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Because tobacco use remains one of the leading causes of disease, disability, and mortality, tobacco treatment programs should be integrated into medical systems such as hospitals and outpatient centers. Medical providers have a unique, high-impact opportunity to initiate smoking cessation treatment with patients. However, there are several barriers that may hinder the development and implementation of these programs. The purpose of this review was to address such barriers by illustrating several examples of successful tobacco treatment programs in US health-care systems that were contributed by the authors. This includes describing treatment models, billing procedures, and implementation considerations. Using an illustrative review of vignettes from existing programs, various models are outlined, emphasizing commonalities and unique features, strengths and limitations, resources necessary, and other relevant considerations. In addition, clinical research and dissemination trials from each program are described to provide evidence of feasibility and efficacy from these programs. This overview of example treatment models designed for hospitals and outpatient centers provides guidelines for any emerging tobacco cessation services within these contexts. For existing treatment programs, this review provides additional insight and ideas about improving these programs within their respective medical systems., (Copyright © 2020 American College of Chest Physicians. All rights reserved.)

Quitting smoking leads to improved outcomes for patients with cancer, yet too few patients receive cessation services during their oncology healthcare visits. The National Cancer Institute (NCI) dedicated Cancer Moonshot funding for NCI-Designated Cancer Centers to develop a population-based approach to reach all patients who smoke with tobacco treatment services. As a result, the Cancer Center Cessation Initiative (C3I) offers an unparalleled opportunity to identify effective implementation strategies and barriers to delivering tobacco treatment services across multiple clinical oncology settings. Over one year after receiving funding, the first cohort of C3I funded Centers demonstrated progress in hiring tobacco treatment specialists, adding new tobacco treatment programs, and integrating EHR-based tobacco treatment referrals. However, tobacco treatment program reach remains low in some settings, even using a broad definition of patient engagement. Centers identified implementation challenges related to staff training needs, devising new clinical workflows, and engagement of IT leadership. Understanding implementation challenges may help other clinical oncology settings effectively implement tobacco treatment programs, leading to improved cancer outcomes by helping patients quit smoking., (©2019 American Association for Cancer Research.)

Adolescence is a time of dramatic changes in brain structure and function, and the adolescent brain is highly susceptible to being altered by experiences like substance use. However, there is much we have yet to learn about how these experiences influence brain development, how they promote or interfere with later health outcomes, or even what healthy brain development looks like. A large longitudinal study beginning in early adolescence could help us understand the normal variability in adolescent brain and cognitive development and tease apart the many factors that influence it. Recent advances in neuroimaging, informatics, and genetics technologies have made it feasible to conduct a study of sufficient size and scope to answer many outstanding questions. At the same time, several Institutes across the NIH recognized the value of collaborating in such a project because of its ability to address the role of biological, environmental, and behavioral factors like gender, pubertal hormones, sports participation, and social/economic disparities on brain development as well as their association with the emergence and progression of substance use and mental illness including suicide risk. Thus, the Adolescent Brain Cognitive Development study was created to answer the most pressing public health questions of our day., (Published by Elsevier Ltd.)

Studies of fungi in upland cotton (Gossypium hirsutum) cultivated in the United States have largely focused on monitoring and controlling plant pathogens. Given increasing interest in asymptomatic fungal endophytes as potential biological control agents, surveys are needed to better characterize their diversity, distribution patterns and possible applications in integrated pest management. We sampled multiple varieties of cotton in Texas, USA and tested for temporal and spatial variation in fungal endophyte diversity and community composition, as well as for differences associated with organic and conventional farming practices. Fungal isolates were identified by morphological and DNA identification methods. We found members of the genera Alternaria, Colletotrichum and Phomopsis, previously isolated as endophytes from other plant species. Other recovered species such as Drechslerella dactyloides (formerly Arthrobotrys dactyloides) and Exserohilum rostratum have not, to our knowledge, been previously reported as endophytes in cotton. We also isolated many latent pathogens, but some species such as Alternaria tennuissima, Epicoccum nigrum, Acremonium alternatum, Cladosporium cladosporioides, Chaetomium globosum and Paecilomyces sp., are known to be antagonists against plant pathogens, insects and nematode pests. We found no differences in endophyte species richness or diversity among different cotton varieties, but did detect differences over time and in different plant tissues. No consistent patterns of community similarity associated with variety, region, farming practice, time of the season or tissue type were observed regardless of the ecological community similarity measurements used. Results indicated that local fungal endophyte communities may be affected by both time of the year and plant tissue, but the specific community composition varies across sites. In addition to providing insights into fungal endophyte community structure, our survey provides candidates for further evaluation as potential management tools against a variety of pests and diseases when present as endophytes in cotton and other plants.

Introduction: Concomitant use of two forms of tobacco is an increasing public health concern, yet there is little consensus regarding a consistent definition of so-called "dual use." We defined dual use as cigarette and smokeless tobacco (ST) consumption with either product used daily or nondaily., Methods: We analyzed a cohort of 36,013 Air Force recruits. We categorized dual tobacco use across 2 dimensions, type of tobacco products (cigarettes, ST, or others), and the frequency of use (daily vs. nondaily). We determined how varying the definition impacted the prevalence estimates and evaluated the prevalence estimate based on our recommended definition of dual use. Multivariate logistic regression analysis was used to evaluate the risk profile of dual users of ST and cigarettes versus mono users of ST and mono users of cigarettes., Results: Varying definitions of dual use vary prevalence estimates 50-fold (0.5%-25.3%). Including only ST and cigarettes narrows the prevalence estimate to less than 4-fold (2.0%-9.7%). Dual users are more likely to be young Caucasian males, with lower education, and from families with relatively higher incomes. Compared with mono users, dual users of cigarettes and ST have a distinct pattern of risk profiles., Conclusions: Depending on the definition of dual use, markedly different prevalence and risk profiles are observed. Dual users of ST and cigarettes are a unique group of tobacco users. We propose a common definition of dual use to advance our understanding of this unique group.

Fueled by the rapid pace of discovery, humankind's ability to understand the ultimate causes of preventable common disease burdens and to identify solutions is now reaching a revolutionary tipping point. Achieving optimal health and well-being for all members of society lies as much in the understanding of the factors identified by the behavioral, social, and public health sciences as by the biological ones. Accumulating advances in mathematical modeling, informatics, imaging, sensor technology, and communication tools have stimulated several converging trends in science: an emerging understanding of epigenomic regulation; dramatic successes in achieving population health-behavior changes; and improved scientific rigor in behavioral, social, and economic sciences. Fostering stronger interdisciplinary partnerships to bring together the behavioral-social-ecologic models of multilevel "causes of the causes" and the molecular, cellular, and, ultimately, physiological bases of health and disease will facilitate breakthroughs to improve the public's health. The strategic vision of the Office of Behavioral and Social Sciences Research (OBSSR) at the National Institutes of Health (NIH) is rooted in a collaborative approach to addressing the complex and multidimensional issues that challenge the public's health. This paper describes OBSSR's four key programmatic directions (next-generation basic science, interdisciplinary research, systems science, and a problem-based focus for population impact) to illustrate how interdisciplinary and transdisciplinary perspectives can foster the vertical integration of research among biological, behavioral, social, and population levels of analysis over the lifespan and across generations. Interdisciplinary and multilevel approaches are critical both to the OBSSR's mission of integrating behavioral and social sciences more fully into the NIH scientific enterprise and to the overall NIH mission of utilizing science in the pursuit of fundamental knowledge about the nature and behavior of living systems and the application of that knowledge to extend healthy life and reduce the burdens of illness and disability.

Purpose: As the science of team science evolves, the development of measures that assess important processes related to working in transdisciplinary teams is critical. Therefore, the purpose of this paper is to present the psychometric properties of scales measuring collaborative processes and transdisciplinary integration., Methods: Two hundred-sixteen researchers and research staff participating in the Transdisciplinary Tobacco Use Research Centers (TTURC) Initiative completed the TTURC researcher survey. Confirmatory-factor analyses were used to verify the hypothesized factor structures. Descriptive data pertinent to these scales and their associations with other constructs were included to further examine the properties of the scales., Results: Overall, the hypothesized-factor structures, with some minor modifications, were validated. A total of four scales were developed, three to assess collaborative processes (satisfaction with the collaboration, impact of collaboration, trust and respect) and one to assess transdisciplinary integration. All scales were found to have adequate internal consistency (i.e., Cronbach alpha's were all >0.70); were correlated with intermediate markers of collaborations (e.g., the collaboration and transdisciplinary-integration scales were positively associated with the perception of a center's making good progress in creating new methods, new science and models, and new interventions); and showed some ability to detect group differences., Conclusions: This paper provides valid tools that can be utilized to examine the underlying processes of team science--an important step toward advancing the science of team science.

Recent epidemiologic data on the stabilization of adult and youth smoking rates underscore the need for vigorous research across the cancer control spectrum on tobacco use interventions. The steady decline in adult rates of smoking has stalled for the first time in 8 years, and certain race, ethnic, and population groups are disproportionately at risk to tobacco-related cancers because of disparities in tobacco use or access to effective interventions. Although substantial progress has been made across levels of basic through applied research, tobacco-control research across the discovery and delivery continuum must be accelerated to further reduce the cancer burden. Following a brief review of the prevalence and trends affecting tobacco use initiation and cessation, we identify and describe four domains of extraordinary research opportunities: genetics and gene-environment interactions, bioinformatics and health informatics, disparities and disproportionate risk, and prevention and treatment. Evolutionary scientific changes, like rapidly advancing technology and emphasis on the paradigm of team science research approaches, provide both a challenge as well as unparalleled opportunities for scientific advancement and public health progress.

Cigarette smoking is the largest preventable cause of death and morbidity in the United States. Heightened recognition of this public health concern has led researchers from multiple and varied disciplines to address this complex and multidimensional behavior. The need for an alternative research paradigm, focusing on a transdisciplinary approach that integrates work across disciplines in order to advance the field most quickly, has been identified. This recognized need led to the development of the Transdisciplinary Tobacco Use Research Centers (TTURC) initiative, funded jointly by the National Cancer Institute, the National Institute on Drug Abuse, and The Robert Wood Johnson Foundation. This paper discusses the formation and early implementation stages of the initiative, including meetings that led to the development of the TTURCs, funders' and research centers' perspectives on implementation, and early observations about the products of the initiative.

Modern technologies incorporating Geographic Information Systems (GIS), Global Positioning Systems (GPS), remote sensing, and geostatistics provide unique opportunities to advance ecological understanding of pests across a landscape. Increased knowledge of the population dynamics of plant pathogens will promote management strategies, such as site-specific management, and cultural practices minimizing the introduction and impact of plant pathogens. The population dynamics of Alternaria solani, Verticillium dahliae, and Pratylenchus penetrans were investigated in commercial potato fields. A 0.5-ha diamond grid-sampling scheme was georeferenced, and all disease ratings and nematode samples were taken at these grid points. Percent disease severity was rated weekly, and P. penetrans densities were quantified 4 weeks after potato emergence. Spatial statistics and interpolation methods were used to identify the spatial distribution and population dynamics of each pathogen. Interpolated maps and aerial imagery identified A. solani intra-season progression across the fields as the potato crop matured. Late-season nitrogen application reduced A. solani severity. The spatial distributions of V. dahliae and P. penetrans were spatially correlated.

Alcohol and other drug use during pregnancy represents a major public health concern. This article characterizes a sample of 240 pregnant opioid- or cocaine-dependent women enrolled in the initial residential component of a comprehensive substance abuse treatment program for pregnant women. Data were collected using the Addiction Severity Index, Psychosocial History Form, and Structured Clinical Interview for DSM-III-R. Patients' substance use history, psychiatric comorbidity, social support network, employability, current and previous pregnancies, child custody arrangements, and the father of the current pregnancy, are described to assist providers in tailoring treatment to the specific needs of this population.

Tobacco exacts an exorbitant toll on the nation's health, causing more than 450,000 deaths yearly. Although rates of smoking (the most common form of tobacco use) among adults have decreased in the past two decades, the decline has recently leveled off. Of additional concern is that youth tobacco use is increasing (1). A combination of recent scientific advances and social, legal, and public policy developments provides an unprecedented opportunity to reduce the burden of death and disease caused by tobacco use (2). Reducing tobacco use among adults and adolescents is an important public health goal.

Background: Although older adults can achieve significant health benefits from smoking cessation, few programs have specifically targeted this population. This study tested the effectiveness of an office-based smoking cessation program tailored to midlife and older smokers., Methods: This paper describes a randomized controlled trial comparing usual care with physician-delivered brief quit-smoking advice and counseling for midlife and older smokers (ages 50-74). Outpatient medical practices assigned to the Immediate Intervention (experimental) condition were trained to deliver brief quit-smoking advice and counseling. Delayed Intervention (control) practices followed usual care procedures. Thirty-nine practices accruing five or more patients per practice were included in the analyses., Results: Using conservative measure of quitting, self-reported quit rates at 6-month follow-up were 15.41% for the Immediate Intervention group versus 8.16% of subjects in the Delayed Intervention group (P < 0.005). Baseline subject (N = 659) characteristics related to 6-month abstinence included number of previous quit attempts, quitting for 24 hr in the past year, desire to quit, confidence in quitting, perceived health benefits, and lower nicotine dependence., Conclusions: Smoking abstinence was significantly increased by training physicians and key office and clinical staff to intervene with older smokers. Brief interventions are tailored to this age cohort can be successfully and efficaciously integrated into routine care.

There has been increasing interest in the effects of chronic dieting and of repeated cycles of weight loss and regain in athletes. The purpose of this investigation was to examine the eating and weight loss practices, nutrition, and psychological factors in 45 male body builders competing in a drug-free competition. Subjects completed a questionnaire on the morning of a body building competition to assess the weight loss and dietary history, psychological distress, reports of binge eating, and vitamin and mineral supplement usage. The subjects reported high levels of dieting, weight loss, and weight regain. The mean weight loss reported in the competitive season was 6.8 kg; the mean weight gain reported was 6.2 kg. Eighty-five percent reported gaining weight while 46% reported episodes of binge eating after competitions. Most (81.5%) reported being preoccupied with food sometimes, often, or always. Between 30 and 50% reported psychological distress when preparing for competition (anxiety, short temper, anger). A similar number (30-50%) reported using amino acid, protein, and vitamin supplements. It appears that severe dieting practices are common in the sport of competitive body building. The potential physiological, psychological, and health implications of these practices, combined with the growing popularity of body building, are of sufficient importance to warrant further attention by investigators and the body building community.

Addictive and conditioning processes interact to make cigarette smoking a common, lethal behavior that is highly resistant to change. In addition to addiction and conditioning, smoking is maintained by a wide range of forces, ranging from social modeling and advertising to the politics and economics of international trade. Parallel to this wide range of causes of smoking, interventions to encourage smoking cessation range from simple information and suggestions to smoking cessation classes, to nicotine replacement, to community or national campaigns that promote nonsmoking. Clinicians can make contributions throughout this range of activities, from the consulting room to political advocacy. While no one of these is highly successful on its own, together they have prompted almost 50% of smokers to quit, an impressive accomplishment.