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The study aimed to investigate the Effect of Academic Stress on Students' Academic Achievements and Its Implications for Their Future Lives. A correlational research design was employed through stratified random sampling (n[subscript i] = 270, where female = 80 and male =190) to collect pertinent data through a questionnaire. Descriptive and inferential statistics were employed. Firstly, academic stress highly affects students' academic achievement, with females being more stressed (65.20%) than males (59.60%), which leads to a high dropout rate and low graduation rate. Secondly, about 69% were accustomed to drinking alcohol, chewing Khat, absenteeism, and smoking whereas about 31% were regularly engaging in unsafe sex, physical fights, smoking shisha, and poor personal sanitation. Thirdly, there were significant positive relationships among sex, age, academic batch, and student's cumulative grade point average. To conclude, academic stress hinders good academic achievement, increases college dropout rates, low graduation rates, and lack of self-confidence. It leads to drinking alcohol, absenteeism, chewing khat, reduced academic morale of students, and failure in completing assignments on time. Therefore, university authorities should ensure a good academic environment for the students and minimize academic stress through appropriate course load, appropriate lecture hours, proper lecture schedules, and non-congested lecture halls.

Background: The origin of inequalities in health outcomes has been explained by health selection and social causation models. Health selection processes operate particularly at school age. We study, if student allocation to teaching groups with aptitude tests (selective vs general class) differentiates adolescents by health behaviors and mental health. Methods: Finnish schoolchildren 12-13 years from 12 selective classes, n = 248; 41 general classes, n = 703 answered a questionnaire on addictive products (tobacco, snus, alcohol, and energy drinks), digital media use, and mental health (health complaints, anxiety, and depression). Structural equation modeling was conducted to identify structures between outcomes, SEP (socioeconomic position), class type, and academic performance. Results: Students in the selective classes reported less addictive digital media and addictive products use than students in the general classes. Differences in academic performance or SEP between the class types did not solely explain these differences. Mental health was not related to the class type. SEP was indirectly associated with health behaviors via the class type and academic performance. Conclusions: Selecting students to permanent teaching groups with aptitude tests differentiates students according to risky health behaviors. The impact of education policies using student grouping should also be evaluated in terms of students' health.

Studies on how smoking media literacy (SML) is associated with susceptibility to smoking among adolescents in South Korea and Vietnam are scarce. Thus, we examined the association of SML with susceptibility to smoking among adolescents in these countries to initiate a collaborative global health program. In total, 460 adolescents (Vietnam: 277, South Korea: 183) aged 15-18 completed an online cross-sectional survey. SML was measured using the 15-item SML scale. Susceptibility to smoking was measured by three questions on future smoking and if offered a cigarette by a friend. A multiple logistic regression model explored the association of SML with susceptibility to smoking. The study revealed that higher SML was significantly associated with lower susceptibility to smoking among Vietnamese, but not South Korean adolescents. Further studies to identify pathways between other factors associated with SML and susceptibility to smoking are needed to develop culture-specific intervention strategies for smoking prevention.

Objectives: In early 2021, Western Sydney school principals expressed heightened concern about rising e-cigarette usage among high school students. This prompted us to assess knowledge, attitudes and perceptions surrounding adolescent vaping in students, school staff and parents, and their preferred strategies to effectively communicate prevention messages. Design: Exploratory qualitative study. Setting: Participants included students (aged 12-16 years), school staff and parents from government high schools in Greater Western Sydney, Australia. Methods: We held research workshops with 162 students, 133 school staff and 29 parents across seven schools. We used interactive activities which included individual written responses, small-group brainstorming and open group discussions. Data analysis was undertaken by two researchers using Framework Analysis. Results: Findings demonstrated differing perceptions among students, staff and parents regarding reasons why adolescents vape. Although common motives emerged, such as the perception that vaping differs from smoking, social normalisation, peer pressure and mental health considerations, there were important differences in emphasis. Students were concerned about dependency and vaping to cope, staff were concerned about the impact of vaping on students' learning and behaviour, and parents were concerned about being ill-equipped to support their children. Strategies to tackle vaping also differed, with an emphasis on education and engagement over surveillance and consequences. Conclusion: Adolescent vaping is a pressing concern within Australian school communities, necessitating a comprehensive, holistic approach supported by strong partnerships between the health and education sectors. Addressing this issue effectively demands heightened education and engagement among students, staff and parents.

Smoking poses a significant threat to adolescent health because of its immediate and long-term detrimental health effects. Smoking refusal self-efficacy predicts smoking behavior in adolescence. In adolescents' health education, digital interventions are potential tools to support smoking refusal self-efficacy. The aim of this two-arm cluster randomized controlled trial was to evaluate the effectiveness of a digital health game intervention compared with a no-intervention control group on smoking refusal self-efficacy in 10- to 13-year-old Finnish early adolescents. The early adolescents (n = 781) were randomized to the control group (n = 394) and the health game intervention group (n = 387). Smoking refusal self-efficacy, sources of smoking and snus refusal self-efficacy, and motivation to decline smoking and snus use in the future were measured at baseline, 2-week postintervention, and 3-month follow-up. Data were analyzed using linear mixed model and Wilcoxon rank-based test for clustered data. According to the results, the intervention group made improvements in sources of smoking and snus refusal self-efficacy between baseline and postintervention, and in sources of snus refusal self-efficacy between baseline and follow-up, compared with the control group. The intervention group showed improvements in smoking refusal self-efficacy among 12-year-olds between baseline and follow-up, and postintervention and follow-up compared with the control group. Similar improvements were also found among those with a smoking friend or a smoking parent between postintervention and follow-up. The results were promising for the use of digital health game interventions to promote early adolescent smoking refusal self-efficacy and preventing smoking experimentation. Further research can evaluate the long-term effects for adolescents.

Recently, multiple health organizations and advocacy groups have pushed for giving an R-rating for movies depicting tobacco imagery. This study examined several predictors of U.S. adults' opinion toward an R-rating policy for movies depicting cigarette smoking. We used data from the Health Information National Trends Survey (2020 cycle), for a nationally representative sample of 3,865 US adults (aged = 18). The outcome variable was opinion toward an R-rating policy (support, neutral, and oppose) for movies depicting cigarette smoking. A weighted adjusted multinomial logistic regression analysis with comparisons of support versus oppose, support versus neutral, and neutral versus oppose was performed. About 48.2% of respondents were supportive of, 31.1% were neutral toward, and 20.7% were opposed to an R-rating policy. Adults aged 50 to 64 years (adjusted odds ratio [aOR] = 2.28, p = 0.008) and =65 years (aOR = 4.54, p <0.001) (vs. 18-34 years) were more likely to support the R-rating policy than oppose it. Non-Hispanic Black respondents (vs. non-Hispanic Whites) were 1.74 times more likely to support than oppose the policy (aOR = 1.74, p = 0.04), whereas adults with a household annual income of US$75,000 or more (vs. <$20,000) and those with moderate (vs. liberal) political viewpoints were more likely to be neutral than oppose the policy. Former and current e-cigarette users (vs. never users) were less likely to support than oppose the policy. Tailored messaging addressing the rationale behind R-rating policy should be directed towards communities based on age, race/ethnicity, household income, e-cigarette usage, and political ideologies.

Legislative smoking bans that prohibit smoking in public places have successfully reduced passive smoking in public areas. However, smokers only partially adhere to smoking restrictions in their homes. Young children are particularly vulnerable to exposure to tobacco smoke because they spend more time at home. In this study, we designed an intervention program based on an empowerment theory to reduce passive smoking among children. The priority participants were nonsmoking mothers living with smokers who smoke in the presence of children. The aim of this randomized control trial study was to examine the effectiveness of this intervention in reducing children's exposure to tobacco smoke at home. The intervention group received tailored educational brochures and two follow-up counseling telephone calls at 2 and 8 weeks, which provided resources to support the mothers to increase their knowledge, skill, and self-confidence in promoting behavior shaping of smokers. The control group received only tailored educational brochures. We found the intervention group demonstrated a higher rate of maternal actions to reduce their children's exposure to smoke and a higher rate than the control group of attempts to avoid smoking in the presence of children at the 16-week follow-up. These results suggest that the intervention helped reduce passive smoking among children. These findings highlight the need to empower and train mothers to help them develop rules for smoking at home. These interventions could be applied in the home of children who live with smokers who are unable or unwilling to quit smoking.

Adolescent school connectedness generally protects from risk behaviors such as tobacco use; however, its relationship to e-cigarette use is unclear. This study examines the relationship between adolescent school connectedness and e-cigarette susceptibility in a diverse longitudinal sample. This secondary analysis of a school-based intervention surveyed 608 middle (66%) and high school (34%) students from 10 schools at 3 time points over 1 year. At baseline, respondents had a mean age of 14 years, 54% were female, and 71% were BIPOC (Black, Indigenous, People of Color). Logistic regression models examined unadjusted and adjusted associations between school connectedness (both baseline and concurrent) and e-cigarette susceptibility over time. E-cigarettes represented the most prevalent form of current nicotine-containing product use in spring 2019 (2.3%), and most respondents reported no e-cigarette susceptibility (69%). E-cigarette susceptibility remained relatively stable during the study. Higher baseline school connectedness levels were associated with lower odds of e-cigarette susceptibility over time. Similarly, higher concurrent school connectedness scores were associated with lower odds of e-cigarette susceptibility over time: spring 2019 (OR, 0.39; 95% CI, 0.32, 0.47), fall 2019 (OR, 0.49; 95% CI, 0.34, 0.72), and spring 2020 (OR, 0.64; 95% CI, 0.47, 0.87). Findings were similar for middle and high school students and did not differ significantly after adjusting for other covariates. Adolescents' school connectedness appears to protect from e-cigarette susceptibility over time, underscoring the importance of promoting positive school experiences to reduce adolescent risk e-cigarette use.

Young people with developmental language disorder (DLD) often have poorer mental health compared to those without DLD. However, not all young people with DLD experience such difficulties. Two hundred and eighty-one young people at risk of DLD (45% Female; 53% White British) were identified from a UK based population-cohort. Main caregivers completed questionnaires about their early life (<5 years) and their mental health (at 14 years). Parent-child conflict was revealed to be an early risk factor for all mental health outcomes, at age 14. Additionally, harsh discipline and second-hand smoke predicted worse externalising problems, and gender differences predicted worse internalising problems. Further findings demonstrated that, as the number of risk factors increased, so did the severity of mental health difficulties.

The prevalence of tobacco use in the Middle East is alarmingly high, especially among university students; most users initiate tobacco use during adolescence and young adulthood. Evidence-based cessation services can be beneficial when quitting tobacco use; however, these services are underutilized. This study aimed to explore the barriers preventing university students in Qatar from seeking tobacco cessation services. Semi-structured interviews were conducted with 20 Qatar University students who are current or former tobacco users (n = 18/2); most current cigarette smokers were also waterpipe users. The interviews were transcribed verbatim, coded, and analyzed using thematic analysis. The major barriers to seeking tobacco cessation services included misconceptions regarding nicotine addiction, negative perceptions of the cessation services' effectiveness, self-efficacy regarding the ability to quit without seeking cessation services, concerns and preferences regarding practitioners' characteristics at clinics, masculine culture that discourages men from seeking cessation help, social stigma around women who use tobacco in Arab culture, and a lack of time to visit cessation clinics. Our findings address gaps in the literature regarding the individual and sociocultural barriers to seeking tobacco cessation among youth in Qatar. A better understanding of these barriers can facilitate successful promotion of tobacco cessation services and enhance cessation-seeking behaviors.

Healthy lifestyle behaviors can improve health-related quality of life (HRQOL) in cancer survivors; but the combination of behaviors most important for HRQOL is not known. This study investigated the patterns of lifestyle behaviors among cancer survivors and differences in HRQOL between behavioral classes. Cancer survivors (n = 2,463) were invited to participate in a cross-sectional survey. Participants (N= 591) were predominately female (63%) and non-Hispanic White (90%). Survey items included self-reported physical activity, diet, smoking, sleep, HRQOL, and demographics. Behavioral classes were estimated by latent class analysis. Differences between classes were assessed by latent class regression. Compared with the "healthy lifestyles" class (higher probabilities of meeting aerobic/strength-based activity guidelines, high fruit/vegetable intake, and no sleep problems; 11% of sample), the "sleep and diet problems with inconsistent physical activity" class (higher probabilities of not meeting strength-based guidelines, low fruit/vegetable intake, some sleep problems; marginally higher probability of meeting aerobic guidelines; 41%) had poorer general and physical HRQOL. The "poor physical activity and diet" class (higher probabilities of not meeting aerobic/strength-based guidelines, low fruit/vegetable intake, and some sleep problems; 48%) had poorer general, physical, and mental HRQOL. Few participants exhibited healthy lifestyle patterns associated with HRQOL. The findings provide opportunities to develop differentiated multiple behavior-change interventions, targeted to two common patterns of behavior. A large subgroup of cancer survivors was susceptible to suboptimal physical activity and diet, warranting interventions exclusively targeting these behaviors. Another subgroup was susceptible to suboptimal physical activity, diet, and sleep, indicating interventions for this group should include strategies targeting these three behaviors.

Background: Adolescents' school engagement, mental health, and substance use have been major concerns during the COVID-19 pandemic, particularly given disruptions to school instruction. We examined how the instructional setting was associated with academic and health-related outcomes within an adolescent cohort followed during the pandemic. Methods: During 3 semi-annual follow-up surveys, adolescents (N = 1066 students; 2242 observations) from 8 California high schools responded to items measuring academic self-efficacy, school connectedness, internalizing and externalizing problems, and use of substances. Separate generalized estimating equation models predicted outcomes based on the instructional setting. Results: Relative to in-person instruction, students in remote instruction reported lower academic self-efficacy (Beta: -0.11; 95% confidence interval [CI]: -0.22, -0.01) and school connectedness (Beta: -0.37; 95% CI: -0.48, -0.25), greater odds of past 30-day internalizing problems (AOR: 1.46; 95% CI: 1.09, 1.95), externalizing problems (AOR: 1.36; 95% CI: 1.02, 1.82), and cigarette, cigar, smokeless tobacco, or hookah use (AOR: 2.50; 95% CI: 1.06, 5.91), but lower odds of past 30-day e-cigarette use (AOR: 0.50; 95% CI: 0.30, 0.86). Conclusions: Multiple adverse outcomes related to school engagement, mental health, and substance use were associated with remote instruction. To reduce such impacts under future emergencies, schools should rely sparingly on remote instruction and provide appropriate supportive resources.

Attention-deficit/hyperactivity disorder (ADHD) is characterized by persistent patterns of inattention, hyperactivity, and impulsiveness. Among US children and adolescents aged 3-17 years, 9.4% have a diagnosis of ADHD. Previous research suggests possible links between parental substance use and ADHD among children. We conducted a systematic review and meta-analysis of 86 longitudinal or retrospective studies of prenatal or postnatal alcohol, tobacco, or other parental substance use and substance use disorders and childhood ADHD and its related behavioral dimensions of inattention and hyperactivity-impulsivity. Meta-analyses were grouped by drug class and pre- and postnatal periods with combined sample sizes ranging from 789 to 135,732. Prenatal exposure to alcohol or tobacco and parent substance use disorders were consistently and significantly associated with ADHD among children. Other parental drug use exposures resulted in inconsistent or non-significant findings. Prevention and treatment of parental substance use may have potential for impacts on childhood ADHD.

Substance use in adolescence is a significant public health issue, particularly in early-to-mid adolescence, which represents a window of risk in the etiology of substance abuse and dependence. Substance use during this development period often results from affiliation with deviant peers, who model, facilitate, and reinforce use. Existing school-based substance use prevention programs have historically aimed to build adolescent knowledge regarding the dangers of substance use and/or enhance peer refusal skills. Research finds that these programs have had some success in reducing substance use, but meta-analyses report that average effect sizes are small. In a small one-year cluster randomized trial (12 middle and high schools; N = 813 students; ClinicalTrials.gov: NCT04478240), cooperative learning (CL) was implemented with the support of specialized technology and evaluated for its ability to reduce deviant peer affiliation and, in turn, reduce substance use. CL is a structured approach to small-group learning that provides at-risk youth with the opportunity to build friendships with more prosocial youth, interrupting the process of deviant peer clustering. Multi-level modeling revealed intervention effects for deviant peer affiliation and alcohol use across the sample, while tobacco use was significantly reduced among non-White students; intervention effects for marijuana use were only marginally significant. Effects for dosage were found for all outcomes, suggesting that every lesson taught had a significant impact. We conclude that CL, delivered with the aid of specialized technology, represents a viable option for universal substance use prevention. Future research should attempt to combine this approach with evidence-based prevention curricula.

Underrepresentation of historically marginalized populations in clinical trials continues to threaten the validity of health intervention research. Evidence supports the merits of intercept and other proactive forms of recruitment for achieving more equitable representation. However, researchers also report lower retention and adherence to protocols among these populations, particularly in longitudinal studies. Few studies have compared recruitment methods for longitudinal randomized trials testing health interventions, with even fewer having done so for trials involving ecological momentary assessment (EMA). As intervention research integrates EMA and other data collection approaches requiring substantial participant effort, it is critical to better understand the effectiveness and implications of strategies to improve the representativeness of health research. This secondary data analysis compared outcomes of proactive and reactive recruitment strategies (mobile lab intercepts and internet/flyer advertising, respectively) in study inclusion, task completion, and retention within a 14-day randomized controlled trial that used EMA to evaluate cigarette package health messages. Proactive recruitment resulted in higher proportions of participants with low income and education, limited health literacy, and of diverse racial/ethnic makeup. However, this recruitment method also resulted in lower task completion, especially in the second week of the trial period, and lower retention, although group differences were not explained by participant sociodemographic characteristics targeted by inclusion efforts. We conclude that proactive recruitment via intercepts is an effective strategy for health intervention research that aims to include stakeholders from historically marginalized groups but that researchers and funders must recognize these methods require additional resources, considerations, and capacity to address non-trivial challenges to successful participation.

Adolescent smoking is dangerous. This study examined the self-assessment of risk factors to expose student teachers to smoking, compared the scores of health belief model structures in experimental and control groups, and summarized the poster and slogan campaign to prevent smoking. The experimental and control groups (n=30 each) were selected using eligibility criteria and simple random sampling. Three-part questionnaires were used to collect information that was analyzed based on mean, minimum, maximum, percentage, and paired sample t-test data. The key findings were: 1) student teachers in the experimental and control groups had smoked 1-2 cigarettes in the past (20% and 6.67%, respectively). In addition, for both the groups, cigarettes were readily available at convenience stores in residential areas (63.34% and 83.34%, respectively), their fathers smoked (16.67% and 20%, respectively), and their peers persuaded them to smoke (16.67 % and 23.30 %, respectively); 2) the health belief model demonstrated that both the experimental and control groups at 8 weeks had comparable pre-post findings for susceptibility (p=0.000 and p=0.049, respectively), perceived severity (p=0.000 and p=0.063, respectively), perceived benefits (p=0.000 and p=0.065, respectively), perceived barriers (p=0.000 and p=0.703, respectively), and cure to action (p=0.000 and p=0.070, respectively); and 3) The main study "Online Health Education Program to Prevent Tobacco Use for Student Teachers during COVID-19 Pandemic in Thailand: Design, Challenges, and Outcomes" worked on anti-smoking posters and slogans. The 8-week education program with events could enhance experimental group health beliefs. Thus, student teacher smoking prevention efforts should incorporate posters and slogans.

Objective: College students use electronic nicotine delivery systems (ENDS) more often than any other US demographic group. In a novel application of the acquired preparedness model, we examined how proximal (e.g., cognitions) and distal (e.g., dispositional) influences accounted for ENDS use and dependence. Participants: Undergraduates (N = 1075; 72% female, 74% White) from seven US campuses completed an online survey between October 2019-March 2020. Methods: We modeled ENDS use and dependence, respectively, as zero-inflated Poisson distributions with impulsivity as an independent variable and perceived risks and benefits of e-cigarettes as mediators. Results: Students higher in impulsivity perceived more benefits and, in turn, reported greater ENDS use and dependence. Curiosity and friends' use motivated ENDS initiation; stress management and nicotine motivated continued use. Conclusions: ENDS interventions should be tailored to students higher in impulsivity, as they hold more favorable perceptions of ENDS, and should enhance skills to manage stress and nicotine cravings.

This study explored substance use trajectories and associations with mental health among an ethnically/racially diverse college student sample before and during the COVID-19 pandemic. We combined repeated cross-sections and panel data from a total of 3,247 college students assessed with an online survey in 2018, 2019, and in three waves in 2020. We estimated trends in substance use and their relation to mental health over the survey waves using generalized estimating equations (GEE). Our results revealed notable associations between 30-day substance use patterns, time of assessment, and psychological well-being. These findings suggest a complex interplay between access to substances, context of substance use, and mental health. We discuss several initiatives that have been launched in response to the results of this ongoing study. Such initiatives may serve as examples for expanding similar efforts to other commuter colleges to prevent further increases in mental health problems and risky substance use.

Objective: This study examined joint trends over time in associations between substance use (heavy drinking, cannabis, and cigarette smoking) and mental health concerns (depression, anxiety, and suicidal ideation) among US post-secondary students. Participants: Data came from 323,896 students participating in the Healthy Minds Study from 2009 to 2019, a national cross-sectional survey of US post-secondary students. Weighted two-level logistic regression models with a time by substance interaction term were used to predict mental health status. Results: Use of each substance was associated with a greater odds of students endorsing depression, anxiety, and suicidal ideation. Over time, the association with mental health concerns strengthened substantially for cannabis, modestly for heavy drinking, and remained stable for smoking. Conclusion: Given co-occurrence is common and increasing among post-secondary students, college and university health systems should prioritize early identification, psychoeducation, harm-reduction, and brief interventions to support students at risk.

Objective: The purpose of this study was to examine patterns of concurrent cannabis and other substance use and their differential associations with cannabis-related problems and academic outcomes in college students. Participants: Participants were undergraduate students (N = 263; M age = 19.1 years; 61.2% female) who were eligible if they used cannabis at least 3 days in the past month (M = 10.1 days). Method: Substance use, academic-related outcomes, and measures of Cannabis Use Disorder (CUD) severity and problems were obtained in an online survey. Results: The five groups evaluated were cannabis-only users (5.3%), cannabis and alcohol (47.1%), cannabis, alcohol and cigarettes (16.7%), cannabis, alcohol and other substances (14.8%), or all-substances (16%). Cannabis-only and all-substance users reported using cannabis most frequently (ps [less than or equal to] 0.034), but only the latter reported greater CUD severity, problems, and poorer academic outcomes. Discussion: College student polysubstance users may be at increased risk for poorer outcomes compared to cannabis-only users and other groups.

No studies have examined vocational education students' intention to change multiple health risk behaviors and whether baseline characteristics predict behavior change. Participants: Participants were vocational education students in New South Wales, Australia. Methods: Students in the no-intervention control arm of a cluster randomized controlled trial completed an online survey at baseline and 6 months later. Results: Of 450 participants (83.3%) who reported multiple health risk behaviors at baseline, one-third (33.1%) intended to change at least two risk behaviors within 6 months. Participants experiencing symptoms of anxiety [OR = 7.43, 95% CIs 1.26-43.87; p = 0.03] and who intended to change three to four risk behaviors [OR = 23.30, 95% CIs 4.01-135.40; p = 0.001] rather than one behavior had significantly greater odds of changing at least one behavior in 6 months. Conclusions: Interventions could support vocational education students to change behaviors they wish to as well as motivate them to address other risk behaviors.

Canadian young adults who identify as Two Spirit, lesbian, gay, bisexual, trans, queer, intersex (2SLGBTQI+) have higher smoking rates compared to their straight cisgender counterparts. One of the reasons for this trend is the perceived social acceptability of smoking and how it relates to stress, mental health and social connections. A sequential mixed-methods study was conducted with qualitative focus groups, followed by quantitative survey data collection starting in the spring of 2020, examining perceptions of both smoking and vaping. Results demonstrate higher social acceptability of vaping compared to smoking in the study sample. Qualitative results showed a strong link between the higher acceptability of smoking and vaping with coping and social connections. Quantitative results indicated that higher smoking acceptability was more common among those who currently smoke, currently vape, are younger, live in smaller cities, identify as a person of color, with variation by gender and sexual orientation; vaping was found to be more acceptable among those who currently smoke, currently vape, were younger participants, and have some post-secondary education. This research is important for the development of prevention and cessation programs in addressing both the negative and positive dimensions affecting smoking among 2SLGBTQI+young adults.

On March 7, 1962 the Royal College of Physicians published a report entitled "Smoking and Health" that made the causal link between smoking and lung cancer clear and explicit. Using a historical data set that contains information on smoking from 1958 to 1965, I find a decrease in smoking for those with more schooling after the report's publication. I do not find a difference in the effect for those with greater access to information (measured by TV ownership or newspaper readership). This suggests the education health gradient is more likely due to processing of information rather than access to information.

Background: Tobacco use continues to be a leading cause of morbidity and mortality in the United States. Rates of tobacco use among college students remain steady with one in ten using some form of tobacco. Specific social and demographic correlates to use are needed to effectively address continued use. Purpose: The purpose of the present study was to examine specific factors associated with daily tobacco use among college students. Methods: The National College Health Assessment was disseminated in classrooms to students at one urban, Midwestern university. Results: Results indicated 8.4% of college students used some form of tobacco daily. The final model found gender and marijuana use predicted daily tobacco use. Discussion: Based on the prevalence rates found in the present study, it is evident that public health professionals are growing concerned regarding the significant adverse health effects of tobacco use. Translation to Health Education Practice: Health education programs targeting college students engaged in risky behaviors could help reduce tobacco use on college campuses. Health education interventions that address smoking cessation, alcohol, and drug abuse, and mental health support could effectively reduce daily tobacco use on college campuses.

This study aimed to identify the prevalence of current smoking and examine the association between meeting combinations of the 24-h movement guidelines and current smoking in autistic adults. This cross-sectional study administered an electronic survey to a national sample of autistic adults in the United States. The study outcome was current smoking. Independent variables included the 24-h movement behaviors. Multivariable statistical modeling was used to assess the study aims. The study sample (n = 259) had a mean age of 31.05 years (standard deviation = 7.70), 58.7% were male, 11.2% were fully independent, and 35.5% were current smokers. Current smokers met significantly fewer 24-h movement guidelines than non-smokers (mean = 1.52 (standard deviation = 0.73) vs mean= 1.93 (standard deviation = 0.88), respectively, t = 3.77, p < 0.01). Autistic adults with high levels of sedentary behavior were almost three times more likely (odds ratio = 2.784, 95% confidence interval = 1.490, 5.237) to be a current smoker than those who did not meet these guidelines. Autistic adults not meeting sleep and sedentary behavior recommendations had a 1.581 increased odds (odds ratio = 1.581 95% confidence interval = 1.25, 2.001) of being a smoker as compared to those meeting these recommendations. Current smoking was highly prevalent in this sample. Improving sleep health and reducing sedentary time may be viable intervention targets to help promote smoking cessation in autistic adults.

This study aimed to assess the fertility knowledge of Japanese education undergraduates who plan to become schoolteachers and examine related factors. A cross-sectional questionnaire survey was conducted with 252 first-year education undergraduates at a Japanese university. The Cardiff Fertility Knowledge Scale (CFKS) was used to measure fertility knowledge, and other items inquiring about basic reproductive knowledge were included. We assessed the relationship between fertility knowledge and gender and the experience of future life planning, among other factors. We found that fertility knowledge varied. Participants possessed a relatively good knowledge of the relationships between fertility and female ageing, and smoking, but limited knowledge about the effect of sexually transmitted infections on fertility. Male participants answered more correctly than female participants (p < 0.01) regarding 'sperm production'; however, female respondents answered more accurately than male respondents (p < 0.01) regarding 'timing of menopause. In Japan, the national curriculum standard for upper secondary schools was revised in 2018, and fertility was added to the Health and Physical Education curriculum. The study results suggested that it is important to include fertility in a sex education teaching curriculum for education undergraduates to enable them to deliver fertility education as teachers in the future.

Objective: Electronic cigarette use represents an important college health concern. This investigation assessed demographic and behavioral correlates associated with actual and perceived e-cigarette use among a national sample of American college students. Methods: Respondents (n = 19,861) comprised college students from over 40 distinct American higher education institutions. Multivariable logistic regression assessed whether (1) alcohol, tobacco or marijuana use were associated with e-cigarette use; (2) perceived peer use of alcohol, tobacco or marijuana were associated with perceived e-cigarette use. Results: Approximately 5% of survey respondents self-reported using e-cigarettes within the past month. More than 7 out of every 10 respondents, however, thought the 'typical student' was an e-cigarette user. As perceptions of typical student substance use increased, respondents were far more likely to contend the typical student used e-cigarettes. Discussion: In addition to adopting smoke-free campus policies, university officials should disseminate accurate information regarding e-cigarette behaviors of students.

Objective: Electronic Nicotine Delivery System (ENDS) proprietors strategically placed near college campuses and pervasive marketing on social media platforms, such as Facebook, are critical to the tobacco industry's effort to acquire new young adult users. Understanding the themes used on Facebook to promote ENDS products to college students is necessary to develop public health messaging to combat the vaping epidemic. Methods: We identified 15 ENDS proprietors located near four Big 10 universities and qualitatively analyzed a random sample of their Facebook posts (n = 405) to identify emerging themes using a grounded theory approach. Results: ENDS proprietors in college towns use Facebook to deploy "promotional" messaging (n = 319), to market ENDS products as a means of celebration (n = 40), to establish a sense of "community" (n = 155) among ENDS users, to make "marijuana references" (n = 36), and to "advocate" (n = 27) for ENDS products. Conclusions: These themes may increase social acceptability and use of ENDS products among college students.

A limited number of findings from empirical studies show that biracial adolescents are at a heightened risk of peer victimization. Black/White biracial adolescents are frequent targets of peer victimization due to racism and systematic oppression that are inherent in U.S. schools. Similar to adolescents of other racial and ethnic groups, biracial adolescents who are victimized by their peers are likely to exhibit psychosocial and behavioral issues. However, little is known about protective factors that might buffer the link between peer victimization and adverse outcomes of these youth. The study examines whether perceived ease of talking with parents and siblings moderates the association between peer victimization and psychosocial problems among Black/White biracial early adolescents. Data were derived from the Health Behavior in School-Aged Children (HBSC) study. Participants were 158 early adolescents, ages 10-14, who self-reported as both Black and White. Adolescents who perceived their fathers as easy to talk to were less likely to bully others or carry a weapon when victimized by their peers. Adolescents who perceived their mothers to be easy to talk to were less likely to carry a weapon. There were also lower rates of psychosomatic symptoms for youth who reported perceived ease talking with siblings.

School bullying and cyberbullying are serious public health problems that negatively affect the lives of school-aged children. We examined the correlation between risk behaviors and lack of resiliency factors with bullying and cyberbullying across seven Mediterranean countries. The sample consisted of 33,399 adolescents (51.1% girls) aged 11, 13, and 15 years who participated in the Health Behavior in School-aged Children (HBSC) survey in 2018 in Greece, Israel, Italy, Macedonia, Malta, Portugal, and Spain. Bivariate logistic regressions were conducted to test the relationship between risk behaviors, resilience, and bullying. All risk behaviors and lack of resiliency factors examined were related to involvement in bullying as a victim, perpetrator, or bully-victim, both in school and cyberbullying. Moreover, the odds of involvement in school bullying and cyberbullying increased as the number of risk behaviors and the lack of resiliency factors grew. Our results may contribute to the development and implementation of anti-bullying programs.

The workplace has been highlighted as a potential setting to deliver health promotion programs to target modifiable health behaviors that contribute to chronic disease. This review evaluated the effectiveness of interventions implemented within the workplace that targeted either smoking, nutrition, alcohol, physical activity, and/or overweight and obesity in men. A review protocol was prospectively registered through PROSPERO (CRD42021293398). Five electronic bibliographic databases were searched for randomized controlled trials conducted in the workplace assessing chronic disease risk factors in men from January 2010 to August 2021. Eleven studies were included, reporting on overweight and obesity n = 8, physical activity n = 7, nutrition n = 4, alcohol n = 3, smoking n = 3, with eight studies assessing multiple outcomes. Results were mixed. Narrative synthesis highlighted studies reporting improvements to snacking frequency, sugar sweetened beverage consumption, and physical activity (METs and Vo2 max). Meta-analysis highlighted pooled mean decrease in body weight of -0.28 kg up to 3 months; -1.38 kg for >3 months, and pooled mean decrease in body mass index 0.06 kg/m2 up to 3 months; -0.27 kg/m2 for >3 months. Despite the encouraging direction of the relationship, results were not statistically significant (p > 0.05). Findings underscore the potential of workplace health promotion programs targeting certain chronic disease risk factors in men; however, future research should consider long-term study designs to assess the efficacy of workplace health programs as a solution to the growing burden of global disease.

Objective: Adverse childhood experiences (ACEs), which refer to childhood traumatic events, have been identified as risk factors for tobacco use in adulthood. However, studies are limited on the effect of sex on the association of ACEs with e-cigarettes and dual use of e-cigarettes and cigarettes. This study explored sex differences in the association of ACEs with e-cigarettes, cigarettes, and dual use of e-cigarettes and cigarettes among adults in the United States. Methods: This was a cross-sectional analysis of data from adults aged [greater than or equal to]18 years in the 2020 Behavioral Risk Factor Surveillance System (N = 62,768). ACEs, the independent variable, was a composite score assessed from 11 questions (with responses yes-1 or no/never-0) related to childhood emotional abuse, physical abuse, sexual abuse, and household dysfunction and categorized as 0 (reference), 1, 2, 3, or [greater than or equal to] 4. The dependent variable, tobacco use patterns, included nonuse (reference), e-cigarette only, cigarette only, and dual use of e-cigarettes and cigarettes. Multinomial logistic regression was performed to test the interaction between sex and ACEs while controlling for potential confounders. Results: Although we found no statistically significant interaction by sex, a greater number of ACEs were associated with higher odds of the different tobacco use patterns among females and males, with varying strengths of associations. Specifically, females who reported [greater than or equal to] 4 ACEs compared with none had higher odds of e-cigarette (aOR [95% CI]: 3.58 [1.49-8.63]), cigarette (2.57 [1.72-3.83]) and dual use (3.25 [1.79-5.91]) relative to nonuse. Males with [greater than or equal to] 4 ACEs had higher odds of cigarette (1.75 [1.15-2.65]) and dual use (7.64 [3.95-14.79]). Conclusion: Our findings underscore the importance of developing appropriate, tailored trauma-informed intervention strategies for females and males. It is also important to consider ACEs in designing tobacco-specific preventive programs to curb initiation and promote cessation among U.S. adults.

Telephone-based services are a practical and effective behavioral support for smoking cessation, yet no in-depth analyses of this counseling have been conducted. Understanding the general content of Quitline conversations can help to improve current practices and may inform future interventions. Therefore, we aimed to independently explore conversation themes, topics, and client questions during Quitline counseling sessions with Quitline clients in Queensland, Australia. A purposive sample of 30 recorded counseling sessions, completed between January and March 2019, were de-identified, transcribed, and thematically analyzed. Seven themes, encompassing 35 topics, were derived from 26 initial calls and four follow-up calls: (1) Client details and building rapport; (2) Client history and motivation to quit; (3) Pharmacotherapy; (4) Behavioral aspects of quitting and relationship with smoking; (5) Understanding nicotine dependence and other important considerations; (6) Additional support and smoking cessation resources; and (7) Planning, goal setting and follow-up. Three themes emerged from 18 client questions including: (1) Pharmacotherapy safety and contraindications; (2) Pharmacotherapy instructions and mechanism of action; and (3) Physiology of nicotine dependence. This is the first qualitative analysis of the content of Quitline counseling sessions in Australia. Counselors collect and deliver a breadth of information to provide tailored, evidence-based health care, while building rapport and trust. Findings may be translatable into personalized self-help interventions that are more accessible or appealing to people reluctant to contact Quitline. Harnessing educational opportunities regarding pharmacotherapy adherence and misconceptions can improve client confidence in the product and smoking cessation outcomes. Further research will map conversations to motivational interviewing and behavior change techniques.

Background: Social factors play an important role in adolescents' behaviors. This study aims to understand percentages of health risk behaviors across country in Europe, North America, and China; explore the associations between friendly school and family contexts and involvement for several health risk behaviors among adolescents. Methods: Data derived from health behavior in school-aged children cross-sectional surveys and China Education Panel Survey in 2014-2015. Hierarchical generalized linear modeling was used to analyze data. Results: The highest percentages of health risk behaviors including unhealthy diet, smoking or alcohol, screen-based sedentary behaviors, and violent behaviors across country ranged from 28.62% to 65.24%. National classmate friendliness was negatively associated with 5 out of 9 health risk behaviors prevalence rates in 41 countries (p < 0.05). Adolescents' perceived peer friendly and helpful were common protective factor for engaging in several health risk behaviors (p < 0.01). Individual family contexts were associated with 3 types of health risk behaviors involvement (p < 0.001). School health policy implications: Health risk behaviors among adolescents reducing was associated with the implementation of friendly school and family contexts, emphasizing the significance of the goals of embedding friendly adolescents, along with the home-school collaboration. Conclusions: Public health strategies should promote national climate of friendship and individual perceived friendly school contexts to reduce health risk behaviors.

Objective: In Denmark, more students smoke in vocational schools than in upper secondary schools. Smoking-prevention initiatives may reduce the prevalence of smoking but may also introduce unforeseen challenges. This study examined the significance of smoking and dilemmas related to smokefree school hours (SFSH) among established smokers in Danish vocational schools. Design: Qualitative research design. Setting: Data collection took place in a vocational education and training (VET) school in Denmark. The subject area was care, health and pedagogy (CHP). Method: Participant observation and focus groups were conducted with students and teachers. Two classes were observed for 2 weeks in total. The data analysed consisted of participant observation field notes (n = 10 school days), transcripts from student focus groups (n = 6; aged 18--56) and transcripts from teacher focus groups (n = 11). Results: Two dilemmas were described as faced by established smokers in relation to the implementation of smokefree school hours: (1) The school is entitled to make rules versus the right to decide for oneself; and (2) life and schoolwork are challenging and demanding versus school work is more important than smoking. Conclusion: The findings illustrate how smoking, as an ingrained everyday practice for established smokers, represents a means of coping with difficult school demands and everyday challenges, particularly for vulnerable students, and how regulations such as SFSH create dilemmas for those students. These dilemmas are important to consider when designing and implementing smoking-prevention initiatives to prevent potential negative side effects and an unintended increase in social inequality in smoking.

Objective: To investigate the impact of generalized joint hypermobility (GJH) on eating behavior. Participants: Physical therapy and rehabilitation students. Methods: The Beighton evaluation (a cutoff of 5/9) for defining GJH. The Eating Attitudes Test (EAT-40) was used for eating disorders. Smoking habits and alcohol use were also questioned. Results: Compared with 51 non-GJH students (mean age 20.5 years, 73% female), 46 students with asymptomatic GJH (20.6 years, 89% female) were more likely to have greater median EAT-40 scores (9 vs. 6, p = 0.002). There was no statistically significant difference between the groups in terms of the susceptibility to eating behavior disorders (6.5% vs. 2.0%), smoking habits (6.5% vs. 9.8%), and alcohol use (15.2% vs. 11.8%) (p > 0.05). Positive correlation (r = 0.221, p = 0.029) and positive effect (R = 0.221, R[superscript 2] = 0.049; p < 0.05) between Beighton scores and EAT-40 scores were found. Conclusion: The more joint hypermobility the greater the risk for eating disorders.

Objective: This study investigated the sex-specific prevalence of smoking (past 30 days) and the associations with height among university/college students. Participants: 25,405 (11,579/14,826 males/females) college students in Xi'an China. Methods: A cross-sectional, self-administered survey. Results: The male and female prevalence of smoking (past 30 days) was 32.9% and 7.4%, respectively. The prevalence of smoking of the male height groups ranged from 29.8% to 36.9%; only the [greater than or equal to]188 cm height group showed significantly higher prevalence than the reference group (i.e., 173-177cm; 33.0%). The female prevalence of smoking was 4.0-8.2% in the [less than or equal to]170cm groups and increased to 12.3% in the 171-175 cm group and 36.1% in the [greater than or equal to]176 cm group, while it was 6.5% for the reference group (161-165 cm). Conclusions: This exploratory study firstly revealed the significantly higher prevalence of smoking among the "tallest" height groups, especially among females. Future studies are warranted to confirm such findings and explore related mechanisms.

Objective: The present study aims to examine whether secondhand smoke exposure (SHSE) in university students can affect three indices of self-satisfaction related to depression as indiced by appearance, weight, and freedom of life choice. Participants: We collected data from 740 nonsmoking students in the summer of 2018, of which 57.84% were exposed to secondhand smoke. Methods: Depressive symptoms, SHSE, smoking status, weight satisfaction, appearance satisfaction, and freedom of life choice were self-reported via a questionnaire. Results: The generalized linear analyses revealed that SHSE was linked to lower scores of perceived freedom of life choice but not significantly associated with weight nor appearance satisfaction. The mediation analyses indicated that perceived freedom of life choice fully mediated the association between SHSE and depressive symptoms. Conclusions: These findings shed light on the importance of SHSE and its effects on mental health in university students. Preventive strategies should therefore locally target university campuses.

Research has linked pre- and perinatal complications (PPCs) with increased risk for autism spectrum disorder (ASD). However, PPCs are also known risk factors for other mental health disorders. This study explored which PPCs are specific risk factors for ASD, as opposed to other forms of psychopathology, among a large sample of clinically-referred youth. Archival data were used from 1177 youth who were evaluated at a hospital-based autism clinic. Results from logistic regressions indicated that use of tobacco, alcohol, or drugs, or experiencing amniocentesis predicted inclusion in the non-ASD group, while physical difficulties with delivery predicted inclusion in the ASD group. Possible explanations and implications for these findings are discussed.

Lifestyle risk behaviours--physical inactivity, poor diet, poor sleep, recreational screen time, and alcohol and tobacco use--collectively known as the "Big 6" emerge during adolescence and significantly contribute to chronic disease development into adulthood. To address this issue, the Health4Life program targeted the Big 6 risk behaviours simultaneously via a co-designed eHealth school-based multiple health behaviour change (MHBC) intervention. This study used multiple causal mediation analysis to investigate some potential mediators of Health4Life's effects on the Big 6 primary outcomes from a cluster randomised controlled trial of Health4Life among Australian school children. Mediators of knowledge, behavioural intentions, self-efficacy, and self-control were assessed. The results revealed a complex pattern of mediation effects across different outcomes. Whilst there was a direct effect of the intervention on reducing moderate-to-vigorous physical activity risk, the impact on sleep duration appeared to occur indirectly through the hypothesised mediators. Conversely, for alcohol and tobacco use, both direct and indirect effects were observed in opposite directions cancelling out the total effect (competitive partial mediation). The intervention's effects on alcohol and tobacco use highlighted complexities, suggesting the involvement of additional undetected mediators. However, little evidence supported mediation for screen time and sugar-sweetened beverage intake risk. These findings emphasise the need for tailored approaches when addressing different risk behaviours and designing effective interventions to target multiple health risk behaviours. The trial was pre-registered with the Australian and New Zealand Clinical Trials Registry: ACTRN12619000431123.

Background: Despite recent declines, youth nicotine vaping remains seen by experts as a national public health epidemic. Few, if any, researchers have examined how related high-profile and school-based prevention programs such as LifeSkills Training (LST) are further disseminated with cooperation from research-to-practice entities as well as the tobacco industry. Purpose: Provides a systems-driven documentary analysis of efforts pertaining to prevention entities at the University of Colorado, Boulder, as well as LST, and the tobacco industry. Methods: Employs focused synthesis data collection with constant comparative analyses. Results: Likely previously unseen and related to LST, is the degree to which prevention entities with a public mission appear to cooperate among themselves and with the tobacco industry as part of a longstanding, if not elaborate, school-based drug prevention social system characterized by patterned evidence of opaque or furtive representations and/or activities. Discussion: Along with limitations, summarizes a research-to-practice social system likely compromising school-based prevention and, in turn, the health of the young people they serve. Theorizes a symbolic politics explanatory mechanism while providing recommendations toward transparency for more informed school-based prevention decision-making. Translation to Health Education Practice: Emphasizes the National Commission for Health Education Credentialing Inc. (NCHEC) critical thinking and program evaluation competencies.

Background: Tobacco use and dependence alongside environmental tobacco exposure collectively form a leading cause of morbidity and mortality for the global population. Several clinical and public health interventions have sought to address this growing epidemic on both micro and macro levels. One national campaign, "Tips From Former Smokers" was prominent across the tobacco cessation landscape. Implemented by the U.S. Centers for Disease Control and Prevention, this campaign garnered coverage and engagement across the national population and also on virtual spaces via social media platforms in our digital era. Purpose: This study is the first of its kind to critically examine sources and formats as well as assess the nature of content covered across the widely viewed videos pertaining to this campaign on YouTube. Prior studies have analyzed this campaign's content on Facebook and Twitter. Method: This study was cross-sectional, descriptive, and observational in design and involved conducting a content analysis of the most popular videos covered on the campaign across YouTube. Results: Videos pertaining to health and aesthetic effects stemming from the sequelae of smoking, environmental tobacco exposure, and comorbidities with smoking attracted the most views. The majority of the widely viewed videos on the campaign were in the form of testimonials. There was scant coverage on tips and strategies for cessation across the videos. Discussion: We present several clinical, campaign and systemic implications from these findings. We also propose recommendations for further considerations in future campaign development and implementation that build off the limitations and draw on the strengths of the "Tips From Former Smokers" campaign in addressing tobacco use and dependence as well as environmental tobacco exposure as targets for future cessation interventions. Translation to Health Education Practice: In addition, we further delineate recommendations that account for health equity, diversity, and inclusivity considerations in coverage of content that could heighten engagement, relatability, connectivity, and acceptability of content by viewers worldwide. A AJHE Self-Study quiz is online for this article via the SHAPE America Online Institute (SAOI) http://portal.shapeamerica.org/trn-Webinars. http://portal.shapeamerica.org/trn-Webinars

This study investigated the extent to which adolescent social network positions are associated with the risk of lifetime daily smoking and nicotine dependence (ND), and whether these associations differ by gender. Using data from the National Longitudinal Study of Adolescent to Adult Health (N = 6,267), this study estimated multinomial logistic regression models. An increase in in-degree nominations, out-degree nominations, and Bonacich centrality was associated with a lower relative risk of never smoking daily versus ever smoking daily. By contrast, adolescents with greater in-degree nominations, out-degree nominations, Bonacich centrality, and network reach in three steps were at decreased risk for lifetime ND. Gender-stratified models indicate that the negative association between network position and never smoking daily was driven largely by women, whereas the positive association between network position and lifetime ND was driven largely by men. Incorporating social network structural approaches into adolescent smoking prevention efforts may be beneficial.

Public health campaigns have the potential to correct vaping misperceptions. However, campaigns highlighting vaping harms to youth may increase misperceptions that vaping is equally/more harmful than smoking. Vaping campaigns have been implemented in the United States and Canada since 2018 and in England since 2017 but with differing focus: youth vaping prevention (United States/Canada) and smoking cessation (England). We therefore examined country differences and trends in noticing vaping campaigns among youth and, using 2022 data only, perceived valence of campaigns and associations with harm perceptions. Seven repeated cross-sectional surveys of 16-19 year-olds in United States, Canada and England (2018-2022, n = 92 339). Over half of youth reported noticing vaping campaigns, and noticing increased from August 2018 to February 2020 (United States: 55.2% to 74.6%, AOR = 1.21, 95% CI = 1.18-1.24; Canada: 52.6% to 64.5%, AOR = 1.13, 1.11-1.16; England: 48.0% to 53.0%, AOR = 1.05, 1.02-1.08) before decreasing (Canada) or plateauing (England/United States) to August 2022. Increases were most pronounced in the United States, then Canada. Noticing was most common on websites/social media, school and television/radio. In 2022 only, most campaigns were perceived to negatively portray vaping and this was associated with accurately perceiving vaping as less harmful than smoking among youth who exclusively vaped (AOR = 1.46, 1.09-1.97). Consistent with implementation of youth vaping prevention campaigns in the United States and Canada, most youth reported noticing vaping campaigns/messages, and most were perceived to negatively portray vaping.

Objective: Despite community colleges accounting for 34% of all undergraduate enrollment, research on substance-use patterns among community college students is limited. Community college students may engage in substance use differently than their 4-year university counterparts due to differences in psychosocial factors and decreased availability of mental health services. The current study aimed to elucidate risk factors underlying non-medical use of prescription simulants (NMUS) and nicotine use by community college students. Methods: A web-based survey was administered to 10 of 13 community colleges within a southeastern state's Board of Regents school system. The survey included questions related to NMUS, nicotine use, alcohol use, mental health diagnosis, and demographics. Results: Overall, 9% of the participants reported NMUS, and 24.6% used nicotine. Multivariate analysis of variance and ?[subscript 2] tests revealed group differences among individuals using only nicotine, only NMUS, both nicotine and NMUS, and neither nicotine nor NMUS. Post-hoc 2 × 2 ?[subscript 2] tests indicated that individuals using both nicotine and NMUS had higher incidence of mental health diagnoses, were more likely to live in urban areas, reported higher weekly alcohol consumption, and were more likely to be male as compared to individuals using neither substance. Attention-deficit hyperactivity disorder (ADHD) symptoms were higher in individuals using only NMUS and both NMUS and nicotine as compared to those using only nicotine or neither substance. Conclusions: These findings provide insight into demographic and psychological variables associated with NMUS and nicotine use among community college students that could be benefitted by greater access to affordable mental health services.

This is part II of a two-part series on integrating a physical activity component in delivering health lessons to elementary and middle school students. The purpose of this series is to illustrate how health content can be implemented with hands-on activities, physical experiments, visual illustrations that are associated with a specific lesson focus, or physical tasks that require students to repeatedly practice memory recall. Two physical activities in the following five health education topics are provided in this article: (1) alcohol, tobacco and other drugs; (2) communicable and chronic diseases; (3) consumer and community health; (4) environmental health; and (5) injury prevention and safety. Corresponding National Health Education Standards and twenty-first-century skills for each activity are also provided. Similar to part I of the series, a few of the designs can be implemented with a different lesson focus or health topic. Examples are discussed at the end of the article.

In the summer of 2020, SARS-CoV-2 infection rates among the U.S. population aged 20-39 years exceeded other age groups, with the largest increases occurring in the southern US. As many colleges reopened for in-person instruction in August and September, these trends continued among campuses across the country. Our study aimed to identify risk factors (demographic and behavioral) associated with SARS-CoV-2 infection among college students. We used data from a survey administered to students at a southern university in the US. The survey had a total of 765 respondents and this study included the 679 (88.8%) who responded about their SARS-CoV-2 infection status. We examined associations between population characteristics and reported SARS-CoV-2 infection and calculated prevalence ratios along with 95% confidence intervals. SARS-CoV-2 infection was 2.5 times more likely among current users of electronic nicotine delivery systems (ENDS) compared to those who do not use ENDS (95% confidence interval [CI]: (1.76-3.4)) and 2.8 times more likely among those who reported a high frequency of binge drinking compared to those who did not report binge drinking (95% CI: (1.81-4.36)). Current high frequency ENDS users were 2.76 (1.79-4.25) more likely to report SARS-CoV-2 infection than non-users. Current low frequency users of ENDS were 2.27 (1.53-3.37) times more likely to report SARS-CoV-2 infection than nonusers. A trend analysis among ENDS use frequency and SARS-CoV-2 infection was statistically significant, showing a significant dose response with increasing ENDS use. The results of this analysis may assist in providing guidance on policies as well as may serve as a steppingstone for future research concerning SAR-CoV-2 infection among university populations.

The school-to-prison pipeline (STPP) describes in shorthand the problematic relationship between some students' school experiences and their subsequent incarceration. One summer, in response to vocal concerned parents, a suburban school board adopted a zero-tolerance policy for smoking and vaping. Through the combined effects of the zero-tolerance approach, exclusionary punishments, the presence of SROs (school resource officers), racially disproportionate disciplinary practices, and a culturally nonresponsive school setting, 90 students were introduced to the criminal justice system in one school year. This case helps school leaders examine the elements of the STPP and how they work together to damaging effect. The questions and activities will guide readers to develop multiple ways to forestall and/or repair STPP supporting policies and practices.

Objective: This study aimed to understand COVID-19 pandemic impacts on anxiety, depression, and addictive/excessive behaviors, with exploration of intolerance of uncertainty (IU) and social connectedness as potential moderators. Participants: Adult college students participated. Method: Our online survey assessed symptoms and behaviors prior to COVID-19, during the initial outbreak (Wave 1), and during early 2021 (Wave 2). Results: Significant increases were found in anxiety, depression, binge eating, sexual behaviors, video game playing, internet/social media usage, and compulsive exercise in both waves. IU moderated the relationship between both depression/anxiety and certain excessive behaviors; social connectedness moderated the relationship between anxiety and smoking. Conclusions: This study replicated prior work and highlights new impacts on addictive/excessive behaviors, as well as moderating effects from social connectedness and IU. Future research is warranted to evaluate the efficacy of treatments targeting IU and social connectedness as the pandemic continues to unfold.

Objective: This longitudinal study tested the relationship between cigarette and e-cigarette use and SARS-CoV-2 seroconversion among US college students. Participants: Undergraduate students (n = 764), drawn from a randomly selected invitation-only pool from a large Midwestern university, that were initially negative for SARS-CoV-2 antibodies and were re-tested in November were included in this study conducted in Fall 2020. Methods: Demographics and cigarette and e-cigarette use behaviors (nicotine use) were collected in a baseline survey. SARS-CoV-2 antibody tests were administered in September (baseline) and November (endline) of 2020. Log-binomial regression analyses were conducted to test the association between nicotine use and SARS-CoV-2 seroconversion. Results: SARS-CoV-2 seroconversion was 5.2%. No statistically significant associations were found between nicotine use and SARS-CoV-2 seroconversion. Conclusions: Contrary to prior results, we found no association between nicotine use and SARS-CoV-2 seroconversion. Nicotine use may not be a key risk factor for COVID-19 acquisition in predominantly healthy college-aged populations.