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Understanding the association between initial experimentation with a tobacco product and subsequent patterns of tobacco use among youth is important to informing prevention activities for youth in the US. We conducted an online survey from August to October 2017 among youth aged 13–18 years. The current analysis focused on respondents reporting initial experimentation with any tobacco product (n = 2,022). Using multinomial logistic regression, we examined the association between first tobacco product tried (cigarettes; cigars including cigarillos, little cigars, and bidis; electronic nicotine delivery systems (ENDS); smokeless and chewing tobacco; or hookah) with subsequent patterns of tobacco use while adjusting for covariates. Of the youth who experimented, 56.8% were non-current tobacco users. Of current tobacco users (n = 934), 13% were exclusive ENDS users, 5.3% exclusive combustible mono-users, 13.4% ENDS plus combustible poly-users, 3.3% combustible product only poly-users, and 8.2% other tobacco poly-users. The most common type of first tobacco product tried was ENDS (44.7%), followed by cigarettes (35.0%) and cigars (8.6%). Those who experimented with combustible tobacco products were less likely to be exclusive ENDS users [Relative Risk Ratio (RRR) = 0.46; 95% CI = 0.28, 0.73 for cigarettes; RRR = 0.32; 95% CI = 0.13, 0.81 for cigars; and RRR = 0.33; 95% CI = 0.14, 0.79 for hookah] when compared to non-current tobacco users (reference group). Tobacco product choices for initial experimentation appear to play a role in subsequent tobacco use patterns among youth. Understanding the reasons behind initial product choice may inform our understanding regarding the reasons for subsequent current tobacco product use, thus informing youth prevention efforts. [ABSTRACT FROM AUTHOR]

This letter published in the Journal of General Internal Medicine presents the findings of a survey conducted among veterans to compare their preferences and barriers for video visits versus in-person visits during the first year of the COVID-19 pandemic. The survey included 400 veterans, with 41% of them preferring video visits over in-person visits. The study found that consistent internet access and younger age were associated with a preference for video visits. The document also discusses the characteristics of the participants and factors associated with their visit preferences. The study highlights the need for digital health literacy and access to technology to improve veterans' experiences with video telehealth. However, there are limitations to the study, and further qualitative research is needed to explore preferences and concerns about telemedicine. The study was funded by the Veterans Affairs Office of Connected Care, and the de-identified data are available upon request from the corresponding author. [Extracted from the article]

The e-cigarette or vaping product-use-associated lung injury (EVALI) epidemic was primarily associated with the use of e-cigarettes containing tetrahydrocannabinol (THC)- the principal psychoactive substance in cannabis, and vitamin-E-acetate- an additive sometimes used in informally sourced THC-containing e-liquids. EVALI case burden varied across states, but it is unclear whether this was associated with state-level cannabis vaping prevalence. We, therefore, used linear regression models to assess the cross-sectional association between state-level cannabis vaping prevalence (obtained from the 2019 behavioral Risk Factor Surveillance System) and EVALI case burden (obtained from the Centers for Disease Control and Prevention) adjusted for state cannabis policies. Cannabis vaping prevalence ranged from 1.14%(95%CI, 0.61%-2.12%) in Wyoming to 3.11%(95%CI, 2.16%-4.44%) in New Hampshire. EVALI cases per million population ranged from 1.90(0.38–3.42) in Oklahoma to 59.10(19.70–96.53) in North Dakota. There was no significant positive association but an inverse association between state cannabis vaping prevalence and EVALI case burden (Coefficient, -18.6; 95%CI, -37.5–0.4; p-value, 0.05). Thus, state-level cannabis vaping prevalence was not positively associated with EVALI prevalence, suggesting that there may not be a simple direct link between state cannabis vaping prevalence and EVALI cases, but rather the relationship is likely more nuanced and possibly reflective of access to informal sources of THC-containing e-cigarettes. [ABSTRACT FROM AUTHOR]

Introduction: Smoking is independently associated with erectile dysfunction and cardiovascular disease. Given existing similarities in the constituents of e-cigarettes or ENDS and cigarettes, this study examines the association between ENDS use and erectile dysfunction.Methods: Data from Wave 4 (2016-2018) of the Population Assessment of Tobacco and Health study were analyzed in 2020. Male participants aged ≥20 years who responded to the erectile dysfunction question were included. Multivariable logistic regression models examined the association of ENDS use with erectile dysfunction within the full sample and in a restricted sample (adults aged 20-65 years with no previous cardiovascular disease diagnosis) while adjusting for multiple risk factors.Results: The proportion of erectile dysfunction varied from 20.7% (full sample) to 10.2% (restricted sample). The prevalence of current ENDS use within the full and restricted samples was 4.8% and 5.6%, respectively, with 2.1% and 2.5%, respectively, reporting daily use. Current daily ENDS users were more likely to report erectile dysfunction than never users in both the full (AOR=2.24, 95% CI=1.50, 3.34) and restricted (AOR=2.41, 95% CI=1.55, 3.74) samples. In the full sample, cardiovascular disease history (versus not present) and age ≥65 years (versus age 20-24 years) were associated with erectile dysfunction (AOR=1.39, 95% CI=1.10, 1.77; AOR= 17.4, 95% CI=12.15, 24.91), whereas physical activity was associated with lower odds of erectile dysfunction in both samples (AOR range=0.44-0.58).Conclusions: The use of ENDS seems to be associated with erectile dysfunction independent of age, cardiovascular disease, and other risk factors. While ENDS remain under evaluation for harm reduction and smoking-cessation potential, ENDS users should be informed about the possible association between ENDS use and erectile dysfunction. [ABSTRACT FROM AUTHOR]

Cannabis use and cannabis use disorder (CUD) are associated with adverse psychosocial outcomes, but their impact on workplace absenteeism remains poorly understood. Moreover, few studies have examined the role of CUD severity. This study aims to address these gaps by examining the associations between cannabis use recency, frequency, CUD severity, and workplace absenteeism. Cross-sectional data from a U.S. representative sample of full-time employed adults aged ≥18 from the 2021 to 2022 National Survey on Drug Use and Health (N =46,499) were analyzed. The associations between cannabis use recency, past-month cannabis use frequency, CUD severity, and workplace absenteeism (measured by self-reported number of missed days due to illness/injury and skipped work in the last 30 days) were evaluated using negative binomial regression, adjusting for sociodemographic characteristics and other substance use. Data were analyzed in 2023–2024. An estimated 15.9% of full-time employed adults used cannabis in the past month, with 6.5% meeting CUD criteria. Past-month cannabis use (compared to no lifetime use), more frequent past-month cannabis use (compared to no use in the past month), and each level of CUD (compared to no CUD) were associated with increased incidence of both missing work due to illness/injury and skipping work, with a dose-response relationship observed between CUD severity and skipping work (mild: adjusted incident rate ratio [aIRR]=1.60 [95% confidence interval [CI]=1.24, 2.08]; moderate: aIRR=1.98 [95% CI=1.50, 2.61]); severe (aIRR=2.87 [95% CI=2.12, 3.88]). Individuals with recent and frequent cannabis use and CUD are disproportionately prone to workplace absenteeism. Results support the enforcement of workplace drug prevention and treatment policies. [ABSTRACT FROM AUTHOR]

Introduction: Qualitative analysis of Twitter posts reveals key insights about user norms, informedness, perceptions, and experiences related to opioid use disorder (OUD). This paper characterizes Twitter message content pertaining to medications for opioid use disorder (MOUD) and Naloxone. Methods: In-depth thematic analysis was conducted of 1,010 Twitter messages collected in June 2019. Our primary aim was to identify user perceptions and experiences related to harm reduction (e.g., Naloxone) and MOUD (e.g., sublingual and Extended-release buprenorphine, Extended-release naltrexone, Methadone). Results: Tweets relating to OUD were most commonly authored by general Twitter users (43.8%), private residential or detoxification programs (24.6%), healthcare providers (e.g., physicians, first responders; 4.3%), PWUOs (4.7%) and their caregivers (2.9%). Naloxone was mentioned in 23.8% of posts and authored most commonly by general users (52.9%), public health experts (7.4%), and nonprofit/advocacy organizations (6.6%). Sentiment was mostly positive about Naloxone (73.6%). Commonly mentioned MOUDs in our search consisted of Buprenorphine-naloxone (13.8%), Methadone (5.7%), Extended-release naltrexone (4.1%), and Extended-release buprenorphine (0.01%). Tweets authored by PWUOs (4.7%) most commonly related to factors influencing access to MOUD or adverse events related to MOUD (70.8%), negative or positive experiences with illicit substance use (25%), policies related to expanding access to treatments for OUD (8.3%), and stigma experienced by healthcare providers (8.3%). Conclusion: Twitter is utilized by a diverse array of individuals, including PWUOs, and offers an innovative approach to evaluate experiences and themes related to illicit opioid use, MOUD, and harm reduction. [ABSTRACT FROM AUTHOR]

Background: Electronic dance music (EDM) party attendees are at high risk for use of various illegal drugs; however, little is known about their tobacco use. Understanding tobacco use patterns in this population at high risk for illegal drug use can inform multi-product interventions. Objectives: 954 EDM party attendees (ages 18–40) were surveyed in New York City in 2017. We estimated prevalence of use of cigarettes, hookah, cigars, other tobacco, and e-cigarettes and delineated correlates of current (past-month) use using bivariable and multivariable models. Results: Past-month use of cigarettes (36.2%), e-cigarettes (15.6%), cigars (12.5%), and hookah (11.7%) in particular was prevalent. In multivariable models, females were less likely to use e-cigarettes than males (adjusted prevalence ratio [aPR] = 0.63, p =.030), and those who attended graduate school were less likely to use cigarettes (aPR = 0.55, p =.003) and/or e-cigarettes (aPR = 0.33, p =.026). Past-year ecstasy/MDMA/Molly use was a risk factor for past-month use of cigarettes (aPR = 1.38, p =.013) and/or cigars (aPR = 1.61, p =.032), and past-year cocaine use was a risk factor for past-month use of cigarettes (aPR = 1.80, p <.001), cigars (aPR = 1.80, p =.013), other tobacco products (aPR = 3.05, p =.003), and/or e-cigarettes (aPR = 2.39, p =.003). 55.4% of ecstasy users and 60.3% of cocaine users were current cigarette smokers, but use of other products among users of these drugs was less prevalent (9.8–27.9%). Conclusions: Results suggest that current tobacco use is prevalent in this population who is also at high risk for use of drugs such as ecstasy and cocaine. Prevention and cessation efforts need to target tobacco users in this scene while incorporating components addressing illegal drug use. [ABSTRACT FROM AUTHOR]

This study aimed to estimate the trends in the body mass index (BMI) and prevalence of obesity among United States (U.S.) adolescents (10–19 years) and to examine the associations between sociodemographic factors and both BMI and obesity prevalence. The 2007–2020 National Health and Nutrition Examination Survey (NHANES), a nationally representative repeated cross-sectional survey data (n = 9,826) were used. Outcomes included: 1) Mean BMI and 2) obesity (yes/no; defined as BMI ≥95% percentile). Sociodemographic variables included age, sex, race/ethnicity, and poverty income ratio (PIR; low-income <1.3, middle-income ≥1.3 and <3.5, high-income ≥3.5). By accounting for the complex survey design, weighted generalized linear/Poisson models were used to conduct the analyses. Girls constituted 49% of the sample. From 2007–2008 to 2017–2020, there was an increase in BMI and obesity prevalence, particularly among Black and Hispanic adolescents, and those from low- and middle-income families. Additionally, there was an increase in obesity prevalence among both boys and girls. However, there were no significant changes in BMI and obesity prevalence in the other race and ethnic adolescents. Girls had a 12% (Adjusted Prevalence Ratio [APR] = 0.88; 95% CI, 0.81–0.96) lower likelihood of being obese than boys. Compared to White adolescents, Black and Hispanic adolescents had 22% (APR = 1.22; 95% CI, 1.06–1.40) and 19% (APR = 1.19; 95% CI, 1.05–1.36) greater risk of being obese. Compared to high-income families, adolescents from low- and middle-income families had 62% (APR = 1.62; 95% CI, 1.39–1.90) and 47% (APR = 1.47; 95% CI, 1.24–1.76) greater risk of being obese, respectively. The results indicated persistent disparities in obesity prevalence among different race/ethnic and sociodemographic groups. Future obesity intervention should address key disparities by targeting specific race/ethnic adolescents from low-income families and promoting health equality. [ABSTRACT FROM AUTHOR]

Hookah use among adolescents is increasing globally. No prior studies in the published literature have examined hookah use among youth in the Russian Federation. We assessed demographic, psychological and behavioral factors associated with lifetime and past 30-day hookah use among Russian youth. This cross-sectional study was conducted in three areas of Bashkortostan, Russia. In 2015, we surveyed Russian high school students (n = 716) on socio-demographic characteristics, tobacco (cigarettes, e-cigarettes, hookah) and drug use (alcohol, marijuana, and other illicit drugs), coping strategies, and getting in trouble (self and/or family). We estimated hookah use prevalence and performed bivariate analyses prior to fitting two multilevel models evaluating lifetime and past 30-day hookah use. Within this sample, 34.92% and 9.36% were lifetime and last 30-day hookah users, respectively. Lifetime hookah use was associated with older age (OR = 1.29), higher anger coping (OR = 1.41), school troubles (OR = 2.30), lifetime cigarette (OR = 1.59), e-cigarette (OR = 4.62), alcohol (OR = 5.61), and marijuana use (OR = 8.05). Additionally, past 30-day hookah use was associated with older age (OR = 1.71), lifetime use of alcohol (OR = 5.39), school troubles (OR = 5.82), and anger coping strategies (OR = 1.40). Hookah use is currently high among Russian youth in Bashkortostan and is associated with other risky behaviors. Effective interventions targeting multiple substances and coping strategies are needed. Social media campaigns encouraging cessation and advocating against its use at home may be beneficial in curbing hookah use among youth. [ABSTRACT FROM AUTHOR]

Objective: To examine the association between state-level tobacco control measures and current use estimates of both e-cigarettes and cigarettes, while accounting for socio-demographic correlates.Methods: Using the 2012-2013 and 2013-2014 National Adult Tobacco Survey (NATS), we assessed prevalence estimates of US adults' e-cigarette and cigarette current use. Four state groups were created based on the combined state-specific prevalence of both products: low cigarette/e-cigarette (n = 15), high cigarette/e-cigarette (n = 16), high cigarette/low e-cigarette (n = 11), and low cigarette/high e-cigarette) (n = 9). To evaluate the implementation of state-level tobacco control measures, Tobacco Control Index (TCI) was calculated using the State of Tobacco Control annual reports for 2012 and 2013. Multinomial logistic regression models were used to examine differences among the four groups on socio-demographic factors and TCI. Low cigarette/e-cigarette group was used as the referent group.Results: Current use estimates of each product varied substantially by state; current e-cigarette use was highest in Oklahoma (10.3%) and lowest in Delaware (2.7%), and current cigarette use was highest in West Virginia (26.1%), and lowest in Vermont (12.6%). Compared to low cigarette/e-cigarette, all other US-state categories had significantly lower TCI scores (high cigarette/e-cigarette: adjusted Relative Risk Ratio [aRRR] = 0.61; 95% confidence interval [CI]: 0.60-0.61, high cigarette/low e-cigarette: aRRR = 0.74; 95% CI: 0.73-0.74, and low cigarette/high e-cigarette: aRRR = 0.72; 95% CI: 0.71-073).Conclusions: Enforcing existing tobacco control measures likely interacts with e-cigarette use despite being cigarette-focused. Continuing to monitor e-cigarette use is critical to establish baseline use and evaluate future e-cigarette specific federal and state-level tobacco regulatory actions while accounting for the existing tobacco control environment.Implications: This study investigates state-level current use estimates of e-cigarettes and cigarettes among US adults; and their association with four existing tobacco control measures. The overall score of these measures was negatively associated with state-level current use estimates such that states with low current e-cigarette and cigarette use had the highest mean overall score. This study assesses the potential relationship between existing state-level tobacco control measures and e-cigarette use and calls for improving the enforcement of the known-to-work tobacco control measures across all US states, while developing evidence-based regulations and interventions specific to e-cigarettes within the existing US tobacco use environment. [ABSTRACT FROM AUTHOR]

Clinical Practice Guidelines for Treating Tobacco Use and Dependence advocate for using counseling targeted at tobacco users' motivation to quit during each office visit. We evaluate tobacco use screening and counseling interventions delivered during routine periodic health examinations by 44 adult primary care physicians practicing in 22 clinics of a large health system in southeast Michigan. 484 office visits were audio-recorded and transcribed. For this study, current tobacco users (N = 91) were identified using pre-visit surveys and audio-recordings. Transcripts were coded for the delivery of tobacco-related counseling interventions. The extent to which counseling interventions were used and/or targeted to the patients' readiness to quit was the main outcome measure. The majority of tobacco users (n = 77) had their tobacco use status assessed, and most received some sort of tobacco-related counseling (n = 74). However, only 15% received the recommended counseling targeted to their readiness to quit. On the other hand, 19% received less counseling than recommended given their readiness to quit, 7% received only nonindicated counseling, and 59% received nonindicated counseling in addition to indicated counseling. Results illustrate physicians' commitment to cessation counseling and also identify potential opportunities to improve the efficiency of tobacco-related counseling in primary care. [ABSTRACT FROM AUTHOR]

We examined the association between a general construct of wellness beliefs, sense of coherence, and a specific measure of tobacco-related beliefs, tobacco use myths, as predictors of two smoking-related outcome measures-next year smoking expectation and last 30-day smoking. Self-report questionnaires were administered to 710 adolescents attending California continuation high schools at baseline and at 1-year follow-up between 2006 and 2008. Cross-sectionally, predictor and outcome measures were correlated. However, in longitudinal analyses, only tobacco use myths predicted change in outcome measures. We speculate that future smoking interventions among adolescents would achieve relatively efficacious outcomes by targeting specific health beliefs instead of global health beliefs. The study's limitations are noted. [ABSTRACT FROM AUTHOR]

Background: Most hookah use studies have not included racial and ethnic minorities which limits our understanding of its use among these growing populations. This study aimed to investigate the individual characteristics of hookah use patterns and associated risk behaviors among an ethnically diverse sample of college students.Methods: A cross-sectional survey of 2460 students (aged 18-25) was conducted in 2015, and data was analyzed in 2017. Descriptive statistics were used to present the sociodemographic characteristics, hookah use-related behavior, and binge drinking and marijuana use according to the current hookah use group, including never, exclusive, dual/poly hookah use. Multivariate logistic regression was conducted to examine how hookah related behavior and other risk behaviors varied by sociodemographics and hookah use patterns.Results: Among current hookah users (n = 312), 70% were exclusive hookah users and 30% were dual/poly hookah users. There were no statistically significant differences in sociodemographic characteristics except for race/ethnicity (p < 0.05). Almost half (44%) of the exclusive hookah users reported having at least five friends who also used hookah, compared to 30% in the dual/poly use group. Exclusive users were less likely to report past year binge drinking (17%) and past year marijuana use (25%) compared to those in the dual/poly use group (44 and 48% respectively); p < 0.001.Conclusions: The socialization aspects of hookah smoking seem to be associated with its use patterns. Our study calls for multicomponent interventions designed to target poly tobacco use as well as other substance use that appears to be relatively common among hookah users. [ABSTRACT FROM AUTHOR]

Background: Engaging researchers as research subjects is key to informing the development of effective and relevant research practices. It is important to understand how best to engage researchers as research subjects. Methods: A 24 factorial experiment, as part of a Multiphase Optimization Strategy, was performed to evaluate effects of four recruitment strategy components on participant opening of an emailed survey link and survey completion. Participants were members of three US-based national health research consortia. A stratified simple random sample was used to assign potential survey participants to one of 16 recruitment scenarios. Recruitment strategy components were intended to address both intrinsic and extrinsic sources of motivation, including: $50 gift, $1,000 raffle, altruistic messaging, and egoistic messaging. Multivariable generalized linear regression analyses adjusting for consortium estimated component effects on outcomes. Potential interactions among components were tested. Results are reported as adjusted odds ratios (aOR) with 95% confidence intervals (95% CI). Results: Surveys were collected from June to December 2023. A total of 418 participants were included from the consortia, with final analytical sample of 400 eligible participants. Out of the final sample, 82% (341) opened the survey link and 35% (147) completed the survey. Altruistic messaging increased the odds of opening the survey (aOR 2.02, 95% CI: 1.35–2.69, p = 0.033), while egoistic messaging significantly reduced the odds of opening the survey (aOR 0.56, 95%CI 0.38–0.75, p = 0.08). The receipt of egoistic messaging increased the odds of completing the survey once opened (aOR 1.81, 95%CI: 1.39–2.23, p < 0.05). There was a significant negative interaction effect between the altruistic appeal and egoistic messaging strategies for survey completion outcome. Monetary incentives did not a have a significant impact on survey completion. Conclusion: Intrinsic motivation is likely to be a greater driver of health researcher participation in survey research than extrinsic motivation. Altruistic and egoistic messaging may differentially impact initial interest and survey completion and when combined may lead to improved rates of recruitment, but not survey completion. Further research is needed to determine how to best optimize message content and whether the effects observed are modified by survey burden. [ABSTRACT FROM AUTHOR]

Background: The present research aimed to determine the effect of an educational intervention based on the extended theory of planned behavior (ETPB) on waterpipe (WT) smoking cessation in women. Methods: The present quasi-experimental had a pre-test, post-test design with 3, 6 and 12 months follow-ups was conducted in Bandar Abbas city, south of Iran in December 2021-March 2023. A total of 448 women over the age of 15 (224 in the intervention group (IG), 224 in the control group (CG)), using a two-stage cluster sampling method participated. The educational intervention focused on WT smoking cessation implemented in 14 sessions. The educational methods in the training sessions were lectures, collaborative discussions, Q&As, brainstorming, role plays, and peer education. The main outcome was WT cessation behavior. Repeated measures ANOVA tests and post hoc were run to compare the IG and CG at baseline in terms of demographic variables, t-test and chi square test, and in the four points of time of data collection. The data were analyzed in Stata14. A p-value < 0.05 was considered as statistically significant. Results: The mean and standard deviation of WT cessation behavior and all ETPB constructs in the IG was significantly higher than the CG. After the educational intervention, in the IG, the perceived behavioral control, attitude, subjective norm, intention and knowledge increased, and the weekly smoking and WT smoking habit decreased (P < 0.001). The CG did not have any significant change in other variables except for the increased knowledge score. During the 12-month follow-up, the cessation rate was 43.81% (P = 0.645) in the IG and 7.45% in the CG (P = 0.081). Conclusions: The educational intervention positively affected WT smoking reduction and cessation in women through influencing the ETPB constructs. It is strongly recommended to design theory-based interventions beyond the individual level with an emphasis on interpersonal relationships to facilitate WT cessation as far as possible. [ABSTRACT FROM AUTHOR]

Background: We assessed longitudinal effects of e-cigarette use on respiratory symptoms in a nationally representative sample of US adults by combustible tobacco smoking status. Methods: We analyzed Waves 4–5 public-use data from the Population Assessment of Tobacco and Health Study. Study sample included adult respondents who reported no diagnosis of respiratory diseases at Wave 4, and completed Waves 4–5 surveys with no missing data on analytic variables (N = 15,291). Outcome was a validated index of functionally important respiratory symptoms based on 7 wheezing/cough questions (range 0–9). An index score of ≥2 was defined as having important respiratory symptoms. Weighted lagged logistic regression models were performed to examine the association between e-cigarette use status at Wave 4 (former/current vs. never use) and important respiratory symptoms at Wave 5 by combustible tobacco smoking status (i.e., never/former/current smokers), adjusting for Wave 4 respiratory symptom index, sociodemographic characteristics, secondhand smoke exposure, body mass index, and chronic disease. Results: Among current combustible tobacco smokers, e-cigarette use was associated with increased odds of reporting important respiratory symptoms (former e-cigarette use: adjusted odds ratio [AOR] = 1.39, 95% confidence interval [CI]: 1.07–1.81; current e-cigarette use: AOR = 1.55, 95% CI: 1.17–2.06). Among former combustible tobacco smokers, former e-cigarette use (AOR = 1.51, 95% CI: 1.06–2.15)—but not current e-cigarette use (AOR = 1.59, 95% CI: 0.91–2.78)—was associated with increased odds of important respiratory symptoms. Among never combustible tobacco smokers, no significant association was detected between e-cigarette use and important respiratory symptoms (former e-cigarette use: AOR = 1.62, 95% CI: 0.76–3.46; current e-cigarette use: AOR = 0.82, 95% CI: 0.27–2.56). Conclusions: The association between e-cigarette use and respiratory symptoms varied by combustible tobacco smoking status. Current combustible tobacco smokers who use e-cigarettes have an elevated risk of respiratory impairments. [ABSTRACT FROM AUTHOR]

Introduction: There has been much discussion in recent years about the use of Brain natriuretic peptide (BNP) or Pro-brain natriuretic peptide (Pro-BNP) for cardiovascular disease (CVD) risk stratification. The purpose of this study is to assess the association between the presence of abnormal BNP/pro BNP with Left ventricular Hypertrophy (LVH) in asymptomatic subjects with or without hypertension and their value for early CVD risk stratification. Methods: We evaluated 2230 subjects aged 23-80 years, who underwent screening for CVD risk using Early CVD Risk Score (ECVDRS), also known as Rasmussen Risk Score (RRS). ECVDRS consists of 10 non-invasive tests: large (C1) and small (C2) artery stiffness, blood pressure (BP) at rest and post mild exercise (BP PME), Carotid Intima Media Thickness (CIMT), abdominal aorta ultrasound, retinal photography, microalbuminuria, electrocardiogram (ECG), left ventricular ultrasound, and BNP/Pro-BNP. Results: Among the 2230 asymptomatic participants, we analyzed 933 who were treated by at least one or more cardiovascular medication for Diabetes, Hypertension (HTN) or Hyperlipidemia. Our hypothesis was that asymptomatic subjects with LVH have a significantly higher BNP/ProBNP values than those without LVH independent of HTN management. We used 3 Chi-square tests to test the independence between the two groups (with or without LVH) regarding their BNP/ProBNP status for the whole sample and further stratified by their HTN control. The findings in three tests were highly significant; the proportion of abnormal LVH was 0.17 and 0.39 respectively with normal vs elevated BNP/ProBNP for the whole sample, ² (1, N = 933) = 36.693, p < 0.001. When we stratified by HTN control, with uncontrolled HTN the proportion of abnormal LVH was 0.25 and 0.46 respectively with the normal vs elevated BNP/ProBNP, ² (1, N = 271) = 11.983, p =0.0005. Among participants with controlled HTN the proportion of abnormal LVH was 0.15 and 0.33 respectively with normal vs elevated BNP/ProBNP, ² (1, N = 662) = 18.257, p < 0.001. Conclusions: Abnormal BNP/pro-BNP levels are significantly associated with abnormal LVH findings in asymptomatic subjects independent of their HTN control. Thus, ProBNP/BNP could be considered an important follow up test for early detection of serious CV structural abnormality like LVH during the management of patients with HTN regardless of the degree of their HTN control. This finding may justify a more aggressive treatment approach and close monitoring with BNP/ProBNP as a possible screener for CVD manifestations like LVH in HTN patients. [ABSTRACT FROM AUTHOR]

Background: Research on women with substance use disorders has expanded, yet knowledge and implementation gaps remain.Methods: Drawing from topics discussed at the 2017 meeting of InWomen's in Montreal, Canada, this article reviews key progress in research on substance use among women, adolescents, and families to delineate priorities for the next generation of research.Results: The field has seen significant accomplishments in multiple domains, including the management of pregnant women with substance use and comorbid psychiatric disorders, caring for neonates in opioid withdrawal, greater inclusion of and treatment options for LGBTQ + communities, gendered instrumentation, and gender-focused HIV interventions for adolescent girls and women. Women who use alcohol and other drugs often experience other comorbid medical conditions (chronic Hepatitis C and HIV), contextual confounders (intimate partner violence exposure, homelessness, trauma), and social expectations (e.g., as caretakers) that must be addressed as part of integrated care to effectively treat women's substance use issues. Although significant advances have been made in the field to date, gender-based issues for women remain a neglected area in much of substance abuse research. Few dedicated and gender-focused funding opportunities exist and research has been siloed, limiting the potential for collaborations or interdisciplinary cross-talk.Conclusion: Given renewed attention to substance use in the context of the burgeoning opioid epidemic and shifts in global politics that affect women's substance use, the field requires a strategic rethink to invigorate a pipeline of future research and researchers. [ABSTRACT FROM AUTHOR]

Abnormal birth weight, particularly low birth weight (LBW), is known to have long-term adverse health consequences in adulthood, with disrupted sleep being suggested as a mediator or modifier of this link. We thus aimed to assess the associations between birth weight and self-reported adult sleep characteristics: sleep duration, difficulty waking up in the morning, daily nap frequency, sleep problems at night, snoring, daytime tiredness or sleepiness, and ever-stop breathing during sleep. This cross-sectional analysis used the United Arab Emirates Healthy Future Study data collected from February 2016 to March 2023 involving 2124 Emiratis aged 18–61 years. We performed a Poisson regression under unadjusted and age-sex-and-BMI-adjusted models to obtain the risk ratio and its 95% confidence interval for our analysis of the association between birth weight and each adult sleep characteristics, compared to individuals with normal birth weight (≥2.5 kg). Those with LBW had significantly a 17% increased risk of difficulty waking up in the morning, compared to those with normal birth weight. In addition, females with LBW history were also at an increased risk of reporting difficulty waking up in the morning. Studies with objective sleep assessments that include measurements of more confounding factors are recommended to confirm these risks. [ABSTRACT FROM AUTHOR]

INTRODUCTION Acute exposure to e-cigarette aerosol has been shown to have potentially deleterious effects on the cardiovascular system. However, the cardiovascular effects of habitual e-cigarette use have not been fully elucidated. Therefore, we aimed to assess the association of habitual e-cigarette use with endothelial dysfunction and inflammation -- subclinical markers known to be associated with increased cardiovascular risk. METHODS In this cross-sectional study, we analyzed data from 46 participants (23 exclusive e-cigarette users; 23 non-users) enrolled in the VAPORS-Endothelial function study. E-cigarette users had used e-cigarettes for ≥6 consecutive months. Non-users had used e-cigarettes <5 times and had a negative urine cotinine test (<30 ng/mL). Flow-mediated dilation (FMD) and reactive hyperemia index (RHI) were used to assess endothelial dysfunction, and we assayed high-sensitivity C-reactive protein, interleukin-6, fibrinogen, p-selectin, and myeloperoxidase as serum measures of inflammation. We used multivariable linear regression to assess the association of e-cigarette use with the markers of endothelial dysfunction and inflammation. RESULTS Of the 46 participants with mean age of 24.3 ± 4.0 years, the majority were males (78%), non-Hispanic (89%), and White (59%). Among non-users, 6 had cotinine levels <10 ng/mL while 17 had levels 10-30 ng/mL. Conversely, among e-cigarette users, the majority (14 of 23) had cotinine ≥500 ng/mL. At baseline, the systolic blood pressure was higher among e-cigarette users than non-users (p=0.011). The mean FMD was slightly lower among e-cigarette users (6.32%) compared to non-users (6.53%). However, in the adjusted analysis, current e-cigarette users did not differ significantly from non-users in their mean FMD (Coefficient=2.05; 95% CI: -2.52-6.63) or RHI (Coefficient= -0.20; 95% CI: -0.88-0.49). Similarly, the levels of inflammatory markers were generally low and did not differ between e-cigarette users and non-users. CONCLUSIONS Our findings suggest that e-cigarette use may not be significantly associated with endothelial dysfunction and systemic inflammation in relatively young and healthy individuals. Longer term studies with larger sample sizes are needed to validate these findings. [ABSTRACT FROM AUTHOR]

INTRODUCTION E-cigarette use among youth and young adults remains of public health concern. Pod-based e-cigarettes, including JUUL, significantly changed the e-cigarette landscape in the US. Using an online survey, we explored the socio-behavioral correlates, predisposing factors, and addictive behaviors, among young adult pod-mod users within a University in Maryland, USA. METHODS In total, 112 eligible college students aged 18--24 years, recruited from a University in Maryland, who reported using pod-mods were included in this study. Participants were categorized into current/non-current users based on past- 30-day use. Descriptive statistics were used to analyze participants' responses. RESULTS The mean age of the survey participants was 20.5 ± 1.2 years, 56.3% were female, 48.2% White, and 40.2% reported past-30-day (current) use of pod-mods. The mean age of first experimentation with pod-mods was 17.8 ± 1.4 years, while the mean age of regular use was 18.5 ± 1.4 years, with the majority (67.9%) citing social influence as the reason for initiation. Of the current users, 62.2% owned their own devices, and 82.2% predominantly used JUUL and menthol flavor (37.8%). A significant proportion of current users (73.3%) reported buying pods in person, 45.5% of whom were aged <21 years. Among all participants, 67% had had a past serious quit attempt. Among them, 89.3% neither used nicotine replacement therapy nor prescription medications. Finally, current use (adjusted odds ratio, AOR=4.52; 95% CI: 1.76--11.64), JUUL use (AOR=2.56; 95% CI: 1.08-6.03), and menthol flavor (AOR=6.52; 95% CI: 1.38-30.89) were associated with reduced nicotine autonomy, a measure of addiction. CONCLUSIONS Our findings provide specific data to inform the development of public health interventions targeted at college youth, including the need for more robust cessation support for pod-mod users. [ABSTRACT FROM AUTHOR]

Both diabetes and smoking significantly increase the risk of cardiovascular disease (CVD). Understanding whether a diagnosis of diabetes can be leveraged to promote smoking cessation is a gap in the literature. We used data from the US National Health Interview Survey, 2006 to 2018, to investigate the relationship between self-report of diagnosis of diabetes and subsequent smoking abstinence among 142,884 respondents who reported regular smoking at baseline. Effect sizes were presented as hazard ratios (HRs) derived from multivariable Cox regression models adjusted for potential confounders using diabetes as a time-dependent covariate. Subgroup-specific estimates were obtained using interaction terms between diabetes and variables of interest. A self-reported diagnosis of diabetes was associated with smoking abstinence (HR: 1.21; 95% CI: 1.16 to 1.27). The strength of the association varied based on race (P for interaction: 0.004), where it was strongest in African Americans (HR: 1.44; 95% CI: 1.29 to 1.60); income (P for interaction <0.001), where it was strongest in those with a yearly income less than $35,000 (HR: 1.45; 95% CI: 1.36 to 1.53); and educational attainment (P for interaction <0.001), where it was strongest in those who did not attend college (HR: 1.48; 95% CI: 1.40 to 1.57). Among adults who smoke, a diagnosis of diabetes is significantly associated with subsequent smoking abstinence. The association is strongest in socially disadvantaged demographics, including African Americans, low-income individuals, and those who did not attend college. [ABSTRACT FROM AUTHOR]

Tobacco use is the cause of several urologic cancers. Persistent use after diagnosis is associated with worse cancer-specific, quality of life, and overall mortality outcomes. Cigarette smoking remains the most common form of tobacco use despite significant population-level decline over the past few decades. The burden of smoking-related urologic disease is under appreciated by urologists and patients which has resulted in gaps in clinical care and limitations to research progress. We sought to summarize evidence-based practices and guideline recommendations for assessing and reporting tobacco use in the clinical and research settings. With a focus on smoking, our two primary goals are: 1) to promote the adoption of standardized and validated measures of tobacco use and 2) to highlight evidence-based strategies for urologists to use in clinical practice. [ABSTRACT FROM AUTHOR]

Purpose: This study describes the frequency of JUUL e-cigarette (referred to as JUUL) quit attempts and identifies characteristics associated with confidence in quitting and perceived difficulty quitting JUUL. Design: Cross-sectional study from a self-administered online survey. Setting: Two public southern California universities. Participants: A total of 1,001 undergraduate students completed the survey from February to May 2019. Measures: Self-report measures about JUUL included use, history of quit attempts, time to first use, perceived difficulty with cessation/reduction, and confidence in quitting. Analysis: Binary logistic regressions were used to identify demographic and tobacco-related behavioral correlates of JUUL cessation-related perceptions and behaviors. Results: Nearly half of ever-JUUL users (47.8%) reported a JUUL quit attempt. Adjusting for demographic factors and other tobacco product use, shorter time to first JUUL use after waking was associated with lower confidence in quitting JUUL (aOR = 0.02, 0.00-0.13) and greater perceived difficulty in quitting JUUL (aOR = 8.08, 2.15-30.35). Previous JUUL quit attempt history was also associated with greater odds of perceived difficulty quitting JUUL (aOR = 5.97, 1.74-20.53). Conclusions: History of JUUL quit attempts among college students was common. Those who had previously tried quitting were more likely to perceive difficulty with cessation. Time to first JUUL use, a marker of dependence, was linked with greater perceived cessation difficulty and lower confidence in quitting. These findings suggest that there is a need for cessation and relapse prevention support for college student JUUL users. [ABSTRACT FROM AUTHOR]

Introduction: People with serious mental illness (SMI) have a high smoking prevalence and low quit rates. Few cessation treatments are tested in smokers with SMI. Mental health (MH) providers are reluctant to address smoking. Proactive tobacco cessation treatment strategies reach out directly to smokers to offer counseling and medication and improve treatment utilization and quit rates. The current study is a secondary analysis of a randomized controlled trial of proactive outreach for tobacco cessation treatment in VA MH patients.Aims and Methods: Participants (N = 1938, 83% male, mean age 55.7) across four recruitment sites, who were current smokers and had a MH visit in the past 12 months, were identified using the electronic medical record. Participants were randomized to Intervention (telephone outreach call plus invitation to engage in MH tailored telephone counseling and assistance obtaining nicotine replacement therapy) or Control (usual care). The current study assessed outcomes in participants with SMI (N = 982).Results: Compared to the Control group, participants assigned to the Intervention group were more likely to engage in telephone counseling (22% vs. 3%) and use nicotine replacement therapy (51% vs. 41%). Participants in the Intervention group were more likely to be abstinent (7-day point prevalence; 18%) at 12 months than participants in the Control group (11%) but equally likely to make quit attempts.Conclusions: Proactive tobacco cessation treatment is an effective strategy for tobacco users with SMI. Proactive outreach had a particularly strong effect on counseling utilization. Future randomized clinical trials examining proactive tobacco treatment approaches in SMI treatment settings are needed.Implications: Few effective treatment models exist for smokers with SMI. Proactive tobacco cessation outreach with connections to MH tailored telephone counseling and medication promotes tobacco abstinence among smokers with SMI and is an effective treatment strategy for this underserved population. [ABSTRACT FROM AUTHOR]

Introduction: The prevalence of e-cigarette use has increased dramatically in the last decade in the U.S. Understanding the prevalence, patterns of use, and risk factor associations of e-cigarette use in pregnant women is particularly important, as this could have potential health implications for the mother and the developing child.Methods: Using Behavioral Risk Factor Surveillance System Survey data from 2016 to 2018, adult women of reproductive age (18-49 years) who reported being pregnant (n=7,434) were studied. Self-reported current e-cigarette use was the main exposure. Other measures included combustible cigarette smoking status and high-risk behaviors (including other tobacco, marijuana, or heavy alcohol use; binge drinking; and others). All analyses were done in 2019.Results: Approximately 2.2% of pregnant women reported current e-cigarette use, of whom 0.6% reported daily use. The highest prevalence of e-cigarette use was observed in the youngest age group of pregnant women (3.2%), with 41.7% of all pregnant current e-cigarette users being aged 18-24 years. There was a marked increase in the prevalence of current use of e-cigarettes among pregnant women from 1.9% in 2016 to 3.8% in 2018. Approximately 46% of pregnant current e-cigarette users reported concomitant cigarette smoking. Compared with pregnant never e-cigarette users, pregnant current e-cigarette users had a higher prevalence of other tobacco product use, marijuana use, heavy alcohol intake, binge drinking, and other high-risk behaviors.Conclusions: These findings underscore the need to strengthen prevention and policy efforts, specifically in the vulnerable subgroup of pregnant women. [ABSTRACT FROM AUTHOR]

Background and objectives: Adolescents in foster care are at high risk for cigarette smoking. However, it is not clear how their smoking behaviors vary by gender. The present study examined lifetime and current smoking among males and females, and explored gender-specific risk factors for engagement in smoking behaviors.Method: Data from the Multi Site Evaluation of Foster Youth Programs was used to evaluate patterns of smoking among adolescents aged 12–18 years (N= 1121; 489 males, 632 females).Results: Males and females did not differ significantly in rates of lifetime and current smoking, or in the age of smoking initiation and number of cigarettes smoked on a typical day. Gender-based analyses revealed that older age and placement in group homes or residential treatment facilities were associated with heightened risk of smoking among males. In contrast, sexual minority status (i.e., nonheterosexual orientation) and increased childhood victimization were associated with heightened risk of smoking among females. A history of running away was linked to smoking in both genders.Conclusion: Gender should be considered when designing intervention programs to address cigarette smoking among foster youth, as the stressors associated with smoking may differ for males and females. [ABSTRACT FROM PUBLISHER]

The e-cigarette or vaping product-use-associated lung injury outbreak in the United States has raised concerns about the potential health effects of cannabis vaping, a method of cannabis use that is becoming increasingly popular. We used 2017-2019 Behavioral Risk Factor Surveillance System data to estimate yearly prevalence and trends of past-30-day cannabis use and vaping among US adults. We used multivariable logistic regression to evaluate the associations of cannabis vaping with high-risk behaviors, asthma, and other respiratory symptoms. Our sample size was 160,209 (53,945-2017; 55,475-2018; and 50,789-2019). Past-30-day cannabis use prevalence increased from 10.0% (95% CI, 9.4%-10.7%) in 2017 to 13.4% (12.8%-12.0%) in 2019. Similarly, past-30-day cannabis vaping prevalence increased from 1.0% (0.8%-1.2%) to 2.0% (1.7%-2.2%) over the same period, with the greatest increase, 1.2% to 3.9%, observed among young adults (18-24 years). Individuals who vaped cannabis were more likely to concurrently vape nicotine. Cannabis vaping was associated with increased odds of heavy alcohol use (aOR, 1.95; 95% CI, 1.45-2.63), binge drinking (aOR, 2.82; 95% CI, 2.25-3.54), and other high-risk behaviors (aOR, 2.47; 95% CI, 1.89-3.24). In analyses adjusting for sociodemographic characteristics and body mass index, cannabis vaping was not associated with asthma (aOR, 1.03; 95% CI, 0.64-1.64) or other respiratory symptoms (aOR, 1.08; 95% CI, 0.44-2.63). Adjusting for nicotine vaping did not substantively alter these associations. The prevalence of past-30-day cannabis vaping has increased, particularly among young adults, and was associated with high-risk behaviors. Although there was no association between cannabis vaping and asthma or other respiratory symptoms, the increasing trends of cannabis vaping, particularly among young adults, raise concern and underscore the need for continued surveillance. [ABSTRACT FROM AUTHOR]

Use of substances other than nicotine in e-cigarettes, especially marijuana, is becoming increasingly popular in the US. However, population-representative data on such poly-use (nicotine and marijuana) remains limited. We therefore conducted a cross-sectional logistic regression analysis of the 2018 Behavioral Risk Factor Surveillance System among 16 US states/territories with data on past 30-day marijuana use to describe the emerging dual nicotine and marijuana vaping population. We additionally examined trends in marijuana use, including marijuana vaping, from 2016 to 2018. Of the 131,807 participants studied, 3068 were current e-cigarette users, among whom 7.1% also vaped marijuana. Prevalence of nicotine-predominant, dual nicotine marijuana, and marijuana-predominant vaping was 3.36%, 0.38% and 1.09%, respectively. Compared to nicotine-predominant vapers, dual and marijuana-predominant vapers were older, had greater proportions of non-Whites, particularly Hispanics, and less likely to be current smokers (nicotine-predominant vs dual vs marijuana-predominant vaping: current tobacco use 44.7 vs 23.7 vs 11.1%). Proportion of dual vapers among current e-cigarette users was 8.6%, 2.6% and 7.1% for 2016, 2017 and 2018, respectively. Prevalence of marijuana use increased from 8.97% (2016) to 13.1% (2018) while no clear trend was observed for marijuana vaping. Dual nicotine and marijuana vaping is prevalent in the US, and compared to predominantly nicotine vapers such users have higher mean ages, and are more likely to be Blacks, Hispanics, and never cigarette smokers. Marijuana use overall increased from 2016 to 2018. Dual vapers represent a large and important emerging population that will require dedicated study of health effects and tailored regulatory strategies. [ABSTRACT FROM AUTHOR]