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Little research has examined mechanisms driving cannabis use disparities among sexual minority (SM; versus heterosexual) young adults (YAs). Participants were US YA women (N  = 1345; 24.8% bisexual, 6.1% lesbian) and men (N  = 998: 8.9% bisexual, 13.8% gay). Bivariate analyses examined associations between sexual orientation (heterosexual, gay/lesbian, bisexual) and cannabis use outcomes (past 30-day [current] use, use frequency, cannabis-tobacco dual use, use intentions), perceived risks (harm, addictiveness) and social norms (social acceptability, peer use). Regressions examined sexual orientation, perceived risks and social norms as correlates of cannabis outcomes. Bisexual and lesbian (versus heterosexual) women reported lower cannabis-related perceived risks, greater social norms and higher odds of current use. Bisexual (versus heterosexual) women reported more days of use, higher odds of cannabis-tobacco dual use and greater use intentions. Gay (versus heterosexual) men reported lower perceived addictiveness, greater social norms and higher odds of current use. Lower perceived risks and greater social norms predicted greater use outcomes for women and men. Bisexual women displayed higher odds of several cannabis use outcomes, whereas lesbian women and gay men displayed higher odds of current cannabis use only. Cannabis-related perceptions and social norms may be important targets for public health messaging for SMYAs. [ABSTRACT FROM AUTHOR]

Aims: To evaluate the effectiveness of a combined internet and text message intervention for smoking cessation compared with an internet intervention alone. The text message intervention was optimized for engagement in an earlier multiphase optimization (MOST) screening phase. Design A parallel, two‐group, individually randomized clinical trial (RCT) was conducted in a MOST confirming phase. Recruitment spanned December 2018 to March 2019. Follow‐up was conducted at 3 and 9 months, beginning March 2019 and ending January 2020. Setting: United States: a digital study conducted among new registrants on a free tobacco cessation website. Participants: Eligible individuals were 618 adult current smokers in the United States, age 18 years or older who signed up for text messages during website registration (67.2% female, 70.4% white). Interventions: The treatment arm (WEB+TXT; n = 311) received access to the website and text messaging. The control arm (WEB; n = 307) received access to the website alone. Measurements The primary outcome was self‐reported 30‐day point prevalence abstinence (ppa) at 9 months post‐randomization analyzed under intent to treat (ITT), counting non‐responders as smoking. Secondary outcomes included 3‐month measures of 30‐day ppa, intervention engagement and intervention satisfaction. Findings Abstinence rates at 9 months were 23.1% among WEB+TXT and 23.2% among WEB (OR = 1.00, 95% CI = 0.69–1.45; P = 0.99). WEB+TXT increased engagement with 5 of 6 interactive features (standardized mean difference (SMD) = 0.26–0.47, all P < 0.001) and repeat website visits (48.7% vs 38.9%, SMD = 0.14, P = 0.02). Satisfaction metrics favored WEB+TXT (satisfied: 96.3% vs 90.5%, SMD = 0.17, P = 0.008; recommend to friend: 95.9% vs 90.1%, SMD = 0.16, P = 0.028). Conclusions: A randomized controlled trial found no evidence that a combined internet and text message intervention for smoking cessation compared with an internet intervention alone increased 9‐month abstinence rates among adult current smokers in the United States, despite evidence of higher levels of intervention engagement and satisfaction at 3 months. [ABSTRACT FROM AUTHOR]

Objectives: In this study, we measured the effects of cigarillo packaging colors and flavor descriptors on appeal and perceived risk among young adults. Methods: United States-based young adults (ages 18-24) recruited via Amazon Mechanical Turk were randomized to view one of 7 images of cigarillo packages that varied in color (Black and White [B&W], brown, red) and flavor descriptor (none, tobacco, apple). Respondents rated the product's appeal, risk, and addictiveness. Differences in ratings by study condition were assessed using linear regression models with bootstrapped standard errors. Results: There were 2818 participants, and 26.5% reported having ever used a little cigar or cigarillo. Brown and red packaging were rated as more appealing (vs B&W) across 4 dimensions (all ps < .05). Compared to no flavor descriptor, tobacco flavor was rated as more "Attention-Grabbing" (b = 0.21, p = .010) and apple flavor was rated higher on all 8 measures of appeal (all ps < .05) and perceived as less addictive (b = -0.13, p = .024). Conclusions: Colors and flavor descriptors on cigarillo packaging increased appeal and decreased perceived addictiveness. Restricting color and flavor descriptors on packaging may reduce their appeal. [ABSTRACT FROM AUTHOR]

Objectives: In 2016 the US Food and Drug Administration (FDA) and Santa Fe Natural Tobacco Company entered into a settlement agreement restricting use of the terms "additive free" and "natural" in American Spirit ads. American Spirit uses a variety of other tactics that could contribute to inaccurate reduced risk perceptions; yet, no research has examined the effects of these tactics. The current study examines the effect of the phrase 'tobacco and water', references to eco-friendly business practices, and plant imagery on young adults' perceptions of product harm, addictiveness, and nicotine content. Methods: We conducted a between-subjects experiment that randomized the presentation of 5 ad tactics (control, 'tobacco and water', eco-friendly reference, plant imagery, or all 3 tactics present) in 2 brands (American Spirit vs Marlboro) with a sample of 3054 18-24 year-old US young adults recruited via Amazon Mechanical Turk. Results: When used in an American Spirit ad, adding eco-friendly language (OR = 1.50, AOR = 1.51) or "tobacco and water" (OR = 1.48, AOR = 1.1.6) was associated with greater odds of misperceiving reduced harm compared to the control condition. Conclusions: Our findings provide additional support for FDA enforcement actions against tobacco companies using these misleading tactics. [ABSTRACT FROM AUTHOR]

Background: As of 2015, more than half of U.S. states have legalized, medicalized, or decriminalized marijuana. Objective: This study examined the prevalence and correlates of support for marijuana legalization in a national sample of young adults and the intention to use marijuana more frequently if it were legalized. Methods: Data were from Wave 7 (weighted N = 3532) of the Truth Initiative Young Adult Cohort, a national sample of men and women aged 18–34. We assessed demographics, past 30-day substance (alcohol, tobacco, marijuana, other drug use), depression and anxiety, social smoking, marijuana harm perceptions (relative to cigarettes), and state-level marijuana policies as correlates of support for marijuana legalization and intentions to use marijuana more often if it were legalized. Multivariable models of correlates of support for legalization and intentions to use marijuana were conducted separately for the full sample and for nonmarijuana users. Results: Weighted estimates showed that 39% of the full sample and 9% of nonmarijuana users supported marijuana legalization. Multivariable models showed that lower marijuana harm perceptions and lifetime and past 30-day tobacco use were common predictors of support for marijuana legalization and intentions to use marijuana among non-users of marijuana. Conclusions/Importance: Over a third of the sample supported marijuana legalization. Tobacco use and perceptions that marijuana is less harmful than cigarettes were robust risk correlates of support for marijuana legalization and intentions to use more frequently among nonusers. Public health campaigns should target these factors to deter marijuana-related harm in susceptible young adults. [ABSTRACT FROM AUTHOR]

Introduction: A challenge in Electronic Nicotine Delivery System (ENDS) research is how to refer to these devices in ways that are meaningful to current or potential users. The objectives of this study were to: (1) describe the frequency of ENDS terms in a web-based smoking cessation intervention; and (2) determine whether terms vary by US geographic region and date.Methods: Data were drawn from public posts between 2008-2015 on http://BecomeAnEX.org and limited to US users. We conducted "exact" and "fuzzy" searches to find posts containing ENDS keywords using custom Python scripts, and extracted geocoding data and date for each post. We examined counts and frequencies of ENDS terms by unique user, by unique user and region, and by unique user and date.Results: We identified 1023 unique US website users who had written a post containing one or more ENDS keywords. Posters were majority female (79%), educated (78% attended at least some college), and had a median age of 47 years. Overall, 92% of ENDS posters employed the term "e-cigarette" or a derivation. Derivations of "vape" became increasingly popular in 2013, whereas "NJoy" and "blu" were employed by fewer than 2% of posters. We found no variation in frequency of ENDS terms by US region.Conclusions: Researchers may have confidence that "e-cigarette" and "vape" are recognizable terms among US treatment-seeking smokers. Conversely, terms such as "ENDS," commonly employed by researchers and public health advocates, are not used by smokers and may be an impediment to tobacco control research.Implications: Researchers may have confidence that "e-cigarette," and, to a lesser extent, "vape" are recognizable terms among US adult smokers referring to ENDS (including accessories, brand names, and actions). Conversely, terms such as "electronic nicotine delivery systems," commonly employed by researchers and public health advocates, are not used by US smokers and may be an impediment to tobacco control research and practice. [ABSTRACT FROM AUTHOR]

Objectives Diagnostic orphans (DOs) represent a group of individuals with no formal diagnosis, despite endorsing some criteria of an alcohol use disorder (AUD). Prior research has indicated that rates of DSM-IV DOs in college are high and closely resemble those with an alcohol abuse diagnosis across pertinent alcohol use risk factors. However, significant changes to the DSM-IV AUD criteria have been made for the current DSM-5 manual, which may impact how DOs are classified. This study examined the unique alcohol and illicit drug use characteristics of a group of 2,620 DSM-5 DOs in college and tested whether DOs differed from those with and without a DSM-5 AUD across pertinent alcohol and drug use risk factors. Methods Participants were 2,620 DSM-5 DO undergraduate college students, between the ages of 18 and 30, recruited from three public universities in the Southeastern, United States. Results Diagnostic orphans represented 19.6% ( n = 506) of the sample; with the most frequently endorsed criteria being tolerance and consuming alcohol in hazardous situations. DOs reported significantly greater alcohol consumption, alcohol and drug related problems, and illicit drug use compared to those with no DSM-5 AUD diagnosis. Alternatively, DOs reported significantly lower alcohol use and illicit drug use compared to those with a DSM-5 AUD. Conclusion The present findings indicate that DSM-5 DOs in college represent a distinct group of drinkers relative to those with and without a DSM-5 AUD. Current screening initiatives should target this group to prevent future escalation of problem drinking. (Am J Addict 2014;23:378-385) [ABSTRACT FROM AUTHOR]

This study used the reasoned action approach (RAA) to examine 1) factors associated with pregnant smokers' intention to switch from cigarettes to e-cigarettes and 2) the influence that intention to switch had on future expectations to resume cigarette use postpartum. U.S. pregnant women (N = 267) who reported past 30-day use of cigarettes completed an online cross-sectional survey between November and December 2019. A 30-item scale measured RAA constructs (intention, instrumental attitudes, experiential attitudes, injunctive norms, descriptive norms, perceived autonomy, and perceived capacity). A confirmatory factor analysis confirmed and structural equation modeling tested the RAA constructs' association with intention to switch and the relationship between intention to switch and future expectations to resume smoking after pregnancy. The confirmatory factor analysis confirmed the seven-factor measurement model. Structural equation modeling found instrumental attitudes (β = 0.43; p <. 001) and descriptive norms (β = 0.53; p <. 001) were associated with intention to switch from cigarettes to e-cigarettes. However, there were differences between the constructs' relationships with intention between those who did and did not use e-cigarettes in the past 30 days. Intention to switch was inversely related with future expectations to resume smoking postpartum (β = –0.13; p <. 001). This study examined multiple facets of behavioral decision-making that may influence pregnant smokers' intention to switch to e-cigarettes during pregnancy. In this sample, pregnant people who believed switching from cigarettes to e-cigarettes was important and that other smokers commonly switched during pregnancy reported greater intention to switch. Novel theories, such as the RAA, may provide an optimal lens to understand pregnant smokers' behavioral decision-making process as they consider switching from cigarettes to e-cigarettes. [ABSTRACT FROM AUTHOR]

Introduction Hookah, or waterpipe, tobacco smoking has increased among young adults (YAs) in the U.S., but few prospective studies have examined predictors of hookah use. The current study examined correlates of hookah use and predictors of hookah initiation at a 6-month follow-up in a nationally representative, prospective sample of U.S. YAs. Methods Data were drawn from a subset of participants aged 18–24 years at study entry from two waves of the Legacy Young Adult Cohort Study. Wave 5 was completed in July 2013 by 1,555 participants and 74% ( n =1,150) completed follow-up 6 months later in January 2014. Weighted bivariate and multivariable analyses were conducted in June 2014 to estimate the prevalence and correlates of ever and past 30–day hookah use and to examine associations between baseline covariates and hookah initiation 6 months later. Results At baseline (Wave 5), almost 25% of the sample had ever used hookah and 4% reported past 30–day use. Alcohol, marijuana, and cigarette use were more prevalent among ever and past 30–day hookah users than among never users. Eight percent of never users at baseline reported trying hookah at the 6-month follow-up. Significant predictors of hookah trial in a multivariable model included college enrollment; alcohol, marijuana, and cigarette use; and perceptions that hookah is less harmful than cigarettes. Conclusions Results highlight rapid transitions in hookah use and several risk factors for initiation. Future studies should examine how these factors could be used as intervention targets to reduce tobacco use in this vulnerable age group. [ABSTRACT FROM AUTHOR]

Introduction: Young adults report high rates of current cannabis use. The proliferation of legalized cannabis in the US has led to greater access and availability, causing cannabis to become the new "gateway" drug. This study examined the prevalence of trying cannabis before alcohol or tobacco and the association of initiation with cannabis first with single and poly-substance use in young adults., Methods: METHODS: Data were analyzed from young adults (n=8062) in Waves 1 through 5 (2013-2019) of the Population Assessment of Tobacco and Health study who had ever tried alcohol, cannabis, or tobacco and provided age at first use of these substances. Weighted multivariable models examined associations between cannabis initiation before, at the same age, or after initiating alcohol or tobacco use with past 30-day substance use (alcohol, cannabis, tobacco, poly-substance use) in a subsequent wave (Waves 2-5)., Results: Initiating cannabis before alcohol and tobacco (6%) was rare. In adjusted regression models, initiating cannabis before alcohol and tobacco was associated with increased odds of past 30-day cannabis use, past 30-day tobacco use, and past 30-day polysubstance use and decreased odds of past 30-day alcohol use. Initiating cannabis at the same age as either alcohol or tobacco, or trying cannabis after these substances was associated with increased odds of all substance use outcomes., Conclusions: Cannabis initiation before alcohol and tobacco is uncommon and may even protect against future alcohol use. Deterring cannabis initiation with multiple substances could have public health benefits., Competing Interests: Declaration of Competing Interest No conflict declared., (Copyright © 2023 Elsevier B.V. All rights reserved.)

Background: Past-month marijuana use has increased significantly among US young adults (aged 18-24) and marijuana use often overlaps with tobacco use. This study investigated the relative prevalence and correlates of individual tobacco product use among young adult marijuana and tobacco users to determine if unique typologies could be identified., Method: Data were from young adults (18-24) in Wave 2 of the Population Assessment of Tobacco and Health (PATH) Study. Analyses examined the prevalence of different patterns of past 30-day marijuana and tobacco use and co-use. Weighted adjusted models were used to examine correlates of different marijuana and individual tobacco co-use profiles (compared to no-use of either product)., Results: Prevalence estimates showed that 30.9% of young adults report past month tobacco-only use, 21.3% report past-month co-use of marijuana and at least one tobacco product, and 4.5% report past 30-day marijuana-only use. Correlates of co-use differed by tobacco product. Using 3+ tobacco products and frequency of past 30-day alcohol use were robustly and consistently associated with each marijuana and individual tobacco co-use profile and any co-use of marijuana with tobacco., Conclusions: Among US young adults between 2014 and 2015, co-use of marijuana and tobacco was common, and there was heterogeneity in correlates associated with use of different tobacco products among those who used marijuana. Different correlates suggest different targets for marijuana and tobacco prevention and intervention in this age group., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

Introduction: Youth may be attracted to menthol cigarettes because they are perceived as less harmful and harsh to smoke relative to non-menthol cigarettes. This study examined demographic factors and menthol cigarette smoking patterns as correlates of youth harm perceptions of cigarette smoking and ease of smoking menthol versus non-menthol cigarettes., Methods: Data were from the Wave 1 (2013-2014) youth sample of the Population Assessment of Tobacco and Health Study. Weighted multivariable logistic regression models were used to examine correlations between demographic factors and menthol cigarette smoking patterns (menthol initiation, past 30-day menthol cigarette smoking, and menthol cigarette brand preference), with harm perceptions of cigarette smoking and ease of smoking a menthol cigarette., Results: Nearly half of ever cigarette smoking youth (43%) first used a menthol cigarette; 21% reported past 30-day menthol cigarette smoking; and 42% of past 30-day smokers providing brand information used a menthol cigarette as their preferred brand. In bivariate analyses, initiation with a menthol cigarette and menthol brand preference (versus non-menthol) were correlated with black race, older age at initiation, and past 30-day menthol cigarette smoking. In adjusted models, past 30-day menthol cigarette smoking and menthol cigarette brand preference, but not menthol initiation, were correlated with the perception that menthol cigarettes are easier to smoke., Conclusions: Youth who smoke menthol cigarettes perceive them as easier to smoke, even after adjusting for other factors. Age of initiation and black race emerged as correlates of menthol cigarette initiation, brand preference, and cigarette harm perceptions, and may inform future prevention campaigns., (Copyright © 2019 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.)

Introduction: Harm perceptions of menthol cigarettes may contribute to their appeal and use. African-Americans, women, and younger smokers disproportionately use menthol cigarettes, and may misperceive harm of menthol cigarettes., Methods: Data were from Wave 1 of the Population Assessment of Tobacco and Health (PATH) Study. Weighted analyses of current adult smokers (18 and older) were used to estimate the correlates of menthol smoking among all cigarette brands and separately for the top three cigarette brands (Newport, Camel, and Marlboro). Adjusted models examined the main effect of menthol smoking on harm perceptions of one's own brand of cigarette and interactions with race/ethnicity, age, and gender., Results: Menthol cigarettes were used by nearly 40% of current smokers, although the prevalence of menthol smoking differed across the top three brands (94% Newport, 46% Camel, and 18% Marlboro). Among menthol smokers, 80% perceived their cigarette as equally harmful, 14% perceived their brand as more harmful, and 7% perceived their brand as less harmful. In adjusted models, menthol smokers were more likely than nonmenthol smokers to misperceive their own brand as more harmful than other brands (compared to no difference in harm). Race and gender emerged as moderators of the association between menthol brand preference and harm perceptions., Conclusions: In adjusted analyses, menthol smokers were more likely than nonmenthol smokers to perceive their brand as more harmful than other brands, with differences by sub-groups who disproportionately use menthol., Implications: Menthol cigarettes have been historically marketed with messages conveying lower harm than other cigarettes. Little is known about how contemporary adult menthol smokers perceive the harm of their usual brand, and potential differences by race, gender, and young adult versus older adult age group. After adjusting for other factors, menthol smokers were more likely than nonmenthol smokers to perceive their cigarette brand as more harmful than other brands. Further, the association between menthol smoking and harm perceptions differed by race and gender, but not by age group (young adult vs. older adult). This type of large-scale study identifies critical links between menthol smoking and harm perceptions among vulnerable smokers that will inform regulatory actions designed to decrease smoking-related harm., (© The Author(s) 2018. Published by Oxford University Press on behalf of the Society for Research on Nicotine and Tobacco. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Background: Cigarette smoking is associated with depression, and new initiates who progress more quickly to daily smoking may be at enhanced risk. In a nationally representative sample of youth, this study examined the association between daily, non-daily, and never smoking with past-year and lifetime major depressive episode (MDE) and, among daily smokers, whether faster progression to daily smoking was associated with increased MDE risk., Methods: Data were from n = 44,921 youth aged 12-17 in the 2013-2015 National Survey on Drug Use and Health. Weighted adjusted multivariable logistic regression models were used to examine the association of smoking status (daily, non-daily, never) with lifetime and past-year MDE, and the association between progression from cigarette trial to daily smoking with MDE outcomes among daily smokers., Results: Daily and non-daily smokers had similar rates of lifetime and past-year MDE; rates of MDE were approximately 50% lower among never smokers. Compared to never smokers, adjusted models showed that non-daily smokers had a higher risk of past-year and lifetime MDE, while daily smokers had a higher risk of past-year but not lifetime MDE. Daily smoking youth who progressed more quickly from cigarette trial to daily use had an increased risk of both lifetime and past-year MDE., Conclusions: Prevention programs should target factors associated with the shift from cigarette experimentation to regular use to curb deleterious consequences of use., (Copyright © 2018. Published by Elsevier Ltd.)

Background and Objectives: This study identified the most common patterns of current alcohol and marijuana use with the spectrum of tobacco products (cigarettes, hookah, e-cigarettes, cigars/little cigars, and other products), among US young adults and older adults and examined associations of mental health and substance use problems with each pattern., Methods: Wave 1 adult dataset (2013-2014) of the Population Assessment of Tobacco and Health (PATH) Study. Weighted analyses estimated the prevalence of the top 10 patterns of current alcohol, marijuana, and tobacco use and co-use separately by young adults aged 18-24 (n = 9,112) and adults 25+ years (n = 23,208). Multivariable models examined associations of substance use and mental health problems to patterns of use, adjusting for demographics., Results: Across both age groups, alcohol-only use was the most popular use pattern (20.7% for young adults and 32.2% older adults) however poly-substance use patterns were more frequent than single use patterns. Cigarettes were the only tobacco product used exclusively; all other tobacco products were used with together, or with alcohol or marijuana. Only one young adult pattern emerged containing e-cigarettes, and this pattern included co-use with alcohol and cigarettes (1.3%). Mental health and substance use problems were most strongly correlated with dual and poly-substance use patterns, regardless of age., Scientific Significance: Prevention and intervention campaigns should focus on multiple product use, as single substance use is uncommon. Alcohol is common in all patterns, suggesting it should also gain more focus in marijuana and tobacco prevention and intervention programs. (Am J Addict 2018;27:491-500)., (© 2018 American Academy of Addiction Psychiatry.)

Introduction: In the United States, the prevalence of tobacco use among sexual and gender minorities (SGM) is higher compared to their non-SGM counterparts. Tobacco harm perceptions have gone largely unexamined as a potential mechanism supporting disproportionate tobacco use among this population. The purpose of this study was to examine differences between SGM and non-SGM young adults in harm perceptions of various tobacco products and tobacco use behavior and whether low tobacco-related harm perceptions moderate the relationship between identifying as a SGM and tobacco use behavior., Methods: This study used data from Wave 10 of the Truth Initiative Young Adult Cohort Study, a sample of U.S. young adults (ages 18-34). Data were collected from September to October 2016 and the study sample included 3089 individuals. Demographics, past 30-day use of cigarettes, little cigars/cigarillos/bidis and electronic cigarettes were assessed. Absolute and relative harm perceptions of these products were also examined., Results: Identifying as a SGM and low tobacco harm perceptions were found to be positively associated with past 30-day tobacco use. There was no interaction between SGM status and harm perceptions on past 30-day tobacco use CONCLUSIONS: Findings confirm that SGM young adults continue to disproportionately use tobacco products, compared to non-SGM young adults. More research is needed to understand moderators of the relationship between SGM status and tobacco use in young adults., (Copyright © 2018 Elsevier Ltd. All rights reserved.)

The legalization of medical and recreational cannabis use has occurred ahead of science. The current evidence base has poor utility for determining if cannabis products can meet the standards of safety, efficacy, and quality intrinsic to modern medicine, and for informing regulation of cannabis as a legal intoxicant. Individual jurisdictions that pass cannabis reforms may not have adequate resources to support the level of new scientific research needed to inform regulatory actions; this could make it difficult to keep a rapidly growing multi-billion-dollar cannabis industry in check. Further, the present lack of evidence-based regulatory oversight for cannabis parallels the climates that gave rise to the tobacco and prescription opioid epidemics, suggesting that continued omission may result in negative public health consequences. However, translating a methodological framework developed through research on these compounds may promote rapid advances in cannabis science germane to regulatory knowledge gaps. The present review highlights specific advancements in these areas, as well as in alcohol regulation, that are prime for informing policy-relevant cannabis science, and also offers some recommendations for evidence-based regulatory policy. Resulting progress may directly inform both regulation of cannabis in both medical and licit recreational drug frameworks, and new cannabis-related public health initiatives.

Background: Certain operative cases occur unpredictably and/or have long operative times, creating a conflict between Accreditation Council for Graduate Medical Education (ACGME) rules and adequate training experience., Methods: A ProModel-based simulation was developed based on historical data. Probabilistic distributions of operative time calculated and combined with an ACGME compliant call schedule., Results: For the advanced surgical cases modeled (cardiothoracic transplants), 80-hour violations were 6.07% and the minimum number of days off was violated 22.50%. There was a 36% chance of failure to fulfill any (either heart or lung) minimum case requirement despite adequate volume., Conclusions: The variable nature of emergency cases inevitably leads to work hour violations under ACGME regulations. Unpredictable cases mandate higher operative volume to ensure achievement of adequate caseloads. Publically available simulation technology provides a valuable avenue to identify adequacy of case volumes for trainees in both the elective and emergency setting., (Copyright © 2015 Elsevier Inc. All rights reserved.)

Introduction: Work-hour restrictions have decreased flexibility in scheduling and reduced exposure to certain operative cases. These restrictions may affect a resident's ability to meet certification requirements, particularly for rare, unscheduled cases (e.g., cardiothoracic transplants). We developed a computer-based simulation model using variables such as case volume and program size to demonstrate the influence of these factors on the likelihood of certifying a set of residents on rare cases., Methods: We built a simulator to predict the probability of attaining certification for surgical residents, using cardiothoracic transplants as a test case. Inputs to the model included operating times, call schedules, and procurement travel times, as well as information on the distribution of times between transplants., Results: We simulated 100 years of schedules using our current system parameters of an average of 33 heart and 31 lung transplants per year, and assuming an Accreditation Council for Graduate Medical Education-compliant daily-rotating call schedule. Despite having enough transplants to certify all residents for lungs if all opportunities were distributed equally among residents, the certification rate achieved when constrained by arrival time (and call schedules) and work restrictions was only 55%. Our calculations show that meeting minimum transplant-certification requirements for all residents would require at least 1.5 times the expected number of annual transplants., Conclusions: Our model enables analysis of a given program's ability to certify its residents based on program size and volume. These results could be used to design alternative scheduling paradigms to improve certification rates, without requiring reductions in certification requirements or program size., (Copyright © 2014 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.)

Rape tactics, rape incident characteristics, and mental health problems (lifetime depression, PTSD, and substance abuse) were investigated as correlates of eight different reasons for not reporting a rape to police among women who had experienced but did not report a rape to police (n = 441) within a national telephone household probability sample. Rape tactics (nonmutually exclusive) included drug or alcohol-facilitated or incapacitated rape (DAFR/IR; n = 119) and forcible rape (FR; n = 376). Principal Components Analysis (PCA) was conducted to extract a dominant set of patterns among the eight reasons for not reporting, and to reduce the set of dependent variables. PCA results indicated three unique factors: Not Wanting Others to Know, Nonacknowledgment of Rape, and Criminal Justice Concerns. Hierarchical regression analyses showed DAFR/IR and FR were both positively and significantly associated with Criminal Justice Concerns, whereas DAFR/IR, but not FR, was associated with Nonacknowledgment as a reason for not reporting to police. Neither DAFR/IR nor FR emerged as significant predictors of Others Knowing after controlling for fear of death or injury at the time of the incident. Correlations among variables showed that the Criminal Justice Concerns factor was positively related to lifetime depression and PTSD and the Nonacknowledgement factor was negatively related to lifetime PTSD. Findings suggest prevention programs should educate women about the definition of rape, which may include incapacitation due to alcohol or drugs, to increase acknowledgement and decrease barriers to police reporting.

This study examined the dimensionality of DSM-IV alcohol use disorder (AUD) criteria in a nationally representative sample of college students (N = 4,605) using latent variable techniques. We used data from the 2009 National Survey of Drug Use and Health and selected those who were currently enrolled in college and current drinkers. Confirmatory factor analysis provided support for a one-factor solution of the AUD criteria. Item Response Theory analyses indicated that the alcohol abuse and dependence criteria severity parameters were intermixed along the AUD severity continuum with high discrimination parameters. Findings support reformulating the current AUD diagnostic system for the DSM-V. Study's limitations are noted.

Item response theory (IRT) methods were applied to items from the 80-item Psychological Inventory of Criminal Thinking Styles (PICTS; G. D. Walters, 1995) to determine how well they measure the latent trait of criminal thinking in a group of 2,872 male medium security prison inmates. Preliminary analyses revealed that the 64 PICTS thinking style items, 32 PICTS proactive criminal thinking items, and 24 PICTS reactive criminal thinking items were sufficiently unidimensional to meet the local independence requirements of IRT. The PICTS was fitted to a 2-parameter logistic-graded response IRT model, the results of which showed that the 8 items measuring denial of harm (Sentimentality) displayed weak discrimination (a < 0.5), whereas most of the proactive and reactive items displayed moderate to good discrimination (a > 1.0). Information function analysis revealed that all 3 components of a hierarchical model of criminal thinking--PICTS total scale, PICTS proactive factor, and PICTS reactive factor--displayed greater precision at higher rather than lower levels of the trait dimension. The study findings indicate that items from the PICTS Sentimentality scale do a poor job of measuring general criminal thinking, whereas items from the other 7 PICTS thinking style scales provide their most precise estimates at the upper end of the trait dimension.