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BackgroundThe See Me Smoke-Free (SMSF) mobile health (mHealth) app was developed to help women quit smoking by targeting concerns about body weight, body image, and self-efficacy through cognitive behavioral techniques and guided imagery audio files addressing smoking, diet, and physical activity. A feasibility trial found associations between SMSF usage and positive treatment outcomes. This paper reports a detailed exploration of program use among eligible individuals consenting to study participation and completing the baseline survey (participants) and ineligible or nonconsenting app installers (nonparticipants), as well as the relationship between program use and treatment outcomes. ObjectiveThe aim of this study was to determine whether (1) participants were more likely to set quit dates, be current smokers, and report higher levels of smoking at baseline than nonparticipants; (2) participants opened the app and listened to audio files more frequently than nonparticipants; and (3) participants with more app usage had a higher likelihood of self-reported smoking abstinence at follow up. MethodsThe SMSF feasibility trial was a single arm, within-subjects, prospective cohort study with assessments at baseline and 30 and 90 days post enrollment. The SMSF app was deployed on the Google Play Store for download, and basic profile characteristics were obtained for all app installers. Additional variables were assessed for study participants. Participants were prompted to use the app daily during study participation. Crude differences in baseline characteristics between trial participants and nonparticipants were evaluated using t tests (continuous variables) and Fisher exact tests (categorical variables). Exact Poisson tests were used to assess group-level differences in mean usage rates over the full study period using aggregate Google Analytics data on participation and usage. Negative binomial regression models were used to estimate associations of app usage with participant baseline characteristics after adjustment for putative confounders. Associations between app usage and self-reported smoking abstinence were assessed using separate logistic regression models for each outcome measure. ResultsParticipants (n=151) were more likely than nonparticipants (n=96) to report female gender (P

BackgroundInternet and mobile health (mHealth) apps hold promise for expanding the reach of evidence-based health interventions. Research in this area is rapidly expanding. However, these studies may experience problems with recruitment and retention. Web-based and mHealth studies are in need of a wide-reaching and low-cost method of recruitment that will also effectively retain participants for the duration of the study. Online recruitment may be a low-cost and wide-reaching tool in comparison to traditional recruitment methods, although empirical evidence is limited. ObjectiveThis study aims to review the literature on online recruitment for, and retention in, mHealth studies. MethodsWe conducted a review of the literature of studies examining online recruitment methods as a viable means of obtaining mHealth research participants. The data sources used were PubMed, CINAHL, EbscoHost, PyscINFO, and MEDLINE. Studies reporting at least one method of online recruitment were included. A narrative approach enabled the authors to discuss the variability in recruitment results, as well as in recruitment duration and study design. ResultsFrom 550 initial publications, 12 studies were included in this review. The studies reported multiple uses and outcomes for online recruitment methods. Web-based recruitment was the only type of recruitment used in 67% (8/12) of the studies. Online recruitment was used for studies with a variety of health domains: smoking cessation (58%; 7/12) and mental health (17%; 2/12) being the most common. Recruitment duration lasted under a year in 67% (8/12) of the studies, with an average of 5 months spent on recruiting. In those studies that spent over a year (33%; 4/12), an average of 17 months was spent on recruiting. A little less than half (42%; 5/12) of the studies found Facebook ads or newsfeed posts to be an effective method of recruitment, a quarter (25%; 3/12) of the studies found Google ads to be the most effective way to reach participants, and one study showed better outcomes with traditional (eg in-person) methods of recruitment. Only one study recorded retention rates in their results, and half (50%; 6/12) of the studies recorded survey completion rates. ConclusionsAlthough online methods of recruitment may be promising in experimental research, more empirical evidence is needed to make specific recommendations. Several barriers to using online recruitment were identified, including participant retention. These unique challenges of virtual interventions can affect the generalizability and validity of findings from Web-based and mHealth studies. There is a need for additional research to evaluate the effectiveness of online recruitment methods and participant retention in experimental mHealth studies.

ObjectivesDocumentation of children's tobacco smoke exposure (TSE) in the electronic health record (EHR) can have important implications for clinical care. However, it may not be accurate if it is not based on biochemical assessment, the most reliable method of verifying TSE. Our objectives were to compare the accuracy of EHR classification of TSE with cotinine verification and to explore parent and child variables associated with biochemically verified TSE.MethodsParticipants were 171 hospitalized pediatric patients (ages 0-17 years; mean age 5.1 [SD 3.7] years) who had EHR documentation of TSE and measured salivary cotinine. Children with cotinine levels >1 ng/mL were classified as having biochemical verification of TSE. Parents reported sociodemographic characteristics, and children's EHRs were abstracted for TSE status, past medical history, and diagnoses. We conducted χ2 tests to assess the agreement between EHR classification of TSE status and cotinine levels. Then, we assessed the relationship between sociodemographic and clinical variables and cotinine using crude and adjusted logistic regression models.ResultsOverall, 71% (121 of 171) of EHR classifications were correct on the basis of cotinine levels. Specificity analyses showed that 77% (53 of 69) were correctly identified as exposed to tobacco smoke. Sensitivity analyses showed that 67% (68 of 102) were correctly identified as unexposed. The negative predictive value was 0.61 (53 of 87); 39% (34 of 87) were misclassified as unexposed. The positive predictive value was 0.81 (68 of 84); 19% (16 of 84) were misclassified as exposed.ConclusionsAlmost 40% of children were misclassified in the EHR as unexposed to tobacco smoke. Biochemical verification should be used as part of universal TSE screening during pediatric hospitalizations.

Introduction Given the rapid increase in the prevalence of e-cigarette use among youth, we updated Click City: Tobacco, an existing, efficacious, online tobacco prevention program for 5th graders with a 6th-grade booster, to also target e-cigarette use. Methods To evaluate the effectiveness of the updated 5th-grade program within a "real world" setting, we conducted a pragmatic randomized trial with 5th-grade students in 43 schools across Arizona and Oregon, assessing change in intentions and willingness to use e-cigarettes/cigarettes, from baseline to one-week post-intervention. Students in intervention schools (n  = 1327) received the updated version of Click City: Tobacco; students in control schools (n  = 1346) received their usual tobacco prevention curriculum. Results Students in intervention schools significantly decreased their intentions and willingness to use e-cigarettes and cigarettes, compared to students in control schools. The intervention also significantly changed all targeted etiological mechanisms predictive of intentions and willingness. The intervention was more effective for at-risk students, as defined by student's previous tobacco use, current family use of tobacco, and/or high in sensation-seeking. The effects of the intervention on all outcomes were similar as a function of state, gender, ethnicity, and historical timing (before COVID-19 pandemic school closures vs. after schools re-opened). Close to 90% of the students in the intervention condition completed the entire program, supporting fidelity of implementation, and teachers reported satisfaction with the program. Conclusions Findings suggest that Click City: Tobacco is effective for all 5th-grade students and can be delivered with fidelity across school settings. Implications The results of a randomized pragmatic effectiveness trial showed that the updated Click City: Tobacco program decreased intentions and willingness to both vape e-cigarettes and smoke cigarettes among 5th-grade students, particularly for those at high risk. Program effectiveness and lack of differences because of factors such as state, gender, ethnicity, and historical timing have universal implications, suggesting that all students can benefit from this program. Click City: Tobacco received high ratings of program satisfaction from teachers and was implemented with fidelity. Findings suggest that Click City: Tobacco is effective and can be easily implemented in schools. [ABSTRACT FROM AUTHOR]

Introduction: Alcohol consumption, including heavy drinking, is the fourth leading preventable cause of death in the United States. Youth who engage in heavy drinking are likely to experience a number of problems associated with their use. In 2015, U.S. prevalence of heavy drinking was 17% among 12th graders. These data suggest a clear need for conducting alcohol prevention activities among youth. Method: We designed the "Click City®: Alcohol" program for 7th graders, with a booster in 8th grade. We conducted an efficacy trial in 25 schools in three counties in Oregon. Schools were randomized to either the "Click City: Alcohol" (n = 12) or Usual Curriculum condition (n = 13). We present the results of a short-term evaluation, assessing change in outcomes from baseline to 1 week following the intervention among students in "Click City: Alcohol" schools versus those in Usual Curriculum schools. Results: Students who used the "Click City: Alcohol" program significantly decreased their intentions to drink heavily in the future, as compared with students in the Usual Curriculum control condition, although the effect size was small. Changes in the targeted mechanisms were in the expected direction and were significant for all but one mechanism, with moderate effect sizes. Conclusion: Our short-term findings provide preliminary support for the efficacy of the "Click City: Alcohol" program to change adolescents' intentions to engage in heavy drinking. If the results are maintained over time, the program has the potential to prevent the onset of heavy drinking among teens and reduce the negative consequences associated with heavy drinking, including neurological and other health consequences.

Introduction: Increasing digital delivery of smoking cessation interventions has resulted in the need to employ novel strategies for remote biochemical verification. This scoping review and meta-analysis aimed to investigate best practices for remote biochemical verification of smoking status.Methods: The scientific literature was searched for studies that reported remotely obtained (not in-person) biochemical confirmation of smoking status (i.e., combustible tobacco). A meta-analysis of proportions was conducted to investigate key outcomes, which included rates of returned biological samples and the ratio of biochemically verified to self-reported abstinence rates.Results: A total of 82 studies were included. The most common samples were expired air (46%) and saliva (40% of studies), the most common biomarkers were carbon monoxide (48%) and cotinine (44%), and the most common verification methods were video confirmation (37%) and mail-in samples for lab analysis (26%). Mean sample return rates determined by random-effects meta-analysis were 70% for smoking cessation intervention studies without contingency management (CM), 77% for CM studies, and 65% for other studies (e.g., feasibility and secondary analyses). Among smoking cessation intervention studies without CM, self-reported abstinence rates were 21%, biochemically verified abstinence rates were 10%, and 47% of individuals who self-reported abstinence were also biochemically confirmed as abstinent.Conclusions: This scoping review suggests that improvements in sample return rates in remote biochemical verification studies of smoking status are needed. Recommendations for reporting standards are provided that may enhance confidence in the validity of reported abstinence rates in remote studies.Implications: This scoping review and meta-analysis included studies using remote biochemical verification to determine smoking status. Challenges exist regarding implementation and ensuring high sample return rates. Higher self-reported compared to biochemically verified abstinence rates suggest the possibility that participants in remote studies may be misreporting abstinence or not returning samples for other reasons (e.g., participant burden, inconvenience). Remote biochemical confirmation of self-reported smoking abstinence should be included in smoking cessation studies whenever feasible. However, findings should be considered in the context of challenges to sample return rates. Better reporting guidelines for future studies in this area are needed. [ABSTRACT FROM AUTHOR]

Background and Objectives: Despite the current literature on the importance of parental antismoking socialization messages, it is unclear if youths and parents agree on the content and frequency of such messages. This study's purpose is to explore the level of agreement between parents and youths on measures of anti-smoking socialization and to assess whether agreement is associated with parental smoking status and/or parental race/ethnicity. Methods: Data was collected from parent and 9- to 16-year-old youth dyads who presented to the emergency department with a non-urgent complaint. A self-administered questionnaire assessing demographics and five antismoking socialization measures was used. Results: Items that showed statistically significant agreement between parents and youths were frequency of explicit messages about smoking. However, the absolute agreement between the items was poor, at less than 50% for the complete sample. The following items did not show statistically significant agreement between parents and youths: maternal negative reaction to smoking (for all youths); specific rules about smoking and maternal negative reaction to smoking (for youths with parental smokers); and paternal negative reaction to smoking (for youths with parental nonsmokers). When pairs that did not agree were analyzed, we found significant discrepancies in youth-parent agreement by parental smoking status, but not by race/ethnicity. Conclusions: In this study, parents and youths had poor agreement on measures of antismoking socialization. Level of agreement was associated with parental smoking status, but not race/ethnicity. Since antismoking socialization is an important means to decrease youth tobacco initiation and use, future studies are needed to investigate the specific content, frequency, and format of parental antismoking messages that are best received and recalled by youths. (Contains 3 tables and 1 figure.)

The purpose of this study was to evaluate the acceptability of a brief, video-based parental intervention that modeled parent-child communication about tobacco, delivered within an emergency department (ED) setting. While waiting to be seen by a physician in the ED, 20 parent-youth dyads watched the video together and then private, semi-structured focused interviews were conducted around the "take-home" message and views on the settings, actors, and content of the videos. Dyads agreed that the design, delivery, and content of the video intervention were acceptable, realistic, and useful in providing parental reinforcements about the importance of parent-youth tobacco communication, and the ED was considered to be a good setting for watching the video. Findings support the development and delivery of such an ED intervention and aids in determining content and scenarios for future intervention development. (Contains 2 figures.)

A study was conducted to assess the effects of two levels of a dental office-based intervention compared with usual care on patients' tobacco use. Findings indicate that patients receiving telephone counseling quit tobacco use at higher rates, but only a small percentage of those proactively referred actually received counseling.

Objectives. We sought to compare the effectiveness of a dental practitioner advice and brief counseling intervention to quit tobacco use versus usual care for patients in community health centers on tobacco cessation, reduction in tobacco use, number of quit attempts, and change in readiness to quit. Methods. We randomized 14 federally funded community health center dental clinics that serve diverse racial/ethnic groups in 3 states (Mississippi, New York, and Oregon) to the intervention (brief advice and assistance, including nicotine replacement therapy) or usual care group. Results. We enrolled 2549 smokers. Participants in the intervention group reported significantly higher abstinence rates at the 7.5-month follow-up, for both point prevalence ([F.sub.1,12]=6.84; P Conclusions. The results of our study suggest the viability and effectiveness of tobacco cessation services delivered to low-income smokers via their dental health care practitioner in community health centers. Tobacco cessation services delivered in public dental clinics have the potential to improve the health and well-being of millions of Americans. (Am J Public Health. 2010;100:1307-1312. doi: 10.2105/AJPH.2009.181214)