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Objectives Aging populations and an increasing number of immigrants in recent years have led to numerous changes in intergenerational relationships. Although many studies have investigated the impact of providing care to a parent with dementia, little is known about the impact of caregiving activities provided from a distance, such as in the case of immigration, and over a long period of time to a person with dementia. Our understanding of how transnational caregiving for a person with dementia affects relationships is also limited. Using the Intergenerational Solidarity Theory as a theoretical framework, this paper examines the experiences of adult children and immigrant caregivers of a parent with dementia living in Poland. Methods A qualitative, semistructured interview was conducted with 37 caregivers living in the United States while providing transnational care to a parent with Alzheimer's disease or other forms of dementia. The data analysis was based on the thematic analysis strategy. Results Four themes were identified: (1) filial obligations and solidarity, (2) caregivers' contradictory emotions regarding transnational care, (3) financial and emotional exhaustion, and (4) challenges of nursing home dilemmas. Discussion Transnational caregivers represent a unique group who face distinctive challenges related to competing demands and limited resources. This study contributes to a better understanding of their experiences whereas the findings highlight the importance of addressing the mental and physical well-being of immigrant caregivers of individuals with dementia and have important implications for health care professionals and immigration policies. Implications for future research were also identified. [ABSTRACT FROM AUTHOR]

Background and Objectives Evidence-based practices to manage distress behaviors in dementia (DBD) are not consistently implemented despite demonstrated effectiveness. The Veterans Health Administration (VA) trained teams to implement Staff Training in Assisted Living Residences (STAR)-VA, an intervention to manage DBD in VA nursing home settings, or Community Living Centers (CLCs). This paper summarizes multiyear formative evaluation results including challenges, adaptations, and lessons learned to support sustained integration into usual care across CLCs nationwide. Research Design and Methods STAR was selected as an evidence-based practice for DBD, adapted for and piloted in VA (STAR-VA), and implemented through a train-the-trainer program from 2013 to 2018. Training and consultation were provided to 92 CLC teams. Evaluation before and after training and consultation included descriptive statistics of measures of clinical impact and survey feedback from site teams regarding self-confidence, engagement, resource quality, and content analysis of implementation facilitators and challenges. Results STAR-VA training and consultation increased staff confidence and resulted in significant decreases in DBD, depression, anxiety, and agitation for Veterans engaged in the intervention. Implementation outcomes demonstrated feasibility and identified facilitators and barriers. Key findings were interpreted using implementation frameworks and informed subsequent modifications to sustain implementation. Discussion and Implications STAR-VA successfully prepared teams to manage DBD and resulted in improved outcomes. Lessons learned include importance of behavioral health–nursing partnerships, continuous engagement, iterative feedback and adaptations, and sustainment planning. Evaluation of sustainment factors has informed selection of implementation strategies to address sustainment barriers. Lessons learned have implications for integrating team-based practices into system-level practice. [ABSTRACT FROM AUTHOR]

Online platforms can support health and educational professionals in their daily work; however, it is challenging to keep online platforms sustainable. This paper aims to indicate the most important factors of platform sustainability from the perspective of professionals involved in online platforms. Further, it aims to understand how these factors operate. A mixed methods study was carried out among professionals from Europe, Australia, the USA and Canada. In the first phase, the importance of 54 factors from the literature was assessed with a questionnaire among 17 professionals. The relative importance of the factors and the consensus regarding this importance were calculated using median scores and interquartile deviations. In total, 19 factors were selected representing general characteristics, characteristics related to the platform, communication, visitor and context. In the second phase, insight was gained regarding the experiences with those factors through 12 individual Skype interviews. The most frequently mentioned important factors of platform sustainability were (i) having sufficient time, resources and expertise, (ii) user friendliness and (iii) creating a sense of belonging. Platforms should use a planned approach to address a combination of factors directly from platform development. Gaining long-term resources is challenging and should be considered from the start of a project by building partnerships. To promote user friendliness, platforms should be simple, have a clear set-up and provide high-quality tools. Finally, establishing a sense of belonging could be supported by branding and face-to-face networking activities. For all aspects, involving visitors and stakeholders is essential. [ABSTRACT FROM AUTHOR]

Peer support is effective in improving self-management behaviors and health outcomes among individuals with Type 2 diabetes. Volunteer peer support programs offer a cost-effective resource for diabetes self-management support; however, factors affecting the retention of volunteer peer leaders remain understudied. Herein, we examined factors associated with volunteer retention and satisfaction among 34 predominantly Mexican-origin peer leaders who assisted patients from a Federally Qualified Health Center located on the US/Mexico border with their diabetes management. Peer leaders completed surveys with open- and close-ended questions at baseline, 6 months and 12 months. Quantitative and qualitative data analyses were guided by the Volunteer Process Model. Using nonparametric Mann–Whitney U tests, self-efficacy as a peer leader at 6 months was most associated with interest to continue volunteering (P  = 0.01), and satisfaction with support from the program at 12 months was most associated with interest to continue volunteering (P  = 0.01). The qualitative data indicated that the relationship between the peer leaders and their patients was the primary factor for a satisfying volunteer experience. Future research should focus on increasing peer leaders' self-efficacy and satisfaction with program support and examine how organizations can support the development of the patient–peer relationship. Practitioners should consider appealing to volunteer peers' motivations to promote their retention. [ABSTRACT FROM AUTHOR]

Recess is a critical source of physical, social and emotional health and well-being for children, but generally not prioritized during online learning. A 13-week structured recreation intervention was delivered virtually during recess to students in the fifth and sixth grades (age 10–12 years; N  = 71) at one elementary school (Phoenix, AZ, USA). We used embedded mixed method with a prospective pre-/post-design to measure change in student-reported emotion and qualities of engagement in an online setting. Students completed an online pre-/post-survey to measure emotion and motivational responses (enjoyment, competence and relatedness). We used narrative notes to qualitatively assess student engagement during programming. Differences in student-reported emotion were analyzed using paired t -tests. The effect of motivational responses on emotion was analyzed using multiple regression analyses. In vivo coding and concept coding were used to analyze qualitative data. We found no statistically significant differences in student-reported emotion; however, student relationships with peers predicted increased positive and decreased negative emotions after the intervention. Seven categories promoted student engagement: challenging, enjoyable, experiential, practical, purposeful, relatable and relevant. School-based health practitioners can offer structured activities virtually during recess, when in-person learning is interrupted and in all-online settings, to promote emotional well-being. [ABSTRACT FROM AUTHOR]

Background and Objectives This study examined the stability over time of activities of daily living (ADL) items in 3 comparable longitudinal data sets and evaluated ADL loss sequences for older adults in the United States, South Korea, and Japan. Research Design and Methods Data from the U.S. Health and Retirement Study, and its 2 international sister surveys, were analyzed. Participants were community-dwelling adults aged 60 and older. For each data set, Rasch analysis was implemented to determine if the ordering of items remained stable across multiple waves (2006–2014), such that a single ADL hierarchy may be derived from multiwave data. Results Data fitted the Rasch model well. Item calibrations were sufficiently stable across measurement periods in each data set, reflecting a stable frame of reference. Results were also robust to sample variations. The derived ADL hierarchies based on scaled logit scores revealed that "dressing" and "bathing" were relatively more difficult items for older adults in all study populations. Discussion and Implications Scale stability is essential when exploiting longitudinal data to analyze patterns in ADL disabilities. The consistency in ADL scales across measurement periods supports their use as screening tools and identifying those at risk for transitions in care. Interventions to reduce dependency in bathing and dressing can help improve independent functioning for community-dwelling older adults. [ABSTRACT FROM AUTHOR]

Despite promising results from individual-level studies, state-level studies of the effectiveness of comprehensive background-check (CBC) policies in reducing firearm fatalities have yielded null results in multiple states. These prior studies focused on CBC laws adopted in the 1990s, when record keeping was far less complete. We estimated the effect of the implementation of CBC policies on state-level firearm homicide and suicide rates in states implementing CBC policies from 2013 to 2015 (Colorado, Delaware, Oregon, and Washington). We compared age-adjusted firearm homicide and suicide rates, measured annually from 15 years prior to policy implementation until 2019, in each treated state to rates in control groups constructed using the synthetic control group method. Differences in firearm homicide rates for Colorado, Oregon, and Washington post treatment were all small (0.09 to 0.18 per 100,000 residents per year) and not well distinguished from natural variation. Oregon had on average 0.80 per 100,000 fewer firearm suicides per year than did synthetic Oregon post treatment. However, these results were inconsistent across modeling approaches and not well distinguished from natural variation. Our models produced poor fit for Delaware. Coupled with previous null results from Indiana, California, Maryland, Pennsylvania, and Tennessee, the present results suggest that extending background check requirements to private transfers alone and implementing these policies as is currently done is not sufficient to achieve significant state-level reductions in firearm fatalities. [ABSTRACT FROM AUTHOR]

Sleep has an essential role in the health, wellbeing, and ability to learn of undergraduate college and university students (UCUS). Due to high credit loads, the music curriculum, and music therapy competencies, music therapy students may experience difficulties obtaining adequate sleep. Therefore, the purpose of this study was to understand factors that enable or inhibit sleep in undergraduate music therapy students. We conducted semi-structured interviews with 14 junior and senior level music therapy UCUS at public institutions in the United States. We used an inductive approach to thematic analysis to analyze data and incorporated member checking and trustworthiness to clarify and verify the results. We identified three themes (supported by seven subthemes) as factors that impacted the sleep of undergraduate music therapy students: (a) academic schedule and expected time commitment; (b) intrinsic motivation to become better student music therapists; and (c) wellness-based education and personal factors. The results of this study provide insight into the various factors that might adversely affect sleep in undergraduate music therapy students and have consequences on their health, wellbeing, and learning. Implications for students and educators, limitations of the study, and suggestions for future research are provided. [ABSTRACT FROM AUTHOR]

The number of music therapy private practices in the United States is growing. While it is thought that improving business skills can improve business success, it is not clear what business education was received by music therapy business owners (MTBOs). The purpose of this qualitative inquiry was to explore MTBOs business education in the United States and their views on business education for music therapists and music therapy students. Following an interpretivist theoretical framework, we conducted semi-structured interviews with 21 MTBOs representing all seven regions of the American Music Therapy Association. Using thematic analysis, we created five themes with supporting subthemes. Our findings indicate that the amount of business education participants received as students did not match the amount of business education they perceived necessary to be business owners, and that they sought out additional training from a variety of sources. Participants' views on music therapy business education and skills important for business ownership in the field of music therapy are explored. [ABSTRACT FROM AUTHOR]

The United States faces rapidly rising rates of violent crime committed with firearms. In this study, we sought to estimate the impact of changes to laws that regulate the concealed carrying of weapons (concealed-carry weapons (CCW) laws) on violent crimes committed with a firearm. We used augmented synthetic control models and random-effects meta-analyses to estimate state-specific effects and the average effect of adopting shall-issue CCW permitting laws on rates of 6 violent crimes: homicide with a gun, homicide by other means, aggravated assault with a gun, aggravated assault with a knife, robbery with a gun, and robbery with a knife. The average effects were stratified according to the presence or absence of several shall-issue permit provisions. Adoption of a shall-issue CCW law was associated with a 9.5% increase in rates of assault with a firearm during the first 10 years after law adoption and was associated with an 8.8% increase in rates of homicide by other means. When shall-issue laws allowed violent misdemeanants to acquire CCW permits, the laws were associated with higher rates of gun assaults. It is likely that adoption of shall-issue CCW laws has increased rates of nonfatal violent crime committed with firearms. Harmful effects of shall-issue laws are most clear when provisions intended to reduce risks associated with civilian gun-carrying are absent. [ABSTRACT FROM AUTHOR]

This study examines undocumented Latinx older adults' perceptions and experiences regarding their economic security in the United States. In-depth semistructured interviews were used to facilitate dialogue with older undocumented adults about their economic security in the United States (N = 25). Participants were on average 61 years old (SD = 4.52), Latinx, and had resided in the United States an average of 23 years (SD = 7.05). More than 70% of the participants were employed; the remaining participants were not working due to poor health (n = 5), advanced age (n = 1), or being in between jobs (n = 1). Authors present a model to illustrate participants' narratives on their economic (in)security in the United States. Some participants discussed having long-term security in their jobs while others described a cycle of job insecurity due to their status. Their precarious status limited their employment opportunities and earning potential. Their savings capacity is narrow; many did not have savings for emergencies, and less so for a time when they are no longer able to work. Many participants believe they will work until they are physically unable to continue working; others believe their children will be a source of support. Practitioners can engage undocumented immigrants in economic empowerment interventions and advocacy efforts to eliminate exploitation in the workplace. Policy change is needed to provide undocumented older adults the opportunity to achieve financial security. [ABSTRACT FROM AUTHOR]

Background and Objectives Partnerships between health care and social service organizations may contribute to lower health care use and spending. Such partnerships are increasing, including Area Agencies on Aging (AAAs) working and contracting with health care organizations. Nevertheless, knowledge about how AAAs establish and manage successful collaborations is limited. We sought to understand how AAAs establish and manage partnerships with health care organizations. Research Design and Methods We conducted an explanatory sequential mixed-methods study using a positive deviance approach. We used national-level data to identify AAAs with multiple health care partners serving areas with low utilization of nursing homes by residents with low-care needs (n = 9) and AAAs with few health care partners and high utilization for comparison (n = 3). We conducted in-depth interviews with key informants from these 12 AAAs and their partner organizations (total n = 130). A 5-person multidisciplinary team used the constant comparative method of analysis, supported by Atlas.ti software. Results Highly partnered AAAs were characterized by 3 distinctive features of organizational culture: (a) attention to external environments, (b) openness to innovation and change, and (c) risk-taking to learn, improve, and grow. AAAs and partners describe a broad set of organizational strategies and partnership development tactics, depending on their local contexts. These features were underdeveloped in AAAs with few health care partnerships. Discussion and Implications While federal and state policies can create more favorable environments for AAA–health care partnerships, AAAs can also work internally to foster an organizational culture that allows them to thrive in dynamic and challenging environments. [ABSTRACT FROM AUTHOR]

Cannabidiol (CBD) product regulatory efforts must be informed by research regarding consumer perceptions. This mixed-methods study examined CBD product information sources, knowledge, perceptions, use and use intentions among young adults. This study analyzed (i) Fall 2020 survey data from 2464 US young adults (M age = 24.67, 51.4% ever users, 32.0% past 6-month users) and (ii) Spring 2021 qualitative interviews among 40 survey participants (27.5% past-month users). Overall, 97.9% of survey participants reported having heard of CBD, 51.4% ever/lifetime use and 32.0% past 6-month use. Survey participants learned about CBD from friends/family (58.9%), products/ads at retailers (36.4%), online content/ads (34.8%), CBD stores (27.5%) and social media (26.7%). One-fourth believed that CBD products were required to be US Food and Drug Administration-approved (24.9%), tested for safety (28.8%) and proven effective to be marketed for pain, anxiety, sleep, etc. (27.2%). Survey and interview participants perceived CBD as safe, socially acceptable and effective for addressing pain, anxiety and sleep. Interview findings expanded on prominent sources of marketing and product exposure, including online and specialty retailers (e.g. vape shops), and on participants' concerns regarding limited regulation and/or evidence regarding CBD's effectiveness/risks. Given young adults' misperceptions about CBD, surveillance of CBD knowledge, perceptions and use is critical as the CBD market expands. [ABSTRACT FROM AUTHOR]

Informed by the ecological perspective, this study explored the ways in which macrosystemic influences interact with other systems and influence Latinx undocumented older adults—specifically, the obstacles and barriers they have faced while living in the United States. Thirty Latinx undocumented older adults (between 55 and 73 years old) participated in in-depth interviews. Four main themes captured participants' experiences: (1) unfulfilled aspirations; (2) social inequities; (3) fear, uncertainty, and threat of deportation; and (4) good immigrant ideology. Participants migrated to the United States in search of better opportunities; while they may have been able to secure jobs, they were limited by their status to achieve other dreams and aspirations. Participants reported that they lack the rights and privileges granted by citizenship. Their precarious status and the policy climates preclude them from feeling safe in the United States, and they fear detection and deportation. They shared that they hope to adjust their status and engage in best behavior as a sign of respect and to safeguard their future in this country. Several participants remarked that it is clear they are not welcomed. These are critical issues that demand attention at a policy and practice level. [ABSTRACT FROM AUTHOR]

Objectives Black persons in the United States are more likely to suffer from social inequality. Chronic stress caused by social inequality and racial discrimination results in weathering of the body that causes physiological dysregulation and biological age being higher than chronological age (accelerated aging). Depression has been linked to both racial discrimination and accelerated aging and accelerated aging has been demonstrated to be higher in Black than White persons, on average. However, we know little about accelerated aging across the life course in Black Americans. Methods We used mixed-effects growth models to measure biological age acceleration, measured with cardiometabolic markers, over a 20-year period in Black participants of the Coronary Artery Risk Development in Young Adults Study who were aged 27–42 years at analytic baseline. We included an interaction between depressive symptoms and time to determine whether risk of depression was associated with a faster rate of biological aging. Results We found that the rate of biological aging increased over a 20-year span and that those at risk for depression had a faster rate of biological aging than those not at risk. We also found that various social factors were associated with biological age acceleration over time. Discussion Given the known association between perceived racial discrimination and depressive symptoms, we provide a novel instance of the long-term effects of social inequality. Specifically, biological age acceleration, a marker of physiological dysregulation, is associated with time among Black persons and more strongly associated among those with depressive symptoms. [ABSTRACT FROM AUTHOR]

Disparities in academic achievement have been well documented between low– and high–socioeconomic status (SES) students in the United States. Studies point to education-related parental involvement as a key factor in academic accomplishments, with higher parental involvement facilitating higher academic achievement. However, current definitions of parental involvement neglect interpretations of parental involvement held by low-SES parents. This work explored these definitions held by low-SES families through focus groups (n  =   10) and individual interviews (n  =   23) with parents of school-age children. Findings suggest that low-SES parents define parental involvement to include the vital role of siblings, limited communication with teachers unless behavioral or academic problems arise, and activating informal enrichment activities. Factors that hindered their involvement include having limited time for engaging in education-related activities and poor proficiency in educational materials. These findings suggest that the concept of parental involvement ought to be conceptualized in more nuanced ways to support the closure of the academic achievement gap between students from low- and high-SES families. [ABSTRACT FROM AUTHOR]

Young adults' perceptions and use of heated tobacco products (HTPs) are understudied. This mixed methods study analyzed (i) Fall 2020 survey data from 2470 US young adults (meanage = 24.67; 19.5% and 25.2% past-month cigarette and e-cigarette use; 4.1% ever HTP use) assessing HTP use intentions and perceptions (1 = not at all to 7 = extremely) and (ii) Spring 2021 interview data regarding IQOS (most widely available HTP) in a subset of 40 e-cigarette users. Among survey participants, HTPs versus cigarettes and e-cigarettes showed lower use intentions (mean = 1.27 vs. mean = 1.73, mean = 2.16) but were perceived as less addictive (mean = 5.11 vs. mean = 6.28, mean = 5.82) and harmful (mean = 5.37 vs. mean = 6.65, mean = 5.62). HTPs were perceived more socially acceptable than cigarettes but less than e-cigarettes (mean = 3.39 vs. mean = 3.13, mean = 4.37). Among interviewees, most reported limited HTP knowledge. A few perceived IQOS as a hybrid of traditional cigarettes and e-cigarettes. Most perceived IQOS as harmful but less harmful than cigarettes and were uncertain in relation to e-cigarettes. Over half reported minimal interest in trying IQOS; common reasons included IQOS containing tobacco, limited flavors and use complexity. The varied perceptions of IQOS versus cigarettes and e-cigarettes underscore the need for continued surveillance of perceptions, use and marketing of IQOS to inform regulatory oversight and potential interventions. [ABSTRACT FROM AUTHOR]

Modifications to the social–ecological model, such as Whole School, Whole Community, Whole Child (WSCC) frameworks, have been utilized in comprehensive school health interventions. Classroom physical activity breaks are used when implementing whole-of-school approaches. However, the onus to implement classroom physical activity breaks is on school stakeholders. This study aimed to explore teacher and principal perceptions and implementation of physical activity breaks in elementary schools. Further, this study investigated how theoretical factors representative of the social–ecological model and their interactions affect teacher and principal perceptions and utilization of classroom physical activity breaks. Interviews were conducted to understand teacher and principal perceptions and implementation. A total of 12 classroom teachers and five principals participated in semi-structured interviews which were analyzed using constant comparison and deductive analysis to identify relationships and themes coded across the social–ecological and WSCC models. To ensure fidelity individuals that led the professional development (n = 2) were also interviewed. Three main themes emerged as part of the data analysis: (i) The Connection Between Intrapersonal Knowledge and Interpersonal Professional Development, (ii) Resources, Sharing Means Caring and (iii) The Policy Level Creates Time. Teachers and principals valued knowledge and resources and felt that policy facilitated implementation. Results suggest that classroom physical activity breaks are influenced by multiple factors across varied levels of the social–ecological model. Understanding this relationship can inform future professional development to increase the provision of classroom physical activity breaks among teachers. [ABSTRACT FROM AUTHOR]

Background African countries are underrepresented in cancer research, partly because of a lack of structured curricula on clinical research during medical education. To address this need, the MD Anderson and Zambia Virtual Clinical Research Training Program (MOZART) was developed jointly by MD Anderson Cancer Center (MDA) and the Cancer Diseases Hospital in Zambia (CDH) for Zambian clinical oncology trainees. We explored participant perspectives to provide insight for implementation of similar efforts. Materials and Methods The MD Anderson and Zambia Virtual Clinical Research Training Program consisted of weekly virtual lectures and support of Zambian-led research protocols through longitudinal mentorship groups that included CDH faculty and MDA peer and faculty mentors. Participants were contacted via email to take part in semi-structured interviews, which were conducted via teleconference and audio-recorded, transcribed, and coded. Emergent themes were extracted and are presented with representative verbatim quotations. Results Thirteen of the 14 (93%) trainees were interviewed. Emergent themes included (1) participants having diverse educational backgrounds but limited exposure to clinical research, (2) importance of cancer research specific to a resource-constrained setting, (3) complementary roles of peer mentors and local and international faculty mentors, (4) positive impact on clinical research skills but importance of a longitudinal program and early exposure to clinical research, and (5) challenges with executing research protocols. Conclusion To our knowledge, this is the first qualitative study of African clinical oncology trainees participating in a virtual clinical research training program. The lessons learned from semi-structured interviews with participants in MOZART provided valuable insights that can inform the development of similar clinical research training efforts and scale-up. [ABSTRACT FROM AUTHOR]

Introduction: This study examined whether smokers' harm perceptions of nicotine replacement therapy (NRT) and nicotine vaping products (NVPs) relative to cigarettes predicted their subsequent use as smoking cessation aids during their last quit attempt (LQA).Aims and Methods: We analyzed data from 1,315 current daily smokers (10+ cigarettes per day) who were recruited at Wave 1 (2016), and who reported making a quit attempt by Wave 2 (2018) of the International Tobacco Control Four Country Smoking and Vaping Surveys in Australia, Canada, England, and the United States. We used multinomial logistic regression models to examine prospective associations between harm perceptions of (a) NRT and (b) NVPs and their use at LQA, controlling for socio-demographic and other potential confounders.Results: Smokers who perceive that (a) NRT and (b) NVPs are much less harmful than cigarettes were more likely to subsequently use the respective product as an aid than using no aid or other aids during LQA (adjusted relative risk ratio [aRRR] = 3.79, 95%CI = 2.16-6.66; and aRRR = 2.11, 95%CI = 1.29-3.45, respectively) compared to smokers who perceive these products as equally or more harmful. Additionally, those who perceive NVPs as much less harmful than cigarettes were less likely to use NRT as a quit aid (aRRR = 0.34, 95%CI = 0.20-0.60). No country variations for these associations were found.Conclusions: This study found that smokers' perceptions of the harmfulness of (a) NRT and (b) NVPs relative to cigarettes predicted the respective product use when trying to quit smoking. Corrective education targeting misperceptions of nicotine products' relative harmfulness may facilitate their use for smoking cessation.Implications: Nicotine replacement therapy and nicotine vaping products are two commonly used smoking cessation aids. This study demonstrates that misperceptions of the harms of nicotine products relative to cigarettes influence their use for smoking cessation. Believing that nicotine vaping products are much less harmful than cigarette smoking may lead some smokers to prefer these products over nicotine replacement therapy to aid smoking cessation. Education targeting misperceptions of nicotine products' harmfulness relative to cigarettes may enable smokers to make informed choices about which are appropriate to aid smoking cessation. [ABSTRACT FROM AUTHOR]

Objectives Retrospective measures of childhood socioeconomic status (SES) in cohort studies of aging that first observe people late in life—such as the Health and Retirement Study (HRS)—are widely used. However, their measurement validity and reliability are unknown. We assess the reliability and validity of the HRS's retrospective measures of parental education and childhood family finances. Methods We use records for 6,343 HRS sample members who were children in 1940 that have been linked to records from the complete-count 1940 U.S. Census. We assess interrater reliability by comparing (a) retrospective reports of childhood SES collected from sample members in the 1992–2018 HRS to (b) prospective measures of parallel concepts collected from HRS sample members' parents in the 1940 Census. We assess predictive validity by comparing the results of analyses that model later-life outcomes as a function of childhood SES as measured both prospectively and retrospectively. Results Interrater reliabilities of retrospective measures of parental education are high; however, the same is not true of the retrospective measure of childhood family finances. Both retrospective and prospective measures of childhood SES are predictive of later-life outcomes, and with similar strengths and directions of associations for most outcomes. Discussion Researchers who rely on retrospective indicators of childhood SES from the HRS should be aware of their measurement properties. They are measured with error, and that error modestly attenuates estimates of their associations with later-life outcomes. However, prospective and retrospective measures of childhood SES have similar predictive validity. These findings should reassure researchers who rely on retrospective measures of childhood SES in the HRS and similarly designed surveys. [ABSTRACT FROM AUTHOR]

Child welfare (CW) professionals who provide direct services to families, referred to as 'caseworkers' in the USA, often have to act in ways that are inconsistent with their professional values, leading to feelings of guilt, anxiety and self-blame, referred to as moral distress. The conceptual basis for moral distress primarily comes from the nursing literature, leaving a theoretical gap in how CW workers experience moral distress. Hence, this study used qualitative system dynamics modelling to develop a dynamic theory of moral distress amongst US CW caseworkers (N  = 25 focus groups, 192 participants). Results, presented in a qualitative system dynamics model, reveal that participants held strong values pertaining to CW casework and that moral distress was common. Participants described discrepancies between the services they wanted to provide and the services they were actually providing, and the distressing feelings that resulted. Study findings also highlight coping strategies and 'breaking points' related to moral distress. Overall, this study's dynamic theory provides a framework that illustrates the stock (accumulation) and flow (release) of moral distress specific to CW caseworkers and sheds light on the psychological distress and conflict experienced in this profession. Implications for social work education and CW organizational change are discussed. [ABSTRACT FROM AUTHOR]

Introduction Few studies, mostly descriptive, have quantitatively analyzed the working conditions of domestic workers (DWers) informally employed by private households in the USA. These workers are explicitly or effectively excluded from numerous workplace protections, and scant data exist on their exposures or how best to categorize them. Methods We analyzed data from the sole nationwide survey of informally employed US DWers with work-related hazards data, conducted by the National Domestic Workers Alliance, the University of Illinois Chicago Center for Urban Economic Development, and the DataCenter in 14 US cities (2011–2012; N = 2086). We used exploratory latent class analysis to identify groups of DWers with distinct patterns of exposure to 21 self-reported economic, social, and occupational workplace hazards (e.g. pay violations, verbal abuse, heavy lifting). We then used multinomial logistic latent class regression to examine associations between workers' individual, household, and occupational characteristics and latent class membership. Results Among the 2086 DWers, mean age was 42.6 years, 97.3% were women, 56.0% Latina/o, 26.5% White, 33.2% undocumented immigrants, and 11.7% live-in. 53.5%, 32.0%, and 14.5% primarily worked doing housecleaning, child care, and adult care, respectively. 49.9% of workers reported ≥3 hazards. Latent class analysis identified four groups of DWers doing: 'Low hazard domestic work' (lowest exposure to all hazards), 'Demanding care work' (moderate exposure to pay violations [item response probability (IRP) = 0.42] and contagious illness care [IRP = 0.39]), 'Strenuous cleaning work' (high exposure to cleaning-related occupational hazards, such as climbing to clean [IRP = 0.87]), and 'Hazardous domestic work' (highest exposure to all but one hazard). Covariates were strongly associated, in many cases, with latent class membership. For example, compared to other DWers, DWers doing 'hazardous domestic work' had the largest predicted probability of being economically insecure (0.53) and living-in with their employers (0.17). Conclusions Results indicate that informally employed US DWers experience distinct patterns of workplace hazards, and that it is informative to characterize DWers' exposures to different sets of multiple hazards using latent class analysis. [ABSTRACT FROM AUTHOR]

Background: A large literature demonstrates associations between socioeconomic status (SES) and health, including physiological health and well-being. Moreover, gender differences are often observed among measures of both SES and health. However, relationships between SES and health are sometimes questioned given the lack of true experiments, and the potential biological and SES mechanisms explaining gender differences in health are rarely examined simultaneously.Purpose: To use a national sample of twins to investigate lifetime socioeconomic adversity and a measure of physiological dysregulation separately by sex.Methods: Using the twin sample in the second wave of the Midlife in the United States survey (MIDUS II), biometric regression analysis was conducted to determine whether the established SES-physiological health association is observed among twins both before and after adjusting for potential familial-level confounds (additive genetic and shared environmental influences that may underly the SES-health link), and whether this association differs among men and women.Results: Although individuals with less socioeconomic adversity over the lifespan exhibited less physiological dysregulation among this sample of twins, this association only persisted among male twins after adjusting for familial influences.Conclusions: Findings from the present study suggest that, particularly for men, links between socioeconomic adversity and health are not spurious or better explained by additive genetic or early shared environmental influences. Furthermore, gender-specific role demands may create differential associations between SES and health. [ABSTRACT FROM AUTHOR]

This article explores the impact of online Irish traditional singing sessions on health and well-being during the COVID-19 pandemic. Singing sessions are unique facets of Ireland's music tradition that saw dramatic closure, interruption and digital transition in response to COVID-19 social distancing measures. This study highlights a gap in health promotion literature with regard to traditional singing sessions as a group singing activity and examines the potential for online group singing activities to have positive impacts on the health and well-being of participants. While traditional singing sessions foreground solo performances, they are quintessentially group activities, and include community engagement and active participation from singers and listeners alike. Through an online survey (n  = 108), and ethnographic interviews (n  = 3), this study explores potential health and well-being implications of online traditional singing sessions, and reveals four main areas of impact: social connection, enjoyment, cognitive motivation and timekeeping. The study suggests that online traditional singing sessions can promote health and well-being in participants, particularly during times of isolation. [ABSTRACT FROM AUTHOR]

In response to the COVID-19 pandemic, many music therapists in the United States turned to telehealth music therapy sessions as a strategy to continue services with older adults. However, the nature and perception of telehealth music therapy services for this age group are unknown. The purpose of this study was to describe music therapy telehealth practices with older adults in the United States including information related to session implementation, strengths and challenges, and adaptations to clinical practice. Of the 110 participants in the United States who responded to the survey (25.2% response rate), 69 reported implementing telehealth music therapy services with older adults and responded to a 32-item survey. Quantitative and qualitative analyses were conducted. Results indicated that while all participants had provided telehealth music therapy for no more than 6 months, their experiences with telehealth varied. Based on participant responses, telehealth session structure, strengths, challenges, and implemented changes are presented. Overall, 48% of music therapists reported that they planned to continue telehealth music therapy with older adults once pandemic restrictions are lifted. Further study on the quality, suitability, and acceptability of telehealth services with older adults is recommended. [ABSTRACT FROM AUTHOR]

Introduction: Concurrent use of tobacco and cannabis may impede successful cigarette smoking cessation. This study examined whether changes in cannabis use frequency were associated with smoking cessation.Aims and Methods: Nationally representative samples of adult cigarette smokers from Canada (n = 1455), the United States (n = 892), England (n = 1416), and Australia (n = 717) were surveyed in 2016 and 2018. In each year, smokers reported how often they used cannabis in the previous 12 months. Reports were compared to determine whether cannabis use increased, remained unchanged, or decreased. Smoking cessation outcomes, measured in 2018, were (1) any attempt to quit in the previous year, (2) currently quit, and (3) currently quit for at least 6 months. Weighted multivariable logistic regression estimated the association between changes in cannabis use and cessation outcomes.Results: Cigarette smokers who increased their frequency of cannabis use were significantly less likely to be currently quit than noncannabis-using smokers (adjusted odds ratio (aOR) = 0.52, 95% CI = 0.31% to 0.86%); they were also less likely to have quit for at least 6 months (aOR = 0.30; 95% CI = 0.15% to 0.62%).Conclusions: Smokers who increase their frequency of cannabis use have poorer smoking cessation outcomes compared to noncannabis-using smokers. It will be important to monitor the impact of cannabis legalization on patterns of cannabis use, and whether this influences cigarette smoking cessation rates.Implications: Cigarette smokers who start using cannabis may be less likely to quit cigarettes compared with smokers who do not use cannabis at all. If smokers who also use cannabis are more likely to continue smoking, it is important to monitor these trends and understand the impact, if any, on smoking cessation in jurisdictions that have legalized cannabis for nonmedical use. [ABSTRACT FROM AUTHOR]

Monitoring outcomes of health care providers, such as patient deaths, hospitalizations, and hospital readmissions, helps in assessing the quality of health care. We consider a large database on patients being treated at dialysis facilities in the United States, and the problem of identifying facilities with outcomes that are better than or worse than expected. Analyses of such data have been commonly based on random or fixed facility effects, which have shortcomings that can lead to unfair assessments. A primary issue is that they do not appropriately account for variation between providers that is outside the providers' control due, for example, to unobserved patient characteristics that vary between providers. In this article, we propose a smoothed empirical null approach that accounts for the total variation and adapts to different provider sizes. The linear model provides an illustration that extends easily to other non-linear models for survival or binary outcomes, for example. The empirical null method is generalized to allow for some variation being due to quality of care. These methods are examined with numerical simulations and applied to the monitoring of survival in the dialysis facility data. [ABSTRACT FROM AUTHOR]

Objective: The purpose of this study was to determine the extent that physical function discrete data elements (DDE) documented in electronic health records (EHR) are complete within pediatric rehabilitation settings. Methods: A descriptive analysis on completeness of EHR-based DDEs detailing physical functioning for children with cerebral palsy was conducted. Data from an existing pediatric rehabilitation research learning health system data network, consisting of EHR data from 20 care sites in a pediatric specialty health care system, were leveraged. Completeness was calculated for unique data elements, unique outpatient visits, and unique outpatient records. Results: Completeness of physical function DDEs was low across 5766 outpatient records (10.5%, approximately 2 DDEs documented). The DDE for Gross Motor Function Classification System level was available for 21% (n = 3746) outpatient visits and 38% of patient records. Ambulation level was the most frequently documented DDE. Intercept only mixed effects models demonstrated that 21.4% and 45% of the variance in completeness for DDEs and the Gross Motor Function Classification System, respectively, across unique patient records could be attributed to factors at the individual care site level. Conclusion: Values of physical function DDEs are missing in designated fields of the EHR infrastructure for pediatric rehabilitation providers. Although completeness appears limited for these DDEs, our observations indicate that data are not missing at random and may be influenced by system-level standards in clinical documentation practices between providers and factors specific to individual care sites. The extent of missing data has significant implications for pediatric rehabilitation quality measurement. More research is needed to understand why discrete data are missing in EHRs and to further elucidate the professional and system-level factors that influence completeness and missingness. Impact: Completeness of DDEs reported in this study is limited and presents a significant opportunity to improve documentation and standards to optimize EHR data for learning health system research and quality measurement in pediatric rehabilitation settings. [ABSTRACT FROM AUTHOR]

Background: Cerebrovascular events, dementia, and cancer can contribute to physical disability with activities of daily living (ADL). It is unclear whether low-dose aspirin reduces this burden in aging populations. In a secondary analysis, we now examine aspirin's effects on incident and persistent ADL disability within a primary prevention aspirin trial in community-dwelling older adults.Methods: The ASPREE (ASPirin in Reducing Events in the Elderly) trial of daily 100 mg aspirin versus placebo recruited 19 114 healthy adults aged 70+ years (65+ years if U.S. minority) in Australia and the United States. Six basic ADLs were assessed every 6 months. Incident ADL disability was defined as inability or severe difficulty with ≥1 ADL; persistence was confirmed if the same ADL disability remained after 6 months. Proportional hazards modeling compared time to incident or persistent ADL disability for aspirin versus placebo; death without prior disability was a competing risk.Results: Over a median of 4.7 years, incident ADL disability was similar in those receiving aspirin (776/9525) and placebo (787/9589) with walking, bathing, dressing, and transferring the most commonly reported. Only 24% of incident ADL disability progressed to persistent. Persistent ADL disability was lower in the aspirin group (4.3 vs 5.3 events/1000 py; hazard ratio [HR] = 0.81, 95% confidence interval [CI]: 0.66-1.00), with bathing and dressing the most common ADL disabilities in both groups. Following persistent ADL disability, there were more deaths in the aspirin group (24 vs 12).Discussion: Low-dose aspirin in initially healthy older people did not reduce the risk of incident ADL disability, although there was evidence of reduced persistent ADL disability. [ABSTRACT FROM AUTHOR]

Context: Gestational diabetes is associated with a long-term risk of developing a disorder of glucose metabolism. However, neither the metabolic changes characteristic of gestational diabetes in a large, multi-ancestry cohort nor the ability of metabolic changes during pregnancy, beyond glucose levels, to identify women at high risk for progression to a disorder of glucose metabolism has been examined.Objective: This work aims to identify circulating metabolites present at approximately 28 weeks' gestation associated with gestational diabetes mellitus (GDM) and development of a disorder of glucose metabolism 10 to 14 years later.Methods: Conventional clinical and targeted metabolomics analyses were performed on fasting and 1-hour serum samples following a 75-g glucose load at approximately 28 weeks' gestation from 2290 women who participated in the Hyperglycemia and Adverse Pregnancy Outcome (HAPO) Study. Postpartum metabolic traits included fasting and 2-hour plasma glucose following a 75-g glucose load, insulin resistance estimated by the homeostasis model assessment of insulin resistance, and disorders of glucose metabolism (prediabetes and type 2 diabetes) during the HAPO Follow-Up Study.Results: Per-metabolite analyses identified numerous metabolites, ranging from amino acids and carbohydrates to fatty acids and lipids, before and 1-hour after a glucose load that were associated with GDM as well as development of a disorder of glucose metabolism and metabolic traits 10 to 14 years post partum. A core group of fasting and 1-hour metabolites mediated, in part, the relationship between GDM and postpartum disorders of glucose metabolism, with the fasting and 1-hour metabolites accounting for 15.7% (7.1%-30.8%) and 35.4% (14.3%-101.0%) of the total effect size, respectively. For prediction of a postpartum disorder of glucose metabolism, the addition of circulating fasting or 1-hour metabolites at approximately 28 weeks' gestation showed little improvement in prediction performance compared to clinical factors alone.Conclusion: The results demonstrate an association of multiple metabolites with GDM and postpartum metabolic traits and begin to define the underlying pathophysiology of the transition from GDM to a postpartum disorder of glucose metabolism. [ABSTRACT FROM AUTHOR]

Background: Breast density (BD) is an independent risk factor for breast cancer and reduces the sensitivity of mammography. This systematic review aims to synthesize evidence from existing studies to understand the impact of BD information and/or notification on women's cognitive, psychological, and behavioral outcomes.Methods: Studies were identified via relevant database searches up to March 2020. Two authors evaluated the eligibility of studies with verification from the study team, extracted and crosschecked data, and assessed the risk of bias.Results: Of the 1134 titles identified, 29 studies were included. Twenty-three studies were quantitative, including only 1 randomized controlled trial of women receiving BD information, and 6 were qualitative. Twenty-seven studies were conducted in the United States, with 19 conducted post-BD legislation. The overall results in terms of BD awareness, knowledge, attitudes, perceptions, and intentions were heterogeneous across included studies, with the strongest consistency demonstrated regarding the importance of communication with and involvement of health-care professionals. Together, the studies did, however, highlight that there is still limited awareness of BD in the community, especially in more socioeconomic disadvantaged communities, and limited knowledge about what BD means and the implications for women. Importantly, BD information in the context of overall breast cancer risk has not yet been studied.Conclusions: There are important gaps in the understanding of the impact of BD information or notification on women and how best to communicate BD information to women. More high-quality evidence to inform both current and future practice related to BD is still needed. [ABSTRACT FROM AUTHOR]

California's Mental Health Services Act (MHSA) substantially expanded funding of county mental health services through a state tax, and led to broad prevention efforts and intensive services for individuals experiencing serious mental disorders. We estimated the associations between MHSA and mortality due to suicide, homicide, and acute effects of alcohol. Using annual cause-specific mortality data for each US state and the District of Columbia from 1976–2015, we used a generalization of the quasi-experimental synthetic control method to predict California's mortality rate for each outcome in the absence of MHSA using a weighted combination of comparison states. We calculated the association between MHSA and each outcome as the absolute difference and percentage difference between California's observed and predicted average annual rates over the postintervention years (2007–2015). MHSA was associated with modest decreases in average annual rates of homicide (−0.81/100,000 persons, corresponding to a 13% reduction) and mortality from acute alcohol effects (−0.35/100,000 persons, corresponding to a 12% reduction). Placebo test inference suggested that the associations were unlikely to be due to chance. MHSA was not associated with suicide. Protective associations with mortality due to homicide and acute alcohol effects provide evidence for modest health benefits of MHSA at the population level. [ABSTRACT FROM AUTHOR]

Introduction: As the FDA works to determine whether a nicotine reduction policy would benefit public health, one key question is whether to mandate an immediate or gradual reduction in nicotine levels in cigarettes. The aim of this study was to determine whether the effects of gradual versus immediate nicotine reduction on cigarettes per day (CPD), total nicotine equivalents, and subjective responses differed in younger adults versus older adults.Methods: Using data from a recent randomized trial conducted in the United States (N = 1250) that switched smokers over a 20-week period to very low nicotine content (VLNC) cigarettes either immediately, gradually (via monthly reductions in nicotine content), or not at all (control condition, normal nicotine content research cigarette), we analyzed the moderating effect of age (age 18-24 or 25+).Results: For both age groups, CPD in the immediate condition was significantly lower relative to gradual condition (estimated mean difference of 6.3 CPD in young adults, 5.2 CPD in older adults; p's < .05). Younger and older adults in the immediate and gradual reduction conditions had lower total nicotine equivalents at Week 20 (all p's < .05) than those in the control condition; age group did not moderate this effect. Positive subjective responses to cigarettes were lower among young adults relative to older adults in the immediate condition.Conclusions: These results indicate that an immediate reduction in nicotine would result in beneficial effects in both young and older adults. Young adults show less positive subjective effects of smoking following switching to VLNC cigarettes relative to older adults.Implications: As researchers work to understand how a potential reduced-nicotine product standard for cigarettes may affect public health, one question is whether nicotine should be reduced immediately or gradually. This study demonstrates that both young and older adults who were switched immediately to the lowest content of nicotine smoked fewer CPD and had lower nicotine intake than those in the gradual condition. Furthermore, young adults appear to show lower positive subjective effects following switching to VLNC cigarettes relative to older adults. This is consistent with previous work demonstrating that young people appear to show lower abuse liability for VLNC cigarettes. [ABSTRACT FROM AUTHOR]

Introduction: This study explores patterns of use of non-cigarette tobacco and nicotine products among adult cigarette smokers and recent ex-smokers. Along with cigarette smoking status we explore differences as a function of countries with different product regulations, gender, and age.Methods: Data came from the ITC Four Country Smoking and Vaping Wave 3 Survey conducted between February-June 2020. The analytic sample consisted of 9112 current cigarette smokers (at least monthly) and 1184 recent ex-smokers (quit cigarettes ≤ 2 years) from Australia, Canada, England, and the United States. Respondents were asked about their cigarette smoking and current use of the following non-cigarette products: combustible tobacco (cigars, cigarillos, pipe, waterpipe); noncombustible tobacco (smokeless tobacco, and heated tobacco products [HTPs]); and non-tobacco nicotine products (nicotine vaping products [NVPs], nicotine replacement therapy [NRT], and nicotine pouches).Results: Overall, NVPs (13.7%) and NRT (10.9%) were the most reported nicotine products used, followed by cigars (5.3%), cigarillos (4.2%), and HTPs (3.5%). More than 21% current and recent ex-smokers of cigarettes reported using a non-tobacco nicotine product and noncombustible product, with respondents in England reporting the highest levels of use (>26%). Males, younger respondents, and current non-daily cigarette smokers were more likely to use non-cigarette nicotine products. Notably, 11.6% of ex-cigarette smokers were using other combustible tobacco.Conclusion: Considerable percentages of current cigarette smokers and ex-smokers use non-cigarette nicotine products, and there are unexpectedly high levels of use of other combustible products by those recent ex-smokers of cigarettes which is concerning and has important implications for definitions of smoking cessation.Implications: The tobacco product market has evolved to include new products which add to existing non-cigarette tobacco products creating a much more diverse nicotine market. This brief report provides a snapshot of use of various combustible and noncombustible nicotine-containing products among current cigarette smokers and recent ex-smokers in four western countries. Our results indicate that use of non-cigarette tobacco and nicotine products among these cigarette smokers and recent ex-smokers is not low, particularly among males, younger and non-daily cigarette smokers. Use of other combustible tobacco among respondents that recently quit cigarette smoking is concerning and has important implications for definitions of smoking cessation. Increased emphasis on researching non-cigarette nicotine product use is warranted in tobacco control generally and smoking cessation in particular. [ABSTRACT FROM AUTHOR]

Introduction: Little is known about the relationship between smoke-free laws and persistent disparities in secondhand smoke (SHS) exposure among nonsmoking adults in the United States.Aims and Methods: We constructed time-varying smoke-free law measures representing whether or not at least 50% of each US county's population was covered by smoke-free laws in workplaces and hospitality venues (restaurants/bars). We merged these data with restricted data on cotinine-derived SHS exposure among nonsmokers from the National Health and Nutrition Examination Survey, 1999-2014 (N = 25 444). Using logistic regression, we estimated associations between smoke-free law coverage and SHS exposure among all nonsmokers, and within age strata (25-39, 40-59, 60+). We explored differential associations by gender, race/ethnicity, education, and poverty-income ratio (PIR) by testing the significance of interactions terms for the full sample and within age strata.Results: In adjusted models, hospitality coverage was associated with lower odds of SHS exposure in the full sample (odds ratio [OR] = 0.62; 95% confidence interval [CI] = 0.51-0.76), and within each age group, with ORs ranging from 0.58 (ages 25-39) to 0.67 (ages 60+). Workplace coverage was associated with lower SHS exposure only among younger adults (OR = 0.81; 95% CI = 0.65-0.99). Within the full sample and among adults ages 40-59, hospitality laws were associated with narrowing SHS exposure differentials between males and females. Among adults ages 40-59, workplace laws were associated with narrowing exposure differentials between males and females, but worsening exposure disparities by PIR.Conclusions: Smoke-free laws may reduce SHS exposure among adult nonsmokers, but may be insufficient to improve disparities in SHS exposure.Implications: In a repeated cross-sectional sample of adult nonsmokers, smoke-free laws in hospitality venues were consistently associated with lower odds of SHS exposure and appeared to narrow exposure differentials between males and females. Associations between workplace smoke-free laws and SHS exposure were variable by age. Among adults ages 40-59, workplace laws were associated with narrowing exposure differentials between males and females while exacerbating exposure differentials by PIR. Differential patterns of association highlight the need to examine the impacts of tobacco control policies on downstream health equity. [ABSTRACT FROM AUTHOR]

Introduction: There is limited research on the role of flavors in nicotine vaping products (NVPs) in relation to smoking. We examined patterns of flavor use in NVPs in relation to progression toward quitting.Aims and Methods: Data come from 886 concurrent users of NVPs (at least weekly) and cigarettes who were first surveyed in 2016 and then successfully recontacted in 2018 as part of the ITC 4CV Surveys conducted in Australia, Canada, England, and the United States. Participants were asked about their main vaping flavor categorized as: (1) tobacco or unflavored, (2) menthol or mint flavored, and (3) "sweet" flavors (eg, fruit or candy). We examined whether flavor was associated with progression toward quitting smoking between survey years.Results: Overall, 11.1% of baseline concurrent users quit smoking by 2018. Compared with users of tobacco flavors, those vaping "sweet" flavors were more likely to quit smoking between surveys (13.8% vs. 9.6%; adjusted odds ratio [aOR] = 1.61, 95% confidence interval [CI] 1.01-2.58, p < .05), but those using menthol flavors were no more likely to quit smoking (8.3% vs. 9.6%, aOR = 0.87, 95% CI 0.43-1.47, p = .69). Among those who had quit smoking in 2018, 52.0% were still vaping, which was lower than the 65.8% among continuing smokers (aOR = 0.60, 95% CI 0.39-0.92, p = .02). Sweet flavor users were no more likely to continue vaping compared with tobacco flavor users, either for those continuing smoking or those having quit smoking by 2018. There was a net shift away from tobacco flavor among those who continued to vape at follow-up.Conclusions: Use of fruit and other sweet flavored e-liquids is positively related to smokers' transition away from cigarettes.Implications: With multiple jurisdictions considering limiting or banning the sale of flavored NVPs, it is important to consider how such policies may impact smokers using NVPs to transition away from cigarette smoking. Our results indicate that vapers who used sweet flavors were more likely to transition away from cigarette smoking and quit cigarette use, at least in the short term, compared with those who used tobacco or unflavored NVPs. Randomized clinical trials are needed to establish if the observed association between use of flavored e-liquids and smoking cessation is due to self-selection or is truly causal. [ABSTRACT FROM AUTHOR]

Biological age captures some of the variance in life expectancy for which chronological age is not accountable, and it quantifies the heterogeneity in the presentation of the aging phenotype in various individuals. Among the many quantitative measures of biological age, the mathematically uncomplicated frailty/deficit index is simply the proportion of the total health deficits in various health items surveyed in different individuals. We used 3 different statistical methods that are popular in machine learning to select 17-28 health items that together are highly predictive of survival/mortality, from independent study cohorts. From the selected sets, we calculated frailty indexes and Klemera-Doubal's biological age estimates, and then compared their mortality prediction performance using Cox proportional hazards regression models. Our results indicate that the frailty index outperforms age and Klemera-Doubal's biological age estimates, especially among the oldest old who are most prone to biological aging-caused mortality. We also showed that a DNA methylation index, which was generated by applying the frailty/deficit index calculation method to 38 CpG sites that were selected using the same machine learning algorithms, can predict mortality even better than the best performing frailty index constructed from health, function, and blood chemistry. [ABSTRACT FROM AUTHOR]

Introduction: The smokeless tobacco (SLT) industry in the U.S. continues to transform with novel products amid an evolving regulatory environment. We report SLT sales trends in the U.S. by analyzing retail market scanner data from 2011 through 2019.Methods: National SLT sales data were obtained from Nielsen's Convenience Track System for January 2011 to December 2019. UPC codes were used to classify products by attributes including type, parent company, brand, form, and flavor. Market share was calculated as percentage of total unit sales. Detailed product analysis was presented for moist snuff, snus, and tobacco-free nicotine products.Results: SLT sales increased by 5.8% between 2011 and 2016 but declined by 3.9% from 2016 to 2019. Moist snuff sales increased by 8.1% between 2011 and 2016 and then declined 7.4% from 2016 to 2019 but still accounted for roughly 90% of the overall market annually. Between 2011 and 2019, snus sales consistently increased while sales of chew, dry snuff, and dissolvables decreased. Tobacco-free nicotine products emerged in 2016 and captured 4.0% of the market by 2019. Portion pouch packaging and flavors showed consistent growth although their popularity varied by the type of smokeless product.Conclusion: This study extends our previous work on U.S. SLT market trends through 2019. Overall sales increased between 2011 and 2016 but there were signs of leveling off including declining sales of moist snuff. Newer products continue to gain market share. Continued monitoring of SLT sales is needed, particularly given the new modified risk status of several products.Implications: This study analyzed the last 9 years of smokeless tobacco market data (2011-2019) to describe recent trends in sales. Overall, the smokeless product category is quite resilient although signs suggest downward trends among some product categories and features. New types of smokeless tobacco products (eg, snus and tobacco-free nicotine pouches) account for a growing share of the market. [ABSTRACT FROM AUTHOR]

Introduction: This study examined in youth (12-17 years), young adults (18-24 years), and adults (25+ years): (1) the prevalence of the first menthol cigarette and menthol/mint cigar use among new tobacco users; (2) association between the first menthol/mint use, subsequent tobacco use, and nicotine dependence ~1 year later compared with the first non-menthol/mint use.Aims and Methods: Longitudinal analysis of data from Waves 1 to 4 of the Population Assessment of Tobacco and Health (PATH) Study (2013-2017; 10 086 youth and 21 281 adults). Main outcome measures were past 12-month and past 30-day cigarette and cigar use, and nicotine dependence.Results: Youth and young adult new cigarette users are more likely to smoke a menthol cigarette or indicate that they do not know the flavor compared with adults aged 25+. A greater proportion of adults aged 25+ first used menthol/mint-flavored cigars (13.4%) compared with youth (8.5%) and young adults (7.4%). Among young adults, first use of a menthol cigarette is associated with past 12-month use of cigarettes at the subsequent wave and first use of any menthol/mint-flavored cigars is associated with past 30-day use of these products at the subsequent wave in both youth and young adults. In youth and adults, there were no significant relationships between first use of a menthol/mint cigarette or cigar and nicotine dependence scores at a subsequent wave in multivariable analyses.Conclusions: The first use of menthol/mint cigarettes and cigars is associated with subsequent cigarette and cigar use in young people aged 12-24.Implications: This study examined the relationship between initiation with menthol cigarettes and menthol/mint cigars, subsequent tobacco use, and nicotine dependence in US youth, young adults, and adults who participated in Waves 1-4 of the Population Assessment of Tobacco and Health study. New use of menthol cigarettes was associated with greater past 12-month cigarette use in young adults and new use of menthol/mint-flavored cigars was associated with greater past 30-day cigar use in youth and young adults compared with non-menthol use. Initiation with menthol/mint cigarette and cigar products may lead to subsequent use of those products. [ABSTRACT FROM AUTHOR]