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This study navigates the terrain of community development in metropolitan areas across the United States (US), spotlighting the interplay between stakeholder engagement, development success, and distinct types of community development characteristics. While urban centers in US cities experienced disinvestment and urban flight for more than 5 decades, they now experience renewed interest amidst the complexities of rampant urbanization. Gentrification and displacement are some of the critical consequences of urban re-development, which warrants the exploration of the success metrics that turn disinvested communities into thriving ones. Methodologically, archetype analysis is employed to examine 73 case studies reported by the United States Department of Housing & Urban Development (HUD) as examples of successful development. The case studies span 37 US states and 67 cities. The analysis utilizes the Distressed Communities Index (DCI) as a supporting metric and offers an intermediate level of abstraction between a case-by-case analysis of successful development strategies and a generalized approach that assumes that one strategy fits all. Instead, the analysis identifies four distinct types of successful community development archetypes based on five relevant characteristics that emerged from our analysis: (1) public investments, (2) private investment (3) development plans, (4) stakeholder engagement, and (5) the DCI. The four identified archetypes represent unique Community Development Success pathways with specific development characteristics. Understanding the diversity reflected in these distinct archetypes is crucial for policymakers and stakeholders seeking to address the specific needs and challenges of each development success type. This can inform more targeted policy initiatives for fostering prosperity and vitality in diverse communities across the US and beyond. [ABSTRACT FROM AUTHOR]

The once antiquated transperineal prostate biopsy has experienced a recent resurgence in popularity based on the many studies demonstrating its low infection risk and preserved diagnostic accuracy when compared to transrectal prostate biopsy. Increased demand for this procedure has placed extra strain on a decreasing supply of urologists in the United States. This has provided an opportunity for advanced practice providers to improve patient access to an important step in the prostate cancer diagnostic pathway. This article aims to demonstrate that an appropriately trained advanced practice provider can successfully perform a transperineal biopsy with local anesthesia and provide a training framework that can be customized and adapted into a variety of practice settings. [ABSTRACT FROM AUTHOR]

Objectives We investigated whether the self-system belief of fear of abandonment mediated the effects of intervention-induced change in 2 protective factors—positive parenting and adaptive coping—and one risk factor—stressful events—on youth mental health problems and maladaptive grief. This study extends prior research on fear of abandonment in youth who experience parental death by examining pathways through which a program reduced fear of abandonment and, in turn, affected subsequent pathways to child mental health problems in the context of a randomized experiment. Methods This is a secondary data analysis study. We used data from the 4-wave longitudinal 2-arm parallel randomized controlled trial of the Family Bereavement Program conducted between 1996 and 1999 in a large city in the Southwestern United States. The sample consisted of 244 offspring between 8 and 16 at the pretest. They were assessed again at posttest, 11-month follow-up, and 6-year follow-up. Offspring, caregivers, and teachers provided data. Results Mediation analyses indicated that intervention-induced reductions in stressful events were prospectively associated with a lower fear of abandonment. For girls, fear of abandonment was related to self-reported maladaptive grief and teacher-reported internalizing problems 6 years later. Conclusions This study extends prior research on the relation between intervention-induced changes in risk and protective factors and improvements in outcomes of bereaved youth. The findings support the reduction of stressful events as a key proximal target of prevention programs for bereaved children. [ABSTRACT FROM AUTHOR]

Rapid advancements in the field of immunotherapy have significantly improved cancer treatments. Specifically, an individualized cell-based modality which involves the removal of some of the patient's own white blood cells, including T cells, has revolutionized research in this field. This study focuses on the recent advances and current challenges of Chimeric Antigen Receptor- T (CAR-T) cell therapy and its regulations in the United States (US) and European Union (EU). Understanding the regulatory regimes of CAR-T cell therapy is critical for researchers and manufacturers as they navigate the hurdles of bringing CAR-T cell therapy to the global market. Benefits of CAR-T cell therapy include high response rates and the potential of long-term remissions in some haematological malignancies. However, the drawbacks are still evident including high costs, adverse reactions, and limited efficacy to solid tumours. CAR-T cell therapy is rapidly advancing, with 1231 clinical trials launched globally according to www.clinicalTrial.gov. The future of CAR-T cell therapy holds enormous promise but improving its safety, effectiveness, and availability are still barriers to its successful implementation. [ABSTRACT FROM AUTHOR]

Human papillomavirus (HPV) is a common infection believed to cause 70% of oropharyngeal cancers, with incidence rising globally. Nurses play a critical role in providing care and education to patients with HPV-induced oropharyngeal squamous cell carcinoma (OPSCC). The etiology, diagnosis, and treatment of HPV-induced OPSCC are addressed. [ABSTRACT FROM AUTHOR]

Introduction: Characteristics of patients in clinical trials may differ from those of real‐world patients. Our objective was to describe biomarker testing and outcomes among patients with advanced non‐small cell lung cancer (aNSCLC) in a real‐world setting. Methods: This retrospective cohort study included patients ≥18 years old, diagnosed with stage IIIB/C or IV NSCLC, and in the TEMPUS oncology dataset from January 1, 2012, to December 31, 2020. Patient characteristics associated with biomarker testing were evaluated in patients with positive biomarkers using univariate logistic regression models. Cox proportional hazard models were used to estimate median survival. Results: Of 9540 patients included, 41.7% had biomarker testing, and 2158 had a positive biomarker result. Men (vs women; odds ratio [OR], 0.82; 95% CI: 0.74–0.91), Black patients (vs White; OR, 0.83; 95% CI: 0.72–0.97), patients with squamous (OR, 0.22; 95% CI: 0.19–0.25) or unknown histology (OR, 0.53; 95% CI: 0.45–0.61) (vs non‐squamous histology), and patients with an Eastern Cooperative Oncology Group performance status (ECOG PS) of 2+ (OR, 0.69; 95% CI: 0.57–0.84) or missing (OR, 0.56; 95% CI: 0.48–0.66) (vs ECOG PS of 0) were less likely to undergo biomarker testing. Patients with positive biomarkers who received NCCN‐recommended treatment options (55.7%) had significantly longer median overall survival (OS) (hazard ratio [HR], 0.84; 95% CI: 0.75–0.95) and real‐world progression‐free survival (rwPFS) (HR, 0.68; 95% CI: 0.62–0.75). Conclusion: More than 50% of patients were untested for biomarkers. Patients who were less likely to be tested included men, Black patients, current smokers, patients with squamous aNSCLC, and patients with an ECOG PS of 2+. Patients with positive biomarkers who received NCCN‐recommended treatment options had significantly longer OS and PFS. [ABSTRACT FROM AUTHOR]

Background: Approximately 1 in 10 patients with a surgically treated open fracture will develop a surgical site infection. The Aqueous-PREP trial will investigate the effect of 10% povidone-iodine versus 4% chlorhexidine in aqueous antiseptic solutions in reducing infections after open fracture surgery. The study protocol was published in April 2020.Methods and Design: The Aqueous-PREP trial is a pragmatic, multicenter, open-label, randomized multiple period cluster crossover trial. Each participating cluster is randomly assigned in a 1:1 ratio to provide 1 of the 2 study interventions on all eligible patients during a study period. The intervention periods are 2 months in length. After completing a 2-month period, the participating cluster crosses over to the alternative intervention. We plan to enroll a minimum of 1540 patients at 14 sites.Results: The primary outcome is surgical site infection guided by the Centers for Disease Control and Prevention's National Healthcare Safety Network reporting criteria (2017). All participants' surgical site infection surveillance period will end 30 days after definitive fracture management surgery for superficial infections and 90 days after definitive fracture management surgery for deep incisional or organ/space infections [1]. The secondary outcome is an unplanned fracture-related reoperation within 12 months of the fracture.Conclusion: This manuscript serves as the formal statistical analysis plan (version 1.0) for the Aqueous-PREP trial. The statistical analysis plan was completed on February 28, 2022. [ABSTRACT FROM AUTHOR]

Food hubs have emerged as innovative alternatives to the conventional United States food system. As aggregators of small local farms, food hubs hold the potential to transform food production, distribution, and consumption, while fostering environmental sustainability and social equity. However, assessing their contributions to environmental sustainability and social equity is challenging due to the diverse structures and practices of U.S. food hubs. This study presents the findings of a national survey of food hub managers conducted in 2022 to assess the sustainability objectives and practices of food hubs across the United States. Our survey questions were designed based on a comprehensive framework of social and environmental sustainability criteria. Our results reveal that food hubs make valuable contributions in supporting small producers and providing healthy local food options. However, there is room for improvement in their environmental sustainability practices, as they only meet 47% of the defined environmental sustainability goals. Addressing food insecurity is a high priority for food hubs, although not their top priority, and many offer fresh food access to low-income households. Food hubs also contribute to environmental sustainability by reducing food transportation, promoting healthy food production methods, and minimizing waste. While food hubs meet 67% of the defined social sustainability goals, there are opportunities for improvement in reaching important institutional stakeholders and enhancing consumer education on healthy nutrition and lifestyles. Expanding technical assistance for farmers is also critical. By addressing these opportunities for improvement, food hubs can drive progress towards a more resilient and equitable food system in the United States. [ABSTRACT FROM AUTHOR]

PhenomenonMoral distress, which occurs when someone's moral integrity is seriously compromised because they feel unable to act in accordance with their core values and obligations, is an increasingly important concern for physicians. Due in part to limited understanding of the root causes of moral distress, little is known about which approaches are most beneficial for mitigating physicians' distress. Our objective was to describe system-level factors in United States (U.S.) healthcare that contribute to moral distress among pediatric hospitalist attendings and pediatric residents. ApproachIn this qualitative study, we conducted one-on-one semi-structured interviews with pediatric hospitalist attendings and pediatric residents from 4 university-affiliated, freestanding children's hospitals in the U.S. between August 2019 and February 2020. Data were coded with an iteratively developed codebook, categorized into themes, and then synthesized. FindingsWe interviewed 22 hospitalists and 18 residents. Participants described in detail how the culture of medicine created a context that cultivated moral distress. Norms of medical education and the practice of medicine created conflicts between residents' strong sense of professional responsibility to serve the best interests of their patients and the expectations of a hierarchical system of decision-making. The corporatization of the U.S. healthcare system created administrative and financial pressures that conflicted with the moral responsibility felt by both residents and hospitalists to provide the care that their patients and families needed. InsightsThese findings highlight the critical role of systemic sources of moral distress. These findings suggest that system-level interventions must supplement existing interventions that target individual health care providers. Preventing and managing moral distress will require a broad approach that addresses systemic drivers, such as the corporatization of medicine, which are entrenched in the culture of medicine. [ABSTRACT FROM AUTHOR]

As adolescent overweight has become a widespread problem in the developed world, it is timely to understand commonalities underlying dietary practices across countries. This study examines whether consumption of fruits and vegetables and fatty foods among adolescents in different countries is related to the same individual difference and social influence factors--in particular, adolescents' self-control, diet concerns and perceptions of typical (un)healthy eating peers (prototypes). We included 511 normal weight and overweight adolescents (14-19 years) from the United States, the Netherlands and Hungary, who completed a survey during class hours. After controlling for country and demographics, an additional 8% of the variance in the consumption of fatty foods was explained by self-control, diet concerns and prototypes of unhealthy eaters. Only 3% of fruit and vegetable consumption was explained by these factors, and only the association with self-control was significant. This study demonstrates that the same individual difference and social influence factors may influence adolescents' dietary practices in different countries. In addition to highlighting country differences in dietary practices and the prevalence of overweight, exploring common factors that may shape dietary practices across countries is important for future research. These commonalities may advance conceptual understanding and inform prevention across developed countries.

Understanding and promoting physical activity is critical to combat the growing obesity epidemic in the U.S. This study was designed to compare two 10-week physical activity programs among college students. One hundred and thirty-six undergraduate college students participated in this randomized posttest only control group study. Seventy-seven participants were randomized to one of two programs and 59 participants served as a control group. Both treatment groups completed a physical activity log every weekday for 10 weeks. The point group, however, was given a point sheet, which provided point values for different types of physical activity (based roughly on caloric expenditure). Participants also recorded the type of physical activity (lifestyle, leisure, or exercise physical activity). At the end of 10 weeks, all participants responded to a general health survey. There were differences in physical activity points between the two treatments. An independent t-test revealed that the point group had higher lifestyle physical activity points than the traditional log group (p less than 0.05). The point group also had higher mean overall points, although this difference was not statistically significant. However, there were no meaningful differences on the post-health survey among the control and treatment groups. A multiple regression analysis revealed that BMI was predicted by gender, perceived healthy weight, and total leisure physical activity points. Physical education interventions that educate about caloric expenditure and promote physical activity may be important for combating obesity. (Contains 2 tables.)

The United States is experiencing an obesity epidemic: A science-technology-society public health issue tied to our built environment, which is characterized by heavy dependence on automobiles and reduced opportunities to walk and bicycle for transportation. This presents an informal science education opportunity within "science in personal and social perspectives" to use pedometer technology for enhancing students' understandings about human energy balance. An exploratory study was conducted with 29 teachers to investigate how pedometers could be used for providing academic enrichment to secondary students participating in after-school Health Sciences and Technology Academy clubs. Frequency analysis revealed that the pedometer activities often investigated kilocalorie expenditure and/or incorporated hypothesis testing/experimenting. Teachers' perspectives on learning outcomes most frequently conveyed that students increased their awareness of the importance of health habits relative to kilocalorie intake and expenditure. Pedometers have considerable merit for the regular science curriculum as they allow for numerous mathematics applications and inquiry learning and target concepts such as energy and equilibrium that cut across the "National Science Education Standards." Pedometers and associated resources on human energy balance are important tools that science teachers can employ in helping schools respond to the national call to prevent childhood obesity.

The United States food system is comprised of a diversity of stakeholders representing a range of sectors including agriculture, health, hospitality, and other sectors of the economy. Coordinating these wide-ranging aspects of the food system is a challenging responsibility of the United States Department of Agriculture (USDA) and its counterparts at the state and county level. While the USDA acknowledges the institutional importance of diversity, it has only recently begun to meaningfully consider the agricultural needs of urban environments, the unique experiences from communities of color, and opportunities for urban agriculture in its purview. This study provides a framework for food systems leaders, specifically in food policy councils (FPCs) in large urban communities, to assess the visibility and effectiveness of their diversity and inclusion initiatives represented across three key domains: (1) leadership and governance structures, (2) key stakeholder engagement strategies, and (3) advance food justice. A cluster analysis of the study results for FPCs in 19 U.S. cities and metropolitan areas across these three domains revealed four distinct groups of food policy councils. Results from the assessment of the urban FPCs reveal that they succeed in embedding diversity and inclusion in all three diversity measures, with key stakeholder engagement receiving the highest score at 73%. On average, FPCs received a score of 54% when assessing diversity and inclusion in their leadership and governance and a score of 49% in their activities to advance food justice. Results of the analysis also highlights opportunities to improve individual, thematic, and cumulative scores. Participation from food systems leadership groups such as food policy councils will be vital in advocating for equitable food systems through urban producer and consumer programs in the upcoming reauthorization of the U.S. farm bill in 2024. [ABSTRACT FROM AUTHOR]

Introduction: Gene therapy clinical trials measure steady‐state clotting factor expression levels (FELs) to evaluate the modulation of the bleeding phenotype, aiming to offer consistent protection against breakthrough bleeding events. The link between FELs and bleeding risk in people with haemophilia B (PwHB) is not well understood. Aim: We evaluated the association between FEL and ABR in PwHB. Methods: This cross‐sectional study extended the CHESS burden of illness studies in Europe and the United States. Recruitment of additional adult males with haemophilia B supplemented the existing CHESS sample size of PwHB and FELs. PwHB receiving prophylaxis were excluded, as fluctuating FELs may have confounded the analysis. Demographic and clinical characteristics were reported descriptively. Any recorded baseline FEL was reported by the haemophilia‐treating physicians according to the medical records. Generalised linear models with log link explored the association between changes in FEL and ABR. Results: The study included 407 PwHB and no inhibitors receiving on‐demand treatment. Mean age was 36.7 years; 56% from the EU, 44% from the United States. Mean baseline FEL was 9.95 IU/dl (SD, 10.47); mean ABR was 2.4 bleeds/year (SD, 2.64). After adjusting for covariates, the model showed that for every 1% increase in FEL the average ABR decreased by.08 (p <.001). Predicted number of bleeding events according to FEL showed a significant non‐linear relationship between FEL and ABR (p <.05). Conclusion: This analysis showed a significant relationship between FEL and ABR, where increases in FEL were associated with decreases in ABR among men with HB in Europe and the US. [ABSTRACT FROM AUTHOR]

Introduction: Treatment decisions in older adults with acute myeloid leukemia (AML) are challenging, particularly for those who are not candidates for intensive chemotherapy (IC), and the trade-offs patients, their families and physicians consider when choosing a treatment option are not well understood. This qualitative research explored the value of extending survival and the treatment decision-making process from a multi-stakeholder perspective. Methods: Overall, 28 patients with AML (≥ 65 years old, unsuitable for IC), 25 of their relatives and 10 independent physicians from the US, UK and Canada took part in one-on-one, 60-minute qualitative interviews. Results: Across all stakeholders, improved health-related quality of life (HRQoL), extended survival and relief of AML symptoms were recognized as most important in AML treatment decision-making. However, extending survival in 'good health' was more important than extending survival alone, particularly because of the extra time it gives patients and their relatives together, and allows patients to achieve important goals. Patients' limited understanding of available treatment options, paired with incorrect perceptions of treatment side effects, impacted their involvement in the treatment decision-making process. Patients and physicians perceived physicians to have the most influence in the decision-making process despite their priorities not always aligning. Conclusion: These findings illustrate the importance of having structured discussions which explicitly assess patients' goals and their understanding and expectations of treatments and also the need for patient friendly resources about the lived experience of AML and available treatment options. These measures will help to ensure that patients are fully involved in the shared decision-making process. [ABSTRACT FROM AUTHOR]

Different seafood supply chain pathways contribute to or conversely detract from the resilience and adaptive capacity of the fishing sector. Direct seafood marketing strategies shorten the link between seafood harvesters and consumers. These strategies appear to be relatively resistant to systemic food system disruptions, making them a potentially important segment of a resilient food system providing benefits to consumers and harvesters. However, little is known about the scale and diversity of the direct seafood marketing sector in the United States. This paper outlines the advantages of collecting data on direct seafood marketing in the US. Additionally, we describe our methodology for creating a sampling frame of direct seafood marketers. We provide initial results from the first national assessment of direct seafood marketing practices, including results from a questionnaire distributed to 39,511 commercial seafood harvesters engaging in wild capture fisheries. Direct seafood marketing was a common strategy among respondents, and the most popular strategy involved selling to a source-identified distributor, i.e. intermediaries who identify the harvester at the point of sale. When combined with data on direct seafood marketing permits, it is estimated that 12% of US seafood harvesters engage in direct seafood sales. These findings suggest that direct marketing is a ubiquitous practice in the commercial fishing sector in the US. Understanding scale and diversity of direct seafood marketing in the US can provide information needed for targeted investments in policies, funding, and technical assistance programs that build diverse, resilient seafood supply chains, and benefit the fishing sector and food security of the nation. [ABSTRACT FROM AUTHOR]

Background: Accurate symptom monitoring is vital when managing pediatric asthma, providing an opportunity to improve control and relieve associated burden. The CHILDHOOD ASTHMA CONTROL TEST (C-ACT) has been validated for asthma control assessment in children; however, there are concerns that response option images used in the C-ACT are not culturally universal and could be misinterpreted. This cross-sectional, qualitative study developed and evaluated alternative response option images using interviews with children with asthma aged 4–11 years (and their parents/caregivers) in the United States, Spain, Poland, and Argentina. Interviews were conducted in two stages (with expert input) to evaluate the appropriateness, understanding and qualitative equivalence of the alternative images (both on paper and electronically). This included comparing the new images with the original C-ACT response scale, to provide context for equivalence results. Results: Alternative response option images included scale A (simple faces), scale B (circles of decreasing size), and scale C (squares of decreasing quantity). In Stage 1, most children logically ranked images using scales A, B and C (66.7%, 79.0% and 70.6%, respectively). However, some children ranked the images in scales B (26.7%) and C (58.3%) in reverse order. Slightly more children could interpret the images within the context of their asthma in scale B (68.4%) than A (55.6%) and C (47.5%). Based on Stage 1 results, experts recommended scales A (with slight modifications) and B be investigated further. In Stage 2, similar proportions of children logically ranked the images used in modified scales A (69.7%) and B (75.7%). However, a majority of children ranked the images in scale B in the reverse order (60.0%). Slightly more children were able to interpret the images in the context of their asthma using scale B (57.6%) than modified scale A (48.5%). Children and parents/caregivers preferred modified scale A over scale B (78.8% and 90.9%, respectively). Compared with the original C-ACT, most children selected the same response option on items using both scales, supporting equivalency. Following review of Stage 2 results, all five experts agreed modified scale A was the optimal response scale. Conclusions: This study developed alternative response option images for use in the C-ACT and provides qualitative evidence of the equivalency of these response options to the originals. Plain English summary: Accurate monitoring of the symptoms associated with pediatric asthma is important when managing the condition. The CHILDHOOD ASTHMA CONTROL TEST (C-ACT) is a questionnaire widely used to measure asthma severity in young children (aged 4–11 years). Each question answered by the child in the C-ACT has four possible answer choices. To help children answer, each choice is presented alongside an image of a male child's face ranging from sad to happy. However, there are concerns that the images used are not culturally universal and could be misinterpreted—due to difficulties translating to electronic formats and a lack of differentiation between the images used. Through interviewing children with asthma, we aimed to address these concerns by developing and testing new images. Alternative image options developed included simpler faces, circles of decreasing size and squares of decreasing quantity. Children aged 4–11 years old were interviewed to test whether they understood the response scale using the new images and if they answered in the same way as with the original images. Interviews were conducted in two stages, with expert guidance at key stages. Results showed that children can interpret and understand the newly developed images and that they answer the questions the same as they would using the original images. These new images have the advantages of being culturally neutral and easier to implement on an electronic device. [ABSTRACT FROM AUTHOR]

States have increasingly adopted cottage food laws across the United States. The laws allow small‐scale food entrepreneurs to produce nonrefrigerated foods in home kitchens and sell them via direct‐to‐consumer outlets. Research has not yet established if the policies are, as intended, supporting start‐up food manufacturing businesses nationally. We estimate a differences‐in‐differences model using state‐level panel data to evaluate whether the passage of cottage food laws impacted the number of manufactured baked good establishments. We find a positive impact on the number of both employer and nonemployer businesses, with a relatively greater proportional impact for nonemployer businesses. [ABSTRACT FROM AUTHOR]

Introduction: Gene therapy has shown promise in clinical trials for patients with haemophilia, but patient preference studies have focused on factor replacement treatments. Aim: We conducted a discrete choice experiment (DCE) to investigate the relative importance and differential preferences patients provide for gene therapy attributes. Methods: We surveyed male adults with haemophilia in the United States recruited from patient panels including the National Hemophilia Foundation Community Voices in Research platform using an online survey over 4 months in 2020/21. Participants indicated preferences for gene therapy attributes including dosing frequency/durability, effect on annual bleeding, uncertainty related to side effects, impact on daily activities, impact on mental health, and post‐treatment requirements. The relative importance of each attribute was analysed overall and for subgroups based on haemophilia type and severity. Results: A total of 183 males with haemophilia A (n = 120) or B (n = 63) were included. Half (47%) had severe haemophilia; most (75%) were White. Overall, participants gave effect on bleeding rate the greatest relative importance (31%), followed by dose frequency/durability (26%), uncertainty regarding safety issues (17%), and impact on daily activities (11%). Dose frequency/durability had the greatest importance for those with haemophilia B (35%). Conclusion: People with haemophilia prioritised reduced bleeding and treatment burden; the former was more important in haemophilia A and the latter in haemophilia B, followed by safety and impact on daily life in this DCE of gene therapy attributes. These findings and differences can inform clinical and health policy decisions to improve health equity for people with haemophilia. [ABSTRACT FROM AUTHOR]

Depression in the postpartum period impacts approximately 13–26% of the general population. This number can be much higher for rural veteran women who face additional barriers to accessing specialized mental health services due to isolation and cultural factors. This study reports on a program evaluation of MomMoodBooster, a coach-supported internet-delivered CBT program for the treatment of maternal depression in veteran women. Repeated measures ANOVA, run with this sample of 326 women, demonstrated an overall positive effect size across outcome measures and engagement with no differences found between rural women and their urban counterparts. Some differences between urban and rural participants were found in total and average time spent with coaches as well as ratings of coach helpfulness, possibly indicating some cultural differences between coaches and rural women that need to be addressed. These results and the results of earlier trials suggest that MomMoodBooster can be a valid and efficacious option for reaching under-served veteran populations with specialized postpartum mental health support and is as effective with rural women as with urban women [ABSTRACT FROM AUTHOR]

There is a growing interest in the utility of complementary health approaches (CHAs) to promote wellness and health in the United States. Research from medical, allied health, and mental health fields reflect this expanding interest; however, very little research focuses on counselors and the integration of CHAs within practice or referral of counseling clients to Complementary Health Practitioners (CHPs). The current study expanded this research using transcendental phenomenology to explore the experiences, perspectives, and processes in use by current independently licensed professional counselors referring to complementary health practitioners (CHPs). The authors discuss and explore implications of these findings. [ABSTRACT FROM AUTHOR]

Background: Hemophilia B is a rare congenital bleeding disorder that has a significant negative impact on patients' functionality and health-related quality of life. The standard of care for severe hemophilia B in the United States is prophylactic factor IX replacement therapy, which incurs substantial costs for this lifelong condition. Accurate estimates of the burden of hemophilia B are important for population health management and policy decisions, but have only recently accounted for current management strategies. The 'Cost of Severe Hemophilia across the US: a Socioeconomic Survey' (CHESS US) is a cross-sectional database of medical record abstractions and physician-reported information, completed by hematologists and care providers. CHESS US+ is a complementary database of completed questionnaires from patients with hemophilia. Together, CHESS US and CHESS US+ provide contemporary, comprehensive information on the burden of severe hemophilia from the provider and patient perspectives. We used the CHESS US and CHESS US+ data to analyze the clinical, humanistic, and economic burden of hemophilia B for patients treated with factor IX prophylaxis between 2017 and 2019 in the US.Results: We conducted analysis to assess clinical burden and direct medical costs from 44 patient records in CHESS US, and of direct non-medical costs, indirect costs, and humanistic burden (using the EQ-5D-5L) from 57 patients in CHESS US+. The mean annual bleed rate was 1.73 (standard deviation, 1.39); approximately 9% of patients experienced a bleed-related hospitalization during the 12-month study period. Nearly all patients (85%) reported chronic pain, and the mean EQ-5D-5L utility value was 0.76 (0.24). The mean annual direct medical cost was $614,886, driven by factor IX treatment (mean annual cost, $611,971). Subgroup analyses showed mean annual costs of $397,491 and $788,491 for standard and extended half-life factor IX treatment, respectively. The mean annual non-medical direct costs and indirect costs of hemophilia B were $2,371 and $6,931.Conclusions: This analysis of patient records and patient-reported outcomes from CHESS US and CHESS US+ provides updated information on the considerable clinical, humanistic, and economic burden of hemophilia B in the US. Substantial unmet needs remain to improve patient care with sustainable population health strategies. [ABSTRACT FROM AUTHOR]

Introduction: People with inherited and long‐term conditions such as haemophilia have been shown to adapt to their levels of disability, often reporting better quality of life (QoL) than expected from the general population (the disability paradox). Aim: To investigate the disability paradox in people with haemophilia in the United States by examining preference differences in health state valuations versus the general population. Methods: We conducted a discrete choice experiment including duration to capture valuations of health states based on patient‐reported preferences. Participants indicated their preferences for hypothetical health states using the EQ‐5D‐5L, where each participant completed 15 of the 120 choice tasks. Response inconsistencies were evaluated with dominated and repeated scenarios. Conditional‐logit regressions with random sampling of the general population responses were used to match the sample of patients with haemophilia. We compared model estimates and derived preferences associated with EQ‐5D‐5L health states. Results: After removing respondents with response inconsistencies, 1327/2138 (62%) participants remained (177/283 haemophilia; 1150/1900 general population). Patients with haemophilia indicated higher preference value for 99% of EQ‐5D‐5L health states compared to the general population (when matched on age and gender). The mean health state valuation difference of 0.17 indicated a meaningful difference compared to a minimal clinically important difference threshold of 0.07. Results were consistent by haemophilia type and severity. Conclusion: Our findings indicated the presence of a disability paradox among patients with haemophilia, who reported higher health states than the general population, suggesting the impact of haemophilia may be underestimated if general population value sets are used. [ABSTRACT FROM AUTHOR]

Background: Standard chemotherapy remains inadequate in metastatic pancreatic adenocarcinoma. Combining an agonistic CD40 monoclonal antibody with chemotherapy induces T-cell-dependent tumour regression in mice and improves survival. In this study, we aimed to evaluate the safety of combining APX005M (sotigalimab) with gemcitabine plus nab-paclitaxel, with and without nivolumab, in patients with pancreatic adenocarcinoma to establish the recommended phase 2 dose.Methods: This non-randomised, open-label, multicentre, four-cohort, phase 1b study was done at seven academic hospitals in the USA. Eligible patients were adults aged 18 years and older with untreated metastatic pancreatic adenocarcinoma, Eastern Cooperative Oncology Group performance status score of 0-1, and measurable disease by Response Evaluation Criteria in Solid Tumors version 1.1. All patients were treated with 1000 mg/m2 intravenous gemcitabine and 125 mg/m2 intravenous nab-paclitaxel. Patients received 0·1 mg/kg intravenous APX005M in cohorts B1 and C1 and 0·3 mg/kg in cohorts B2 and C2. In cohorts C1 and C2, patients also received 240 mg intravenous nivolumab. Primary endpoints comprised incidence of adverse events in all patients who received at least one dose of any study drug, incidence of dose-limiting toxicities (DLTs) in all patients who had a DLT or received at least two doses of gemcitabine plus nab-paclitaxel and one dose of APX005M during cycle 1, and establishing the recommended phase 2 dose of intravenous APX005M. Objective response rate in the DLT-evaluable population was a key secondary endpoint. This trial (PRINCE, PICI0002) is registered with ClinicalTrials.gov, NCT03214250 and is ongoing.Findings: Between Aug 22, 2017, and July 10, 2018, of 42 patients screened, 30 patients were enrolled and received at least one dose of any study drug; 24 were DLT-evaluable with median follow-up 17·8 months (IQR 16·0-19·4; cohort B1 22·0 months [21·4-22·7], cohort B2 18·2 months [17·0-18·9], cohort C1 17·9 months [14·3-19·7], cohort C2 15·9 months [12·7-16·1]). Two DLTs, both febrile neutropenia, were observed, occurring in one patient each for cohorts B2 (grade 3) and C1 (grade 4). The most common grade 3-4 treatment-related adverse events were lymphocyte count decreased (20 [67%]; five in B1, seven in B2, four in C1, four in C2), anaemia (11 [37%]; two in B1, four in B2, four in C1, one in C2), and neutrophil count decreased (nine [30%]; three in B1, three in B2, one in C1, two in C2). 14 (47%) of 30 patients (four each in B1, B2, C1; two in C2) had a treatment-related serious adverse event. The most common serious adverse event was pyrexia (six [20%] of 30; one in B2, three in C1, two in C2). There were two chemotherapy-related deaths due to adverse events: one sepsis in B1 and one septic shock in C1. The recommended phase 2 dose of APX005M was 0·3 mg/kg. Responses were observed in 14 (58%) of 24 DLT-evaluable patients (four each in B1, C1, C2; two in B2).Interpretation: APX005M and gemcitabine plus nab-paclitaxel, with or without nivolumab, is tolerable in metastatic pancreatic adenocarcinoma and shows clinical activity. If confirmed in later phase trials, this treatment regimen could replace chemotherapy-only standard of care in this population.Funding: Parker Institute for Cancer Immunotherapy, Cancer Research Institute, and Bristol Myers Squibb. [ABSTRACT FROM AUTHOR]

Congenital athymia is an ultra-rare pediatric condition characterized by the lack of thymus in utero and the naïve T cells critical for infection defense and immune regulation. Patients with congenital athymia receive supportive care to minimize and treat infections, autoimmune phenomena, and autologous graft-versus-host disease (aGVHD) manifestations, but historically, die within the first 3 years of life with supportive care only. We estimated the healthcare resource utilization and economic burden of supportive care over patients' first 3 years of life in the United States. A medical chart audit by the treating physician was used to collect patient data from birth to age 3 on clinical manifestations associated with congenital athymia (clinical manifestations due to underlying syndromic conditions excluded). Using costs and charges from publicly available sources, the total economic burden of direct medical costs and charges for the first 3 years of life (considered "lifetime" for patients receiving supportive care) and differences in economic burden between patients with higher and lower inpatient hospitalization durations were estimated. All patients (n = 10) experienced frequent infections and aGVHD manifestations; 40% experienced ≥1 episode of sepsis, and 20% had recurrent sepsis episodes annually. The estimated mean 3-year economic burden per patient was US$5,534,121 (2020 US dollars). The annual mean inpatient hospitalization duration was 150.6 days. Inpatient room charges accounted for 79% of the economic burden, reflecting the high costs of specialized care settings required to prevent infection, including isolation. Patients with high inpatient utilization (n = 5; annual mean inpatient hospitalization duration, 289.6 days) had an estimated 3-year economic burden of US$9,926,229. The total economic burden may not be adequately represented due to underestimation of some direct costs or overestimation of others. Current treatment of patients with congenital athymia (supportive care) presents a high economic burden to the healthcare system. [ABSTRACT FROM AUTHOR]

Hemophilia B (HB) is a rare congenital disorder characterized by bleeding-related complications which are managed by prophylactic or post-bleeding event ("on-demand") replacement of clotting factor IX (FIX). The standard of care for severe HB is life-long prophylaxis with standard half-life (SHL) or extended half-life (EHL) products given every 2–3 or 7–14 days, respectively. FIX treatment costs in the US have been investigated, but the lifetime costs of HB treatment have not been well characterized, particularly related to the impact of joint health deterioration and associated health resource utilization. We developed a decision-analytic model to explore outcomes, costs and underlying cost drivers associated with FIX treatment options over the lifetime of an adult with severe or moderately severe HB. With participation from clinicians, health technology assessment specialists and patient advocates, a Markov model was constructed to estimate bleeding events and costs associated with health states including "bleed into joint", "bleed not into joint", "no bleed" and "death". Sub-models of joint health were based on 0, 1, or ≥2 areas of chronic joint damage. US third-party payer and societal perspectives were considered with a lifetime horizon; sensitivity analyses tested the robustness of primary findings. Total adult lifetime costs per patient with severe and moderately severe HB were $21,086,607 for SHL FIX prophylaxis, $22,987,483 for EHL FIX prophylaxis, and $20,971,826 for on-demand FIX treatment. For FIX prophylaxis, the cost of FIX treatment accounts for >90% of the total HB treatment costs. This decision analytic model demonstrated significant economic burden associated with the current HB treatment paradigm. [ABSTRACT FROM AUTHOR]

National-level empirical research can inform how policy can effectively support direct seafood markets. The US Department of Agriculture maintains a directory of farmers markets that has not been extensively used in direct seafood marketing research. I use this directory data to estimate the probability that farmers markets near commercial fishing ports in the United States offer seafood. The results provide insight into two policy-relevant constraints on direct marketing: (1) geographic limits to seafood sales at farmers markets and (2) accessibility challenges for low-income populations. I find that seafood sales at farmers markets are concentrated within 50 miles of commercial fishing ports and that lower-income people are less likely to have access to seafood at farmers markets. I discuss advances made in collecting data from direct marketing farmers and the potential value in collecting analogous data from direct marketing fishers. [ABSTRACT FROM AUTHOR]

We estimate the effect of population density on the use of local food market channels in the United States. Farms with greater market size increase direct sales to consumers, but the spatial scale of this effect operates at shorter distances than previously considered. Local farms do not use distributors to increase production for sales at shorter distances. Our results suggest that technical assistance to increase local food products sold by proximate retail outlets would be more effectively deployed assisting farms that undertake sales directly to retailers instead of marketing products through distributors. [ABSTRACT FROM AUTHOR]

The article examines the necessity for a U.S. federal legislation that regulates the use of familial deoxyribonucleic acid (DNA) searching in criminal investigations in light of the Golden State Killer case investigation in California. Topics discussed include the controversy over the use of a DNA data bank in the identification of suspect Joseph DeAngelo, developments in the use of DNA analysis in police investigation, and the Fourth Amendment jurisprudence on search and seizure.

Objectives: The United States Department of Veterans Affairs offers numerous technology-delivered interventions to self-manage mental health problems. It is unknown, however, what barriers older military veterans face to using these technologies and how willing they would be to use technologies for mental health concerns.Methods: Seventy-seven veterans (Mage = 69.16 years; SD = 7.10) completed interviews in a concurrent mixed methods study. Interviewers asked about technology ownership and described four modalities of delivering self-management interventions: printed materials, DVDs, Internet, and mobile apps. Interviewers obtained feedback about each modality's benefits, barriers, and facilitators. Participants ranked their self-management modalities preferences alone and compared with counseling. Multivariable adjusted logistic regression and qualitative analyses were conducted to investigate the reasons contributing to preferences.Results: Most reported owning a computer (84.4%), having home Internet (80.5%), and a smartphone (70.1%). Participants preferred printed materials (35.1%) over mobile apps (28.6%), Internet (24.7%), and DVDs (13.0%). Lower computer proficiency was associated with preferring DVDs; higher proficiency was associated with Internet and mobile interventions. Residing in an urban area was associated with mobile apps. When counseling was an option, 66% identified this as their first preference. Qualitative findings showed veterans' desire for information, training, and provider support with technology.Conclusions: Older veterans reported high technology ownership rates but varied preferences for self-management interventions. Notably, two-thirds preferred some form of technology, which points to the importance of ensuring that providers offer existing technology-delivered interventions to older veterans. Veterans' strong preference for counseling emphasizes the need for human support alongside self-management. [ABSTRACT FROM AUTHOR]

The argues on the need to create additional comment to Model Rule of Professional Conduct 3.6 (Rule 3.6), enacted by the American Bar Association (ABA) that limit the types of speech attorneys can make while involved in litigation. Topics covered include how the additional comment will make judges in a better position to determine if an attorney's statement reaches and prejudices a jury and factors for a judge to consider when ruling on a case involving social media statements made by a lawyer.

Introduction: The health impact of the heterozygous (Hb Ss) Sickle Cell Trait (SCT) among the estimated one million females of reproductive age in the United States on pregnancy related hypertensive disorders (PRHD) including preeclampsia is not as well understood or researched as Sickle Cell Disease (SCD).Materials and Methods: This retrospective cohort study included 25,020 U.S. enlisted, active duty service women during 1992 to 2013. Race within the sample is primarily black (84%) given that blacks have the highest prevalence of SCT. All 5,004 SCT positive individuals and a matched sample of 20,016 from those considered SCT negative were followed while on active duty for PRHD outcomes including gestational hypertension (GHTN), preeclampsia and eclampsia.Results: The adjusted incidence rate ratio (IRR) for any PRHD in SCT positive compared to negative individuals was 1.46 (95% CI 1.32 - 1.62). SCT positive versus negative subjects had higher health care utilization rates and utilization rate ratios (URR) for all PRHD diagnoses combined 2.03 (95%CI: 1.97 - 2.10) and for each specific PHRD diagnosis. The prevalence of preeclampsia or eclampsia did not vary by SCT status. The overall PRHD attributable risk due to SCT was 30.4% (95% CI 23.1-37.1%) and the overall number needed to screen to detect a case of PRHD was 156 (95% CI 117-220).Conclusions: The results of this study indicate that being SCT positive is a risk factor for PRHD and provides evidence that SCT status may have an adverse effect on reproductive health. Future research needs to include other known risk factors for PRHD to include gravity and parity history, BMI, past history of PRHD prior to enlistment as well as to examine the association with maternal/child pregnancy outcomes. [ABSTRACT FROM AUTHOR]

Researchers are increasingly using data from the Nasdaq market to examine pricing behavior, market design, and other microstructure phenomena. The validity of any study that classifies trades as buys or sells depends on the accuracy of the classification method. Using a Nasdaq proprietary data set that identifies trade direction, we examine the validity of several trade classification algorithms. We find that the quote rule, the tick rule, and the Lee and Ready (1991) rule correctly classify 76.4%, 77.66%, and 81.05% of the trades, respectively. However, all classification rules have only a very limited success in classifying trades executed inside the quotes, introducing a bias in the accuracy of classifying large trades, trades during high volume periods, and ECN trades. We also find that extant algorithms do a mediocre job when used for calculating effective spreads. For Nasdaq trades, we propose a new and simple classification algorithm that improves over extant algorithms. [ABSTRACT FROM AUTHOR]

This analysis uses new questions in the Current Population Survey Annual Social and Economic Supplement to examine rates of offer and take-up of employer-sponsored health insurance over early 2014 and early 2015, as well as reasons reported for why individuals did not enroll. We find increases in offer and eligible rates of 0.5 and 0.9 percentage points, respectively, and a decrease in the take-up rate of 1.5 percentage points, while the coverage rate remained stable. We further find an increase in the proportion of workers covered by another plan and decreases in the proportions eligible for coverage but having a preexisting condition, employed as contract or temporary employees not allowed in the plan, and who have not yet worked for an employer long enough. [ABSTRACT FROM AUTHOR]

Introduction: Removal of symptomatic implants is a common procedure performed by orthopaedic trauma surgeons. No guidance is available regarding which factors contribute to the likelihood of an implant becoming symptomatic. Our objective was to determine whether radiographic parameters associated with distal interlocks in retrograde femoral nails are associated with the rate of symptomatic screw removal.Patients and Methods: We conducted a retrospective review at a Level I trauma center. Study patients (n=442) had femoral fractures treated with retrograde intramedullary nails from 2007 to 2014 and at least 1year of follow-up. The main outcome measurement was symptomatic distal screw removal as predicted by radiographic parameters.Results: Symptomatic screw removal occurred in 12% of the patients. Increased distance between the most distal screw and the articular surface of the femur significantly reduced likelihood of symptomatic screw removal. A cutoff of 40mm from the articular block was predictive of removal (≥40mm, 0% removal; <40mm, 18% removal, p<0.0001). In patients with distal screws placed within 40mm of the articular surface of the femur, a ratio of screw length to distance between medial and lateral femoral cortices that was ≥1 was a strong predictor of symptomatic screw removal (area under Receiver Operating Characteristic curve, 0.75; p<0.0001).Conclusions: More distal screws and screws that radiographically extend to or beyond the medial cortex are more likely to cause pain and require removal in femoral fractures treated with retrograde intramedullary nails. We identified a specific distance from the joint (<40mm) and a ratio of screw length to bone width (≥1) that significantly increased the likelihood of symptomatic screw removal. Clinicians can use these data to inform patients of the likely risk of implant removal and perhaps to better guide placement and length of screws when the clinical scenario allows some flexibility in location and length of screws. [ABSTRACT FROM AUTHOR]

The article offers information on a recent report from the National Academies of Sciences, Engineering, and Medicine (NASEM) on dietary sodium intake adds overwhelming weight to the already strong imperative to reduce the amount of sodium in the U.S. food supply; and mentions the report gives due consideration to the evidence presented in arguments against reducing sodium intake and concludes that there is no harm associated with such dietary changes.

In this article we present the results of a needs assessment evaluating the employment-based needs of individuals with intellectual and developmental disabilities (IDD), from the perspectives of self-advocates, their families and care givers, and IDD service providers in a primarily rural state. Participants were recruited through statewide distribution of a questionnaire about key issues and barriers to employment. A total of 467 adults participated. Employment was identified as a top concern across the groups. An inductive thematic analysis approach was used to analyze the qualitative comments provided by respondents about their employment needs. The results were generally consistent with prior research among Americans with IDD, in that employer expectations, transportation barriers, disability benefits, limited opportunities to develop employment skills, and broader economic factors influencing the community were identified as key issues. However, the results demonstrate the magnified impact of these barriers in rural areas, particularly rural areas facing economic challenges. The results of this needs assessment are discussed in terms of the broad national implications, and in terms of the local process of engaging multiple stakeholder groups to identify potential solutions. [ABSTRACT FROM AUTHOR]

The 2015 Farm to School Census reports that during the 2013–2014 school year there were over 5200 farm to school (FTS) programs in the USA that involved 39,000 schools and 24.1 million children. These FTS programs are intended, in part, to increase market access and therefore the viability of farms and ranches. Accordingly, the majority of FTS programs involve local food procurement directly from farmers, from non-traditional suppliers that market locally branded food products such as 'food hubs', or from traditional suppliers such distributors and food service management companies. Yet, there is reason to believe that transaction costs vary based on the supply chain that schools use to procure local food. Moreover, that the supply chain that schools use to procure local food has a relationship with school's expenditures on local food. We use the 2015 Farm to School Census to estimate the relationship between school district's local food expenditures per student and supply chain structure. We analyzed data using ordinary least squares regressions, controlling for the region of the USA, the type of local food products purchased, and other school-specific characteristics. Importantly, we find a negative and significant relationship between school district's non-milk local food expenditure per student, and purchases directly from the farm and from non-traditional suppliers. This implies that schools that purchase local food from traditional distributors are likely to have higher on average expenditures per student compared with schools that purchase local food directly from farmers or non-traditional distributors. Results point to the need for additional research in determining the efficacy of policies to support direct and non-traditional FTS marketing arrangements. [ABSTRACT FROM AUTHOR]

This article describes how two research teams recruited participants using a mobile application for pregnant women. In both studies, a study description appeared on the home screen of a pregnancy application. Interested women were directed to a secure research website to enroll. Enrollment goals were rapidly exceeded. Both studies enrolled participants from across the USA. Demographic diversity was achieved by one study. Mobile health applications are innovative venues for recruiting research participants. [ABSTRACT FROM AUTHOR]

Most research on health insurance in the United States uses the Current Population Survey Annual Social and Economic Supplement. However, a recent redesign of the health insurance questions disrupted the historical time trend in 2013. Using data from the American Community Survey, which has a parallel trend in the uninsured rate, we model a bridge estimate of the uninsured rate using the traditional questions. Also, we estimate the effect of changing the questionnaire. We show that the impact of redesigning the survey varies substantially by subgroup. This approach can be used to produce bridge estimates when other questionnaires are redesigned. [ABSTRACT FROM AUTHOR]

This qualitative literature review aimed to describe the totality of peer-reviewed scientific evidence from 1990 to 2017 concerning validity of self-reported mammography. This review included articles about mammography containing the words accuracy, validity, specificity, sensitivity, reliability or reproducibility; titles containing self-report, recall or patient reports, and breast or 'mammo'; and references of identified citations focusing on evaluation of 2-year self-reports. Of 45 publications meeting the eligibility criteria, 2 conducted in 1993 and 1995 at health maintenance organisations in Western USA which primarily served highly educated whites provided support for self-reports of mammography over 2 years. Methodological concerns about validity of selfreports included (1) telescoping, (2) biased overestimates particularly among black women, (3) failure to distinguish screening and diagnostic mammography, and (4) failure to address episodic versus consistent mammography use. The current totality of evidence supports the need for research to reconsider the validity of self-reported mammography data as well as the feasibility of alternative surveillance data sources to achieve the goals of the Healthy People Initiative. [ABSTRACT FROM AUTHOR]

This article investigates several issues related to tax-exempt financing. The author examines the effectiveness of one of the first major tax-exempt financed programs in the U.S., the Federal Farm Land Bank system, to answer various questions about tax-exempt financing. The authors explores whether this type of financing is better suited for particular sectors, if it can be structured to help the intended sector without imposing burdens on others and if it makes financial sense to control the capital markets for a specific special interest.

This article investigates whether differences in information-based trading can explain observed differences in spreads for active and infrequently traded stocks. Using a new empirical technique, we estimate the risk of information-based trading for a sample of New York Stock Exchange (NYSE) listed stocks. We use the information in trade data to determine how frequently new information occurs, the composition of trading when it does, and the depth of the market for different volume-decile stocks. Our most important empirical result is that the probability of information-based trading is lower for high volume stocks. Using regressions, we provide evidence of the economic importance of information-based trading on spreads. [ABSTRACT FROM AUTHOR]

Purchased order flow refers to the practice of dealers or trading locales paying brokers for retail order flow. It is alleged that such agreements are used to "cream skim" uninformed liquidity trades, leaving the information-based trades to established markets. We develop a test of this hypothesis, using a model of the stochastic process of trades. We then estimate the model for a sample of stocks known to be used in order purchase agreements that trade on the New York Stock Exchange (NYSE) and the Cincinnati Stock Exchange. Our main empirical result is that there is a significant difference in the information content of orders executed in New York and Cincinnati, and that this difference is consistent with cream-skimming. [ABSTRACT FROM AUTHOR]

This paper investigates the effect on bank equity values of the Comptroller of the Currency's announcement that some banks were "too big to fail" and that for those banks total deposit insurance would be provided. Using an event study methodology, we find positive wealth effects accruing to TBTF banks, with corresponding negative effects accruing to non-included banks. We demonstrate that the magnitude of these effects differed with bank solvency and size. We also show that the policy to which the market reacted was that suggested by the Wall Street Journal and not that actually intended by the Comptroller. [ABSTRACT FROM AUTHOR]

Aims: Economists debate whether changes in availability of alcohol or cannabis are positively or negatively related to changes in use of the other substance. Implicit in these arguments are two competing, individual-level hypotheses-that people use alcohol and cannabis either as complements or substitutes for one another. This is the first study to test these hypotheses using micro-longitudinal data on individuals' alcohol and cannabis use on a given evening.Methods: United States college students who use alcohol and cannabis (n=876) were selected from a larger sample who participated in a 30-day online daily diary study. At baseline, students reported their proclivity to use alcohol/drugs to cope with stress. Each day students reported their level of alcohol use from the prior evening as well as whether they had used cannabis.Results: Evening levels of alcohol use and mean levels of alcohol use positively predicted the likelihood of evening cannabis use, results indicative of complementary use. This relation, however, was moderated by coping style, such that students who were more likely to use alcohol/drugs to cope were less likely to use cannabis as their evening or mean alcohol use levels increased, results indicative of substitution.Conclusions: Substance-using college students showed evidence for complementary alcohol and cannabis use at both the within- and between-person levels. Students with a proclivity toward using alcohol/drugs to cope, however, showed evidence of substitution. These findings suggest that studies based on economic theories of substance use should take into account individual differences in substance use motives. [ABSTRACT FROM AUTHOR]