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PMTCT programs serve women continuing and initiating ART in pregnancy, and follow-up schedules align to delivery rather than ART initiation, making conventional HIV retention measures (assessed from ART initiation) challenging to apply. We evaluated three measures of peripartum non-retention in Kenyan women living with HIV from pregnancy to 2-years postpartum.This longitudinal analysis used programmatic data from the Mobile WAChX trial (NCT02400671). Outcomes included loss to follow-up (LTFU) (no visit for ≥6 months), incomplete visit coverage (80% of 3-month intervals with a visit), and late visits2 weeks after scheduled date). Predictors of non-retention were determined using Cox proportional hazards, log-binomial, and generalized estimating equation models.Among 813 women enrolled at a median of 24 weeks gestation, incidence of LTFU was 13.6/100 person-years; cumulative incidence of LTFU by 6, 12 and 24 months postpartum was 14.0%, 18.4% and 22.5%, respectively. Overall, 35.5% of women had incomplete visit coverage. Among 794 women with 12,437 scheduled visits, a median of 11.1% of visits per woman were late (IQR 4.3%-23.5%). Younger age, unsuppressed viral load, unemployment, ART initiation in pregnancy, and non-disclosure were associated with non-retention by all measures. Partner involvement was associated with better visit coverage and timely attendance. Women who became LTFU had higher frequency of previous late visits (16.7% vs. 7.7%, p0.0001).Late visit attendance may be a sentinel indicator of LTFU. Identified cofactors of PMTCT programmatic retention may differ depending on retention measure assessed, highlighting need for standardized measures.

Introduction Although the U.S. Food and Drug Administration (FDA) banned characterizing flavors in cigarettes in 2009, this initial ban exempted menthol. After examining numerous reports on the adverse health effects of menthol cigarettes, the FDA proposed a menthol ban in April 2022. This study analyzed Twitter data to describe public reaction to this announcement. Aims and Methods Posts containing the word “menthol” and/or “#menthol” were collected from April 21, 2022 to May 5, 2022 from Twitter’s Streaming Application Programming Interface (API). A random sampling procedure supplied 1041 tweets for analysis. Following an inductive approach to content analysis, posts were classified into one or more of 11 themes. Results Posts discussed the FDA announcement (n = 153, 14.7%), racial discrimination (n = 101, 9.7%), distrust in government (n = 67, 6.4%), inconsistencies between policies (n = 52, 5.0%), public health benefits (n = 42, 4%), freedom of choice (n = 22, 2.1%), and health equity (n = 21, 2.0%). Posts contained misinformation (n = 20, 1.9%), and discussed the potential for illicit markets (n = 18, 1.7%) and the need for cessation support (n = 4, 0.4%). 541 (52.0%) tweets did not fit into any of the prescribed themes. Conclusions Twitter posts with the word “menthol” commonly discussed distrust in government and mentioned racial discrimination. Findings demonstrated the possibility of near real-time Twitter monitoring of public opinion on a menthol ban. These data may be valuable for designing tobacco control health communication campaigns in the future. Implications The U.S. FDA proposed a ban on menthol cigarettes in April 2022. This study’s content analyzed Twitter posts over a 2-week period to understand the public’s response to the proposed menthol ban. Twitter posts with the word “menthol” often discussed distrust in government and mentioned racial discrimination. Findings demonstrated the possibility of near real-time Twitter monitoring of public opinion of regulatory action. Findings underscore the need to educate the public about the potential health benefits of banning menthol from cigarettes, particularly for populations that experience tobacco-related health disparities.

IntroductionLocal e-cigarette sales restrictions (ESRs) may impact e-cigarette use. This study examined the associations between living in localities with various ESR policies and changes in e-cigarette use among young adults in Los Angeles (LA) County, California, USA.MethodsData were from a cohort of LA County young adults (18–21 years; n=2100) who completed two waves of surveys (Fall 2018–Summer 2019 and Summer–Fall 2020). Local flavoured (n=9) and comprehensive (n=2) ESRs in LA County implemented between June 2019 and May 2020 were identified, coded and merged with the baseline data. Multivariable logistic regressions were used to examine the associations between living in ESR localities and e-cigarette use at follow-up, controlling for covariates and stratified by cigarette smoking at baseline.ResultsOverall, 20.9% and 14.3% of participants lived in localities with flavoured and comprehensive ESRs, respectively. Participants who were non-Hispanic, had higher socioeconomic statuses and were currently using e-cigarettes were generally more likely to live in ESR localities than their counterparts. The associations between living in ESR localities and e-cigarette use at follow-up were not found among baseline non-e-cigarette users regardless of their cigarette smoking status; a positive relationship was found among baseline e-cigarette users who also smoked cigarettes but not among non-smokers.DiscussionParticipants who lived in localities with various ESR policies were different in their baseline e-cigarette use and socioeconomic backgrounds. Future research examining the potential impact of ESRs on e-cigarette use change should consider the localities’ overall sociodemographic and tobacco-using characteristics and individuals’ cigarette smoking histories.

BACKGROUND: The packaging and marketing of nicotine gums, lozenges, and pouches can influence users’ perceptions about which products are evidence-based for tobacco cessation and which are designed for nicotine maintenance—which could keep people nicotine dependent. Lucy, a company that produces flavored nicotine gums, lozenges, and pouches, could cause confusion by mimicking the packaging of traditional chewing gum and using similar marketing for its approved smoking cessation products and non-approved products. METHODS: This commentary describes Lucy’s marketing practices that could prolong nicotine dependence rather than aid cessation. RESULTS: Lucy’s marketing as “FDA approved for smoking cessation” (true for the lozenges but not the gum or pouches) and “PMTA [Premarket Tobacco Product Application] accepted” could create a false narrative of regulatory acceptance. Its scientific conference presentations could imply that it is endorsed by the scientific community. Its colorful pack design, emphasizing flavors and minimizing nicotine warnings, may attract youth and non-nicotine-users to initiate nicotine use. CONCLUSION: Lucy’s promotion of its products as safe alternatives to other forms of tobacco, its packaging that recalls innocuous chewing gum, and its use of social media to advertise its products should be explored by researchers and considered by policymakers for potential population-level health effects.

PURPOSE: Ethnic disparities in childhood cancer survivor (CCS) mental health have been identified, although prior survivorship research has focused predominantly on non-Hispanic/Latinx (H/L) white survivors. METHODS: This study examined the association of acculturation with depressive symptoms and wellbeing among 582 young adult H/L CCS recruited to a population-based study of CCS in Southern California. RESULTS: In multivariable regression models adjusted for covariates, greater identification with both the Hispanic and Anglo cultures was positively associated with wellbeing (p = 0.007 and p

The aim of this study was to understand predictors of adverse pregnancy outcomes (APOs) among women on antiretroviral treatment (ART).A longitudinal cohort.Participants from the Mobile WAChX trial were evaluated for APOs, including stillbirth (fetal death at ≥20 weeks' gestation), preterm birth (PTB, livebirth at37 weeks' gestation,) and neonatal death (NND, ≤28 days after live birth). Predictors were determined by univariable and multivariable Cox proportional hazards and log-binomial models.Among 774 women included, median age was 27 years and 29.0% had unsuppressed HIV viral load (1000 copies/ml) at enrollment. Half (55.1%) started ART prepregnancy, 89.1% on tenofovir-based regimens. Women with depression had a higher risk of stillbirth (adjusted hazard ratio [aHR] 2.93, 95% confidence interval (95% CI) 1.04-8.23), and women with lower social support score had higher risk of late stillbirth (aHR 11.74, 2.47-55.86). Among 740 livebirths, 201 (27.2%) were preterm and 22 (3.0%) experienced NND. PTB was associated with unsuppressed maternal viral load (adjusted prevalence ratio [aPR] 1.28, 95% CI 1.02-1.61), intimate partner violence (IPV) in pregnancy (aPR 1.94, 95% CI 1.28-2.94), and history of any sexually transmitted infection (STI) (aPR 1.63, 95% CI 1.06-2.51). NND was associated with PTB (aPR 2.53, 95% CI 1.10-5.78) and STI history (aPR 4.25, 95% CI 1.39-13.06). Most associations retained significance in the subgroup of women with viral suppression.Maternal viremia during pregnancy predicted PTB as did IPV, lower education, and STI history, while psychosocial stressors predicted stillbirth. Implementing mental health services, ART adherence, partner support, and routine STI screening and treatment could reduce APOs among women with HIV in sub-Saharan Africa settings.

Youth of immigrant origin vary across their families’ migration history (e.g., country of heritage, reasons for migration, etc.) and in the communities in which they reside. As such, these youth are often faced with different cultural and immigrant stressors. Although prior research documented the detrimental impact of cultural and immigrant stressors, variable-centered approaches fail to account for the fact that these stressors often co-occur. Addressing this gap, the current study identified typologies of cultural stressors in Hispanic/Latino adolescents using latent profile analysis. Cultural stress profiles were derived using socio-political stress, language brokering, in-group identity threats, and within-group discrimination as indicators. The study was conducted in two sites (Los Angeles and Miami; total N = 306) during Spring and Summer 2020. A four-profile solution was identified: Low Cultural Stress (n = 94, 30.7%), Sociopolitical and Language Brokering Stress (n = 147, 48%), Sociopolitical and In-group Identity Threat Stress (n = 48, 15.7%), and Higher Stress (n = 17, 5.6%). Results indicate that profiles with stress were characterized by worse mental health symptoms, reporting higher means of depression, stress, and lower self-esteem, as well as by higher heritage cultural orientation compared to the low stress profile. Interventions designed to mitigate the deleterious effects of cultural stressors would benefit from adopting an individualized, tailored approach that addresses youth’s stress profile membership.

Background Mistrust in science and scientists may adversely influence the rate of COVID-19 vaccination and undermine public health initiatives to reduce virus transmission. Methods Students, staff and faculty responded to an email invitation to complete an electronic survey. Surveys included 21-items from the Trust in Science and Scientists Inventory questionnaire. Responses were coded so higher scores indicated a higher trust in science and scientists, A linear regression model including sex, age group, division, race and ethnicity, political affiliation, and history of COVID-19, was used to determine variables significantly associated with trust in science and scientists scores at the p Results Participants were mostly female (62.1%), Asian (34.7%) and White (39.5%) and students (70.6%). More than half identified their political affiliation as Democrat (65%). In the final regression model, all races and ethnicities had significantly lower mean trust in science and scientists scores than White participants [Black ($$B$$= -0.42, 95% CI: -0.55, -0.43, p $$B$$= -0.20, 95% CI: -0.24, -0.17, p $$B$$= -0.22, 95% CI: -0.27, -0.18, p $$B$$= -0.19, 95% CI: -0.26, -0.11, p $$B$$ =-0.49, 95% CI: -0.55, -0.43, p $$B$$ =-0.29, 95% CI: -0.33, -0.25, p $$B$$ =-0.19, 95% CI: -0.25, -0.12, p $$B$$= -0.10, 95% CI: -0.15, -0.06, p Conclusion Despite the setting of a major research University, trust in science is highly variable. This study identifies characteristics that could be used to target and curate educational campaigns and university policies to address the COVID19 and future pandemics.

Background Human papillomavirus (HPV) vaccine hesitancy is a growing concern in the United States, yet understudied among racial/ethnic minority parents. We conducted qualitative research to understand parental HPV vaccine hesitancy and inform community-specific, multilevel approaches to improve HPV vaccination among diverse populations in Los Angeles. Methods We recruited American Indian/Alaska Native (AI/AN), Hispanic/Latino/a (HL) and Chinese parents of unvaccinated children (9–17 years) from low-HPV vaccine uptake regions in Los Angeles for virtual focus groups (FGs). FGs were conducted in English (2), Mandarin (1), and Spanish (1) between June-August 2021. One English FG was with AI/AN-identifying parents. FGs prompted discussions about vaccine knowledge, sources of information/hesitancy, logistical barriers and interpersonal, healthcare and community interactions regarding HPV vaccination. Guided by the social-ecological model, we identified multilevel emergent themes related to HPV vaccination. Results Parents (n = 20) in all FGs reported exposure to HPV vaccine information from the internet and other sources, including in-language media (Mandarin) and health care providers (Spanish). All FGs expressed confusion around the vaccine and had encountered HPV vaccine misinformation. FGs experienced challenges navigating relationships with children, providers, and friends/family for HPV vaccine decision-making. At the community-level, historical events contributed to mistrust (e.g., forced community displacement [AI/AN]). At the societal-level, transportation, and work schedules (Spanish, AI/AN) were barriers to vaccination. Medical mistrust contributed to HPV vaccine hesitancy across the analysis levels. Conclusion Our findings highlight the importance of multilevel influences on parental HPV vaccine hesitancy and decision-making and the need for community-specific messaging to combat medical mistrust and other barriers to HPV vaccination among racial/ethnic minority communities.

Rationale Specific cannabis products may differentially increase risk of initiating non-cannabis illicit drug use during adolescence. Objective To determine whether ever- and poly-use of smoked, vaporized, edible, concentrate, or blunt cannabis products are associated with subsequent initiation of non-cannabis illicit drug use. Methods High school students from Los Angeles completed in-classroom surveys. The analytic sample (N = 2163; 53.9% female; 43.5% Hispanic/Latino; baseline M age = 17.1 years) included students who reported never using illicit drugs at baseline (spring, 11th grade) and provided data at follow-up (fall and spring, 12th grade). Logistic regression models assessed associations between use of smoked, vaporized, edible, concentrate, and blunt cannabis at baseline (yes/no for each product) and any non-cannabis illicit drug use initiation—including cocaine, methamphetamine, psychedelics, ecstasy, heroin, prescription opioids, or benzodiazepines—at follow-up. Results Among those who never used non-cannabis illicit drugs at baseline, ever cannabis use varied by cannabis product (smoked = 25.8%, edible = 17.5%, vaporized = 8.4%, concentrates = 3.9%, and blunts = 18.2%) and patterns of use (single product use = 8.2% and poly-product use = 21.8%). After adjustment for baseline covariates, odds of illicit drug use at follow-up were largest for baseline ever users of concentrates (aOR [95% CI] = 5.74[3.16–10.43]), followed by vaporized (aOR [95% CI] = 3.11 [2.41–4.01]), edibles (aOR [95% CI] = 3.43 [2.32–5.08]), blunts (aOR [95% CI] = 2.66[1.60–4.41]), and smoked (aOR [95% CI] = 2.57 [1.64–4.02]) cannabis. Ever use of a single product (aOR [95% CI] = 2.34 [1.26–4.34]) or 2 + products (aOR [95% CI] = 3.82 [2.73–5.35]) were also associated with greater odds of illicit drug initiation. Conclusions For each of five different cannabis products, cannabis use was associated with greater odds of subsequent illicit drug use initiation, especially for cannabis concentrate and poly-product use.

To determine the contribution of specific contraceptive side effects to method switch and modern-method discontinuation among Kenyan women.A prospective cohort study.Five counties in Western Kenya.Women aged ≥18 years old and emancipated female minors ≥14 years old using modern, reversible contraception were recruited while attending 10 public health facilities.Patient-reported adverse effect symptoms, method switch and discontinuation were reported through weekly text message-based surveys for 24 weeks.Prevalence, hazards ratio (HR).Among 825 women, 44% were using implants, 43% injectables, 7% an intrauterine device and 6% oral contraceptive pills at enrolment. Most (61%) women were continuing a method used in the previous month. During the 24-week follow up, incidence of contraceptive switch was 61.3 per 100 person-years (95% confidence interval [CI] 52.4-71.8) and incidence of discontinuation was 38.5 per 100 person-years (95% CI 31.6-47.0). On average, one-quarter (prevalence [Pr] 0.24, 95% CI 0.22-0.26) of participants reported side effects or method problems weekly, with sexual side effects the most prevalent symptom (Pr 0.15, 95% CI 0.13-0.16). Lack of expected bleeding was associated with higher risk of method switch (adjusted hazard ratio [aHR] 2.36, 95% CI 1.22-4.57). Risk of all-modern method discontinuation was higher among women experiencing irregular bleeding (aHR 2.39, 95% CI 1.20-4.77), weight changes (aHR 2.72, 95% CI 1.47-4.68) and sexual side effects (aHR 2.42, 95% CI 1.40-4.20).Addressing irregular bleeding, weight changes and sexual side effects through development of new products that minimise these specific side effects and anticipatory counseling may reduce method-related discontinuation.Bleeding, weight changes, sexual problems associated with discontinuation of #contraception, but many continue despite side effects.

The present article proposes an extension of the concept of adverse childhood experiences (ACEs) to apply to crisis migration – where youth and families are fleeing armed conflicts, natural disasters, community violence, government repression, and other large-scale emergencies. We propose that adverse events occurring prior to, during, and following migration can be classified as crisis-migration-related ACEs, and that the developmental logic underlying ACEs can be extended to the new class of crisis-migration-related ACEs. Specifically, greater numbers, severity, and chronicity of crisis-migration-related ACEs would be expected to predict greater impairments in mental and physical health, poorer interpersonal relationships, and less job stability later on. We propose a research agenda centered around definitional clarity, rigorous measurement development, prospective longitudinal studies to establish predictive validity, and collaborations among researchers, practitioners, and policymakers.

OBJECTIVE Acculturation discrepancy occurs when the rate of host culture acquisition and/or heritage culture retention between non-native parents and their children diverges. The resulting conflict may exacerbate mental health conditions in already vulnerable populations. The present study examined discrepancies between Hispanic and Anglo-American acculturation, as two separate constructs, and mental health symptomology in Hispanic childhood cancer survivors (HCCS) and their parents. METHODS Participants were 68 matched parent-child dyads (HCCS (Mage = 19.4 (2.77) years., 50.0% female); and parent (Mage = 46.3 (6.07) years., 89.7% female)). Study variables were HCCS posttraumatic-growth (PTG) and quality-of-life (PedsQL); parent posttraumatic stress (PTSD); and parent/HCCS depressive symptoms (CESD) and acculturation orientations. Discrepancy was calculated as the dyadic difference between like acculturation measures. RESULTS After controlling for covariates, Hispanic acculturation discrepancy and HCCS psychosocial health (a subset of PedsQL) was negatively correlated (r = -0.26, p

Background: Psychosocial sequelae are common for individuals with physical injuries to the upper extremity. However, psychosocially oriented interventions are not common in this occupational therapy practice area. Purpose: This study implemented an online survey of hand therapy patients’ psychological symptoms. Second, it explored patients’ interest in one psychosocially oriented intervention: mindfulness meditation. Methods: The design was a cross-sectional survey of 120 consecutively recruited hand therapy patients. Survey measures included functioning, psychosocial factors, and trait mindfulness. Findings: Anxiety was prevalent in this sample, and moderately correlated with trait mindfulness (r = −0.542, p < .001). While most participants (77%) indicated mindfulness meditation would be an acceptable intervention, women were 2.8 times as likely to be interested ( p = .044). Implications: Psychosocially oriented interventions are indicated in hand therapy based on the prevalence of these symptoms. Further examination of using mindfulness meditation in hand therapy is warranted due to patient interest.

Background Most research and health education efforts to address the opioid crisis have focused on white populations. However, opioid use, opioid use disorder, and opioid overdose deaths also have increased among Hispanics. Methods This study conducted four focus groups in a Hispanic community in Southern California ( N = 45) to assess opioid-related knowledge, perceptions, and preventive behaviors among Hispanic residents. Focus group questions assessed medication storage, disposal, and sharing; opioid-related knowledge; how to recognize a drug problem; perceptions of the extent of the opioid use problem in the community; and sources of help for drug problems. Results Qualitative analysis revealed that most participants were aware of the potential dangers of opioids and the importance of keeping them out of the reach of children. However, participants reported stockpiling, sharing, and borrowing prescription medications for financial reasons. They perceived marijuana use as a larger problem in the community than opioids. They were familiar with the behavioral indicators of opioid addiction, but they were unaware of the availability of naloxone to reverse overdoses. They were ambivalent about searching for information about opioids and treatment options because they lacked self-efficacy to find accurate information on the internet. Conclusions Findings identify some knowledge gaps about opioids among Hispanics and suggest opportunities for culturally accessible health education to provide Hispanics with information about opioid use disorder, overdose reversal, and treatment options.

Depression among pregnant women living with HIV (WLWH) in sub-Saharan Africa leads to poor pregnancy and HIV outcomes. This cross-sectional analysis utilized enrollment data from a randomized trial (Mobile WAChX, NCT02400671) in 6 Kenyan public maternal and child health clinics. Depressive symptoms were assessed with the Patient Health Questionnaire-9 (PHQ-9), stigma with the Stigma Scale for Chronic Illness, and intimate partner violence (IPV) with the Abuse Assessment Screen. Correlates of moderate-to-severe depressive symptoms (“depression”, PHQ-9 score ≥10) were assessed using generalized estimating equation models clustered by facility. Among 824 pregnant WLWH, 9% had depression; these women had more recent HIV diagnosis than those without depression (median 0.4 versus 2.0 years since diagnosis, p=0.008). Depression was associated with HIV-related stigma (adjusted Prevalence Ratio [aPR]:2.36, p=0.025), IPV (aPR:2.93, p=0.002), and lower social support score (aPR:0.99, p=0.023). Using population-attributable risk percent to estimate contributors to maternal depression, 81% were attributable to stigma (27%), recent diagnosis (24%), and IPV (20%). Integrating depression screening and treatment in prevention of mother-to-child HIV transmission programs may be beneficial, particularly in women recently diagnosed or reporting stigma and IPV.

Exposure to social media and its content featuring tobacco products is associated with e-cigarette use among adolescents. This study measured the association between frequency of Instagram, TikTok and YouTube use and exposure to tobacco-related content on each of these platforms with e-cigarette ever-use, current (past 30-day) use and initiation among adolescents. A cross-sectional and longitudinal analyses were used based on a self-reported survey conducted online in January - May 2021-2022 among socioeconomically- and racially-diverse Los Angeles, California high school students (N = 2,036). Adolescents had higher odds of e-cigarette ever-use (adjusted odds ratio [AOR] = 2.16; CI: 1.20;3.90) and current (past 30-day) use (AOR = 3.11; CI: 1.64;5.89) if they used TikTok several times per day, compared to adolescents who used TikTok less frequently or not at all. Adolescents also had higher odds of e-cigarette initiation (AOR = 2.97; CI: 1.53;5.77) if they used TikTok daily or several times per day, compared to adolescents who used TikTok less frequently or not at all. Adolescents had higher odds of e-cigarette ever-use (AOR = 2.60; CI: 2.02;3.35) and current use (AOR = 3.11; CI: 1.64;5.89) if they reported seeing tobacco or nicotine posts, including e-cigarettes, on TikTok at least weekly. Frequent use of and frequent exposure to tobacco content on TikTok is associated with increased risk of e-cigarette use and initiation among adolescents. Tobacco-related content on social media popular among youth, especially on TikTok, requires stronger regulation and better enforcement by platforms of their policies restricting tobacco content.

Lack of education and training on caring for patients with substance use disorder (SUD) is common among healthcare providers, often resulting in clinicians feeling unprepared to treat patients with SUD.This study explored resident physicians' experiences with SUD education throughout medical school and residency and qualitatively evaluated whether a SUD initiative improved resident's knowledge and efficacy of treating various SUDs.We implemented a brief (seven hours total) educational initiative focused on treating SUDs virtually over the course of an academic year for residents enrolled in the University of Southern California Internal Medicine Residency program. Semi-structured interviews were conducted with residents after completion of the initiative. A thematic analysis was conducted to identify common themes that emerged from the qualitative data.Every resident noted receiving insufficient training for the treatment of SUDs prior to the initiative. The initiative was viewed favorably, and participants particularly appreciated having an introduction to prescribing medication for the treatment of SUD such as buprenorphine. Despite the perceived success of the initiative in increasing awareness of treatment modalities for SUD, residents expressed a lack of comfort in handling SUD cases and desired additional practical lectures and application of knowledge through increased experiential training.SUD education and training appears to be a useful constituent of resident training and should be included in the standard curriculum and rotations. Residency programs should consider including formal education, hands-on practice, and providing adequate resources for residents to develop their capabilities to care for patients with SUD.

BACKGROUND: Sexual identity is dynamic, and changes in identity (e.g., from heterosexual to lesbian, gay, bisexual, or queer [LGBQ+]) are common during young adulthood. It is not well-understood how sexual identity changes may be associated with substance use risk. METHODS: Two waves of data (baseline: October, 2018–October, 2019; follow-up: May–October, 2020) were used from a prospective cohort of young adults (N = 1896; mean age=21.2). Frequency of past 30-day use and new initiation of five substance use outcomes (alcohol, any tobacco, e-cigarettes, cannabis, illicit drugs) were compared across four groups: consistently heterosexual (N = 1567), consistently LGBQ+ (N = 244), heterosexual to LGBQ+ (N = 65), and LGBQ+ to heterosexual (N = 20). RESULTS: Consistently LGBQ+ (vs. consistently heterosexual) participants reported greater frequency of past 30-day use of alcohol (aOR=1.34, 95% CI=1.04–1.72), any tobacco products (aOR=1.88, CI=1.34–2.63), e-cigarettes (aOR=1.49, CI=1.01–2.19), cannabis (aOR=1.36, CI=1.01–1.84), and illicit drugs (aOR=2.84, CI=1.77–4.56). Heterosexual to LGBQ+ (vs. consistently heterosexual) participants reported greater frequency of past 30-day use of any tobacco products (aOR=1.87, CI=1.06–3.33) and illicit drugs (aOR=2.48, CI=1.10–5.62), and had greater risk of initiating alcohol (aRR=1.82, CI=1.02–3.25) and cannabis use (aRR=2.90, CI=1.81–4.64). LGBQ+ to heterosexual (vs. consistently LGBQ+) participants reported lower frequency of past 30-day use of alcohol (aOR=0.35, CI=0.14–0.88) and any tobacco products (aOR=0.15, CI=0.03–0.80). CONCLUSIONS: Identifying as LGBQ+ was associated with increased risk for frequent substance use, and newly adopting an LGBQ+ identity was associated with increased risk for new substance use initiation. Prevention and treatment interventions may need to tailor messaging to young people who have newly adopted an LGBQ+ identity.

PurposeTo evaluate the association between lifetime personal cigarette smoking and young-onset breast cancer (YOBC; diagnosed

Modern oral nicotine products (ONPs; nontherapeutic nicotine pouches, gums, lozenges, and gummies) may be perceived in ways that could promote uptake in nonvapers, dual use with e-cigarettes, or use to quit vaping. In this cross-sectional digital remote survey of 1,460 respondents aged 21–24 from Southern California, we examined beliefs about ONPs among past-30-day e-cigarette nonusers, users unmotivated to quit vaping, and users motivated to quit vaping. Positive beliefs about ONPs were reported by 31.8% of the overall sample and higher in past-30-day e-cigarette users (with or without quit motivation) than nonusers. Perceiving ONPs to be easy to conceal, convenient, and able to be used where vaping/smoking is not allowed were the most common types of beliefs reported. Among e-cigarette users with quit motivation (n = 142), interest in using ONPs to quit/reduce vaping (44.4%) was higher than interest in using medicinal nicotine gum/lozenges (23.4%), nicotine patch (17.6%), or prescription medications (16.6%). Interest in using ONPs to reduce/quit vaping (vs. no interest) was greater among participants who reported vaping ≥20 (vs.

IntroductionE-cigarette users typically initiate vaping with flavoured e-liquids. People who vape flavours tend to underestimate the harm of vaping. We examined the inter-relationship between flavour preference, vaping for cessation purposes, e-cigarette dependence, e-cigarette harm perception and purchase/use intention, given a hypothetical flavour ban. We hypothesised that non-tobacco flavour preference and vaping for cessation would be negatively associated with harm perception of e-cigarettes and intention to continue vaping if a flavour ban occurred and that these effects would be mediated by e-cigarette dependence.MethodsFrom July 2019 to March 2020, we conducted intercept interviews with 276 customers at 44 vape shops in California. The predictor variables were flavour preference and vaping for cessation. The outcome variables were harm perception of e-cigarettes and intention to purchase/use, given a hypothetical flavour ban. Multilevel structural equation modelling tested whether e-cigarette dependence mediates the effects of flavour preference on hypothetical continued vaping and purchase.ResultsThose who preferred flavours showed significantly lower intention to purchase e-liquids (β=−0.28, pDiscussionFlavour preference was negatively related to intention to continue to vape within a hypothetical flavour ban. Our results also highlight the importance of e-cigarette dependence and use of e-cigarettes as smoking cessation methods. Implications for future flavour bans are discussed.