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IntroductionWe examined the relationship between current tobacco use and functionally important respiratory symptoms.MethodsLongitudinal cohort study of 16 295 US adults without COPD in Waves 2-3 (W2-3, 2014-2016) of the Population Assessment of Tobacco and Health Study. Exposure-Ten mutually exclusive categories of tobacco use including single product, multiple product, former, and never use (reference). Outcome-Seven questions assessing wheezing/cough were summed to create a respiratory symptom index; cutoffs of ≥2 and ≥3 were associated with functional limitations and poorer health. Multivariable regressions examined both cutoffs cross-sectionally and change over approximately 12 months, adjusting for confounders.ResultsAll tobacco use categories featuring cigarettes (>2/3's of users) were associated with higher risk (vs. never users) for functionally important respiratory symptoms at W2, for example, at symptom severity ≥ 3, risk ratio for exclusive cigarette use was 2.34 [95% CI, 1.92, 2.85] and for worsening symptoms at W3 was 2.80 [2.08, 3.76]. There was largely no increased symptom risk for exclusive use of cigars, smokeless tobacco, hookah, or e-cigarettes (adjustment for pack-years and marijuana attenuated the cross-sectional e-cigarette association from 1.53(95% CI 0.98, 2.40) to 1.05 (0.67, 1.63); RRs for these products were also significantly lower compared to exclusive use of cigarettes. The longitudinal e-cigarette-respiratory symptom association was sensitive to the respiratory index cutoff level; exclusive e-cigarette use was associated with worsening symptoms at an index cutoff ≥ 2 (RR = 1.63 [1.02, 2.59]) and with symptom improvement at an index cutoff of ≥ 3 (RR = 1.64 [1.04, 2.58]).ConclusionsPast and current cigarette smoking drove functionally important respiratory symptoms, while exclusive use of other tobacco products was largely not associated. However, the relationship between e-cigarette use and symptoms was sensitive to adjustment for pack-years and symptom severity.ImplicationsHow noncigarette tobacco products affect respiratory symptoms is not clear; some studies implicate e-cigarettes. We examined functionally important respiratory symptoms (wheezing/nighttime cough) among US adults without COPD. The majority of adult tobacco users smoke cigarettes and have higher risk of respiratory symptoms and worsening of symptoms, regardless of other products used with them. Exclusive use of other tobacco products (e-cigarettes, cigars, smokeless, hookah) was largely not associated with functionally important respiratory symptoms and risks associated with their use was significantly lower than for cigarettes. The association for e-cigarettes was greatly attenuated by adjustment for cigarette pack-years and sensitive to how symptoms were defined.

Background: Digital technology is becoming a central component of schooling. We measured parents perceptions of their children's digital privacy on school-issued digital devices. Methods: We surveyed 571 parents of K-12th grade children, recruited nationally, regarding their child's use of school-issued devices. Parents reported their awareness of, and ratings of importance for, seven types of privacy policies for school-issued devices. Results: About half (45.9%) of children were in K-5th grade and 84.9% attended public school. Most (80.7%) children used a school-issued device and 66.6% took one home during the coronavirus pandemic. Parents most often rated policies for preventing the collection of geolocation (76%) and sharing of data with third parties (75%) as "very important." However, 35.4% of parents did not know with certainty if their school had any digital policies. Many (55.7%) parents "strongly agreed" their child's school protected student digital privacy and most (68.1%) felt schools were the most responsible party to do so, yet those ratings differed by parent awareness of privacy policies (p < 0.05). Conclusions: Parents consider digital privacy policies highly important and perceive schools to be responsible for such protections, highlighting the need to support schools in those efforts.

Objective:We leveraged an observational, repeated-measures study to examine the within-child associations between sleep quality and emotional self-regulation, controlling for between-child effects. Methods: Children aged 3-5 years and one parent each were recruited from the community in northern New England between 2019 and 2022. Parents completed online surveys at baseline and 2, 4, and 6 months post-baseline. Child sleep quality was measured with the validated Children's Sleep Habits Questionnaire modified for preschoolers; higher scores indicate worse sleep quality (range 32-96). Child emotional self-regulation was measured with the validated Child Social Behavior Questionnaire; higher scores indicate better emotional self-regulation (range 1-7). Adjusted mixed-effects linear regression was used to model the associations between nighttime sleep quality (exposure) and emotional self-regulation (outcome)measured at each of the four study time points while disaggregating the between- and within-child effects. Results: Children (n = 91) were largely white, non-Hispanic (88.7%), and from a higher social-economic status. Sleep quality scores averaged 38.9 (SD: 6.6) at baseline; 23.1% of children had scores >41, which is considered evidence of significant sleep problems. Emotional self-regulation scores averaged 4.2 (SD: 1.0). There was a significant within-child association between sleep quality and emotional self-regulation. Specifically, a decrease in sleep quality at any one time point, relative to each child'smean sleep quality, related to worse emotional self-regulation [standardized beta, βs = -0.31; 95% CI (0.53, -0.09)]; the between-child effect was not significant. Results were consistent when limited to children with complete data at all study visits (n = 78). Conclusions: The findings support a causal, within-child association between sleep quality and emotional self-regulation in preschool-aged children, with effects evident over 6 months. [ABSTRACT FROM AUTHOR]