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This study investigates correlates of smoking behaviors among 290 students in a Mississippi Delta middle school and how these adolescents identify their own smoking behaviors. Self-identified 'regular smokers' were more socially exposed to smoking, and reported more indications of habitual smoking than 'non-smokers,' 'once in a while smokers' and 'ex-smokers.' These differences could lead to intervention studies that, in addition to traditionally categorized regular smokers, recruit adolescent smokers who do not identify themselves as regular smokers, but who nevertheless exhibit behaviors characteristic of regular smokers. [ABSTRACT FROM AUTHOR]

Background: Entertainment education is a field of health communication that utilizes a variety of entertainment to change health behaviors. Method: In this article, we describe a pilot project in which we measured the effectiveness of drama as a health communication tool. Attendees completed a pretest and posttest measuring knowledge, attitudes, and behavior related to breast cancer screening. Results. At posttest, more women indicated breast self-exam rather than mammogram to be the 'best method of early detection.' Conclusion: Researchers who use drama as a communication tool cannot be assured of the final health message delivered. Careful evaluation to monitor the effectiveness of drama as a cancer awareness tool is vital. [ABSTRACT FROM AUTHOR]

Objective: Cannabis use is increasingly pervasive throughout the U.S. People in treatment for substance use disorders (SUD) may be especially at-risk of harm due to this changing context of cannabis in the U.S. This study's objective was to qualitatively describe experiences and beliefs around cannabis among people who had entered treatment for any SUD in the past 12-months., Methods: From May to November of 2022, we conducted 27 semi-structured interviews (n=16 in Georgia, n=11 in Connecticut) with individuals in treatment for SUD in Georgia and Connecticut. Interviews were recorded, transcribed, and thematically analyzed using an emergent approach., Results: All participants had used cannabis in the past. Four themes emerged from the interviews. Participants: (1) perceived cannabis as an important contributor to non-cannabis substance use initiation in adolescence; (2) viewed cannabis as a substance with the potential to improve health with fewer side effects than prescription medications; (3) expressed conflicting opinions regarding cannabis as a trigger or tool to manage cravings for other non-cannabis substances currently; and 4) described concerns related to negative legal, social service, and treatment-related consequences as well as negative peer perception relating to the use of cannabis., Conclusion: Although participants described cannabis's important role as an initiatory drug in adolescence and young adulthood, many felt that cannabis was a medicinal substance for a range of health challenges. These findings suggest SUD treatment clinicians should address medicinal beliefs related to cannabis among their clients and emphasizes the need for research on cannabis use and SUD treatment outcomes., Competing Interests: No conflict of interest was declared., (© 2024 The Author(s).)

As a next step to better understand the role of cultural tightness-looseness (CTL), this study aimed to examine whether CTL is associated with COVID-19 vaccination behavior among university students, taking into consideration sociocultural perceptions of vaccination across countries. A global online survey was conducted. University students from Japan, the US, and India participated. The average CTL score, three sociocultural perceptions related to COVID-19 vaccination, side effects, infection experience of themselves and family members, and other demographic variables were used to identify the model and to explain the second vaccination status using stepwise logistic regression methods with Akaike Information Criterion (AIC) scores which was for both the total, with the country as a variable, and for each country. Analyses of data from 1289 respondents who received the first vaccine revealed the essential role of CTL in individuals getting the second vaccine, while also revealing differences between countries. Regardless of the limitations, this study adds knowledge about CTL's roles in the COVID-19 vaccination behavior among young generations and provides insights into public health communication practices for issues like COVID-19.

Background: People experiencing substance use disorders (SUD) face myriad challenges in maintaining changes in substance use after treatment. Mobile phones can play a role in supporting the recovery process. To date, research has not explored how individuals use mobile phones to seek social support as they enter SUD recovery. Objectives: We sought to understand how individuals in SUD treatment use mobile technology in support of their recovery. Methods: We conducted semi-structured interviews with thirty individuals in treatment for any SUD in northeastern Georgia and southcentral Connecticut. Interviews explored participants' attitudes toward mobile technology and how they used mobile technology while using substances, in treatment, and in recovery. Qualitative data were coded and analyzed using thematic analysis. Results: We identified three major themes related to how participants: (1) adapted their use of mobile technology as they entered recovery, (2) relied on mobile technology for social support while in recovery, while (3) some found aspects of mobile technology triggering. Many individuals in SUD treatment reported using mobile phones to buy or sell drugs; as such, they took measures to adapt their use of mobile technology as they changed substance use behaviors. As they entered recovery, individuals relied on mobile phones for affiliational, emotional, informational, and instrumental support, though some did share they found some aspects of mobile phones triggering. Conclusion: These findings highlight the importance of treatment providers engaging in conversations around mobile phone use to help individuals avoid triggers and connect with social supports. These findings uncover new opportunities for recovery support interventions utilizing mobile phones as a delivery mechanism.

This study examined the limited efficacy of a mixed media campaign that promoted bystander intervention as a sexual violence (SV) prevention strategy and aimed to decrease alcohol use. A quasi-experimental design was used to assess the limited efficacy of the Be a Watch Dawg mixed media campaign implemented at a large Southeastern public university in 2017. Social marketing along with social cognitive theory, social norms theory, and theory of planned behavior were utilized as the framework for the campaign. Be a Watch Dawg promoted bystander intervention in SV risk situations and targeted bystanders' alcohol use via social media (e.g., Facebook, Instagram, and Twitter) and printed materials (e.g., posters, stickers, and handbills). Participants included 244 undergraduate students 18 to 24 years of age. Study outcomes included bystander intervention, intentions to intervene, and alcohol use. Adjusted linear regression and logistic regression models were used to examine differences in outcomes between pre and postcampaign samples as well as associations with campaign exposure. Significant increases in bystander intervention were observed between the pre and postcampaign samples. Campaign exposure was marginally related to intentions to intervene but was not significantly associated with bystander intervention. Social media analytics revealed that the campaign reached 39,466 social media users and received 50,854 impressions and 19,523 views. A mixed media campaign may be a promising and low-resource approach to increase bystander intervention as a strategy to combat campus SV.

Approximately 41% of adults aged 18-24 years in the United States are enrolled in a college or university (1). Wearing a face mask can reduce transmission of SARS-CoV-2, the virus that causes coronavirus disease 2019 (COVID-19) (2), and many colleges and universities mandate mask use in public locations and outdoors when within six feet of others. Studies based on self-report have described mask use ranging from 69.1% to 86.1% among adults aged 18-29 years (3); however, more objective measures are needed. Direct observation by trained observers is the accepted standard for monitoring behaviors such as hand hygiene (4). In this investigation, direct observation was used to estimate the proportion of persons wearing masks and the proportion of persons wearing masks correctly (i.e., covering the nose and mouth and secured under the chin*) on campus and at nearby off-campus locations at six rural and suburban universities with mask mandates in the southern and western United States. Trained student observers recorded mask use for up to 8 weeks from fixed sites on campus and nearby. Among 17,200 observed persons, 85.5% wore masks, with 89.7% of those persons wearing the mask correctly (overall correct mask use: 76.7%). Among persons observed indoors, 91.7% wore masks correctly. The proportion correctly wearing masks indoors varied by mask type, from 96.8% for N95-type masks and 92.2% for cloth masks to 78.9% for bandanas, scarves, and similar face coverings. Observed indoor mask use was high at these six universities with mask mandates. Colleges and universities can use direct observation findings to tailor training and messaging toward increasing correct mask use., Competing Interests: All authors have completed and submitted the International Committee of Medical Journal Editors form for disclosure of potential conflicts of interest. No potential conflicts of interest were disclosed.

Background: Electronic cigarette (e-cigarette) conventions regularly bring together thousands of users around the world. In these environments, secondhand exposures to high concentrations of e-cigarette emissions are prevalent. Some biomarkers for tobacco smoke exposure may be used to characterize secondhand e-cigarette exposures in such an environment., Methods: Participants who did not use any tobacco product attended four separate e-cigarette events for approximately six hours. Urine and saliva samples were collected from participants prior to the event, immediately after the event, 4-h after the event, and the next morning (first void). Urine samples from 34 participants were analyzed for cotinine, trans-3'-hydroxycotinine, S-(3-hydroxypropyl)-N-acetylcysteine (3-HPMA), S-carboxyethyl-N-acetylcysteine (CEMA), select tobacco-specific nitrosamines (TSNAs), and 8-isoprostane. Saliva samples were analyzed for cotinine and trans-3'-hydroxycotinine., Results: Data from 28 of 34 participants were used in the data analysis. Creatinine-adjusted urinary cotinine concentrations increased up to 13-fold and peaked 4-h after completed exposure (range of adjusted geometric means [AGMs] = 0.352-2.31 μg/g creatinine). Salivary cotinine concentrations were also the highest 4-h after completed exposure (range of AGMs = 0.0373-0.167 ng/mL). Salivary cotinine and creatinine-corrected concentrations of urinary cotinine, trans-3'-hydroxycotinine, CEMA, and 3-HPMA varied significantly across sampling times. Urinary and salivary cotinine, urinary trans-3'-hydroxycotinine, and urinary 3-HPMA concentrations also varied significantly across events., Conclusion: Secondhand e-cigarette exposures lasting six hours resulted in significant changes in exposure biomarker concentrations of both nicotine and acrolein but did not change exposure to tobacco-specific nitrosamines. Additional research is needed to understand the relationship between biomarker concentrations and environmental concentrations of toxicants in e-cigarette emissions., (Published by Elsevier GmbH.)

In the USA, partner non-monogamy is reported to be more common among African American women than White women and may contribute to African American women's increased risk for HIV and other sexually transmitted infections (STIs). Few studies have explicitly and comprehensively described the protective behaviours that African American women employ with non-monogamous partners to reduce their HIV risk. We conducted interviews to examine protective behaviours among 11 African American women aged 18-24 years who perceived that a partner in the preceding 12 months had another sex partner. Participants described three types of partnerships with 29 non-monogamous men; these partnerships clustered into three categories. Narrative analysis revealed an overall paucity of protective behaviours with non-monogamous partners. Protective behaviours (i.e. communication and condom use) were informed by partnership type, rather than perceptions of non-monogamy. There were few instances in which partner non-monogamy motivated women to terminate sex partnerships. Rather, these decisions were often motivated by changes in other relationship dynamics. To address HIV/STI risk related to partner non-monogamy, HIV prevention strategies for young African American women should emphasise the importance of condom use in all non-marital partnership types. Interventions where testing is available may be effective for women who frequently test for HIV/STIs but do not use condoms.

Background: Electronic cigarette (e-cigarette) conventions bring hundreds to thousands of e-cigarette users together socially regularly across the world. E-cigarette secondhand exposures to chemicals in this environment, likely the public setting with the highest concentration of e-cigarette secondhand aerosol, have not been characterized., Methods: Air sampling for formaldehyde, acetaldehyde, acrolein, nicotine, and propylene glycol was conducted at three e-cigarette conventions and one smaller event from April 2016 to March 2017 in three states in the Southeastern United States. Volunteers attended the events as members of the public and wore backpacks containing air sampling pumps. Control sampling was conducted when venues were crowded for non-e-cigarette events. Additional control sampling was conducted in two venues when they were empty., Results: Formaldehyde and acetaldehyde concentrations during e-cigarette events were comparable to background concentrations. The median formaldehyde concentrations during events, crowded control events, and empty control events were 12.0, 10.5, and 12.5 μg/m 3 , respectively. The median acetaldehyde concentrations during events, crowded control events, and empty control events were 9.7, 15.5, and 3.5 μg/m 3 , respectively. Propylene glycol and nicotine were not detected during control sampling. The median nicotine concentration during events was 1.1 μg/m 3 . The median propylene glycol concentration during events was 305.5 μg/m 3 ., Conclusion: Results indicate e-cigarette secondhand exposures are sources of elevated nicotine and propylene glycol exposures. Secondhand exposures to e-cigarettes did not contain consistently elevated concentrations of formaldehyde or acetaldehyde. Additional research is needed to characterize exposures via inhalation to propylene glycol at concentrations measured in this study., (Copyright © 2018 Elsevier GmbH. All rights reserved.)

Electronic cigarette (e-cigarette) conventions are trade shows held across the globe to promote e-cigarette products and provide a venue for users to socialize. E-cigarette users that attend these events likely represent the most intensive e-cigarette user group. No study has characterized addiction and behavior characteristics in this population. We surveyed 131 e-cigarette users attending a large Southeastern e-cigarette convention in Fall 2015. All questions from the Fagerstrom Test for Nicotine Dependence (FTND), select questions from the Penn State Electronic Cigarette Dependence Index, and novel user behavior questions were included. In total, 25 questions were included in the survey. FTND scores were calculated for each respondent who answered all six FTND questions (n = 117). Fisher's Exact Chi square test was used to assess the relationship between addiction and behavior characteristics and FTND scores. Most respondents were classified as moderately dependent (score 5-7, 45.3% of respondents). Length of use, waking at night to use an e-cigarette, strength of cravings, strength of urges over the past week, and frequency of visiting e-cigarette blogs were significantly associated with FTND scores. E-cigarettes users have average FTND scores higher than tobacco smokers. Scores were not significantly associated with prior tobacco cigarette use. Characteristics associated with tobacco smokers' nicotine addiction, such as waking at night to smoke and strength of cravings experienced, are relevant to e-cigarette users. E-cigarettes do not contain the magnitude of toxicants in tobacco cigarettes, but e-cigarettes may produce new chemical exposures evidenced by the adverse health effects reported by some respondents.

This study examined the prevalence of and factors (psychological climate for change and staff attributes) related to indoor and outdoor tobacco bans for patients, employees, and visitors in U.S. substance use disorder treatment programs. Data were collected from a random sample of 1,026 program administrators. Almost all programs banned tobacco use indoors and around one third banned tobacco use outdoors. When there was no tobacco ban, the majority of programs restricted smoking to designated indoor and/or outdoor areas. Further, all psychological climate for change factors (perceived program support, perceived tobacco culture, and tobacco ban beliefs) but none of the staff attributes (percentage licensed/certified clinicians, percentage clinicians with master's degrees, total staff with education in health-related field) were significantly related to the implementation of comprehensive tobacco bans (both indoors and outdoors).

Purpose: Adolescence is a prime developmental stage for early tobacco cessation (TC) intervention. This study examined substance use disorder counselors' reports of the availability and implementation of TC services (behavioral treatments and pharmacotherapies) in their treatment programs and the relationship between their tobacco-related knowledge and implementation of TC services., Methods: Survey data were collected in 2012 from 63 counselors working in 22 adolescent-only treatment programs. Measures included 15 TC behavioral treatments, nine TC pharmacotherapies, and three tobacco-related knowledge scales (morbidity/mortality, modalities and effectiveness, pharmacology)., Results: First, nine of the 15 behavioral treatments are reported as being available by more than half of counselors; four of the 15 behavioral treatments are used by counselors with more than half of adolescents. Of the nine pharmacotherapies, availability of the nicotine patch is reported by almost 40%, buproprion by nearly 30%, and clonidine by about 21% of counselors. Pharmacotherapies are used by counselors with very few adolescents. Second, counselors' tobacco-related knowledge varies based on the knowledge scale examined. Third, we only find a significant positive relationship between counselors' implementation of TC behavioral treatments and TC modalities and effectiveness knowledge., Discussion: Findings suggest that more behavioral treatments should be made available in substance use disorder treatment programs considering that they are the main treatment recommendation for adolescents. Counselors should be encouraged to routinely use a wide range of available behavioral treatments. Finally, counselors should be encouraged to expand their knowledge of TC modalities and effectiveness because of the relationship with behavioral treatments implementation., (Copyright © 2015 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.)

This study examined longitudinal adoption patterns of tobacco cessation (TC) counseling and TC pharmacotherapy in substance use disorder treatment programs and baseline predictors (program characteristics and program culture) of these patterns 12-months later. Telephone survey data were collected in 2010 from 685 randomly sampled program administrators working in geographically representative treatment programs across the U.S. Regarding TC counseling, about 41% of programs never adopt, 33% sustain, and 27% change adoption patterns. Concerning TC pharmacotherapy, about 62% of programs never adopt, 19% sustain, and 18% change adoption patterns. The three most consistent predictors of counseling adoption patterns are TC reimbursement, TC financial resource availability, and smoking culture. For TC pharmacotherapy adoption patterns, the most consistent predictors include profit status, TC reimbursement, level of care, TC financial resource availability, and smoking culture. Findings provide insights into program characteristics and program culture as both potential barriers and facilitators of longitudinal TCS adoption., (Copyright © 2015 Elsevier Inc. All rights reserved.)

Low income adults with substance use disorders (SUDs) have a high prevalence of tobacco use and often limited access to tobacco cessation treatment. This study examines the relationship between low-income SUD patient census (i.e., percentage of patients whose treatment costs are covered by Medicaid and Federal block grants) and SUD programs' availability of three evidence-based tobacco cessation services: behavioral treatments, system-level support, and pharmacotherapy. Data were collected from a random sample of 1,006 program administrators in 2010. Mixed-effects models results show that the percentage of low-income patients is significantly positively associated with the availability of behavioral treatments and system-level support but not pharmacotherapy. Thus, low-income patients may have similar access to tobacco cessation pharmacotherapy but greater access to behavioral treatments and system-level support. However, the availability of tobacco cessation services is not widespread overall, which may hamper access to extensive services to address low-income SUD patients' high smoking rates.

Study Background: Despite efforts to promote the use of tobacco cessation services (TCS), implementation extensiveness remains limited. This study investigated three factors (cognitive, behavioral, environmental) identified by social cognitive theory as predictors of substance use disorder counselors' likelihood of use versus non-use of tobacco cessation (TC) 5 A's (ask patients about tobacco use, advise to quit, assess willingness to quit, assist in quitting, arrange for follow-up contact), counseling, and pharmacotherapy with their patients who smoke cigarettes., Methods: Data were collected in 2010 from 942 counselors working in 257 treatment programs that offered TCS. Cognitive factors included perceived job competence and TC attitudes. Behavioral factors encompassed TC-related skills and general training. External factors consisted of TC financial resource availability and coworker TC attitudes. Data were analyzed using logistic regression models with nested data., Results: Approximately 86% of counselors used the 5 A's, 76% used counseling, and 53% used pharmacotherapy. When counselors had greater TC-related skills and greater general training they were more likely to implement the 5 A's. Implementation of counseling was more likely when counselors had more positive attitudes toward TC treatment, greater general training, greater financial resource availability, and when coworkers had more positive attitudes toward TC treatment. Implementation of pharmacotherapy was more likely when counselors had more positive attitudes toward TC treatment, greater general training, and greater financial resource availability., Conclusion: Findings indicate that interventions to promote TCS implementation should consider all three factors simultaneously as suggested by social cognitive theory.

This study aimed to understand substance use disorder counselors' implementation of evidence-based tobacco cessation services (TCS) with their patients who smoke. Drawing from an established adoption of innovations framework, we investigated the association between counselors' perceptions of the availability of TCS (both pharmacotherapies and behavioral treatments) in their treatment program and the implementation of TCS (both pharmacotherapies and behavioral treatments) with their patients who smoke and whether this association is moderated by the strength of an organization's climate for implementation and the fit of the innovation with users' values. Data were collected in 2010 from 682 counselors working in 239 treatment programs across the U.S. that offer evidence-based TCS. Mixed-effect models showed that perceived availability of TCS was related with greater TCS implementation. This relationship was moderated by several indicators of climate for implementation but not by the fit of the innovation with users' values., (Copyright © 2014 Elsevier Inc. All rights reserved.)

This study examined the relationship between (1) three indicators of climate for innovation (clinician skills, absence of program obstacles, policy-related incentives) and adoption extensiveness of both behavioral treatments for tobacco cessation (TC) and system-level support for TC in substance use disorder treatment programs, (2) a program's 12-step treatment orientation and adoption extensiveness, and (3) whether 12-step treatment orientation moderates the relationship between climate for innovation and adoption extensiveness. Data were obtained from a random sample of 1006 program administrators. Hierarchical regression results showed that both absence of program obstacles and policy-related incentives are positively related to adoption extensiveness. Twelve-step treatment orientation is neither related to adoption extensiveness nor a moderator of the relationship between climate for innovation and adoption extensiveness. Although the adoption of both behavioral treatments for TC and system-level support for TC is not extensive, we conclude that a 12-step treatment orientation neither hampers nor promotes adoption extensiveness., (Copyright © 2014 Elsevier Inc. All rights reserved.)

Objectives: This study investigated 3 organizational factors (ie, counseling staff clinical skills, absence of treatment program obstacles, and policy-related incentives) as predictors of tobacco cessation pharmacotherapy (TCP) adoption (comprised of the 9 available TCPs) in addiction treatment programs using the innovation implementation effectiveness framework., Methods: Data were obtained in 2010 from a random sample of 1006 addiction treatment program administrators located across the United States using structured telephone interviews., Results: According to program administrator reports, TCP is adopted in approximately 30% of treatment programs. Negative binomial regression results show that fewer treatment program obstacles and more policy-related incentives are related to greater adoption of TCP. Counter to prediction, clinical skills are unrelated to TCP adoption., Conclusions: Our findings suggest that organizational factors, on the basis of established theoretical frameworks, merit further examination as facilitators of the adoption of diverse TCP in addiction treatment programs.

US veterinary students are subject to significant stress throughout their veterinary education. In this article, the authors characterize the use of over-the-counter (OTC) medications and relate their use to stress in a veterinary student population. Of the students sampled, 35% were OTC medication users; 33% of these were regular OTC medication users. Forty-three percent of students were energy drink (ED) users; 45% of these were regular ED users. OTC medication users had significantly higher stress scores than non-OTC medication users, and ED users had significantly higher anxiety scores than non-ED users. The most common reasons for use given by OTC medication users were to help with studying and to fall asleep at night. Depression scores were significantly higher for juniors and sophomores than for freshmen. Depression, stress, and anxiety scores were all lower in the Colorado State University students when compared with the University of Georgia students. OTC medication and ED veterinary student users had distinct characteristics that differed from those of nonusers. Users suffered from more stress and anxiety and had more difficulties with sleep, which may have affected their overall health and academic performance. Educating veterinary students about the consequences of using OTC medication and ED and providing counseling support may be of benefit to veterinary students' psychological well-being.

Background: The purpose of this study was to examine attitudes towards attempts to limit second-hand smoke (SHS) in five Eastern European nations., Methods: The data consist of a Eurobarometer (64.3) survey distributed from November to December 2005. Logistic regression was employed to investigate support levels for indoor smoking bans across the five political units., Results: Across nations, there is more support for smoking bans in offices and indoor work spaces and indoor public space as opposed to restaurants and bars and pubs. Personal smoking behaviours are linked strongly with the smoking bans. Most importantly, it is specific knowledge about the health dangers of smoking which fosters support for indoor smoking bans., Conclusion: Policy implications suggest that government and the media must disseminate accurate information about the harm of smoking to broader segments of the population to gain support for policies that affect the dangers of SHS in these nations.

Health promotion strategies continue to evolve, with interventions using e-mail, text messaging, and Web sites becoming commonplace. The use of online virtual worlds is a less familiar venue for health promotion but offers numerous possibilities for wired citizens with health issues. The authors discuss three examples of virtual worlds--the River City Project, Whyville, and Second Life--and how health promotion strategies can be implemented in virtual worlds. They also address several challenges associated with implementing health interventions in virtual worlds, including questions of ethics, diffusion of health knowledge and logistics of intervening outside of the real world.

Background: In this study, we investigated different sources of information concerning the use of tobacco and the impact that these sources may have on attitudes toward tobacco policies., Methods: We surveyed 4336 high school students gathered from 5 high schools in the Southeastern United States., Results: The results indicate that just over half of these youth are supportive of public policies targeting bans on smoking in public places and having a minimum age to purchase tobacco products. Race is significant in impacting both age restriction and prohibition of smoking in public places, with African American youth being less supportive of both dependent variables. However, holding this variable constant in an ordinal logistic regression, we found that attitudes toward policy are impacted by the environment related to smoking in which the youth lives; the extent to which the youth believes he/she is well informed; and more important, the amount of correct and accurate information on smoking the youth possess., Conclusions: Communicating accurate information is vital in increasing youth support for pending or already existing tobacco policies.

Purpose: This paper examines the impact of smoking menthol cigarettes among secondary students, primarily African Americans, across five measures of smoking behavior., Methods: Data were gathered from a 2006 survey of six secondary schools in a large urban area in the southeastern United States. Ordered logit analysis is employed to estimate race and menthol effects on cigarette consumption., Results: African American youth smoke at lower rates than white adolescents; menthol smokers consume cigarettes at higher rates irrespective of race. Most importantly, there is a strong interaction effect with black menthol smokers demonstrating the highest levels of cigarette consumption., Conclusions: There is a need to provide adolescent and adult African Americans accurate information on the dangers of menthol cigarettes. Any proposed legislation should consider the special problems of menthol and its relationship to high cigarette consumption, especially for African American adolescents.

Little research has been reported on the risky behaviors of pre-driving adolescents revolving around alcohol use, in particular impaired driving behaviors, which in general have been shown to be higher in rural areas. This study investigated the prevalence of drinking while driving and riding with a drinking driver among 290 middle school students in a Mississippi Delta area middle school. Just under half (45.3%) responded that at least once in the past 30 days they had ridden with a drinking driver and 17% indicated they had driven an automobile after drinking alcohol. The prevalence of underage drinking, driving under the influence of alcohol, and riding with a drinking driver among our sample of middle school students is alarming. This study shows alcohol-related driving behaviors are not solely performed by those who are legally licensed to drive, but simply by those who have access to vehicles. The authors recommend that prevention programs focusing on reducing the incidence of impaired driving should start in early adolescence.

This study found 20.4% of children attending a middle school located in rural Mississippi had used inhalants to "get high", a figure that is much larger than the national average. Many (3.4%) students reported they had used inhalants on 10 or more occasions. Inhalant use was most associated with being younger, ever smoking, riding with a driver who had been drinking, and being involved in a fight. Nearly twice as many younger students reported usage in our sample compared to other studies. Longitudinal studies need to be conducted to investigate whether use of inhalants is a precursor to other risky behaviors, and subsequent progression to alcohol abuse or illicit drug use.

This study investigated racial differences of tobacco use and social exposure to tobacco products in a sample of middle school students. Questionnaires were administered in January 2005 to 290 students in a Mississippi Delta-area middle school. The participants were 51.0% female and 56.6% African American. Unadjusted odds ratios revealed that Caucasian students were statistically more likely than were African American students to (1) have ever tried smoking, (2) have ever been a daily smoker, (3) have smoked in the past 30 days, (4) live with someone who smokes, (5) have seen a parent or guardian smoke, and (6) have friends who smoke. In contrast, African Americans were more likely to report "no one is allowed to smoke" in their home. Caucasian females had the highest rates of smoking, as well as the highest exposure to social smoking behaviors. This study not only showed that Caucasians were indeed smoking more but also that African American adolescents do not have the same exposure to social smoking, particularly African American females. Of particular interest was why the differences eventually dissipate and smoking rates are virtually the same in adulthood. A greater understanding of the impact of exposure to tobacco use on an adolescent's own tobacco use is vital to prevention efforts, especially in regard to racial differences. Future research on youth tobacco prevention and cessation programs should focus on sociocultural and racial differences in the development of tobacco use in adolescents.