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Background: Hookah is one of the most commonly used tobacco products among U.S. young adults due in part to widespread misperceptions that it is not harmful or addictive. There is growing evidence that hookah tobacco is associated with health harms and can lead to addiction. Research on interventions to address these misperceptions by communicating the harms and addictiveness of hookah use is needed. Aims: This study developed and pretested mobile multimedia message service (MMS) message content communicating the risks of hookah tobacco use to young adult hookah smokers. Method: Message content, delivery, and pretesting were tailored to participants' risk beliefs, hookah use frequency, and responses to simulated text message prompts. Participants viewed 4 of 12 core MMS messages randomized within-subjects and completed postexposure measures of message receptivity and emotional response (e.g., worry). Results: The sample included 156 young adult (age 18-30 years) hookah smokers; 31% smoked hookah monthly and 69% weekly/daily. Prior to viewing messages, a majority endorsed beliefs reflecting misperceptions about the risks of hookah tobacco. Postexposure measures showed participants were receptive to the messages and the messages evoked emotional response. As anticipated, messages produced similar receptivity and there were few differences in emotional response between the messages tested. Discussion: Young adult hookah tobacco smokers were receptive to tailored mobile MMS messages and messages evoked emotional response, two critical precursors to behavior change. Conclusion: Findings indicate that research testing the efficacy of tailored MMS messaging as a strategy for reducing hookah tobacco use in young adults is warranted.

One-on-one peer coaching/support programs hold promise in promoting healthy outcomes among women at risk for and surviving with breast cancer, with the potential to bridge gaps in "whole person care." Although popularly cited for their benefits, emerging evidence is mixed and suggests that peer support program impacts may be attenuated by individual- and community-specific factors. We evaluated a national not-for-profit breast cancer organization's peer support program outcomes (2015–2018) serving women from predominantly Jewish backgrounds to examine program engagement, facilitation, and satisfaction. Of the N = 392 women sampled, 37% utilized the peer support program: the majority were referred by a family member/friend (40%) or had connected with the program online (34%). Logistic regression modeling revealed that mothers (odds ratio [OR] = 1.82; 95% confidence interval [CI] = 1.04 to 3.19), women at increased genetic risk for breast cancer (OR = 2.07; 95% CI = 1.08 to 3.94), and those who connected with the organization through a family member/friend (OR = 1.97; 95% CI = 1.23 to 3.15) were significantly more likely to utilize peer support (all p 's <.05). Satisfaction with peer support was high and reliably measured (M = 42.8 out of possible 50; α =.95). These findings emphasize opportunities for peer support programs to serve a range of needs among breast cancer previvors and survivors and increase health care's organizational capacity to reach and impact this community through trusted and well-trained lay coaches. [ABSTRACT FROM AUTHOR]

Many young adult hookah tobacco users do not consider themselves hookah "smokers," but data on this topic are limited. There are no existing measures of young adults' mental schemas of hookah "smokers." We examined the factor structure and reliability of the Hookah Smoker Scale and examined associations with perceived harm and addictiveness and attitudes toward hookah. Two hundred and forty-six young adult (ages 18–30) hookah smokers participated in a cross-sectional online study. Participants completed items assessing schemas characterizing hookah smokers and valid measures of perceived harm and addictiveness of hookah smoking, risk appraisals, and attitudes toward hookah. Exploratory factor analysis using principal axis factoring with oblique rotation extracted a 12-item scale with three dimensions (Regular Use, Social-Enabled Use, and Self-Enabled Use). The scale explained 69.7% of the variance (eigenvalue = 9.2). Cronbach's α for the scale was.89, with Cronbach's α ≥.80 for four-item subscales. Higher subscale scores indicate stronger beliefs that the dimension characterizes a hookah smoker. Higher Regular Use scores (score variance = 46.9%; eigenvalue = 5.6) were associated with greater perceived harm and addictiveness (β = 0.21, p =.01), greater risk appraisals (β = 0.20, p =.02), and more negative attitudes toward hookah (β = −0.18, p =.03). The Hookah Smoker Scale is a promising measure that can be used to identify targets for preventing and reducing young adults' hookah tobacco use. Findings also suggest young adults associate health risks of hookah with daily smoking, but not with intermittent social smoking patterns. [ABSTRACT FROM AUTHOR]

Objective: We examined effects of hookah tobacco risk messages on risk appraisals, attitudes towards hookah, ambivalence about hookah use, and willingness to smoke in young adults aged 18–30 years (n = 234). Design: In an online experiment, participants completed pre-exposure measures and were randomized to hookah tobacco risk messages or to a no message control condition. Main Outcome Measures: Risk appraisals, attitudes, ambivalence, and willingness to smoke hookah. Results: Those who viewed risk messages reported greater risk appraisals (M 4.50, SD 1.17 vs. M 3.87, SD 1.16, p <.001), less positive attitudes (M −0.56, SD 1.24, vs. M 0.39, SD 1.35, p <.001), greater ambivalence (M 3.86, SD 1.26, vs. M 3.08, SD 1.32, p <.001), and less willingness to smoke than controls (M 4.48, SD 1.27, vs. M 4.85, SD 1.37, p =.034). Structural equation modeling demonstrated messages reduced willingness to smoke by evoking less positive attitudes (b = −0.15, 95% CI −0.32, −0.05) and by the effect of heightened risk appraisals on less positive attitudes (b = −0.14, 95% CI −0.30, −0.07). Conclusions: Honing messages and understanding their mechanisms of action are necessary to produce more effective interventions to address hookah and other tobacco use in young adults. [ABSTRACT FROM AUTHOR]

Background: Hookah tobacco use is common among young adults. Unlike cigarette smoking, there is limited evidence on mobile (ie, mHealth) interventions to promote cessation. Objectives: This pilot study tested the preliminary effects of mobile messaging for cessation in young adult hookah smokers. Methods: Young adults (N = 20) aged 18 to 30 years who smoke hookah at least monthly and have done so at least once in the past 30 days received a 6-week mHealth multimedia messaging (text and images) intervention. Message scheduling (2 days/week × 6 weeks) was based on the literature. Content was developed iteratively by the study team and focused on health harms and addictiveness of hookah. Content was individually tailored by baseline hookah use frequency, risk beliefs, and responses to interactive text messages assessing participants' hookah tobacco use behavior and beliefs to maximize impact. Engagement was assessed during the intervention, and we examined effects on risk perceptions, risk beliefs, and risk appraisals, motivation to quit, and behavior change immediately post-intervention. Results: Participants responded to 11.5 (SD = 0.69) of 12 text message prompts on average, endorsed high message receptivity (M = 6.1, SD = 0.93, range = 1-7), and reported the messages were helpful (M = 8.5, SD = 1.5, range = 1-10). There were significant (P <.05) increases in risk perceptions (d's = 0.22-0.88), risk appraisals (d = 0.49), risk beliefs (d = 1.11), and motivation to quit (d = 0.97) post-intervention. Half of participants reported reducing frequency of hookah use (20%) or quitting completely (30%) by end of treatment. Conclusions: These pilot results provide preliminary support for an mHealth messaging intervention about risks of hookah tobacco for promoting cessation. Rigorously examining the efficacy of this promising intervention is warranted. [ABSTRACT FROM AUTHOR]

Objectives: Philip Morris International's heated tobacco product, Marlboro IQOS, is available internationally and soon will be marketed in the United States (US). We examined correlates of curiosity, interest, and likelihood to use IQOS among US young adults. Methods: Young adults ages 18-30 years (N = 346) were recruited online, viewed a description of IQOS, and completed measures of socio-demographic characteristics, perceived risks, curiosity, interest, and likelihood to use IQOS. Results: Males had greater curiosity, interest, and likelihood to use IQOS than females. Individuals with household income of $50,000-$75,000 were more curious than those with household income of greater than $75,000. Cigarette smokers, e-cigarette and dual users had greater curiosity, interest, and likelihood of use than non-tobacco users. Non-white individuals and older young adults had greater likelihood of use. Greater perceived risks of IQOS were negatively associated with curiosity, interest, and likelihood of use. Conclusions: Among young adults, IQOS has greater appeal among males, non-whites, those who are older, those with household income of $50,000-$75,000, cigarette smokers, e-cigarette and dual users, and those with fewer perceived risks of IQOS. Research on public education communicating the potential risks of IQOS to vulnerable young adults is warranted. [ABSTRACT FROM AUTHOR]

Background: Asian Americans and Pacific Islanders (AAPI) are one of the fastest‐growing populations in the United States, yet these communities comprise less than one percent of participants in NIH's Alzheimer's disease and Alzheimer's disease related dementias (AD/ADRD) clinical research. This underrepresentation is due to numerous barriers well‐documented in the literature, with a key deterrent being a lack of culturally and linguistically appropriate outreach materials. This abstract presents findings from focus groups conducted by the National Institute on Aging (NIA) to identify culturally and linguistically appropriate message concepts that raise awareness, address barriers and motivate Asian American and Pacific Islanders to consider participation in AD/ADRD research studies. Method: Eighteen virtual focus groups (N = 103 individuals) were conducted with Chinese Americans, Filipino Americans, and Indian Americans who are at‐risk for AD/ADRD or are caregivers to people living with dementia. Focus groups were conducted in Chinese, Hindi, Tagalog and English. The sessions tested multiple audience‐tailored message concepts designed to increase interest and encourage participation in AD/ADRD clinical research. These discussions also examined participants' preferred language, terminology and communication approaches. Result: Overall, message concepts that 1) emphasized the value of caring for family members; 2) offered a sense of hope; 3) communicated a clear call to action; and 4) provided opportunities to learn more information about clinical research resonated across all groups. Between participant audiences, there were some important differences, including around terminology preferences. For example, Chinese‐American participants expressed concern about the term "caregiver" as it implied that taking care of a loved one was a burden or a professional job, rather than a familial responsibility. Concept visuals will be presented. Conclusion: This research conducted by NIA improves our understanding of messaging concepts that do and do not resonate with AAPI, providing valuable insight into themes that should be leveraged to effectively promote awareness about AD/ADRD clinical research with these communities. The finding from this study were used to develop, finalize and make available to the research community a suite of culturally and linguistically appropriate materials to increase awareness and interest in AD/ADRD clinical research among AAPI communities. [ABSTRACT FROM AUTHOR]

Purpose: Adolescent and young adult (AYA) cancer survivors experience fertility and childrearing challenges in adulthood, but there is limited evidence on awareness, beliefs, and concerns about oncofertility in this population, needs for supportive resources, and associations with quality of life (QoL). Methods: Participants were 69 AYAs aged 12–25 who were diagnosed with cancer at age 18 years or younger and ≥1 year cancer free, recruited from childhood cancer clinical records and support organizations. Participants completed self-report assessment of oncofertility knowledge and beliefs, information needs, and measures of QoL. Analyses examined associations between oncofertility-related variables and QoL. Results: Knowledge and beliefs about oncofertility options were considerably low in the sample, and participants reported unmet oncofertility resource needs. In multivariable analyses, QoL was associated with beliefs valuing the importance of fertility in childhood cancer (β = 0.87, p = 0.01) and lower information needs (β = −1.19, p = 0.022). Conclusions: Infertility is a well-documented effect of childhood cancer treatment. Our findings indicate that clinical providers are a preferred source of information for AYA patients, and there is a need to address oncofertility concerns and challenges in this group. Research is needed to examine barriers to addressing fertility issues in childhood cancer treatment and ways to promote dialogue between providers and patients and their families. [ABSTRACT FROM AUTHOR]

Background: Limited participation of Black/African American (B/AA), Hispanic/Latino (H/L), and Asian American & Pacific Islander (AAPI) communities in AD/ADRD clinical trials (CT) is partly due to few researchers offering trial opportunities and inadequate CT information that is culturally relevant. We present the results of three National Institute on Aging (NIA) national surveys conducted with B/AA, H/L, and AAPI samples to assess the impact of culturally tailored outreach materials for each group, respectively, on individuals' likelihood to consider participating in CTs. Method: Online panel surveys were conducted with B/AA (N = 616; 2019), H/L (N = 545; 2020), and AAPI (N = 756; 2021) individuals who: 1) had a family history AD/ADRD, 2) were caring for an individual with AD/ADRD, or 3) reported no family history of AD/ADRD. The surveys assessed if viewing creative concepts (four print/photo ads developed specifically with and for each population using focus groups) positively impacted participants' likelihood to consider participating in an AD/ADRD CTs. Result: After reviewing their respective ads, B/AA and H/L at‐risk, caregiver, and healthy audiences, and AAPI at‐risk individuals, all significantly increased their reported pre‐posttest "likelihood to consider a CT". AAPI caregivers started with and maintained a high level of interest but did not change their likelihood to consider a CT. Across all groups, there was a median 12.5% increase of individuals reporting "very" or "extremely interested" in AD/ADRD CTs. Persons with family history had greater increases among B/AA and AAPI, while caregivers did among H/L. Motivating CT messages for all groups were: help/hope for their future generations (family/community) the potential to prevent/treat the disease. B/AA respondents also were motivated to find treatments that could work for all races. Conclusion: The findings highlight that culturally appropriate outreach materials, developed with and for specific groups, can generate significant interest in participation of AD/ADRD clinical trials after viewing only four ads. Though common themes emerged, focus groups and surveys indicated specific yet critical nuances differentiating message preferences across B/AA, H/L, and AAPI groups. This is the only known research to systematically explore AD/ADRD CT communication needs within and across traditionally underserved populations. [ABSTRACT FROM AUTHOR]

Background: Though Hispanics/Latinos (H/L) comprise 18% of the U.S. population and are 1.5 times at greater risk for Alzheimer's and related dementias (AD/ADRD) than non‐Hispanic Whites, a median of only 2% of participants in NIH‐funded AD/ADRD clinical trials are H/L. Reasons abound for this inequity; key documented impediments to enrollment of Latinos are too few researchers offering studies and limited materials that provide culturally and linguistically relevant information. This abstract presents findings from focus groups conducted by the National Institute on Aging (NIA) to identify salient, culturally appropriate message concepts that raise awareness, address barriers, and motivate H/L to consider participation in AD/ADRD studies. Method: Twelve remote focus groups (N=72) were conducted among two H/L audiences: 1) those at risk for AD/ADRD; and 2) those caring for a family member or friend with AD/ADRD. Messages were designed to motivate H/L to learn more about AD/ADRD clinical studies. Sessions explored participants' knowledge, attitudes, and beliefs regarding AD/ADRD and clinical studies. Participants reviewed and provided feedback on messaging designed to motivate them to seek more information about AD/ADRD clinical studies. Result: Message concepts that resonated strongly were those that 1) framed clinical studies as one step to finding a cure for AD/ADRD and 2) connected participation with helping their family members' future health. Concepts were more acceptable if they represented multi‐generational families, emphasized the importance of family support, and promoted diversity and inclusivity (showing a diversity of age, gender, skin tone). Participants requested that concepts offered more opportunities to learn about Alzheimer's and local clinical studies. Trusted concepts are those that clearly identified the document's source and avoided the terms "trial" and "dementia," as both had negative connotations in the Spanish language. Conclusion: The data from these focus groups improve our understanding of message concepts that motivate H/L to consider participating in AD/ADRD clinical research. They also provide insights to develop, finalize and make available to the research community a suite of culturally appropriate, well‐tested materials for H/L populations in both English and Spanish that can be used to increase awareness of AD/ADRD and clinical research. [ABSTRACT FROM AUTHOR]

Introduction: Young adults generally do not perceive waterpipe tobacco smoking (WTS) to be addictive. Underlying reasons for these false perceptions have received limited research attention and little is known about effective WTS prevention messaging. This study examined perceptions of the addictiveness of WTS among young adults and ascertained their feedback on WTS prevention message content., Methods: Young adult (n=44, Mean [M] age 25.3, SD 2.7, range 18-30) waterpipe tobacco users were recruited online for a cross-sectional survey. Closed-ended measures assessed demographics, waterpipe use, other tobacco consumption, and perceived addictiveness of WTS. Open-ended items assessed perceptions of WTS and ascertained feedback on WTS prevention message content. Quantitative data were analyzed descriptively. Open-ended data were coded to identify emerging themes., Results: Participants reported low perceived addictiveness of WTS (Mean 2.0, SD 0.9, range 1- not at all, 4 - very), perceived chances of becoming addicted (Mean 3.0, SD 1.6, range 1- no chance, 7- certain), and desire to quit (Mean 3.0, SD 1.8, range 1- not at all, 7- very). In open-ended responses, participants indicated social WTS does not lead to addiction and believe it is easy to quit. Some expressed concerns that WTS addiction may lead to health harms, social stigma, and financial costs. Participants indicated messages using vivid imagery and conveying negative health effects could motivate cessation., Conclusions: Young adults view that WTS is not addictive, particularly related to use in social settings. Research can build from this study by developing and testing messages to motivate WTS cessation in young adults., Competing Interests: The authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest and none was reported., (© 2017 Mays D.)