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Galimov A, Leventhal AM, Hamoud J, Meza L, Unger JB, Huh J, Baezconde-Garbanati L, Sussman S. Adult harm perceptions, purchase, and use related to synthetic vs. tobacco-derived nicotine vaping products: A mixed-methods study. Prev Med Rep 2024; 41:102692. [PMID: 38524276 PMCID: PMC10960099 DOI: 10.1016/j.pmedr.2024.102692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 02/19/2024] [Accepted: 03/15/2024] [Indexed: 03/26/2024] Open
Abstract
Objective Synthetic nicotine (SN) e-cigarettes emerged on the market as an alternative to tobacco-derived nicotine (TDN) vaping products. It is critical to understand the harm perceptions, purchase, and use of SN vs. TDN e-cigarettes. Methods From November 2021 to February 2023, we conducted intercept interviews with 263 adult customers at 37 vape shops in Southern California. Self-reported use and harm perceptions towards SN vs TDN e-cigarettes were examined. A qualitative analysis of researcher-obtained photographs of vaping items just purchased by customer participants was conducted. Results Past 30-day SN e-cigarette use was reported by 44 (16.7 %) customers. Past 30-day SN e-cigarette users vs. non-users reported vaping on more days in the past month (29.3 vs. 26.1 days, p = 0.02). Overall, 23.8 % of participants perceived SN e-cigarettes as less harmful than TDN ones; never-smoking vapers and dual users perceived SN e-cigarettes as less harmful than salt-based TDN e-cigarettes. Among 44 customers who purchased SN products (verified through qualitative analysis of photographs), only 13 (29.6 %) self-reported using SN products in the past month, while 5 (11.4 %) indicated they were not aware of the existence of SN products. Most SN vaping products (71.4 %) displayed a modified "tobacco-free" warning label. Conclusions Misperceptions about SN e-cigarettes were documented in this study, including the perception that SN is either less or more harmful than TDN. Further, some customers may be unknowingly purchasing and using SN e-cigarettes. Regulating "tobacco-free nicotine" terminology in SN vaping products marketing is suggested. SN product labeling should not imply that SN is safe/safer than TDN.
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Affiliation(s)
- Artur Galimov
- Institute for Health Promotion and Disease Prevention, Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, USA
| | - Adam M. Leventhal
- Institute for Health Promotion and Disease Prevention, Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, USA
- Institute for Addiction Science, University of Southern California, Los Angeles, USA
| | | | - Leah Meza
- Institute for Health Promotion and Disease Prevention, Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, USA
| | - Jennifer B. Unger
- Institute for Health Promotion and Disease Prevention, Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, USA
| | - Jimi Huh
- Institute for Health Promotion and Disease Prevention, Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, USA
| | - Lourdes Baezconde-Garbanati
- Institute for Health Promotion and Disease Prevention, Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, USA
| | - Steve Sussman
- Institute for Health Promotion and Disease Prevention, Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, USA
- Department of Psychology, University of Southern California, USA
- School of Social Work, University of Southern California, USA
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Vassey J, Kennedy CJ, Herbert Chang HC, Smith AS, Unger JB. Scalable Surveillance of E-Cigarette Products on Instagram and TikTok Using Computer Vision. Nicotine Tob Res 2024; 26:552-560. [PMID: 37947283 PMCID: PMC11033573 DOI: 10.1093/ntr/ntad224] [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: 04/02/2023] [Revised: 09/14/2023] [Accepted: 11/01/2023] [Indexed: 11/12/2023]
Abstract
INTRODUCTION Instagram and TikTok, video-based social media platforms popular among adolescents, contain tobacco-related content despite the platforms' policies prohibiting substance-related posts. Prior research identified themes in e-cigarette-related social media posts using qualitative or text-based machine learning methods. We developed an image-based computer vision model to identify e-cigarette products in social media images and videos. AIMS AND METHODS We created a data set of 6999 Instagram images labeled for 8 object classes: mod or pod devices, e-juice containers, packaging boxes, nicotine warning labels, e-juice flavors, e-cigarette brand names, and smoke clouds. We trained a DyHead object detection model using a Swin-Large backbone, evaluated the model's performance on 20 Instagram and TikTok videos, and applied the model to 14 072 e-cigarette-related promotional TikTok videos (2019-2022; 10 276 485 frames). RESULTS The model achieved the following mean average precision scores on the image test set: e-juice container: 0.89; pod device: 0.67; mod device: 0.54; packaging box: 0.84; nicotine warning label: 0.86; e-cigarette brand name: 0.71; e-juice flavor name: 0.89; and smoke cloud: 0.46. The prevalence of pod devices in promotional TikTok videos increased by 15% from 2019 to 2022. The prevalence of e-juices increased by 33% from 2021 to 2022. The prevalence of e-juice flavor names and e-cigarette brand names increased by about 100% from 2019 to 2022. CONCLUSIONS Deep learning-based object detection technology enables automated analysis of visual posts on social media. Our computer vision model can detect the presence of e-cigarettes products in images and videos, providing valuable surveillance data for tobacco regulatory science (TRS). IMPLICATIONS Prior research identified themes in e-cigarette-related social media posts using qualitative or text-based machine learning methods. We developed an image-based computer vision model to identify e-cigarette products in social media images and videos. We trained a DyHead object detection model using a Swin-Large backbone, evaluated the model's performance on 20 Instagram and TikTok videos featuring at least two e-cigarette objects, and applied the model to 14 072 e-cigarette-related promotional TikTok videos (2019-2022; 10 276 485 frames). The deep learning model can be used for automated, scalable surveillance of image- and video-based e-cigarette-related promotional content on social media, providing valuable data for TRS. Social media platforms could use computer vision to identify tobacco-related imagery and remove it promptly, which could reduce adolescents' exposure to tobacco content online.
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Affiliation(s)
- Julia Vassey
- Department of Population and Public Health Sciences, University of Southern California, Los Angeles, CA, USA
| | - Chris J Kennedy
- Center for Precision Psychiatry, Massachusetts General Hospital, Boston, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Ho-Chun Herbert Chang
- Department of Quantitative Social Science, Dartmouth College, Hanover, NH, USA
- Information Sciences Institute, Viterbi School of Engineering, University of Southern California, Los Angeles, CA, USA
| | - Ashley S Smith
- Department of Population and Public Health Sciences, University of Southern California, Los Angeles, CA, USA
| | - Jennifer B Unger
- Department of Population and Public Health Sciences, University of Southern California, Los Angeles, CA, USA
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Laestadius L, Vassey J, Kim M, Ozga J, Li D, Stanton C, Wipfli H, Unger JB. Themes in e-liquid concept names as a marketing tactic: evidence from Premarket Tobacco Product Applications in the USA. Tob Control 2024; 33:412-413. [PMID: 36171148 PMCID: PMC10043038 DOI: 10.1136/tc-2022-057657] [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: 07/20/2022] [Accepted: 09/16/2022] [Indexed: 02/05/2023]
Affiliation(s)
- Linnea Laestadius
- Zilber School of Public Health, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin, USA
| | - Julia Vassey
- Department of Population and Public Health Sciences, University of Southern California, Los Angeles, California, USA
| | - Minji Kim
- Department of Health Promotion, Education, and Behavior, University of South Carolina, Columbia, South Carolina, USA
| | - Jenny Ozga
- Behavioral Health and Health Policy Practice, Westat, Inc, Rockville, Maryland, USA
| | - Dongmei Li
- Department of Clinical and Translational Research, University of Rochester Medical Center, Rochester, New York, USA
| | - Cassandra Stanton
- Behavioral Health and Health Policy Practice, Westat, Inc, Rockville, Maryland, USA
| | - Heather Wipfli
- Department of Population and Public Health Sciences, University of Southern California, Los Angeles, California, USA
| | - Jennifer B Unger
- Department of Population and Public Health Sciences, University of Southern California, Los Angeles, California, USA
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Han DH, Harlow AF, Feldstein Ewing SW, Audrain-McGovern JE, Unger JB, Sussman SY, McConnell R, Barrington-Trimis JL, Leventhal AM. Disposable E-Cigarette Use and Subsequent Use Patterns in Adolescents and Young Adults. Pediatrics 2024; 153:e2023063430. [PMID: 38463010 PMCID: PMC10979299 DOI: 10.1542/peds.2023-063430] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/12/2023] [Indexed: 03/12/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Disposable electronic cigarettes (e-cigarettes) are widely used by adolescents and young adults (AYAs). Whether using disposable devices is associated with future e-cigarette use patterns is unknown but important for informing e-cigarette regulation. METHODS Prospective longitudinal study combining data from adolescent (14-17 years) and young adult (21-24 years) cohorts from Southern California surveyed at baseline and approximately 8-month follow-up during 2021 to 2022. The analyses included AYAs who used e-cigarettes in the past 30 days at baseline and had exposure and outcome data (N = 403; adolescent n = 124, young adult n = 279). RESULTS In the pooled sample of AYAs who used e-cigarettes at baseline (57.2% cis-gender female, 56.2% Hispanic), 278 (69.0%) reported past 30-day disposable e-cigarette use, and 125 (31.0%) used only nondisposable e-cigarettes. Baseline use of disposable (versus only nondisposable) devices was associated with higher odds of continued e-cigarette use (adjusted odds ratio = 1.92; 95% confidence interval = 1.09-3.42) and a greater number of times used e-cigarettes per day at follow-up (adjusted incidence rate ratio = 1.29; 95% confidence interval = 1.02-1.63). In supplemental analyses, disposable e-cigarette use was associated with greater odds of no changes (versus reductions) in e-cigarette use frequency and puffs per episode from baseline to follow-up but was not associated with increases in use frequency and intensity. No differences in e-cigarette use outcomes were found between those with poly-device (disposable and nondisposable) versus only disposable device use. CONCLUSIONS Use of disposable e-cigarette devices among AYAs may be associated with higher risks for persistent e-cigarette use patterns, which should be considered in tobacco product regulation designed to protect AYAs.
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Affiliation(s)
- Dae-Hee Han
- Department of Population and Public Health Sciences, University of Southern California Keck School of Medicine, Los Angeles, California
- Institute for Addiction Science, University of Southern California, Los Angeles, California
| | - Alyssa F Harlow
- Department of Population and Public Health Sciences, University of Southern California Keck School of Medicine, Los Angeles, California
- Institute for Addiction Science, University of Southern California, Los Angeles, California
| | | | | | - Jennifer B Unger
- Department of Population and Public Health Sciences, University of Southern California Keck School of Medicine, Los Angeles, California
- Institute for Addiction Science, University of Southern California, Los Angeles, California
| | - Steve Y Sussman
- Department of Population and Public Health Sciences, University of Southern California Keck School of Medicine, Los Angeles, California
- Institute for Addiction Science, University of Southern California, Los Angeles, California
- Department of Psychology
- School of Social Work, University of Southern California, Los Angeles, California
| | - Rob McConnell
- Department of Population and Public Health Sciences, University of Southern California Keck School of Medicine, Los Angeles, California
- Institute for Addiction Science, University of Southern California, Los Angeles, California
| | - Jessica L Barrington-Trimis
- Department of Population and Public Health Sciences, University of Southern California Keck School of Medicine, Los Angeles, California
- Institute for Addiction Science, University of Southern California, Los Angeles, California
| | - Adam M Leventhal
- Department of Population and Public Health Sciences, University of Southern California Keck School of Medicine, Los Angeles, California
- Institute for Addiction Science, University of Southern California, Los Angeles, California
- Department of Psychology
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Donaldson SI, Dormanesh A, Majmundar A, Pérez C, Lopez H, Saghian M, Beard TA, Unger JB, Allem JP. Examining the Peer-Reviewed Literature on Tobacco-Related Social Media Data: Scoping Review. Nicotine Tob Res 2024; 26:413-420. [PMID: 37795944 DOI: 10.1093/ntr/ntad186] [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: 01/06/2023] [Revised: 09/07/2023] [Accepted: 09/27/2023] [Indexed: 10/06/2023]
Abstract
INTRODUCTION Tobacco researchers have used social media data to examine tobacco industry marketing practices (eg, influencers), and to document user experience with tobacco products. This study summarized the literature that analyzed tobacco-related social media data, including domain, social media platform, tobacco product type, and themes of findings, among other variables. AIMS AND METHODS PubMed, PsycINFO, Web of Science, and Communication Source were searched between 2004 and 2022. Peer-reviewed articles were included if they were written in English, included at least one tobacco-related term, and one social media-related term, and analyzed a social media post. Two coders screened all-titles and abstracts. The final sample consisted of (n = 255) articles. Studies were coded for domain, social media platform, tobacco product type, data source, type of data, coding and analytic method, and presence of validation procedure, among other variables. RESULTS A total of 10 504 820 581 tobacco-related social media posts were assessed across 255 studies. User experience (54.1%) and promotion (23.1%) were the most researched domains. Researchers used data from Twitter the most (42.7%). Text (43.1%) was the most common type of data analyzed. Thematic analysis (80.8%) was the most common analytic technique. Themes of findings from content analyses often pertained to the health effects of tobacco use (61.0%) and promotion (44.2%). CONCLUSIONS Researchers have analyzed billions of tobacco-related social media posts to describe user experience with, and promotions related to, tobacco products like e-cigarettes on platforms like Twitter. Future research may examine tobacco-related social media data from newer platforms like TikTok. IMPLICATIONS Real-time surveillance of tobacco-related content on social media can keep the tobacco control community abreast of tobacco industry promotional strategies, user experience with tobacco products, and perceived health effects of tobacco use. A framework may be developed to establish best-practices for social media data collection and analysis, including strategies to identify posts from bot accounts and validate methodological approaches used in thematic analysis.
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Affiliation(s)
- Scott I Donaldson
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Allison Dormanesh
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Anuja Majmundar
- Tobacco Control Research, Surveillance and Health Equity Science, American Cancer Society, Inc., Kennesaw, GA, USA
| | - Cindy Pérez
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Heather Lopez
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Megan Saghian
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Trista A Beard
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Jennifer B Unger
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Jon-Patrick Allem
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
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Beard TA, Donaldson SI, Unger JB, Allem JP. Examining Tobacco-Related Social Media Research in Government Policy Documents: Systematic Review. Nicotine Tob Res 2024; 26:421-426. [PMID: 37712553 PMCID: PMC10959066 DOI: 10.1093/ntr/ntad172] [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: 03/29/2023] [Revised: 07/21/2023] [Accepted: 09/03/2023] [Indexed: 09/16/2023]
Abstract
BACKGROUND Social media data have been used to describe tobacco industry marketing practices, user experiences with tobacco, and youth-oriented protobacco content. OBJECTIVE Examine the extent to which tobacco-related social media research is cited in government policy documents. SEARCH METHODS Peer-reviewed tobacco-related social media studies were searched for on Web of Science, PubMed, and other databases from 2004 to 2022. The DOI number for each identified article was then used to search the Overton database to find policy documents citing such research. A secondary, manual search of national and international governmental agency websites was also conducted. SELECTION CRITERIA Documents were included in this study if they were tobacco-related, written in English, cited social media research in the document text and reference section, and were published by a governmental office or agency. DATA COLLECTION AND ANALYSIS The analytic sample consisted of (n = 38) government policy documents, and were coded for content themes, agency type, document type, and subsequent citations. MAIN RESULTS When this research was utilized, it was often in the context of highlighting tobacco industry marketing practices, bringing attention to an issue (eg, youth e-cigarette use), and/or describing how social media platforms can be used as a data source to understand tobacco-related attitudes and behaviors. Agencies that often cited this research were the WHO, FDA, and CDC. The document types included research reports, policy recommendations, industry guidance, legal complaints, and practice-based recommendations. CONCLUSIONS Tobacco-related social media research has been utilized by government agencies in the last decade to guide the policy process. IMPLICATIONS Tobacco-related social media research has been used in government policy documents to detail tobacco industry marketing and bring attention to youth exposure to protobacco content online. Continued surveillance of social media may be necessary to track the changing tobacco landscape.
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Affiliation(s)
- Trista A Beard
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Scott I Donaldson
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Jennifer B Unger
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Jon-Patrick Allem
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
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Galimov A, Kirkpatrick MG, Vassey J, Galstyan E, Smith A, Allem JP, Unger JB. Oral Nicotine Gum Discussions on Twitter: Content Analysis. Nicotine Tob Res 2024; 26:503-507. [PMID: 37791822 PMCID: PMC10959151 DOI: 10.1093/ntr/ntad190] [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: 02/27/2023] [Revised: 08/15/2023] [Accepted: 09/27/2023] [Indexed: 10/05/2023]
Abstract
BACKGROUND Oral nicotine gum such as LUCY, which comes in colorful packaging, mimicking traditional chewing gum, is becoming popular. Many brands of gum have not been approved by the FDA for smoking cessation. This study examined public discourse about, including sentiment toward, oral nicotine gum on Twitter. METHODS We used Twitter's Streaming Application Programming Interface to collect data from January 1, 2021, to December 21, 2021, using "nicotine gum" and/or "#nicotinegum" search terms (N = 19 171 unique tweets were collected). We used an inductive approach to become familiar with the data, generated a codebook, and conducted a content analysis on (n = 2152) tweets. RESULTS Cessation (n = 716, 33.3%), personal experience (n = 370, 17.2%), and addiction to gum (n = 135, 6.3%) were the most prevalent themes. Cessation tweets primarily discussed cigarette smoking cessation (n = 418, 58.4% of cessation tweets) and successful cessation experiences (n = 155, 21.6%). Other identified themes pertained to using nicotine gum for cognitive enhancement or catching a "buzz" (n = 102, 4.7%), marketing (n = 98, 4.6%), using nicotine gum with other substances (n = 90, 4.2%), and adverse effects (n = 63, 2.9%). Sentiment analysis results revealed that 675 (44.2%) tweets were categorized as neutral, 605 (39.6%) tweets were classified as positive, and 248 tweets (16.2%) were negative. CONCLUSIONS About one-third of tweets in our corpus mentioned nicotine gum in the context of smoking cessation. Most nicotine gum-related posts conveyed positive and neutral sentiments. Future studies should consider adding novel nicotine gum-specific search terms as well as exploring other social media platforms to gain more insights about these products. IMPLICATIONS Our findings suggest that Twitter has the potential to track and facilitate conversations between those seeking cigarette cessation advice and those who have successfully quit tobacco by using nicotine gum. Monitoring of promotional content from nicotine gum companies is needed to ensure these products are not appealing to youth and nonusers of tobacco.
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Affiliation(s)
- Artur Galimov
- Department of Population and Public Health Sciences, Tobacco Center of Regulatory Science, Institute for Health Promotion and Disease Prevention Research, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Matthew G Kirkpatrick
- Department of Population and Public Health Sciences, Tobacco Center of Regulatory Science, Institute for Health Promotion and Disease Prevention Research, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Julia Vassey
- Department of Population and Public Health Sciences, Tobacco Center of Regulatory Science, Institute for Health Promotion and Disease Prevention Research, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Ellen Galstyan
- Department of Population and Public Health Sciences, Tobacco Center of Regulatory Science, Institute for Health Promotion and Disease Prevention Research, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Ashley Smith
- Department of Population and Public Health Sciences, Tobacco Center of Regulatory Science, Institute for Health Promotion and Disease Prevention Research, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Jon-Patrick Allem
- Department of Population and Public Health Sciences, Tobacco Center of Regulatory Science, Institute for Health Promotion and Disease Prevention Research, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Jennifer B Unger
- Department of Population and Public Health Sciences, Tobacco Center of Regulatory Science, Institute for Health Promotion and Disease Prevention Research, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
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Meyer Z, Unger JB, Zheng Y. Gene-environment transactions between peer cigarette use, parental supervision, and Chinese adolescent cigarette smoking initiation. J Adolesc 2024. [PMID: 38445782 DOI: 10.1002/jad.12314] [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: 11/25/2023] [Revised: 01/29/2024] [Accepted: 02/28/2024] [Indexed: 03/07/2024]
Abstract
INTRODUCTION The initiation and continued use of tobacco products constitute an ongoing source of preventable disease that continues to pose a significant risk to global adolescent health. Scarce research has sought to explore the influences of two well-known environmental risk factors, parental supervision and peer cigarette use, on genetic and environmental contributions to adolescent cigarette use, especially in non-Western populations. METHODS Following 602 Chinese twin pairs (52% female, N = 1204) from early to middle adolescence at two-time points (Mage = 12 and 15) from 2006 to 2009 and using multivariate biometric modeling, this study examined gene-environment interplay (i.e., gene-environment correlation and interaction) between perceived parental supervision, peer cigarette use, and adolescent cigarette smoking initiation. RESULTS From early to middle adolescence, genetic influences on cigarette smoking initiation became more pronounced, whereas shared environmental influences that promote similarity between family members diminished. Genetic factors primarily explained the links between parental supervision and cigarette smoking initiation in mid-adolescence. Peer cigarette use displayed stronger associations with and moderating potential in adolescent cigarette smoking initiation than parental supervision. High levels of peer cigarette use amplified genetic risk for cigarette smoking initiation in mid-adolescence. CONCLUSIONS Chinese adolescent cigarette smoking initiation involves dynamic gene-environment transactions primarily with peer processes over development. Mid-adolescence constitutes a developmental period wherein underlying genetic risk for cigarette smoking initiation is particularly sensitive to peer influences. Targeted interventions aimed at reducing Chinese adolescent cigarette smoking initiation should focus on peer processes during this developmental period.
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Affiliation(s)
- Zachary Meyer
- Department of Psychology, University of Alberta, Alberta, Canada
| | - Jennifer B Unger
- Department of Population and Public Health Sciences, University of Southern California, Los Angeles, California, USA
| | - Yao Zheng
- Department of Psychology, University of Alberta, Alberta, Canada
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Donaldson SI, Beard TA, Trinh J, Jaladanki S, Unger JB, Galimov A, Wipfli HL, Allem JP. Content analysis of email marketing communications among online e-cigarette retailers. Nicotine Tob Res 2024:ntae046. [PMID: 38430545 DOI: 10.1093/ntr/ntae046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Indexed: 03/04/2024]
Abstract
INTRODUCTION Online e-cigarette retailers use email communications to promote products directly to consumers, which may facilitate e-cigarette use. Little is known about the content of these emails. As such, this study collected emails from online e-cigarette retailers in California to conduct a content analysis. METHODS This study included 13 online e-cigarette retailers in California using Yelp. To be included in the study, e-cigarette retailers needed a live website, physical retail location (i.e., vape shop), and e-cigarettes available for purchase online. The research team entered each website and signed up (if possible) for an email newsletter. Data were collected from the Gmail Application Programming Interface over a 1-year study period (11/01/21-11/01/22). Members of the research team coded emails for the presence of e-cigarettes, other products, flavors, marketing categories, and promotional activities, among other variables. RESULTS 749 promotional emails (2.1 avg/per day) were received over the 1-year study period. Second-generation e-cigarettes (n=581, 77.6%) were the most observed product in emails followed by disposable e-cigarettes (n=391, 52.2%). The most common flavor profile was fruit/sweet/liquor (n=424, 56.6%). Emails included links to social media pages (n=366, 48.9%). Online coupons were found in 53.1% (n=398) of the emails. Age warnings were displayed in 8.0% (n=60) of the emails. CONCLUSIONS E-cigarette retailers' emails promoted new products, flavors, and contained promotional discounts. Future research should examine the impact of exposure to such emails on e-cigarette-related attitudes and behaviors. IMPLICATIONS Findings from this study may help inform prevention programs and interventions focused on increasing tobacco-related digital media literacy (i.e., evaluate tobacco advertising messages on digital media) among gender and ethnic minorities. Future research should examine if exposure to email marketing is causally linked with e-cigarette use among gender and ethnic minorities.
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Affiliation(s)
- Scott I Donaldson
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Trista A Beard
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Jacqueline Trinh
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Sarayu Jaladanki
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Jennifer B Unger
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Artur Galimov
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Heather L Wipfli
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Jon-Patrick Allem
- Department of Health Behavior, Society and Policy, Rutgers School of Public Health, The State University of New Jersey, New Brunswick, NJ, USA
- Institute for Nicotine and Tobacco Studies, Rutgers Biomedical and Health Sciences, Newark, NJ, USA
- Division of General Internal Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
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Galimov A, Albers L, Rahman T, Vassey J, Kirkpatrick MG, Unger JB. Assessing the public discourse on Twitter: Reactions to the JUUL e-cigarettes ban in the United States. Tob Induc Dis 2024; 22:TID-22-46. [PMID: 38410122 PMCID: PMC10895646 DOI: 10.18332/tid/184053] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 02/09/2024] [Accepted: 02/13/2024] [Indexed: 02/28/2024] Open
Abstract
INTRODUCTION JUUL is a high-nicotine pod-based vaping device that is popular among adolescents and young adults. On 23 June 2022, the US Food and Drug Administration (FDA) denied authorization to market JUUL, and ordered JUUL Labs to remove products from the US market. The next day, a US federal appeals court temporarily suspended the ban. The mixed public discourse surrounding the FDA ban warrants further investigation. METHODS This study examined Twitter data to describe public reaction to these announcements. Posts containing terms 'JUUL' and/or '#JUUL' (N=97548 unique tweets) were collected from 23 June to 3 July 2022, from Twitter's Streaming Application Programming Interface (API). After removing retweets, we used an inductive approach to become familiar with the data, generated a codebook, and conducted a content analysis on a random sample of n=4000 tweets. RESULTS A total of 2755 (68.9%) tweets discussed JUUL in the context of the FDA ban. News (n=1425/2755; 51.7%) about the JUUL ban, government distrust (n=588; 21.3%), and individual rights (n=253; 9.2%) were the most prevalent themes. Less commonly discussed themes included inconsistencies between policies (n=174; 6.3%), mentions of switching to other products (n=162; 5.9%), smoking cessation (n=99; 3.6%), and craving for JUUL (n=94; 3.4%). Sentiment analysis of JUUL ban-related posts (n=2755) demonstrated that 1989 (72.2%) tweets were categorized as neutral, while anti-ban posts (n=566; 20.5%) were more prevalent than pro-ban posts (n=200; 7.3%). CONCLUSIONS Besides straightforward announcements of the JUUL ban and its suspension, Twitter posts discussed government distrust, individual rights, and policy inconsistencies. While most posts conveyed neutral sentiments, anti-ban posts were almost three times more prevalent than pro-ban posts. Our findings suggest that text-based social media platforms like Twitter may be an effective instrument to understand opinions, attitudes, and beliefs regarding the FDA's JUUL ban.
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Affiliation(s)
- Artur Galimov
- Tobacco Center of Regulatory Science, Institute for Health Promotion and Disease Prevention Research, Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, United States
| | - Larisa Albers
- Tobacco Center of Regulatory Science, Institute for Health Promotion and Disease Prevention Research, Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, United States
| | - Tahsin Rahman
- Tobacco Center of Regulatory Science, Institute for Health Promotion and Disease Prevention Research, Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, United States
| | - Julia Vassey
- Tobacco Center of Regulatory Science, Institute for Health Promotion and Disease Prevention Research, Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, United States
| | - Matthew G Kirkpatrick
- Tobacco Center of Regulatory Science, Institute for Health Promotion and Disease Prevention Research, Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, United States
| | - Jennifer B Unger
- Tobacco Center of Regulatory Science, Institute for Health Promotion and Disease Prevention Research, Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, United States
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Vogel EA, Barrington-Trimis JL, Vassey J, Soto D, Unger JB. Young Adults' Exposure to and Engagement With Tobacco-Related Social Media Content and Subsequent Tobacco Use. Nicotine Tob Res 2024; 26:S3-S12. [PMID: 38366337 PMCID: PMC10873498 DOI: 10.1093/ntr/ntad108] [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: 01/02/2023] [Revised: 04/18/2023] [Accepted: 06/28/2023] [Indexed: 02/18/2024]
Abstract
INTRODUCTION Nicotine/tobacco social media content may increase young people's risk for use. This study examined prospective associations between exposure to and engagement with nicotine/tobacco-related social media content and nicotine/tobacco use among young adults. AIMS AND METHODS Young adults (N = 2080) originally recruited from Southern California high schools for a prospective cohort study reported frequency of viewing and posting nicotine/tobacco content on four social media platforms (Facebook, Instagram, Twitter, and YouTube). Participants also reported frequency of seeing nicotine/tobacco posts from friends, seeing nicotine/tobacco posts from influencers or celebrities, and liking nicotine/tobacco posts. Within subsamples of nicotine/tobacco never users (n = 794), past users (n = 897) and current users (n = 389), analyses examined associations of baseline (May-October 2020) social media content exposure and engagement with follow-up (January-June 2021) tobacco use initiation (among never users), resumption (among past users), and continuation (among current users), adjusting for sociodemographic and socioenvironmental characteristics. RESULTS Never users who saw nicotine/tobacco posts from friends (Adjusted Odds Ratio [AOR] = 2.91 [95% Confidence Interval [CI]: 1.46, 5.82], p = .002) or from celebrities or influencers (AOR = 2.77 [1.32, 5.84], p = .007) were significantly more likely to initiate nicotine/tobacco use than their peers. Among past users, posting nicotine/tobacco content at baseline was associated with use resumption (AOR = 1.77 [1.12, 2.80], p = .014). Content exposure and engagement were not associated with nicotine/tobacco use continuation among current users (p-values > .05). CONCLUSIONS Seeing nicotine/tobacco posts from friends, influencers, or celebrities was associated with greater odds of tobacco use initiation, but not resumption or continuation, 6 months later. Young adults with past nicotine/tobacco use who post about nicotine/tobacco may be at elevated risk for resuming use. IMPLICATIONS Young adults with exposure to nicotine/tobacco social media content were more likely than their peers to initiate nicotine/tobacco use 6 months later. Past nicotine/tobacco users who reported posting about nicotine/tobacco on social media at baseline were more likely than their peers to resume nicotine/tobacco use. Among young adults with current nicotine/tobacco use at baseline, social media activity did not predict odds of nicotine/tobacco use continuation at follow-up. Nicotine/tobacco content on social media should be restricted to reduce young people's chances of nicotine/tobacco use initiation or resumption.
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Affiliation(s)
- Erin A Vogel
- Department of Population and Public Health Sciences, University of Southern California Keck School of Medicine, San Francisco, Los Angeles, CA, USA
- Institute for Addiction Science, University of Southern California, Los Angeles, CA, USA
| | - Jessica L Barrington-Trimis
- Department of Population and Public Health Sciences, University of Southern California Keck School of Medicine, San Francisco, Los Angeles, CA, USA
- Institute for Addiction Science, University of Southern California, Los Angeles, CA, USA
| | - Julia Vassey
- Department of Population and Public Health Sciences, University of Southern California Keck School of Medicine, San Francisco, Los Angeles, CA, USA
| | - Daniel Soto
- Department of Population and Public Health Sciences, University of Southern California Keck School of Medicine, San Francisco, Los Angeles, CA, USA
- Institute for Addiction Science, University of Southern California, Los Angeles, CA, USA
| | - Jennifer B Unger
- Department of Population and Public Health Sciences, University of Southern California Keck School of Medicine, San Francisco, Los Angeles, CA, USA
- Institute for Addiction Science, University of Southern California, Los Angeles, CA, USA
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12
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Lee RC, Sood N, Lam CN, Unger JB. Demographic Characteristics Associated With Intentions to Receive the 2023-2024 COVID-19 Vaccine. Am J Prev Med 2024:S0749-3797(24)00044-8. [PMID: 38342478 DOI: 10.1016/j.amepre.2024.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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] [Received: 11/28/2023] [Revised: 02/05/2024] [Accepted: 02/05/2024] [Indexed: 02/13/2024]
Abstract
INTRODUCTION The U.S. Food and Drug Administration approved the updated 2023-2024 COVID-19 vaccines by Pfizer-BioNTech and Moderna on September 11, 2023. Despite the Centers for Disease Control and Prevention's recommendation that everyone aged ≥6 years receive the updated COVID-19 vaccine, the general public's intentions to receive the new 2023-2024 vaccine are unknown. METHODS Intentions to receive the new COVID-19 vaccine and the demographic predictors of those intentions were assessed from a survey of adult residents, aged ≥18 years, of Los Angeles County, California conducted in October 2023. RESULTS Of the 1,090 participants, 701 (64.3%) indicated they were planning on receiving the new COVID-19 vaccine, 217 (19.9%) responded no, and 172 (15.8%) were unsure. Male gender (versus female); age groups of 50-64 and ≥65 years (versus 18-29 years); and ≥$100,000 household income (versus ≤$49,999) were associated with higher odds of reporting yes than reporting no regarding their vaccination intentions. Asian and Hispanic race/ethnicity (versus Non-Hispanic White) were associated with higher odds of indicating not sure than the odds of indicating no vaccination intentions. A significantly higher proportion of not-sure respondents reported "I plan to wait and see if it is safe and may get it later", whereas a significantly higher proportion of no respondents reported "I don't believe I need a COVID-19 vaccine booster" and "I don't trust COVID-19 vaccines." CONCLUSIONS This study demonstrates demographic differences in attitudes toward COVID-19 vaccination intentions and highlights the importance of promotional messages and initiatives that target more hesitant populations. These messages should address possible side effects and vaccine safety.
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Affiliation(s)
- Ryan C Lee
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, California.
| | - Neeraj Sood
- Sol Price School of Public Policy, University of Southern California, Los Angeles, California
| | - Chun Nok Lam
- Department of Emergency Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Jennifer B Unger
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, California
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13
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Vogel EA, Unger JB, Vassey J, Barrington-Trimis JL. Effects of a nicotine warning label and vaping cessation resources on young adults' perceptions of pro-vaping instagram influencer posts. Addict Behav 2024; 149:107888. [PMID: 37857044 PMCID: PMC10841614 DOI: 10.1016/j.addbeh.2023.107888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 10/04/2023] [Accepted: 10/10/2023] [Indexed: 10/21/2023]
Abstract
BACKGROUND Exposure to social media content promoting e-cigarette use ("vaping") is associated with subsequent tobacco use among young adults. Adding features to pro-vaping Instagram influencer posts, such as a nicotine warning label and vaping cessation resources, could help counteract posts' negative influence. METHODS Young adults (N = 2,179; Mage = 22.6 [SD = 0.4]; 53.0 % cisgender women, 45.1 % Hispanic) completed an online experiment in 2021-2022 through an ongoing prospective cohort study. Participants viewed three simulated pro-vaping Instagram influencer posts in a four-group, between-subjects design. Post features differed by experimental condition: "label-only" (nicotine warning label on post), "link-only" (link to vaping cessation resources under post), "L&L" (label and link), or "control" (neither). Participants rated each influencer's traits (honest, trustworthy, informed, smart, attractive, popular; 0-100 %). After viewing all three posts, participants reported use intentions, susceptibility, positive and negative expectancies, and harm perceptions around the fictitious advertised vaping product. Past-month vapers additionally reported their desire and self-efficacy for quitting. RESULTS L&L (versus control and link-only) participants viewed influencers as more honest, trustworthy, and informed. L&L (versus control) participants had lower odds of susceptibility to using the advertised product, lower positive expectancies, and greater negative expectancies. The label and link did not significantly affect participants' intentions to use the product, perceived harm of the product, or desire or self-efficacy for quitting vaping. CONCLUSIONS Providing a nicotine warning label and link to vaping cessation resources on influencers' Instagram posts may have the unintended effect of increasing positive perceptions of the influencer. However, they may reduce susceptibility to product use.
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Affiliation(s)
- Erin A Vogel
- Department of Population and Public Health Sciences, University of Southern California Keck School of Medicine, 1845 N. Soto St., Los Angeles, CA 90089, USA; Institute for Addiction Sciences, University of Southern California, 1845 N. Soto St., Los Angeles, CA 90089, USA.
| | - Jennifer B Unger
- Department of Population and Public Health Sciences, University of Southern California Keck School of Medicine, 1845 N. Soto St., Los Angeles, CA 90089, USA; Institute for Addiction Sciences, University of Southern California, 1845 N. Soto St., Los Angeles, CA 90089, USA; Norris Comprehensive Cancer Center, University of Southern California, 1441 Eastlake Ave., Los Angeles, CA 90033, USA
| | - Julia Vassey
- Department of Population and Public Health Sciences, University of Southern California Keck School of Medicine, 1845 N. Soto St., Los Angeles, CA 90089, USA
| | - Jessica L Barrington-Trimis
- Department of Population and Public Health Sciences, University of Southern California Keck School of Medicine, 1845 N. Soto St., Los Angeles, CA 90089, USA; Institute for Addiction Sciences, University of Southern California, 1845 N. Soto St., Los Angeles, CA 90089, USA; Norris Comprehensive Cancer Center, University of Southern California, 1441 Eastlake Ave., Los Angeles, CA 90033, USA
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14
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Harlow AF, Liu F, Young LE, Coreas SI, Rahman T, Unger JB, Leventhal AM, Barrington-Trimis JL, Krueger EA. Sexual and Gender Identity Disparities in Nicotine and Tobacco Use Susceptibility and Prevalence: Disaggregating Emerging Identities Among Adolescents From California, USA. Nicotine Tob Res 2024; 26:203-211. [PMID: 37493636 PMCID: PMC10803110 DOI: 10.1093/ntr/ntad131] [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: 05/18/2023] [Revised: 07/18/2023] [Accepted: 07/24/2023] [Indexed: 07/27/2023]
Abstract
INTRODUCTION Prior studies report nicotine/tobacco use disparities for sexual and gender minority (SGM) youth but have insufficiently characterized SGM identity diversity. AIMS AND METHODS Adolescents (mean age = 15.2) from 11 high schools in Southern California completed surveys in Fall 2021. Ever use of combustible (cigarettes, cigars, hookah) and noncombustible (e-cigarettes, e-hookah, heated tobacco, smokeless/snus, oral nicotine) nicotine/tobacco (among overall sample, n = 3795) and susceptibility to future initiation of cigarettes, e-cigarettes, and flavored non-tobacco oral nicotine (among n = 3331 tobacco-naïve youth) were compared across four gender (male/masculine, female/feminine, transgender male/female, non-binary) and seven sexual (heterosexual, bisexual, pansexual, queer, questioning, gay/lesbian, asexual) identities. RESULTS Non-binary (vs. cisgender male) youth had greater prevalence of ever combustible (prevalence ratio [PR] = 2.86, 95% confidence intervals (CI): 1.76 to 4.66) and non-combustible (PR = 1.94, 95% CI: 1.31 to 2.86) nicotine/tobacco use, and susceptibility to future nicotine/tobacco initiation (PR range = 2.32-2.68). Transgender (vs. cisgender male) youth had greater susceptibility to nicotine/tobacco use (PR range = 1.73-1.95), but not greater tobacco use prevalence. There was greater prevalence of non-combustible nicotine/tobacco use (PR range = 1.78-1.97) and susceptibility to nicotine/tobacco initiation (PR range = 1.36-2.18) for all sexual minority (vs. heterosexual) identities, except for asexual. Bisexual (PR = 2.03, 95% CI: 1.30 to 3.16) and queer (PR = 2.87, 95% CI: 1.31 to 6.27) youth had higher ever combustible tobacco use than heterosexual youth. Questioning (vs. heterosexual) youth were more susceptible to future tobacco initiation (PR range = 1.36-2.05) but did not differ in ever use. CONCLUSIONS Disparities in nicotine/tobacco use and susceptibility were present with similar effect sizes across most, but not all, SGM identities. Inclusive measurement of SGM identities in research and surveillance may inform more precise tobacco control efforts to reduce disparities. IMPLICATIONS Among high school students from Southern California with substantial diversity in sexual and gender identities, there was greater prevalence of tobacco use and susceptibility to future tobacco initiation for most, but not all, sexual and gender minority youth, including those with emerging sexual and gender identities such as non-binary, queer and pansexual. Additionally, findings indicate that tobacco control initiatives targeting youth who are questioning their sexual identities may be particularly important for preventing tobacco use initiation. This study reinforces the importance of measuring diversity within the LGBTQ + community for tobacco use research, and highlights how inclusive measurement can inform more precise tobacco control interventions.
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Affiliation(s)
- Alyssa F Harlow
- University of Southern California, Department of Population and Public Health Sciences, Los Angeles, CA, USA
- University of Southern California, Institute for Addiction Science, Los Angeles, CA, USA
| | - Fei Liu
- University of Southern California, Department of Population and Public Health Sciences, Los Angeles, CA, USA
| | - Lindsay E Young
- University of Southern California, Institute for Addiction Science, Los Angeles, CA, USA
- University of Southern California, Annenberg School for Communication and Journalism, Los Angeles, CA, USA
| | - Saida I Coreas
- University of Southern California, Department of Population and Public Health Sciences, Los Angeles, CA, USA
| | - Tahsin Rahman
- University of Southern California, Department of Population and Public Health Sciences, Los Angeles, CA, USA
| | - Jennifer B Unger
- University of Southern California, Department of Population and Public Health Sciences, Los Angeles, CA, USA
- University of Southern California, Institute for Addiction Science, Los Angeles, CA, USA
| | - Adam M Leventhal
- University of Southern California, Department of Population and Public Health Sciences, Los Angeles, CA, USA
- University of Southern California, Institute for Addiction Science, Los Angeles, CA, USA
| | - Jessica L Barrington-Trimis
- University of Southern California, Department of Population and Public Health Sciences, Los Angeles, CA, USA
- University of Southern California, Institute for Addiction Science, Los Angeles, CA, USA
| | - Evan A Krueger
- Tulane University, School of Social Work, New Orleans, LA, USA
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15
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Lee R, Sood N, Lam CN, Unger JB, Herzig SE, Hu H. Nirmatrelvir-ritonavir (Paxlovid) Access, Use, and Eligibility Among Adults with COVID-19 in Los Angeles County: The LA Pandemic Surveillance Cohort Study. J Gen Intern Med 2024:10.1007/s11606-023-08591-9. [PMID: 38252251 DOI: 10.1007/s11606-023-08591-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 12/22/2023] [Indexed: 01/23/2024]
Affiliation(s)
- Ryan Lee
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
| | - Neeraj Sood
- Sol Price School of Public Policy, University of Southern California, Los Angeles, CA, USA
| | - Chun Nok Lam
- Department of Emergency Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Jennifer B Unger
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Shirin Emma Herzig
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Howard Hu
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
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16
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Bolshakova M, González JL, Thompson T, Schneberk T, Sussman S, Unger JB, Bluthenthal RN. A qualitative analysis of internal medicine residents' experience with substance use disorder education and training: a pilot study. J Addict Dis 2024; 42:63-70. [PMID: 36330994 DOI: 10.1080/10550887.2022.2139580] [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] [Indexed: 11/06/2022]
Abstract
BACKGROUND Lack of education and training on caring for patients with substance use disorder (SUD) is common among healthcare providers, often resulting in clinicians feeling unprepared to treat patients with SUD. OBJECTIVES This study explored resident physicians' experiences with SUD education throughout medical school and residency and qualitatively evaluated whether a SUD initiative improved resident's knowledge and efficacy of treating various SUDs. METHODS We implemented a brief (seven hours total) educational initiative focused on treating SUDs virtually over the course of an academic year for residents enrolled in the University of Southern California Internal Medicine Residency program. Semi-structured interviews were conducted with residents after completion of the initiative. A thematic analysis was conducted to identify common themes that emerged from the qualitative data. RESULTS Every resident noted receiving insufficient training for the treatment of SUDs prior to the initiative. The initiative was viewed favorably, and participants particularly appreciated having an introduction to prescribing medication for the treatment of SUD such as buprenorphine. Despite the perceived success of the initiative in increasing awareness of treatment modalities for SUD, residents expressed a lack of comfort in handling SUD cases and desired additional practical lectures and application of knowledge through increased experiential training. CONCLUSIONS SUD education and training appears to be a useful constituent of resident training and should be included in the standard curriculum and rotations. Residency programs should consider including formal education, hands-on practice, and providing adequate resources for residents to develop their capabilities to care for patients with SUD.
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Affiliation(s)
- Maria Bolshakova
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - José Luis González
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
- LAC + USC Medical Center, Los Angeles, CA, USA
| | - Tiana Thompson
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | | | - Steve Sussman
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Jennifer B Unger
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Ricky N Bluthenthal
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
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17
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Rahman T, Rogers CJ, Albers LD, Forster M, Unger JB. Adverse Childhood Experiences, Acculturation, and Risky Sexual Behaviors in Hispanic Young Adults: Findings from Project RED. J Sex Res 2024; 61:105-118. [PMID: 36877805 PMCID: PMC10480355 DOI: 10.1080/00224499.2023.2184762] [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] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
While adverse childhood experiences (ACE) are well-documented predictors of maladaptive behaviors in adulthood, including risky sexual behaviors (RSB), the influence of acculturation in this association remains unknown. Although Hispanics are a rapidly growing population in the United States and are disproportionately affected by adverse sexual health outcomes, there is a paucity of research examining the interplay of ACE, acculturation, and RSB in this population. We observed the ACE-RSB association and how this relationship varies across U.S. and Hispanic acculturation levels, in a sample of Hispanic young adults (n = 715). Data for this study were from Project RED, a longitudinal study of Hispanic health. We ran regression models to test associations between ACE (0, 1-3, 4+) and several RSB (e.g., early sexual initiation (≤14 years), condomless sex, lifetime sexual partners, and alcohol/drug use before intercourse), and assessed moderation by U.S./Hispanic acculturation. Compared with those without ACE, individuals with 4 + ACE had higher odds of early sexual initiation (AOR: 2.23), alcohol/drug use before last intercourse (AOR: 2.31), and condomless sex (AOR: 1.66), as well as a higher number of lifetime sexual partners (β: 0.60). For those reporting 4 + ACE, high U.S. acculturation was protective in the association between ACE and using alcohol/drugs before intercourse. Future research implications are discussed.
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Affiliation(s)
- Tahsin Rahman
- Department of Population and Public Health Sciences, University of Southern California, Los Angeles, United States
| | - Christopher J. Rogers
- Department of Health Sciences, California State University, Northridge, Los Angeles, United States
| | - Larisa D. Albers
- Department of Population and Public Health Sciences, University of Southern California, Los Angeles, United States
| | - Myriam Forster
- Department of Health Sciences, California State University, Northridge, Los Angeles, United States
| | - Jennifer B. Unger
- Department of Population and Public Health Sciences, University of Southern California, Los Angeles, United States
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18
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Vogel EA, Tackett AP, Unger JB, Gonzalez MJ, Peraza N, Jafarzadeh NS, Page MK, Goniewicz ML, Wong M, Leventhal AM. Effects of flavour and modified risk claims on nicotine pouch perceptions and use intentions among young adults who use inhalable nicotine and tobacco products: a randomised controlled trial. Tob Control 2023:tc-2023-058382. [PMID: 38148143 DOI: 10.1136/tc-2023-058382] [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: 09/06/2023] [Accepted: 12/13/2023] [Indexed: 12/28/2023]
Abstract
BACKGROUND Availability of flavours and potential modified risk tobacco product (MRTP) claims may influence young adults' (YAs') perceptions of and intentions to use nicotine pouches ('pouches'). METHODS YAs aged 21-34 years (N=47, M age=24.5, SD=3.1) with past-month nicotine/tobacco use (10.6% cigarette-only, 51.1% e-cigarette-only, 38.3% dual use) and no intention to quit were randomised to self-administer four Zyn 3 mg nicotine pouches in a 4 (flavour; within-subjects: smooth, mint, menthol, citrus) × 2 (MRTP claim on packaging; between subjects: present or absent) mixed-factorial design. After self-administering each pouch, participants reported appeal, use intentions and perceived harm compared with cigarettes and e-cigarettes. Three mixed-factorial analysis of variances (ANOVAs) examined main and interactive effects of flavour and MRTP claim on appeal, use intentions and comparative harm perceptions. RESULTS Mint (M=55.9, SD=26.4), menthol (M=49.7, SD=26.8) and citrus (M=46.6, SD=24.8) flavours were significantly more appealing than smooth (M=37.6, SD=25.4; p<0.001). MRTP claim did not significantly affect product appeal (p=0.376). Use intentions were greater for mint (M=2.6, SD=1.3) and menthol (M=2.0, SD=1.1) flavours than smooth (M=1.8, SD=1.0; p=0.002). Flavour did not affect comparative harm perceptions (p values>0.418). MRTP claims increased use intention (p=0.032) and perceptions of pouches as less harmful than cigarettes (p=0.011), but did not affect perceived harm relative to e-cigarettes (p=0.142). Flavour × MRTP claim interactions were not significant. CONCLUSIONS Flavoured (vs smooth) pouches were more appealing to YAs. MRTP claims reduced perceived harm of pouches compared with cigarettes; however, intentions to switch were low. To protect YAs' health, regulatory restrictions could target flavours and MRTP claims.
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Affiliation(s)
- Erin A Vogel
- TSET Health Promotion Research Center, The University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Alayna P Tackett
- Center for Tobacco Research, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Jennifer B Unger
- Department of Population and Public Health Sciences, University of Southern California, Los Angeles, California, USA
| | - Maria J Gonzalez
- Department of Population and Public Health Sciences, University of Southern California, Los Angeles, California, USA
| | - Natalia Peraza
- Department of Population and Public Health Sciences, University of Southern California, Los Angeles, California, USA
- Institute for Addiction Science, University of Southern California, Los Angeles, California, USA
| | - Nikki S Jafarzadeh
- Department of Population and Public Health Sciences, University of Southern California, Los Angeles, California, USA
- Institute for Addiction Science, University of Southern California, Los Angeles, California, USA
| | - Michelle K Page
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, New York, USA
| | - Maciej L Goniewicz
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, New York, USA
| | - Melissa Wong
- Department of Population and Public Health Sciences, University of Southern California, Los Angeles, California, USA
- Institute for Addiction Science, University of Southern California, Los Angeles, California, USA
| | - Adam M Leventhal
- Department of Population and Public Health Sciences, University of Southern California, Los Angeles, California, USA
- Institute for Addiction Science, University of Southern California, Los Angeles, California, USA
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Albers L, Rogers CJ, Steinberg J, Vos RO, Soto D, Lee R, Wu JS, Unger JB. Proximity to Cannabis Retailers and Recent Cannabis Use among a Diverse Sample of California Adolescents. Subst Use Misuse 2023; 59:643-650. [PMID: 38115623 DOI: 10.1080/10826084.2023.2294965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2023]
Abstract
Background: As of May 2023, 23 states and Washington, DC have legalized the sale of cannabis for adults aged 21+, and 38 states, three territories, and D.C. have legalized medical cannabis. Exposure to cannabis retailers could increase adolescent cannabis use. Few studies have examined the impact of residential proximity to cannabis retailers on adolescent cannabis use, and previous findings are inconsistent. Methods: This study examined associations between proximity to cannabis retailers and past 30-day cannabis use. Data were from Project Cal Teens, a statewide survey of California adolescents regarding cannabis-related opinions/behaviors (N = 1406, mean age = 15.5 years, 48% female, 38% Hispanic/Latinx, 33% White, 15% Asian/Pacific Islander, 10% Black/African American, 5% Other/Multiracial). Participants were recruited via schools/social media in 2018-2020. Results: For every additional 5 driving miles to the nearest cannabis retailer, the risk of past 30-day cannabis use was reduced by 3.6% [IRR: 0.964; 95% CI: 0.935-0.994]. For every additional 5 miles from a licensed retailer, the risk of past 30-day cannabis use was reduced by 4.3% [IRR: 0.957; 95% CI: 0.926-0.989]. Interaction analyses revealed that among Hispanic/Latinx students, every 5 miles from a licensed retailer was associated with an 11.9% reduction in the risk of past 30-day cannabis use [IRR: 0.881; 95% CI: 0.820-0.945]. Conclusions: As the number of cannabis retailers in the U.S. increases with the continued legalization of adult cannabis use, research examining the effects of these policies on underage use is crucial. Interventions could include enforcement of zoning laws in/near residential areas to reduce accessibility of adolescents to cannabis retailers.
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Affiliation(s)
- Larisa Albers
- Department of Population and Public Health Sciences, University of Southern California, Los Angeles, CA, USA
| | - Christopher J Rogers
- Department of Health Sciences, California State University, Northridge, Los Angeles, CA, USA
| | - Jane Steinberg
- Department of Population and Public Health Sciences, University of Southern California, Los Angeles, CA, USA
| | - Robert O Vos
- Spatial Sciences Institute, University of Southern California, Los Angeles, CA, USA
| | - Daniel Soto
- Department of Population and Public Health Sciences, University of Southern California, Los Angeles, CA, USA
| | - Ryan Lee
- Department of Population and Public Health Sciences, University of Southern California, Los Angeles, CA, USA
| | - Jasmine Siyu Wu
- Spatial Sciences Institute, University of Southern California, Los Angeles, CA, USA
| | - Jennifer B Unger
- Department of Population and Public Health Sciences, University of Southern California, Los Angeles, CA, USA
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20
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Chen-Sankey J, Jeong M, Wackowski OA, Unger JB, Niederdeppe J, Bernat E, Bansal-Travers M, Moran M, Kennedy RD, Broun A, Hacker K, Choi K. Noticing people, discounts and non-tobacco flavours in e-cigarette ads may increase e-cigarette product appeal among non-tobacco-using young adults. Tob Control 2023; 33:30-37. [PMID: 35672144 PMCID: PMC9726993 DOI: 10.1136/tobaccocontrol-2022-057269] [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: 01/11/2022] [Accepted: 05/31/2022] [Indexed: 02/05/2023]
Abstract
INTRODUCTION Young adults new to tobacco (including e-cigarettes) are at an increased risk of e-cigarette use after e-cigarette exposure. This study examined the association between noticing e-cigarette advertising features and perceived product appeal among non-tobacco-using young adults. METHODS A sample of non-tobacco-using young adults (ages 18-29 years; n=1993) completed an online survey in 2021. We content analysed visible features from 12 e-cigarette ads that represented commonly used e-cigarette brands. Participants viewed the ads and clicked on the areas of the ads that drew their attention. Participants reported e-cigarette product appeal for each ad, including ad liking, product curiosity and use interest. We used generalised estimating equations to examine within-person associations between noticing specific ad features and reporting each and any type of product appeal, adjusting for noticing other features and participant characteristics. RESULTS Noticing people, discounts, non-tobacco (menthol and mint/fruit) flavours, positive experience claims or product images was positively associated with having any e-cigarette product appeal. Noticing discounts or mint/fruit flavours was also positively associated with e-cigarette use interest. In contrast, noticing nicotine warnings or smoking cessation claims was negatively associated with ad liking and product curiosity. CONCLUSIONS Attention to several e-cigarette ad features (eg, people, discounts, non-tobacco flavours) was associated with increased e-cigarette product appeal, whereas attention to nicotine warnings and smoking cessation claims was associated with reduced appeal among non-tobacco-using young adults. Restricting appeal-promoting features while strengthening the effects of nicotine warnings and smoker-targeted claims in e-cigarette ads may potentially reduce e-cigarettes' overall appeal among this priority population.
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Affiliation(s)
- Julia Chen-Sankey
- Center for Tobacco Studies, Rutgers Biomedical and Health Sciences, New Brunswick, New Jersey, USA
- Department of Health Behavior, Society, and Policy, Rutgers School of Public Health, Piscataway, New Jersey, USA
| | - Michelle Jeong
- Center for Tobacco Studies, Rutgers Biomedical and Health Sciences, New Brunswick, New Jersey, USA
- Department of Health Behavior, Society, and Policy, Rutgers School of Public Health, Piscataway, New Jersey, USA
| | - Olivia A Wackowski
- Center for Tobacco Studies, Rutgers Biomedical and Health Sciences, New Brunswick, New Jersey, USA
- Department of Health Behavior, Society, and Policy, Rutgers School of Public Health, Piscataway, New Jersey, USA
| | - Jennifer B Unger
- Department of Population and Public Health Sciences, University of Southern California Keck School of Medicine, Los Angeles, California, USA
| | - Jeff Niederdeppe
- Department of Communication, Cornell University, Ithaca, New York, USA
| | - Edward Bernat
- Department of Psychology, University of Maryland College Park, College Park, Maryland, USA
| | | | - Meghan Moran
- Department of Health, Behavior & Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Ryan David Kennedy
- Department of Health, Behavior & Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Aaron Broun
- School of Public Health, George Washington University, Washington, District of Columbia, USA
| | - Kiana Hacker
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, Bethesda, Maryland, USA
| | - Kelvin Choi
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, Bethesda, Maryland, USA
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21
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Unger JB, Steinberg J, Vos R, Soto DW, Albers L, Rogers CJ. Surveying Adolescents During a Pandemic: Comparison of Adolescents Recruited via Social Media vs. Schools. Prev Sci 2023:10.1007/s11121-023-01621-2. [PMID: 38038891 DOI: 10.1007/s11121-023-01621-2] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/21/2023] [Indexed: 12/02/2023]
Abstract
School-based surveys of adolescents can be logistically difficult and exclude students who do not attend school. Social media recruitment could be a promising strategy to recruit representative samples of adolescents. However, few studies have compared adolescent survey data collected via different methodologies. Our team was conducting a school-based survey when the COVID-19 pandemic closed all schools, necessitating a shift to online adolescent recruitment. To achieve our goal of obtaining a sample of high school students throughout California, we placed ads on social media. We compared the adolescents recruited in schools with those recruited on social media on demographic characteristics, mental health, and substance use. The sample of students recruited in schools (N = 737) and adolescents recruited via social media (N = 953) did not differ significantly on gender or substance use. However, compared with school-based recruitment, social media recruitment yielded a higher proportion of boys, whites, and Asians and a lower proportion of girls, Hispanic/Latinx adolescents, and those who spoke other languages at home. The social media sample had significantly higher levels of depression and anxiety symptoms and perceived stress than the school-based sample. Results indicate that social media can be useful for recruiting adolescents for survey research, especially if strategies such as Spanish-language social media ads are used to recruit and consent Hispanic/Latinx adolescents and those with non-English-speaking parents. This method could potentially replace school-based surveys in cases where schools are unwilling to participate in research, or it could be used to supplement school-based samples. Advantages and disadvantages of both methods are discussed.
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Affiliation(s)
| | | | - Robert Vos
- University of Southern California, Los Angeles, CA, USA
| | - Daniel W Soto
- University of Southern California, Los Angeles, CA, USA
| | - Larisa Albers
- University of Southern California, Los Angeles, CA, USA
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22
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Ertanir B, Cobb CL, Unger JB, Celada-Dalton T, West AE, Zeledon I, Perazzo PA, Cano MÁ, Des Rosiers SE, Duque MC, Ozer S, Cruz N, Scaramutti C, Vos SR, Salas-Wright CP, Maldonado-Molina MM, Nehme L, Martinez CR, Zayas LH, Schwartz SJ. Crisis Migration Adverse Childhood Events: A New Category of Youth Adversity for Crisis Migrant Children and Adolescents. Res Child Adolesc Psychopathol 2023; 51:1871-1882. [PMID: 36626084 PMCID: PMC10661744 DOI: 10.1007/s10802-022-01016-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/21/2022] [Indexed: 01/11/2023]
Abstract
The present article proposes an extension of the concept of adverse childhood experiences (ACEs) to apply to crisis migration - where youth and families are fleeing armed conflicts, natural disasters, community violence, government repression, and other large-scale emergencies. We propose that adverse events occurring prior to, during, and following migration can be classified as crisis-migration-related ACEs, and that the developmental logic underlying ACEs can be extended to the new class of crisis-migration-related ACEs. Specifically, greater numbers, severity, and chronicity of crisis-migration-related ACEs would be expected to predict greater impairments in mental and physical health, poorer interpersonal relationships, and less job stability later on. We propose a research agenda centered around definitional clarity, rigorous measurement development, prospective longitudinal studies to establish predictive validity, and collaborations among researchers, practitioners, and policymakers.
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Affiliation(s)
- Beyhan Ertanir
- School of Education, Institute Research and Development, University of Applied Sciences and Arts Northwestern Switzerland, Bahnhofstrasse 6, 5210, Windisch, Switzerland.
| | | | | | | | - Amy E West
- University of Southern California, Los Angeles, United States
| | - Ingrid Zeledon
- University of Southern California, Los Angeles, United States
| | | | | | | | - Maria C Duque
- University of Texas at Austin, Austin, United States
| | | | - Natalie Cruz
- Children's Hospital Los Angeles, Los Angeles, United States
| | | | - Saskia R Vos
- University of Miami (Florida), Miami, United States
| | | | | | - Lea Nehme
- Florida International University, Miami, United States
| | | | - Luis H Zayas
- University of Texas at Austin, Austin, United States
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23
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Kirkpatrick MG, Dormanesh A, Unger JB, Allem JP. Cartoon marketing exposure decreases perceived risks of e-cigarette use in adolescents. Exp Clin Psychopharmacol 2023; 31:1032-1038. [PMID: 36757963 DOI: 10.1037/pha0000642] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Abstract
e-Cigarette companies use cartoon images to market their products, and exposure to this marketing strategy may lead to increased risk for adolescent e-cigarette use. This study examined the effects of cartoon marketing image exposure on perceived expectations of benefits and risks of e-cigarette use, and willingness to buy e-cigarette-related products in the future, among adolescents with and without a history of e-cigarette use. To accomplish this, participants completed an online survey experiment, during which they were randomly assigned to view pictures of e-cigarette products with cartoon or noncartoon packaging, followed by questionnaires about wanting to buy e-cigarettes, and perceived benefits and risks of e-cigarette use. Participants, a sample of Southern California high school students (ninth to 11th grade; N = 1,376), completed the study from September 2021 to November 2021. Overall, 27% of participants had used an e-cigarette or other tobacco product at least once in their lifetime (ever user). Thirty-six percent of participants never used e-cigarettes or other tobacco products but were considered to be susceptible to using e-cigarettes in the future (susceptible-never user). Thirty-seven percent of participants never used e-cigarettes or other tobacco products and were considered insusceptible to using e-cigarettes in the future (insusceptible-never user). There were no significant differences between image exposure groups (cartoon, no cartoon) on demographic variables (age, gender, race/ethnicity), lifetime e-cigarette use, or susceptibility to use in the future. Exposure to e-cigarette-related cartoon-based marketing produced lower perceived e-cigarette-related risks in insusceptible-never users. Exposure to e-cigarette marketing with cartoon images decreases the perceived harmfulness of e-cigarettes, which can increase adolescents' intentions to try e-cigarettes. Curbing adolescent e-cigarette use is a national public health priority. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
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Affiliation(s)
- Matthew G Kirkpatrick
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California
| | - Allison Dormanesh
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California
| | - Jennifer B Unger
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California
| | - Jon-Patrick Allem
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California
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24
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Sood N, Lam CN, Kawaguchi E, Pernet O, Kovacs A, Unger JB, Hu H. Association between levels of receptor binding domain antibodies of SARS-CoV-2, receipt of booster and risk of breakthrough infections: LA pandemic surveillance cohort study. Sci Rep 2023; 13:20761. [PMID: 38007568 PMCID: PMC10676434 DOI: 10.1038/s41598-023-47261-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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 11/10/2023] [Indexed: 11/27/2023] Open
Abstract
Prevention of COVID-19 with vaccine requires multiple doses and updated boosters to maintain protection; however currently there are no tests that can measure immunity and guide clinical decisions about timing of booster doses. This study examined the association between the risk of COVID-19 breakthrough infections and receptor binding domain (RBD) antibody levels and receipt of booster of COVID-19 vaccines. A community sample of Los Angeles County adults were surveyed between 2021 and 2022 to determine if they had a self-reported breakthrough infection. Predictors included RBD antibody levels, measured by binding antibody responses to the ancestral strain at baseline and self-reported booster shot during the study period. Of the 859 participants, 182 (21%) reported a breakthrough infection. Irrespective of the level of antibodies, the risk of breakthrough infection was similar, ranging from 19 to 23% (P = 0.78). The risk of breakthrough infections was lower among participants who had a booster shot (P = 0.004). The protective effect of a booster shot did not vary by antibody levels prior to receiving the booster. This study found no association between RBD antibody levels and risk of breakthrough infections, while the receipt of booster was associated with lower risk of breakthrough infections, which was independent of pre-booster antibody levels. Therefore, antibody levels might not be a useful guide for clinical decisions about timing of booster doses.
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Affiliation(s)
- Neeraj Sood
- Sol Price School of Public Policy, University of Southern California, University Park Campus, Verna and Peter Dauterive Hall, 635 Downey Way, Los Angeles, CA, 90089, USA.
- Schaeffer Center for Health Policy & Economics, University of Southern California, Los Angeles, USA.
- Keck School of Medicine, University of Southern California, Los Angeles, USA.
| | - Chun Nok Lam
- Keck School of Medicine, University of Southern California, Los Angeles, USA
| | - Eric Kawaguchi
- Keck School of Medicine, University of Southern California, Los Angeles, USA
| | - Olivier Pernet
- Keck School of Medicine, University of Southern California, Los Angeles, USA
| | - Andrea Kovacs
- Keck School of Medicine, University of Southern California, Los Angeles, USA
| | - Jennifer B Unger
- Keck School of Medicine, University of Southern California, Los Angeles, USA
| | - Howard Hu
- Keck School of Medicine, University of Southern California, Los Angeles, USA
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25
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Allem JP, Rodriguez V, Pattarroyo M, Ramirez CM, Beard TA, Soto D, Donaldson SI, Unger JB. Spanish-language tobacco-related posts on Twitter: content analysis. Nicotine Tob Res 2023:ntad220. [PMID: 37942524 DOI: 10.1093/ntr/ntad220] [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: 03/30/2023] [Indexed: 11/10/2023]
Abstract
INTRODUCTION Twitter data has been used to surveil public sentiment about tobacco products, however, most tobacco-related Twitter research has been conducted with English-language posts. There is a gap in the literature on tobacco-related discussions on Twitter in languages other than English. This study summarized tobacco-related discussions in Spanish on Twitter. METHODS A set of Spanish terms reflecting electronic cigarettes (e.g., cigarillos electrónicos), cigarettes (e.g., "pitillo"), and cigars (e.g., "cigaro") were identified. A content analysis of tweets (n=1,352) drawn from 2021 was performed to examine themes and sentiment. An initial codebook was developed in English then translated to Spanish and then translated back to English by a bilingual (Spanish and English) member of the research team. Two bilingual members of the research team coded the tweets into themes and sentiment. RESULTS Themes in the tweets included 1) product promotion (n=168, 12.4%), 2) health warnings (n=161, 11.9%), 3) tobacco use (n=136, 10.1%), 4) health benefits of vaping (n=58, 4.3%), 5) cannabis use (n=50, 3.7%), 6) cessation (n=47, 3.5%), 7) addiction (n=33, 2.4%), 8) policy (n=27, 2.0%), and 9) polysubstance use (n=12, 0.9%). Neutral (n=955, 70.6%) was the most common category of sentiment observed in the data. CONCLUSIONS Tobacco products are discussed in multiple languages on Twitter and can be summarized by bilingual research teams. Future research should determine if Spanish-speaking individuals are frequently exposed to pro-tobacco content on social media and if such exposure increases susceptibility to use tobacco among never users or sustained use among current users. IMPLICATIONS Spanish-language pro-tobacco content exists on Twitter, which has implications for Spanish-speaking individuals who may be exposed to this content. Spanish-language pro-tobacco-related posts may help normalize tobacco use among Spanish-speaking populations. As a result, anti-tobacco tweets in Spanish may be necessary to counter areas of the online environment that can be considered pro-tobacco.
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Affiliation(s)
- Jon-Patrick Allem
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Viviana Rodriguez
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Monica Pattarroyo
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Carla M Ramirez
- Department of Human Development and Family Studies, Colorado State University, Fort Collins, CO
| | - Trista A Beard
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Daniel Soto
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Scott I Donaldson
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Jennifer B Unger
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA
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26
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Nicolo M, Kawaguchi E, Ghanem-Uzqueda A, Soto D, Deva S, Shanker K, Lee R, Gilliland F, Klausner JD, Baezconde-Garbanati L, Kovacs A, Van Orman S, Hu H, Unger JB. Characteristics associated with attitudes and behaviors towards mask wearing during the COVID-19 pandemic: The Trojan Pandemic Response Initiative. BMC Public Health 2023; 23:1968. [PMID: 37821836 PMCID: PMC10566076 DOI: 10.1186/s12889-023-16915-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 10/05/2023] [Indexed: 10/13/2023] Open
Abstract
BACKGROUND Attitudes and behaviors towards mask wearing may influence the ability to reduce transmission of COVID-19 and other diseases. METHODS University students, staff, and faculty (N = 9653) responded to an email invitation to complete electronic surveys (November 2021 and April 2022). Surveys included 19 items measuring attitudes and behaviors towards mask wearing from the Understanding America Study. Linear mixed models including variables for sex, age group, division, race and ethnicity, political affiliation, and history of COVID-19, were used to estimate the mean difference of the mean score for attitudes and behavior between Time 1 (November 2021) and Time 2 (April 2022). RESULTS Participants were mostly female (62.1%), students (70.6%), White (39.5%) and Asian (34.7%). More than half identified their political affiliation as Democrat (65.5%). Characteristic variable-by-time interactions for difference in mean mask attitude scores difference were significant at Time 1 (T1) and Time 2 (T2) between Black and White participants (B = 0.18 (0.05), 95% CI: 0.07, 0.28, p = 0.001), Asian and White participants (B = 0.07 (0.02), 95% CI: 0.03-0.12, p = 0.001), participants with self-reported history of COVID-19 and no history of COVID-19 (B= -0.13 (0.02), 95% CI: -0.07, -0.18, p < 0.0001), females and males (B = 0.07 (0.02), 95% CI: 0.03, 0.11, p = 0.001), Republicans and Democrats (B= -0.18 (0.04), 95%CI: -0.26, -0.10, p < 0.0001) and Independents and Democrats (B= -0.10 (0.03), 95%CI: -0.15, -0.05, p < 0.0001). Mean difference in mean scores for mask behaviors at Time and Time 2 were significant between participants with COVID-19 and participants who did not have COVID-19 (B= -0.12 (0.04), 95% CI: -0.19, -0.04, p = 0.004), students compared to faculty and staff (B=-0.22 (0.05), -0.32, -0.12, p < 0.0001), between Republicans and Democrats (B-= -0.16 (0.07), 95% CI: -0.28, -0.03, p = 0.020, and between Independents and Democrats (B=-0.08 (0.04), 95% CI: -0.16, -0.002, p = 0.04). CONCLUSION Race and ethnicity, political affiliation, and division may affect attitudes and behaviors in mask wearing. Further investigation into how characteristics influence public health measures such as mask wearing is needed to contain the spread of the COVID-19 virus, other infectious diseases, and future pandemics.
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Affiliation(s)
- Michele Nicolo
- Department of Nutrition and Food Science, California State University Los Angeles, Los Angeles, CA, USA.
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
| | - Eric Kawaguchi
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Angie Ghanem-Uzqueda
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
- Family Medicine, Keck Medicine of USC, Los Angeles, CA, USA
| | - Daniel Soto
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Sohini Deva
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Kush Shanker
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Ryan Lee
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Frank Gilliland
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Jeffrey D Klausner
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | | | - Andrea Kovacs
- Keck School Medicine of USC, University of Southern California, Los Angeles, USA
| | - Sarah Van Orman
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
- Family Medicine, Keck Medicine of USC, Los Angeles, CA, USA
| | - Howard Hu
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Jennifer B Unger
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
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27
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Lam CN, Tam B, Kawaguchi ES, Unger JB, Hur K. The Differential Experience of COVID-19 on Asian American Subgroups: The Los Angeles Pandemic Surveillance Cohort Study. J Racial Ethn Health Disparities 2023:10.1007/s40615-023-01742-y. [PMID: 37819411 DOI: 10.1007/s40615-023-01742-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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 08/01/2023] [Accepted: 08/02/2023] [Indexed: 10/13/2023]
Abstract
Data from Asian Americans (AsA) are commonly aggregated in research studies and reporting, obscuring the significant differences across AsA subgroups. We investigated the differential experience of AsA subgroups in COVID-19 testing, vaccination, engagement in risky and protective behaviors and mental health status against this infectious disease. We surveyed a representative sample of the Los Angeles County population (N = 5500) in April 2021 as part of the Los Angeles Pandemic Surveillance Cohort Study and focused on participants who self-identified as AsA (N = 756). There were significant differences across the AsA subgroups, with Koreans, Asian Indians, and Other Asians living in areas with higher COVID-19 mortality rates, and Asian Indians demonstrating the lowest proportion of COVID-19 vaccination. Vietnamese and Koreans had a higher proportion of becoming unemployed during the pandemic. Although the AsA sample on average demonstrated better outcomes than other racial and ethnic groups, the apparent advantages were heterogenous and due to specific subgroups of AsAs rather than AsAs as a whole. The observed differences in COVID-19 measures across AsA subgroups underscore the need to disaggregate AsA data to identify and reduce existing disparities.
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Affiliation(s)
- Chun Nok Lam
- Department of Emergency Medicine, Keck School of Medicine of USC, 1200 N State Street, Room 1011, Los Angeles, CA, 90033, USA.
- Department of Population and Public Health Sciences, Keck School of Medicine of USC, 1845 N Soto Street, Los Angeles, CA, 90032, USA.
| | - Benjamin Tam
- Caruso Department of Otolaryngology - Head and Neck Surgery, Keck School of Medicine of USC, Los Angeles, USA
| | - Eric S Kawaguchi
- Department of Population and Public Health Sciences, Keck School of Medicine of USC, 1845 N Soto Street, Los Angeles, CA, 90032, USA
| | - Jennifer B Unger
- Department of Population and Public Health Sciences, Keck School of Medicine of USC, 1845 N Soto Street, Los Angeles, CA, 90032, USA
| | - Kevin Hur
- Caruso Department of Otolaryngology - Head and Neck Surgery, Keck School of Medicine of USC, Los Angeles, USA
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Bostean G, Ponicki WR, Padon AA, McCarthy WJ, Unger JB. A statewide study of disparities in local policies and tobacco, vape, and cannabis retail environments. Prev Med Rep 2023; 35:102373. [PMID: 37691887 PMCID: PMC10483047 DOI: 10.1016/j.pmedr.2023.102373] [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: 03/27/2023] [Revised: 08/15/2023] [Accepted: 08/16/2023] [Indexed: 09/12/2023] Open
Abstract
The current study: (1) assesses sociodemographic disparities in local policies related to tobacco and cannabis retail, and (2) examines the cross-sectional association between policy strength and retailer densities of tobacco, e-cigarette (vape), and cannabis retailers within California cities and county unincorporated areas (N = 539). We combined (a) American Community Survey data (2019 5-year estimates), (b) 2018 tobacco, vape, and cannabis retailer locations from a commercial data provider, (c) 2017 tobacco and vape retail environment policy data from American Lung Association, and (d) 2018 cannabis policy data from California Cannabis Local Laws Database. Conditional autoregressive models examined policy strength associations with sociodemographic composition and retailer density in California jurisdictions. Jurisdictions with larger percentages of Black and foreign-born residents had stronger tobacco and vape policies. For cannabis policy, only income had a small, significant positive association with policy strength. Contrary to hypothesis, tobacco/vape policies were not significantly associated with retailer density, but cannabis policy strength was associated with lower cannabis retailer density (relative rate = 0.58, 95% Uncertainty Interval 0.47-0.70)-this effect was completely driven by storefront bans. Thus, storefront cannabis bans were the only policy studied that was associated with lower cannabis retailer density. Further research is needed to understand policies and disparities in retail environments for tobacco, vape, and cannabis, including data on the prospective association between policy implementation and subsequent retailer density, and the role of enforcement.
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Affiliation(s)
- Georgiana Bostean
- Sociology Department, Environmental Science & Policy Program, Chapman University, One University Drive, Orange, CA 92866, USA
| | - William R. Ponicki
- Prevention Research Center, Pacific Institute for Research and Evaluation, Berkeley, CA, USA
| | | | - William J. McCarthy
- Department of Health Policy & Management, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, CA, USA
| | - Jennifer B. Unger
- Department of Population and Public Health Sciences, University of Southern California, Los Angeles, CA, USA
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Donaldson SI, Dormanesh A, Perez C, Zaffer MO, Majmundar A, Unger JB, Allem JP. Monitoring the Official YouTube Channels of E-Cigarette Companies: A Thematic Analysis. Health Educ Behav 2023; 50:677-682. [PMID: 36680338 DOI: 10.1177/10901981221148964] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND E-cigarette companies use YouTube to foster brand awareness, market their products, and interact with current and future tobacco users. However, research on the official YouTube channels of e-cigarette companies is limited. This study determined the themes of, and degree of user engagement with, videos posted to the official channels of e-cigarette companies on YouTube. METHODS Data were collected from the official YouTube channels of seven e-cigarette companies by scraping (i.e., electronically copying) the videos. The earliest video was posted on October 10, 2013, and the most recent video was posted on April 22, 2021 (n = 260). An inductive approach was used to identify themes in the data. User engagement with posts including number of likes, dislikes, and comments were also collected. RESULTS Prevalent themes included branding (n = 250 of 260 videos, 96%), youth use (n = 222, 85%), and tobacco use (n = 210, 81%), while less common themes included misleading health statements (n = 4, 2%), personal choice (n = 4, 2%), and antitobacco (n = 2, 1%). Videos that contained the themes testimonial, product design features, and instructional received the highest mean number of likes. Videos that contained the themes antitobacco, cessation, and testimonial received the highest mean number of dislikes. The 260 videos in this study were collectively viewed 6,619,700 times as of May 5, 2021. CONCLUSIONS Videos from the official YouTube channels of seven e-cigarette companies often focused on branding and user experience but rarely mentioned cessation. While videos about cessation were rare, they received the second highest mean number of dislikes. Future research should assess the impact of exposure to e-cigarette-related content on YouTube and e-cigarette-related attitudes and behaviors.
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Affiliation(s)
| | | | - Cindy Perez
- University of Southern California, Los Angeles, CA, USA
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Donaldson SI, Beard T, Dormanesh A, Pérez C, Escobedo P, Unger JB, Wipfli HL, Galimov A, Allem JP. Monitoring website marketing among leading e-cigarette brands and vendors in California: content analysis. Tob Control 2023:tc-2023-058000. [PMID: 37643863 DOI: 10.1136/tc-2023-058000] [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: 02/13/2023] [Accepted: 08/16/2023] [Indexed: 08/31/2023]
Abstract
BACKGROUND Electronic cigarette (e-cigarette) brands and vendors use websites to promote pro-tobacco messages that may increase susceptibility to use e-cigarettes among never users or help sustain continued e-cigarette use among current users. E-cigarette website marketing is lightly regulated, and little is known about promotional strategies used on e-cigarette companies' websites. This study conducted a content analysis of website marketing from leading e-cigarette companies selling products in California. METHODS This study identified 20 e-cigarette vendors and 6 e-cigarette brands that had products available for purchase online in California. Two coders visited 26 websites between 06 February 2022 and 17 April 2022. Websites were coded for marketing themes, promotional and interactive content, availability of flavoured e-cigarette products, presence of health warnings, and reference to tobacco control policies. RESULTS Marketing themes related to physical health benefits of e-cigarette use were found on 50.0% of the websites. 57.7% of the websites had sales/discounts/coupons. 65.4% of the websites had fruit-flavoured disposable e-cigarettes, while 73.1% of the websites had fruit-flavoured e-liquids available for purchase. 69.2% of the websites allowed users to sign up for email newsletters, and 88.9% of such websites did not require users to create an age-verified account to receive email newsletters. CONCLUSIONS Findings from this study can be used to inform statewide regulations of promotional communications found on e-cigarette companies' websites and encourage enforcement of age-verification procedures. This may help reduce susceptibility to use, or continued use of, e-cigarette products among price-sensitive populations, such as adolescents and young adults.
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Affiliation(s)
- Scott I Donaldson
- Department of Population and Public Health Sciences, USC Keck School of Medicine, Los Angeles, California, USA
| | - Trista Beard
- Department of Population and Public Health Sciences, USC Keck School of Medicine, Los Angeles, California, USA
| | - Allison Dormanesh
- Department of Population and Public Health Sciences, USC Keck School of Medicine, Los Angeles, California, USA
| | - Cindy Pérez
- Department of Population and Public Health Sciences, USC Keck School of Medicine, Los Angeles, California, USA
| | - Patricia Escobedo
- Department of Psychology, California State University Northridge, Northridge, California, USA
| | - Jennifer B Unger
- Department of Population and Public Health Sciences, USC Keck School of Medicine, Los Angeles, California, USA
| | - Heather Lynn Wipfli
- Department of Population and Public Health Sciences, USC Keck School of Medicine, Los Angeles, California, USA
| | - Artur Galimov
- Department of Population and Public Health Sciences, USC Keck School of Medicine, Los Angeles, California, USA
| | - Jon-Patrick Allem
- Department of Population and Public Health Sciences, USC Keck School of Medicine, Los Angeles, California, USA
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31
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Shin MB, Sloan K, Baezconde-Garbanati L, Dang E, Garcia S, Palinkas LA, Unger JB, Willgerodt M, Crabtree BF, Tsui J. Multilevel perspectives on school-based opportunities to improve HPV vaccination among medically underserved adolescents: Beyond school entry mandates. Hum Vaccin Immunother 2023; 19:2251815. [PMID: 37666253 PMCID: PMC10478734 DOI: 10.1080/21645515.2023.2251815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 07/12/2023] [Accepted: 08/01/2023] [Indexed: 09/06/2023] Open
Abstract
School-based HPV vaccination programs have improved vaccine uptake among adolescents globally. However, school-based HPV vaccination strategies in the United States (US) have mainly focused on school-entry mandates for vaccination, which have passed in only five states/jurisdictions. Many schools and school-based health centers (SBHCs) already provide health services to medically underserved adolescents and opportunities to improve disparities in HPV vaccine education and uptake are underexplored. This qualitative study of clinic and community members assessed potential opportunities within and outside schools to increase HPV vaccination. Data were generated from a larger mixed-methods study designed to understand experiences with HPV vaccination evidence-based strategies in medically underserved communities. The parent study included interviews and focus groups conducted with clinic (providers, clinic leaders, staff) and community (racial/ethnic minority parents, advocates, payers, policy representatives) members in Los Angeles and New Jersey between December 2020-January 2022. We created a reduced dataset of text related to schools/SBHCs (30 in-depth interviews, 7 focus groups) and conducted a directed content analysis. Participants indicated that schools and SBHCs are ideal venues for reaching medically underserved adolescents experiencing barriers to primary care access. Parents/providers expressed mutual interest in HPV vaccine administration/education in schools, but some advocates/policy participants experienced challenges due to increasing politicization of vaccines. Participants highlighted policies for expanding HPV vaccine education and administration in schools, including minor consent and increasing SBHC funding for HPV vaccines. More research is needed to explore existing infrastructure, partner motivation, and opportunities to improve HPV vaccination among medically underserved adolescents within schools beyond vaccine mandates.
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Affiliation(s)
- Michelle B. Shin
- Department of Child, Family, and Population Health Nursing, School of Nursing, University of Washington, Seattle, WAUSA
| | - Kylie Sloan
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Lourdes Baezconde-Garbanati
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
- Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, USA
| | - Emily Dang
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Samantha Garcia
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Lawrence A. Palinkas
- USC Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, CA, USA
| | - Jennifer B. Unger
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
- Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, USA
| | - Mayumi Willgerodt
- Department of Child, Family, and Population Health Nursing, School of Nursing, University of Washington, Seattle, WAUSA
| | | | - Jennifer Tsui
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
- Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, USA
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32
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Vassey J, Valente T, Barker J, Stanton C, Li D, Laestadius L, Cruz TB, Unger JB. E-cigarette brands and social media influencers on Instagram: a social network analysis. Tob Control 2023; 32:e184-e191. [PMID: 35131947 PMCID: PMC9473311 DOI: 10.1136/tobaccocontrol-2021-057053] [Citation(s) in RCA: 32] [Impact Index Per Article: 32.0] [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: 09/12/2021] [Accepted: 12/22/2021] [Indexed: 01/15/2023]
Abstract
BACKGROUND Exposure to visual posts featuring e-cigarette products on social media is associated with increased e-cigarette use among US adolescents. Instagram is the largest source of e-cigarette social media marketing, where influencers-for example, bloggers, brand ambassadors-post promotional materials. This study analysed the network of e-cigarette brands and influencers on Instagram, characterising the most central players in e-cigarette social media marketing. METHODS We tracked influencers with public profiles on Instagram who posted promotional e-cigarette content in 2020, had over 1000 followers and high user engagement rate (ratio of likes and comments to followers) of 1%-25% per post. By conducting a social network analysis, we identified the most central (highly involved in promotional activities) influencers and e-cigarette brands. The number of the influencers' followers aged 13-17 years old and the age verification practices restricting youth access were also assessed. RESULTS There is a highly interconnected network of engaging e-cigarette influencers (n=55) worldwide who collaborated with over 600 e-cigarette brands in 2020. The Asian and US influencers had five to six times more teenage followers compared with the European influencers. 75% of the influencers did not restrict youth access to their promotional content on Instagram. The brands Voopotech, Innokin, Geekvape, Lost Vape, Smok and Vaporesso collaborated with the largest number of influencers (mean n=20). CONCLUSIONS It is important to understand associations among influencers and e-cigarette use behaviours, especially youth, to inform effective public health communication and potential policies that could regulate social media marketing sponsored by e-cigarette companies.
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Affiliation(s)
- Julia Vassey
- Population and Public Health Sciences, University of Southern California, Los Angeles, California, USA
| | - Tom Valente
- Population and Public Health Sciences, University of Southern California, Los Angeles, California, USA
| | - Joshua Barker
- Population and Public Health Sciences, University of Southern California, Los Angeles, California, USA
| | - Cassandra Stanton
- Behavioral Health and Health Policy Practice, Westat, Rockville, Maryland, USA
| | - Dongmei Li
- Clinical and Translational Science Institute, University of Rochester, Rochester, New York, USA
| | - Linnea Laestadius
- Zilber School of Public Health, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin, USA
| | - Tess Boley Cruz
- Population and Public Health Sciences, University of Southern California, Los Angeles, California, USA
| | - Jennifer B Unger
- Population and Public Health Sciences, University of Southern California, Los Angeles, California, USA
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33
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Unger JB, Herzig E, Rodriguez V, Soto D, Lee R, Sood N. Application of Protection Motivation Theory to COVID-19 vaccination among a predominantly Hispanic sample of adolescents. Prev Med Rep 2023; 34:102245. [PMID: 37252067 PMCID: PMC10197527 DOI: 10.1016/j.pmedr.2023.102245] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 03/01/2023] [Accepted: 05/11/2023] [Indexed: 05/31/2023] Open
Abstract
Despite the efficacy and widespread availability of COVID-19 vaccines, vaccine uptake has been relatively low in U.S. Hispanic communities, especially among adolescents. This study examined vaccination status among 444 high school students in predominantly Hispanic neighborhoods of Los Angeles County, California in May-June 2022 (mean age = 15.74 years, 55% female, 93% Hispanic). Guided by Protection Motivation Theory, we hypothesized that the odds of being fully vaccinated (at least 2 vaccine doses) would be significantly associated with higher levels of perceived severity, perceived vulnerability, response efficacy, and self-efficacy. 79% of the respondents were fully vaccinated. Binary logistic regression analyses found that response efficacy (belief in the effectiveness of the COVID-19 vaccine) and self-efficacy to get vaccinated were significantly associated with the likelihood of being fully vaccinated. Perceived severity of COVID-19 and perceived vulnerability to COVID-19 were not associated with the likelihood of being fully vaccinated. Results indicate that health communications are needed to convince Hispanic adolescents and their parents that the COVID-19 vaccine is effective, and outreach efforts are needed to remove barriers to vaccination among this population.
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Affiliation(s)
- Jennifer B Unger
- University of Southern California Keck School of Medicine, United States
| | - Emma Herzig
- University of Southern California Keck School of Medicine, United States
| | - Viviana Rodriguez
- University of Southern California Keck School of Medicine, United States
| | - Daniel Soto
- University of Southern California Keck School of Medicine, United States
| | - Ryan Lee
- University of Southern California Keck School of Medicine, United States
| | - Neeraj Sood
- University of Southern California Sol Price School of Public Policy, United States
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34
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Vassey J, Unger JB. Should Tobacco-Related Marketing on Social Media Have Stronger Restrictions? Commentary. Subst Use Misuse 2023; 58:1615-1619. [PMID: 37442760 DOI: 10.1080/10826084.2023.2223287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/15/2023]
Abstract
Background: Tobacco-related promotional content on social media often features young-looking influencers, models, or brand ambassadors who are appealing to youth; their posts often have inconsistent disclosures of partnerships with tobacco brands and lack age-restrictions prohibiting access to users under 18 or 21 years of age. These examples demonstrate violations of the U.S. Federal Food and Drug Administration (FDA) marketing restrictions. Methods: Marketing granted orders issued by the FDA to RJ Reynolds, Logic Technology, NJOY and Phillip Morris as part of the Premarket Tobacco Product Applications (PMTA) review process were qualitatively analyzed. Marketing practices that the tobacco companies intended to adhere to (e.g., refrain from using young-looking influencers in marketing materials) were documented. Perceived age of 55 micro-influencers who promote e-cigarette products on Instagram were assessed by 15 undergraduate student raters. Results: Despite the existing regulations of tobacco-related online marketing, the use of models or influencers and overall social media marketing is not prohibited, which leaves room for potential use of loopholes. The tobacco companies that were issued marketing granted orders set different age limits for the models to be considered young-looking and not to be used in marketing materials. The perceived age of the 55 influencers assessed by the raters was between 21-30, which is below the age limit proposed in several PMTA applications. Conclusion: Tobacco product online marketing, especially on social media, is underregulated. Strengthening tobacco marketing regulations, along with partnering of policymakers with social media platforms on establishing and maintaining effective tobacco-restriction policies, could help reduce proliferation of youth-appealing marketing of tobacco products.
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Affiliation(s)
- Julia Vassey
- Department of Population and Public Health Sciences, University of Southern California, Los Angeles, California, USA
| | - Jennifer B Unger
- Department of Population and Public Health Sciences, University of Southern California, Los Angeles, California, USA
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Abstract
Introduction This mixed-methods study analyzed English-language U.S.-based Twitter posts related to E-cigarette use from February 2021. Methods Posts were manually identified as health-related or not and, if health-related, whether they were posted by an E-cigarette user. A random selection of 1,000 health-related tweets from 986 unique E-cigarette users were qualitatively content analyzed for theory of planned behavior constructs as well as nature and tone of each tweet message. Using quantitative semantic network analysis, relationships among the identified topics and sentiment-specific conversation patterns were explored. Results The most salient health-related conversation topics of E-cigarette users, health beliefs corresponding to each theory of planned behavior construct, and major motivational contexts of E-cigarette use were identified. Seven topics emerged in positive tweets: smoking cessation, social impact generation, controls over addiction, therapeutic effects on physical and mental health, social support, device attachment, and peer influence. Nine topics emerged in negative tweets: side effects on physical health, vaping addiction, lack of E-cigarette regulations, peer pressure, increased risk of COVID-19, side effects on mental health, no help in smoking cessation, social conflict, and polysubstance use. Most assertions for E-cigarette benefits were not substantiated. Jokes in tweets appeared to contribute to the view of vaping as an attractive, enjoyable, safe, and fun activity. Discussions about positive aspects of E-cigarette use were concentrated on a few related topics, whereas tweets discouraging E-cigarette use presented a diverse, less related set of topics. Conclusions The results provide insights into the drivers of E-cigarette use behaviors. E-cigarette user perspectives gathered from social media may inform research to guide future prevention and cessation interventions.
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Affiliation(s)
- Ian Kim
- Keck School of Medicine of USC, University of Southern California, Los Angeles, California
- Dornsife Spatial Sciences Institute, University of Southern California, Los Angeles, California
| | - Cynthia Begay
- Keck School of Medicine of USC, University of Southern California, Los Angeles, California
| | - Harrison J. Ma
- Keck School of Medicine of USC, University of Southern California, Los Angeles, California
| | - Francis R. Orozco
- Keck School of Medicine of USC, University of Southern California, Los Angeles, California
| | - Christopher J. Rogers
- College of Health and Human Development, California State University Northridge, Los Angeles, California
| | - Thomas W. Valente
- Keck School of Medicine of USC, University of Southern California, Los Angeles, California
| | - Jennifer B. Unger
- Keck School of Medicine of USC, University of Southern California, Los Angeles, California
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36
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Bostean G, Palma AM, Padon AA, Linstead E, Ricks-Oddie J, Douglas JA, Unger JB. Adolescent use and co-use of tobacco and cannabis in California: The roles of local policy and density of tobacco, vape, and cannabis retailers around schools. Prev Med Rep 2023; 33:102198. [PMID: 37223551 PMCID: PMC10201907 DOI: 10.1016/j.pmedr.2023.102198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 03/30/2023] [Accepted: 03/31/2023] [Indexed: 05/25/2023] Open
Abstract
Adolescent tobacco use (particularly vaping) and co-use of cannabis and tobacco have increased, leading some jurisdictions to implement policies intended to reduce youth access to these products; however, their impacts remain unclear. We examine associations between local policy, density of tobacco, vape, and cannabis retailers around schools, and adolescent use and co-use of tobacco/vape and cannabis. We combined 2018 statewide California (US) data on: (a) jurisdiction-level policies related to tobacco and cannabis retail environments, (b) jurisdiction-level sociodemographic composition, (c) retailer locations (tobacco, vape, and cannabis shops), and (d) survey data on 534,176 middle and high school students (California Healthy Kids Survey). Structural equation models examined how local policies and retailer density near schools are associated with frequency of past 30-day cigarette smoking or vaping, cannabis use, and co-use of tobacco/vape and cannabis, controlling for jurisdiction-, school-, and individual-level confounders. Stricter retail environment policies were associated with lower odds of past-month use of tobacco/vape, cannabis, and co-use of tobacco/vape and cannabis. Stronger tobacco/vape policies were associated with higher tobacco/vape retailer density near schools, while stronger cannabis policies and overall policy strength (tobacco/vape and cannabis combined) were associated with lower cannabis and combined retailer densities (summed tobacco/vape and cannabis), respectively. Tobacco/vape shop density near schools was positively associated with tobacco/vape use odds, as was summed retailer density near schools and co-use of tobacco, cannabis. Considering jurisdiction-level tobacco and cannabis control policies are associated with adolescent use of these substances, policymakers may proactively leverage such policies to curb youth tobacco and cannabis use.
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Affiliation(s)
- Georgiana Bostean
- Sociology Department, Environmental Science & Policy Program, Chapman University, One University Drive, Orange, CA 92866, USA
| | - Anton M. Palma
- Institute for Clinical and Translational Science, University of California Irvine, 843 Health Science Rd, Irvine, CA 92697, USA
| | - Alisa A. Padon
- Public Health Institute, 555 12th Street, Suite 600, Oakland, CA 94607, USA
| | - Erik Linstead
- Electrical Engineering and Computer Science, Fowler School of Engineering, Chapman University, One University Drive, Orange, CA 92866, USA
| | - Joni Ricks-Oddie
- Institute for Clinical and Translational Science, University of California Irvine, 843 Health Science Rd, Irvine, CA 92697, USA
- Center for Statistical Consulting, Department of Statistics, University of California, Irvine, Irvine CA, USA
| | - Jason A. Douglas
- Department of Health Sciences, Crean College of Health and Behavioral Sciences, Chapman University, One University Drive, Orange, CA 92866, USA
| | - Jennifer B. Unger
- Department of Population and Public Health Sciences, University of Southern California, 1845 N Soto St, Los Angeles, CA 90032, USA
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37
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Zeledon I, Unger JB, Meca A, Duque M, Lee R, Soto DW, Pickering T, Schwartz SJ. Cultural Stress Profiles: Describing Different Typologies of Migration Related and Cultural Stressors among Hispanic or Latino Youth. J Youth Adolesc 2023:10.1007/s10964-023-01784-9. [PMID: 37199851 DOI: 10.1007/s10964-023-01784-9] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 04/29/2023] [Indexed: 05/19/2023]
Abstract
Youth of immigrant origin vary across their families' migration history (e.g., country of heritage, reasons for migration, etc.) and in the communities in which they reside. As such, these youth are often faced with different cultural and immigrant stressors. Although prior research documented the detrimental impact of cultural and immigrant stressors, variable-centered approaches fail to account for the fact that these stressors often co-occur. Addressing this gap, the current study identified typologies of cultural stressors in Hispanic/Latino adolescents using latent profile analysis. Cultural stress profiles were derived using socio-political stress, language brokering, in-group identity threats, and within-group discrimination as indicators. The study was conducted in two sites (Los Angeles and Miami; total N = 306) during Spring and Summer 2020. A four-profile solution was identified: Low Cultural Stress (n = 94, 30.7%), Sociopolitical and Language Brokering Stress (n = 147, 48%), Sociopolitical and In-group Identity Threat Stress (n = 48, 15.7%), and Higher Stress (n = 17, 5.6%). Results indicate that profiles with stress were characterized by worse mental health symptoms, reporting higher means of depression, stress, and lower self-esteem, as well as by higher heritage cultural orientation compared to the low stress profile. Interventions designed to mitigate the deleterious effects of cultural stressors would benefit from adopting an individualized, tailored approach that addresses youth's stress profile membership.
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Affiliation(s)
- Ingrid Zeledon
- University of Southern California Keck School of Medicine, Los Angeles, CA, USA.
| | - Jennifer B Unger
- University of Southern California Keck School of Medicine, Los Angeles, CA, USA
| | - Alan Meca
- University of Texas at San Antonio, San Antonio, TX, USA
| | - Maria Duque
- University of Texas at Austin, Austin, TX, USA
| | - Ryan Lee
- University of Southern California Keck School of Medicine, Los Angeles, CA, USA
| | - Daniel W Soto
- University of Southern California Keck School of Medicine, Los Angeles, CA, USA
| | - Trevor Pickering
- University of Southern California Keck School of Medicine, Los Angeles, CA, USA
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38
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Montero-Zamora P, Vos SR, Unger JB, Zeledon I, Lee R, Soto DW, Brown EC, Duque M, Garcia MF, Scaramutti C, Ertanir B, Schwartz SJ. Perceived Negative Political Climate Among Hispanic/Latino Adolescents Before and After the 2020 U.S. Presidential Election: Associations with Internalizing Symptoms and Substance Use. Int J Intercult Relat 2023; 94:101790. [PMID: 37091741 PMCID: PMC10121197 DOI: 10.1016/j.ijintrel.2023.101790] [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] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
The political climate often changes following the installment of a new president. This volatility presents opportunities for examining how elections might affect vulnerable subgroups such as Hispanic/Latino (HL) adolescents. The present study explored the perception of negative political climate among HL adolescents before and after the 2020 U.S. presidential election and its association with internalizing symptoms and substance use. We conducted the study in Los Angeles and Miami between 2020-2021, with a sample of 304 HL adolescents (Females = 60.8%), aged 15.3 years on average. Participants completed measures of negative political climate (pre- post-election) and measures of depressive symptoms, anxiety, substance misuse, and substance use intentions after the election. We used paired tests and linear mixed-effects modeling to explore changes in perceived negative climate before and after the election. Structural equation modeling was used to determine predictors of negative political climate and its associations with internalizing symptoms and substance use. Results indicated that following the election negative political climate increased significantly in Miami and among Cuban-origin adolescents but not in Los Angeles or among Mexican-origin adolescents. Pre-election perceived negative political climate was significantly predicted by gender, study site, and mother's nativity. Pre-election negative political climate predicted post-election internalizing symptoms and substance use intentions indirectly through post-election negative political climate. HL youth's perceived political climate is a complex construct that might vary across different sociopolitical contexts and populational sub-groups. Exploring variations in politically-based cultural stressors and their role as mental health and substance use risk factors is crucial to addressing HL disparities. KEY WORDS: Adolescence, Hispanic/Latino, political climate, presidential election, internalizing symptoms, substance use.
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Affiliation(s)
- Pablo Montero-Zamora
- Department of Kinesiology and Health Education, The University of Texas at Austin, Bellmont Hall, 2109 San Jacinto Blvd., Austin, TX 78712, USA
- Corresponding Author: Pablo Montero-Zamora, , Telephone: +1-305-799-6681
| | - Saskia R. Vos
- Department of Public Health Sciences, Miller School of Medicine, University of Miami, 1120, NW 14 Street, Miami FL 33136 USA
| | - Jennifer B. Unger
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, 1975 Zonal Ave, Los Angeles CA 90033 USA
| | - Ingrid Zeledon
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, 1975 Zonal Ave, Los Angeles CA 90033 USA
| | - Ryan Lee
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, 1975 Zonal Ave, Los Angeles CA 90033 USA
| | - Daniel W. Soto
- Schaeffer Center for Health Policy & Economics, University of Southern California, 635 Downey Way, Verna & Peter Dauterive Hall, Los Angeles CA 90089 USA
| | - Eric C. Brown
- Department of Public Health Sciences, Miller School of Medicine, University of Miami, 1120, NW 14 Street, Miami FL 33136 USA
| | - Maria Duque
- Department of Kinesiology and Health Education, The University of Texas at Austin, Bellmont Hall, 2109 San Jacinto Blvd., Austin, TX 78712, USA
| | - Maria Fernanda Garcia
- Department of Educational and Psychological Studies, School of Education and Human Development, University of Miami, 5202 University Drive, Coral Gables FL 33124 USA
| | - Carolina Scaramutti
- Department of Public Health Sciences, Miller School of Medicine, University of Miami, 1120, NW 14 Street, Miami FL 33136 USA
| | - Beyhan Ertanir
- School of Education, University of Applied Sciences and Arts Northwestern Switzerland, 5210 Windisch, Switzerland
| | - Seth J. Schwartz
- Department of Kinesiology and Health Education, The University of Texas at Austin, Bellmont Hall, 2109 San Jacinto Blvd., Austin, TX 78712, USA
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Herzig SE, Albers L, Soto D, Lee R, Ramirez C, Rahman T, Unger JB. Pandemic-related life changes and adolescent initiation of cannabis and tobacco/nicotine use. Addict Behav 2023; 144:107724. [PMID: 37087769 PMCID: PMC10103764 DOI: 10.1016/j.addbeh.2023.107724] [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: 12/08/2022] [Revised: 04/10/2023] [Accepted: 04/11/2023] [Indexed: 04/25/2023]
Abstract
BACKGROUND The COVID-19 pandemic required the public to alter their daily lives drastically. For adolescents, school closures and social isolation added further challenges to a stressful stage of life, potentially increasing the likelihood of substance use initiation. This study explored the relationship between adolescent substance use initiation and negative life changes due to COVID-19. METHODS Students from 9 high schools (N = 2478) in Los Angeles County were surveyed as 9th graders in the 2019-2020 school year and re-surveyed in 10th and 11th grades as part of an ongoing longitudinal study. Two logistic regression models were conducted to test hypotheses that negative life changes due to the COVID-19 pandemic increases the odds of initiation of both tobacco/nicotine products and cannabis products, controlling for sex, age, and race/ethnicity. RESULTS The final analytic sample included adolescents in 10th grade who were never-users of tobacco/nicotine (N = 809) and cannabis (N = 837). The odds of initiating cannabis use increased by 6.42% for every 1 standard deviation increase in the COVID-19 negative daily life changes index [AOR: 1.063; 95% CI: 1.010, 1.121]. The association between the COVID-19 negative daily life changes index and tobacco/nicotine use initiation was not significant. DISCUSSION Adolescents who experienced life changes due to COVID-19 were more likely to initiate cannabis use, but not tobacco/nicotine use. Results identify a need for early intervention efforts to promote effective coping skills and prevent cannabis initiation among adolescents during a wide-scale stressor, such as COVID-19.
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Affiliation(s)
- Shirin Emma Herzig
- University of Southern California, Institute for Health Promotion and Disease Prevention Research, 2001 N Soto Street, Los Angeles, CA 90089-9239, USA.
| | - Larisa Albers
- University of Southern California, Institute for Health Promotion and Disease Prevention Research, 2001 N Soto Street, Los Angeles, CA 90089-9239, USA.
| | - Daniel Soto
- University of Southern California, Institute for Health Promotion and Disease Prevention Research, 2001 N Soto Street, Los Angeles, CA 90089-9239, USA.
| | - Ryan Lee
- University of Southern California, Institute for Health Promotion and Disease Prevention Research, 2001 N Soto Street, Los Angeles, CA 90089-9239, USA.
| | - Carla Ramirez
- University of Southern California, Institute for Health Promotion and Disease Prevention Research, 2001 N Soto Street, Los Angeles, CA 90089-9239, USA.
| | - Tahsin Rahman
- University of Southern California, Institute for Health Promotion and Disease Prevention Research, 2001 N Soto Street, Los Angeles, CA 90089-9239, USA.
| | - Jennifer B Unger
- University of Southern California, Institute for Health Promotion and Disease Prevention Research, 2001 N Soto Street, Los Angeles, CA 90089-9239, USA.
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Allem JP, Donaldson SI, Vogel EA, Pang RD, Unger JB. An Analysis of Twitter Posts About the U.S. Food and Drug Administration's Menthol Ban. Nicotine Tob Res 2023; 25:962-966. [PMID: 36534973 PMCID: PMC10077934 DOI: 10.1093/ntr/ntac290] [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: 07/28/2022] [Revised: 11/22/2022] [Accepted: 12/15/2022] [Indexed: 12/23/2022]
Abstract
INTRODUCTION Although the U.S. Food and Drug Administration (FDA) banned characterizing flavors in cigarettes in 2009, this initial ban exempted menthol. After examining numerous reports on the adverse health effects of menthol cigarettes, the FDA proposed a menthol ban in April 2022. This study analyzed Twitter data to describe public reaction to this announcement. AIMS AND METHODS Posts containing the word "menthol" and/or "#menthol" were collected from April 21, 2022 to May 5, 2022 from Twitter's Streaming Application Programming Interface (API). A random sampling procedure supplied 1041 tweets for analysis. Following an inductive approach to content analysis, posts were classified into one or more of 11 themes. RESULTS Posts discussed the FDA announcement (n = 153, 14.7%), racial discrimination (n = 101, 9.7%), distrust in government (n = 67, 6.4%), inconsistencies between policies (n = 52, 5.0%), public health benefits (n = 42, 4%), freedom of choice (n = 22, 2.1%), and health equity (n = 21, 2.0%). Posts contained misinformation (n = 20, 1.9%), and discussed the potential for illicit markets (n = 18, 1.7%) and the need for cessation support (n = 4, 0.4%). 541 (52.0%) tweets did not fit into any of the prescribed themes. CONCLUSIONS Twitter posts with the word "menthol" commonly discussed distrust in government and mentioned racial discrimination. Findings demonstrated the possibility of near real-time Twitter monitoring of public opinion on a menthol ban. These data may be valuable for designing tobacco control health communication campaigns in the future. IMPLICATIONS The U.S. FDA proposed a ban on menthol cigarettes in April 2022. This study's content analyzed Twitter posts over a 2-week period to understand the public's response to the proposed menthol ban. Twitter posts with the word "menthol" often discussed distrust in government and mentioned racial discrimination. Findings demonstrated the possibility of near real-time Twitter monitoring of public opinion of regulatory action. Findings underscore the need to educate the public about the potential health benefits of banning menthol from cigarettes, particularly for populations that experience tobacco-related health disparities.
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Affiliation(s)
- Jon-Patrick Allem
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Scott I Donaldson
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Erin A Vogel
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Raina D Pang
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Jennifer B Unger
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
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Han DH, Cho J, Harlow AF, Tackett AP, Vogel EA, Wong M, Barrington-Trimis JL, Lerman C, Unger JB, Leventhal AM. Young adults' beliefs about modern oral nicotine products: Implications for uptake in nonvapers, dual use with e-cigarettes, and use to reduce/quit vaping. Exp Clin Psychopharmacol 2023; 31:455-463. [PMID: 36048111 PMCID: PMC10026537 DOI: 10.1037/pha0000595] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [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] [Indexed: 11/08/2022]
Abstract
Modern oral nicotine products (ONPs; nontherapeutic nicotine pouches, gums, lozenges, and gummies) may be perceived in ways that could promote uptake in nonvapers, dual use with e-cigarettes, or use to quit vaping. In this cross-sectional digital remote survey of 1,460 respondents aged 21-24 from Southern California, we examined beliefs about ONPs among past-30-day e-cigarette nonusers, users unmotivated to quit vaping, and users motivated to quit vaping. Positive beliefs about ONPs were reported by 31.8% of the overall sample and higher in past-30-day e-cigarette users (with or without quit motivation) than nonusers. Perceiving ONPs to be easy to conceal, convenient, and able to be used where vaping/smoking is not allowed were the most common types of beliefs reported. Among e-cigarette users with quit motivation (n = 142), interest in using ONPs to quit/reduce vaping (44.4%) was higher than interest in using medicinal nicotine gum/lozenges (23.4%), nicotine patch (17.6%), or prescription medications (16.6%). Interest in using ONPs to reduce/quit vaping (vs. no interest) was greater among participants who reported vaping ≥ 20 (vs. < 10) days in the past month, vaping ≥ 10 (vs. < 10) times per day, low/moderate (vs. high) quit vaping self-efficacy, and low/moderate (vs. high) desire to quit vaping. These findings suggest that: (a) appreciable subsets of the young adult population may hold positive beliefs about ONPs that could promote ONP uptake, particularly e-cigarette users and (b) some young adult e-cigarette users may be interested in using ONPs to reduce/quit vaping, particularly frequent vapers with relatively lower self-efficacy and desire to quit vaping. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
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Affiliation(s)
- Dae-Hee Han
- Institute for Addiction Science, University of Southern California
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California
| | - Junhan Cho
- Institute for Addiction Science, University of Southern California
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California
| | - Alyssa F. Harlow
- Institute for Addiction Science, University of Southern California
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California
| | - Alayna P. Tackett
- Institute for Addiction Science, University of Southern California
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California
- Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California
| | - Erin A. Vogel
- Institute for Addiction Science, University of Southern California
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California
| | - Melissa Wong
- Institute for Addiction Science, University of Southern California
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California
| | - Jessica L. Barrington-Trimis
- Institute for Addiction Science, University of Southern California
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California
- Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California
| | - Caryn Lerman
- Institute for Addiction Science, University of Southern California
- Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California
| | - Jennifer B. Unger
- Institute for Addiction Science, University of Southern California
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California
- Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California
| | - Adam M. Leventhal
- Institute for Addiction Science, University of Southern California
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California
- Norris Comprehensive Cancer Center, Keck School of Medicine, University of Southern California
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Nicolo M, Kawaguchi E, Ghanem-Uzqueda A, Soto D, Deva S, Shanker K, Lee R, Gilliland F, Klausner JD, Baezconde-Garbanati L, Kovacs A, Van Orman S, Hu H, Unger JB. Trust in science and scientists among university students, staff, and faculty of a large, diverse university in Los Angeles during the COVID-19 pandemic, the Trojan Pandemic Response Initiative. BMC Public Health 2023; 23:601. [PMID: 36997945 PMCID: PMC10061384 DOI: 10.1186/s12889-023-15533-x] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 03/27/2023] [Indexed: 04/01/2023] Open
Abstract
BACKGROUND Mistrust in science and scientists may adversely influence the rate of COVID-19 vaccination and undermine public health initiatives to reduce virus transmission. METHODS Students, staff and faculty responded to an email invitation to complete an electronic survey. Surveys included 21-items from the Trust in Science and Scientists Inventory questionnaire. Responses were coded so higher scores indicated a higher trust in science and scientists, A linear regression model including sex, age group, division, race and ethnicity, political affiliation, and history of COVID-19, was used to determine variables significantly associated with trust in science and scientists scores at the p < 0.05 level. RESULTS Participants were mostly female (62.1%), Asian (34.7%) and White (39.5%) and students (70.6%). More than half identified their political affiliation as Democrat (65%). In the final regression model, all races and ethnicities had significantly lower mean trust in science and scientists scores than White participants [Black ([Formula: see text]= -0.42, 95% CI: -0.55, -0.43, p < 0.001); Asian ([Formula: see text]= -0.20, 95% CI: -0.24, -0.17, p < 0.001); Latinx ([Formula: see text]= -0.22, 95% CI: -0.27, -0.18, p < 0.001); Other ([Formula: see text]= -0.19, 95% CI: -0.26, -0.11, p < 0.001)]. Compared to those identifying as Democrat, all other political affiliations had significantly lower mean scores. [Republican ([Formula: see text] =-0.49, 95% CI: -0.55, -0.43, p < 0.0001); Independent ([Formula: see text] =-0.29, 95% CI: -0.33, -0.25, p < 0.0001); something else ([Formula: see text] =-0.19, 95% CI: -0.25, -0.12, p < 0.0001)]. Having had COVID-19 ([Formula: see text]= -0.10, 95% CI: -0.15, -0.06, p < 0.001) had significantly lower scores compared to those who did not have COVID-19. CONCLUSION Despite the setting of a major research University, trust in science is highly variable. This study identifies characteristics that could be used to target and curate educational campaigns and university policies to address the COVID19 and future pandemics.
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Affiliation(s)
- Michele Nicolo
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
- Department of Nutrition and Food Science, California State University, Los Angeles, CA, USA
| | - Eric Kawaguchi
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Angie Ghanem-Uzqueda
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
- Family Medicine, Keck Medicine of USC, Los Angeles, CA, USA
| | - Daniel Soto
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Sohini Deva
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Kush Shanker
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Ryan Lee
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Frank Gilliland
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Jeffrey D Klausner
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | | | - Andrea Kovacs
- Family Medicine, Keck Medicine of USC, Los Angeles, CA, USA
| | - Sarah Van Orman
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
- Family Medicine, Keck Medicine of USC, Los Angeles, CA, USA
| | - Howard Hu
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Jennifer B Unger
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
- University of Southern California, SSB 302, 2001 N. Soto Street, Los Angeles, CA, 90033, USA.
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Shin MB, Sloan KE, Martinez B, Soto C, Baezconde-Garbanati L, Unger JB, Kast WM, Cockburn M, Tsui J. Examining multilevel influences on parental HPV vaccine hesitancy among multiethnic communities in Los Angeles: a qualitative analysis. BMC Public Health 2023; 23:545. [PMID: 36949438 PMCID: PMC10031192 DOI: 10.1186/s12889-023-15318-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 02/24/2023] [Indexed: 03/24/2023] Open
Abstract
BACKGROUND Human papillomavirus (HPV) vaccine hesitancy is a growing concern in the United States, yet understudied among racial/ethnic minority parents. We conducted qualitative research to understand parental HPV vaccine hesitancy and inform community-specific, multilevel approaches to improve HPV vaccination among diverse populations in Los Angeles. METHODS We recruited American Indian/Alaska Native (AI/AN), Hispanic/Latino/a (HL) and Chinese parents of unvaccinated children (9-17 years) from low-HPV vaccine uptake regions in Los Angeles for virtual focus groups (FGs). FGs were conducted in English (2), Mandarin (1), and Spanish (1) between June-August 2021. One English FG was with AI/AN-identifying parents. FGs prompted discussions about vaccine knowledge, sources of information/hesitancy, logistical barriers and interpersonal, healthcare and community interactions regarding HPV vaccination. Guided by the social-ecological model, we identified multilevel emergent themes related to HPV vaccination. RESULTS Parents (n = 20) in all FGs reported exposure to HPV vaccine information from the internet and other sources, including in-language media (Mandarin) and health care providers (Spanish). All FGs expressed confusion around the vaccine and had encountered HPV vaccine misinformation. FGs experienced challenges navigating relationships with children, providers, and friends/family for HPV vaccine decision-making. At the community-level, historical events contributed to mistrust (e.g., forced community displacement [AI/AN]). At the societal-level, transportation, and work schedules (Spanish, AI/AN) were barriers to vaccination. Medical mistrust contributed to HPV vaccine hesitancy across the analysis levels. CONCLUSION Our findings highlight the importance of multilevel influences on parental HPV vaccine hesitancy and decision-making and the need for community-specific messaging to combat medical mistrust and other barriers to HPV vaccination among racial/ethnic minority communities.
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Affiliation(s)
- Michelle B Shin
- Department of Child, Family, and Population Health Nursing, School of Nursing, University of Washington, Seattle, WA, United States
| | - Kylie E Sloan
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Bibiana Martinez
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Claradina Soto
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Lourdes Baezconde-Garbanati
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Jennifer B Unger
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - W Martin Kast
- Department of Molecular Microbiology & Immunology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Myles Cockburn
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Jennifer Tsui
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
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Lee RC, Sood N, Deva S, Macedo M, Soto DW, Unger JB. Evaluation of a COVID-19 rapid antigen testing program among student athletes in a public high school district. Eval Program Plann 2023; 98:102280. [PMID: 36996640 PMCID: PMC10032046 DOI: 10.1016/j.evalprogplan.2023.102280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 02/27/2023] [Accepted: 03/21/2023] [Indexed: 05/14/2023]
Abstract
PURPOSE The purpose of this study is to evaluate a COVID-19 rapid antigen testing program among high school athletes through testing data and qualitative analysis from key stakeholders. METHODS Testing data was obtained by the partnering school district. Testing staff, coaches, and parents participated in a focus group using a semi-structured focus group guide. Transcripts were analyzed using a grounded theory approach to produce the themes of the study. RESULTS Rapid antigen tests quickly identified a COVID-19-positive student athlete, which allowed for quick isolation and zero transmission to teammates. Focus groups with parents, testing staff, and coaches indicated the testing program improved perceived safety and demonstrated the ability for school staff to implement a widespread COVID-19 screening program with minimal training. CONCLUSIONS As schools continue to respond to various waves of COVID-19 infections, targeted testing for high-risk activities in school settings such as sports programs may help prevent school outbreaks during times of high community transmission rates. This evaluation adds to a body of literature that will aid schools and policy makers in their decision on how to best keep student athletes and school communities safe for future waves of COVID-19 infection and other pandemics.
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Affiliation(s)
- Ryan C Lee
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, SSB, 1845 N. Soto Street, Los Angeles, CA 90033, USA.
| | - Neeraj Sood
- Department of Health Policy and Management, Sol Price School of Public Policy, University of Southern California, VPD 512F, 635 Downey Way, Los Angeles, CA 90089, USA
| | - Sohini Deva
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, SSB, 1845 N. Soto Street, Los Angeles, CA 90033, USA
| | - Marisol Macedo
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, SSB, 1845 N. Soto Street, Los Angeles, CA 90033, USA
| | - Daniel W Soto
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, SSB, 1845 N. Soto Street, Los Angeles, CA 90033, USA
| | - Jennifer B Unger
- Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, SSB, 1845 N. Soto Street, Los Angeles, CA 90033, USA
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Braymiller JL, Riehm KE, Meier M, Krueger EA, Unger JB, Barrington-Trimis JL, Cho J, Lanza HI, Madden DR, Kechter A, Leventhal AM. Associations of alternative cannabis product use and poly-use with subsequent illicit drug use initiation during adolescence. Psychopharmacology (Berl) 2023:10.1007/s00213-023-06330-w. [PMID: 36864260 PMCID: PMC10475141 DOI: 10.1007/s00213-023-06330-w] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 01/28/2023] [Indexed: 03/04/2023]
Abstract
RATIONALE Specific cannabis products may differentially increase risk of initiating non-cannabis illicit drug use during adolescence. OBJECTIVE To determine whether ever- and poly-use of smoked, vaporized, edible, concentrate, or blunt cannabis products are associated with subsequent initiation of non-cannabis illicit drug use. METHODS High school students from Los Angeles completed in-classroom surveys. The analytic sample (N = 2163; 53.9% female; 43.5% Hispanic/Latino; baseline M age = 17.1 years) included students who reported never using illicit drugs at baseline (spring, 11th grade) and provided data at follow-up (fall and spring, 12th grade). Logistic regression models assessed associations between use of smoked, vaporized, edible, concentrate, and blunt cannabis at baseline (yes/no for each product) and any non-cannabis illicit drug use initiation-including cocaine, methamphetamine, psychedelics, ecstasy, heroin, prescription opioids, or benzodiazepines-at follow-up. RESULTS Among those who never used non-cannabis illicit drugs at baseline, ever cannabis use varied by cannabis product (smoked = 25.8%, edible = 17.5%, vaporized = 8.4%, concentrates = 3.9%, and blunts = 18.2%) and patterns of use (single product use = 8.2% and poly-product use = 21.8%). After adjustment for baseline covariates, odds of illicit drug use at follow-up were largest for baseline ever users of concentrates (aOR [95% CI] = 5.74[3.16-10.43]), followed by vaporized (aOR [95% CI] = 3.11 [2.41-4.01]), edibles (aOR [95% CI] = 3.43 [2.32-5.08]), blunts (aOR [95% CI] = 2.66[1.60-4.41]), and smoked (aOR [95% CI] = 2.57 [1.64-4.02]) cannabis. Ever use of a single product (aOR [95% CI] = 2.34 [1.26-4.34]) or 2 + products (aOR [95% CI] = 3.82 [2.73-5.35]) were also associated with greater odds of illicit drug initiation. CONCLUSIONS For each of five different cannabis products, cannabis use was associated with greater odds of subsequent illicit drug use initiation, especially for cannabis concentrate and poly-product use.
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Affiliation(s)
- Jessica L Braymiller
- Department of Population and Public Health Sciences, University of Southern California, Keck School of Medicine, Los Angeles, CA, 90033, USA
| | - Kira E Riehm
- Department of Mental Health, Johns Hopkins University, Bloomberg School of Public Health, Baltimore, MD, 21205, USA
| | - Madeline Meier
- Department of Psychology, Arizona State University, Tempe, AZ, 85281, USA
| | - Evan A Krueger
- Department of Population and Public Health Sciences, University of Southern California, Keck School of Medicine, Los Angeles, CA, 90033, USA
| | - Jennifer B Unger
- Department of Population and Public Health Sciences, University of Southern California, Keck School of Medicine, Los Angeles, CA, 90033, USA
| | - Jessica L Barrington-Trimis
- Department of Population and Public Health Sciences, University of Southern California, Keck School of Medicine, Los Angeles, CA, 90033, USA
- Institute for Addiction Science, University of Southern California, 2001 N Soto Street, #302-C, Los Angeles, CA, 90032, USA
- USC Norris Comprehensive Cancer Center, Los Angeles, CA, 90033, USA
| | - Junhan Cho
- Department of Population and Public Health Sciences, University of Southern California, Keck School of Medicine, Los Angeles, CA, 90033, USA
- Institute for Addiction Science, University of Southern California, 2001 N Soto Street, #302-C, Los Angeles, CA, 90032, USA
| | - H Isabella Lanza
- Department of Human Development, California State University, Long Beach, CA, 90840, USA
| | - Danielle R Madden
- Institute for Addiction Science, University of Southern California, 2001 N Soto Street, #302-C, Los Angeles, CA, 90032, USA
- USC Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, CA, 90089, USA
| | - Afton Kechter
- Department of Population and Public Health Sciences, University of Southern California, Keck School of Medicine, Los Angeles, CA, 90033, USA
| | - Adam M Leventhal
- Department of Population and Public Health Sciences, University of Southern California, Keck School of Medicine, Los Angeles, CA, 90033, USA.
- Institute for Addiction Science, University of Southern California, 2001 N Soto Street, #302-C, Los Angeles, CA, 90032, USA.
- USC Norris Comprehensive Cancer Center, Los Angeles, CA, 90033, USA.
- Department of Psychology, University of Southern California, Los Angeles, CA, 90033, USA.
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Hansen J, Galimov A, Unger JB, Sussman SY, Hanewinkel R. Mental Health and Physical Complaints of German Children and Adolescents before and during the COVID-19 Pandemic: A Repeated Cross-Sectional Study. Int J Environ Res Public Health 2023; 20:ijerph20054478. [PMID: 36901485 PMCID: PMC10001698 DOI: 10.3390/ijerph20054478] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 03/01/2023] [Accepted: 03/01/2023] [Indexed: 06/01/2023]
Abstract
The potential impact of the COVID-19 pandemic on young people's mental and physical health is of increasing concern. We examined the levels of internalizing and externalizing problem behavior and physical complaints before and during the COVID-19 pandemic in Germany. Data came from a repeated cross-sectional study on child and youth health in schools in Germany. Assessments took place from November to February each year. Two data collections were conducted before the COVID-19 pandemic in 2018-2019 and in 2019-2020. Collections during the pandemic took place in 2020-2021 and 2021-2022. A total of 63,249 data observations were included in the analyses. Multilevel analyses were used to examine temporal trends in mean emotional problems (e.g., often unhappy, downhearted), hyperactivity-inattention (e.g., constantly fidgeting or squirming), conduct problems (e.g., fights with other children), and physical complaints. Models were adjusted for age, gender, school type, socioeconomic status, and sensation seeking. During the COVID-19 pandemic, children and adolescents in Germany experienced an increase in emotional problems from the pre-pandemic cohort 2019-2020 to the pandemic cohort 2021-2022 (β = 0.56, 95% CI (0.51-0.62)) and, over the course of the pandemic, reported elevated levels of physical complaints (β = 0.19, 95% CI (0.16-0.21)). Findings of increased emotional problems and physical complaints after the two years of the pandemic support the ongoing demand for low-threshold health promotion and prevention and the need for further monitoring of young people's health in Germany.
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Affiliation(s)
- Julia Hansen
- Institute for Therapy and Health Research, IFT-Nord, Harmsstraße 2, 24114 Kiel, Germany
| | - Artur Galimov
- Tobacco Center of Regulatory Science, Department of Population and Public Health Sciences, Institute for Health Promotion and Disease Prevention Research, Keck School of Medicine, University of Southern California, 1845 N. Soto Street, Los Angeles, CA 90033, USA
| | - Jennifer B. Unger
- Tobacco Center of Regulatory Science, Department of Population and Public Health Sciences, Institute for Health Promotion and Disease Prevention Research, Keck School of Medicine, University of Southern California, 1845 N. Soto Street, Los Angeles, CA 90033, USA
| | - Steve Y. Sussman
- Tobacco Center of Regulatory Science, Department of Population and Public Health Sciences, Institute for Health Promotion and Disease Prevention Research, Keck School of Medicine, University of Southern California, 1845 N. Soto Street, Los Angeles, CA 90033, USA
| | - Reiner Hanewinkel
- Institute for Therapy and Health Research, IFT-Nord, Harmsstraße 2, 24114 Kiel, Germany
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Unger JB, Soto D, Lee R, Deva S, Shanker K, Sood N. COVID-19 Testing in Schools: Perspectives of School Administrators, Teachers, Parents, and Students in Southern California. Health Promot Pract 2023; 24:350-359. [PMID: 34963362 PMCID: PMC9931884 DOI: 10.1177/15248399211066076] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND School-based COVID-19 testing is a potential strategy to facilitate the safe reopening of schools that have been closed due to the pandemic. This qualitative study assessed attitudes toward this strategy among four groups of stakeholders: school administrators, teachers, parents, and high school students. METHODS Focus groups and interviews were conducted in Los Angeles from December 2020 to January 2021 when schools were closed due to the high level of COVID transmission in the community. RESULTS Findings indicated similarities and differences in attitudes toward in-school COVID-19 testing. All groups agreed that frequent in-school COVID-19 testing could increase the actual safety and perceived safety of the school environment. School administrators expressed pessimism about the financial cost and logistics of implementing a testing program. Parents supported frequent testing but expressed concerns about physical discomfort and stigma for students who test positive. Teachers and parents noted that testing would prevent parents from sending sick children to school. Students were in favor of testing because it would allow them to return to in-person school after a difficult year of online learning. CONCLUSION In-school COVID-19 testing could be a useful component of school reopening plans and will be accepted by stakeholders if logistical and financial barriers can be surmounted and stigma from positive results can be minimized.
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Affiliation(s)
| | - Daniel Soto
- University of Southern California, Los Angeles, CA, USA
| | - Ryan Lee
- University of Southern California, Los Angeles, CA, USA
| | - Sohini Deva
- University of Southern California, Los Angeles, CA, USA
| | - Kush Shanker
- University of Southern California, Los Angeles, CA, USA
| | - Neeraj Sood
- University of Southern California, Los Angeles, CA, USA
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Chen-Sankey J, Unger JB, Bernat E, Niederdeppe J, Bansal-Travers M, Choi K. Price promotion receipt and use progression of any tobacco, cigarettes, e-cigarettes and cigars among US youth between 2016 and 2018. Tob Control 2023; 32:225-232. [PMID: 34301838 PMCID: PMC8782922 DOI: 10.1136/tobaccocontrol-2021-056667] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [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: 03/18/2021] [Accepted: 07/07/2021] [Indexed: 01/24/2023]
Abstract
BACKGROUND Tobacco price promotions may prompt tobacco trials among youth. We assessed whether receiving price promotions for any tobacco, cigarettes, e-cigarettes and cigars was associated with product use progression. METHODS The analysis included a nationally representative sample of youth never tobacco users (aged 12-16; n=9405) from wave 4 (2016-2018) of the Population Assessment of Tobacco and Health Study. We assessed past-year receipt of price promotions and use progression (initiation, current use and ever regular use) for any tobacco, cigarettes, e-cigarettes and cigars 1 year later at wave 4.5 (2017-2018). Multivariable logistic regressions were used to examine the associations between receiving price promotions and use progression by product type, controlling for covariates. RESULTS At wave 4.5, 9.4% of youth initiated any tobacco (1.8%, 7.8% and 0.9% for cigarettes, e-cigarettes and cigars), and 5.4% received any price promotions (3.8%, 3.1% and 0.9% for cigarettes, e-cigarettes and cigars). Receiving any tobacco price promotions was associated with any tobacco initiation (adjusted OR (AOR)=1.77; 95% CI 1.30 to 2.41), current use (AOR=1.54; 95% CI 1.06 to 2.23) and ever regular use (AOR=1.76; 95% CI 1.04 to 3.10). Receiving e-cigarette price promotions was associated with e-cigarette initiation (AOR=1.78; 95% CI 1.18 to 2.26), current use (AOR=1.88; 95% CI 1.17 to 3.02) and ever regular use (AOR=2.10; 95% CI 1.02 to 4.40). The associations specific to cigarettes and cigars were only found for product initiation. DISCUSSION Receiving price promotions for any tobacco and e-cigarettes was respectively associated with the use progression of any tobacco and e-cigarettes. Continuous monitoring of tobacco marketing activities is needed to identify youth-appealing price promotion tactics.
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Affiliation(s)
- Julia Chen-Sankey
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, Bethesda, Maryland, USA
| | - Jennifer B Unger
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Edward Bernat
- Department of Psychology, University of Maryland, College Park, Maryland, USA
| | - Jeff Niederdeppe
- Department of Communication, Cornell University, Ithaca, New York, USA
| | | | - Kelvin Choi
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, Bethesda, Maryland, USA
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Cho J, Sussman S, Kechter A, Vogel EA, Barrington-Trimis JL, Unger JB, Leventhal AM. Alcohol use and life stressors during the COVID-19 pandemic: a longitudinal study of young adults. Journal of Substance Use 2023. [DOI: 10.1080/14659891.2023.2183909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/03/2023]
Affiliation(s)
- Junhan Cho
- Department of Population and Public Health Sciences, University of Southern California Keck School of Medicine, Los Angeles, California, USA
| | - Steve Sussman
- Department of Population and Public Health Sciences, University of Southern California Keck School of Medicine, Los Angeles, California, USA
| | - Afton Kechter
- Department of Population and Public Health Sciences, University of Southern California Keck School of Medicine, Los Angeles, California, USA
| | - Erin A. Vogel
- Department of Pediatrics, University of Oklahoma College of Medicine, Oklahoma, Oklahoma, USA
| | - Jessica L. Barrington-Trimis
- Department of Population and Public Health Sciences, University of Southern California Keck School of Medicine, Los Angeles, California, USA
| | - Jennifer B. Unger
- Department of Population and Public Health Sciences, University of Southern California Keck School of Medicine, Los Angeles, California, USA
| | - Adam M. Leventhal
- Department of Population and Public Health Sciences, University of Southern California Keck School of Medicine, Los Angeles, California, USA
- Department of Psychology, University of Southern California, Los Angeles, California, USA
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Zheng Y, Meyer Z, Unger JB, Rijsdijk F. Gene-environment interplay linking perceived parental supervision and peer drunkenness with Chinese adolescent alcohol initiation. Child Dev 2023. [PMID: 36752139 DOI: 10.1111/cdev.13902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
Following 602 Chinese twin pairs (48% male, all Han ethnicity) from primarily lower-than-average socioeconomic status families from early to mid-adolescence (Ms = 12 and 15 in 2006 and 2009), this study investigated gene-environment interplay between perceived parental supervision, peer drunkenness, and adolescent alcohol initiation. For alcohol initiation, shared environmental influences were initially negligible but became substantial. Genetic factors largely explained the links between both correlates with alcohol initiation. Parental supervision amplified genetic risks for alcohol initiation in early adolescence but suppressed it in mid-adolescence. Peer drunkenness augmented genetic and environmental influences at both times. Peer drunkenness showed stronger links and moderating potential than parental supervision. Chinese adolescents show dynamic gene-environment interplay patterns involving parent-child and peer processes in alcohol initiation.
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Affiliation(s)
- Yao Zheng
- Department of Psychology, University of Alberta, Edmonton, Alberta, Canada
| | - Zachary Meyer
- Department of Psychology, University of Alberta, Edmonton, Alberta, Canada
| | - Jennifer B Unger
- Department of Preventive Medicine, University of Southern California, Los Angeles, California, USA
| | - Frühling Rijsdijk
- Faculty of Social Sciences, Anton de Kom University of Suriname, Paramaribo, Suriname
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