Effect of age at initiation of the human papillomavirus vaccine on the association between race/ethnicity and completion of the vaccine series

BACKGROUND

Up-to-date (UTD) of the human papillomavirus (HPV) vaccine series has been low despite 2016 recommendations for 2 doses among initiators <15 years of age and 3 doses for 15+ year olds. This study examined how age at initiation affected the association between race/ethnicity and UTD among adolescent HPV vaccine initiators. We also examined how administration of other adolescent vaccines affected UTD.

METHODS

A secondary analysis of The National Immunization Survey - Teen data between 2016 and 2020 was conducted. Characteristics associated with initiation of the vaccine series was examined and used to evaluate UTD among initiators. All data were weighted. Associations between characteristics and HPV vaccine initiation were examined using Rao Scott chi-square tests and univariable logistic regression. Multivariable binary logistic regression models stratified by race/ethnicity calculated the strength of association between independent variables and odds of initiation and UTD among initiators.

RESULTS

The final sample size was 99,719 with 67,855 (68.1 %) initiating HPV vaccination. Among HPV vaccine initiators, Hispanic and black adolescents had lower odds of UTD. However, 9-10-year-old initiators had increased odds (aOR: 5.71; 95 %CI: 3.78-8.63) of UTD compared to 12-year-old initiators. Increased odds of UTD among initiators younger than 12 years were found across racial/ethnic groups. Flu vaccination was associated with decreased odds of UTD among white (aOR: 0.76; 95 %CI:0.65-0.88) and black adolescents (aOR: 0.67; 95 %CI: 0.46-0.96).

CONCLUSION

Strong recommendations to ensure patients are UTD on the HPV vaccine series are essential to improving UTD among all adolescents and follow-up should occur when administering other vaccines to reduce missed opportunities.

Distracted and Impaired Driving Among U.S. Adolescents, 2019, USA

Distracted driving, the act of focusing on something else while operating a vehicle, is a significant health problem among adolescents. Although some studies have reported on prevalence among adolescents in the United States, limited studies have examined differences by sexual identity status. The purpose of the present study was to examine past 30-day distracted driving by sexual identity status among a large, national sample of adolescents ages 14 to 18 years. A secondary analysis was conducted on the 2019 Youth Risk Behavioral Surveillance System (YRBSS) data, and associations between distracted driving and demographics (e.g., biological sex, age, race/ethnicity) were assessed with weighted logistic regression analyses. A total of 13,590 adolescents ages 14 to 18 years were part of the final analytic sample. Twenty-three percent of adolescents reported distracted driving in the past 30 days. Compared with heterosexual adolescents, gay/lesbian (14.3%), bisexual (18.1%), and questioning (12.9%) adolescents reported lower distracted driving in the past 30 days. Findings through a health equity approach may inform harm reduction efforts and behavioral interventions.

Examining gender and the longitudinal effect of weight conscious drinking dimensions on body mass index among a college freshman cohort

Objective: This study aims to: (1) examine gender differences for weight conscious drinking among college students accounting for the broader phenomenon (e.g. including the Alcohol Effects dimension); and (2) longitudinally examine the effect of weight conscious drinking behaviors on body mass index (BMI). Participants: United States freshmen students from eight participating universities (N= 1,149). Methods: Structural equation modeling was used to model the effect of gender on weight conscious drinking dimensions at 7-month follow-up. Results: Findings suggest a significant effect of gender on Alcohol Effects (β = -.15, SE = .05, p = .005) at 7-month follow-up among college freshmen. Weight conscious drinking dimensions predicted no significant change in BMI at 7-month follow-up among college freshmen. Conclusion: Findings contribute to weight conscious drinking theory and provide campus weight conscious drinking prevention initiatives with evidence to tailor their programming to address female tendencies to engage in compensatory strategies to enhance the psychoactive effects of alcohol.

Measuring vaping-related expectancies in young adults: Psychometric evaluation of the Electronic Nicotine Vaping Outcomes (ENVO) scale

OBJECTIVE

Electronic cigarettes are the most commonly used tobacco products by young adults. Measures of beliefs about outcomes of use (i.e., expectancies) can be helpful in predicting use, as well as informing and evaluating interventions to impact use.

METHODS

We surveyed young adult students (N = 2296, Mean age=20.0, SD=1.8, 64 % female, 34 % White) from a community college, a historically black university, and a state university. Students answered ENDS expectancy items derived from focus groups and expert panel refinement using Delphi methods. Factor Analysis and Item Response Theory (IRT) methods were used to understand relevant factors and identify useful items.

RESULTS

A 5-factor solution [Positive Reinforcement (consists of Stimulation, Sensorimotor, and Taste subthemes, α = .92), Negative Consequences (Health Risks and Stigma, α = .94), Negative Affect Reduction (α = .95), Weight Control (α = .92), and Addiction (α = .87)] fit the data well (CFI=0.95; TLI=0.94; RMSEA=0.05) and was invariant across subgroups. Factors were significantly correlated with relevant vaping measures, including vaping susceptibility and lifetime vaping. Hierarchical linear regression demonstrated factors were significant predictors of lifetime vaping after controlling for demographics, vaping ad exposure, and peer/family vaping. IRT analyses indicated that individual items tended to be related to their underlying constructs (a parameters ranged from 1.26 to 3.18) and covered a relatively wide range of the expectancies continuum (b parameters ranged from -0.72 to 2.47).

CONCLUSIONS

A novel ENDS expectancy measure appears to be a reliable measure for young adults with promising results in the domains of concurrent validity, incremental validity, and IRT characteristics. This tool may be helpful in predicting use and informing future interventions.

IMPLICATIONS

Findings provide support for the future development of computerized adaptive testing of vaping beliefs. Expectancies appear to play a role in vaping similar to smoking and other substance use. Public health messaging should target expectancies to modify young adult vaping behavior.

Past-Year Blunt Smoking among Youth: Differences by LGBT and Non-LGBT Identity

Blunt use (co-use of tobacco and marijuana) is a growing phenomenon among youth and disproportionately affects minority populations. LGBT+ populations are significantly more likely to use marijuana and tobacco, but this relationship has yet to be examined among LGBT+ adolescents. This analysis aimed to investigate past-year blunt use among a national sample of youth and delineate the differences between non-LGBT and LGBT+ youth. We used Wave 2 of the Population and Tobacco Health (PATH) study. We analyzed data from 7518 youth, comparing past-year blunt use between LGBT+ and non-LGBT youth, controlling for biological sex, race, and age using weighted logistic regression models. Greater than 1 in 10 youth (10.6%) reported using blunts in the past year. More than one in five (21.6%) LGBT+ youth reported using blunts in the past year. There were no significant differences between boys and girls. Older youth (17 years old) were more likely to use blunts in the past year (aPR: 3.04, 95% CI 2.48, 3.79) than younger youth. Compared with non-LGBT youth, LGBT+ youth were 2.17 times (95% CI 1.86, 2.54) more likely to report using blunts in the past year. Blunt use and its respective impact on health outcomes among developing youth are of concern to public health. These findings demonstrate that certain subgroups of youth are more at risk for use and emphasize the need for tailored interventions to mitigate initiation and current use, given that one of the goals of the Healthy People 2030 initiative is to "Improve the health, safety, and well-being of lesbian, gay, bisexual, and transgender (LGBT) individuals".

Aerosol, vapor, or chemicals? College student perceptions of harm from electronic cigarettes and support for a tobacco-free campus policy

Objective: This study is the first to examine the influence of e-cigarette emission phrasing on perceived harm of secondhand exposure, and whether harm perception was associated with support for a tobacco-free campus policy. Participants: In the fall 2018 and spring 2019 semesters, 52 sections of a college English course (N = 791 students) were cluster randomized to one of three conditions ("vapor," "aerosol," or "chemicals") assessing harm of secondhand exposure to e-cigarette emissions. Methods: Regression models adjusted for demographic characteristics, tobacco use, and other potential confounders. Results: Compared to the "vapor" condition, "chemicals" and "aerosol" conditions were associated with increased odds of perceiving secondhand exposure to e-cigarettes to be harmful/very harmful (AOR = 2.0, p < 0.01). Greater perceived harm of secondhand e-cigarette exposure was associated with increased odds of supporting a tobacco-free campus policy (AOR = 2.22, p < 0.001). Conclusions: Health campaigns should use accurate terminology to describe e-cigarette emissions, rather than jargon that conveys lower risk.

Tobacco-related health inequalities among Black Americans: A narrative review of structural and historical influences

We conducted a narrative literature review to examine contributing factors of disparities in tobacco usage and outcomes affecting Black Americans. We propose potential solutions that can be used to effectively address these disparities. We identified historical factors; socioeconomic factors; targeted marketing/advertising; the influence of racism/discrimination; neighborhood socioeconomic disadvantage; and mass incarceration. We call for more thorough examinations of these factors as a key element of tobacco-focused research and interventions to eliminate the disproportionate burdens faced by Black Americans. We advocate for greater emphases on the impacts of personal and structural racism on tobacco usage and outcomes affecting Black Americans.

Discordance Between Perinatal Alcohol Use Among Women and Provider Counseling for Alcohol Use: An Assessment of the Pregnancy Risk Assessment Monitoring System

OBJECTIVE

In the United States, guidelines indicate all pregnant women should be screened for and counseled on alcohol use to prevent adverse perinatal outcomes due to alcohol consumption. The objective of this study was to describe sociodemographic factors associated with receipt of prenatal alcohol counseling and perinatal alcohol use among US women.

METHODS

State health departments collected data for the Pregnancy Risk Assessment Monitoring System Phase 7 during 2012-2015, and we restricted the sample to a complete case analysis (N = 135 111). The 3 dichotomous outcomes were preconception alcohol use (3 months before pregnancy), prenatal alcohol use (during last 3 months of pregnancy), and prenatal alcohol counseling. Predictor variables were age, race, Hispanic ethnicity, education, marital status, health insurance status, and previous live births. We estimated survey-weighted logistic regression models for each outcome.

RESULTS

Half (56.0%) of pregnant women reported preconception alcohol use, 70.5% received prenatal alcohol counseling, and 7.7% reported prenatal alcohol use during the last 3 months of pregnancy. Black women were significantly less likely than White women (odds ratio [OR] = 0.49; 95% CI, 0.46-0.52) and Hispanic women were significantly less likely than non-Hispanic women (OR = 0.62; 95% CI, 0.58-0.66) to report preconception alcohol use. We found similar patterns for prenatal alcohol use among Black women. Black women were significantly more likely than White women (OR = 1.66; 95% CI, 1.55-1.77) and Hispanic women were significantly more likely than non-Hispanic women (OR = 1.51; 95% CI, 1.40-1.61) to receive prenatal alcohol counseling. We found similar patterns for age, education, and health insurance status.

CONCLUSION

Disparities in alcohol counseling occurred despite the national recommendation for universal screening and counseling prenatally. Continued integration of universal screening for alcohol use during pregnancy is needed.

The Role of Alcohol-Related Proactive Dietary Restriction to Feel the Psychoactive Effects of Alcohol Faster on Binge Drinking Frequency among Freshmen College Students

BACKGROUND

There is a positive cross-sectional relationship between alcohol-related proactive dietary restriction to feel the effects of alcohol faster (APDR) and binge drinking, a health and safety issue impacting college students. Objective: To examine: 1) the longitudinal predictive ability of varying levels of APDR on binge drinking frequency; and 1a) the strength of the relationship between varying levels of APDR and binge drinking frequency during freshman year of college (n = 1,149).

METHODS

Ordinal logistic regression was used to model the relationship between APDR and binge drinking frequency.

RESULTS

Main findings suggest APDR of students who reported eating less than usual (low APDR) prior to drinking to feel the effects of alcohol faster was a significant predictor of binge drinking frequency (1.27 (95% CI, 0.06 to 0.42), Wald χ² (1) = 8.46, p=.009) at baseline, but not at 7-month follow-up (1.02 (95% CI, -0.18 to 0.23), Wald χ² (1) = .51, p=.83). APDR for students who reported skipping one or more meals (high APDR) to feel the effects of alcohol faster was not a significant predictor of binge drinking frequency at baseline nor at 7-month follow-up.

CONCLUSION

Low APDR is a significant predictor of binge drinking frequency that is established early in the first semester of college with no significant change occurring in binge drinking frequency over the course of students' freshman year at 7-month follow-up. Campus health professionals are urged to emphasize the detrimental health effects of low APDR early in the first semester of college.

Examining the effect of weight conscious drinking on binge drinking frequency among college freshmen

To examine the effect of weight-conscious drinking and compensatory behavior temporality on binge drinking frequency of college freshmen. Participants: Freshmen (n = 1149) from eight US universities, Fall 2015. Methods: Participants completed the Compensatory Eating Behaviors in Response to Alcohol Consumption Scale and Alcohol Use Disorders Identification Test-Consumption. Structural equation modeling was used to model the effect of weight-conscious drinking constructs on binge drinking frequency. Results: Bulimia, Dietary Restraint and Exercise, Restriction, proactive Alcohol Effects, during Alcohol Effects, and proactive Dietary Restraint and Exercise factors significantly predicted binge drinking frequency. Conclusion: Weight-conscious drinking among this cohort of college students comprises temporal factors significantly associated with binge drinking frequency. Relationships between Bulimia, Dietary Restraint and Exercise, and Restriction compensatory behaviors and binge drinking should be considered in interventions to address binge drinking among college students.

Electronic cigarette explosion/burn and poisoning related emergency department visits, 2018-2019

BACKGROUND

Electronic cigarette (ECIG) use has increased dramatically in recent years. Negative ECIG-related acute health effects have included explosion/burn injuries from battery failure and child ingestion/poisoning of liquid nicotine. However, there is an urgent need for continued surveillance of ECIG health effects to determine whether these outcomes change as ECIG devices and liquids rapidly evolve. This study updates national estimates of ECIG-related emergency department (ED) visits and describes the context of these injuries.

METHODS

A keyword search of case narrative text was used to identify ECIG-related ED visits in the National Electronic Injury Surveillance System (NEISS) data. These cross-sectional data are designed to be weighted to provide national estimates of consumer product-related injuries treated in EDs. ECIG-related injuries were described and categorized, and sampling weights applied to model national estimates.

RESULTS

From 2015 to 2019 there were an estimated 3369 ED visits from ECIG explosion/burn injuries (95% CI = 2020, 4718), and an estimated 676 visits from 2019 alone (95% CI = 315, 1036). In 2018-2019, there were an estimated 1550 cases of children <5 years old ingesting ECIG liquids (95% CI = 778, 2322).

CONCLUSIONS

Despite a notable shift in the US market towards ECIG devices that use lower electrical power and disposable "pods" (e.g., JUUL), liquid chemical ingestion among young children and ECIG explosion/burn injuries persist. Improved product regulations are urgently needed to prevent negative health effects caused by ECIGs, as well as prevent their ingestion and use by children.

Smoking cessation and survival among people diagnosed with non-metastatic cancer

Background

We aimed to estimate the effects of smoking cessation on survival among people diagnosed with cancer.

Methods

We used data from a Comprehensive Community Cancer Program that is part of a large urban safety-net hospital system. Eligible patients were diagnosed with primary invasive solid tumors between 2013 and 2015, and were current smokers at time of diagnosis. Our exposure of interest was initiation of smoking cessation within 6 months of cancer diagnosis. We estimated inverse probability weighted restricted mean survival time (RMST) differences and risk ratio (RR) for all cause 3-year mortality.

Results

Our study population comprised 369 patients, of whom 42% were aged < 55 years, 59% were male, 44% were racial/ethnic minorities, and 59% were uninsured. The 3-year RMST was 1.8 (95% CL: − 1.5, 5.1) months longer for individuals who initiated smoking cessation within 6 months of cancer diagnosis. The point estimate for risk of 3-year mortality was lower for initiation of smoking cessation within 6 months of diagnosis compared with no initiation within 6 months (RR = 0.72, 95% CL: 0.37, 1.4).

Conclusions

Our point estimates suggest longer 3-year survival, but the results are compatible with 1.5 month shorter or 5.1 longer 3-year overall survival after smoking cessation within 6 months of cancer diagnosis. Future studies with larger sample sizes that test the comparative effectiveness of different smoking cessation strategies are needed for more detailed evidence to inform decision-making about the effect of smoking cessation on survival among cancer patients.

Implications for Cancer survivors

The benefits of smoking cessation after cancer diagnosis may include longer survival, but the magnitude of benefit is unclear.

Correlates of Nonmedical Prescription Opioid Use Among U.S. Adolescents

INTRODUCTION

The purpose of this study is to assess risk factors, including other substance use, for nonmedical prescription opioid use among U.S. adolescents.

METHODS

A secondary data analysis of the 2017 Youth Risk Behavior Survey was conducted (n=10,175) in 2018. The outcome was nonmedical prescription opioid use. Predictor variables included other substance use, mood, sleep, academic performance, and demographic characteristics. Survey-weighted procedures in SAS, version 9.4 were used, and an adjusted logistic regression model was conducted.

RESULTS

Among the sampled adolescents, 13.8% (95% confidence limit=12.4%, 15.3%) reported nonmedical prescription opioid use. Nonmedical prescription opioid use was more likely among participants aged 15 years (versus 16 years), American Indian/Alaskan Natives, and those who reported being sad or hopeless. All other substance use was significantly associated with increased odds of nonmedical prescription opioid use. Nonmedical prescription opioid use was 1.5 times more likely among electronic vapor users (AOR=1.58, 95% CI=1.34, 1.86), 2 times more likely among cigarette (AOR=2.49, 95% CI=2.16, 2.88) and marijuana users (AOR=2.45, 95% CI=2.05, 2.93), and almost 3 times as likely among alcohol users (AOR=2.98, 95% CI=2.18, 4.07).

CONCLUSIONS

Study findings suggest a need for more interventions for nonmedical prescription opioid use among adolescents in the U.S. Information on nonmedical prescription opioid use should be added to all substance use prevention programs for adolescents. Moreover, future research needs to identify longitudinal predictors of adolescent nonmedical prescription opioid use to inform prevention efforts.

Vaping Expectancies: A Qualitative Study among Young Adult Nonusers, Smokers, Vapers, and Dual Users

BACKGROUND

"Expectancies," or beliefs about outcomes, robustly correlate with and predict several behaviors including electronic nicotine delivery system ("e-cigarette") use. However, there is limited qualitative research available regarding relevant e-cigarette vaping expectancies.

OBJECTIVES

The present study used a qualitative approach to derive and refine e-cigarette expectancy themes among young adults.

METHODS

We conducted 12 focus groups and two individual interviews with young adult nonusers, e-cigarette vapers, cigarette smokers, and dual users to assess beliefs about the effects of e-cigarettes. After a series of open-ended questions, follow-up questions assessed reactions to domains previously examined in expectancy measures for cigarette smoking and e-cigarette vaping. The constant comparative method was used to derive themes from transcripts.

RESULTS

Four main themes (Positive Reinforcement, Social Benefits, Negative Affect Reduction, Negative Consequences) emerged from the results. Each theme contained three associated subthemes (Positive Reinforcement: Sensorimotor Experiences, Taste, Stimulation; Social Benefits: Social Facilitation, Influence on Others, Convenience; Negative Affect Reduction: Stress Reduction, Appetite Reduction, Boredom Reduction; and Negative Consequences: Health Risks, Addiction, Secondhand Effects).

CONCLUSIONS/IMPORTANCE

Previously identified smoking expectancies appear relevant for young adult vaping, with some notable refinements. Positive reinforcement aspects encompassed aerosol clouds, vaping tricks, and unique flavors. Social benefits included influencing others via social media and competitive activity, as well as the convenience of use in a variety of places. Negative affect reduction was controversial among user groups, but vaping was seen as more interesting than smoking and thus more effective at boredom reduction. Young adults were uncertain regarding negative consequences, but appreciated a potential for secondhand effects. Measure refinement via qualitative research and future field testing can enhance our understanding of this relatively new behavior, supporting tobacco control surveillance, marketing/labeling regulations, and counter-advertising development/evaluation.

Racial and ethnic disparities in a state-wide registry of patients with pancreatic cancer and an exploratory investigation of cancer cachexia as a contributor to observed inequities

Pancreatic cancer (PC) is characterized by racial/ethnic disparities and the debilitating muscle-wasting condition, cancer cachexia. Florida ranks second in the number of PC deaths and has a large and understudied minority population. We examined the primary hypothesis that PC incidence and mortality rates may be highest among Black Floridians and the secondary hypothesis that biological correlates of cancer cachexia may underlie disparities. PC incidence and mortality rates were estimated by race/ethnicity, gender, and county using publicly available state-wide cancer registry data that included approximately 2700 Black, 25 200 Non-Hispanic White (NHW), and 3300 Hispanic/Latino (H/L) Floridians diagnosed between 2004 and 2014. Blacks within Florida experienced a significantly (P < 0.05) higher incidence (12.5/100 000) and mortality (10.97/100 000) compared to NHW (incidence = 11.2/100 000; mortality = 10.3/100 000) and H/L (incidence = 9.6/100 000; mortality = 8.7/100 000), especially in rural counties. To investigate radiologic and blood-based correlates of cachexia, we leveraged data from a subset of patients evaluated at two geographically distinct Florida Cancer Centers. In Blacks compared to NHW matched on stage, markers of PC-induced cachexia were more frequent and included greater decreases in core musculature compared to corresponding healthy control patients (25.0% vs 10.1% lower), greater decreases in psoas musculature over time (10.5% vs 4.8% loss), lower baseline serum albumin levels (3.8 vs 4.0 gm/dL), and higher platelet counts (332.8 vs 268.7 k/UL). Together, these findings suggest for the first time that PC and cachexia may affect Blacks disproportionately. Given its nearly universal contribution to illness and PC-related deaths, the early diagnosis and treatment of cachexia may represent an avenue to improve health equity, quality of life, and survival.

Abstract 592: The potential effect of smoking cessation on mortality among patients diagnosed with smoking-related cancers

Background: The benefit of smoking cessation on mortality after cancer diagnosis is unclear, particularly given ethical restrictions of randomizing patients who are smokers to a smoking cessation intervention or continued smoking. We thus aimed to assess the effect of a hypothetical smoking cessation intervention on mortality among patients diagnosed with smoking-related cancers using observational data.

Methods: We used data from the JPS Oncology Registry, for which the source population is cancer patients in Tarrant County, TX who received care at a public health care system regardless of their ability to pay. Our eligible population included patients diagnosed with primary lung, head and neck, or colorectal cancer between January 2008 and June 2013 with follow-up through 2016, and self-reported current or former use of cigarette, cigar, or pipe tobacco products. We used a potential outcomes framework to estimate cancer-specific effects of a hypothetical smoking cessation intervention on 1- and 3-year all-cause mortality. Under certain assumptions, the estimated marginal risk ratios and risk differences from this approach are analogous to intention to treat estimates from a randomized controlled trial.

Results: Our study population comprised 1,058 patients diagnosed with lung (n=582), head and neck (n=248), or colorectal cancer (n=228). The median age at diagnosis overall was 57 years (interquartile range=51-63). Patients were predominantly male (64%), non-Hispanic White (63%), and uninsured (50%). Modeled smoking cessation decreased mortality for head and neck cancers but not lung or colorectal cancers (Table 1).

Conclusion: Albeit with certain limitations, our findings suggest that a hypothetical smoking cessation intervention initiated at the time of cancer diagnosis may not have homogeneous effects on mortality across cancer types. These results provide insight about target populations for whom smoking cessation may benefit cancer survival.

Table 1. Risk ratios and differences for the effect of hypothetical smoking cessation intervention1-year mortality3-year mortalitySiteRRa (95% CL)bRDc (95% CL)RR (95% CL)RD (95% CL)Lung0.98 (0.86, 1.1)-0.01 (-0.10, 0.08)1.0 (0.95, 1.1)0.02 (-0.05, 0.08)Head and Neck0.71 (0.45, 1.1)-0.11 (-0.25, 0.03)0.78 (0.58, 1.0)-0.14 (-0.29, 0.01)Colorectal0.87 (0.48, 1.6)-0.03 (-0.16, 0.10)1.1 (0.73, 1.5)0.02 (-0.14, 0.19)aRisk Ratio &lt; 1 indicate lower risk of mortality if all patients adhered to a hypothetical smoking cessation intervention.bConfidence LimitscRisk difference &lt; 0 indicate a lower risk of mortality if all patients adhered to a hypothetical smoking cessation intervention.

Citation Format: Bradford E. Jackson, Tracey E. Barnett, Yan Lu, Bassam Ghabach, Rohit P. Ojha. The potential effect of smoking cessation on mortality among patients diagnosed with smoking-related cancers [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2018; 2018 Apr 14-18; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2018;78(13 Suppl):Abstract nr 592.

Development and Preliminary Testing of the Food Choice Priorities Survey (FCPS): Assessing the Importance of Multiple Factors on College Students' Food Choices

Understanding factors that influence food choice may help improve diet quality. Factors that commonly affect adults' food choices have been described, but measures that identify and assess food choice factors specific to college students are lacking. This study developed and tested the Food Choice Priorities Survey (FCPS) among college students. Thirty-seven undergraduates participated in two focus groups ( n = 19; 11 in the male-only group, 8 in the female-only group) and interviews ( n = 18) regarding typical influences on food choice. Qualitative data informed the development of survey items with a 5-point Likert-type scale (1 = not important, 5 = extremely important). An expert panel rated FCPS items for clarity, relevance, representativeness, and coverage using a content validity form. To establish test-retest reliability, 109 first-year college students completed the 14-item FCPS at two time points, 0-48 days apart ( M = 13.99, SD = 7.44). Using Cohen's weighted κ for responses within 20 days, 11 items demonstrated moderate agreement and 3 items had substantial agreement. Factor analysis revealed a three-factor structure (9 items). The FCPS is designed for college students and provides a way to determine the factors of greatest importance regarding food choices among this population. From a public health perspective, practical applications include using the FCPS to tailor health communications and behavior change interventions to factors most salient for food choices of college students.

Hookah use among adolescents: Differential cognitions about hookah and cigarettes

Background Hookah use is prevalent among adolescent and young adult populations. The study assessed how positive cognitions toward cigarettes moderate the impact of positive hookah cognitions on past 30day hookah use among a representative sample of youth. Understanding cognitions about products can contribute to effective interventions. Methods Data from the 2015 Florida Youth Tobacco Survey was used to determine cognitions and use patterns among high school students. Weighted means and proportions were used for demographic comparisons for cognitions about products. t-Tests and chi-square analysis were conducted for differences between users and non-users. Logistic regressions were conducted for the modeling of interaction between hookah and cigarette cognition. Results Nearly one out of ten (9.6%) of adolescents reported current hookah use. Across all cognition measures, positive hookah cognitions were associated with current hookah use. Additionally, there was a pattern of hookah cognitions being more strongly associated with current hookah use among those students that did not endorse the equivalent cognition for traditional cigarettes. Conclusions Hookah cognitions were generally more associated with hookah use among youth who did not endorse positive cognitions for cigarettes compared to those that did endorse positive cognitions for cigarettes. This finding is novel given youth who feel negatively about cigarettes are more influenced by their hookah-specific cognitions. Youth who believe cigarettes pose harm may benefit from messaging about the harms of hookah. Interventions or prevention efforts that draw strong comparisons between cigarettes and hookah may be effective among youth.

Recreational Cannabis Legalization and Opioid-Related Deaths in Colorado, 2000-2015

OBJECTIVES

To examine the association between Colorado's legalization of recreational cannabis use and opioid-related deaths.

METHODS

We used an interrupted time-series design (2000-2015) to compare changes in level and slope of monthly opioid-related deaths before and after Colorado stores began selling recreational cannabis. We also describe the percent change in opioid-related deaths by comparing the unadjusted model-smoothed number of deaths at the end of follow-up with the number of deaths just prior to legalization.

RESULTS

Colorado's legalization of recreational cannabis sales and use resulted in a 0.7 deaths per month (b = -0.68; 95% confidence interval = -1.34, -0.03) reduction in opioid-related deaths. This reduction represents a reversal of the upward trend in opioid-related deaths in Colorado.

CONCLUSIONS

Legalization of cannabis in Colorado was associated with short-term reductions in opioid-related deaths. As additional data become available, research should replicate these analyses in other states with legal recreational cannabis.

Factors Associated with Self-Estimated Breath Alcohol Concentration Among Bar Patrons

BACKGROUND

Few studies have examined the context in which drinkers underestimate their breath alcohol concentration (BrAC) in natural drinking environments. This study examined factors associated with bar patrons' self-estimated BrAC in high-risk college town settings.

METHODS

Guided interview and BrAC data were collected from 510 participants recruited as they exited bars located close to large universities: 1 in Florida and 1 in Texas.

RESULTS

Participants with the highest measured BrACs underestimated their BrAC levels the most. Findings from multivariable linear regression analysis indicated that BrAC (std β = 0.014, p < 0.001), number of alcoholic drinks consumed (std β = 0.006, p < 0.01), and perceived drunkenness (std β = 0.024, p < 0.001) had significant positive associations with BrAC self-estimates, where the regression coefficients were scaled by values approximately equal to each variable's interquartile range. Among the 321 participants with BrAC levels ≥ 0.08 g/dl, 21.2% believed their BrAC was below the legal per se driving limit of 0.08 g/dl. Results from a logistic regression analysis indicated that higher levels of perceived drunkenness were associated with better self-recognition that one's BrAC level exceeded the legal driving threshold (OR = 3.312, p < 0.001). Further, participants under 26 years of age had reduced odds of recognizing that their BrAC was greater than 0.079 g/dl (OR = 0.245, p < 0.05).

CONCLUSIONS

These findings highlight the inaccuracy of self-estimated BrAC when drinking, particularly among younger drinkers. Adjusting for BrAC, situational factors were strongly associated with self-estimated BrAC. Future research is needed to better understand how altering drinking environments may improve accuracy of BrAC self-estimates and deter driving after drinking.

Patterns of Waterpipe Tobacco Smoking Among U.S. Young Adults, 2013-2014

INTRODUCTION

Patterns of waterpipe smoking and associated other tobacco use were assessed among U.S. young adults (aged 18-24 years).

METHODS

A descriptive analysis of baseline data (2013-2014) from the Population Assessment of Tobacco and Health Study was conducted in 2016.

RESULTS

The study included 9,119 young adults-44% ever and 11% past-30 day waterpipe smokers (12% of men and 9% of women were past-30 day smokers). Among past-30 day smokers, waterpipe smoking frequency was distributed as follows: 4% daily, 23% weekly, 36% monthly, and 37% less than monthly. The average session exceeded 30 minutes for 79% of respondents. In this age group, 29% were exclusive waterpipe smokers, 16% were dual (waterpipe/cigarette) smokers, 8% were dual (waterpipe/e-cigarette) users, 19% were waterpipe/cigarette/e-cigarette users, and 28% presented with other combinations of poly use.

CONCLUSIONS

Waterpipe smoking is widespread among U.S. young adults. Although waterpipe patterns are predominantly intermittent, the average smoking session provides prolonged exposure. Waterpipe smoking among young adults is primarily characterized by the use of flavored tobacco, the café culture, and poly tobacco use. Rising trends in waterpipe smoking among U.S. youth warrant a strong regulatory response to prevent future waterpipe-related morbidity and mortality.

Hookah Use Among Florida High School Students, 2011-2014

INTRODUCTION

Adolescent use of hookah continues to increase in the U.S., even in states that have reported decreases in traditional cigarette use among youth. Hookah use typically involves smoking a moistened, loose, sweetened tobacco product with charcoal as the heat source.

METHODS

Data from the 2011-2014 Florida Youth Tobacco Survey were analyzed in 2016 to determine trends in the prevalence of lifetime hookah use (at least once in the adolescent's lifetime) and current hookah use (used in the past 30 days) among high school students (grades 9-12).

RESULTS

In 2014, a total of 22.5% of Florida public high school students reported ever smoking a hookah, up from 18.2% in 2011. Current hookah use was reported by 11.6% of high school students, an increase from 8.0% in 2011. Female high school students had an increase in use whereas male students' prevalence was relatively stable. Hispanic and non-Hispanic black students reported significant increases over time.

CONCLUSIONS

The increase in hookah use among adolescents needs continuous monitoring given the recent increase after relatively stable patterns. Efforts are needed to reduce the appeal and use of hookah by young people.

Hookah Smoking Outcome Expectations Among Young Adults

BACKGROUND

Despite the dangers associated with hookah tobacco smoking, use and popularity in the United States among young adults continue to increase. While quantitative studies have assessed users' attitudes toward hookah, qualitative research can provide a more in-depth description of positive and negative attitudes and beliefs associated with hookah use.

OBJECTIVES

To determine outcome expectancies associated with hookah use among young adults.

METHODS

We conducted six focus groups in 2013 to identify outcome expectancies associated with hookah use. Participants (N = 40) were young adults aged 18-23 who reported hookah use in the past three months. Using Outcome Expectancy Theory perspective, we posed the question "Hookah smoking is _______?" to elicit words or phrases that users associate with hookah use.

RESULTS

Over 75% of the users' hookah use outcome expectancies were positive, including associating hookah smoking with relaxation and a social experience. Content analysis of the words engendered six themes. These themes included Social Appeal, Physical Attractiveness, Pleasant Smoke, Comparison to Cigarettes, Relaxation, and Deterrents. Fewer negative hookah use expectancy words and phrases were identified, but included "tar" and "cough."

CONCLUSIONS

The findings suggest that participants lacked basic knowledge about hookah tobacco smoking, had misconceptions about its danger, and had many positive associations with hookah use. Incorporating components addressing positive hookah expectancies may improve the efficacy of established and new hookah use prevention and cessation interventions and policies.

Prevalence of and beliefs about electronic cigarettes and hookah among high school students with asthma

PURPOSE

To assess current cigarette, hookah, and electronic cigarette (e-cigarette) use among high school students with and without asthma. Beliefs and use of tobacco products by a household member were also examined.

METHODS

The 2014 Florida Youth Tobacco Survey was administered to high school students to assess current use of cigarettes, hookah, and e-cigarettes (i.e., within past 30 days). Student's home exposure and beliefs about cigarettes, hookah, and e-cigarettes were also assessed. Students were randomly selected using a two-stage cluster probability design.

RESULTS

Adolescents with asthma had a higher prevalence of current hookah (14.0%) and e-cigarette use (12.4%) compared with their peers (10.9%, 10.2%, respectively). Adolescents with asthma were also at increased risk for current use of cigarettes (adjusted odds ratio [AOR]: 1.24), hookah (AOR: 1.32), and e-cigarettes (AOR: 1.34). Adolescents with asthma reported positive beliefs about tobacco products and were more likely to report living with individuals who used cigarettes (31.5%), hookah (12.1%), and e-cigarettes (15.5%) compared with their peers (26.5%, 8.5%, 12.5%, respectively).

CONCLUSIONS

Adolescents with asthma reported tobacco product use, positive beliefs about tobacco products, and high potential home exposure to tobacco products. There is a pressing need for education regarding potential harm of alternative tobacco products among adolescents with asthma.

Income differences in social control of eating behaviors and food choice priorities among southern rural women in the US: A qualitative study

The role of social influences on rural women's food choice is not well understood. Rural adults experience high rates of obesity and poor diet quality prompting exploration of how social factors influence food choice in this population. Semi-structured qualitative interviews were conducted with 20 women in rural North Central Florida. Women were purposively sampled and stratified by race and income. Lower income was defined as household income at or below 185% of the federal poverty level (FPL). Women at or below 185% poverty level (BPL) experienced direct social control of their eating behaviors, which occurred when social network members explicitly regulated or otherwise sanctioned eating behaviors or food choices. Women above 185% of the federal poverty level (APL) internalized social norms and self-regulated their eating behaviors to maintain healthy habits. APL women described choosing foods for health reasons whereas BPL women offered a variety of reasons including taste, convenience, family history, price, health, and routine. Findings suggest that women in different income groups have different social influences working to help them regulate eating behaviors as well as diverse priorities influencing their food choices. Future interventions to promote healthy eating may be more effective by incorporating social network members and framing intervention messages so they are consistent with priorities.

A Systematic Review of Effects of Waterpipe Smoking on Cardiovascular and Respiratory Health Outcomes

BACKGROUND

Waterpipe smoking (WPS) is a social custom common in many Middle Eastern, North African, and Asian countries and has become increasingly popular in the US, especially among youth; however, WPS smoking may be increasing in the US adult population as well. There is a common belief among waterpipe (WP) smokers that WPS is less harmful than smoking cigarettes. Thus, this review aims to systematically explore the literature on the effects of WP tobacco smoking with a particular focus on cardiovascular and respiratory health outcomes as well as on oxidative stress, immunity, and cell cycle interference health outcomes.

METHODOLOGY

We conducted a systematic review, guided by the criteria of The Preferred Reporting Items for Systematic Reviews and Meta-Analyses, using the following online databases MEDLINE, CINAHL, ScienceDirect, PMC, and Cochrane Library. Results were summarized qualitatively.

RESULTS

Forty studies met the inclusion criteria established for this review. Based on the existing evidence, several cardiovascular and respiratory physiologic health indicators and conditions have been shown to be negatively affected by WPS. In addition to the effects of nicotine and chemical toxicant exposures, WPS was significantly associated with an increase in heart rate, blood pressure, and lower pulmonary function test results, as well as a number of health conditions such as lung cancer, alterations in oxidative stress, immunity, and cell cycle interference.

CONCLUSION

The current literature provides evidence that WPS is associated with a number of negative health indicators and outcomes. There is need for more research related to WPS and its effects on health so that appropriate campaigns and prevention interventions can be implemented to control the epidemic increase of WPS in the US.

Alcohol mixed with energy drink: Use may be a consequence of heavy drinking

AIMS

In recent years, studies have indicated that consumers of alcohol mixed with energy drink (AmED) are more likely to drink heavily and experience more negative consequences than consumers who avoid these beverages. Although researchers have identified a number of plausible hypotheses that explain how alcohol-energy drink co-ingestion could cause greater alcohol consumption, there has been no postulation about reverse causal relations. This paper identifies several plausible hypotheses for the observed associations between AmED consumption and greater alcohol consumption, and provides initial evidence for one such hypothesis suggesting that heavy drinking may be a determinant of AmED use.

METHOD

Data collected from 511bar patrons were used to examine the plausibility of one of the proposed hypotheses, i.e., AmED is an artifact of heavy drinking. Associations between the consumption of an assortment of alcoholic beverage types and total alcohol consumption were examined at the event-level, to assess whether AmED is uniquely related with greater alcohol consumption.

RESULTS

Increased alcohol consumption was associated with greater odds of consuming most alcoholic beverage types; this association was not unique to AmED.

CONCLUSIONS

Results support the overlooked hypothesis that AmED use is an artifact of heavy drinking. Thus, AmED consumption may be a consequence or marker of heavier drinking. Much of the existing research on alcoholic beverage types is limited in its ability to implicate any specific type of drink, including AmED, as a cause of increased alcohol consumption and related harm. More rigorous study designs are needed to examine causal relationships.

Consensus statement on assessment of waterpipe smoking in epidemiological studies

Numerous epidemiological accounts suggest that waterpipe smoking (aka hookah, shisha, narghile) has become a global phenomenon, especially among youth. The alarming spread of waterpipe and accumulating evidence of its addictive and harmful effects represent a new threat in the global fight to limit tobacco-related morbidity and mortality. In response to waterpipe's alarming trends, major public health and tobacco control organisations have started or are considering systematic collection of data about waterpipe smoking to monitor its trends and assess its harmful effects in different societies. Such plans require coordination and agreement on epidemiological measurement tools that reflect the uniqueness of this tobacco use method, and at the same time allow comparison of waterpipe trends across time and place, and with other tobacco use methods. We started a decade ago our work to develop standardised measures and definitions for the assessment of waterpipe smoking in epidemiological studies. In this communication, we try to expand and update these assessment tools in light of our increased knowledge and understanding of waterpipe use patterns, its context and marketing, as well as the need for evidence-guided policies and regulations to curb its spread. We have assembled for this purpose a group of leading waterpipe researchers worldwide, and worked through an iterative process to develop the suggested instruments and definitions based on what we know currently about the waterpipe epidemic. While the suggested measures are by no means comprehensive, we hope that they can provide the building blocks for standard and comparable surveillance of waterpipe smoking globally.

Hookah smoking behavior initiation in the context of Millennials

OBJECTIVES

This study aims to examine current hookah users' perceptions, attitudes, and normative beliefs regarding hookah smoking to further elucidate the rise in hookah smoking prevalence among young adults (aged 18-24 years) and reveal why hookah smoking is perceived as less harmful than other forms of tobacco consumption.

STUDY DESIGN

Qualitative.

METHODS

Data from six focus group interviews with hookah smokers aged between 18 and 24 years were analyzed using a grounded theory approach. Focus groups were evenly split between frequent and infrequent hookah users, and were predominantly composed of college students, with two groups of hookah users consisting of 18-24 year olds of non-student status.

RESULTS

Hookah users shared a much larger set of positive hookah smoking behavioral beliefs as opposed to negative behavioral beliefs. Generational traits served as the overarching commonality among the behavior performance initiation determinants observed. The most notable generational trends observed were within the cultural category, which included the following millennial characteristics: autonomy, personalization, novelty appeal, convenience, globally oriented, entertainment, collaboration, health conscious, and valuing their social network.

CONCLUSIONS

Millennial hookah users revealed mindfulness regarding both potential negative and positive reasons stemming from continued hookah use; however, behavioral beliefs were primarily fixated on the perception that hookah smoking was a healthier alternative to cigarette smoking. Future implications for this study's findings include generating more positive ways to express these traits for young adults; policy implications include raising hookah bar age limits, implementing indoor smoking restrictions, and limiting the ease of accessibility for purchasing hookah supplies.

Content Analysis of Anti-Tobacco Videogames: Characteristics, Content, and Qualities

OBJECTIVE

Although the prevalence of adolescent smoking has declined over the past two decades, the rate of decline has slowed. Electronic videogames show promise as an effective tool for health behavior change; however, the current state of tobacco prevention and cessation games has not been previously reviewed or evaluated.

METHODS AND MATERIALS

Currently available tobacco-related videogames were identified through online searches and in smartphone application stores. In total, 88 games were systematically coded for characteristics, content, and quality using a reliable and valid coding instrument developed for this research.

RESULTS

The majority of games included at least two components of interactivity (75.0 percent) and at least one mechanism for rewarding (69.3 percent). However, most games lacked a story line (97.7 percent) and components for sense of control (25.0 percent). There were an average of 3.54 (standard deviation = 2.20) theoretical constructs in the games, with attitudes (83.0 percent), knowledge (78.4 percent), and perceived severity (55.7 percent) being the most common. The most common educational approach used was the affective education model (83.0 percent). Most games included at least one tobacco message (90.9 percent), with a majority of messages being loss-framed (63.6 percent) and/or one-sided (75.0 percent).

CONCLUSIONS

Although today's anti-tobacco videogames contain many effective features, numerous qualities and best practices for changing behaviors through games are not present. Future games should seek to address these best practices in their development and evaluation to increase the likelihood they will be effective.

Extreme Weight-Control Behaviors and Suicide Risk Among High School Students

BACKGROUND

Suicide is the third leading cause of death for people ages 15-19. Research has established an association across numerous risk factors and suicide, including depression, substance abuse, bullying victimization, and feelings of alienation. However, the connection between disordered eating as manifested in extreme weight-control behaviors (EWCB), and suicidal thoughts, ideation, and attempts among adolescents is less understood. Given the prevalence of adolescent suicide, this investigation examined associations between EWCB and suicide risk among high school students.

METHODS

Data were collected from a convenience sample of 4178 students in grades 9-12 attending 5 public high schools using the Youth Risk Behavior Survey (YRBS) questionnaire. Logistic regressions were used to estimate associations between EWCB and suicide controlling for grade level and race, reported separately by sex.

RESULTS

Students who reported seriously considering suicide had higher odds of exhibiting all 3 EWCBs [adjusted odds ratio (AOR)(male) = 3.0 (confidence interval (CI): 1.4, 6.5); AOR(female) = 4.5 (CI: 2.5, 8.3)]. Moreover, students who reported they made plans about suicide were also more likely to exhibit all EWCBs [AOR(male) = 3.7 (CI: 1.7, 7.9); AOR(female) = 4.2 (CI: 2.3, 7.7)].

CONCLUSIONS

EWCBs were significantly associated with suicide risk, furthering the evidence suggesting a link between disordered eating and suicide. Findings demonstrated the need for school health services that address disordered eating in the effort to reduce adolescent suicide.

"It is just another test they want to do": Patient and caregiver understanding of the colonoscopy procedure

OBJECTIVE

Colonoscopy is a complex procedure that requires bowel preparation, sedation, and has the potential for substantial risk. Given this, we investigated colonoscopy patients' perceived and actual understanding of the procedure.

METHODS

Consecutive colonoscopy patients were enrolled and surveyed, with their caregivers, immediately prior to their procedure. Demographics, health literacy, socioeconomic status and perceived risks/benefits were assessed. Thematic analysis was conducted on open-ended responses and a 3-level outcome variable was created to categorize correctness of patients' and caregivers' understanding. Multinomial logistic regression was used to determine predictors of response level.

RESULTS

Patients (N=1821) were 77% White, 60% female, and averaged 54 years old; caregivers were demographically similar. Among patients, bivariate analysis revealed that younger age, minority race, and low income, education, and health literacy were associated with incomplete understanding. Multinomial regression revealed that age, education, health literacy, first-time colonoscopy, and perceived risk-benefit difference discriminated among groups. Bivariate and multinomial results for caregivers were similar.

CONCLUSION

Patients and caregivers varied on information, understanding and misconceptions about colonoscopy. Implications are discussed for inadequate: 1. informed consent, 2. bowel preparation, and 3. emotional preparation for cancer detection or adverse events.

PRACTICE IMPLICATIONS

Attention should be paid to patients' understanding of the purpose, anatomy, and logistics of colonoscopy, preferably prior to bowel preparation.

Waterpipe Tobacco Smoking and Susceptibility to Cigarette Smoking Among Young Adults in the United States, 2012-2013

Introduction

Waterpipe tobacco smoking, also known as hookah and shisha, has surged in popularity among young people in the United States. Waterpipe is also increasingly becoming the first tobacco product that young people try. Given the limited access to and limited portability of waterpipes, waterpipe smokers who become more nicotine dependent over time may be more likely to turn to cigarettes. This study examined the relationship between waterpipe tobacco smoking and susceptibility to cigarette smoking among young adults in the United States.

Methods

Using data from the 2012–2013 National Adult Tobacco Survey, a nationally representative sample of US adults, we reported rates of current waterpipe smoking and susceptibility to cigarette smoking by demographic characteristics and by use of other tobacco products among survey participants aged 18 to 24 years. Multivariable logistic regression was used to examine the relationship between current waterpipe smoking and susceptibility to cigarette smoking, defined as the lack of a firm intention not to smoke soon or within the next year.

Results

Of 2,528 young adults who had never established cigarette smoking, 15.7% (n = 398) reported being waterpipe smokers (every day or some days [n = 97; 3.8%] or rarely [n = 301; 11.9%]); 44.2% (176/398) of waterpipe smokers reported being susceptible to cigarette smoking. Those who smoked waterpipe rarely were 2.3 times as susceptible to cigarette smoking as those who were not current waterpipe smokers (OR = 2.3; 95% CI, 1.6–3.4).

Conclusion

Current waterpipe smoking is associated with susceptibility to cigarette smoking among young adults in the United States. Longitudinal studies are needed to demonstrate causality between waterpipe smoking and initiation of cigarette smoking.

Development of a Coding Instrument to Assess the Quality and Content of Anti-Tobacco Video Games

Previous research has shown the use of electronic video games as an effective method for increasing content knowledge about the risks of drugs and alcohol use for adolescents. Although best practice suggests that theory, health communication strategies, and game appeal are important characteristics for developing games, no instruments are currently available to examine the quality and content of tobacco prevention and cessation electronic games. This study presents the systematic development of a coding instrument to measure the quality, use of theory, and health communication strategies of tobacco cessation and prevention electronic games. Using previous research and expert review, a content analysis coding instrument measuring 67 characteristics was developed with three overarching categories: type and quality of games, theory and approach, and type and format of messages. Two trained coders applied the instrument to 88 games on four platforms (personal computer, Nintendo DS, iPhone, and Android phone) to field test the instrument. Cohen's kappa for each item ranged from 0.66 to 1.00, with an average kappa value of 0.97. Future research can adapt this coding instrument to games addressing other health issues. In addition, the instrument questions can serve as a useful guide for evidence-based game development.

Hookah and Alcohol Use among Young Adult Hookah Smokers: A Mixed Methods Study

OBJECTIVES

Hookah tobacco smoking has grown steadily in popularity among young adults in the United States. Little attention has been given to the relationship between hookah smoking and another behavior that is common among young adults - alcohol use. The purpose of this study was to examine hookah and alcohol use among young adults.

METHODS

Forty young adult hookah smokers (55% female) participated in focus group sessions on hookah use beliefs and a brief survey examining hookah and alcohol use including drinking alcohol before, during, or after smoking hookah.

RESULTS

Quotes from the focus groups indicated that alcohol use may promote hookah use among individuals who have little or no hookah smoking experience. Alcohol use, binge drinking, and alcohol use before, during, and after hookah use were common among the participants regardless of legal drinking age status. Nearly half of the participants preferred to drink alcohol while smoking hookah due to the improved physical and social effects they associated with combining the 2 behaviors.

CONCLUSIONS

For some young adult hookah smokers, alcohol appears to enhance the hookah smoking experience and may play a role in hookah smoking initiation. Future research and interventions should address the association between hookah and alcohol use.

Adolescent Electronic Cigarette Use: Associations With Conventional Cigarette and Hookah Smoking

INTRODUCTION

The emerging trends and rapid growth of electronic cigarettes (e-cigarettes) among adolescents are being monitored closely. The trends are critical as policy to prevent uptake among adolescents is considered. The purpose of this study is to describe the prevalence of e-cigarette use and potential correlates for use. Associations between e-cigarettes, cigarettes, and hookah are assessed.

METHODS

This study used data from the 2013 Florida Youth Tobacco Survey. Prevalence estimates were calculated in 2014 and differences were determined based on CIs. Adjusted logistic regression models were used to identify correlates of e-cigarette use among participants based on demographic and other tobacco products used.

RESULTS

There were no sex differences in middle school, whereas male high school students reported higher use than their female counterparts. Cigarette smoking and hookah use were significantly associated with ever and current e-cigarette use among both middle and high school students.

CONCLUSIONS

Although e-cigarettes are being assessed as a potential replacement product for traditional tobacco, evidence from this study indicates the possibility of multiple product use among adolescents. E-cigarettes are not only associated with traditional cigarettes, but also with hookahs, a similar emerging product that offer tobacco flavors that may appeal to adolescents. Notably, many e-cigarette users also reported no cigarette or hookah use.

Self-Efficacy to Drive While Intoxicated: Insights into the Persistence of Alcohol-Impaired Driving

BACKGROUND

Scant research has examined event-level risk factors for impaired driving in natural drinking settings. This study assessed driving self-efficacy among intoxicated individuals to better understand decision-making about alcohol-impaired driving at night after exiting on-premise drinking establishments.

METHODS

Interview and breath test data were collected from bar patrons (n = 512) exiting 2 college bar districts in Florida and Texas.

RESULTS

Results from a multivariable linear regression model indicated that self-efficacy to drive while intoxicated was more strongly associated with situational variables, that is, perceived drunkenness and self-estimated blood alcohol concentration than patron traits, that is, past-year history of drinking, risk proneness, and sex. A large proportion of bar patrons, particularly men, expressed confidence in their ability to drive, despite being highly intoxicated. Moreover, the majority of legally intoxicated patrons who were confident in their ability to drive were aware of their high level of intoxication.

CONCLUSIONS

Emphasis should be placed on the enactment and enforcement of policies and laws to prevent alcohol-impaired driving.

Waterpipe Smoking and Regulation in the United States: A Comprehensive Review of the Literature

BACKGROUND

Researchers in tobacco control are concerned about the increasing prevalence of waterpipe smoking in the United States, which may pose similar risks as cigarette smoking. This review explores the prevalence of waterpipe smoking in the United States as well as the shortcomings of current U.S. policy for waterpipe control and regulation.

METHODS

Researchers conducted a literature review for waterpipe articles dated between 2004 and 2015 using five online databases: MEDLINE, CINHAHL, ScienceDirect, PMC, and Cochrane Library.

RESULTS

To date, few studies have explored the marketing and regulation of waterpipe smoking in the U.S., which has increased in the last ten years, especially among women, adolescents, and young adults. Data indicate that the majority of waterpipe smokers are unaware of the potential risks of use. In addition, current tobacco control policies do not address waterpipe smoking, enabling tobacco companies to readily market and sell waterpipe products to young adults, who are at risk for becoming lifelong smokers.

CONCLUSION

Policy makers in the area of public health need to update existing tobacco regulations to include waterpipe smoking. Similarly, public health researchers should develop public health campaigns and interventions to address the increasing rates of waterpipe smoking in the United States.

Poor health among smokers obtaining colonoscopy screening: making the case for cessation intervention

OBJECTIVES

Assess differences in perceived health status among individuals receiving colonoscopy screening based on smoking status.

STUDY DESIGN

Cross-sectional data were collected as part of a larger study investigating whether verbal and non-verbal communication and behaviors of gastroenterologists and nurses.

METHOD

Data for this study were collected between 2011 and 2013 among receiving colonoscopy screenings. Data were collected as part of a study assessing patients (n = 1785) undergoing colonoscopy screenings about their expectations, concerns, understanding of the procedure, and perceived health status. Differences between current, former and never smokers were analyzed using a one-way between subjects ANOVA, with a Scheffe post hoc.

RESULTS

Post hoc analyses revealed that current smokers were significantly different from former or never smokers on the following variables: days their physical health was not good, days their mental health was not good, days health influenced their activities, days pain influenced their ability to perform activities, perceived general health, and current anxiety.

CONCLUSION

This study looked at perceived health among individuals receiving colonoscopy screening by on smoking status, a relevant population based on the recent Surgeon Generals link. Former smokers reported similar health status across all variables as never smokers, suggesting the effect of quitting smoking on self-perceived health. With this link, tailored smoking cessation messages to smokers receiving colonoscopy screenings may be an excellent vantage point for a smoking cessation intervention.

Reigniting tobacco ritual: waterpipe tobacco smoking establishment culture in the United States

INTRODUCTION

Waterpipe tobacco smoking (WTS) is an increasingly prevalent form of tobacco use in the United States. Its appeal may stem from its social, ritualistic, and aesthetic nature. Our aim in this study was to understand WTS as a social ritual with the goal of informing prevention efforts.

METHODS

We conducted a covert observational study consisting of 38 observation sessions in 11 WTS establishments in 3 U.S. cities. Data collection was based on an established conceptual framework describing ritualistic elements of tobacco use. Iterative codebook development and qualitative thematic synthesis were used to analyze data.

RESULTS

Atmospheres ranged from quiet coffee shop to boisterous bar party environments. While some children and older adults were present, the majority of clientele were young adults. Men and women were evenly represented. However, there were 19 occurrences of a male smoking by himself, but no women smoked alone. The vast majority (94%) of the clientele were actively smoking waterpipes. All 83 observed groups manifested at least 1 of the ritual elements of our conceptual framework, while 41 of the 83 observed groups (49%) demonstrated all 4 ritual elements.

CONCLUSIONS

Despite its heterogeneity, WTS is often characterized by 1 or more established elements of a tobacco-related social ritual. It may be valuable for clinical and public health interventions to acknowledge and address the ritualistic elements and social function of WTS.

Creating a Tobacco Cessation Program for People with Disabilities: A Community Based Participatory Research Approach

Introduction:

Smoking is the single most preventable cause of morbidity and mortality, accountable for one out of every five fatalities in the United States annually. Fifty million Americans (22%) suffer from some form of disability, with evidence suggesting that smoking rates within the disabled community are double that of the general population.

Methods:

The purpose of this study was to develop a tobacco cessation program designed by and for people with disabilities (PWD). Limited research data regarding tobacco interventions suggest that both adapting treatment methods and developing novel approaches may be effective in establishing cessation programs for low-income populations. Community-Based Participatory Research (CBPR) was conducted to develop a tobacco cessation group treatment program for PWD. Consumers with disabilities who use tobacco were recruited from a large population of PWD utilizing services at multiple centers for independent living (CIL) within North Central Florida.

Results:

Following qualitative interviews, multiple Community Advisory Board (CAB) meetings, and expert panel review, the tobacco cessation program was modified across several areas including: updating epidemiological data, decreasing text density, adding personal vignettes from PWD, adjusting for person-first language, adding disability-specific issues, and incorporating appropriate counseling strategies.

Conclusions:

Study findings suggest that CBPR-based methods are useful when developing tobacco cessation programs for persons with disability. Forty-two changes were recommended for the resulting LIFT Curriculum. Next steps include pilot testing the curriculum among individuals with disability and comparing results to a standard tobacco cessation curriculum.

A multiyear assessment of hookah use prevalence among Florida high school students

INTRODUCTION

The purpose of this study was to assess the prevalence of hookah use among Florida high school students over time. Alternative tobacco products, including hookah, pose a public health threat to tobacco prevention efforts, especially among adolescents.

METHODS

Florida Youth Tobacco Survey data, representing all public high school students in the state, were analyzed to assess the prevalence of lifetime and current hookah use and were compared by demographic groups. Multiple years of data (2007-2012) were examined to assess changes over time.

RESULTS

During the past 6 years, there was an increase in lifetime hookah use among Florida high school students. While males remained at a higher rate overall, female adolescents increased at a faster rate. Hispanic and non-Hispanic White respondents reported increased trends as well. Current use trends did not change over 4 years, remaining at about 8%.

CONCLUSIONS

Hookah is a new tobacco product in the United States that appears attractive to youth, with dramatic increases among the state population. While cigarette use among youth is declining in Florida, the increasing uptake of alternative tobacco products may lessen the overall public health gains for tobacco use. There is a need for continued monitoring of hookah use among the adolescent population, for both prevention and cessation efforts as well as policy interventions to address this emerging trend.

Knowledge, attitudes, and normative beliefs as predictors of hookah smoking initiation: a longitudinal study of university students

INTRODUCTION

While cross-sectional studies have shown that hookah tobacco smoking (HTS) is an increasingly popular behavior among university students, little is known about factors associated with initiation. This study sought to determine associations between knowledge, attitudes, and normative beliefs and initiation of HTS among university students.

METHODS

Data were from a prospective longitudinal cohort study of 569 randomly selected first- and second-year university students. Online questionnaires that were developed in accordance with our composite theoretical model were completed in September 2010 and April 2011.

RESULTS

About one-seventh (13%) of participants initiated HTS by follow-up. Positive attitudes and favorable normative beliefs were associated with increased adjusted odds of initiation (AOR = 4.12, 95% CI = 2.56, 6.59; and AOR = 2.01, 95% CI = 1.35, 2.99, respectively), while negative attitudes were associated with decreased adjusted odds (AOR = 0.62, 95% CI = 0.48, 0.80). Correct knowledge regarding toxicants associated with HTS was not significantly associated with initiation.

CONCLUSIONS

While positive attitudes and favorable normative beliefs are associated with initiation of HTS in a cohort of never-users, increased knowledge about toxins is not associated with lower initiation. It may be particularly valuable for educational interventions to attempt to alter positive attitudes and normative beliefs related to HTS.

The predictive utility of attitudes toward hookah tobacco smoking

OBJECTIVE

To determine associations between positive and negative attitudes and hookah tobacco smoking (HTS) among college students.

METHODS

Among a random sample of university students (N = 852), multivariable logistic regression models assessed associations between positive and negative attitudes toward HTS.

RESULTS

Positive attitudes were associated with adjusted odds of 4.32 (95% CI = 3.20, 5.82) for current HTS, whereas negative attitudes were associated with lower adjusted odds for current smoking HTS (AOR = 0.64, 95% CI = 0.53, 0.76). Positive attitudes were also associated with adjusted odds of 9.31 (95% CI = 6.77, 12.80) for intention for future hookah use among non-HTS users.

CONCLUSION

Positive attitudes toward HTS were more strongly associated with HTS compared to negative attitudes. It may be particularly valuable for future research and interventions to focus on decreasing positive attitudes toward HTS.