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Leas EC, Ayers JW, Desai N, Dredze M, Hogarth M, Smith DM. Using Large Language Models to Support Content Analysis: A Case Study of ChatGPT for Adverse Event Detection. J Med Internet Res 2024; 26:e52499. [PMID: 38696245 DOI: 10.2196/52499] [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] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 03/14/2024] [Accepted: 03/28/2024] [Indexed: 05/04/2024] Open
Abstract
This study explores the potential of using large language models to assist content analysis by conducting a case study to identify adverse events (AEs) in social media posts. The case study compares ChatGPT's performance with human annotators' in detecting AEs associated with delta-8-tetrahydrocannabinol, a cannabis-derived product. Using the identical instructions given to human annotators, ChatGPT closely approximated human results, with a high degree of agreement noted: 94.4% (9436/10,000) for any AE detection (Fleiss κ=0.95) and 99.3% (9931/10,000) for serious AEs (κ=0.96). These findings suggest that ChatGPT has the potential to replicate human annotation accurately and efficiently. The study recognizes possible limitations, including concerns about the generalizability due to ChatGPT's training data, and prompts further research with different models, data sources, and content analysis tasks. The study highlights the promise of large language models for enhancing the efficiency of biomedical research.
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Affiliation(s)
- Eric C Leas
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, CA, United States
- Qualcomm Institute, University of California San Diego, La Jolla, CA, United States
| | - John W Ayers
- Qualcomm Institute, University of California San Diego, La Jolla, CA, United States
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, La Jolla, CA, United States
- Altman Clinical Translational Research Institute, University of California San Diego, La Jolla, CA, United States
| | - Nimit Desai
- Qualcomm Institute, University of California San Diego, La Jolla, CA, United States
| | - Mark Dredze
- Department of Computer Science, Johns Hopkins University, Baltimore, MD, United States
| | - Michael Hogarth
- Altman Clinical Translational Research Institute, University of California San Diego, La Jolla, CA, United States
- Department of Biomedical Informatics, University of California San Diego, La Jolla, CA, United States
| | - Davey M Smith
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, La Jolla, CA, United States
- Altman Clinical Translational Research Institute, University of California San Diego, La Jolla, CA, United States
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Leas EC. Need for improved regulation of tobacco e-commerce. Tob Control 2024:tc-2023-058515. [PMID: 38191235 DOI: 10.1136/tc-2023-058515] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2024]
Affiliation(s)
- Eric C Leas
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, La Jolla, CA, USA
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Leas EC, Pierce JP, Satybaldiyeva N. Place-based inequities in cigarette smoking across the USA. Tob Control 2023; 33:135-136. [PMID: 35584902 PMCID: PMC9672136 DOI: 10.1136/tobaccocontrol-2022-057293] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Accepted: 05/05/2022] [Indexed: 11/04/2022]
Affiliation(s)
- Eric C Leas
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, La Jolla, California, USA
| | - John P Pierce
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, La Jolla, California, USA
| | - Nora Satybaldiyeva
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, La Jolla, California, USA
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Pierce JP, Luo M, McMenamin SB, Stone MD, Leas EC, Strong D, Shi Y, Kealey S, Benmarhnia T, Messer K. Declines in cigarette smoking among US adolescents and young adults: indications of independence from e-cigarette vaping surge. Tob Control 2023:tc-2022-057907. [PMID: 37940404 DOI: 10.1136/tc-2022-057907] [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: 12/16/2022] [Accepted: 10/17/2023] [Indexed: 11/10/2023]
Abstract
OBJECTIVE To compare trends in cigarette smoking and nicotine vaping among US population aged 17-18 years and 18-24 years. METHODS Regression analyses identified trends in ever and current use of cigarettes and e-cigarettes, using three US representative surveys from 1992 to 2022. RESULTS From 1997 to 2020, cigarette smoking prevalence among those aged 18-24 years decreased from 29.1% (95% CI 27.4% to 30.7%) to 5.4% (95% CI 3.9% to 6.9%). The decline was highly correlated with a decline in past 30-day smoking among those aged 17-18 years (1997: 36.8% (95% CI 35.6% to 37.9%; 2022: 3.0% (95% CI 1.8% to 4.1%). From 2017 to 2019, both ever-vaping and past 30-day nicotine vaping (11.0% to 25.5%) surged among those 17-18 years, however there was no increase among those aged 18-24 years. Regression models demonstrated that the surge in vaping was independent of the decline in cigarette smoking. In the 24 most populous US states, exclusive vaping did increase among those aged 18-24 years, from 1.7% to 4.0% to equivalent to 40% of the decline in cigarette smoking between 2014-15 and 2018-19. Across these US states, the correlation between the changes in vaping and smoking prevalence was low (r=0.11). In the two US states with >US$1/fluid mL tax on e-cigarettes in 2017, cigarette smoking declined faster than the US average. CONCLUSIONS Since 1997, a large decline in cigarette smoking occurred in the US population under age 24 years, that was independent of the 2017-19 adolescent surge in past 30-day e-cigarette vaping. Further research is needed to assess whether the 2014-15 to 2018-19 increase in exclusive vaping in those aged 18-24 years is a cohort effect from earlier dependence on e-cigarette vaping as adolescents.
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Affiliation(s)
- John P Pierce
- Division of Health Policy, Herbert Wertheim School of Public Health, University of California San Diego, La Jolla, California, USA
- Cancer Control Program, Moores Cancer Center, University of California San Diego, La Jolla, California, USA
| | - Man Luo
- Division of Biostatistics, Herbert Wertheim School of Public Health, University of California San Diego, La Jolla, CA, USA
| | - Sara B McMenamin
- Division of Health Policy, Herbert Wertheim School of Public Health, University of California San Diego, La Jolla, California, USA
| | - Matthew D Stone
- Division of Health Policy, Herbert Wertheim School of Public Health, University of California San Diego, La Jolla, California, USA
- Cancer Control Program, Moores Cancer Center, University of California San Diego, La Jolla, California, USA
| | - Eric C Leas
- Division of Health Policy, Herbert Wertheim School of Public Health, University of California San Diego, La Jolla, California, USA
| | - David Strong
- Division of Health Behavior, Herbert Wertheim School of Public Health, University of California San Diego, La Jolla, CA, USA
| | - Yuyan Shi
- Division of Health Policy, Herbert Wertheim School of Public Health, University of California San Diego, La Jolla, California, USA
| | - Sheila Kealey
- Cancer Control Program, Moores Cancer Center, University of California San Diego, La Jolla, California, USA
| | - Tarik Benmarhnia
- Scripps Institution of Oceanography, University of California San Diego, La Jolla, California, USA
| | - Karen Messer
- Division of Biostatistics, Herbert Wertheim School of Public Health, University of California San Diego, La Jolla, CA, USA
- Biostatistics Shared Resource, Moores Cancer Center, University of California San Diego, La Jolla, California, USA
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Leas EC, Mejorado T, Harati R, Ellis S, Satybaldiyeva N, Morales N, Poliak A. E-commerce licensing loopholes: a case study of online shopping for tobacco products following a statewide sales restriction on flavoured tobacco in California. Tob Control 2023:tc-2023-058269. [PMID: 37935483 PMCID: PMC11074236 DOI: 10.1136/tc-2023-058269] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 10/11/2023] [Indexed: 11/09/2023]
Abstract
INTRODUCTION Retailer licensing programmes can be an effective method of enforcing tobacco control laws, but most programmes do not require e-commerce retailers to obtain licenses. California's implementation of a statewide flavour restriction (Senate Bill 793 (SB-793)) in December 2022 enforced through its tobacco retailer licensing programme presented an opportunity to assess whether the exclusion of e-commerce in the definition of 'tobacco retailer' might have resulted in a shift in consumer behaviour towards e-commerce. METHODS To examine the association between SB-793 implementation and online shopping for tobacco, we collected weekly Google search rates related to online shopping for cigarettes and vaping products in California from January 2018 to May 2023. We compared observed rates of shopping queries after SB-793 implementation to counterfactual expected rates and prediction intervals (PI) calculated from autoregressive iterative moving average models fit to historical trends. Content analysis was performed on the search results to identify websites marketing flavoured vaping products and menthol cigarettes. RESULTS The week SB-793 was implemented, shopping queries were 194.4% (95% PI 100.8% to 451.5%) and 161.7% (95% PI 81.7% to 367.5%) higher than expected for cigarettes and vapes, respectively. Cigarette shopping queries remained elevated significantly for 11 weeks and vape shopping queries for 6 weeks. All search results contained links to websites that offered flavoured vaping products or menthol cigarettes to Californian consumers. DISCUSSION These findings raise concerns about potential loopholes in policy enforcement created by the absence of explicit regulations on e-commerce sales in retailer licensing programmes. Strengthening regulations to include e-commerce and monitoring e-commerce compliance are recommended to enhance the impact of laws enforced through retailer licensing programmes.
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Affiliation(s)
- Eric C Leas
- Herbert Wertheim School of Public Health, UC San Diego, La Jolla, California, USA
| | - Tomas Mejorado
- Herbert Wertheim School of Public Health, UC San Diego, La Jolla, California, USA
| | - Raquel Harati
- Herbert Wertheim School of Public Health, UC San Diego, La Jolla, California, USA
| | - Shannon Ellis
- Department of Cognitive Science, University of California San Diego, La Jolla, California, USA
- Halıcıoğlu Data Science Institute, University of California San Diego, La Jolla, California, USA
| | - Nora Satybaldiyeva
- Herbert Wertheim School of Public Health, UC San Diego, La Jolla, California, USA
| | - Nicolas Morales
- Herbert Wertheim School of Public Health, UC San Diego, La Jolla, California, USA
| | - Adam Poliak
- Department of Computer Science, Bryn Mawr College, Bryn Mawr, Pennsylvania, USA
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Stone M, Dimofte C, Strong D, Pulvers K, Crespo NC, Leas EC, Pierce JP. Evaluating US smokers' willingness to pay for different cigarette packaging designs before and after real-world exposure in a randomised trial. Tob Control 2023; 32:689-695. [PMID: 35232793 DOI: 10.1136/tobaccocontrol-2021-057071] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 09/23/2021] [Accepted: 02/20/2022] [Indexed: 11/03/2022]
Abstract
INTRODUCTION Removal of tobacco industry branding from cigarette packs may reduce their appeal. Adding graphic warning labels (GWLs) should enhance this effect. We investigate whether willingness to pay for various packaging designs changes after 3 months' use of: (1) US branded packs without GWLs (US), (2) non-branded packs without GWLs (Blank), and (3) rotating non-branded packs with GWLs (gangrene; throat cancer; neonatal baby) covering >75% of pack (GWL). METHODS Californian adult daily smokers not planning to quit (n=287; 56% female; mean age=39.6) completed a discrete choice purchase task before and after 3 months' experience using one of three packaging options. Conjoint analysis and pre-post modelling evaluated the change in importance of pack attributes and willingness to pay for US, Blank or GWL (blindness; teeth; gangrene) pack designs. RESULTS Price determined ~70% of purchase choices, while pack design determined ~22%. Irrespective of intervention arm, US packaging generated appeal valuations compared with Blank packaging, while GWLs consistently provoked strong aversive valuations at baseline and follow-up. Compared with the US pack arm, using GWL packs for 3 months decreased willingness to pay for US packaging (β=-$0.38, 95% CI -0.76 to 0.00). Wear-out effects were detected in the discount needed to willingly purchase the gangrene-GWL pack (β=$0.49, 95% CI 0.16 to 0.82) and Blank pack (β=$0.42, 95% CI 0.09 to 0.74) but not for GWLs (blindness, teeth) not used in trial. CONCLUSION Compared with US branded packs, the negative valuation of non-branded GWL packs attenuates with even 3 months' use but does not generalise to non-used GWLs. This suggests that GWLs should be regularly refreshed. The appeal valuation of industry imagery suggests that the US plan to retain such imagery on packs may ameliorate the effect of GWLs.
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Affiliation(s)
- Matthew Stone
- Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Claudiu Dimofte
- Marketing, San Diego State University, San Diego, California, USA
| | - David Strong
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, California, USA
- Cancer Prevention and Control Program, University of California San Diego Moores Cancer Center, La Jolla, California, USA
| | - Kim Pulvers
- Psychology, California State University San Marcos, San Marcos, California, USA
| | - Noe C Crespo
- School of Public Health, San Diego State University, San Diego, California, USA
| | - Eric C Leas
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, California, USA
- Cancer Prevention and Control Program, University of California San Diego Moores Cancer Center, La Jolla, California, USA
| | - John P Pierce
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, California, USA
- Cancer Prevention and Control Program, University of California San Diego Moores Cancer Center, La Jolla, California, USA
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Bowdring MA, Leas EC, Vishwakarma M, Schleicher NC, Prochaska JJ, Henriksen L. Kratom availability in California vape shops. Prev Med Rep 2023; 35:102380. [PMID: 37680858 PMCID: PMC10481347 DOI: 10.1016/j.pmedr.2023.102380] [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: 07/28/2023] [Revised: 08/21/2023] [Accepted: 08/22/2023] [Indexed: 09/09/2023] Open
Abstract
Kratom products are derived from trees native to Southeast Asia and have dose-dependent stimulant and opioid-like effects. Despite being on the Drug Enforcement Administration "Drugs and Chemicals of Concern List," kratom is legal for sale in most US states. However, there are scarce data on its availability. The goal of this study was to examine kratom availability in vape shops across the state of California and assess shop compliance with a local kratom sales ban (enacted in 2016) in San Diego City. As part of a larger study about retail tobacco marketing near colleges, availability of kratom was assessed in summer 2019 in a random sample of 614 vape shops that was stratified to compare stores near (≤ 3 miles) and distant (>3 miles) from colleges. Logistic regression examined kratom availability as a function of store type (stores that sold vape products only vs. stores selling other tobacco), nearness to college, and tract-level demographics. Kratom was available in 62.4% of observed stores and more often in vape-and-smoke (81.1%) than vape-only shops (11.5%, AOR = 40.4, 95% CI = 23.3-74.1). Kratom availability did not differ by nearness to colleges. In San Diego City, 46.2% of observed stores (95% CI = 28.8-64.5) sold kratom products. Findings indicate that kratom was available in the majority of vape shops and most commonly in vape-and-smoke shops. Widespread availability in tobacco specialty shops suggests the need for research on dual use with tobacco, kratom advertising and cross-product promotion, and the potential of state and local tobacco retail licensing to prohibit sales.
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Affiliation(s)
- Molly A. Bowdring
- Stanford University School of Medicine, Stanford Prevention Research Center, 3180 Porter Drive, Palo Alto, CA, USA
- Stanford University School of Medicine, Department of Psychiatry and Behavioral Sciences, 401 Quarry Road, Stanford, CA, USA
| | - Eric C. Leas
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, CA, USA
| | - Monika Vishwakarma
- Stanford University School of Medicine, Stanford Prevention Research Center, 3180 Porter Drive, Palo Alto, CA, USA
| | - Nina C. Schleicher
- Stanford University School of Medicine, Stanford Prevention Research Center, 3180 Porter Drive, Palo Alto, CA, USA
| | - Judith J. Prochaska
- Stanford University School of Medicine, Stanford Prevention Research Center, 3180 Porter Drive, Palo Alto, CA, USA
| | - Lisa Henriksen
- Stanford University School of Medicine, Stanford Prevention Research Center, 3180 Porter Drive, Palo Alto, CA, USA
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Strong DR, Glasser AM, Leas EC, Pierce JP, Abrams DB, Hrywna M, Hyland A, Cummings KM, Hatsukami DK, Fong GT, Elton-Marshall T, Sharma E, Edwards KC, Stanton CA, Sawdey MD, Ramôa CP, Silveira ML, Kimmel HL, Niaura RS. Indicators of Tobacco Dependence Among Youth: Findings From Wave 1 (2013-2014) of the Population Assessment of Tobacco and Health Study. Nicotine Tob Res 2023; 25:1565-1574. [PMID: 37156636 PMCID: PMC10439486 DOI: 10.1093/ntr/ntad072] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 05/01/2023] [Indexed: 05/10/2023]
Abstract
BACKGROUND Prior work established a measure of tobacco dependence (TD) among adults that can be used to compare TD across different tobacco products. We extend this approach to develop a common, cross-product metric for TD among youth. METHODS One thousand one hundred and forty-eight youth aged 12-17 who used a tobacco product in the past 30 days were identified from 13 651 youth respondents in Wave 1 of the Population Assessment of Tobacco and Health (PATH) Study. FINDINGS Analyses confirmed a single primary latent construct underlying responses to TD indicators for all mutually exclusive tobacco product user groups. Differential Item Functioning analyses supported the use of 8 of 10 TD indicators for comparisons across groups. With TD levels anchored at 0.0 (standard deviation [SD] = 1.0) among cigarette only (n = 265) use group, mean TD scores were more than a full SD lower for e-cigarette only (n = 150) use group (mean = -1.09; SD = 0.64). Other single product use group (cigar, hookah, pipe, or smokeless; n = 262) on average had lower TD (mean = -0.60; SD = 0.84), and the group with the use of multiple tobacco products (n = 471) experienced similar levels of TD (mean = 0.14; SD = 0.78) as the cigarette only use group. Concurrent validity was established with product use frequency among all user groups. A subset of five TD items comprised a common metric permitting comparisons between youth and adults. CONCLUSION The PATH Study Youth Wave 1 Interview provided psychometrically valid measures of TD that enable future regulatory investigations of TD across tobacco products and comparisons between youth and adult tobacco product use group. IMPLICATIONS A measure of tobacco dependence (TD) has been established previously among adults to compare TD across tobacco products. This study established the validity of a similar, cross-product measure of TD among youth. Findings suggest a single latent TD construct underlying this measure, concurrent validity of the scale with product use frequency across different types of tobacco users, and a subset of common items that can be used to compare TD between youth and adults who use tobacco.
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Affiliation(s)
- David R Strong
- Cancer Prevention and Control Program, Moores Cancer Center University of California, San Diego, CA, USA
- Department of Family Medicine and Public Health, University of California, San Diego, CA, USA
| | - Allison M Glasser
- School of Global Public Health, New York University, New York, NY, USA
| | - Eric C Leas
- Department of Family Medicine and Public Health, University of California, San Diego, CA, USA
| | - John P Pierce
- Department of Family Medicine and Public Health, University of California, San Diego, CA, USA
| | - David B Abrams
- School of Global Public Health, New York University, New York, NY, USA
| | - Mary Hrywna
- Department of Health Behavior, Society and Policy, Rutgers School of Public Health, New Brunswick, NJ, USA
| | | | | | - Dorothy K Hatsukami
- Department of Psychiatry and Behavioral Sciences, University of Minnesota, Minneapolis, MN, USA
| | - Geoffrey T Fong
- School of Public Health Sciences, University of Waterloo, Waterloo, ON,Canada
- Ontario Institute for Cancer Research, Toronto, ON, Canada
| | - Tara Elton-Marshall
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, Canada
| | | | | | | | - Michael D Sawdey
- Center for Tobacco Products, Food and Drug Administration, Silver Spring, MD, USA
| | - Carolina P Ramôa
- Center for Tobacco Products, Food and Drug Administration, Silver Spring, MD, USA
| | - Marushka L Silveira
- Kelly Government Solutions, Rockville, MD, USA
- National Institute of Dental and Craniofacial Research (NIDCR/NIH), Bethesda, MD, USA
| | | | - Raymond S Niaura
- School of Global Public Health, New York University, New York, NY, USA
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Chen R, Pierce JP, Leas EC, Benmarhnia T, Strong DR, White MM, Stone M, Trinidad DR, McMenamin SB, Messer K. Effectiveness of e-cigarettes as aids for smoking cessation: evidence from the PATH Study cohort, 2017-2019. Tob Control 2023; 32:e145-e152. [PMID: 35131948 PMCID: PMC10423520 DOI: 10.1136/tobaccocontrol-2021-056901] [Citation(s) in RCA: 34] [Impact Index Per Article: 34.0] [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: 07/06/2021] [Accepted: 11/12/2021] [Indexed: 12/29/2022]
Abstract
OBJECTIVE To assess the effectiveness of e-cigarettes in smoking cessation in the USA from 2017 to 2019, given the 2017 increase in high nicotine e-cigarette sales. METHODS In 2017, the PATH Cohort Study included data on 3578 previous year smokers with a recent quit attempt and 1323 recent former smokers. Respondents reported e-cigarettes or other products used to quit cigarettes and many covariates associated with e-cigarette use. Study outcomes were 12+ months of cigarette abstinence and tobacco abstinence in 2019. We report weighted unadjusted estimates and use propensity score matched analyses with 1500 bootstrap samples to estimate adjusted risk differences (aRD). RESULTS In 2017, 12.6% (95% CI 11.3% to 13.9%) of recent quit attempters used e-cigarettes to help with their quit attempt, a decline from previous years. Cigarette abstinence for e-cigarette users (9.9%, 95% CI 6.6% to 13.2%) was lower than for no product use (18.6%, 95% CI 16.0% to 21.2%), and the aRD for e-cigarettes versus pharmaceutical aids was -7.3% (95% CI -14.4 to -0.4) and for e-cigarettes versus any other method was -7.7% (95% CI -12.2 to -3.2). Only 2.2% (95% CI 0.0% to 4.4%) of recent former smokers switched to a high nicotine e-cigarette. Subjects who switched to e-cigarettes appeared to have a higher relapse rate than those who did not switch to e-cigarettes or other tobacco, although the difference was not statistically significant. CONCLUSIONS Sales increases in high nicotine e-cigarettes in 2017 did not translate to more smokers using these e-cigarettes to quit smoking. On average, using e-cigarettes for cessation in 2017 did not improve successful quitting or prevent relapse.
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Affiliation(s)
- Ruifeng Chen
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, California, USA
| | - John P Pierce
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, California, USA
- Moores Cancer Center, University of California San Diego, La Jolla, California, USA
| | - Eric C Leas
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, California, USA
| | - Tarik Benmarhnia
- Scripps Institution of Oceanography, University of California San Diego, La Jolla, California, USA
| | - David R Strong
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, California, USA
- Moores Cancer Center, University of California San Diego, La Jolla, California, USA
| | - Martha M White
- Moores Cancer Center, University of California San Diego, La Jolla, California, USA
| | - Matthew Stone
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, California, USA
| | - Dennis R Trinidad
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, California, USA
| | - Sara B McMenamin
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, California, USA
| | - Karen Messer
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, California, USA
- Moores Cancer Center, University of California San Diego, La Jolla, California, USA
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Ayers JW, Zhu Z, Poliak A, Leas EC, Dredze M, Hogarth M, Smith DM. Evaluating Artificial Intelligence Responses to Public Health Questions. JAMA Netw Open 2023; 6:e2317517. [PMID: 37285160 PMCID: PMC10248742 DOI: 10.1001/jamanetworkopen.2023.17517] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 04/20/2023] [Indexed: 06/08/2023] Open
Abstract
This cross-sectional study analyzes the quality of ChatGPT responses to public health questions.
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Affiliation(s)
- John W. Ayers
- Qualcomm Institute, University of California San Diego, La Jolla
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, La Jolla
| | - Zechariah Zhu
- Qualcomm Institute, University of California San Diego, La Jolla
| | - Adam Poliak
- Department of Computer Science, Bryn Mawr College, Bryn Mawr, Pennsylvania
| | - Eric C. Leas
- Qualcomm Institute, University of California San Diego, La Jolla
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla
| | - Mark Dredze
- Department of Computer Science, Johns Hopkins University, Baltimore, Maryland
| | - Michael Hogarth
- Department of Biomedical Informatics, University of California San Diego, La Jolla
- Altman Clinical Translational Research Institute, University of California San Diego, La Jolla
| | - Davey M. Smith
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, La Jolla
- Altman Clinical Translational Research Institute, University of California San Diego, La Jolla
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Ayers JW, Poliak A, Dredze M, Leas EC, Zhu Z, Kelley JB, Faix DJ, Goodman AM, Longhurst CA, Hogarth M, Smith DM. Comparing Physician and Artificial Intelligence Chatbot Responses to Patient Questions Posted to a Public Social Media Forum. JAMA Intern Med 2023; 183:589-596. [PMID: 37115527 PMCID: PMC10148230 DOI: 10.1001/jamainternmed.2023.1838] [Citation(s) in RCA: 322] [Impact Index Per Article: 322.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 02/28/2023] [Indexed: 04/29/2023]
Abstract
Importance The rapid expansion of virtual health care has caused a surge in patient messages concomitant with more work and burnout among health care professionals. Artificial intelligence (AI) assistants could potentially aid in creating answers to patient questions by drafting responses that could be reviewed by clinicians. Objective To evaluate the ability of an AI chatbot assistant (ChatGPT), released in November 2022, to provide quality and empathetic responses to patient questions. Design, Setting, and Participants In this cross-sectional study, a public and nonidentifiable database of questions from a public social media forum (Reddit's r/AskDocs) was used to randomly draw 195 exchanges from October 2022 where a verified physician responded to a public question. Chatbot responses were generated by entering the original question into a fresh session (without prior questions having been asked in the session) on December 22 and 23, 2022. The original question along with anonymized and randomly ordered physician and chatbot responses were evaluated in triplicate by a team of licensed health care professionals. Evaluators chose "which response was better" and judged both "the quality of information provided" (very poor, poor, acceptable, good, or very good) and "the empathy or bedside manner provided" (not empathetic, slightly empathetic, moderately empathetic, empathetic, and very empathetic). Mean outcomes were ordered on a 1 to 5 scale and compared between chatbot and physicians. Results Of the 195 questions and responses, evaluators preferred chatbot responses to physician responses in 78.6% (95% CI, 75.0%-81.8%) of the 585 evaluations. Mean (IQR) physician responses were significantly shorter than chatbot responses (52 [17-62] words vs 211 [168-245] words; t = 25.4; P < .001). Chatbot responses were rated of significantly higher quality than physician responses (t = 13.3; P < .001). The proportion of responses rated as good or very good quality (≥ 4), for instance, was higher for chatbot than physicians (chatbot: 78.5%, 95% CI, 72.3%-84.1%; physicians: 22.1%, 95% CI, 16.4%-28.2%;). This amounted to 3.6 times higher prevalence of good or very good quality responses for the chatbot. Chatbot responses were also rated significantly more empathetic than physician responses (t = 18.9; P < .001). The proportion of responses rated empathetic or very empathetic (≥4) was higher for chatbot than for physicians (physicians: 4.6%, 95% CI, 2.1%-7.7%; chatbot: 45.1%, 95% CI, 38.5%-51.8%; physicians: 4.6%, 95% CI, 2.1%-7.7%). This amounted to 9.8 times higher prevalence of empathetic or very empathetic responses for the chatbot. Conclusions In this cross-sectional study, a chatbot generated quality and empathetic responses to patient questions posed in an online forum. Further exploration of this technology is warranted in clinical settings, such as using chatbot to draft responses that physicians could then edit. Randomized trials could assess further if using AI assistants might improve responses, lower clinician burnout, and improve patient outcomes.
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Affiliation(s)
- John W. Ayers
- Qualcomm Institute, University of California San Diego, La Jolla
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, La Jolla
| | - Adam Poliak
- Department of Computer Science, Bryn Mawr College, Bryn Mawr, Pennsylvania
| | - Mark Dredze
- Department of Computer Science, Johns Hopkins University, Baltimore, Maryland
| | - Eric C. Leas
- Qualcomm Institute, University of California San Diego, La Jolla
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla
| | - Zechariah Zhu
- Qualcomm Institute, University of California San Diego, La Jolla
| | | | - Dennis J. Faix
- Naval Health Research Center, Navy, San Diego, California
| | - Aaron M. Goodman
- Division of Blood and Marrow Transplantation, Department of Medicine, University of California San Diego, La Jolla
- Moores Cancer Center, University of California San Diego, La Jolla
| | | | - Michael Hogarth
- Department of Biomedical Informatics, University of California San Diego, La Jolla
- Altman Clinical Translational Research Institute, University of California San Diego, La Jolla
| | - Davey M. Smith
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, La Jolla
- Altman Clinical Translational Research Institute, University of California San Diego, La Jolla
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Leas EC, Harati RM, Satybaldiyeva N, Morales NE, Huffaker SL, Mejorado T, Grant I. Self-reported adverse events associated with ∆ 8-Tetrahydrocannabinol (Delta-8-THC) Use. J Cannabis Res 2023; 5:15. [PMID: 37217977 PMCID: PMC10204335 DOI: 10.1186/s42238-023-00191-y] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 05/17/2023] [Indexed: 05/24/2023] Open
Abstract
BACKGROUND There is an expanding unregulated market for a psychotropic compound called ∆8-Tetrahydrocannabinol (delta-8-THC) that is being derived from hemp, but a summary of adverse events related to delta-8-THC has not been publicly reported. METHODS This case series assessed adverse events reported by delta-8-THC users on the Reddit forum r/Delta8 and compared these to delta-8-THC AEs in the US Food and Drug Administration Adverse Event Reporting System (FAERS). Delta-8-THC and cannabis AEs reported in FAERS were also compared. The r/Delta8 forum was selected because it includes a large sample of 98,700 registered individuals who publicly discuss their experiences using delta-8-THC. All r/Delta8 posts were obtained from August 20, 2020, through September 25, 2022. A random sample of r/Delta8 posts was drawn (n = 10,000) and filtered for posts in which delta-8-THC users reported an adverse event (n = 335). FAERS reports that listed delta-8-THC (N = 326) or cannabis (N = 7076) as a suspect product active ingredient were obtained. Adverse events claimed to result from delta-8-THC use were coded using Medical Dictionary for Regulatory Activities to system organ class and preferred term categories. RESULTS The absolute number of delta-8-THC adverse event reports (N = 2184, 95% CI = 1949-2426) and serious adverse event reports (N = 437; 95% CI = 339-541) on r/Delta 8 were higher than the adverse event reports (N = 326) and serious adverse event reports (N = 289) to FAERS. Psychiatric disorders were the most frequently cited system organ class in r/Delta8 adverse event reports, mentioned in 41.2% (95% CI = 35.8%-46.3%) of reports, followed by respiratory, thoracic and mediastinal disorders (29.3%, 95% CI = 25.1%-34.0%) and nervous system disorders (23.3%, 95% CI = 18.5%-27.5%). Anxiety (16.4%, 95% CI = 12.8-20.6), Cough (15.5%, 95% CI = 11.9-20.0) and Paranoia (9.3%, 95% CI = 6.3-12.5) were the most frequently cited preferred terms in adverse event reports. The overall prevalence of AEs reported for cannabis and delta-8-THC on FAERS were also similar when analyzed by system organ class (Pearson's r = 0.88). CONCLUSIONS The findings of this case series suggest that most of the adverse events reported by delta-8-THC users are like those reported during acute cannabis intoxication. This finding suggests that health care professionals follow similar treatment and management protocols, and that jurisdictions should clarify whether delta-8-THC can be sold as a hemp product.
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Affiliation(s)
- Eric C Leas
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, 9500 Gilman Drive, 0725, La Jolla, San Diego, CA, 94304-1334, USA.
- Qualcomm Institute, University of California, La Jolla, San Diego, CA, USA.
| | - Raquel M Harati
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, 9500 Gilman Drive, 0725, La Jolla, San Diego, CA, 94304-1334, USA
| | - Nora Satybaldiyeva
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, 9500 Gilman Drive, 0725, La Jolla, San Diego, CA, 94304-1334, USA
| | | | - Shelby L Huffaker
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, 9500 Gilman Drive, 0725, La Jolla, San Diego, CA, 94304-1334, USA
| | - Tomas Mejorado
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, 9500 Gilman Drive, 0725, La Jolla, San Diego, CA, 94304-1334, USA
| | - Igor Grant
- Center for Medicinal Cannabis Research, Department of Psychiatry, University of California, La Jolla, San Diego, CA, USA
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13
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Stone M, Strong D, Dimofte C, Brighton E, Oratowski J, Yang T, Alkuzweny M, Asslani A, Velasco K, Skipworth M, Crespo NC, Hurst S, Leas EC, Pulvers K, Pierce JP. Role of affective reactivity induced by cigarette packaging including graphic warning labels: the CASA Study. Tob Control 2023; 32:315-322. [PMID: 34511408 PMCID: PMC8917242 DOI: 10.1136/tobaccocontrol-2021-056650] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 03/11/2021] [Accepted: 08/24/2021] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To identify whether three types of cigarette pack designs, including three versions of graphic warning label (GWL) plain packs, one GWL absent and branding absent pack (blank) and the smoker's own GWL absent and branding present pack (US), elicit different valence, type and levels of affect. DESIGN US daily smokers (n=324) were asked to handle each of the five pack types and 'think aloud' their reactions. To avoid a muted familiarity response, exposure to their own US pack followed exposure to at least one GWL plain pack. Reactions were scored on a reactivity scale (-3 to +3) and the text was coded for speech polarity (-1 to +1) and emotive word frequency. RESULTS Reactivity scores had excellent inter-rater reliability (agreement ≥86%; intraclass correlation coefficient ≥0.89) and were correlated with speech polarity (r=0.21-0.37, p<0.001). When considering their US pack, approximately two-thirds of smokers had a low (31.5%) to medium (34.6%) positive response (reactivity=1.29; polarity=0.14) with expressed feelings of joy and trust. Blank packaging prompted a largely (65.4%) neutral response (reactivity=0.03; polarity=0.00). The gangrenous foot GWL provoked mostly medium (46.9%) to high (48.1%) negative responses (reactivity=-2.44; polarity=-0.20), followed by neonatal baby (reactivity=-1.85; polarity=-0.10) and throat cancer (reactivity=-1.76; polarity=-0.08) warnings. GWLs varied in their elicitation of disgust, anger, fear and sadness. CONCLUSION Initial reactions to GWL packs, a blank pack, and smokers' current US pack reflected negative, neutral, and positive affect, respectively. Different versions of the GWL pack elicited different levels and types of immediate negative affect.
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Affiliation(s)
- Matthew Stone
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, California, USA
- School of Public Health, San Diego State University, San Diego, California, USA
| | - David Strong
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, California, USA
- Cancer Control Program, University of California San Diego Moores Cancer Center, La Jolla, California, USA
| | - Claudiu Dimofte
- Marketing Department, San Diego State University, San Diego, California, USA
| | - Elizabeth Brighton
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, California, USA
| | - Jesica Oratowski
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, California, USA
| | - Tingyi Yang
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, California, USA
| | - Manar Alkuzweny
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, California, USA
| | - Atean Asslani
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, California, USA
| | - Katherine Velasco
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, California, USA
| | - Michael Skipworth
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, California, USA
| | - Noe C Crespo
- School of Public Health, San Diego State University, San Diego, California, USA
| | - Samantha Hurst
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, California, USA
- Cancer Control Program, University of California San Diego Moores Cancer Center, La Jolla, California, USA
| | - Eric C Leas
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, California, USA
- Cancer Control Program, University of California San Diego Moores Cancer Center, La Jolla, California, USA
| | - Kim Pulvers
- Department of Psychology, California State University San Marcos, San Marcos, California, USA
| | - John P Pierce
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, California, USA
- Cancer Control Program, University of California San Diego Moores Cancer Center, La Jolla, California, USA
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14
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Leas EC, Benmarhnia T, Strong DR, Pierce JP. Effects of menthol use and transitions in use on short-term and long-term cessation from cigarettes among US smokers. Tob Control 2023; 32:e31-e36. [PMID: 34230056 PMCID: PMC8733048 DOI: 10.1136/tobaccocontrol-2021-056596] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [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: 02/16/2021] [Accepted: 06/11/2021] [Indexed: 01/09/2023]
Abstract
OBJECTIVES To estimate the effect of menthol use and transitions in use (switching to or from menthol) on short-term and long-term cessation from cigarette smoking and whether this differed across demographic groups (age, sex, race). METHODS We compared the probability of 30+ day and 12-month abstinence from cigarette smoking by menthol use status using two cohorts of US adult cigarette smokers who attempted to quit smoking in the Population Assessment of Tobacco and Health (wave 1 to wave 3 and wave 2 to wave 4; n=5759), inverse probability of treatment weighting and adjusted risk ratios (aRRs). RESULTS Using menthol (vs non-menthol) prior to a quit attempt decreased the probability of 30+ day abstinence by 28% (aRR=0.78; 95% CI 0.67 to 0.91) and the probability of 12-month abstinence by 53% (aRR=0.65; 95% CI 0.47 to 0.88). Additionally, switching from menthol (vs maintaining menthol use) increased the probability of 30+ day abstinence by 58% (aRR=1.58; 95% CI 1.00 to 2.50) and the probability of 12-month abstinence by 97% (aRR=1.86; 95% CI 0.92 to 3.74). Switching to menthol (vs maintaining non-menthol use) was associated with a lower probability of 30+ day (aRR=0.70; 95% CI 0.42 to 1.16) and 12-month abstinence (aRR=0.64; 95% CI 0.30 to 1.36), but these associations were imprecise. The effects of menthol use on impaired quitting were slightly larger for non-Hispanic Black smokers, but not different for other demographic groups. CONCLUSION These results demonstrate that menthol impaired menthol smokers' attempts to quit smoking but switching from menthol improved success. This suggests that removing menthol may improve menthol smokers' success during quit attempts.
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Affiliation(s)
- Eric C Leas
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, California, USA
| | - Tarik Benmarhnia
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, California, USA
- Scripps Institution of Oceanography, University of California San Diego, La Jolla, CA, USA
| | - David R Strong
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, California, USA
| | - John P Pierce
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, California, USA
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16
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Leas EC, Trinidad DR, Pierce JP, McMenamin SB, Messer K. Trends in cigarette consumption across the United States, with projections to 2035. PLoS One 2023; 18:e0282893. [PMID: 36913367 PMCID: PMC10010542 DOI: 10.1371/journal.pone.0282893] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 02/26/2023] [Indexed: 03/14/2023] Open
Abstract
OBJECTIVES To make projections of cigarette consumption that incorporate state-specific trends in smoking behaviors, assess the potential for states to reach an ideal target, and identify State-specific targets for cigarette consumption. METHODS We used 70 years (1950-2020) of annual state-specific estimates of per capita cigarette consumption (expressed as packs per capita or "ppc") from the Tax Burden on Tobacco reports (N = 3550). We summarized trends within each state by linear regression models and the variation in rates across states by the Gini coefficient. Autoregressive Integrated Moving Average (ARIMA) models were used to make state-specific forecasts of ppc from 2021 through 2035. RESULTS Since 1980, the average rate of decline in US per capita cigarette consumption was 3.3% per year, but rates of decline varied considerably across US states (SD = 1.1% per year). The Gini coefficient showed growing inequity in cigarette consumption across US states. After reaching its lowest level in 1984 (Gini = 0.09), the Gini coefficient began increasing by 2.8% (95% CI: 2.5%, 3.1%) per year from 1985 to 2020 and is projected to continue to increase by 48.1% (95% PI = 35.3%, 64.2%) from 2020 to 2035 (Gini = 0.35; 95% PI: 0.32, 0.39). Forecasts from ARIMA models suggested that only 12 states have a realistic chance (≥50%) of reaching very low levels of per capita cigarette consumption (≤13 ppc) by 2035, but that all US states have opportunity to make some progress. CONCLUSION While ideal targets may be out of reach for most US states within the next decade, every US state has the potential to lower its per capita cigarette consumption, and our identification of more realistic targets may provide a helpful incentive.
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Affiliation(s)
- Eric C. Leas
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, California, United States of America
- * E-mail:
| | - Dennis R. Trinidad
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, California, United States of America
| | - John P. Pierce
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, California, United States of America
| | - Sara B. McMenamin
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, California, United States of America
| | - Karen Messer
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, California, United States of America
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Ayers JW, Leas EC, Dredze M, Caputi TL, Zhu SH, Cohen JE. Did Philip Morris International use the e-cigarette, or vaping, product use associated lung injury (EVALI) outbreak to market IQOS heated tobacco? Tob Control 2023; 32:131-132. [PMID: 33863833 DOI: 10.1136/tobaccocontrol-2021-056661] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 03/16/2021] [Accepted: 03/24/2021] [Indexed: 11/03/2022]
Affiliation(s)
- John W Ayers
- Department of Medicine, University of California San Diego, La Jolla, California, USA
- Center for Data Driven Health at the Qualcomm Institute, University of California San Diego, La Jolla, California, USA
| | - Eric C Leas
- Center for Data Driven Health at the Qualcomm Institute, University of California San Diego, La Jolla, California, USA
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, California, USA
| | - Mark Dredze
- Department of Computer Science, Johns Hopkins University, Baltimore, Maryland, USA
| | - Theodore L Caputi
- Department of Economics, Massachusetts Institute of Technology, Boston, Massachusetts, USA
| | - Shu-Hong Zhu
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, California, USA
| | - Joanna E Cohen
- Institute for Global Tobacco Control, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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Poliak A, Satybaldiyeva N, Strathdee SA, Leas EC, Rao R, Smith D, Ayers JW. Internet Searches for Abortion Medications Following the Leaked Supreme Court of the United States Draft Ruling. JAMA Intern Med 2022; 182:1002-1004. [PMID: 35767270 PMCID: PMC9244771 DOI: 10.1001/jamainternmed.2022.2998] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
This cross-sectional study evaluates whether internet searches for abortion medications increased following the leak of a draft Supreme Court of the United States ruling that would overturn the 1973 Roe v Wade decision.
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Affiliation(s)
- Adam Poliak
- Department of Computer Science, Bryn Mawr College, Bryn Mawr, Pennsylvania
| | - Nora Satybaldiyeva
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, La Jolla.,Qualcomm Institute, University of California, San Diego, La Jolla
| | - Steffanie A Strathdee
- Division of Infectious Diseases and Global Public Health, University of California, San Diego, La Jolla
| | - Eric C Leas
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, La Jolla.,Qualcomm Institute, University of California, San Diego, La Jolla
| | - Ramesh Rao
- Qualcomm Institute, University of California, San Diego, La Jolla
| | - Davey Smith
- Division of Infectious Diseases and Global Public Health, University of California, San Diego, La Jolla
| | - John W Ayers
- Qualcomm Institute, University of California, San Diego, La Jolla.,Division of Infectious Diseases and Global Public Health, University of California, San Diego, La Jolla
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Leas EC, Benmarhnia T, Strong DR, Pierce JP. Use of Menthol Cigarettes, Smoking Frequency, and Nicotine Dependence Among US Youth. JAMA Netw Open 2022; 5:e2217144. [PMID: 35666498 PMCID: PMC9171563 DOI: 10.1001/jamanetworkopen.2022.17144] [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] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE Menthol may make cigarette smoke less aversive and could lead youth to smoke more frequently and become more dependent on nicotine. OBJECTIVE To assess the association of menthol use with cigarette smoking frequency and nicotine dependence (ND) among youth cigarettes users. DESIGN, SETTING, AND PARTICIPANTS This cohort study used a pooled sample of cohorts of US youth (aged 12-17 years at their baseline and follow-up interviews) in the Population Assessment of Tobacco and Health Study (September 2013 to November 2019). Household interviews were conducted using audio computer-assisted self-interviews. US youth who were past-30-day cigarette smokers at any of wave 2 through wave 5, completed the preceding survey (eg, wave 2 past-30-day cigarette smokers completed wave 1), and indicated whether they used menthol cigarettes were eligible. The association of menthol use with smoking frequency and ND was estimated using inverse probability of treatment weighting adjusted mean differences (aMDs), adjusted risk ratios (aRRs), and corresponding 95% CIs. Data were analyzed from December 2021 to March 2022. EXPOSURES Menthol use and transitions in use (switching to or from menthol cigarettes). MAIN OUTCOMES AND MEASURES Main outcomes were the number of days smoked in the past 30 days, the risk of frequent smoking (smoking ≥20 days in the past 30 days), and symptoms of ND. RESULTS There were a total of 1492 observations among 1096 US youth cigarette smokers, of whom 49.4% were female, 67.2% were non-Hispanic White, and 28.7% were aged 12 to 14 years at their baseline survey (all percentages are weighted). Among those who switched from not smoking to smoking (61% of the sample), menthol use was associated with smoking on 3.1 additional days (aMD; 95% CI, 1.9 to 4.2 days), 59% higher risk of being a frequent smoker (aRR, 1.59; 95% CI, 1.23 to 2.06), and 10% higher ND scores (aMD, 1.09; 95% CI, 1.02 to 1.17). Switching from smoking menthol to smoking nonmenthol (vs maintaining menthol use) was associated with smoking on 3.6 fewer days (aMD; 95% CI, -6.3 to -0.9 days) and 47% lower risk of being a frequent smoker (aRR, 0.68; 95% CI, 0.50 to 0.92). CONCLUSIONS AND RELEVANCE These findings suggest that the addition of menthol to cigarettes is associated with increased smoking frequency and ND among US youth.
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Affiliation(s)
- Eric C. Leas
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, La Jolla
| | - Tarik Benmarhnia
- Scripps Institution of Oceanography, University of California, San Diego, La Jolla
| | - David R. Strong
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, La Jolla
| | - John P. Pierce
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, La Jolla
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Pierce JP, Kealey S, Leas EC, Pulvers K, Stone MD, Oratowski J, Brighton E, Villaseñor A, Strong DR. Effect of Graphic Warning Labels on Cigarette Pack-Hiding Behavior Among Smokers: The CASA Randomized Clinical Trial. JAMA Netw Open 2022; 5:e2214242. [PMID: 35653155 PMCID: PMC9164006 DOI: 10.1001/jamanetworkopen.2022.14242] [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] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
IMPORTANCE The inclusion of graphic warning labels (GWLs) on cigarette packs is recommended for tobacco control but has not yet been implemented in the US. It is unknown whether and to what extent the inclusion of GWLs on cigarette packs affects smokers' willingness to display the packs in public. OBJECTIVE To determine whether the inclusion of GWLs on cigarette packs affects pack-hiding behavior among smokers in social settings. DESIGN, SETTING, AND PARTICIPANTS This community-based randomized clinical trial assessed smokers' real-world experience of using cigarettes repackaged to include GWLs (GWL packs) compared with standard US packs and blank packs over a 3-month intervention period with 12 months of follow-up between September 6, 2016, and December 3, 2019. The study included 357 participants aged 21 to 65 years from San Diego County, California, who smoked 5 or more cigarettes per day, were not actively planning to quit smoking, were not pregnant, and had no unstable medical conditions. Participants purchased and received cigarette packs through the study website. INTERVENTIONS During the 1-month run-in period, participants received their usual US cigarette packs. During the 3-month intervention period, participants were randomized to receive GWL packs (study-manufactured packs with 3 rotating images under license from the Commonwealth of Australia; GWL pack group), blank packs (study-manufactured packs devoid of industry marketing imagery; blank pack group), or standard US packs (US pack group). MAIN OUTCOMES AND MEASURES Pack hiding was queried daily (with participants reporting behavior within the last 4 hours) and weekly via interactive text messages during the 1-month run-in and intervention periods. Self-reported smoking behavior was biochemically validated. RESULTS Among 357 enrolled participants, the mean (SD) age was 39.3 (11.8) years; 195 participants (54.6%) were female, 40 (11.2%) were Hispanic, 243 (68.1%) were non-Hispanic White, and 74 (20.7%) were of other non-Hispanic races (including American Indian or Alaska Native, Asian or Pacific Islander, Black or African American, or multiracial). A total of 18 987 cigarette packs were purchased and delivered during the run-in and intervention periods. Daily querying showed that the inclusion of GWLs on cigarette packs increased the percentage of smokers who hid their packs at least some of the time from 41.3% (95% CI, 39.6%-43.0%) during the run-in period to 57.1% (95% CI, 55.9%-58.1%) by the end of the intervention period. In the postintervention period, returning to standard US packs reduced pack-hiding behavior to the levels observed during the run-in period. Pack hiding remained at run-in levels for both the blank pack group (35.2%; 95% CI, 33.6%-36.8%) and the US pack group (41.4%; 95% CI, 39.7%-43.1%]) throughout the study. Although even participants in the GWL group with the lowest prestudy tendency to conceal score (ie, 1) had a mean (SE) probability of pack hiding during the intervention of 0.84 (0.02), this group's probability of pack hiding decreased to a mean (SE) of 0.43 (0.03) after intervention. When social reactions to packs were queried at the end of the study, the modal response from participants in the GWL pack group was observers' aversive reactions to the packs, whereas the modal response from participants in the blank pack group was observers' positive interest in the study. Neither smoking prevalence nor consumption differed by group at any point in the study. CONCLUSIONS AND RELEVANCE In this randomized clinical trial, receiving cigarettes in GWL packs vs blank packs increased pack-hiding behavior in social settings, which may be associated with aversive reactions from observers. However, 12-month smoking behavior did not change. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02676193.
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Affiliation(s)
- John P. Pierce
- Cancer Control Program, Moores Cancer Center, University of California, San Diego, La Jolla
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, San Diego
| | - Sheila Kealey
- Cancer Control Program, Moores Cancer Center, University of California, San Diego, La Jolla
| | - Eric C. Leas
- Cancer Control Program, Moores Cancer Center, University of California, San Diego, La Jolla
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, San Diego
| | - Kim Pulvers
- Department of Psychology, California State University, San Marcos
| | - Matthew D. Stone
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, San Diego
| | - Jesica Oratowski
- Cancer Control Program, Moores Cancer Center, University of California, San Diego, La Jolla
| | - Elizabeth Brighton
- Cancer Control Program, Moores Cancer Center, University of California, San Diego, La Jolla
| | - Adriana Villaseñor
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, San Diego
- Department of Epidemiology, Public Health Services, San Diego County, San Diego, California
| | - David R. Strong
- Cancer Control Program, Moores Cancer Center, University of California, San Diego, La Jolla
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, San Diego
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21
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Pierce JP, Zhang J, Crotty Alexander LE, Leas EC, Kealey S, White MM, Strong DR, Trinidad DR, McMenamin SB, Chen R, Benmarhnia T, Messer K. Daily E-cigarette Use and the Surge in JUUL Sales: 2017-2019. Pediatrics 2022; 149:e2021055379. [PMID: 35634883 PMCID: PMC9647987 DOI: 10.1542/peds.2021-055379] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/17/2022] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES To identify how the 2017 rapid surge in sales of JUUL e-cigarettes affected usage among US youth and young adults. METHODS Annual surveys in the Population Assessment of Tobacco and Health Study assess tobacco use by product and brand among the US population. We identified 2 cohorts aged 14 to 34 years, 1 with baseline survey in 2014 before the rapid surge of JUUL and the other in 2017 as the surge in JUUL sales was occurring. For 5 age groups, we compared 2-year incidence of first tobacco use and of new-onset daily tobacco use by product, and report levels of dependence. RESULTS Sociodemographic variables and rates of experimentation with any tobacco product were similar between cohorts. Among baseline nondaily tobacco users, only those aged 14 to 17 years had an increase in the 2-year incidence of new daily tobacco use (2014 cohort = 4.8%, 95% confidence interval 4.3, 5.5 vs 2017 cohort = 6.3%, 95% confidence interval 5.8-7.0) to rates approaching those in the 1990s. In 2019, three-quarters of new daily tobacco users aged 14 to 17 vaped daily and had e-cigarette dependence scores similar to daily cigarette smokers and older adult e-cigarette vapers. We estimate that about 600 000 Americans aged <21 years used JUUL products daily in 2019, a rate 2.5 times those aged 25 to 34 years. CONCLUSIONS The surge in US JUUL sales was associated with a sharp rise in daily e-cigarette vaping and daily tobacco use among US youth, not young adults.
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Affiliation(s)
- John P. Pierce
- Herbert Wertheim School of Public Health and Human
Longevity Science
- Moores Cancer Center
| | - Jasen Zhang
- Herbert Wertheim School of Public Health and Human
Longevity Science
| | - Laura E. Crotty Alexander
- School of Medicine, Division of Pulmonary Critical Care
& Sleep
- Section of Pulmonary Critical Care, Veteran's
Administration San Diego Healthcare System, San Diego, California
| | - Eric C. Leas
- Herbert Wertheim School of Public Health and Human
Longevity Science
| | | | | | - David R. Strong
- Herbert Wertheim School of Public Health and Human
Longevity Science
- Moores Cancer Center
| | | | - Sara B. McMenamin
- Herbert Wertheim School of Public Health and Human
Longevity Science
| | - Ruifeng Chen
- Herbert Wertheim School of Public Health and Human
Longevity Science
| | - Tarik Benmarhnia
- Scripps Institution of Oceanography, University of
California San Diego, San Diego, California
| | - Karen Messer
- Herbert Wertheim School of Public Health and Human
Longevity Science
- Moores Cancer Center
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22
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Leas EC, Nobles AL, Shi Y, Hendrickson E. Public interest in ∆ 8-Tetrahydrocannabinol (delta-8-THC) increased in US states that restricted ∆ 9-Tetrahydrocannabinol (delta-9-THC) use. Int J Drug Policy 2022; 101:103557. [PMID: 34952279 PMCID: PMC9126323 DOI: 10.1016/j.drugpo.2021.103557] [Citation(s) in RCA: 29] [Impact Index Per Article: 14.5] [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: 09/08/2021] [Revised: 11/19/2021] [Accepted: 11/28/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND There is an expanding unregulated market for a psychotropic compound called ∆8-Tetrahydrocannabinol (delta-8-THC) that is being derived from hemp, but there are no empirical estimates of public interest in this compound. METHODS To measure public interest, we obtained yearly Google query fractions (QFs) that mentioned delta-8-THC (i.e., "delta 8," "delta-8," or "Δ8") for the past decade (from January 2011 through August 2021) for every country and territory in the world and every state in the United States (US) from Google Trends. We also obtained the same trends for the last complete month of data for all US states (July 2021) to compare across cannabis use policies. We summarized QFs across years, countries, US states and cannabis policies in US states using linear regression, means and ratios. We estimated raw search counts for the US using comscore.com. RESULTS The global rate of delta-8-THC searches was stable between 2011 and 2019 before increasing by 257.0% from 2019 to 2020 and 705.0% from 2020 to 2021. In 2021, the rate of delta-8-THC searches in the US was at least 10 times higher than the rates in other countries or territories. In absolute terms, there were 22.3 million delta-8-THC searches in the US in the first 8 months of 2021 alone. Increases in delta-8-THC searches from 2020 to 2021 occurred in all 50 US states and the District of Columbia (Mean 854.2%; range = 256.4% - 2831.2%) but continued to vary substantially between states in 2021. In July 2021, the legal status of delta-9-THC use across US states explained 49.0% of the variance in delta-8-THC QFs between US states (R2 = 0.490; p < 0.001) and was inversely associated, where delta-8-THC QFs were higher in jurisdictions with stricter cannabis use policies. CONCLUSION Public interest in delta-8-THC increased rapidly in 2020 and 2021 and was particularly high in US states that restricted delta-9-THC use. Jurisdictions should clarify whether delta-8-THC can be sold as a hemp product.
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Affiliation(s)
- Eric C Leas
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, CA, USA.
| | - Alicia L Nobles
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, La Jolla, CA, USA
| | - Yuyan Shi
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, CA, USA
| | - Erik Hendrickson
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, CA, USA
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23
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Affiliation(s)
- Eric C Leas
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego
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24
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Leas EC. The Hemp Loophole: A Need to Clarify the Legality of Delta-8-THC and Other Hemp-Derived Tetrahydrocannabinol Compounds. Am J Public Health 2021; 111:1927-1931. [PMID: 34618542 PMCID: PMC8630489 DOI: 10.2105/ajph.2021.306499] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/26/2021] [Indexed: 11/04/2022]
Affiliation(s)
- Eric C Leas
- The author is with the Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, La Jolla
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25
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Gunadi C, Benmarhnia T, White M, Pierce JP, McMenamin SB, Leas EC, Shi Y. Tobacco price and use following California Proposition 56 tobacco tax increase. PLoS One 2021; 16:e0257553. [PMID: 34644338 PMCID: PMC8513910 DOI: 10.1371/journal.pone.0257553] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 09/03/2021] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND California Proposition 56 increased cigarette excise tax by $2 per pack with equivalent increases on non-cigarette tobacco products. We estimated the changes in cigarette price, cigarette use, and non-cigarette use following the implementation of Proposition 56 in California in 2017. METHODS Seven waves of Tobacco Use Supplements to the Current Population Survey (TUS-CPS) 2011-2019 data were used to obtain state-level aggregate self-reported outcomes, including cigarette price per pack, current and daily cigarette use, cigarette consumption per day, and current and daily use of non-cigarette tobacco products (hookah, pipe, cigar, and smokeless tobacco). A modified version of a synthetic control method was used to create a "synthetic" California that best resembled pre-policy sociodemographic characteristics and outcome trends in California while correcting time-invariant pre-policy differences. Various sensitivity analyses were also conducted. RESULTS The implementation of Proposition 56 was associated with an increase in self-reported cigarette price per pack in California ($1.844, 95%CI: $0.153, $3.534; p = 0.032). No evidence suggested that Proposition 56 was associated with the changes in the prevalence of current or daily cigarette use, cigarette consumption per day, or the prevalence of current or daily use of non-cigarette tobacco products. CONCLUSION Most of the cigarette tax increase following Proposition 56 in California was passed on to consumers. There is a lack of evidence that the implementation of Proposition 56 was associated with the changes in the use of cigarettes and other tobacco products such as hookah, pipe, cigar, and smokeless tobacco.
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Affiliation(s)
- Christian Gunadi
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, California, United States of America
| | - Tarik Benmarhnia
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, California, United States of America
- Scripps Institution of Oceanography, University of California San Diego, La Jolla, California, United States of America
| | - Martha White
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, California, United States of America
| | - John P. Pierce
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, California, United States of America
| | - Sara B. McMenamin
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, California, United States of America
| | - Eric C. Leas
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, California, United States of America
| | - Yuyan Shi
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, California, United States of America
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26
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Pierce JP, Chen R, Kealey S, Leas EC, White MM, Stone MD, McMenamin SB, Trinidad DR, Strong DR, Benmarhnia T, Messer K. Incidence of Cigarette Smoking Relapse Among Individuals Who Switched to e-Cigarettes or Other Tobacco Products. JAMA Netw Open 2021; 4:e2128810. [PMID: 34665239 PMCID: PMC8527352 DOI: 10.1001/jamanetworkopen.2021.28810] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
IMPORTANCE Although e-cigarettes are not approved as a cessation device, many who smoke believe that e-cigarettes will help them quit cigarette smoking successfully. OBJECTIVE To assess whether people who recently quit smoking and who had switched to e-cigarettes or another tobacco product were less likely to relapse to cigarette smoking compared with those who remained tobacco free. DESIGN, SETTING, AND PARTICIPANTS This cohort study analyzed a nationally representative sample of US households that participated in 4 waves of the Population Assessment of Tobacco and Health Study (conducted 2013 through 2017), combining 2 independent cohorts each with 3 annual surveys. Eligible participants were individuals who smoked at baseline, had recently quit at the first follow-up, and completed the second follow-up survey. EXPOSURES Use of e-cigarettes or alternate tobacco products at follow-up 1 after recently quitting smoking. MAIN OUTCOMES AND MEASURES Weighted percentage of participants with over 12 months abstinence by follow-up 2. RESULTS Of a total of 13 604 participants who smoked cigarettes at baseline, 9.4% (95% CI, 8.7%-10.0%) recently had quit smoking (mean age, 41.9; 95% CI, 39.7-46.6 years; 641 [43.2%] women) Of these, 22.8% (95% CI, 19.7%-26.0%) had switched to e-cigarettes, with 17.6% (95% CI, 14.8%-20.5%) using them daily. A total of 37.1% (95% CI, 33.7%-40.4%) used a noncigarette tobacco product and 62.9% (95% CI, 59.6%-66.3%) were tobacco free. Rates of switching to e-cigarettes were highest for those who were in the top tertile of tobacco dependence (31.3%; 95% CI, 25.0%-37.7%), were non-Hispanic White (26.4%; 95% CI, 22.3%-30.4%), and had higher incomes (annual income ≥$35 000, 27.5%; 95% CI, 22.5%-32.4% vs <$35 000, 19.3%; 95% CI, 16.3%-22.3%). At follow-up 2, unadjusted relapse rates were similar among those who switched to different tobacco products (for any tobacco product: successfully quit, 41.5%; 95% CI, 36.2%-46.9%; relapsed with significant requit, 17.0%; 95% CI, 12.4%-21.6%; currently smoking, 36.2%; 95% CI, 30.9%-41.4%). Controlled for potential confounders, switching to any tobacco product was associated with higher relapse rate than being tobacco free (adjusted risk difference, 8.5%; 95% CI, 0.3%-16.6%). Estimates for those who switched to e-cigarettes, whether daily or not, were not significant. While individuals who switched from cigarettes to e-cigarettes were more likely to relapse, they appeared more likely to requit and be abstinent for 3 months at follow-up 2 (17.0%; 95% CI, 12.4%-21.6% vs 10.4%; 95% CI, 8.0%-12.9%). CONCLUSIONS AND RELEVANCE This large US nationally representative study does not support the hypothesis that switching to e-cigarettes will prevent relapse to cigarette smoking.
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Affiliation(s)
- John P. Pierce
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, La Jolla
- Moores Cancer Center, University of California, San Diego, La Jolla
| | - Ruifeng Chen
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, La Jolla
| | - Sheila Kealey
- Moores Cancer Center, University of California, San Diego, La Jolla
| | - Eric C. Leas
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, La Jolla
- Moores Cancer Center, University of California, San Diego, La Jolla
| | - Martha M. White
- Moores Cancer Center, University of California, San Diego, La Jolla
| | - Matthew D. Stone
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, La Jolla
| | - Sara B. McMenamin
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, La Jolla
| | - Dennis R. Trinidad
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, La Jolla
- Moores Cancer Center, University of California, San Diego, La Jolla
| | - David R. Strong
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, La Jolla
- Moores Cancer Center, University of California, San Diego, La Jolla
| | - Tarik Benmarhnia
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, La Jolla
- Moores Cancer Center, University of California, San Diego, La Jolla
- Scripps Institution of Oceanography, University of California, San Diego, La Jolla
| | - Karen Messer
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, La Jolla
- Moores Cancer Center, University of California, San Diego, La Jolla
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27
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Ayers JW, Chu B, Zhu Z, Leas EC, Smith DM, Dredze M, Broniatowski DA. Spread of Misinformation About Face Masks and COVID-19 by Automated Software on Facebook. JAMA Intern Med 2021; 181:1251-1253. [PMID: 34096988 PMCID: PMC8185625 DOI: 10.1001/jamainternmed.2021.2498] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
This cross-sectional study examines the spread of misinformation regarding the Danish Study to Assess Face Masks for the Protection Against COVID-19 Infection on Facebook.
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Affiliation(s)
- John W Ayers
- Division of Infectious Diseases and Global Public Health, University of California, San Diego, La Jolla
| | - Brian Chu
- Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Zechariah Zhu
- Department of Mathematics, University of California, Los Angeles
| | - Eric C Leas
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, La Jolla
| | - Davey M Smith
- Division of Infectious Diseases and Global Public Health, University of California, San Diego, La Jolla
| | - Mark Dredze
- Department of Computer Science, Johns Hopkins University, Baltimore, Maryland
| | - David A Broniatowski
- Department of Engineering Management and Systems Engineering, The George Washington University, Washington, DC
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28
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Strong DR, Pierce JP, Pulvers K, Stone MD, Villaseñor A, Pu M, Dimofte CV, Leas EC, Oratowski J, Brighton E, Hurst S, Kealey S, Chen R, Messer K. Effect of Graphic Warning Labels on Cigarette Packs on US Smokers' Cognitions and Smoking Behavior After 3 Months: A Randomized Clinical Trial. JAMA Netw Open 2021; 4:e2121387. [PMID: 34347057 PMCID: PMC8339936 DOI: 10.1001/jamanetworkopen.2021.21387] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE The US Food and Drug Administration's implementation of graphic warning labels (GWLs) on cigarette packs is under challenge in US courts. OBJECTIVE To determine whether GWLs can affect US smokers' perceptions about their cigarettes or health consequences and changes in smoking behavior. DESIGN, SETTING, AND PARTICIPANTS This study was a randomized clinical trial of the effect of a 3-month, real-world experience of cigarettes with GWL packaging. Community recruitment was done from September 2016 through December 2019 of daily smokers from San Diego, California, aged 21 to 65 years, who were not ready to quit. Participants were randomized to purchase and receive cigarettes in 1 of 3 pack designs: GWL, blank, or standard US pack. Data analysis was performed from July 2020 to February 2021. INTERVENTIONS The study manufactured GWL cigarette packs (3 versions with Australian-licensed images) and packs devoid of marketing. For 3 months, participants purchased GWL, blank, or standard US pack cigarettes that were delivered to their home. MAIN OUTCOMES AND MEASURES Smoking-related cognitions and behavior were queried by daily and weekly interactive text messages. Smoking behavior was self-reported before and after the intervention by 96% of randomized participants and was biochemically validated on a subsample. RESULTS The study sample included 357 participants (195 women [54.6%]; mean [SD] age, 39.5 [11.9] years); 116 were randomized to the standard US pack group, 118 were randomized to the GWL pack group, and 125 were randomized to the blank pack group. Over the 3 months, participants who received the GWL packs had reduced positive perceptions of recent cigarettes smoked compared with participants who received the branded US pack (mean difference, -0.46 SD; 95% CI, -0.73 SD to -0.20 SD; P < .001). Health concerns increased in all groups, with a significant increase in the GWL group vs the US pack group (mean difference, 0.35 SD; 95% CI, 0.09 SD to 0.62 SD; P = .002). Quitting cognitions increased in all study groups, with a peak mean change of 0.60 SD for GWL participants vs 0.34 SD for US pack participants (mean difference, 0.55 SD; 95% CI, 0.28 SD to 0.81 SD; P < .001). GWL participants had slightly more cigarette abstinence periods per week than the US pack group, but the difference was not significant (adjusted odds ratio, 1.06; 95% CI, 0.99 to 1.13). At 3 months, there was no between-group difference in any smoking behavior. The blank pack group was similar to the US pack group on all measures. CONCLUSIONS AND RELEVANCE These findings suggest that the introduction of GWL packs appears to decrease positive perceptions of cigarettes and increase quitting cognitions in the short term. However, additional complementary tobacco control strategies may be necessary for GWL packs to be associated with reduced smoking behavior. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02676193.
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Affiliation(s)
- David R. Strong
- Cancer Control Program, Moores Cancer Center, University of California, San Diego, La Jolla
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, La Jolla
| | - John P. Pierce
- Cancer Control Program, Moores Cancer Center, University of California, San Diego, La Jolla
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, La Jolla
| | - Kim Pulvers
- Department of Psychology, California State University San Marcos, San Marcos
| | - Matthew D. Stone
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, La Jolla
| | - Adriana Villaseñor
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, La Jolla
- Department of Epidemiology, Public Health Services, San Diego County, San Diego, California
| | - Minya Pu
- Cancer Control Program, Moores Cancer Center, University of California, San Diego, La Jolla
| | - Claudiu V. Dimofte
- Department of Marketing, San Diego State University, San Diego, California
| | - Eric C. Leas
- Cancer Control Program, Moores Cancer Center, University of California, San Diego, La Jolla
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, La Jolla
| | - Jesica Oratowski
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, La Jolla
| | - Elizabeth Brighton
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, La Jolla
| | - Samantha Hurst
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, La Jolla
| | - Sheila Kealey
- Cancer Control Program, Moores Cancer Center, University of California, San Diego, La Jolla
| | - Ruifeng Chen
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, La Jolla
| | - Karen Messer
- Cancer Control Program, Moores Cancer Center, University of California, San Diego, La Jolla
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, La Jolla
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29
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Sakuma KLK, Pierce JP, Fagan P, Nguyen-Grozavu FT, Leas EC, Messer K, White MM, Tieu AS, Trinidad DR. Racial/Ethnic Disparities Across Indicators of Cigarette Smoking in the Era of Increased Tobacco Control, 1992-2019. Nicotine Tob Res 2021; 23:909-919. [PMID: 33196799 PMCID: PMC8522466 DOI: 10.1093/ntr/ntaa231] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Accepted: 11/11/2020] [Indexed: 11/15/2022]
Abstract
INTRODUCTION This study compared tobacco use and cessation for African Americans (AA), Asians/Pacific Islanders (API), Hispanics/Latinos (H/L), American Indian/Alaskan Natives (AI/AN), and non-Hispanic Whites (NHW) in the United States to California (CA), the state with the longest continually funded tobacco control program. The purpose of this study was to identify tobacco use disparities across racial/ethnic groups across time. METHODS Cigarette use prevalence (uptake and current use), consumption (mean number of cigarettes smoked per day [CPD]), and quit ratios were calculated across survey years, and trends were examined within each race/ethnic group and comparing between CA and the United States, utilizing the 1992-2019 Tobacco Use Supplements to the Current Population Survey. RESULTS Prevalence decreased for all race/ethnic groups. Current use among CA NHW showed significant decline compared with US counterparts, whereas US H/L showed greater decline than CA counterparts. CPD decreased by approximately 30% across race/ethnic groups, with CA groups having lower numbers. The greatest decrease occurred among AA in CA (average 10.3 CPD [95% confidence interval (CI): 10.3, 12.6] in 1992/1993 to 3 CPD [95% CI: 2.4, 3.7] in 2018/2019). Quit ratios increased from 1992/1993 to 2018/2019 for CA H/L 52.4% (95% CI: 49.8, 53.0) to 59.3 (95% CI: 55.8, 62.5) and CA NHWs 61.5% (95% CI: 60.7, 61.9) to 63.8% (95% CI: 63.9, 66.9). CONCLUSIONS Although overall prevalence decreased over time for each racial/ethnic group, declines in CA outpaced the United States only for NHWs. Reductions in CPD were encouraging but the quit ratio points to the need to increase tobacco control efforts toward cessation. IMPLICATIONS The successes in reduced cigarette use uptake and prevalence across time for both California and the rest of the United States were observed largely among non-Hispanic White populations. Although reductions in the number of cigarettes smoked per day are a notable success, particularly among the Californian African Americans, efforts to support quitting across racial/ethnic groups, especially marginalized groups, need to be prioritized.
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Affiliation(s)
- Kari-Lyn K Sakuma
- Health Promotion and Health Behavior Program, School of Social and
Behavioral Health Sciences, College of Public Health and Human Sciences, Oregon State
University, Corvallis, OR
| | - John P Pierce
- Department of Family Medicine and Public Health, Moores Cancer
Center, University of California San Diego, La Jolla,
CA
| | - Pebbles Fagan
- Fay W. Boozman College of Public Health, University of Arkansas for
Medical Sciences, Little Rock, AR
| | - France T Nguyen-Grozavu
- Department of Family Medicine and Public Health, Moores Cancer
Center, University of California San Diego, La Jolla,
CA
| | - Eric C Leas
- Division of Health Policy, Department of Family Medicine and Public
Health, University of California San Diego, La Jolla,
CA
| | - Karen Messer
- Department of Family Medicine and Public Health, Moores Cancer
Center, University of California San Diego, La Jolla,
CA
| | - Martha M White
- Department of Family Medicine and Public Health, Moores Cancer
Center, University of California San Diego, La Jolla,
CA
| | - Amanda S Tieu
- Department of Family Medicine and Public Health, Moores Cancer
Center, University of California San Diego, La Jolla,
CA
| | - Dennis R Trinidad
- Department of Family Medicine and Public Health, Moores Cancer
Center, University of California San Diego, La Jolla,
CA
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Pierce JP, Leas EC, Benmarhnia T, McMenamin SB, Strong DR, Chen R, Messer K. E-cigarettes and Cessation: The Introduction of Substantial Bias in Analyses of PATH Study. Nicotine Tob Res 2021; 23:876-877. [PMID: 33188408 PMCID: PMC8522440 DOI: 10.1093/ntr/ntaa234] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 11/11/2020] [Indexed: 08/13/2023]
Affiliation(s)
- John P Pierce
- Herbert Wertheim School of Public Health and Human Longevity Science,
University of California San Diego, La Jolla, CA
- Moores Cancer Center, University of California San Diego,
La Jolla, CA
| | - Eric C Leas
- Herbert Wertheim School of Public Health and Human Longevity Science,
University of California San Diego, La Jolla, CA
- Moores Cancer Center, University of California San Diego,
La Jolla, CA
| | - Tarik Benmarhnia
- Herbert Wertheim School of Public Health and Human Longevity Science,
University of California San Diego, La Jolla, CA
- Moores Cancer Center, University of California San Diego,
La Jolla, CA
- Scripps Institution of Oceanography, University of California San
Diego, La Jolla, CA
| | - Sara B McMenamin
- Herbert Wertheim School of Public Health and Human Longevity Science,
University of California San Diego, La Jolla, CA
| | - David R Strong
- Herbert Wertheim School of Public Health and Human Longevity Science,
University of California San Diego, La Jolla, CA
- Moores Cancer Center, University of California San Diego,
La Jolla, CA
| | - Ruifeng Chen
- Herbert Wertheim School of Public Health and Human Longevity Science,
University of California San Diego, La Jolla, CA
| | - Karen Messer
- Herbert Wertheim School of Public Health and Human Longevity Science,
University of California San Diego, La Jolla, CA
- Moores Cancer Center, University of California San Diego,
La Jolla, CA
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Johnson DC, Nobles AL, Caputi TL, Liu M, Leas EC, Strathdee SA, Smith DM, Ayers JW. Monitoring HIV testing and pre-exposure prophylaxis information seeking by combining digital and traditional data. BMC Infect Dis 2021; 21:215. [PMID: 33632140 PMCID: PMC7908754 DOI: 10.1186/s12879-021-05907-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Accepted: 02/16/2021] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Public health is increasingly turning to non-traditional digital data to inform HIV prevention and control strategies. We demonstrate a parsimonious method using both traditional survey and internet search histories to provide new insights into HIV testing and pre-exposure prophylaxis (PrEP) information seeking that can be easily extended to other settings. METHOD We modeled how US internet search volumes from 2019 for HIV testing and PrEP compared against expected search volumes for HIV testing and PrEP using state HIV prevalence and socioeconomic characteristics as predictors. States with search volumes outside the upper and lower bound confidence interval were labeled as either over or under performing. State performance was evaluated by (a) Centers for Disease Control and Prevention designation as a hotspot for new HIV diagnoses (b) expanding Medicaid coverage. RESULTS Ten states over-performed in models assessing information seeking for HIV testing, while eleven states under-performed. Thirteen states over-performed in models assessing internet searches for PrEP information, while thirteen states under-performed. States that expanded Medicaid coverage were more likely to over perform in PrEP models than states that did not expand Medicaid coverage. While states that were hotspots for new HIV diagnoses were more likely to over perform on HIV testing searches. CONCLUSION Our study derived a method of measuring HIV and PrEP information seeking that is comparable across states. Several states exhibited information seeking for PrEP and HIV testing that deviated from model assessments. Statewide search volume for PrEP information was affected by a state's decision to expand Medicaid coverage. Our research provides health officials with an innovative way to monitor statewide interest in PrEP and HIV testing using a metric for information-seeking that is comparable across states.
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Affiliation(s)
- Derek C Johnson
- Department of Medicine, Division of Infectious Diseases and Global Public Health, University of California San Diego, 9500 Gilman Dr, La Jolla, California, 92093, USA.
- The Center for Data Driven Health at the Qualcomm Institute, University of California San Diego, La Jolla, California, USA.
| | - Alicia L Nobles
- Department of Medicine, Division of Infectious Diseases and Global Public Health, University of California San Diego, 9500 Gilman Dr, La Jolla, California, 92093, USA
- The Center for Data Driven Health at the Qualcomm Institute, University of California San Diego, La Jolla, California, USA
| | - Theodore L Caputi
- The Center for Data Driven Health at the Qualcomm Institute, University of California San Diego, La Jolla, California, USA
- Department of Health Sciences, University of York, York, UK
| | | | - Eric C Leas
- The Center for Data Driven Health at the Qualcomm Institute, University of California San Diego, La Jolla, California, USA
- Department of Family Medicine and Public Health, Division of Health Policy, University of California San Diego, La Jolla, California, USA
| | - Steffanie A Strathdee
- Department of Medicine, Division of Infectious Diseases and Global Public Health, University of California San Diego, 9500 Gilman Dr, La Jolla, California, 92093, USA
| | - Davey M Smith
- Department of Medicine, Division of Infectious Diseases and Global Public Health, University of California San Diego, 9500 Gilman Dr, La Jolla, California, 92093, USA
| | - John W Ayers
- Department of Medicine, Division of Infectious Diseases and Global Public Health, University of California San Diego, 9500 Gilman Dr, La Jolla, California, 92093, USA
- The Center for Data Driven Health at the Qualcomm Institute, University of California San Diego, La Jolla, California, USA
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Leas EC, Moy NH, Nobles AL, Ayers J, Zhu SH, Purushothaman V. Google shopping queries for vaping products, JUUL and IQOS during the E-cigarette, or Vaping, product use Associated Lung Injury (EVALI) outbreak. Tob Control 2021; 31:e74-e77. [PMID: 33608466 DOI: 10.1136/tobaccocontrol-2021-056481] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [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: 01/11/2021] [Accepted: 01/15/2021] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To assess whether the late 2019 US outbreak of pulmonary disease linked to vaping ('E-cigarette, or Vaping, product use Associated Lung Injury' (EVALI)) impacted online shopping queries for vaping products and the Philip Morris 'IQO' brand of heated tobacco. METHODS We tracked online shopping queries for vape(s), JUUL and IQOS by analysing rates of Google queries indicative of shopping (eg, buy IQOS) after news of the outbreak was first reported (the week of 29 July 2019) until hospitalisations ceased (the week of 16 February 2020). We compared observed rates of shopping during the outbreak to counterfactual expected rates that were predicted using an autoregressive iterative moving average model fit to queries from 1 January 2014 to the week of 21 July 2019. RESULTS During the outbreak, vape shopping queries were 34% (95% CI 30% to 38%) lower than expected and JUUL shopping queries were 39% (95% CI 34% to 45%) lower than expected, translating into about 7.2 and 1.0 million fewer searches. IQOS shopping queries were 58% (95% prediction interval (PI): 34-87) higher than expected, translating into 35 000 more searches. Moreover, IQOS shopping queries reached a historic high the week they were discussed as a potentially safe alternative to vaping (the week of 29 September 2019), when they were 382% (95% PI: 219-881) above expected rates for the week. CONCLUSIONS These results suggest that unplanned events, such as the EVALI outbreak, can provoke changes in the epidemiology of product usage. Tobacco companies should be prohibited from using events such as disease outbreaks to position their products as less harmful without prior approval.
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Affiliation(s)
- Eric C Leas
- Department of Family Medicine and Public Health, University of California San Diego, La Jolla, California, USA
| | - Natalie H Moy
- Department of Family Medicine and Public Health, University of California San Diego, La Jolla, California, USA
| | - Alicia L Nobles
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, La Jolla, California, USA
| | - John Ayers
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, La Jolla, California, USA
| | - Shu-Hong Zhu
- Department of Family Medicine and Public Health, University of California San Diego, La Jolla, California, USA
| | - Vidya Purushothaman
- Department of Anesthesiology, University of California, San Diego, La Jolla, CA, USA
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Pierce JP, Chen R, Leas EC, White MM, Kealey S, Stone MD, Benmarhnia T, Trinidad DR, Strong DR, Messer K. Use of E-cigarettes and Other Tobacco Products and Progression to Daily Cigarette Smoking. Pediatrics 2021; 147:peds.2020-025122. [PMID: 33431589 PMCID: PMC7849197 DOI: 10.1542/peds.2020-025122] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/05/2020] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVES To identify predictors of becoming a daily cigarette smoker over the course of 4 years. METHODS We identified 12- to 24-year-olds at wave 1 of the US Population Assessment of Tobacco and Health Study and determined ever use, age at first use, and daily use through wave 4 for 12 tobacco products. RESULTS Sixty-two percent of 12- to 24-year-olds (95% confidence interval [CI]: 60.1% to 63.2%) tried tobacco, and 30.2% (95% CI: 28.7% to 31.6%) tried ≥5 tobacco products by wave 4. At wave 4, 12% were daily tobacco users, of whom 70% were daily cigarette smokers (95% CI: 67.4% to 73.0%); daily cigarette smoking was 20.8% in 25- to 28-year-olds (95% CI: 18.9% to 22.9%), whereas daily electronic cigarette (e-cigarette) vaping was 3.3% (95% CI: 2.4% to 4.4%). Compared with single product triers, the risk of progressing to daily cigarette smoking was 15 percentage points higher (adjusted risk difference [aRD] 15%; 95% CI: 12% to 18%) among those who tried ≥5 products. In particular, e-cigarette use increased the risk of later daily cigarette smoking by threefold (3% vs 10%; aRD 7%; 95% CI: 6% to 9%). Daily smoking was 6 percentage points lower (aRD -6%; 95% CI: -8% to -4%) for those who experimented after age 18 years. CONCLUSIONS Trying e-cigarettes and multiple other tobacco products before age 18 years is strongly associated with later daily cigarette smoking. The recent large increase in e-cigarette use will likely reverse the decline in cigarette smoking among US young adults.
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Affiliation(s)
- John P. Pierce
- Herbert Wertheim School of Public Health and Human Longevity Science,,Moores Cancer Center, and
| | - Ruifeng Chen
- Herbert Wertheim School of Public Health and Human Longevity Science
| | - Eric C. Leas
- Herbert Wertheim School of Public Health and Human Longevity Science,,Moores Cancer Center, and
| | | | | | - Matthew D. Stone
- Herbert Wertheim School of Public Health and Human Longevity Science
| | - Tarik Benmarhnia
- Herbert Wertheim School of Public Health and Human Longevity Science,,Moores Cancer Center, and,Scripps Institution of Oceanography, University of California, San Diego, La Jolla, California
| | - Dennis R. Trinidad
- Herbert Wertheim School of Public Health and Human Longevity Science,,Moores Cancer Center, and
| | - David R. Strong
- Herbert Wertheim School of Public Health and Human Longevity Science,,Moores Cancer Center, and
| | - Karen Messer
- Herbert Wertheim School of Public Health and Human Longevity Science,,Moores Cancer Center, and
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Abstract
This cross-sectional study assesses trends in suicide-related internet search rates in the early stages of the COVID-19 pandemic in the US.
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Affiliation(s)
- John W. Ayers
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, La Jolla
| | - Adam Poliak
- Department of Computer Science, Barnard College, Columbia University, New York, New York
| | - Derek C. Johnson
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, La Jolla
| | - Eric C. Leas
- Department of Family Medicine and Public Health, Division of Health Policy, University of California San Diego, La Jolla
| | - Mark Dredze
- Department of Computer Science, Johns Hopkins University, Baltimore, Maryland
| | - Theodore Caputi
- Department of Health Sciences, University of York, York, United Kingdom
| | - Alicia L. Nobles
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, La Jolla
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35
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Nobles AL, Johnson DC, Leas EC, Goodman-Meza D, Zúñiga ML, Ziedonis D, Strathdee SA, Ayers JW. Characterizing Self-Reports of Self-Identified Patient Experiences with Methadone Maintenance Treatment on an Online Community during COVID-19. Subst Use Misuse 2021; 56:2134-2140. [PMID: 34486471 PMCID: PMC8820092 DOI: 10.1080/10826084.2021.1972317] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Background: The coronavirus disease (COVID-19) pandemic has impacted patients receiving methadone maintenance treatment (MMT) through opioid treatment programs (OTPs), especially because of the unique challenges of the care delivery model. Previously, documentation of patient experiences during emergencies often comes years after the fact, in part because there is a substantial data void in real-time. Methods: We extracted 308 posts that mention COVID-19 keywords on r/methadone, an online community for patients receiving MMT to share information, on Reddit occurring between January 31, 2020 and September 30, 2020. 215 of these posts self-report an impact to their MMT. Using qualitative content analysis, we characterized the impacts described in these posts and identified four emergent themes describing patients' experience of impacts to MMT during COVID-19. Results: The themes included (1) 54.4% of posts reporting impediments to accessing their methadone, (2) 28.4% reporting impediments to accessing physicial OTPs, (3) 19.5% reporting having to self-manage their care, and (4) 4.7% reporting impediments to accessing OTP providers and staff. Conclusions: Patients described unanticipated consequences to one-size-fits-all policies that are unevenly applied resulting in suboptimal dosing, increased perceived risk of acquiring COVID-19 at OTPs, and reduced interaction with OTP providers and staff. While preliminary, these results are formative for follow-up surveillance metrics for patients of OTPs as well as digitally-mediated resource needs for this online community. This study serves as a model of how social media can be employed during and after emergencies to hear the lived experiences of patients for informed emergency preparedness and response.
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Affiliation(s)
- Alicia L Nobles
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, La Jolla, California, USA
| | - Derek C Johnson
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, La Jolla, California, USA
| | - Eric C Leas
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, California, USA
| | - David Goodman-Meza
- Division of Infectious Diseases, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - María Luisa Zúñiga
- School of Social Work, San Diego State University, San Diego, California, USA
| | - Douglas Ziedonis
- University of New Mexico Health Sciences, Albuquerque, New Mexico, USA
| | - Steffanie A Strathdee
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, La Jolla, California, USA
| | - John W Ayers
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, La Jolla, California, USA
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Abstract
BACKGROUND The accuracy of statistical reporting that informs medical and public health practice has generated extensive debate, but no studies have evaluated the frequency or accuracy of effect size (the magnitude of change in outcome as a function of change in predictor) reporting in prominent health journals. OBJECTIVE To evaluate effect size reporting practices in prominent health journals using the case study of ORs. DESIGN Articles published in the American Journal of Public Health (AJPH), Journal of the American Medical Association (JAMA), New England Journal of Medicine (NEJM) and PLOS One from 1 January 2010 through 31 December 2019 mentioning the term 'odds ratio' in all searchable fields were obtained using PubMed. One hundred randomly selected articles that reported original research using ORs were sampled per journal for in-depth analysis. MAIN OUTCOMES AND MEASURES We report prevalence of articles using ORs, reporting effect sizes from ORs (reporting the magnitude of change in outcome as a function of change in predictor) and reporting correct effect sizes. RESULTS The proportion of articles using ORs in the past decade declined in JAMA and AJPH, remained similar in NEJM and increased in PLOS One, with 6124 articles in total. Twenty-four per cent (95% CI 20% to 28%) of articles reported the at least one effect size arising from an OR. Among articles reporting any effect size, 57% (95% CI 47% to 67%) did so incorrectly. Taken together, 10% (95% CI 7% to 13%) of articles included a correct effect size interpretation of an OR. Articles that used ORs in AJPH more frequently reported the effect size (36%, 95% CI 27% to 45%), when compared with NEJM (26%, 95% CI 17.5% to 34.7%), PLOS One (22%, 95% CI 13.9% to 30.2%) and JAMA (10%, 95% CI 3.9% to 16.0%), but the probability of a correct interpretation did not statistically differ between the four journals (χ2=0.56, p=0.90). CONCLUSIONS Articles that used ORs in prominent journals frequently omitted presenting the effect size of their predictor variables. When reported, the presented effect size was usually incorrect. When used, ORs should be paired with accurate effect size interpretations. New editorial and research reporting standards to improve effect size reporting and its accuracy should be considered.
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Affiliation(s)
- Brian Chu
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | | | - Eric C Leas
- Department of Family Medicine and Public Health, Division of Health Policy, University of California San Diego, La Jolla, California, USA
| | | | - John W Ayers
- Department of Medicine, Division of Infectious Diseases and Global Health, University of California San Diego, La Jolla, California, USA
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Chen R, Pierce JP, Leas EC, White MM, Kealey S, Strong DR, Trinidad DR, Benmarhnia T, Messer K. Use of Electronic Cigarettes to Aid Long-Term Smoking Cessation in the United States: Prospective Evidence From the PATH Cohort Study. Am J Epidemiol 2020; 189:1529-1537. [PMID: 32715314 PMCID: PMC7705599 DOI: 10.1093/aje/kwaa161] [Citation(s) in RCA: 36] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2019] [Revised: 07/17/2020] [Accepted: 07/21/2020] [Indexed: 11/13/2022] Open
Abstract
Electronic cigarettes (e-cigarettes) are the preferred smoking-cessation aid in the United States; however, there is little evidence regarding long-term effectiveness among those who use them. We used the Population Assessment of Tobacco and Health Study to compare long-term abstinence between matched US smokers who tried to quit with and without use of e-cigarettes as a cessation aid. We identified a nationally representative cohort of 2,535 adult US smokers in 2014-2015 (baseline assessment), who, in 2015-2016 (exposure assessment), reported a past-year attempt to quit and the cessation aids used, and reported smoking status in 2016-2017 (outcome assessment; self-reported ≥12 months continuous abstinence). We used propensity-score methods to match each e-cigarette user with similar nonusers. Among US smokers who used e-cigarettes to help quit, 12.9% (95% confidence interval (CI): 9.1%, 16.7%) successfully attained long-term abstinence. However, there was no difference compared with matched non-e-cigarette users (cigarette abstinence difference: 2%; 95% CI: -3%, 7%). Furthermore, fewer e-cigarette users were abstinent from nicotine products in the long term (nicotine abstinence difference: -4%; 95% CI: -7%, -1%); approximately two-thirds of e-cigarette users who successfully quit smoking continued to use e-cigarettes. These results suggest e-cigarettes may not be an effective cessation aid for adult smokers and, instead, may contribute to continuing nicotine dependence.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Karen Messer
- Correspondence to Dr. Karen Messer, University of California, San Diego, Moores Cancer Center, Room 3037, 3855 Health Sciences Drive, La Jolla CA 92093-0901 (e-mail: )
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Ayers JW, Leas EC, Johnson DC, Poliak A, Althouse BM, Dredze M, Nobles AL. Internet Searches for Acute Anxiety During the Early Stages of the COVID-19 Pandemic. JAMA Intern Med 2020; 180:1706-1707. [PMID: 32832984 PMCID: PMC7445624 DOI: 10.1001/jamainternmed.2020.3305] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
This cross-sectional study analyzes internet search data to evaluate the association of COVID-19 with anxiety.
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Affiliation(s)
- John W Ayers
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California, San Diego, La Jolla
| | - Eric C Leas
- Division of Health Policy, Department of Family Medicine and Public Health, University of California, San Diego, La Jolla
| | - Derek C Johnson
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California, San Diego, La Jolla
| | - Adam Poliak
- Department of Computer Science, Johns Hopkins University, Baltimore, Maryland
| | | | - Mark Dredze
- Department of Computer Science, Johns Hopkins University, Baltimore, Maryland
| | - Alicia L Nobles
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California, San Diego, La Jolla
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Pierce JP, Strong DR, Stone MD, Villaseñor A, Dimofte CV, Leas EC, Oratowski J, Brighton E, Hurst S, Pulvers K, Kealey S, Chen R, Messer K. Real-world exposure to graphic warning labels on cigarette packages in US smokers: The CASA randomized trial protocol. Contemp Clin Trials 2020; 98:106152. [PMID: 32966877 PMCID: PMC7502239 DOI: 10.1016/j.cct.2020.106152] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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: 05/19/2020] [Revised: 09/11/2020] [Accepted: 09/14/2020] [Indexed: 01/29/2023]
Abstract
BACKGROUND The US lags behind >120 countries in implementing graphic warning labels (GWLs) on cigarette packs. US courts prevented implementation of FDA's 2012 rule requiring GWLs citing the need for more evidence on effectiveness. After more research, in 2020, the FDA proposed a revised rule mandating GWLs. This trial will test how the introduction of GWLs influence cognitions and behavior in US smokers. METHOD To investigate the "real-world" impact of GWLs in US smokers, we are conducting a randomized trial involving a 3-month intervention and 8-month follow-up. The study recruited California smokers between September 2016 through December 2019 and randomly assigned them into 3 groups (1) Blank Pack devoid of any cigarette branding; (2) GWL Pack featuring 1 of 3 rotating images added to blank pack; or (3) their usual Standard US Pack. Throughout the 3-month intervention, participants purchased study-packaged cigarettes and reported daily cognitions and behavior through ecological momentary assessments. We will validate self-reported tobacco use with saliva cotinine concentrations following the 3-month intervention and 8-month follow-up. RESULTS The trial enrolled 359 participants (average age 39 years; average cigarette consumption half a pack/day). The 3 study groups were balanced on age, gender, race-ethnicity, education and income (17% low income) as well as on smoking related variables. CONCLUSIONS This 3-month real-world randomized trial will test the effect of repackaging cigarettes from standard US packs to GWL plain packs on smokers' perceptions of the risks of smoking, their perception of the appeal of their cigarettes, and on their smoking behavior.
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Affiliation(s)
- John P. Pierce
- Cancer Control Program, Moores Cancer Center, UC San Diego, 3855 Health Sciences Drive, La Jolla, CA 92093-0901, United States,Department of Family Medicine and Public Health, UC San Diego, 9500 Gilman Drive, La Jolla, CA 92093, United States,Corresponding author at: Cancer Control Program, Moores Cancer Center, UC San Diego, 3855 Health Sciences Drive, La Jolla, CA 92093-0901, United States
| | - David R. Strong
- Cancer Control Program, Moores Cancer Center, UC San Diego, 3855 Health Sciences Drive, La Jolla, CA 92093-0901, United States,Department of Family Medicine and Public Health, UC San Diego, 9500 Gilman Drive, La Jolla, CA 92093, United States
| | - Matthew D. Stone
- Department of Family Medicine and Public Health, UC San Diego, 9500 Gilman Drive, La Jolla, CA 92093, United States
| | - Adriana Villaseñor
- Department of Family Medicine and Public Health, UC San Diego, 9500 Gilman Drive, La Jolla, CA 92093, United States
| | - Claudiu V. Dimofte
- Department of Marketing, San Diego State University, 5500 Campanile Dr, San Diego, CA 92182, United States
| | - Eric C. Leas
- Cancer Control Program, Moores Cancer Center, UC San Diego, 3855 Health Sciences Drive, La Jolla, CA 92093-0901, United States,Department of Family Medicine and Public Health, UC San Diego, 9500 Gilman Drive, La Jolla, CA 92093, United States
| | - Jesica Oratowski
- Department of Family Medicine and Public Health, UC San Diego, 9500 Gilman Drive, La Jolla, CA 92093, United States
| | - Elizabeth Brighton
- Department of Family Medicine and Public Health, UC San Diego, 9500 Gilman Drive, La Jolla, CA 92093, United States
| | - Samantha Hurst
- Cancer Control Program, Moores Cancer Center, UC San Diego, 3855 Health Sciences Drive, La Jolla, CA 92093-0901, United States
| | - Kimberley Pulvers
- Department of Psychology, Social and Behavioral Sciences Building, California State University, San Marcos 200 E Barham Dr, San Marcos, CA, 92096, United States
| | - Sheila Kealey
- Cancer Control Program, Moores Cancer Center, UC San Diego, 3855 Health Sciences Drive, La Jolla, CA 92093-0901, United States
| | - Ruifeng Chen
- Division of Biostatistics, Department of Family Medicine and Public Health, UC San Diego, 9500 Gilman Drive, La Jolla, CA 92093, United States
| | - Karen Messer
- Cancer Control Program, Moores Cancer Center, UC San Diego, 3855 Health Sciences Drive, La Jolla, CA 92093-0901, United States,Division of Biostatistics, Department of Family Medicine and Public Health, UC San Diego, 9500 Gilman Drive, La Jolla, CA 92093, United States
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Ayers JW, Althouse BM, Poliak A, Leas EC, Nobles AL, Dredze M, Smith D. Quantifying Public Interest in Police Reforms by Mining Internet Search Data Following George Floyd's Death. J Med Internet Res 2020; 22:e22574. [PMID: 33084578 PMCID: PMC7641778 DOI: 10.2196/22574] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 08/21/2020] [Accepted: 09/21/2020] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND The death of George Floyd while in police custody has resurfaced serious questions about police conduct that result in the deaths of unarmed persons. OBJECTIVE Data-driven strategies that identify and prioritize the public's needs may engender a public health response to improve policing. We assessed how internet searches indicative of interest in police reform changed after Mr Floyd's death. METHODS We monitored daily Google searches (per 10 million total searches) that included the terms "police" and "reform(s)" (eg, "reform the police," "best police reforms," etc) originating from the United States between January 1, 2010, through July 5, 2020. We also monitored searches containing the term "police" with "training," "union(s)," "militarization," or "immunity" as markers of interest in the corresponding reform topics. RESULTS The 41 days following Mr Floyd's death corresponded with the greatest number of police "reform(s)" searches ever recorded, with 1,350,000 total searches nationally. Searches increased significantly in all 50 states and Washington DC. By reform topic, nationally there were 1,220,000 total searches for "police" and "union(s)"; 820,000 for "training"; 360,000 for "immunity"; and 72,000 for "militarization." In terms of searches for all policy topics by state, 33 states searched the most for "training," 16 for "union(s)," and 2 for "immunity." States typically in the southeast had fewer queries related to any police reform topic than other states. States that had a greater percentage of votes for President Donald Trump during the 2016 election searched more often for police "union(s)" while states favoring Secretary Hillary Clinton searched more for police "training." CONCLUSIONS The United States is at a historical juncture, with record interest in topics related to police reform with variability in search terms across states. Policy makers can respond to searches by considering the policies their constituencies are searching for online, notably police training and unions. Public health leaders can respond by engaging in the subject of policing and advocating for evidence-based policy reforms.
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Affiliation(s)
- John W Ayers
- University of California San Diego, La Jolla, CA, United States
| | - Benjamin M Althouse
- Institute for Disease Modeling, Bill and Melinda Gates Foundation, Seattle, WA, United States
| | - Adam Poliak
- Barnard College, Columbia University, New York, NY, United States
| | - Eric C Leas
- University of California San Diego, La Jolla, CA, United States
| | - Alicia L Nobles
- University of California San Diego, La Jolla, CA, United States
| | - Mark Dredze
- Johns Hopkins University, Baltimore, MD, United States
| | - Davey Smith
- University of California San Diego, La Jolla, CA, United States
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Leas EC, Nobles AL, Caputi TL, Dredze M, Zhu SH, Cohen JE, Ayers JW. News coverage of the E-cigarette, or Vaping, product use Associated Lung Injury (EVALI) outbreak and internet searches for vaping cessation. Tob Control 2020; 30:578-582. [PMID: 33051278 DOI: 10.1136/tobaccocontrol-2020-055755] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [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: 03/07/2020] [Revised: 05/27/2020] [Accepted: 06/03/2020] [Indexed: 01/17/2023]
Abstract
BACKGROUND In the latter half of 2019, an outbreak of pulmonary disease in the USA resulted in 2807 hospitalisations and 68 deaths, as of 18 February 2020. Given the severity of the outbreak, we assessed whether articles during the outbreak era more frequently warned about the dangers of vaping and whether internet searches for vaping cessation increased. METHODS Using Tobacco Watcher, a media monitoring platform that automatically identifies and categorises news articles from sources across the globe, we obtained all articles that (a) discussed the outbreak and (b) primarily warned about the dangers of vaping. We obtained internet search trends originating from the USA that mentioned 'quit' or 'stop' and 'e cig(s),' 'ecig(s),' 'e-cig(s),' 'e cigarette(s),' 'e-cigarette(s),' 'electronic cigarette(s),' 'vape(s),' 'vaping' or 'vaper(s)' from Google Trends (eg, 'how do I quit vaping?'). All data were obtained from 1 January 2014 to 18 February 2020 and ARIMA models were used with historical trends to forecast the ratio of observed to expected search volumes during the outbreak era. RESULTS News of the vaping-induced pulmonary disease outbreak was first reported on 25 July 2019 with 195 articles, culminating in 44 512 articles by 18 February 2020. On average, news articles warning about the dangers of vaping were 130% (95% prediction interval (PI): -15 to 417) and searches for vaping cessation were 76% (95% PI: 28 to 182) higher than expected levels for the days during the period when the sources of the outbreak were unknown (25 July to 27 September 2019). News and searches stabilised just after the US Centers for Disease Control and Prevention reported that a primary source of the outbreak was an additive used in marijuana vapes on 27 September 2019. In sum, there were 12 286 articles archived in Tobacco Watcher primarily warning about the dangers of vaping and 1 025 000 cessation searches following the outbreak. CONCLUSION The vaping-induced pulmonary disease outbreak spawned increased coverage about the dangers of vaping and internet searches for vaping cessation. Resources and strategies that respond to this elevated interest should become a priority among public health leaders.
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Affiliation(s)
- Eric C Leas
- School of Medicine, University of California San Diego, La Jolla, California, USA.,Center for Data Driven Health, Qualcomm Institute, La Jolla, California, USA
| | - Alicia L Nobles
- School of Medicine, University of California San Diego, La Jolla, California, USA.,Center for Data Driven Health, Qualcomm Institute, La Jolla, California, USA
| | - Theodore L Caputi
- University College Cork National University of Ireland, Cork, Ireland
| | - Mark Dredze
- Computer Science, Johns Hopkins University, Baltimore, Maryland, USA
| | - Shu-Hong Zhu
- School of Medicine, University of California San Diego, La Jolla, California, USA
| | - Joanna E Cohen
- Institute for Global Tobacco Control, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - John W Ayers
- School of Medicine, University of California San Diego, La Jolla, California, USA .,Center for Data Driven Health, Qualcomm Institute, La Jolla, California, USA
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Nguyen-Grozavu FT, Pierce JP, Sakuma KLK, Leas EC, McMenamin SB, Kealey S, Benmarhnia T, Emery SL, White MM, Fagan P, Trinidad DR. Widening disparities in cigarette smoking by race/ethnicity across education level in the United States. Prev Med 2020; 139:106220. [PMID: 32693179 PMCID: PMC7494609 DOI: 10.1016/j.ypmed.2020.106220] [Citation(s) in RCA: 12] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Revised: 07/09/2020] [Accepted: 07/13/2020] [Indexed: 01/07/2023]
Abstract
Reducing tobacco use is an important public health objective. It is the largest preventable cause of death and disease, yet inequalities remain. This study examines combined educational and racial/ethnic disparities in the United States related to cigarette smoking for the three largest racial/ethnic groups (African Americans, Hispanics/Latinos, and non-Hispanic Whites). Data included nine Tobacco Use Supplements to the Current Population Surveys (TUS-CPS) conducted in the United States from 1992/1993-2018 for four smoking metrics: ever smoking rates, current smoking rates, consumption (cigarettes per day), and quit ratios. Across all TUS-CPS samples, there were 9.5% African Americans, 8.8% Hispanics/Latinos, and 81.8% non-Hispanic Whites who completed surveys. Findings revealed that lower educational attainment was associated with increased ever and current smoking prevalence over time across all racial/ethnic groups, and education-level disparities within each race/ethnicity widened over time. Disparities in ever and current smoking rates between the lowest and highest categories of educational attainment (less than a high school education vs. completion of college) were larger for African Americans and non-Hispanic Whites than Hispanics/Latinos. Non-Hispanic Whites had the highest cigarette consumption across all education levels over time. College graduates had the highest quit ratios for all racial/ethnic groups from 1992 to 2018, with quit ratios significantly increasing for Hispanics/Latinos and non-Hispanic Whites, but not African Americans. In conclusion, educational disparities in smoking have worsened over time, especially among African Americans and Hispanics/Latinos. Targeted tobacco control efforts could help reduce these disparities to meet public health objectives, although racial/ethnic disparities may persist regardless of educational attainment.
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Affiliation(s)
- France T Nguyen-Grozavu
- University of California, San Diego, Family Medicine and Public Health, La Jolla, CA, United States of America.
| | - John P Pierce
- University of California, San Diego, Family Medicine and Public Health, La Jolla, CA, United States of America
| | - Kari-Lyn K Sakuma
- Oregon State University, College of Public Health and Human Sciences, School of Social and Behavioral Health Sciences, Corvallis, OR, United States of America
| | - Eric C Leas
- University of California, San Diego, Family Medicine and Public Health, La Jolla, CA, United States of America
| | - Sara B McMenamin
- University of California, San Diego, Family Medicine and Public Health, La Jolla, CA, United States of America
| | - Sheila Kealey
- University of California, San Diego, Family Medicine and Public Health, La Jolla, CA, United States of America
| | - Tarik Benmarhnia
- University of California, San Diego, Family Medicine and Public Health, La Jolla, CA, United States of America
| | - Sherry L Emery
- University of Chicago, NORC, 1155 East 60th Street, 2nd Floor, Chicago, IL, United States of America
| | - Martha M White
- University of California, San Diego, Family Medicine and Public Health, La Jolla, CA, United States of America
| | - Pebbles Fagan
- University of Arkansas for Medical Sciences, Fay W. Boozman College of Public Health, Department of Health Behavior and Health Education, Little Rock, AR, United States of America
| | - Dennis R Trinidad
- University of California, San Diego, Family Medicine and Public Health, La Jolla, CA, United States of America
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Abstract
IMPORTANCE Use of cannabidiol (CBD) has markedly increased in the past 5 years, concurrent with marketing claims that over-the-counter CBD can be used to treat almost any health condition. However, the reasons why individuals use CBD remain unclear. OBJECTIVE To assess whether individuals are using CBD for diagnosable conditions that have evidence-based therapies. DESIGN, SETTING, AND PARTICIPANTS This case series assessed claimed treatment applications reported by CBD users in public testimonials shared on the Reddit forum r/CBD. The r/CBD forum was selected because it includes a large, naturally occurring sample of 104 917 registered individuals who publicly discuss their experiences using CBD. All r/CBD posts were obtained from January 1, 2014, through August 31, 2019. A random sample of posts was drawn (n = 3000) and filtered to include posts in which self-identified CBD users testified why they take CBD (n = 376). EXPOSURES Self-reported use of CBD for medicinal purposes. MAIN OUTCOMES AND MEASURES Cannabidiol testimonials were divided into 11 subcategories corresponding with the condition's medical subspecialty and 2 subcategories corresponding with wellness benefits. Posts were allowed to receive more than 1 label. RESULTS Of the 376 posts labeled as testimonials, 90.0% (95% CI, 86.8%-92.8%) of testimonials claimed that CBD treated the individual's diagnosable conditions. Psychiatric conditions (eg, autism or depression) were the most frequently cited subcategory, mentioned in 63.9% (95% CI, 59.0%-69.1%) of testimonials, followed by orthopedic (26.4%; 95% CI, 21.8%-31.1%), sleep (14.6%; 95% CI, 11.3%-18.5%), and neurological (6.9%; 95% CI, 4.4%-9.6%) conditions. Testimonials also claimed that CBD treated gastroenterological conditions (3.9%; 95% CI, 1.9%-6.1%), as well as addiction, cardiological, dermatological, ophthalmological, oral health, and sexual health conditions (<2.0% each). By contrast, just 29.5% (95% CI, 24.8%-34.2%) of testimonies claimed any wellness benefit, with most citing mental wellness (eg, "quieting my mind") (29.5% [95% CI, 24.2%-34.4%]); 1.4% (95% CI, 0.3%-2.8%) claimed a physical wellness benefit (eg, "exercise performance"). CONCLUSIONS AND RELEVANCE The findings of this case series suggest a need for regulation of factors associated with CBD being used to treat diagnosable conditions, engagement of health care professionals with patients on their potential CBD use, and implementation of public health campaigns that encourage the public to seek treatment advice from health care professionals regarding evidence-based therapies.
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Affiliation(s)
- Eric C. Leas
- The Center for Data Driven Health at the Qualcomm Institute, University of California, San Diego, La Jolla
| | - Erik M. Hendrickson
- The Center for Data Driven Health at the Qualcomm Institute, University of California, San Diego, La Jolla
- Department of Family Medicine and Public Health, University of California, San Diego, La Jolla
| | - Alicia L. Nobles
- The Center for Data Driven Health at the Qualcomm Institute, University of California, San Diego, La Jolla
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California, San Diego, La Jolla
| | - Rory Todd
- The Center for Data Driven Health at the Qualcomm Institute, University of California, San Diego, La Jolla
| | - Davey M. Smith
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California, San Diego, La Jolla
| | - Mark Dredze
- Department of Computer Science, Johns Hopkins University, Baltimore, Maryland
| | - John W. Ayers
- The Center for Data Driven Health at the Qualcomm Institute, University of California, San Diego, La Jolla
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California, San Diego, La Jolla
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Nobles AL, Leas EC, Latkin CA, Dredze M, Strathdee SA, Ayers JW. #HIV: Alignment of HIV-Related Visual Content on Instagram with Public Health Priorities in the US. AIDS Behav 2020; 24:2045-2053. [PMID: 31916098 PMCID: PMC10712936 DOI: 10.1007/s10461-019-02765-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [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] [Indexed: 01/16/2023]
Abstract
Instagram, with more than 1 billion monthly users, is the go-to social media platform to chronicle one's life via images, but how are people using the platform to present visual content about HIV? We analyzed public Instagram posts containing the hashtag "#HIV" (because they are self-tagged as related to HIV) between January 2017 and July 2018. We described the prevalence of co-occurring hashtags and explored thematic concepts in the images using automated image recognition and topic modeling. Twenty-eight percent of all #HIV posts included hashtags focused on awareness, followed by LGBTQ (24.5%) and living with HIV (17.9%). However, specific strategies were rarely cited, including testing (10.8%), treatment (10.3%), PrEP (6.2%) and condoms (4.1%). Image analyses revealed 44.5% of posts included infographics followed by people (21.3%) thereby humanizing HIV and stigmatized populations and promoting community mobilization. Novel content such as the handwriting image-theme (3.8%) where posters shared their HIV test results appeared. We discuss how this visual content aligns with public health priorities to reduce HIV in the US and the novel, organic messages that public health could help amplify.
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Affiliation(s)
- Alicia L Nobles
- The Center for Data Driven Health at Qualcomm Institute, California Institute for Telecommunications and Information Technology, University of California San Diego, La Jolla, CA, USA
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, La Jolla, CA, USA
| | - Eric C Leas
- The Center for Data Driven Health at Qualcomm Institute, California Institute for Telecommunications and Information Technology, University of California San Diego, La Jolla, CA, USA
- Division of Health Policy, Department of Family Medicine and Public Health, University of California San Diego, La Jolla, CA, USA
| | - Carl A Latkin
- Department of Health, Behavior and Society, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Mark Dredze
- Department of Computer Science, Johns Hopkins University, Baltimore, MD, USA
| | - Steffanie A Strathdee
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, La Jolla, CA, USA
| | - John W Ayers
- The Center for Data Driven Health at Qualcomm Institute, California Institute for Telecommunications and Information Technology, University of California San Diego, La Jolla, CA, USA.
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, La Jolla, CA, USA.
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Nobles AL, Leas EC, Dredze M, Ayers JW. Examining Peer-to-Peer and Patient-Provider Interactions on a Social Media Community Facilitating Ask the Doctor Services. Proc Int AAAI Conf Weblogs Soc Media 2020; 14:464-475. [PMID: 32724726 PMCID: PMC7386284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Ask the Doctor (AtD) services provide patients the opportunity to seek medical advice using online platforms. While these services represent a new mode of healthcare delivery, study of these online health communities and how they are used is limited. In particular, it is unknown if these platforms replicate existing barriers and biases in traditional healthcare delivery across demographic groups. We present an analysis of AskDocs, a subreddit that functions as a public AtD platform on social media. We examine the demographics of users, the health topics discussed, if biases present in offline healthcare settings exist on this platform, and how empathy is expressed in interactions between users and physicians. Our findings suggest a number of implications to enhance and support peer-to-peer and patient-provider interactions on online platforms.
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Affiliation(s)
| | - Eric C Leas
- Department of Family Medicine and Public Health, University of California San Diego
| | - Mark Dredze
- Department of Computer Science, Johns Hopkins University
| | - John W Ayers
- Department of Medicine, University of California San Diego
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Nobles AL, Leas EC, Noar S, Dredze M, Latkin CA, Strathdee SA, Ayers JW. Automated image analysis of instagram posts: Implications for risk perception and communication in public health using a case study of #HIV. PLoS One 2020; 15:e0231155. [PMID: 32365124 PMCID: PMC7197791 DOI: 10.1371/journal.pone.0231155] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Accepted: 03/17/2020] [Indexed: 01/03/2023] Open
Abstract
People’s perceptions about health risks, including their risk of acquiring HIV, are impacted in part by who they see portrayed as at risk in the media. Viewers in these cases are asking themselves “do those portrayed as at risk look like me?” An accurate perception of risk is critical for high-risk populations, who already suffer from a range of health disparities. Yet, to date no study has evaluated the demographic representation of health-related content from social media. The objective of this case study was to apply automated image recognition software to examine the demographic profile of faces in Instagram posts containing the hashtag #HIV (obtained from January 2017 through July 2018) and compare this to the demographic breakdown of those most at risk of a new HIV diagnosis (estimates of incidence of new HIV diagnoses from the 2017 US Centers for Disease Control HIV Surveillance Report). We discovered 26,766 Instagram posts containing #HIV authored in American English with 10,036 (37.5%) containing a detectable human face with a total of 18,227 faces (mean = 1.8, standard deviation [SD] = 1.7). Faces skewed older (47% vs. 11% were 35–39 years old), more female (41% vs. 19%), more white (43% vs. 26%), less black (31% vs 44%), and less Hispanic (13% vs 25%) on Instagram than for new HIV diagnoses. The results were similarly skewed among the subset of #HIV posts mentioning pre-exposure prophylaxis (PrEP). This disparity might lead Instagram users to potentially misjudge their own HIV risk and delay prophylactic behaviors. Social media managers and organic advocates should be encouraged to share images that better reflect at-risk populations so as not to further marginalize these populations and to reduce disparity in risk perception. Replication of our methods for additional diseases, such as cancer, is warranted to discover and address other misrepresentations.
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Affiliation(s)
- Alicia L. Nobles
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, La Jolla, California, United States of America
| | - Eric C. Leas
- Division of Health Policy, Department of Family Medicine and Public Health, University of California San Diego, La Jolla, California, United States of America
| | - Seth Noar
- School of Media and Journalism, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Mark Dredze
- Department of Computer Science, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Carl A. Latkin
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Steffanie A. Strathdee
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, La Jolla, California, United States of America
| | - John W. Ayers
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, La Jolla, California, United States of America
- * E-mail:
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Affiliation(s)
- John P Pierce
- Department of Family Medicine and Public Health, University of California, San Diego, CA
| | - Karen Messer
- Department of Family Medicine and Public Health, University of California, San Diego, CA
| | - Eric C Leas
- Department of Family Medicine and Public Health, University of California, San Diego, CA
| | - Sheila Kealey
- Department of Family Medicine and Public Health, University of California, San Diego, CA
| | - Martha M White
- Department of Family Medicine and Public Health, University of California, San Diego, CA
| | - Tarik Benmarhnia
- Department of Family Medicine and Public Health, University of California, San Diego, CA
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Leas EC, Trinidad DR, Pierce JP, Benmarhnia T. The effect of college attendance on young adult cigarette, e-cigarette, cigarillo, hookah and smokeless tobacco use and its potential for addressing tobacco-related health disparities. Prev Med 2020; 132:105954. [PMID: 31917304 PMCID: PMC7104572 DOI: 10.1016/j.ypmed.2019.105954] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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: 07/20/2019] [Revised: 12/03/2019] [Accepted: 12/16/2019] [Indexed: 10/25/2022]
Abstract
The goal of this study was to assess the effect of college attendance on tobacco use among young adults and across subpopulations with disparities in tobacco use. Using a cohort of US youth (<18 years) who aged into young adulthood (18-24 years) in the Population Assessment of Tobacco and Health (2013-14, 2015-16, n = 3619) and propensity score matching we estimated the effect of college attendance on past 30-day use of cigarettes, e-cigarettes, cigarillos, hookah and smokeless tobacco. In unmatched analysis, college attenders (vs. nonattenders) had lower risk of using any form of tobacco (Risk Difference (RD): -10.0; 95% CI: -13.2, -7.0), cigarettes (RD: -13.0; 95% CI: -15.4, -10.5), e-cigarettes (RD: -4.1; 95% CI: -6.8, -1.7), cigarillos (RD: -5.7; 95% CI: -7.6, -3.8), and smokeless tobacco (RD: -2.0; 95% CI: -3.4, -0.6), but not hookah (RD: -0.2; 95% CI: -2.1, 1.6). In matched analysis, these associations were all near-null, with the exception of cigarettes (matched RD: -7.1; 95% CI: -10.3, -3.9). The effect of college attendance on cigarette smoking was stable for all subpopulations we assessed including among those identifying as non-Hispanic Black or Lesbian, Gay or Bisexual as well as among those living in the South, Midwest or whose parents did not attend college. The results suggest that college attendance may reduce young adults' risk of cigarette smoking but may not reduce the risk of using other tobacco products.
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Affiliation(s)
- Eric C Leas
- Department of Family Medicine and Public Health, University of California, San Diego School of Medicine, La Jolla, CA, United States.
| | - Dennis R Trinidad
- Department of Family Medicine and Public Health, University of California, San Diego School of Medicine, La Jolla, CA, United States
| | - John P Pierce
- Department of Family Medicine and Public Health, University of California, San Diego School of Medicine, La Jolla, CA, United States
| | - Tarik Benmarhnia
- Department of Family Medicine and Public Health, University of California, San Diego School of Medicine, La Jolla, CA, United States; Scripps Institution of Oceanography, University of California San Diego, La Jolla, CA, United States
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Affiliation(s)
- Eric C Leas
- Division of Health Policy, Department of Family Medicine and Public Health, University of California San Diego, School of Medicine, La Jolla, California, USA .,The Center for Data Driven Health at Qualcomm Institute, University of California San Diego, La Jolla, California, USA
| | - Joanna E Cohen
- Institute for Global Tobacco Control, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - John W Ayers
- The Center for Data Driven Health at Qualcomm Institute, University of California San Diego, La Jolla, California, USA.,Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, La Jolla, CA, USA
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Nobles AL, Leas EC, Caputi TL, Zhu SH, Strathdee SA, Ayers JW. Responses to addiction help-seeking from Alexa, Siri, Google Assistant, Cortana, and Bixby intelligent virtual assistants. NPJ Digit Med 2020; 3:11. [PMID: 32025572 PMCID: PMC6989668 DOI: 10.1038/s41746-019-0215-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Accepted: 10/21/2019] [Indexed: 11/09/2022] Open
Abstract
We investigated how intelligent virtual assistants (IVA), including Amazon's Alexa, Apple's Siri, Google Assistant, Microsoft's Cortana, and Samsung's Bixby, responded to addiction help-seeking queries. We recorded if IVAs provided a singular response and if so, did they link users to treatment or treatment referral services. Only 4 of the 70 help-seeking queries presented to the five IVAs returned singular responses, with the remainder prompting confusion (e.g., "did I say something wrong?"). When asked "help me quit drugs" Alexa responded with a definition for the word drugs. "Help me quit…smoking" or "tobacco" on Google Assistant returned Dr. QuitNow (a cessation app), while on Siri "help me quit pot" promoted a marijuana retailer. IVAs should be revised to promote free, remote, federally sponsored addiction services, such as SAMSHA's 1-800-662-HELP helpline. This would benefit millions of IVA users now and more to come as IVAs displace existing information-seeking engines.
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Affiliation(s)
- Alicia L. Nobles
- The Center for Data Driven Health at Qualcomm Institute, California Institute for Telecommunications and Information Technology, University of California San Diego, La Jolla, CA USA
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, La Jolla, CA USA
| | - Eric C. Leas
- The Center for Data Driven Health at Qualcomm Institute, California Institute for Telecommunications and Information Technology, University of California San Diego, La Jolla, CA USA
- Division of Health Policy, Department of Family Medicine & Public Health, University of California San Diego, La Jolla, CA USA
| | - Theodore L. Caputi
- The Center for Data Driven Health at Qualcomm Institute, California Institute for Telecommunications and Information Technology, University of California San Diego, La Jolla, CA USA
- Department of Health Sciences, University of York, York, UK
| | - Shu-Hong Zhu
- Division of Behavioral Medicine, Department of Family Medicine & Public Health, University of California San Diego, La Jolla, CA USA
| | - Steffanie A. Strathdee
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, La Jolla, CA USA
| | - John W. Ayers
- The Center for Data Driven Health at Qualcomm Institute, California Institute for Telecommunications and Information Technology, University of California San Diego, La Jolla, CA USA
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, La Jolla, CA USA
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