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Age of first exposure to tackle football and head impact kinematics have been used to examine the effect of head impacts on mental health outcomes. These measures coupled with retrospective and cross-sectional designs have contributed to conflicting results. The purpose of this study was to identify the effect of one season of head impact exposure, age of first exposure to football, and psychological need satisfaction on acute mental health outcomes in adolescent football players.This prospective single-season cohort study used sensor-installed mouthguards to collect head impact exposure along with surveys to assess age of first exposure to football, psychological satisfaction, depressive symptoms, anxiety symptoms, and thriving from football players at four high schools (n = 91). Linear regression was used to test the association of head impact exposure, age of first exposure, and psychological satisfaction with acute mental health outcomes.A total of 9,428 impacts were recorded with a mean of 102 ± 113 impacts/player. Cumulative head impact exposure and age of first exposure were not associated with acute mental health outcomes at postseason or change scores from preseason to postseason. Greater psychological satisfaction was associated with fewer depressive symptoms (β = -0.035, SE = 0.008, p =.001), fewer anxiety symptoms (β = -0.021, SE = 0.008, p = .010), and greater thriving scores (β = 0.278, SE = 0.040, p =.001) at postseason.This study does not support the premise that greater single-season head impact exposure or earlier age of first exposure to tackle football is associated with worse acute mental health indicators over the course of a single season in adolescent football players.

2019 Novel coronavirus (COVID-19) vaccination rates in the United States have plateaued in specific populations, including rural areas. To improve COVID-19 vaccination rates and to encourage early vaccine uptake in future pandemics, this study aimed to examine vaccine attributes associated with early adoption. Data are from an anonymous online survey of adults using targeted Facebook pages of rural southern Indiana towns in January and February 2021 (n = 286). The diffusion of innovation theory states that the rate of adoption of a product in a specific population is explained by five perceived attributes: relative advantage, compatibility, observability, complexity and trialability. Binary logistic regression analyses were used to examine the association of Diffusion of Innovation theory attributes of the COVID-19 vaccine on early adoption. Results indicated that trialability [odds ratio (OR) = 3.307; 95% confidence interval (CI) = 1.964–5.571; P

To estimate the associations between high-risk alcohol consumption and (1) severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) seroconversion, (2) self-reported new SARS-CoV-2 infection and (3) symptomatic COVID-19.Prospective cohort study.Indiana University Bloomington (IUB), IN, USA.A total of 1027 IUB undergraduate students (64% female), aged 18 years or older, residing in Monroe County, Indiana, seronegative for SARS-CoV-2 at study baseline.Primary exposure was high-risk alcohol consumption measured with an Alcohol Use Disorders Identification Test (AUDIT) questionnaire score of 8 or more. Primary outcome was SARS-CoV-2 seroconversion since baseline, assessed with two SARS-CoV-2 antibody tests, at baseline (September 2020) and end-line (November 2020). Secondary outcomes were (a) self-reported new SARS-CoV-2 infection at the study end-line and (b) self-reported symptomatic COVID-19 at baseline.Prevalence of high-risk alcohol consumption was 32 %. In models adjusted for demographics, students with high-risk alcohol consumption status had 2.44 [95% confidence interval (CI) = 1.35, 4.25] times the risk of SARS-CoV-2 seroconversion and 1.84 (95% CI = 1.04, 3.28) times the risk of self-reporting a positive SARS-CoV-2 infection, compared with students with no such risk. We did not identify any association between high-risk alcohol consumption and symptomatic COVID-19 (prevalence ratio = 1.17, 95% CI = 0.93, 1.47). Findings from sensitivity analyses corroborated these results and suggested potential for a dose-response relationship.Among American college students, high-risk alcohol consumption appears to be associated with higher risk for severe acute respiratory syndrome coronavirus 2 seroconversion/infection.

Purpose Colleges and universities across the United States are developing and implementing data-driven prevention and containment measures against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Identifying risk factors for SARS-CoV-2 seropositivity could help to direct these efforts. This study aimed to estimate the associations between demographic factors and social behaviors and SARS-CoV-2 seropositivity and self-reported positive SARS-CoV-2 diagnostic test. Methods In September 2020, we randomly sampled Indiana University Bloomington undergraduate students. Participants completed a cross-sectional online survey about demographics, SARS-CoV-2 testing history, relationship status, and risk behaviors. Additionally, during a subsequent appointment, participants were tested for SARS-CoV-2 antibodies using a fingerstick procedure and SARS-CoV-2 IgM/IgG rapid assay kit. We used unadjusted modified Poisson regression models to evaluate the associations between predictors of both SARS-CoV-2 seropositivity and self-reported positive SARS-CoV-2 infection history. Results Overall, 1,076 students were included in the serological testing analysis, and 1,239 students were included in the SARS-CoV-2 infection history analysis. Current seroprevalence of SARS-CoV-2 was 4.6% (95% confidence interval: 3.3%, 5.8%). Prevalence of self-reported SARS-CoV-2 infection history was 10.3% (95% confidence interval: 8.6%, 12.0%). Greek membership, having multiple romantic partners, knowing someone in one's immediate environment with SARS-CoV-2 infection, drinking alcohol more than 1 day a week, and hanging out with more than five people when drinking alcohol increased both the likelihood of seropositivity and SARS-CoV-2 infection history. Conclusion Our findings have implications for American colleges and universities and could be used to inform SARS-CoV-2 prevention and control strategies on such campuses.

BACKGROUND AND OBJECTIVES The objective of this study was to examine head-impact exposure by intensity level and position group, and to test the hypothesis that there would be an increase in cumulative head-impact exposure between drill intensities after controlling for duration in each level with air recording the lowest frequency and magnitude and live recording the highest: air < bags < control < thud < live. METHODS We conducted a prospective, multisite study in 1 season with players from 3 high school football teams (n = 74). Each player wore a sensor-installed mouthguard, which monitored head-impact frequency, peak linear acceleration (PLA), and peak rotational acceleration (PRA). Practice drills and games were categorized by level of contact. RESULTS A total of 7312 impacts were recorded with a median of 67 (interquartile range:128) impacts per player. After controlling for duration, increases in head-impact outcomes by level of contact were observed (air < bags = control < thud = live). Live drills had higher cumulative head-impact frequency (45.4 ± 53.0 hits) and magnitude (PLA: 766.3 ± 932.9 g; PRA: 48.9 ± 61.3 kilorad/s2) per player than other levels (P < .0001). In comparison, air drills had the lowest cumulative frequency (4.2 ± 6.9 hits) and magnitude (PLA: 68.0 ± 121.6 g; PRA: 6.4 ± 13.2 kilorad/s2). CONCLUSIONS These data support the levels-of-contact system as a practical approach to limiting head-impact exposure in tackle football. Our findings are clinically important, because data have begun to suggest the relationship between chronic head-impact exposure and decline in brain health. Since head-impact exposure was influenced by levels of contact, regulation of the duration of certain drill intensities (eg, thud, live) may associate with reduced head-impact exposure in high school football.

Physical activity during adolescence is associated with positive health outcomes, yet only 26% of US middle and high school students report daily physical activity. Moreover, the number of high school students playing a sport is declining, with the largest decline in football. One reason for this decline in playing football may be increased attention to the risk of head injury. For public health, the decline is alarming because football offers a physical activity opportunity for millions of young people every year. In response, efforts have been made to institute measures to enhance the safety of football. The objective of this topical review was to review these measures and the data supporting their effectiveness. We conducted a search of scientific literature supplemented by a web search to identify safety measures. We used the Indiana University library electronic database, PubMed, and web browser searches with specific search terms. In addition to peer-reviewed studies, we searched news stories and reports from sport-related organizations. We summarized the measures and evaluations of effectiveness and categorized the measures by type (game rules, practice guidelines, equipment innovations, strategic initiatives) and target age group (elementary/middle school, high school, college, professional). We found that attempts are being made to improve the safety of football at all levels. However, many measures lack scientific evidence to support their effectiveness. Therefore, researchers need to systematically evaluate safety measures. By implementing evidence-based interventions, we can balance the public health risk of playing football versus the public health risk of continued declines in participation.

Objective To describe the point prevalence rates, relapse rates, smoking status, and symptoms of depression and to examine the relationship between smoking status and symptoms of depression from early pregnancy to 12 months after childbirth among low-income women. Design Secondary data analysis. Setting Data from the national Nurse-Family Partnership program. Participants Women who were enrolled in the national Nurse-Family Partnership program between 2011 and 2016 with histories of smoking 3 months before pregnancy (N = 1,554). Methods We used smoking status and Edinburgh Postnatal Depression Scale scores in early pregnancy, late pregnancy, and 12 months after childbirth to identify point prevalence rates, relapse rates, smoking status, and symptoms of depression. We used chi-square and additional analyses to examine the relationship between smoking status and symptoms of depression. Results The prevalence of smoking was 30.12% (n = 468) in early pregnancy, 24.39% (n = 379) in late pregnancy, and 50.58% (n = 786) 12 months after childbirth. Prevalence rates of a positive depression screening result were 30.31% (n = 471), 20.46% (n = 318), and 18.08% (n = 281), respectively. Smoking relapse rates were 2.45% (n = 38) during the third trimester and 27.86% (n = 433) at 12 months after childbirth. Eight distinct patterns of smoking and depression were identified. Women who smoked were significantly more likely to also have positive depression screening results during the third trimester and at 12 months after childbirth compared with nonsmoking women (OR = 1.37, 95% confidence interval [1.04, 1.81] and OR = 1.93, 95% confidence interval [1.47, 2.51], respectively). Conclusion Prevalence rates of smoking, relapse, and positive depression screening results were great in this sample of low-income women during and after pregnancy. Pivotal time points exist where the trajectory of smoking and depression screening patterns may change. It is important for smoking cessation interventions to incorporate mental health assessment and treatment.

AimsTo estimate the associations between high-risk alcohol consumption and (1) SARS-CoV-2 seroconversion, (2) self-reported new SARS-CoV-2 infection, and (3) symptomatic COVID-19.DesignProspective cohortSettingIndiana University Bloomington (IUB), a public university of 34,660 students in southern Indiana.ParticipantsAt the beginning of the fall 2020 semester, we randomly sampled N=1,267 IU undergraduate students, aged 18 years or older and residing in Monroe County, IN.MeasurementsPrimary exposure was high-risk alcohol consumption measured with the AUDIT questionnaire. We used an AUDIT score of 8 or more as the cut-off score when detecting high-risk alcohol consumption. Primary outcome was SARS-CoV-2 seroconversion, assessed with two SARS-CoV-2 antibody tests, at baseline and endline. Secondary outcomes were a) self-reported new SARS-CoV-2 infection at the study endline, and b) self-reported symptomatic COVID-19 at baseline.FindingsPrevalence of high-risk alcohol consumption was 34%. We found that students with high-risk alcohol consumption status had 2.34 [95% CI: (1.29, 4.24)] times the risk of SARS-CoV-2 seroconversion and 1.89 [95% CI: (1.08, 3.32)] times the risk of self-reporting a positive SARS-CoV-2 infection, compared to students with no such risk. Moreover, students with high-risk alcohol consumption were 18% more likely to develop symptomatic COVID-19, though this association was not statistically significant. Similar results were found after adjusting for sex at birth, race, and year in school. Findings from sensitivity analyses corroborated these results and suggested potential for a dose-response relationship.ConclusionsIn this sample of American college students, high-risk alcohol consumption was associated with higher risk for SARS-CoV-2 seroconversion/infection. These findings could have implications for colleges’ reopening planning in fall 2021.

Background: Pregnant women are a priority for cessation interventions. Guided by the Reasoned Action Approach, this study tested whether partner’s smoking status moderated the effects of attitude, ...

Cigarette smoking is a well-established cause of excess morbidity and mortality in the United States and globally. The current study builds on the existing literature by examining how smoking trajectories might be a mechanism through which adolescent tolerance for deviance predicts premature all-cause and tobacco-specific mortality. Participants were from a cohort-sequential study conducted in the Midwestern United States of the natural history of cigarette smoking from adolescence through midlife that collected nine waves of data from 1980 to 2011. For the current study, we selected participants who were measured at least once at age 18 or older and who did not die before age 24 (n = 7575). Participants' tolerance for deviance was assessed in adolescence, smoking trajectory group was based on self-reported smoking status during the first six waves of data collection, and cause of death for deceased participants (n = 222) was obtained from the National Death Index. Mediation analyses using the joint significance test were conducted separately for all-cause mortality and tobacco-specific mortality. Adolescent tolerance for deviance significantly predicted smoking trajectory group over and above the influence of covariates. Adolescents with higher tolerance for deviance were more likely to belong to any smoking trajectory group compared to abstainers, and membership in a smoking trajectory group characterized by early onset and heavy, persistent smoking was related to premature all-cause and tobacco-specific mortality. Finally, smoking trajectory group was a significant mediator of the relation between adolescent tolerance for deviance and all-cause mortality.

Little is known about the individual factors, such as knowledge and attitudes (i.e., football safety knowledge, football attitudes), related to adults’ willingness to allow adolescents to participate in tackle football. To address this gap, this study examined the extent to which football safety knowledge and attitudes toward head injury risk are associated with adults’ willingness to allow teenage boys to play high school tackle football. Data were obtained from an internet-based survey of a nationally representative sample of U.S. adults aged 18 to 93 years (n = 1,018). We conducted multilevel linear regression modelling to examine independent effects of the football safety knowledge- and attitude-based predictors. Our analyses revealed that knowledge of football safety measures, along with four of the five attitude-based variables were significantly associated with adults’ willingness to allow teenagers to participate in tackle football, over and above demographic factors. This study provides the first nationally representative examination of willingness to allow tackle football participation while extending our understanding of the gap between policy, public perception, and behavior present in U.S. high school football. These results point to promising directions for stakeholders aiming to increase tackle football participation as an increased understanding of the factors associated with participation may help inform effective policymaking, intervention design, and parental decision making.

BackgroundColleges and universities across the United States are developing and implementing data-driven prevention and containment measures against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Identifying risk factors for SARS-CoV-2 seropositivity could help to direct these efforts.ObjectiveTo estimate the associations between demographic factors and social behaviors and SARS-CoV-2 seropositivity and self-reported positive SARS-CoV-2 diagnostic test.MethodsIn September 2020, we randomly sampled Indiana University Bloomington (IUB) undergraduate students. Participants completed a cross-sectional, online survey about demographics, SARS-CoV-2 testing history, relationship status, and risk behaviors. Additionally, during a subsequent appointment, participants were tested for SARS-CoV-2 antibodies using a fingerstick procedure and SARS-CoV-2 IgM/IgG rapid assay kit. We used unadjusted modified Poisson regression models to evaluate the associations between predictors of both SARS-CoV-2 seropositivity and self-reported positive SARS-CoV-2 infection history.ResultsOverall, 1,076 students were included in the serological testing analysis, and 1,239 students were included in the SARS-CoV-2 infection history analysis. Current seroprevalence of SARS-CoV-2 was 4.6% (95% CI: 3.3%, 5.8%). Prevalence of self-reported SARS-CoV-2 infection history was 10.3% (95% CI: 8.6%, 12.0%). Greek membership, having multiple romantic partners, knowing someone in one’s immediate environment with SARS-CoV-2 infection, drinking alcohol more than 1 day per week, and hanging out with more than 4 people when drinking alcohol increased both the likelihood of seropositivity and SARS-CoV-2 infection history.ConclusionOur findings have implications for American colleges and universities and could be used to inform SARS-C0V-2 prevention and control strategies on such campuses.

Background Few studies have assessed the association between e-cigarette use and sleep deprivation. This is an important question given the rapid increase in e-cigarette use among young adults in recent years. Purpose To determine whether e-cigarette use is associated with sleep deprivation in a sample of young (18–24 years-old) American adults. Methods We used pooled cross-sectional data from the 2017 and 2018 Behavioral Risk Factor Surveillance System (BRFSS), selecting respondents aged 18 to 24 from forty-one states and U.S. territories that included the e-cigarette and sleep modules in the interview (N = 19,701). Poisson regression models tested the relationship between e-cigarette use and sleep deprivation. We adjusted for sociodemographic variables, physical activity, mental health, BMI, smokeless tobacco products use, alcohol drinking, and smoking. Results In the pooled dataset, the weighted prevalence of current or former e-cigarette use was 47% and 35% of participants self-reported sleep deprivation. After adjusting for confounders, former e-cigarette users were 1.17 times more likely to report sleep deprivation, compared to never users (95%CI: 1.06, 1.29). The prevalence ratio for self-reported sleep deprivation increased to 1.42 (95%CI: 1.23, 1.65) for everyday users, compared to never e-cigarette users. Conclusions These findings suggest that e-cigarette use might be related to sleep deprivation in young adults. Future longitudinal studies should assess the causal and dose–response nature of this relationship.

USA Football established five levels-of-contact to guide the intensity of high school football practices. The objective of this study was to examine head impact frequency and magnitude by levels-of-contact to determine which drills had the greatest head impact exposure. Our primary hypothesis was that there would be an incremental increase in season-long head impact exposure between levels-of-contact: air100g) head impacts were more frequently observed during live and thud drills. Level-of-contact influences cumulative head impact frequency and magnitude in high-school football, with players incurring frequent, high magnitude head impacts during live, thud, and control. It is important to consider level-of-contact to refine clinical exposure guidelines to minimize head impact burden in high-school football.

PurposeUSA Football established five levels of contact (LOC) to guide the intensity of high school football practices. However, it remains unclear whether head impact exposure differs by LOC. The purpose of this study was to examine head impact frequency and magnitude by LOC in the overall sample and three position groups.MethodsThis longitudinal observational study included 24 high school football players during all practices and games in the 2019 season. Players wore a sensor-installed mouthguard that monitored head impact frequency, peak linear acceleration (PLA), and rotational head acceleration (PRA). Practice/game drills were filmed and categorized into 5 LOCs (air, bags, control, thud, live), and head impact data were assigned into 5 LOCs. Player position was categorized into linemen, hybrid, and skill.ResultsA total of 6016 head impacts were recorded during 5 LOCs throughout the season. In the overall sample, total number of impacts, sum of PLA, and PRA per player increased in an incremental manner (air

The objective of the study was to examine the association between diffusion MRI techniques [diffusion tensor imaging (DTI) and neurite orientation/dispersion density imaging (NODDI)] and brain-injury blood biomarker levels [Tau, neurofilament-light (NfL), glial-fibrillary-acidic-protein (GFAP)] in high-school football and cross-country runners at their baseline, aiming to detect cumulative neuronal damage from prior seasons. Twenty-five football players and 8 cross-country runners underwent MRI and blood biomarker measures during preseason data collection. The whole-brain, tract-based spatial statistics was conducted for six diffusion metrics: fractional anisotropy (FA), mean diffusivity (MD), axial/radial diffusivity (AD, RD), neurite density index (NDI), and orientation dispersion index (ODI). Diffusion metrics and blood biomarker levels were compared between groups and associated within each group. The football group showed lower AD and MD than the cross-country group in various axonal tracts of the right hemisphere. Elevated ODI was observed in the football group in the right hemisphere of the corticospinal tract. Blood biomarker levels were consistent between groups except for elevated Tau levels in the cross-country group. Tau level was positively associated with MD and negatively associated with NDI in the corpus callosum of football players, but not in cross-country runners. Our data suggest that football players may develop axonal microstructural abnormality. Levels of MD and NDI in the corpus callosum were associated with serum Tau levels, highlighting the vulnerability of the corpus callosum against cumulative head impacts. Despite observing multimodal associations in some brain areas, neuroimaging and blood biomarkers may not strongly correlate to reflect the severity of brain damage.

Evaluate the association between perceived risk of harm and self-reported binge drinking, cigarette smoking, and marijuana smoking among college students.Participants were 599 students (ages 19-28) at a large Midwestern university recruited from October 2015 to December 2017.Hurdle regression was used to test the relationship between perceived risk of harm from substance use (i.e., binge drinking, cigarette smoking, and marijuana smoking), and self-reported use. Demographic characteristics were tested as moderators of this relationship.Engagement in all three substance use behaviors was less likely when perceived risk was high. Age moderated the association between perceived risk and self-reported marijuana smoking with younger participants demonstrating a stronger relationship between perceived risk of smoking marijuana and self-reported marijuana smoking.Intervention programs will be most effective when perceived risk of substance use is high. Therefore, intervention programs should aim to increase college students' perceived risk of substance use.

Subconcussive head impacts (SHI), defined as impacts to the cranium that do not result in concussion symptoms, are gaining traction as a major public health concern. The contribution of physiological factors such as physical exertion and muscle damage to SHI-dependent changes in neurological measures remains unknown. A prospective longitudinal study examined the association between physiological factors and SHI kinematics in 15 high school American football players over one season. Players wore a sensor-installed mouthguard for all practices and games, recording frequency and magnitude of all head impacts. Serum samples were collected at 12 time points (pre-season, pre- and post-game for five in-season games, and post-season) and were assessed for an isoenzyme of creatine kinase (CK-MM) primarily found in skeletal muscle. Physical exertion was estimated in the form of excess post-exercise oxygen consumption (EPOC) from heart rate data captured during the five games. Mixed-effect regression models indicated that head impact kinematics were significantly and positively associated with change in CK-MM but not EPOC. There was a significant and positive association between CK-MM and EPOC. These data suggest that when examining SHI, effects of skeletal muscle damage should be considered when using outcome measures that may have an interaction with muscle damage.

Subconcussive head impacts, defined as impacts to the cranium that do not result in clinical symptoms of concussion, are gaining traction as a major public health concern. Researchers begin to suggest subconcussive impact-dependent changes in various neurological measures. However, a contribution of physiological factors such as physical exertion and muscle damage has never been accounted. We conducted a prospective longitudinal study during a high school American football season to examine the association between physiological factors and subconcussive head impact kinematics. Fifteen high-school American football players volunteered in the study. A sensor-installed mouthguard recorded the number of head impacts, peak linear (PLA:g) and peak rotational (PRA: rad/s2) head accelerations from every practice and game. Serum samples were collected at 12 time points (pre-season baseline, five in-season pre-post games, and post-season) and assessed for the creatine kinase skeletal muscle-specific isoenzyme (CK-MM), as a surrogate for skeletal muscle damage. Physical exertion was estimated in the form of excess post-exercise oxygen consumption (EPOC) from heart rate data captured during five games via a wireless heart rate monitor. A total of 9,700 hits, 214,492g, and 19,885,037 rad/s2were recorded from 15 players across the study period. Mixed-effect regression models indicated that head impact kinematics (frequency, PLA, and PRA) were significantly and positively associated with CK-MM increase, but not with EPOC. There was a significant and positive association between CK-MM and EPOC. These data suggest that skeletal muscle damage effects should be considered when using outcome measures that may have an interaction with muscle damage, including inflammatory biomarkers and vestibular/balance tests.

To test the effect of exposure to the US Food and Drug Administration's proposed graphic images with text warning statements for cigarette packages on implicit and explicit attitudes towards smoking.A two-session web-based study was conducted with 2192 young adults 18-25-years-old. During session one, demographics, smoking behaviour, and baseline implicit and explicit attitudes were assessed. Session two, completed on average 18 days later, contained random assignment to viewing one of three sets of cigarette packages, graphic images with text warnings, text warnings only, or current US Surgeon General's text warnings. Participants then completed post-exposure measures of implicit and explicit attitudes. ANCOVAs tested the effect of condition on the outcomes, controlling for baseline attitudes.Smokers who viewed packages with graphic images plus text warnings demonstrated more negative implicit attitudes compared to smokers in the other conditions (p = .004). For the entire sample, explicit attitudes were more negative for those who viewed graphic images plus text warnings compared to those who viewed current US Surgeon General's text warnings (p = .014), but there was no difference compared to those who viewed text-only warnings.Graphic health warnings on cigarette packages can influence young adult smokers' implicit attitudes towards smoking.

People living with serious mental illness (SMI) are at increased risk for metabolically related disease. This study aimed to examine the impact of a collaborative care intervention that targeted metabolically related health risk in adults diagnosed with SMI in a community mental health center. Markers of physical health were collected from a sample of 169 adults served by a federally funded integrated healthcare project. At the six-month follow-up, significant decreases in weight, cholesterol, and cigarette use were found. These findings highlight the important role social work practitioners hold for improving the health status of persons living with SMI.

Secondhand smoke (SHS) exposure is responsible for numerous diseases of the lungs and other bodily systems among children. In addition to the adverse health effects of SHS exposure, studies show that children exposed to SHS are more likely to smoke in adolescence. Susceptibility to smoking is a measure used to identify adolescent never-smokers who are at risk for smoking. Limited research has been conducted on the influence of SHS on susceptibility to smoking. The purpose of this study was to determine a robust measure of the strength of correlation between SHS exposure and susceptibility to smoking among never-smoking U.S. adolescents. This study used data from the 2009 National Youth Tobacco Survey to identify predictors of susceptibility to smoking in the full (pre-match) sample of adolescents and a smaller (post-match) sample created by propensity score matching. Results showed a significant association between SHS exposure and susceptibility to smoking among never-smoking adolescents in the pre-match (OR=1.47) and post-match (OR=1.52) samples. The odds ratio increase after matching suggests that the strength of the relationship was underestimated in the pre-match sample. Other significant correlates of susceptibility to smoking identified include: gender, race/ethnicity, personal income, smoke-free home rules, number of smoking friends, perception of SHS harm, perceived benefits of smoking, and exposure to pro-tobacco media messages. The use of propensity score matching procedures reduced bias in the post-match sample, and provided a more robust estimate of the influence of SHS exposure on susceptibility to smoking, compared to the pre-match sample estimates.

Introduction Identifying trajectories of tobacco use is critical for understanding its natural history and targeting interventions, but research on trajectories of smokeless tobacco and dual use of smokeless tobacco and cigarettes is very limited. This study identified tobacco use trajectories from adolescence to midlife and tested correlates of trajectory group membership. Methods This study included all male participants in a longitudinal study who reported cigarette smoking or smokeless tobacco use in 1987, 1993, 1999, 2005, or 2011 (N = 2230). Group-based trajectory analyses were conducted with zero-inflated Poisson models. Analysis of covariance was used to test adolescent health beliefs associated with trajectory group membership. Results Five smoking trajectory groups were identified: (1) consistent abstinence from cigarettes; (2) late onset intermittent, then cessation; (3) early onset regular, then cessation; (4) delayed onset regular, then cessation; and (5) consistent regular. Four smokeless tobacco trajectory groups were identified: (1) early onset, then cessation; (2) consistent abstinence from smokeless tobacco; (3) late onset, escalating; and (4) consistent regular. The proportion of participants in trajectory groups representing dual use was low. Adolescent beliefs favorable to smoking and smokeless tobacco were associated with membership in consistent regular use groups. Conclusions The prevalence of dual use of cigarettes and smokeless tobacco was low, and there was little evidence to suggest switching between tobacco products. Participants who held more positive beliefs about smoking and smokeless tobacco as adolescents were more likely to be consistent regular users of cigarettes and smokeless tobacco into adulthood.

In this chapter, findings from a long-term, cohort-sequential, multigenerational study of cigarette smoking are used to illustrate the importance of a developmental approach for (1) understanding trajectories of smoking behavior (in relation to other forms of tobacco use) and the conditions and challenges of the developmental periods that show transitions in smoking status (particularly adolescent smoking onset and challenges for parents with adolescent children), (2) understanding heterogeneity in these trajectories because differing trajectories may have different etiological underpinnings as well as different implications for the intergenerational transmission of smoking, (3) recognizing that development unfolds within the larger context of societal and historical change and that societal change can influence outcomes, and (4) considering development within a family systems and multigenerational context.

Background Strategies to prevent gastric cancer by decreasing Helicobacter pylori infections in high-prevalence, low-income countries could include a population-based “screen and treat” eradication program. Methods We tested residents of two rural villages for H. pylori infection using urea breath test (UBT), treated infected persons using directly observed therapy (DOT), retested for cure, and retested after 1 year later for H. pylori infection. Findings We tested 1,065 (92%) of 1153 residents from two villages in rural Bolivia. Baseline H. pylori prevalence was 80% (95% confidence interval [CI]: 78–84). Age-specific cure rates were similar (≥92%) after DOT. Among those cured, 12% (95% CI: 8–15) had recurrent infection. Age-specific annual H. pylori recurrence rates for combined villages were 20% (95% CI: 10–29) in persons

ObjectiveThe purpose of this investigation was to examine the relationships between subconcussive head impact frequency and magnitude and measures of physical exertion and muscle damage.BackgroundSubconcussive head impacts, or impacts that do not present with concussion symptoms, are gaining traction as a major public health concern. However, there is a gap in knowledge about the contribution of physiological variables, such as muscle damage and physical exertion, to neurological measures used to assess subconcussive impact-dependent changes. The unknown contribution of physical exertion and strenuous exercise is often listed as a limitation in field studies of subconcussive head impacts.Design/MethodsFifteen high school football players wore mouthguards installed with triaxial accelerometers and gyroscopes in order to quantify the linear and rotational accelerations of every head impact sustained throughout one season (practices and games). Additionally, serum samples were collected at twelve time points (pre-season, pre- and post-competition for five in-season games, and post-season) and assayed for CK-MM, the skeletal muscle-specific isoenzyme of creatine kinase. Subjects wore heart rate monitors during the five games, and heart rate data were used to estimate physical exertion in terms of excess post-exercise oxygen consumption (EPOC).ResultsMixed-effect regression modeling (MRM) showed significant and positive associations between CK-MM and subconcussive head impact kinematic variables, in addition to a significant and positive association between CK-MM and EPOC. The models were adjusted for cumulative head impact exposures up to each game and the pre-season serum CK-MM levels, when applicable.ConclusionsWhen investigating subconcussive head impacts, the effects of muscle damage should be considered when using correlated outcome measures, such as inflammatory biomarkers and vestibular assessments.

Introduction Young people in the United States are exposed to secondhand smoke (SHS) primarily in 2 settings: homes and cars. Recently, researchers reported that the prevalence of U.S students exposed to SHS in cars decreased from 2000 to 2009; however, comparisons of trends across school levels, gender, and racial/ethnic groups were not assessed. Moreover, no studies have examined trends of exposure to SHS in rooms. Methods We used data from the 2000, 2002, 2004, 2006, and 2009 waves of the National Youth Tobacco Survey, a nationally representative cross-sectional survey of U.S. middle and high school students. For SHS in cars and rooms, we identified exposure trends among nonsmokers from 2000 to 2009 and compared trends across subpopulations with binary logistic regression. Results We identified significant downward linear trends in SHS in cars and rooms for nearly all measured subpopulations of nonsmoking students from 2000 to 2009. SHS exposure in cars and rooms declined at a significantly greater rate for males than for females. SHS exposure in cars declined at a significantly greater rate for non-Hispanic (NH) Blacks than for NH Whites. SHS exposure in rooms declined at a significantly greater rate for NH Whites than for Hispanics and Native Hawaiians/Pacific Islanders. Conclusions Although prevalence of exposure to SHS in cars and rooms among nonsmoking U.S. middle and high school students has declined from 2000 to 2009, the rates of decline were not equal across genders and racial/ethnic groups. Identification of these differing rates of exposure can help the public health community advocate for interventions focused on reducing adolescent SHS exposure.

Economic declines and their associated stress, shortage of financial resources, and changes in available time can impair health behaviors. This study tested the association between change in working hours, change in employment status, and financial strain and health behaviors measured after the 2008 recession after controlling for pre-recession levels of the health behaviors. The moderating influences of demographic factors and pre-recession levels of the health behaviors on the association between change in working hours and employment status and financial strain and the health behaviors were also tested. Participants (N = 3984) were from a longitudinal study of a U.S. Midwestern community-based sample. Regression analyses tested the unique relations between change in hours worked per week, change in employment status, and financial strain and five health behaviors over and above demographic factors and pre-recession levels of the same behavior. Models included predictor by covariate interactions. Participants who reported higher levels of financial strain engaged in lower levels of all but one of the five health behaviors, but there were no significant main effects of a change in the number of hours worked per week or change in employment status. Significant interactions revealed moderation of these relations by demographic characteristics, but findings differed across health behaviors. Financial strain negatively affected engagement in multiple healthy behaviors. Promoting the maintenance of healthy behaviors for disease prevention is an important public health goal during times of economic decline.

INTRODUCTION This study examined the association between implicit and explicit attitudes toward smoking and support for tobacco control policies. METHODS Participants were from an ongoing longitudinal study of the natural history of smoking who also completed a web-based assessment of implicit attitudes toward smoking (N = 1,337). Multiple regression was used to test the association between covariates (sex, age, educational attainment, parent status, and smoking status), implicit attitude toward smoking, and explicit attitude toward smoking and support for tobacco control policies. The moderating effect of the covariates on the relation between attitudes and support for policies was also tested. RESULTS Females, those with higher educational attainment, parents, and nonsmokers expressed more support for tobacco control policy measures. For nonsmokers, only explicit attitude was significantly associated with support for policies. For smokers, both explicit and implicit attitudes were significantly associated with support. The effect of explicit attitude was stronger for those with lower educational attainment. CONCLUSIONS Both explicit and implicit smoking attitudes are important for building support for tobacco control policies, particularly among smokers. More research is needed on how to influence explicit and implicit attitudes to inform policy advocacy campaigns.

Smoke-free air policies have been shown to reduce smoking, but the mechanism of behavior change is not well understood. The authors used structural equation modeling to conduct a theory of planned behavior analysis with data from 395 smokers living in seven Texas cities, three with a comprehensive smoke-free air law and four without a comprehensive law. Agreement with regulating smoking in public places was significantly associated with attitudes and perceived normative pressure about quitting. Nicotine dependence was significantly associated with attitudes and perceived behavioral control. There was also a direct effect of nicotine dependence on intention to take measures to quit smoking. Smoke-free air laws appear to influence quitting intentions through the formation of positive attitudes about regulating smoking in public places and the perception of normative pressure to take measures to quit. Implications for smoke-free air policy campaigns and challenges in evaluating their effectiveness are discussed.

The current study tested implicit and explicit attitudes as prospective predictors of smoking cessation in a Midwestern community sample of smokers. Results showed that the effects of attitudes significantly varied with levels of experienced failure to control smoking and plans to quit. Explicit attitudes significantly predicted later cessation among those with low (but not high or average) levels of experienced failure to control smoking. Conversely, however, implicit attitudes significantly predicted later cessation among those with high levels of experienced failure to control smoking, but only if they had a plan to quit. Because smoking cessation involves both controlled and automatic processes, interventions may need to consider attitude change interventions that focus on both implicit and explicit attitudes.

This study examined the intergenerational transmission of implicit and explicit attitudes toward smoking, as well as the role of these attitudes in adolescents’ smoking initiation. There was evidence of intergenerational transmission of implicit attitudes. Mothers who had more positive implicit attitudes had children with more positive implicit attitudes. In turn, these positive implicit attitudes of adolescents predicted their smoking initiation 18-months later. Moreover, these effects were obtained above and beyond the effects of explicit attitudes. These findings provide the first evidence that the intergenerational transmission of implicit cognition may play a role in the intergenerational transmission of an addictive behavior.

Objectives. We sought to identify prospective predictors of long-term abstinence versus relapse among individuals who quit smoking as young adults. Methods. Participants from an ongoing longitudinal study of smoking who had quit for at least 1 year between the ages of 18 and 24 years (n=327) were divided into those who later reported not smoking for more than 5 years (long-term abstinence) or reported current smoking, defined as smoking at least monthly (relapse). Logistic regression was used to examine odds ratios (ORs) of prospective predictors of long-term abstinence versus relapse. Results. Overall, 67% of participants maintained long-term abstinence and 33% relapsed. The strongest predictor of avoiding relapse was marrying a nonsmoker (adjusted OR [AOR]=0.07; 95% confidence interval [CI]=0.03, 0.21). Other predictors included making 1 lifetime quit attempt (AOR=0.13; 95% CI=0.04, 0.44), having as a young adult only 1 parent who smoked (AOR=0.23; 95% CI=0.06, 0.93), and working in a completely smoke-free building (AOR=0.13; 95% CI=0.03, 0.58). Conclusions. The factors related to smoking in the social environment played the largest role in predicting long-term abstinence versus relapse.

© 2014, Springer Science+Business Media New York. Implicit attitudes have been shown to predict smoking behaviors. Therefore, an important goal is the development of interventions to change these attitudes. This study assessed the effects of a web-based intervention on implicit attitudes toward smoking and receptivity to smoking-related information. Smokers (N = 284) were recruited to a two-session web-based study. In the first session, baseline data were collected. Session two contained the intervention, which consisted of assignment to the experimental or control version of an approach-avoidance task and assignment to an anti-smoking or control public service announcement (PSA), and post-intervention measures. Among smokers with less education and with plans to quit, implicit attitudes were more negative for those who completed the approach-avoidance task. Smokers with more education who viewed the anti-smoking PSA and completed the approach-avoidance task spent more time reading smoking-related information. An approach-avoidance task is a potentially feasible strategy for changing implicit attitudes toward smoking and increasing receptivity to smoking-related information.