los Angeles, CA, USA.
| | - Wave-Ananda Baskerville
- Department of Psychology, University of California at Los Angeles, 1285 Franz Hall, Box 951563, Los Angeles, CA, 90095-1563, USA
| | - Steven J Nieto
- Department of Psychology, University of California at Los Angeles, 1285 Franz Hall, Box 951563, Los Angeles, CA, 90095-1563, USA
| | - Erica Grodin
- Department of Psychiatry and Biobehavioral Sciences, University of California at Los Angeles, Los Angeles, CA, USA
| | - Craig Enders
- Department of Psychology, University of California at Los Angeles, 1285 Franz Hall, Box 951563, Los Angeles, CA, 90095-1563, USA
| | - Annabel Kady
- Department of Psychology, University of California at Los Angeles, 1285 Franz Hall, Box 951563, Los Angeles, CA, 90095-1563, USA
| | - Lindsay Meredith
- Department of Psychology, University of California at Los Angeles, 1285 Franz Hall, Box 951563, Los Angeles, CA, 90095-1563, USA
| | - Artha Gillis
- Department of Psychiatry and Biobehavioral Sciences, University of California at Los Angeles, Los Angeles, CA, USA
| | - Adam Leventhal
- Department of Population and Public Health Sciences, University of Southern California, Los Angeles, CA, USA
| | - Diana Ho
- Department of Psychology, University of California at Los Angeles, 1285 Franz Hall, Box 951563, Los Angeles, CA, 90095-1563, USA
| | - Karen Miotto
- Department of Psychiatry and Biobehavioral Sciences, University of California at Los Angeles, Los Angeles, CA, USA
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Tackett AP, Urman R, Barrington-Trimis J, Liu F, Hong H, Pentz MA, Islam TS, Eckel SP, Rebuli M, Leventhal A, Samet JM, Berhane K, McConnell R. Prospective study of e-cigarette use and respiratory symptoms in adolescents and young adults. Thorax 2024; 79:163-168. [PMID: 37582630 DOI: 10.1136/thorax-2022-218670] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 07/03/2023] [Indexed: 08/17/2023]
Abstract
RATIONALE Electronic cigarette (e-cigarette) aerosol contains volatile aldehydes, including flavourings and oxidant metals with known pulmonary toxicity. OBJECTIVES To evaluate the associations of e-cigarette use with symptoms of wheeze, bronchitic symptoms and shortness of breath (SOB) across 4 years of prospective data. METHODS Participants completed questionnaires on respiratory symptoms and past 30-day e-cigarette, cigarette and cannabis use in 2014 (wave 1; N=2094; mean age 17.3 years, SD=0.6 years). Follow-up information was collected in 2015 (wave 2; n=1609), 2017 (wave 3; n=1502) and 2018 (wave 4; n=1637) using online surveys. Mixed-effects logistic regression models evaluated associations of e-cigarette use with respiratory symptoms. MEASUREMENTS AND MAIN RESULTS Participants were mostly Hispanic white (51.8%) and evenly representative by sex (49.6% female; 50.4% male). Compared with never e-cigarette users, past 30-day e-cigarette users reported increased odds of wheeze (OR 1.81; 95% CI 1.28, 2.56), bronchitic symptoms (OR 2.06; 95% CI 1.58, 2.69) and SOB (OR 1.78; 95% CI 1.23, 2.57), adjusting for study wave, age, sex, race, lifetime asthma diagnosis and parental education. Effect estimates were attenuated (wheeze (OR 1.41; 95% CI 0.99, 2.01), bronchitic symptoms (OR 1.55; 95% CI 1.18, 2.05), SOB (OR 1.48; 95% CI 1.01, 2.18)), after adjusting additionally for current cigarette use, cannabis use and secondhand exposure to e-cigarettes/cigarettes/cannabis. CONCLUSIONS E-cigarette use in young adults was associated with respiratory symptoms, independent of combustible cannabis and cigarette exposures.
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Affiliation(s)
- Alayna P Tackett
- Department of Internal Medicine, Division of Medical Oncology, Center for Tobacco Research, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Robert Urman
- Department of Population and Public Health Sciences, University of Southern California Keck School of Medicine, Los Angeles, California, USA
| | - Jessica Barrington-Trimis
- Department of Population and Public Health Sciences, University of Southern California Keck School of Medicine, Los Angeles, California, USA
| | - Feifei Liu
- Department of Population and Public Health Sciences, University of Southern California Keck School of Medicine, Los Angeles, California, USA
| | - Hanna Hong
- Division of Pulmonology, Children's Hospital of Orange County, Orange, California, USA
| | - Mary Ann Pentz
- Department of Population and Public Health Sciences, University of Southern California Keck School of Medicine, Los Angeles, California, USA
| | - Talat S Islam
- Department of Population and Public Health Sciences, University of Southern California Keck School of Medicine, Los Angeles, California, USA
| | - Sandrah P Eckel
- Department of Population and Public Health Sciences, University of Southern California Keck School of Medicine, Los Angeles, California, USA
| | - Meghan Rebuli
- Department of Pediatrics, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina, USA
| | - Adam Leventhal
- Department of Population and Public Health Sciences, University of Southern California Keck School of Medicine, Los Angeles, California, USA
| | - Jonathan M Samet
- Department of Epidemiology, Colorado School of Public Health, Aurora, Colorado, USA
| | - Kiros Berhane
- Department of Biostatistics, Columbia University, New York, New York, USA
| | - Rob McConnell
- Department of Population and Public Health Sciences, University of Southern California Keck School of Medicine, Los Angeles, California, USA
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Freitas-Lemos R, Tomlinson DC, Yeh YH, Dwyer CL, Dai HD, Leventhal A, Tegge AN, Bickel WK. Can delay discounting predict vaccine hesitancy 4-years later? A study among US young adults. Prev Med Rep 2023; 35:102280. [PMID: 37576839 PMCID: PMC10413160 DOI: 10.1016/j.pmedr.2023.102280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 05/15/2023] [Accepted: 06/07/2023] [Indexed: 08/15/2023] Open
Abstract
Despite being a major threat to health, vaccine hesitancy (i.e., refusal or reluctance to vaccinate despite vaccine availability) is on the rise. Using a longitudinal cohort of young adults (N = 1260) from Los Angeles County, California we investigated the neurobehavioral mechanisms underlying COVID-19 vaccine hesitancy. Data were collected at two time points: during adolescence (12th grade; fall 2016; average age = 16.96 (±0.42)) and during young adulthood (spring 2021; average age = 21.33 (±0.49)). Main outcomes and measures were delay discounting (DD; fall 2016) and tendency to act rashly when experiencing positive and negative emotions (UPPS-P; fall 2016); self-reported vaccine hesitancy and vaccine beliefs/knowledge (spring 2021). A principal components analysis determined four COVID-19 vaccine beliefs/knowledge themes: Collective Responsibility, Confidence and Risk Calculation, Complacency, and Convenience. Significant relationships were found between themes, COVID-19 vaccine hesitancy, and DD. Collective Responsibility (β = -1.158[-1.213,-1.102]) and Convenience (β = -0.132[-0.185,-0.078]) scores were negatively associated, while Confidence and Risk Calculation (β = 0.283[0.230,0.337]) and Complacency (β = 0.412[0.358,0.466]) scores were positively associated with COVID-19 vaccine hesitancy. Additionally, Collective Responsibility (β = -0.060[-0.101,-0.018]) was negatively associated, and Complacency (β = -0.063[0.021,0.105]) was positively associated with DD from fall 2016. Mediation analysis revealed immediacy bias during adolescence, measured by DD, predicted vaccine hesitancy 4 years later while being mediated by two types of vaccine beliefs/knowledge: Collective Responsibility (β = 0.069[0.022,0.116]) and Complacency (β = 0.026[0.008,0.044]). These findings provide a further understanding of individual vaccine-related decision-making among young adults and inform public health messaging to increase vaccination acceptance.
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Affiliation(s)
| | - Devin C. Tomlinson
- Fralin Biomedical Research Institute at Virginia Tech Carilion, Roanoke, VA, USA
- Graduate Program in Translational Biology, Medicine, and Health, Virginia Tech, Blacksburg, VA, USA
| | - Yu-Hua Yeh
- Fralin Biomedical Research Institute at Virginia Tech Carilion, Roanoke, VA, USA
| | - Candice L. Dwyer
- Fralin Biomedical Research Institute at Virginia Tech Carilion, Roanoke, VA, USA
| | - Hongying Daisy Dai
- College of Public Health, University of Nebraska Medical Center, Omaha, NE, USA
| | - Adam Leventhal
- Department of Preventive Medicine, University of Southern California Keck School of Medicine, Los Angeles, CA, USA
- Department of Psychology, University of Southern California, Los Angeles, CA, USA
| | - Allison N. Tegge
- Fralin Biomedical Research Institute at Virginia Tech Carilion, Roanoke, VA, USA
- Department of Statistics, Virginia Tech, Blacksburg, VA, USA
| | - Warren K. Bickel
- Fralin Biomedical Research Institute at Virginia Tech Carilion, Roanoke, VA, USA
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Jacobs W, Merianos AL, Quinn P, Barrington-Trimis J, Leventhal A. Association of self-reported use of cannabis for the purpose of improving physical, mental, and sleep health with problematic cannabis use risk. BMC Public Health 2023; 23:1560. [PMID: 37587415 PMCID: PMC10429075 DOI: 10.1186/s12889-023-16324-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 07/17/2023] [Indexed: 08/18/2023] Open
Abstract
BACKGROUND Little is known about health-focused cannabis use purposes and their associations with risk for problematic cannabis use. This cross-sectional study examined three broad cannabis use purposes and association with risk for problematic use among young adult cannabis users who report using for > 1 health reasons. METHODS Young adults completed an electronic survey as part of an ongoing study on substance use and health. Those who self-reported past 6-month use of ≥ 1 cannabis products-smoking, vaping, dabbing, eating, and blunts-were included in the analysis. Their purposes for use were coded into three categories: sleep, mental, and physical health. Problematic cannabis use (PCU) was measured with the three-level structure Cannabis Abuse Screening Test (CAST-3). Adjusted multivariable regression models were used to estimate use purposes associated with with problematic cannabis use at the p < 0.05 level. RESULTS Participants (n = 954) were mostly female (63.94%) and Hispanic (54.93%). Mental health was the most endorsed reason (73.38%) for use among study sample. Among participants, 36.3% were classified as being at severe risk (CAST-3 score ≥ 8). There was a significant association between PCU risk and reporting cannabis use for physical health (p < 0.01), mental health, and sleep health (p < 0.01) purposes. Those who used cannabis for physical heath purposes had about four times the risk (adjusted relative risk ratio (aRRR) = 4.38, 95% CI = 3.06-6.69), those who used for mental health had about three times the risk (aRRR = 2.81, 95% CI = 1.86-4.72), and those who used for sleep health had almost two times the risk (aRRR = 1.83, 95% CI = 1.17-2.63) for severe PCU. CONCLUSION All cannabis use purposes examined increased risk of problematic cannabis use. Physical health use purposes was associated with highest PCU risk. This study demonstrates the risk for cannabis use disorder associated with self-medicating with cannabis.
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Affiliation(s)
- Wura Jacobs
- School of Public Health, Indiana University, 1025 E. 7th St., SPH 116, Bloomington, IN, 47405, USA.
| | | | - Patrick Quinn
- School of Public Health, Indiana University, 1025 E. 7th St., SPH 116, Bloomington, IN, 47405, USA
| | | | - Adam Leventhal
- Preventive Medicine, Keck School of Medicine, University of Southern California, California, USA
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Page MK, Paul EE, Leigh NJ, Meza LR, Galimov A, Sussman S, Leventhal A, O'Connor RJ, Goniewicz ML. Still 'Cool': tobacco industry responds to state-wide menthol ban with synthetic coolants. Tob Control 2023:tc-2023-058149. [PMID: 37500508 DOI: 10.1136/tc-2023-058149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 07/14/2023] [Indexed: 07/29/2023]
Abstract
INTRODUCTION In December 2022, California (CA) enforced a voter-approved regulation restricting the retail sale of flavoured tobacco products, including menthol cigarettes. Shortly after, new products emerged on the market containing similar blue and green package colours yet with 'non-menthol' descriptors. Using chemical analyses, we measured the content of menthol and 15 other cooling chemicals in Californian cigarettes with 'non-menthol' descriptors and compared concentrations to similar 'menthol'-labelled counterparts available in New York State (NY). METHODS A convenience sample of 10 brands and types of cigarettes in CA were purchased based on package colours suggesting a cooling effect and/or 'non-menthol' descriptors. The exact brand and type of cigarettes (with menthol descriptors) were purchased in NY. Cigarettes from CA were compared with equivalent cigarettes from NY on package design and colours, cigarette physical characteristics and the presence of cooling additives. RESULTS Menthol was not detected in any CA cigarette, except for Maverick-green box type, while its presence was confirmed in most NY counterpart products. A synthetic cooling chemical WS-3 was not detected in any NY cigarettes but was detected in four CA brands and types with implied cooling effect, ranging from 1.24±0.04 to 1.97±0.05 mg/cigarette. CONCLUSION While manufacturers have removed menthol descriptors from CA packaging and the menthol ingredient from cigarettes, synthetic cooling chemicals detected in several CA brands suggest that cooling sensory effects may still be sustained. Policymakers must consider both the chemical ingredients themselves and sensory effects in future regulatory approaches.
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Affiliation(s)
- Michelle K Page
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, New York, USA
| | - Emily E Paul
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, New York, USA
| | - Noel J Leigh
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, New York, USA
| | - Leah R Meza
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Artur Galimov
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Steve Sussman
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
- Departments of Preventive Medicine and Psychology, and School of Social Work, University of Southern California, Pasadena, California, USA
- Institute for Addiction Science, University of Southern California, Los Angeles, California, USA
| | - Adam Leventhal
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
- Institute for Addiction Science, University of Southern California, Los Angeles, California, USA
| | - Richard J O'Connor
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, New York, USA
| | - Maciej L Goniewicz
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, New York, USA
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Meza LR, Galimov A, Sussman S, Goniewicz ML, Page MK, Leventhal A. Proliferation of 'non-menthol' cigarettes amid a state-wide flavour ban. Tob Control 2023:tc-2023-058074. [PMID: 37474314 DOI: 10.1136/tc-2023-058074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 07/05/2023] [Indexed: 07/22/2023]
Affiliation(s)
- Leah R Meza
- Department of Population and Public Health Sciences, University of Southern California Keck School of Medicine, Los Angeles, California, USA
| | - Artur Galimov
- Department of Population and Public Health Sciences, University of Southern California Keck School of Medicine, Los Angeles, California, USA
| | - Steve Sussman
- Department of Population and Public Health Sciences, University of Southern California Keck School of Medicine, Los Angeles, California, USA
- Department of Psychology, and School of Social Work, University of Southern California, Los Angeles, California, USA
- Institute for Addiction Science, University of Southern California, Los Angeles, California, USA
| | - Maciej Lukasz Goniewicz
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, New York, USA
| | - Michelle K Page
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, New York, USA
| | - Adam Leventhal
- Department of Population and Public Health Sciences, University of Southern California Keck School of Medicine, Los Angeles, California, USA
- Institute for Addiction Science, University of Southern California, Los Angeles, California, USA
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Islam T, Eckel S, Liu F, Barrington-Trimis J, Harlow AF, Benowitz N, Leventhal A, McConnell R, Cho J. Effects of dual use of e-cigarette and cannabis during adolescence on cigarette use in young adulthood. Tob Control 2023:tc-2022-057542. [PMID: 37147126 DOI: 10.1136/tc-2022-057542] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 04/06/2023] [Indexed: 05/07/2023]
Abstract
INTRODUCTION E-cigarette and cannabis use by adolescents are risk factors for smoking initiation. We hypothesised that increasingly common dual use of e-cigarette and cannabis in adolescence leads to more frequent cigarette smoking in young adulthood. METHODS Data are from a prospective cohort study in Southern California, where 1164 participants who ever used nicotine products in their lifetime completed surveys in 12th grade (T1:2016), and at 24-month (T2) and 42-month (T3) follow-ups. Past 30-day use (number of days: range=0-30) of cigarettes, e-cigarettes and cannabis, and nicotine dependence, were assessed in each survey. Nicotine dependence for cigarettes and e-cigarettes was assessed using original and modified (for e-cigarette) Hooked on Nicotine Checklists (number of dependent products: range=0-2). Path analysis examined the mediation process via nicotine dependence linking baseline e-cigarette and cannabis use to subsequent increased cigarette use. RESULTS Baseline exclusive use of e-cigarettes (baseline prevalence, 2.5%) was associated with 2.61-fold increase in frequency of smoking days at T3 (95% CI 1.04 to 13.1), exclusive cannabis use (26.0%) with 2.58-fold increase (95% CI 1.43 to 4.98), and dual use (7.4%) with 5.84-fold increase (95% CI 3.16 to 12.81), compared with baseline non-users. Nicotine dependence at T2 mediated 10.5% (95% CI 6.3 to 14.7) and 23.2% (95% CI 9.6 to 36.3) of the association of cannabis and dual use, respectively, with increased smoking at T3. DISCUSSION Adolescent e-cigarette and cannabis use was associated with more frequent smoking during young adulthood, with larger effects of dual use. Associations were partially mediated through nicotine dependence. Dual use of cannabis and e-cigarettes may contribute to the development of nicotine dependence and increased use of combustible cigarettes.
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Affiliation(s)
- Talat Islam
- Department of Population and Public Helath Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Sandrah Eckel
- Department of Population and Public Helath Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Feifei Liu
- Department of Population and Public Helath Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Jessica Barrington-Trimis
- Department of Population and Public Helath Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Alyssa F Harlow
- Department of Population and Public Helath Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Neal Benowitz
- University of California San Francisco, San Francisco, California, USA
| | - Adam Leventhal
- Department of Population and Public Helath Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Rob McConnell
- Department of Population and Public Helath Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Junhan Cho
- Department of Population and Public Helath Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
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Tatum Z, Leventhal A, Wipfli HL. Playtime: vaping devices designed as cartoons and toys may appeal to kids. Tob Control 2023:tc-2022-057908. [PMID: 36990685 DOI: 10.1136/tc-2022-057908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 03/10/2023] [Indexed: 03/31/2023]
Affiliation(s)
- Zacari Tatum
- Population and Public Health Sciences, University of Southern California, Los Angeles, California, USA
| | - Adam Leventhal
- Population and Public Health Sciences, University of Southern California, Los Angeles, California, USA
| | - Heather Lynn Wipfli
- Population and Public Health Sciences, University of Southern California, Los Angeles, California, USA
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Chen-Sankey JC, Kechter A, Barrington-Trimis J, McConnell R, Krueger EA, Cruz TB, Unger JB, Chaffee BW, Leventhal A. Effect of a hypothetical modified risk tobacco product claim on heated tobacco product use intention and perceptions in young adults. Tob Control 2023; 32:42-50. [PMID: 34059552 PMCID: PMC8630081 DOI: 10.1136/tobaccocontrol-2021-056479] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 04/01/2021] [Accepted: 04/06/2021] [Indexed: 01/03/2023]
Abstract
INTRODUCTION Modified risk tobacco product (MRTP) claims for heated tobacco products (HTPs) that convey reduced exposure compared with conventional cigarettes may promote product initiation and transition among young people. We assessed the effects of a hypothetical MRTP claim for HTPs on young adults' intention and perceptions of using HTPs and whether these effects differed by their current cigarette and e-cigarette use. METHODS We embedded a randomised between-subjects experiment into a web-based survey administered among a cohort of 2354 Southern California young adults (aged 20-23) in 2020. Participants viewed depictions of HTPs with an MRTP claim (n=1190) or no claim (n=1164). HTP use intention and HTP-related harm and use perceptions relative to cigarettes and e-cigarettes were assessed. RESULTS Overall, participants who viewed versus did not view the claim did not differ in HTP use intention (28.5% vs 28.7%) but were more likely to perceive HTPs as less harmful than cigarettes (11.4% vs 7.0%; p<0.001). The experimental effect on HTP use intention did not differ among past 30-day cigarette smokers versus non-smokers (interaction adjusted OR (AOR)=0.78, 95% CI 0.36 to 1.76) but differed among past 30-day e-cigarette users versus non-users (interaction AOR=1.67, 95% CI 1.02 to 2.68). DISCUSSION The hypothetical MRTP claim may lower young adults' HTP harm perceptions compared with cigarettes but may not change HTP use intention overall or differentially for cigarette smokers. The larger effect on HTP use intention among e-cigarette users than non-users raises the question of whether MRTP claims may promote HTP use or HTP and e-cigarette dual use among young e-cigarette users.
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Affiliation(s)
- Julia C Chen-Sankey
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, Bethesda, Maryland, USA
| | - Afton Kechter
- Department of Preventive Medicine, University of Southern California Keck School of Medicine, Los Angeles, California, USA
| | - Jessica Barrington-Trimis
- Department of Preventive Medicine, University of Southern California Keck School of Medicine, Los Angeles, California, USA
- Institute for Addiction Science, University of Southern California, Los Angeles, California, USA
| | - Rob McConnell
- Department of Preventive Medicine, University of Southern California Keck School of Medicine, Los Angeles, California, USA
| | - Evan A Krueger
- Department of Preventive Medicine, University of Southern California Keck School of Medicine, Los Angeles, California, USA
| | - Tess Boley Cruz
- Department of Preventive Medicine, University of Southern California Keck School of Medicine, Los Angeles, California, USA
| | - Jennifer B Unger
- Department of Preventive Medicine, University of Southern California Keck School of Medicine, Los Angeles, California, USA
| | - Benjamin W Chaffee
- Preventive and Restorative Dental Sciences, University of California San Francisco, San Francisco, California, USA
| | - Adam Leventhal
- Department of Preventive Medicine, University of Southern California Keck School of Medicine, Los Angeles, California, USA
- Institute for Addiction Science, University of Southern California, Los Angeles, California, USA
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11
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Xi Q, Meza R, Leventhal A, Tam J. Modeling cigarette smoking disparities between people with and without serious psychological distress in the US, 1997-2100. Prev Med 2023; 166:107385. [PMID: 36495925 PMCID: PMC9994605 DOI: 10.1016/j.ypmed.2022.107385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 12/02/2022] [Accepted: 12/04/2022] [Indexed: 12/12/2022]
Abstract
Cigarette smoking rates are significantly higher among people with serious psychological distress (SPD) compared to the general population. US simulation models that project future smoking disparities by SPD status could inform policy interventions, but have not been developed. We calibrated two compartmental models to the National Health Interview Survey 1997-2018 for populations with and without SPD, calculating smoking prevalence, mortality, and life-years lost by SPD status under different scenarios from 2023 to 2100. Under the Status Quo, smoking prevalence among women with SPD falls from 27.0% in 2023 to 10.7% in 2100 (men: 30.1% to 12.2%). For women without SPD, it declines from 9.4% to 3.1% (men: 11.5% to 4.0%). The absolute difference in smoking prevalence between those with and without SPD decreases over time, whereas the relative smoking prevalence ratio increases. From 2023 to 2100, 609,000 premature smoking-attributable deaths would occur in the SPD population, with 8 million life-years lost. Under an ideal tobacco control scenario for people with SPD, in which all smokers quit in 2023 and no new smoking initiation occurs thereafter, up to 386,000 of these premature deaths could be averted with 4.9 million life-years gained. Preventing smoking initiation could avert up to 18% of these deaths, while improving smoking cessation could avert up to 82%. Smoking-related disparities for people with SPD will persist unless a shift in tobacco control substantially improves cessation and prevents initiation in this subpopulation. Smoking disparities by SPD may widen in relative but narrow in absolute terms, so both perspectives should be evaluated.
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Affiliation(s)
- Qin Xi
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK; Yale School of Public Health, 60 College St., New Haven, CT 06520, United States of America.
| | - Rafael Meza
- BC Cancer Research Institute, 675 West 10th Avenue, Vancouver, BC V5Z 1L3, Canada.
| | - Adam Leventhal
- University of Southern California, School of Medicine, Soto Street Health Sciences Campus, Los Angeles, CA 90033, United States of America.
| | - Jamie Tam
- Yale School of Public Health, 60 College St., New Haven, CT 06520, United States of America.
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12
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Vogel EA, Rebuli ME, Wong M, Leventhal A, Monterosso J, Tackett AP. Feasibility and acceptability of remote procedures to study tobacco product use and respiratory health: an observational study. BMJ Open 2022; 12:e065962. [PMID: 36456013 PMCID: PMC9716794 DOI: 10.1136/bmjopen-2022-065962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVE Obtaining ecologically valid biological samples is critical for understanding respiratory effects of tobacco use, but can be burdensome. In two diverse samples, we examined feasibility and acceptability of studying pulmonary function and respiratory health entirely remotely. DESIGN Observational feasibility and acceptability study. SETTING AND PARTICIPANTS Adults age 18-25 (Biomedical Respiratory Effects Associated through Habitual Use of E-Cigarettes [BREATHE] Study) and 21-65 (Adult IQOS Respiratory [AIRS] Study) recruited from previous research studies and advertisements in Southern California, USA (BREATHE (AIRS): N=77 (N=31) completed baseline, n=64 (n=20) completed feasibility and acceptability measures). Shared inclusion criteria for the two studies were ownership of a smartphone, willingness to download applications and English fluency. In addition, BREATHE participants reported one of three tobacco use patterns. AIRS participants smoked daily and were willing to use a heated tobacco product. Exclusion criteria were medical contraindications. INTERVENTIONS A 4-week study consisted of five virtual study visits, twice daily ecological momentary assessment diaries and spirometry assessments, and weekly Nasal Epithelial Lining Fluid and saliva collection. All study visits were conducted via video conference; study materials and biospecimens were exchanged via mail. Participants reported feasibility and acceptability of daily diaries, breath tests, biospecimen collection and shipments. MEASURES Surveys assessed perceptions of timing and overall experience of daily diaries and breath tests, difficulty of and overall experience with biospecimen collection, and experience sending and receiving shipments. RESULTS Most participants evaluated daily diaries and breath tests as manageable (62.5%-95.0%) and likeable (54.7%-70.0%). Breath tests were frequently described as 'interesting' (55.0%-57.8%) and 'easy' (25.0%-48.4%). Most participants reported that biospecimen collection was easy (50.0%-85.0%), and that shipments were easy to send (87.5%-95.0%), receive (95.3%-95.0%) and schedule (56.3%-60.0%). No participants received shipments in poor condition. CONCLUSIONS Remote research procedures may be feasible and acceptable to facilitate tobacco research studies, potentially resulting in more diverse samples of participants and more generalisable research results.
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Affiliation(s)
- Erin A Vogel
- Department of Population and Public Health Sciences, University of Southern California Keck School of Medicine, Los Angeles, California, USA
- Institute for Addiction Science, University of Southern California, Los Angeles, California, USA
| | - Meghan E Rebuli
- Department of Pediatrics, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Melissa Wong
- Department of Population and Public Health Sciences, University of Southern California Keck School of Medicine, Los Angeles, California, USA
- Institute for Addiction Science, University of Southern California, Los Angeles, California, USA
| | - Adam Leventhal
- Department of Population and Public Health Sciences, University of Southern California Keck School of Medicine, Los Angeles, California, USA
- Institute for Addiction Science, University of Southern California, Los Angeles, California, USA
| | - John Monterosso
- Institute for Addiction Science, University of Southern California, Los Angeles, California, USA
- Department of Psychology, University of Southern California, Los Angeles, California, USA
| | - Alayna P Tackett
- Department of Population and Public Health Sciences, University of Southern California, Los Angeles, California, USA
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13
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Dai HD, Leventhal A. Changes in electronic cigarette use among U.S. Adults by cigarette smoking status, socciodemographics, and subjective depression, 2019-2020. Prev Med Rep 2022; 30:102048. [PMID: 36531098 PMCID: PMC9747635 DOI: 10.1016/j.pmedr.2022.102048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 10/29/2022] [Accepted: 11/05/2022] [Indexed: 11/09/2022] Open
Abstract
E-cigarette use increased from 2017 to 2019 and then declined in 2020 among U.S. adults. It is important to understand whether the decline differed by smoking status and sociodemographic groups and whether daily e-cigarette use has subsequently changed. This study estimated e-cigarette use prevalence in 2019 and 2020 by analyzing the pooled National Health Interview Survey (n = 63,565) in 2022. Multivariable logistics regressions were performed to examine biannual change in current and daily e-cigarette use, overall and stratified by cigarette smoking status, sociodemographic factors, and subjective depression frequency. Among US adults, change in current e-cigarette use during 2019-2020 differed by smoking status (cigarette smoking status × year, p =.01) and race/ethnicity (race/ethnicity × year, p =.03). Current e-cigarette use prevalence decreased among current cigarette smokers (11.7 % to 8.0 %, p = 0.0001) but not among former or never smokers, and among Non-Hispanic White adults (5.1 % to 4.2 %, p = 0.04) and Non-Hispanic Black adults (3.4 % to 1.6 %, p = 0.0003) but not among other racial and ethnic groups. Current e-cigarette use also declined among those 25-64 years old but not among young adults 18-24 years old. Daily e-cigarette use did not significantly change during 2019-2020 in the overall sample (2.3 % to 2.0 %, p = 0.10), but declined among adults who were Non-Hispanic Black (2.4 % to 0.9 %, p = 0.0007), aged 35-44 years, and lived below the federal poverty level. Adults with monthly depressive episodes (vs without) continued to have a higher prevalence of current (7.0 % vs 3.0 %) and daily e-cigarette use (3.6 % vs 1.6 %) in 2020. Continuous monitoring of cross-population differences in adult e-cigarette use is warranted.
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Affiliation(s)
- Hongying Daisy Dai
- Corresponding author at: 84375 Nebraska Medical Center, College of Public Health, University of Nebraska Medical Center, Omaha, NE, USA.
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14
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Galimov A, Leventhal A, Meza L, Unger JB, Huh J, Baezconde-Garbanati L, Sussman SY. Prevalence of disposable pod use and consumer preference for e-cigarette product characteristics among vape shop customers in Southern California: a cross-sectional study. BMJ Open 2021; 11:e049604. [PMID: 34610937 PMCID: PMC8493914 DOI: 10.1136/bmjopen-2021-049604] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES In February 2020, the US Food and Drug Administration issued a guidance restricting the sales and distribution of cartridge-based e-cigarettes with flavours other than tobacco and menthol. Disposable devices were exempt from this guidance. This study examined the prevalence of disposable pod use and flavour preference compared with refillable pod and other e-cigarette users among vape shop customers. DESIGN Cross-sectional study. SETTING In July 2019-March 2020, trained data collectors visited 44 vape shops in California with permission to recruit customers from shop owners. PARTICIPANTS Intercept interviews with 276 customers were conducted. OUTCOMES AND PROCEDURES Customers were grouped based on self-reported device type used most often (disposable pod, refillable pod and other e-cigarettes). Groups were compared on self-reported demographics, flavours preferred, daily e-cigarette use, preferred nicotine concentration levels and cigarette use. RESULTS Of the 276 customers surveyed, 11.2% used disposable pods in the past 30 days. Among disposable pod users, fruit/candy (80.7%), mint (77.4%) and menthol (67.7%) were common preferred flavours, while tobacco flavours were less commonly preferred (19.4%). When compared with refillable pod and other non-pod e-cigarette device users, disposable pod users were younger, used higher nicotine concentration levels, were more likely to prefer mint and menthol flavours and use e-cigarettes as their first product, while less likely to ever use cigarettes and use e-cigarettes daily. DISCUSSION Despite using higher nicotine levels and preferred menthol/mint flavours more often than users of other devices, disposable pod users reported lower prevalence of lifetime smoking and daily vaping and were younger. Given the current findings, regulations addressing non-tobacco flavours and nicotine concentration in disposable pod devices merit consideration in efforts to reduce vaping in younger adult never smokers.
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Affiliation(s)
- Artur Galimov
- Department of Population and Public Health Sciences, University of Southern California Keck School of Medicine, Los Angeles, California, USA
| | - Adam Leventhal
- Department of Population and Public Health Sciences, University of Southern California Keck School of Medicine, Los Angeles, California, USA
- Institute for Addiction Science, University of Southern California, Los Angeles, CA, USA
| | - Leah Meza
- Department of Population and Public Health Sciences, University of Southern California Keck School of Medicine, Los Angeles, California, USA
| | - Jennifer B Unger
- Department of Population and Public Health Sciences, University of Southern California Keck School of Medicine, Los Angeles, California, USA
| | - Jimi Huh
- Department of Population and Public Health Sciences, University of Southern California Keck School of Medicine, Los Angeles, California, USA
| | - Lourdes Baezconde-Garbanati
- Department of Population and Public Health Sciences, University of Southern California Keck School of Medicine, Los Angeles, California, USA
| | - Steven Y Sussman
- Department of Population and Public Health Sciences, University of Southern California Keck School of Medicine, Los Angeles, California, USA
- Department of Psychology, University of Southern California, Los Angeles, CA, USA
- School of Social Work, University of Southern California, Los Angeles, CA, USA
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Affiliation(s)
- Brian P Lee
- University of Southern California Keck School of Medicine, Los Angeles, California
| | - Jennifer L Dodge
- University of Southern California Keck School of Medicine, Los Angeles, California
| | - Adam Leventhal
- University of Southern California Keck School of Medicine, Los Angeles, California
| | - Norah A Terrault
- University of Southern California Keck School of Medicine, Los Angeles, California
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16
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Schiff S, Liu F, Cruz TB, Unger JB, Cwalina S, Leventhal A, McConnell R, Barrington-Trimis J. E-cigarette and cigarette purchasing among young adults before and after implementation of California's tobacco 21 policy. Tob Control 2021; 30:206-211. [PMID: 32108084 PMCID: PMC8260105 DOI: 10.1136/tobaccocontrol-2019-055417] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Revised: 01/07/2020] [Accepted: 01/29/2020] [Indexed: 11/04/2022]
Abstract
BACKGROUND Tobacco 21 (T21) laws, which raise the minimum legal age of sale of tobacco products to 21, have been proposed and implemented in states and cities across the USA. However, limited data are available on the effect of T21 laws on youth tobacco purchasing behaviours and access to tobacco products. METHODS Participants in a population-based prospective cohort in southern California completed questionnaires before (n=1609, age=18-19 y) and after (n=1502, age=19-20 y) T21 was implemented in California (June 2016). We examined the prevalence of past 30-day cigarette and e-cigarette use, and among past 30-day users, purchase location of tobacco products before (pre-) versus after (post-) T21. We also examined whether, post-T21, participants were refused purchase of tobacco products due to their age, and the perceived relative ease of purchasing cigarettes and e-cigarettes (vs pre-T21). RESULTS Negligible changes in cigarette and e-cigarette use were observed pre-T21 versus post-T21. At both time points, the majority of past 30-day users purchased cigarettes from gas stations and e-cigarettes from vape shops. Post-T21, the proportion of participants who reported purchasing cigarettes at gas stations decreased. Post-T21, most past 30-day cigarette or e-cigarette users were not refused purchase of cigarettes (65.4%) or e-cigarettes (82.0%) in the past 30 days, despite being under 21; half of the participants felt it was harder to purchase cigarettes (54.3%) and e-cigarettes (43.6%) post-T21. CONCLUSION Post-T21, few participants were refused purchase of any tobacco product, despite the illegality of such sales. Better enforcement of T21 is needed to improve the efficacy of T21 legislation.
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Affiliation(s)
- Sara Schiff
- Department of Preventive Medicine, University of Southern California, Los Angeles, California, USA
| | - Fei Liu
- Department of Preventive Medicine, University of Southern California, Los Angeles, California, USA
| | - Tess Boley Cruz
- Department of Preventive Medicine, University of Southern California, Los Angeles, California, USA
- University of Southern California Norris Comprehensive Cancer Center, Los Angeles, California, USA
- Institute for Addiction Science, University of Southern California, Los Angeles, California, USA
| | - Jennifer B Unger
- Department of Preventive Medicine, University of Southern California, Los Angeles, California, USA
- University of Southern California Norris Comprehensive Cancer Center, Los Angeles, California, USA
- Institute for Addiction Science, University of Southern California, Los Angeles, California, USA
| | - Sam Cwalina
- Department of Preventive Medicine, University of Southern California, Los Angeles, California, USA
| | - Adam Leventhal
- Department of Preventive Medicine, University of Southern California, Los Angeles, California, USA
- University of Southern California Norris Comprehensive Cancer Center, Los Angeles, California, USA
- Institute for Addiction Science, University of Southern California, Los Angeles, California, USA
| | - Rob McConnell
- Department of Preventive Medicine, University of Southern California, Los Angeles, California, USA
- University of Southern California Norris Comprehensive Cancer Center, Los Angeles, California, USA
- Institute for Addiction Science, University of Southern California, Los Angeles, California, USA
| | - Jessica Barrington-Trimis
- Department of Preventive Medicine, University of Southern California, Los Angeles, California, USA
- University of Southern California Norris Comprehensive Cancer Center, Los Angeles, California, USA
- Institute for Addiction Science, University of Southern California, Los Angeles, California, USA
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17
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Abstract
IMPORTANCE US adolescent nicotine vaping increased at a record pace from 2017 to 2019, prompting new national policies to reduce access to flavors of vaping products preferred by youth. OBJECTIVE To estimate prevalence, perceived harm, and accessibility of nicotine vaping products among US adolescents from 2017 to 2020. DESIGN, SETTING, AND PARTICIPANTS This survey study includes data from Monitoring the Future, which conducted annual, cross-sectional, school-based, nationally representative surveys from 2017 to 2020 of 10th- and 12th-grade students (results pooled grades, n = 94 320) about vaping and other topics. MAIN OUTCOMES AND MEASURES Prevalence of self-reported nicotine vaping; vaping brand and flavor used most often; perceived risk of nicotine vaping; and perceived ease of getting vaping devices, nicotine solutions for vaping, and flavored solutions. RESULTS In 2020, Monitoring the Future surveyed 8660 students in 10th and 12th grade, of whom 50.6% (95% CI, 47%-54%) were female, 13% (95% CI, 8%-21%) were non-Hispanic Black, 29% (95% CI, 21%-40%) were Hispanic, and 53% (95% CI, 42%-63%) were non-Hispanic White. Nicotine vaping prevalence in 2020 was 22% (95% CI, 19%-25%) for past 30-day use, 32% (95% CI, 28%-37%) for past 12-month use, and 41% (95% CI, 37%-46%) for lifetime use; these levels did not significantly change from 2019. Daily nicotine vaping (use on ≥20 days of the last 30 days) significantly declined from 9% (95% CI, 8%-10%) to 7% (95% CI, 6%-9%) over 2019 to 2020. JUUL brand prevalence in the past 30 days decreased from 20% (95% CI, 18%-22%) in 2019 to 13% (95% CI, 11%-15%) in 2020, while use of other brands increased. Among youth who vaped in the past 30 days in 2020, the most often used flavor was fruit at 59% (95% CI, 55%-63%), followed by mint at 27% (95% CI, 24%-30%) and menthol at 7% (95% CI, 5%-9%); significantly fewer reported easy access to vaping devices and nicotine solutions compared with 2019; and 80% (95% CI, 75%-84%) reported they could easily get a vaping flavor other than tobacco or menthol. Among all youth, perceived risk of both occasional and regular nicotine vaping increased from 2019 to 2020. CONCLUSIONS AND RELEVANCE Increasing US adolescent nicotine vaping trends from 2017 to 2019 halted in 2020, including a decline in daily vaping. Decreases in perceived accessibility of some vaping products, as well as increases in perceived risk of nicotine vaping, occurred from 2019 to 2020. Yet, adolescent nicotine vaping remains highly prevalent, flavors remain highly accessible, and declines in JUUL use were countered by increased use of other brands.
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18
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Leventhal A, Cho J, Barrington-Trimis J, Pang R, Schiff S, Kirkpatrick M. Sensory attributes of e-cigarette flavours and nicotine as mediators of interproduct differences in appeal among young adults. Tob Control 2019; 29:679-686. [PMID: 31852818 DOI: 10.1136/tobaccocontrol-2019-055172] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Revised: 10/13/2019] [Accepted: 10/31/2019] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To estimate the extent to which specific sensory attributes, for example, smoothness, mediate differences in electronic cigarette (e-cigarette) appeal between products in non-tobacco versus tobacco flavours and varying nicotine content in young adults. METHOD E-cigarette users (n=100; aged 18-34 years) administered standardised two-puff e-cigarette doses of different products varying in a flavour (fruit, menthol, tobacco) × nicotine (nicotine-containing (6 mg/mL freebase), nicotine-free) within-subject design. Participants rated sensory attributes (sweetness, bitterness, smoothness and harshness) and appeal on 100-unit visual analogue scales after administering each product. Sensory ratings were tested as simultaneous mediators of flavour, nicotine and flavour × nicotine effects on appeal. RESULTS Appeal preferences for fruit versus tobacco flavours were mediated by sweetness-enhancing (βindirect=0.092), smoothness-enhancing (βindirect=0.045) and bitterness-reducing (βindirect=0.072) effects of fruit flavours. Appeal preferences for menthol versus tobacco flavours were mediated by menthol's smoothness-enhancing (βindirect=0.039) and bitterness-reducing (βindirect=0.034) effects. Lower appeal of nicotine-containing versus nicotine-free products was mediated by nicotine's sweetness-reducing (βindirect=-0.036), smoothness-reducing (βindirect=-0.156) and bitterness-increasing (βindirect=0.045) effects. Flavour × nicotine interaction effects on appeal were explained by menthol-related suppression of nicotine's bitterness-enhancing and sweetness-reducing mediation pathways and fruit-related suppression of nicotine's bitterness-enhancing mediation pathway. Harshness did not mediate appeal after adjusting for other sensory attributes. CONCLUSION Bitterness and smoothness may be cross-cutting mediators of interproduct variation in the effects of types of non-tobacco flavours and nicotine on e-cigarette appeal in young adults. Sweetness may also mediate appeal-enhancing effects of fruit and appeal-reducing effects of nicotine. Non-tobacco flavours may suppress appeal-reducing effects of nicotine in e-cigarettes through attenuation of nicotine's aversive taste attributes.
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Affiliation(s)
- Adam Leventhal
- Preventive Medicine, Keck School of Medicine of the University of Southern California, Los Angeles, California, USA
| | - Junhan Cho
- Preventive Medicine, Keck School of Medicine of the University of Southern California, Los Angeles, California, USA
| | - Jessica Barrington-Trimis
- Preventive Medicine, Keck School of Medicine of the University of Southern California, Los Angeles, California, USA
| | - Raina Pang
- Preventive Medicine, Keck School of Medicine of the University of Southern California, Los Angeles, California, USA
| | - Sara Schiff
- Preventive Medicine, Keck School of Medicine of the University of Southern California, Los Angeles, California, USA
| | - Matthew Kirkpatrick
- Preventive Medicine, Keck School of Medicine of the University of Southern California, Los Angeles, California, USA
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19
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Liao Y, Chou CP, Huh J, Leventhal A, Dunton G. Associations of Affective Responses During Free-Living Physical Activity and Future Physical Activity Levels: an Ecological Momentary Assessment Study. Int J Behav Med 2018; 24:513-519. [PMID: 28008556 DOI: 10.1007/s12529-016-9626-z] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
PURPOSE Affective response during physical activity may influence motivation to perform future physical activity behavior. However, affective response during physical activity is often assessed under controlled laboratory conditions. The current study used ecological momentary assessment (EMA) to capture affective responses during free-living physical activity performed by adults, and determined whether these affective responses predict future moderate-to-vigorous physical activity (MVPA) levels after 6 and 12 months. METHOD At baseline, electronic EMA surveys were randomly prompted across 4 days asking about current activities and affective states (e.g., happy, stressed, energetic, tired). Affective response during physical activity was operationalized as the level of positive or negative affect reported when concurrent physical activity (e.g., exercise or sports) was also reported. Data were available for 82 adults. Future levels of moderate-to-vigorous physical activity (MVPA) were measured using accelerometers, worn for seven consecutive days at 6 and 12 months after the baseline assessment. RESULTS Feeling more energetic during physical activity was associated with performing more minutes of daily MVPA after both 6 and 12 months. Feeling less negative affect during physical activity was associated with engaging in more daily MVPA minutes after 12 months only. CONCLUSION This study demonstrated how EMA can be used to capture affective responses during free-living physical activity. Results found that feelings more energetic and less negative during physical activity were associated with more future physical activity, suggesting that positive emotional benefits may reinforce behavior.
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Affiliation(s)
- Yue Liao
- Department of Behavioral Science, University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA.
| | - Chih-Ping Chou
- Department of Preventive Medicine, University of Southern California, Los Angeles, CA, 90032, USA
| | - Jimi Huh
- Department of Preventive Medicine, University of Southern California, Los Angeles, CA, 90032, USA
| | - Adam Leventhal
- Department of Preventive Medicine, University of Southern California, Los Angeles, CA, 90032, USA
| | - Genevieve Dunton
- Department of Preventive Medicine, University of Southern California, Los Angeles, CA, 90032, USA
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20
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Rudy A, Leventhal A, Goldenson NI, Eissenberg T. Assessing electronic cigarette effects and regulatory impact: Challenges with user self-reported device power. Drug Alcohol Depend 2017; 179:337-340. [PMID: 28843084 PMCID: PMC5599371 DOI: 10.1016/j.drugalcdep.2017.07.031] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Revised: 07/27/2017] [Accepted: 07/27/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Electronic cigarettes (ECIGs) aerosolize liquids for user inhalation that usually contain nicotine. ECIG nicotine emission is determined, in part, by user behavior, liquid nicotine concentration, and electrical power. Whether users are able to report accurately nicotine concentration and device electrical power has not been evaluated. This study's purpose was to examine if ECIG users could provide data relevant to understanding ECIG nicotine emission, particularly liquid nicotine concentration (mg/ml) as well as battery voltage (V) and heater resistance (ohms, Ω) - needed to calculate power (watts, W). METHODS Adult ECIG users (N=165) were recruited from Los Angeles, CA for research studies examining the effects of ECIG use. We asked all participants who visited the laboratory to report liquid nicotine concentration, V, and Ω. RESULTS Liquid nicotine concentration was reported by 89.7% (mean=9.5mg/ml, SD=7.3), and responses were consistent with the distribution of liquids available in commonly marketed products. The majority could not report voltage (51.5%) or resistance (63.6%). Of the 40 participants (24.8%) who reported voltage and resistance, there was a substantial power range (2.2-32,670W) the upper limit of which exceeds that of the highest ECIG reported by any user to our knowledge (i.e., 2512W). If 2512W is taken as the upper limit, only 30 (18.2%) reported valid results (mean 237.3W, SD=370.6; range=2.2-1705.3W). CONCLUSIONS Laboratory, survey, and other researchers interested in understanding ECIG effects to inform users and policymakers may need to use methods other than user self-report to obtain information regarding device power.
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Affiliation(s)
- Alyssa Rudy
- Center for the Study of Tobacco Products, Department of Psychology, Virginia Commonwealth University, Richmond, Virginia
| | - Adam Leventhal
- University of Southern California Health, Emotion, and Addiction Laboratory, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033
| | - Nicholas I. Goldenson
- University of Southern California Health, Emotion, and Addiction Laboratory, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033
| | - Thomas Eissenberg
- Center for the Study of Tobacco Products, Department of Psychology, Virginia Commonwealth University, Richmond, VA, United States.
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McConnell R, Barrington-Trimis JL, Wang K, Urman R, Hong H, Unger J, Samet J, Leventhal A, Berhane K. Electronic Cigarette Use and Respiratory Symptoms in Adolescents. Am J Respir Crit Care Med 2017; 195:1043-1049. [PMID: 27806211 DOI: 10.1164/rccm.201604-0804oc] [Citation(s) in RCA: 232] [Impact Index Per Article: 33.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
RATIONALE Rates of adolescent electronic (e-) cigarette use are increasing, but there has been little study of the chronic effects of use. Components of e-cigarette aerosol have known pulmonary toxicity. OBJECTIVES To investigate the associations of e-cigarette use with chronic bronchitis symptoms and wheeze in an adolescent population. METHODS Associations of self-reported use of e-cigarettes with chronic bronchitic symptoms (chronic cough, phlegm, or bronchitis) and of wheeze in the previous 12 months were examined in 2,086 Southern California Children's Health Study participants completing questionnaires in 11th and 12th grade in 2014. MEASUREMENTS AND MAIN RESULTS Ever e-cigarette use was reported by 502 (24.0%), of whom 201 (9.6%) used e-cigarettes during the last 30 days (current users). Risk of bronchitic symptoms was increased by almost twofold among past users (odds ratio [OR], 1.85; 95% confidence interval [CI], 1.37-2.49), compared with never-users, and by 2.02-fold (95% CI, 1.42-2.88) among current users. Risk increased with frequency of current use (OR, 1.66; 95% CI, 1.02-2.68) for 1-2 days and 2.52 (95% CI, 1.56-4.08) for 3 or more days in past 30 days compared with never-users. Associations were attenuated by adjustment for lifetime number of cigarettes smoked and secondhand smoke exposure. However, risk of bronchitic symptoms among past e-cigarette users remained elevated after adjustment for relevant potential confounders and was also observed among never-cigarette users (OR, 1.70; 95% CI, 1.11-2.59). There were no statistically significant associations of e-cigarette use with wheeze after adjustment for cigarette use. CONCLUSIONS Adolescent e-cigarette users had increased rates of chronic bronchitic symptoms. Further investigation is needed to determine the long-term effects of e-cigarettes on respiratory health.
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Affiliation(s)
- Rob McConnell
- 1 Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California; and
| | - Jessica L Barrington-Trimis
- 1 Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California; and
| | - Kejia Wang
- 1 Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California; and
| | - Robert Urman
- 1 Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California; and
| | - Hanna Hong
- 2 Division of Pulmonary Medicine, Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, California
| | - Jennifer Unger
- 1 Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California; and
| | - Jonathan Samet
- 1 Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California; and
| | - Adam Leventhal
- 1 Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California; and
| | - Kiros Berhane
- 1 Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California; and
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Shuldiner J, Leventhal A, Chemtob D, Mor Z. Mortality after anti-tuberculosis treatment completion: results of long-term follow-up. Int J Tuberc Lung Dis 2016; 20:43-8. [PMID: 26688527 DOI: 10.5588/ijtld.14.0427] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Mycobacterium tuberculosis affects the lung parenchyma even after successful treatment. OBJECTIVE To assess long-term mortality in a cohort of individuals who had recovered from tuberculosis (TB), and to compare their mortality rate and causes of death with those of the general population. METHODS This retrospective cohort study of all Israeli citizens who recovered from tuberculosis between 2000 and 2010 included all patient files and death certificates and/or hospitalisation records of deceased individuals. Death rates were computed using standard mortality rates (SMR). Cox proportional hazard regression was conducted to identify risk factors for death, and causes of death were compared with those in the general Israeli population. RESULTS Over 11 years of follow-up, comprising 18,246 person-years, 389 (12.0%) Israeli citizens died after completion of anti-tuberculosis treatment, giving an SMR of 3.7. The SMR was strongly correlated with age, and was highest in males and individuals aged 25-44 years. Compared to the general population, among individuals who recovered from TB there were more deaths due to septicaemia and pneumonia, and fewer deaths due to cerebrovascular diseases, stroke and diabetes (P < 0.05). CONCLUSIONS Individuals who recover from TB are at higher risk of long-term mortality than the general population, and their causes of death are different. Periodical follow-up might be beneficial for individuals to facilitate early diagnosis.
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Affiliation(s)
- J Shuldiner
- Hadassah School of Public Health and Community Medicine, Braun Hebrew University, Jerusalem, Israel
| | - A Leventhal
- Hadassah School of Public Health and Community Medicine, Braun Hebrew University, Jerusalem, Israel; Department of International Relations, Ministry of Health, Jerusalem, Israel
| | - D Chemtob
- Department of Tuberculosis and AIDS, Ministry of Health, Jerusalem, Israel
| | - Z Mor
- Department of Tuberculosis and AIDS, Ministry of Health, Jerusalem, Israel; Ramla Department of Health, Ministry of Health, Ramla, Israel
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Unger JB, Soto DW, Leventhal A. E-cigarette use and subsequent cigarette and marijuana use among Hispanic young adults. Drug Alcohol Depend 2016; 163:261-4. [PMID: 27141841 PMCID: PMC7453602 DOI: 10.1016/j.drugalcdep.2016.04.027] [Citation(s) in RCA: 136] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Revised: 04/04/2016] [Accepted: 04/19/2016] [Indexed: 12/31/2022]
Abstract
PURPOSE Electronic cigarettes (e-cigarettes) could have a multifaceted effect on public health by changing the likelihood that: (a) non-smokers and non-users of marijuana subsequently transition to cigarette and marijuana use, respectively, and/or: (b) cigarette smokers subsequently quit smoking. We analyzed data from a longitudinal study of Hispanic young adults in Los Angeles, California to determine whether e-cigarette use is associated with subsequent cigarette or marijuana use over a one-year period. METHODS Survey data were collected from 1332 Hispanic young adults (59% female, mean age=22.7 years, SD=0.39 years) in 2014 and 2015. Logistic regression analyses examined the association between e-cigarette use in 2014 and cigarette/marijuana use in 2015, controlling for age, sex, and other substance use. RESULTS In 2014, prevalence of past-month use was 9% for e-cigarettes, 21% for cigarettes, and 23% for marijuana. Among past-month cigarette nonsmokers in 2014, those who were past-month e-cigarette users in 2014 were over 3 times more likely to be past-month cigarette smokers in 2015, compared with those who did not report past-month e-cigarette use in 2014 (26% vs. 7%; OR=3.32, 95% CI=1.55, 7.10). Among past-month marijuana non-users in 2014, those who were past-month e-cigarette users in 2014 were nearly 2 times more likely to be past-month marijuana users in 2015 (24% vs. 12%;OR=1.97, 95% CI=1.01, 3.86). Among past-month cigarette and marijuana users in 2014, e-cigarette use in 2014 was not associated with a change cigarette and marijuana use, respectively, in 2015. CONCLUSIONS Among Hispanic young adults, e-cigarettes could increase the likelihood of transitioning from non-user to user of cigarettes or marijuana and was not associated with smoking cessation.
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Affiliation(s)
- Jennifer B Unger
- University of Southern California Keck School of Medicine, 2001 N. Soto St., SSB 302, Los Angeles, CA 90089, United States.
| | - Daniel W Soto
- University of Southern California Keck School of Medicine, 2001 N. Soto St., SSB 302, Los Angeles, CA 90089, United States
| | - Adam Leventhal
- University of Southern California Keck School of Medicine, 2001 N. Soto St., SSB 302, Los Angeles, CA 90089, United States
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Gilreath TD, Leventhal A, Barrington-Trimis JL, Unger JB, Cruz TB, Berhane K, Huh J, Urman R, Wang K, Howland S, Pentz MA, Chou CP, McConnell R. Patterns of Alternative Tobacco Product Use: Emergence of Hookah and E-cigarettes as Preferred Products Amongst Youth. J Adolesc Health 2016; 58:181-5. [PMID: 26598059 PMCID: PMC4963235 DOI: 10.1016/j.jadohealth.2015.10.001] [Citation(s) in RCA: 95] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2015] [Revised: 10/01/2015] [Accepted: 10/02/2015] [Indexed: 11/28/2022]
Abstract
PURPOSE There is a growing public health concern related to the rapid increase in the use of multiple tobacco products among adolescents. This study examined patterns of adolescent use of cigarettes, e-cigarettes, cigars/cigarillo, hookah/waterpipe, and smokeless/dip/chewing tobacco in a population of southern California adolescents. METHODS Data from 2,097 11th- and 12th-grade participants in the Southern California Children's Health Study were collected via self-report in 2014. Study participants were asked about lifetime and current (past 30 days) use of cigarettes, cigars/cigarillos/little cigars, e-cigarettes, hookah/waterpipe, and smokeless/dip/chewing tobacco. Latent class analysis (LCA) was used to identify patterns of tobacco use. RESULTS Hookah/waterpipe tobacco use had the highest current prevalence (10.7%) followed by e-cigarettes (9.6%). The prevalence of use of smokeless/dip/chewing tobacco was lowest, with 2.2% of adolescents reporting current use. The LCA suggested four distinct classes, comprising nonusers (72.3% of the sample), polytobacco experimenters (13.9%), e-cigarette/hookah users (8.2%), and polytobacco users (5.6%). Multinomial logistic regression based on these four classes found that males had double the odds to be polytobacco users relative to nonusers compared to females (odds ratio, 2.3; 95% confidence interval, 1.26-4.25). CONCLUSIONS By identifying naturally occurring configurations of tobacco product use in teens, these findings may be useful to practitioners and policymakers to identify the need for tobacco control interventions that address specific tobacco products and particular combinations of polytobacco use. LCA can be used to identify segments of the population overrepresented among certain tobacco use classes (e.g., boys) that may benefit most from targeted polyproduct intervention approaches.
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Affiliation(s)
- Tamika D Gilreath
- Department of Preventive Medicine, University of Southern California, Los Angeles, California.
| | - Adam Leventhal
- Department of Preventive Medicine, University of Southern California, Los Angeles, California
| | | | - Jennifer B Unger
- Department of Preventive Medicine, University of Southern California, Los Angeles, California
| | - Tess Boley Cruz
- Department of Preventive Medicine, University of Southern California, Los Angeles, California
| | - Kiros Berhane
- Department of Preventive Medicine, University of Southern California, Los Angeles, California
| | - Jimi Huh
- Department of Preventive Medicine, University of Southern California, Los Angeles, California
| | - Robert Urman
- Department of Preventive Medicine, University of Southern California, Los Angeles, California
| | - Kejia Wang
- Department of Preventive Medicine, University of Southern California, Los Angeles, California
| | - Steve Howland
- Department of Preventive Medicine, University of Southern California, Los Angeles, California
| | - Mary Ann Pentz
- Department of Preventive Medicine, University of Southern California, Los Angeles, California
| | - Chih Ping Chou
- Department of Preventive Medicine, University of Southern California, Los Angeles, California
| | - Rob McConnell
- Department of Preventive Medicine, University of Southern California, Los Angeles, California
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Dunton GF, Liao Y, Intille S, Huh J, Leventhal A. Momentary assessment of contextual influences on affective response during physical activity. Health Psychol 2015; 34:1145-53. [PMID: 26053885 DOI: 10.1037/hea0000223] [Citation(s) in RCA: 66] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Higher positive and lower negative affective response during physical activity may reinforce motivation to engage in future activity. However, affective response during physical activity is typically examined under controlled laboratory conditions. This research used ecological momentary assessment (EMA) to examine social and physical contextual influences on momentary affective response during physical activity in naturalistic settings. METHOD Participants included 116 adults (mean age = 40.3 years, 73% female) who completed 8 randomly prompted EMA surveys per day for 4 days across 3 semiannual waves. EMA surveys measured current activity level, social context, and physical context. Participants also rated their current positive and negative affect. Multilevel models assessed whether momentary physical activity level moderated differences in affective response across contexts controlling for day of the week, time of day, and activity intensity (measured by accelerometer). RESULTS The Activity Level × Alone interaction was significant for predicting positive affect (β = -0.302, SE = 0.133, p = .024). Greater positive affect during physical activity was reported when with other people (vs. alone). The Activity Level × Outdoors interaction was significant for predicting negative affect (β = -0.206, SE = 0.097, p = .034). Lower negative affect during physical activity was reported outdoors (vs. indoors). CONCLUSIONS Being with other people may enhance positive affective response during physical activity, and being outdoors may dampen negative affective response during physical activity.
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Affiliation(s)
| | - Yue Liao
- Department of Preventive Medicine
| | | | - Jimi Huh
- Department of Preventive Medicine
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26
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Sussman S, Baezconde-Garbanati L, Garcia R, Barker DC, Samet JM, Leventhal A, Unger JB. Commentary: Forces That Drive the Vape Shop Industry and Implications for the Health Professions. Eval Health Prof 2015; 39:379-88. [PMID: 25967071 DOI: 10.1177/0163278715586295] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
At least three factors may be driving the evolution of the vape shop industry, a rapidly growing market sector that specializes in the sales of electronic cigarettes: (1) the tobacco industry, (2) the public health sector and its diverse stakeholders, and (3) consumer demand. These influences and the responses of the vape shop sector have resulted in a rapidly changing landscape. This commentary briefly discusses these three factors and the implications for the health professions, as they address the vape shop industry and its consequences for public health.
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Affiliation(s)
- Steve Sussman
- Department of Preventive Medicine, University of Southern California, Los Angeles, CA, USA Department of Psychology, University of Southern California, Los Angeles, CA, USA School of Social Work, University of Southern California, Los Angeles, CA, USA
| | - Lourdes Baezconde-Garbanati
- Department of Preventive Medicine, University of Southern California, Los Angeles, CA, USA Department of Sociology, University of Southern California, Los Angeles, CA, USA
| | - Robert Garcia
- Department of Preventive Medicine, University of Southern California, Los Angeles, CA, USA
| | - Dianne C Barker
- Barker Bi-Coastal Health Consultants, Inc., Calabasas, CA, USA
| | - Jonathan M Samet
- Department of Preventive Medicine, University of Southern California, Los Angeles, CA, USA
| | - Adam Leventhal
- Department of Preventive Medicine, University of Southern California, Los Angeles, CA, USA Department of Psychology, University of Southern California, Los Angeles, CA, USA
| | - Jennifer B Unger
- Department of Preventive Medicine, University of Southern California, Los Angeles, CA, USA
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27
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Strong DR, Noble M, Lei A, Dunton G, Huh J, Leventhal A. Differential Item Functioning Analysis Of The Physical Activity Enjoyment Scale. Med Sci Sports Exerc 2015. [DOI: 10.1249/01.mss.0000478744.58572.b0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Abstract
SETTING Tuberculosis (TB) epidemiology in Israel is similar to that reported from other industrialised countries where most patients are foreign-born. OBJECTIVES To assess TB case fatality rate (CFR) and mortality trends during treatment and to identify risk factors associated with mortality. DESIGN Retrospective cohort study of all TB patients in Israel diagnosed between 2000 and 2010. Cause of death was classified by TB-specific and non-TB-specific causes. RESULTS During the study period, 451 TB patients died during treatment, representing a CFR of 9.9%. Of these, 72.5% died due to TB-related causes, giving a TB-related CFR of 7.2%. Both the overall and TB-related CFR decreased over the study period. Risk factors for death included male sex, older age, human immunodeficiency virus coinfection, culture positivity and multidrug-resistant TB (MDR-TB). Patients aged ≥65 years comprised 70% of the TB-related deaths, and more than half of these (54.9%) were born in the former Soviet Union, Europe (excluding the former Soviet Union) or the USA. CONCLUSION Both the overall and TB-related CFR decreased over the study period. Physicians who treat older male TB patients with MDR-TB or HIV should increase the index of suspicion to include the possibility of a higher risk of mortality.
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Affiliation(s)
- J Shuldiner
- Hadassah School of Public Health and Community Medicine, Braun Hebrew University, Jerusalem
| | - A Leventhal
- Hadassah School of Public Health and Community Medicine, Braun Hebrew University, Jerusalem
| | - D Chemtob
- Department of Tuberculosis and AIDS, Ministry of Health, Jerusalem
| | - Z Mor
- Department of Tuberculosis and AIDS, Ministry of Health, Jerusalem
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29
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Bujarski S, Roche DJO, Lunny K, Moallem NR, Courtney KE, Allen V, Hartwell E, Leventhal A, Rohrbaugh T, Ray LA. The relationship between methamphetamine and alcohol use in a community sample of methamphetamine users. Drug Alcohol Depend 2014; 142:127-32. [PMID: 24975477 PMCID: PMC4157644 DOI: 10.1016/j.drugalcdep.2014.06.004] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2014] [Revised: 05/18/2014] [Accepted: 06/06/2014] [Indexed: 11/19/2022]
Abstract
BACKGROUND While methamphetamine (MA) and alcohol are often used in combination, little is known about the pattern of co-use between these substances. The goal of the present study is to examine the relationship between MA use and alcohol use in a community sample of non-treatment seeking regular MA users. METHODS Participants completed a face-to-face assessment battery, which included a diagnostic interview for MA dependence and the timeline follow-back interview for both alcohol and MA use over the past 30 days. Sixty regular MA and alcohol users supplied data for 1800 person-days. RESULTS Compared with non-drinking days, drinking days and binge drinking days increased the odds of same day MA use by 4.22 and 4.50 times, respectively (p's<0.0001). Further, binge drinking incrementally increased risk for MA use above and beyond the effects of drinking itself (p<0.0001). Lagged models revealed previous day MA use to predict following day MA use (p<0.0001), yet, after controlling for this relationship, neither previous day alcohol use nor previous day binge drinking predicted following-day MA use. Finally, the effect of binge drinking on MA use was stronger among individuals with lower MA dependence severity or higher alcohol problem severity (p's<0.05). CONCLUSIONS These results suggest that alcohol and MA are co-used in predictable patterns, and in particular, that binge drinking may be incrementally associated with the likelihood of MA use. Future studies are needed to explore the temporal relationship between alcohol and MA use within a given episode.
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Affiliation(s)
- Spencer Bujarski
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, USA
| | - Daniel J O Roche
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, USA
| | - Katy Lunny
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, USA
| | - Nathasha R Moallem
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, USA
| | - Kelly E Courtney
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, USA
| | - Vincent Allen
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, USA
| | - Emily Hartwell
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, USA
| | - Adam Leventhal
- Department of Preventive Medicine and Psychology, University of Southern California Keck School of Medicine, Los Angeles, CA, USA
| | - Taylor Rohrbaugh
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, USA
| | - Lara A Ray
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, USA; Department of Psychiatry, University of California, Los Angeles, Los Angeles, CA, USA.
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Abstract
Research has documented consistent and robust relations between emotional disorders (i.e., depressive and anxiety disorders) and smoking. Yet, it is presently unclear whether anxiety sensitivity--the fear of aversive internal anxiety states--accounts for the relations between emotional disorders and various smoking processes, including nicotine dependence, perceived barriers to smoking cessation, and severity of problematic symptoms during past cessation attempts. Participants (N = 465) were treatment-seeking daily tobacco smokers recruited as part of a larger tobacco-cessation study. Baseline (pretreatment) data were utilized. Emotional disorders were assessed via clinical diagnostic interview; self-report measures were used to assess anxiety sensitivity and 3 criterion variables: nicotine dependence, barriers to smoking cessation, and severity of problematic symptoms while quitting in past attempts. Emotional disorders were predictive of higher levels of nicotine dependence, greater perceived barriers to cessation, and greater severity of problematic symptoms while attempting to quit in the past; each of these relations were accounted for by the indirect effect of anxiety sensitivity. The present findings suggest that anxiety sensitivity may be an important transdiagnostic construct in explicating the nature of the relations between emotional disorders and various smoking processes.
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Affiliation(s)
- Michael J. Zvolensky
- University of Houston, Department of Psychology
- The University of Texas MD Anderson Cancer Center, Department of Behavioral Science
| | | | - Adam Leventhal
- Department of Psychology, University of Southern California
- Department of Preventive Medicine, University of Southern California Keck School of Medicine
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31
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Kaliner E, Moran-Gilad J, Grotto I, Somekh E, Kopel E, Gdalevich M, Shimron E, Amikam Y, Leventhal A, Lev B, Gamzu R. Silent reintroduction of wild-type poliovirus to Israel, 2013 - risk communication challenges in an argumentative atmosphere. ACTA ACUST UNITED AC 2014; 19:20703. [PMID: 24576475 DOI: 10.2807/1560-7917.es2014.19.7.20703] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Israel has been certified as polio-free by the World Health Organization and its routine immunisation schedule consists of inactivated poliovirus vaccine (IPV) only. At the end of May 2013, the Israeli Ministry of Health (MOH) has confirmed the reintroduction of wild-type poliovirus 1 into the country. Documented ongoing human-to-human transmission necessitated a thorough risk assessment followed by a supplemental immunisation campaign using oral polio vaccine (OPV). The unusual situation in which ongoing poliovirus transmission was picked up through an early warning system of sewage monitoring without active polio cases, brought about significant challenges in risk communication. This paper reviews the challenges faced by the MOH and the communication strategy devised, in order to facilitate and optimise the various components of the public health response, particularly vaccination. Lessons learned from our recent experience may inform risk communication approaches in other countries that may face a similar situation as global polio eradication moves towards the 'End game'.
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Affiliation(s)
- E Kaliner
- Public Health Services, Ministry of Health, Jerusalem, Israel
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Abstract
Anhedonia refers to the inability of experiencing pleasure in positive life events. It has been conceptualized as a stable yet malleable characteristic and is associated with hypoactivity in the mesolimbic and mesocortical dopaminergic systems. Very recently, it has been posited as an etiologic factor associated with drug addiction onset, escalation, and relapse. Prevention programming could be developed to counteract the harmful impact of anhedonia, so as to minimize its impact on drug misuse. Remedial efforts are those that either (1) permit the individual to tolerate low levels of pleasure without resorting to drug misuse or other maladaptive behaviors that may unhealthily besot pleasure (for example, through normalization, structuring time, or meditation) or (2) counteract anhedonia by enhancing ones capability to experience pleasure (for example, behavioral activation, positive psychology, pharmacotherapy, or pursuit of positive addictions). School-based activities could be developed that can be completed by individuals, small workgroups, or the whole classroom. The concept of anhedonia is described in this chapter, and possible prevention strategies that might be utilized in schools as well as other contexts are discussed.
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Affiliation(s)
- Steve Sussman
- Preventive Medicine and Psychology, University of Southern California
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33
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Mor Z, Kolb H, Lidji M, Migliori GB, Leventhal A. Tuberculosis diagnostic delay and therapy outcomes of non-national migrants in Tel Aviv, 1998-2008. Euro Surveill 2013. [DOI: 10.2807/ese.18.12.20433-en] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Non-national migrants have limited access to medical therapy. This study compares diagnostic delay and treatment outcomes of non-insured non-national migrants (NINNM) with insured Israeli citizens (IC) in the Tel Aviv tuberculosis (TB) clinic between 1998 and 2008. Patient delay was the time from symptoms onset to doctor's visit, while system delay was measured from doctor visit to anti-TB therapy administration. We randomly sampled 222 NINNM and 265 IC. NINNM were younger than IC, had lower male to female ratio and fewer smoked. They had less drug/alcohol abuse, more cavitations on chest radiography, longer patient and shorter system delay. Mean patient and system delays of all patients were 25±14 and 79±42 days, respectively. In multivariate analysis, being NINNM, asymptomatic or smoking predicted longer patient delay, while being asymptomatic or having additional co-morbidity predicted longer system delay. Treatment success in sputum smear-positive pulmonary TB NINNM was 81% and 95.7% in IC (p=0.01). Treatment success was not associated with patient or system delay. In multivariate analysis, work security and treatment adherence predicted treatment success. NINNM had longer patient delay and worse therapy outcome, while IC had longer system delay. Both delays should be reduced. NINNM should be informed that TB therapy is free and unlinked with deportation.
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Affiliation(s)
- Z Mor
- Department of Tuberculosis and AIDS, Ministry of Health, Jerusalem, Israel
| | - H Kolb
- Ben Gurion University in the Negev, Beer Sheva, Israel
| | - M Lidji
- Tel Aviv Tuberculosis Clinic, Israeli Lung Association, Tel Aviv, Israel
| | - G B Migliori
- World Health Organization Collaborating Centre for Tuberculosis and Lung Diseases, Fondazione S. Maugeri, Tradate, Italy
| | - A Leventhal
- Braun School of Public Health, Hebrew University, Jerusalem, Israel
- Department of International Relations, Ministry of Health, Jerusalem, Israel
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34
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Mor Z, Kolb H, Lidji M, Migliori G, Leventhal A. Tuberculosis diagnostic delay and therapy outcomes of non-national migrants in Tel Aviv, 1998-2008. Euro Surveill 2013; 18:20433. [PMID: 23557947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023] Open
Abstract
Non-national migrants have limited access to medical therapy. This study compares diagnostic delay and treatment outcomes of non-insured non-national migrants (NINNM) with insured Israeli citizens (IC) in the Tel Aviv tuberculosis (TB) clinic between 1998 and 2008. Patient delay was the time from symptoms onset to doctor's visit, while system delay was measured from doctor visit to anti-TB therapy administration. We randomly sampled 222 NINNM and 265 IC. NINNM were younger than IC, had lower male to female ratio and fewer smoked. They had less drug/alcohol abuse, more cavitations on chest radiography, longer patient and shorter system delay. Mean patient and system delays of all patients were 25 ± 14 and 79 ± 42 days, respectively. In multivariate analysis, being NINNM, asymptomatic or smoking predicted longer patient delay, while being asymptomatic or having additional co-morbidity predicted longer system delay. Treatment success in sputum smear-positive pulmonary TB NINNM was 81% and 95.7% in IC (p=0.01). Treatment success was not associated with patient or system delay. In multivariate analysis, work security and treatment adherence predicted treatment success. NINNM had longer patient delay and worse therapy outcome, while IC had longer system delay. Both delays should be reduced. NINNM should be informed that TB therapy is free and unlinked with deportation.
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Affiliation(s)
- Z Mor
- Department of Tuberculosis and AIDS, Ministry of Health, Jerusalem, Israel.
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35
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Abstract
The potential impact of stem cell technology on medical and dental practice is vast. Stem cell research will not only provide the foundation for future therapies, but also reveal unique insights into basic disease mechanisms. Therefore, an understanding of stem cell technology will be necessary for clinicians in the future. Herein, we give a basic overview of stem cell biology and therapeutics for the practicing clinician.
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Affiliation(s)
- A Leventhal
- Center for Molecular Medicine,National Heart, Lung, and Blood Institute, National Institutes of Health, Building 10-CRC, Room 5-3132, Bethesda, MD 20817, USA
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Sussman S, Leventhal A, Bluthenthal RN, Freimuth M, Forster M, Ames SL. A framework for the specificity of addictions. Int J Environ Res Public Health 2011; 8:3399-415. [PMID: 21909314 PMCID: PMC3166750 DOI: 10.3390/ijerph8083399] [Citation(s) in RCA: 93] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/24/2011] [Accepted: 08/05/2011] [Indexed: 12/11/2022]
Abstract
Research over the last two decades suggests that a wide range of substance and behavioral addictions may serve similar functions. Yet, co-occurrence of addictions has only been reported among a minority of addicts. "Addiction specificity" pertains to a phenomenon in which one pattern of addictive behaviors may be acquired whereas another is not. This paper presents the PACE model as a framework which might help explain addiction specificity. Pragmatics, attraction, communication, and expectation (PACE) variables are described, which may help give some direction to future research needs in this arena.
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Affiliation(s)
- Steve Sussman
- Departments of Preventive Medicine and Psychology, University of Southern California, California 90032, CA, USA; E-Mails: (A.L.); (R.N.B.); (M.F.)
| | - Adam Leventhal
- Departments of Preventive Medicine and Psychology, University of Southern California, California 90032, CA, USA; E-Mails: (A.L.); (R.N.B.); (M.F.)
| | - Ricky N. Bluthenthal
- Departments of Preventive Medicine and Psychology, University of Southern California, California 90032, CA, USA; E-Mails: (A.L.); (R.N.B.); (M.F.)
| | - Marilyn Freimuth
- Clinical Psychology, Fielding Graduate University, Santa Barbara, California 93105, CA, USA; E-Mail:
| | - Myriam Forster
- Departments of Preventive Medicine and Psychology, University of Southern California, California 90032, CA, USA; E-Mails: (A.L.); (R.N.B.); (M.F.)
| | - Susan L. Ames
- School of Community and Global Health, Claremont Graduate University, Claremont, California 91711, CA, USA; E-Mail:
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Okamoto J, Johnson CA, Leventhal A, Milam J, Pentz MA, Schwartz D, Valente TW. Social Network Status and Depression among Adolescents: An Examination of Social Network Influences and Depressive Symptoms in a Chinese Sample. Res Hum Dev 2011; 8:67-88. [PMID: 23226988 PMCID: PMC3515061 DOI: 10.1080/15427609.2011.549711] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Despite the well established influence of peer experiences on adolescent attitudes, thoughts, and behaviors, surprisingly little research has examined the importance of peer context and the increased prevalence of depressive symptoms accompanying the transition into adolescence. Examination of social networks may provide some insight into the role of peers in the vulnerability of some adolescents to depression. To address this issue, we leveraged an existing sample of 5,563 Chinese 10(th) graders to incorporate social network data into a multilevel regression model of depressive symptoms. We found that, in this sample, being nominated as a friend was more important than being nominated as most liked. Social network centrality was significantly associated with depression; those adolescents who were less connected were more likely to suffer from depression. The risk of depression for those who were marginal members of classroom social networks was substantial. These findings suggest that a social network perspective could help to increase the effectiveness of programs aimed at preventing adolescent depression.
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Abstract
How much longer will current RAID techniques persevere? The RAID levels were codified in the late 1980s; double-parity RAID, known as RAID-6, is the current standard for high-availability, space-efficient storage. The incredible growth of hard-drive capacities, however, could impose serious limitations on the reliability even of RAID-6 systems. Recent trends in hard drives show that triple-parity RAID must soon become pervasive. In 2005,
Scientific American
reported on Kryder’s law, which predicts that hard-drive density will double annually. While the rate of doubling has not quite maintained that pace, it has been close.
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Ray LA, MacKillop J, Leventhal A, Hutchison KE. Catching the alcohol buzz: an examination of the latent factor structure of subjective intoxication. Alcohol Clin Exp Res 2009; 33:2154-61. [PMID: 19764932 DOI: 10.1111/j.1530-0277.2009.01053.x] [Citation(s) in RCA: 72] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND The goal of this study was to examine the latent structure among measures of alcohol-induced subjective feelings of intoxication from a behavioral pharmacology perspective. METHODS Data on subjective intoxication, measured concomitantly by the Subjective High Assessment Scale, Biphasic Alcohol Effect Scale, and the Short Version of the Profile of Mood States, were collected at 3 levels of breath alcohol concentration during an alcohol administration study in a sample of heavy drinkers (n = 135). RESULTS Results of exploratory factor analyses supported a 3-factor model which captured the following dimensions of subjective intoxication: (1) stimulation and other pleasant effects, (2) sedative and unpleasant effects, and (3) alleviation of tension and negative mood. The tension-reduction factor was most consistently associated with more frequent drinking and alcohol problems in this sample. CONCLUSIONS These findings support the notion that the neuropharmacological and behavioral effects of alcohol are multifaceted and cannot be simply defined as either positive or negative. Rather, moderate levels of intoxication appear to have concomitant dimensions of positive reinforcement, negative reinforcement, and punishment. This study also suggests that factor scores may be useful in future alcohol administration studies to reduce the number of comparisons and perhaps increase statistical power to detect meaningful effects.
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Affiliation(s)
- Lara A Ray
- Department of Psychology, University of California-Los Angeles, CA 90095-1563, USA.
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Mor Z, Lerman Y, Leventhal A. Pre-immigration screening process and pulmonary tuberculosis among Ethiopian migrants in Israel. Eur Respir J 2008; 32:413-8. [DOI: 10.1183/09031936.00145907] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Leventhal A. Clinical insights from research on gender differences in tobacco withdrawal. Brown Univ Dig Addict Theory Appl 2007; 26:8. [PMID: 20490367 PMCID: PMC2873210 DOI: 10.1002/data.20053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Affiliation(s)
- Adam Leventhal
- Postdoctoral Fellow at the Brown University Center for Alcohol and Addiction Studies
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Chemtob D, Sasson M, Leventhal A, Stein-Zamir C, Maayan S. Sexually transmitted infections among individuals with and without HIV. Isr Med Assoc J 2006; 8:892. [PMID: 17214118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
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Whitehead JH, Leventhal A. On-site wastewater management system design and landslide risk assessment. Water Sci Technol 2005; 51:55-63. [PMID: 16104406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
On-site wastewater management system design and performance is significant in assessing landslide risk in areas with potential for slope instability. Much of the development in Pittwater, NSW, local government area is on steep coastal land which has a history of slope instability. Concern over cases of poorly performing or failing on-site wastewater systems and the recognition that these and newly designed systems could be contributory to slope instability has been a factor in Pittwater Council, NSW, requiring that landslide risk assessment be undertaken for new and amended on-site wastewater management systems in potentially unstable areas. This paper describes the wastewater management system design and landslide risk assessment undertaken at Pittwater Youth Hostel in accordance with the Australian Geomechanics Society's Geotechnical Risk Management procedure to comply with the Pittwater Policy. The work completed illustrates both necessary and effective interaction of the wastewater and geotechnical professions to achieve a successful outcome for the client. It is likely that this professional interaction will be increasingly common along the NSW coast and elsewhere.
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Affiliation(s)
- J H Whitehead
- University of Newcastle, Callaghan, NSW 2308, Australia.
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Slater PE, Leventhal A. Immunization saves lives. Isr Med Assoc J 2004; 6:646; author reply 646-7. [PMID: 15473602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/30/2023]
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Weiler-Ravell D, Leventhal A, Coker RJ, Chemtob D. Compulsory detention of recalcitrant tuberculosis patients in the context of a new tuberculosis control programme in Israel. Public Health 2004; 118:323-8. [PMID: 15178138 DOI: 10.1016/j.puhe.2003.10.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2003] [Revised: 10/06/2003] [Accepted: 10/14/2003] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To analyse the use of compulsory detention in the context of a new national tuberculosis (TB) control programme launched in 1997. METHODS A retrospective review was made of the use of compulsory detention in the management of infectious TB before and after the initiation of a new TB control programme, using data from the central TB registry in the Ministry of Health and the charts of each patient. RESULTS Between 1994 and 2001, 13 recalcitrant patients out of 3056 (0.43%) cases of pulmonary TB were brought to trial. Eleven patients were detained. All were either hospitalized under a court order and, when failing to comply with the order, hospitalized in prison, or referred directly to a prison hospital. Twelve of 13 (92%) patients were new immigrants. After the new programme was launched, proportionately fewer patients were brought to trial [6/943 (0.64%) in 1994-1996 compared with 7/2113 (0.33%) in 1997-2001]. CONCLUSION The reduction in the number of individuals detained could be viewed as an improvement in TB control due to the new TB control programme. It remains to be shown whether these individuals, most of whom had drug-resistant strains of TB, posed a sufficient threat to public health to justify detention.
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Affiliation(s)
- D Weiler-Ravell
- Public Health Services, Ministry of Health, Jerusalem, Israel.
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Karsenty E, Sgan-Cohen H, Vered Y, Leventhal A. [Optimal fluoride level in drinking water and public health]. Harefuah 2003; 142:754-8, 806. [PMID: 14631907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/27/2023]
Abstract
Water fluoridation is a safe, efficient, and well-proven way of preventing dental decay in the community. In countries such as Israel, where dental care is not covered by the national insurance law, this has an important role in reducing social inequalities in health care. For toddlers and children, water fluoridation is the only way of promoting dental health without a need for regular visits to dental clinics, and without regard to parent awareness and motivation. The other methods of fluoride supplementation do not succeed in reaching the level of safety and cost-efficiency of water fluoridation, and their use is successful only among upper socio-economic classes. Water fluoridation has been defined by the US CDC as one of the main achievements in health care during the 20th century. In spite of the legal difficulties raised by various activist groups, the use of water fluoridation is growing steadily among developed as well as third world countries. The Israeli bylaw of national water fluoridation that is in effect will enable the safe improvement of the overall dental health status of the population at an extremely low cost.
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Affiliation(s)
- E Karsenty
- Environmental Epidemiology Unit, Israeli Ministry of Health, Public Health Services, Israeli Ministry of Health, Jerusalem
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Chemtob D, Leventhal A, Weiler-Ravell D. Screening and management of tuberculosis in immigrants: the challenge beyond professional competence. Int J Tuberc Lung Dis 2003; 7:959-66. [PMID: 14552566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/27/2023] Open
Abstract
SETTING Right of entry may sometimes be denied to immigrants because of the threat of tuberculosis. During 1990-2000 some 1050000 immigrants, mostly from countries highly endemic for TB, arrived in Israel, a low prevalence country. Nevertheless, TB rates in Israel have remained low. OBJECTIVE To emphasise the challenge beyond technical competence for TB control for immigrants from the perspective of Israel's National Tuberculosis Programme (NTP). MATERIALS AND METHODS We defined criteria for an NTP geared to immigration, and analysed our implementation of the European Task Force recommendations on international migration and TB control. We interviewed immigrants and health care workers to identify barriers to diagnosis, prevention and treatment of TB among immigrants. We used classical epidemiology to evaluate the impact of immigration on TB rates in the host population. RESULTS Until now there has been no evidence of significant spread of TB from immigrants to the host population. Successful outcome of treatment has been noted in over 75%, although a sub-population of immigrant substance abusers is proving more difficult to treat. CONCLUSIONS The risk of TB for the host country is very low and it seems possible to enhance TB control in immigrants with measures designed to address their cultural needs.
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Affiliation(s)
- D Chemtob
- Department of Tuberculosis and AIDS, Ministry of Health, Jerusalem, Israel.
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Chemtob D, Leventhal A, Berlowitz Y, Weiler-Ravell D. The new National Tuberculosis Control Programme in Israel, a country of high immigration. Int J Tuberc Lung Dis 2003; 7:828-36. [PMID: 12971665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/04/2023] Open
Abstract
SETTING Israel has implemented a new tuberculosis (TB) control programme in response to the rise in the incidence of tuberculosis due to immigration in the last decade. It complies with World Health Organization guidelines, and also includes specific measures addressing the needs of immigrants. We describe the new programme and compare the outcome of treatment prior and after its realisation. METHODS Each component of the new strategy was scrutinised, aspects that did not function well were identified and how we contended with these issues is described. Analysis of outcome of treatment was according to WHO/IUATLD definitions. RESULTS Better and clearer organisation of TB treatment in all its aspects, including cultural sensitivity, has been obtained. Compliance improved from less than 27% for successful outcome before the new programme to more than 75% after. In addition to the improvement in completion rates, the universal use of directly observed treatment has ensured enhanced adherence. CONCLUSION Using legislative, administrative and budgetary measures, as well as clinical guidelines published by the Ministry of Health, the TB infrastructure in Israel has been successfully reorganised. The decision to do so was not only clinically and organisationally justifiable, it is also economically viable.
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Affiliation(s)
- D Chemtob
- Department of Tuberculosis and AIDS, Ministry of Health, Jerusalem, Israel.
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Dror Y, Stern F, Berner YN, Kaufmann NA, Berry E, Maaravi Y, Altman H, Cohen A, Leventhal A, Nitzan Kaluski D. Recommended micronutrient supplementation for institutionalized elderly. J Nutr Health Aging 2002; 6:295-300. [PMID: 12474017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/28/2023]
Abstract
A committee nominated by the Israel Ministry of Health examined the relevant literature and the local recommendations as well as the recommendations from other countries and suggested a daily micronutrient supplementation for institutionalized elderly living in institutions supervised by the Ministry of Health. The micronutrient preparatory, tailored for this population, is designed to contain about half the RDA for most of the vitamins and some microelements. Biotin and vitamins C, D and B12 as well as zinc, copper, chromium and molybdenum are suggested at a level higher than half the RDA, whereas fluorine, at a lower level. Major elements (calcium, magnesium and phosphorus) are excluded and should be supplied separately. Vitamin K and iron are also excluded. Fat-soluble vitamins should be microencapsulated. Micronutrient supplementation for institutionalized elderly is part of the Ministry of Health s balanced nutrition policy. The committee s recommendations are also applicable to the free-living elderly population.
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Affiliation(s)
- Y Dror
- Yosef Dror, PhD, Institute of Biochemistry, Food Science and Nutrition, Faculty of Agricultural, Food and Environmental Quality Sciences, P.O.Box 12, Rehovot 76100, Israel. Telephone: 972-8-9489280. Fax: 972-8-9476189.
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