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IMPORTANCE: Substance use is high among American Indian/Alaska Native adolescents. Pain interference is a risk factor for substance use, and identifying potential protective factors, such as Tribal identity, is important to help inform culturally grounded substance use prevention strategies. OBJECTIVE: To examine the protective potential of Tribal identity as a moderator in the association between pain interference and substance use in American Indian/Alaska Native adolescents. DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study of 10th-grade students self-identifying as American Indian/Alaska Native was conducted among students enrolled at 20 high schools on or near the Cherokee Nation Reservation. Data for this study were collected from the baseline assessments of a cluster randomized trial to prevent substance use among adolescents living on or near the Cherokee Nation Reservation. Inclusion criteria for high schools’ participation included being located within counties that partially or fully fall within the Cherokee Nation reservation, a town population of 3000 individuals or fewer, and class sizes between 30 and 100 students. Exclusion criteria included high schools within metropolitan and micropolitan cores (per the US Census Bureau’s Rural-Urban Commuting Area codes) and the existence of an established community drug prevention coalition. Student surveys were conducted from September 2021 to May 2024. EXPOSURE: Pain interference in the 7 days prior to baseline assessment. MAIN OUTCOMES AND MEASURES: The primary outcomes were past 30-day alcohol use, marijuana use, and prescription opioid misuse. Generalized estimating equations Poisson models were used, with an exchangeable correlation structure clustered on the school level using baseline data from a cluster randomized trial to prevent alcohol and substance use among adolescents. For each substance, a separate multivariable model was fit, which included pain interference, Tribal identity, an interaction term between pain interference and Tribal identity, age, gender, food insecurity, anxiety symptoms, and depressive symptoms. RESULTS: Among 514 self-identified American Indian/Alaska Native students at 20 high schools on or near the Cherokee Nation Reservation, mean (SD) participant age was 15.59 (0.62) years, and 252 participants (49.0%) self-identified as female. Pain interference was associated with alcohol use and prescription opioid misuse in American Indian/Alaska Native adolescents, controlling for age, gender, food insecurity, anxiety symptoms, and depressive symptoms. Tribal identity significantly moderated the association between pain interference and alcohol use (coefficient, −0.13; 95% CI, −0.23 to −0.02). CONCLUSIONS AND RELEVANCE: When Tribal identity was high, the adverse association of pain interference with alcohol use was significantly attenuated. This demonstrates a protective role of Tribal identity on alcohol use, which can inform future substance use prevention efforts among American Indian/Alaska Native adolescents. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT04839978

A team of tribe-based behavioral health specialists and university-based researchers partnered to implement a cluster randomized trial for the prevention of drug misuse among adolescents attending public high schools on or near the Cherokee Nation Reservation in northeastern Oklahoma. The conceptual framework, which guided intervention and measurement design for the trial, incorporates indigenous knowledge and worldviews with empirically-based frameworks and evidence-based practices. Our goal is to serve multicultural youth, families, and schools and to provide a model of effective strategies for wide dissemination. This paper presents the conceptual model, survey design, and psychometric properties of scales to measure risk and protective factors for substance misuse. The survey includes common measures drawn from the PhenX Toolkit on substance use patterns—adolescent module, measured with standard items from the Monitoring the Future (MTF) study and items harmonized across ten NIH-funded research projects with diverse samples of youth. In our trial, brief (20-minute) self-report questionnaires were administered to 10th grade students in fall 2021 (n= 919, 87% response rate) and spring 2022 (n= 929, 89% response rate) in 20 participating high schools on or near the Cherokee Nation Reservation. The sample primarily fell into the following three categories of race/ethnicity identification: only American Indian (AI-only, 29%), AI and another race/ethnicity (AI+, 27%), and only White (35%). Results indicate that risk and protective factor scales were reliably and validly measured with 10 scales and 10 subscales. There were minimal differences between youth who identified as AI only, AI+, and White only, especially for the main scales, which provide confidence in the interpretation of trial outcomes across demographic groups. Study results may not be generalizable to AI/AN youth who live and attend school in more homogenous reservation lands, or alternatively, live in large diverse metropolitan areas.

Inexpensive drinks and price promotions increase alcohol consumption and have been observed at on‐premise drinking establishments near large colleges. Some bars may sell tobacco products and allow indoor tobacco use to encourage patrons to stay and drink more. This study examined drink prices/specials and associated practices of on‐premise drinking establishments including tobacco sales and policies regarding tobacco use. In 2018, telephone calls about prices/practices were made to 403 randomly selected bars/nightclubs within 2 miles of large residential universities in each U.S. state. The Alcohol Policy Information System provided data on state‐level alcohol laws. Multivariable linear and logistic regression models examined associations between alcohol prices/specials, state laws, and establishment practices. The average price for the least expensive draft beer and a vodka shot at each location were $3.62 (SD= $1.15) and $4.77 (SD= $1.16), respectively. Most establishments (65%) had happy hour specials, 6% had 2‐for‐1 specials, 91% sold food, 9% sold cigarettes, 8% allowed smoking indoors, and 18% permitted electronic cigarette (e‐cigarette) use indoors. Allowing e‐cigarette use indoors (b= −0.54) and selling cigarettes (b= −0.79) were associated with lower vodka prices; allowing cigarette smoking indoors (b= −0.46) was associated with lower beer prices. Lower beer prices (OR = 1.38), selling food (OR = 2.97), and no state law banning happy hour specials altogether (OR = 4.24) or with full‐day price reduction exemptions (OR = 12.74) were associated with higher odds of having happy hour specials. Allowing e‐cigarette use indoors was associated with having 2‐for‐1 specials (OR = 6.38). In bars near large public universities, beers and shots were often available for less than $5 and drink specials were prevalent. Further, some establishments allowed tobacco use indoors and/or sold cigarettes. Laws that increase alcohol taxes, set minimum drink prices, and ban the sale and indoor use of tobacco products at on‐premise drinking locations are important harm reduction tools. We examined drink prices/specials and associated practices of on‐premise drinking establishments (n=403) near large universities in each state. On average, a beer and a vodka shot cost <$5, and most establishments had happy hours (HHs). Indoor tobacco use and cigarette retail were associated with lower drink prices. Lower drink prices, food retail, and no state law restricting HHs were positively associated with HHs. Setting minimum drink prices, restricting drink specials, and banning indoor use/retail of tobacco products should be priorities.

ABSTRACTObjective: At a large public university, we aimed to evaluate an intervention designed to increase serogroup B meningococcal (MenB) vaccine uptake and awareness.Methods:Using a pretest-posttest design with a double posttest, we evaluated an intervention conducted by a local foundation and the Florida Department of Health that distributed MenB vaccine on campus and conducted an educational campaign. Prior to intervention activities, we recruited students to complete a survey about their MenB knowledge and attitudes. For survey participants who provided contact information, we sent two follow-up surveys and assessed MenB vaccine records. We used chi-square tests, adjusted for nonindependence, to compare preintervention to postintervention (three-month and one-year) vaccination and attitudes.Results:Among the 686 students with accessible vaccine records, MenB vaccine initiation increased 9% (from 24% to 33%) and completion increased 8% (from 13% to 21%) from before the intervention to one year after the intervention. When restricting to students who completed the relevant follow-up surveys, the percentage of students who heard of the MenB vaccine increased by 15% (p> .001) from before the intervention to three months after (n = 188 students) and maintained a 10% increase (p> .001) one year after the intervention (n = 261 students). Among students that heard of the MenB vaccine, the percentage of students who thought they needed the MenB vaccine even though they received the MenACWY increased 14% (p= .03) by the three-month postintervention survey and up to 18% by the one-year follow-up (p= .002).Conclusions:A university-wide, on-campus vaccination and educational campaign increased college students’ MenB vaccine initiation, completion, and knowledge.Clinicaltrials.gov ID: NCT02975596.

The COVID-19 pandemic has disproportionately impacted communities of color and highlighted longstanding racial health inequities. Communities of color also report higher rates of medical mistrust driven by histories of medical mistreatment and continued experiences of discrimination and systemic racism. Medical mistrust may exacerbate COVID-19 disparities. This study utilizes the Behavior Model for Vulnerable Populations to investigate predictors of medical mistrust during the COVID-19 pandemic among urban youth of color. Minority youth (N= 105) were recruited from community organizations in Kansas City, Missouri to complete an online survey between May and June 2020. Multiple linear regressions were performed to estimate the effect of personal characteristics, family and community resources, and COVID-19 need-based factors on medical mistrust. Results indicated that loneliness, financial insecurity (e.g., job loss, loss of income) due to the COVID-19 pandemic, and eligibility for free or reduced lunch predicted medical mistrust. Insurance status, neighborhood median household income, social support, and perceived COVID-19 risk were not significantly associated with medical mistrust. Future research and policies are necessary to address systemic factors that perpetuate medical mistrust among youth of color.

Supersized alcopops are single‐serving, ready‐to‐drink beverages with very high alcohol content. Research suggests that consumption of these products is especially dangerous. The current study was one of the first to examine individual‐level characteristics associated with recent consumption of supersized alcopops. Adults on probation (n= 253; 70% male) in Baltimore City, MD, and Dallas, TX, who reported heavy drinking or any illicit drug use completed interviews. Psychosocial scales were drawn from the Criminal Justice Client Evaluation of Self and Treatment Intake. Bivariate analyses were conducted to examine characteristics associated with past 30‐day consumption of supersized alcopops. Past 30‐day consumption of supersized alcopops was significantly associated with higher scores for hostility and risk‐taking, and lower scores on the self‐esteem scale compared to nonconsumers. Recent consumption of supersized alcopops was also significantly associated with past 30‐day homelessness and current gang affiliation. Among those who did not experience homelessness, 11% consumed supersized alcopops, compared to 30% of those who experienced homelessness. Further, 11% of those who were not gang‐affiliated reported consuming a supersized alcopop within the past 30 days, compared to 57% of those who were gang‐affiliated. This study identifies disparate consumption of dangerous supersized alcopop products by vulnerable and at‐risk groups. Better regulation of supersized alcopop marketing is needed to reduce alcohol consumption among high‐risk groups, including people who are homeless and gang members, and display greater hostility and risk‐taking traits. Previous research suggests that reducing the alcohol by volume and increasing the retail price of supersized alcopops would reduce some of the harms associated with consumption.

BackgroundSocial welfare policies such as the minimum wage can affect population health, though the impact may differ by the level of unemployment experienced by society at a given time.MethodsWe ran difference-in-differences models using monthly data from all 50 states and Washington, DC from 1990 to 2015. We used educational attainment to define treatment and control groups. The exposure was the difference between state and federal minimum wage in US$2015, defined both by the date the state law became effective and lagged by 1 year. Models included state and year fixed effects, and additional state-level covariates to account for state-specific time-varying confounding. We assessed effect modification by the state-level unemployment rate, and estimated predicted suicide counts under different minimum wage scenarios.ResultsThe effect of a US$1 increase in the minimum wage ranged from a 3.4% decrease (95% CI 0.4 to 6.4) to a 5.9% decrease (95% CI 1.4 to 10.2) in the suicide rate among adults aged 18–64 years with a high school education or less. We detected significant effect modification by unemployment rate, with the largest effects of minimum wage on reducing suicides observed at higher unemployment levels.ConclusionMinimum wage increases appear to reduce the suicide rate among those with a high school education or less, and may reduce disparities between socioeconomic groups. Effects appear greatest during periods of high unemployment.

Purpose: Law enforcement officers (LEOs) suffer from premature mortality, intentional and unintentional injury, suicide and are at an increased risk for several non-communicable disease outcomes including cardiovascular disease and several cancers, compared to those employed in other occupations. Repeated exposure to stressful and traumatic stimuli is a possible mechanism driving these adverse health outcomes among LEOs. To better identify the sources of these health problems, the purpose of this paper is to determine the feasibility of conducting a cohort study using physiological measures of stress (e.g. heart rate) with LEOs; perceptions of the FitBit device, including LEO buy-in and attitudes associated with the protocol. Design/methodology/approach: Data were collected from ten recent graduates of the Dallas Police Training Academy. Findings: Results suggest that officer buy-in and protocol compliance was high. Officers were eager to participate in this study, and completion of weekly surveys was 100 percent. Minute-level missing data from wearable devices was relatively low (25 percent), and 90 percent of participants wore the FitBit devices on more than 90 percent of study days. Originality/value: Results from this study suggest that wearable physiological devices can be effectively used in law enforcement populations to measure stress.

BackgroundElectronic cigarette (e-cigarette) battery failure can result in explosions and burn injuries. Previous attempts to quantify these events has been limited to compilations of case studies, federal agency reports and media reports. Although e-cigarette explosions and burn injuries are thought to be rare, current surveillance methods likely underestimate actual occurrences.MethodsAnalyses were conducted on cross-sectional data from the US Consumer Product Safety Commission’s (CPSC) National Electronic Injury Surveillance System (NEISS). A keyword search of case narrative text was used to identify e-cigarette-related explosion and burn injuries presenting to US emergency departments from 2015 to 2017. Sampling weights were applied to make conservative national incidence estimates.ResultsFrom 2015 to 2017, there were an estimated 2035 e-cigarette explosion and burn injuries presenting to US hospital emergency departments (95% CI 1107 to 2964).ConclusionsThere are more e-cigarette explosion and burn injuries in the USA than estimated in the past reports. Improved surveillance of e-cigarette injuries and regulation of e-cigarette devices is urgently needed. NEISS could be a valuable resource for e-cigarette injury surveillance.

Introduction Lung cancer screening is greatly underutilized among those who may benefit from early detection.Methods We analysed data from a subsample (n = 929) of the 2020 Health Information National Trends Survey. We tested multivariable logistic regression models of associations of cancer worry, information insufficiency, and perceived information gathering capacity with reports of having discussed lung cancer screening with a health care provider.Results Among former smokers, no factors were associated significantly with lung cancer screening information seeking. However, for current smokers, extreme cancer worry was positively and significantly associated with having discussed lung cancer screening with a health care provider (OR: 12.95; 95% CI: 2.11, 79.39).Conclusion To increase uptake of lung cancer screening, public health campaigns and healthcare providers will face the dual challenge of increasing perceived need for screening among former smokers while directing current smokers with high levels of worry to see the benefits of early detection.

Poverty has numerous deleterious effects on health, and the Earned Income Tax Credit (EITC) is the major policy tool used to alleviate poverty in the U.S. We evaluate effects of four distinct changes in earned income tax credit law in Washington, DC on maternal behaviors and infant outcomes. An interrupted time-series design was used with 312 monthly measures from 1990 through 2015 analyzed in 2018 (total n = 225,933 births). States with no EITC were included as the comparison group; analyses involved ARIMA modeling. Outcomes were derived from birth certificates, and included percent of live births below 2500 g, mean birth weight, mean gestation weeks, first trimester prenatal care, and maternal smoking during pregnancy. We found a pattern of significant improvements across all three infant outcome measures, with the size of the effect estimate monotonically matching the magnitude of the tax credit—ranging from a 1.9 (-2.9, -0.9) reduction in rate per 100 births of low birth weight for the smaller 10% credit, to a 4.7 (-5.4, -4.0) reduction with the 40% credit. Results for maternal smoking and prenatal care were mixed. Results suggest that earned income tax credit policies improve birth outcomes; mechanisms for this effect deserve further study.

Abstract: We show how to use generalized linear mixed models to adjust for confounding by cluster of the effect of a within-cluster covariate. We derive estimators for both a cluster-specific causal effect and a population-averaged causal effect. [ABSTRACT FROM AUTHOR]