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Tobacco-related deaths remain the leading cause of preventable death in the United States. Veterans suffering from posttraumatic stress disorder (PTSD)—about 11% of those receiving care from the Department of Veterans Affairs (VA)—have triple the risk of developing tobacco use disorder (TUD). The most efficacious strategies being used at the VA for smoking cessation only result in a 23% abstinence rate, and veterans with PTSD only achieve a 4.5% abstinence rate. Therefore, there is a critical need to develop more effective treatments for smoking cessation. Recent studies suggest the insula is integrally involved in the neurocircuitry of TUD. Thus, we propose a feasibility phase II randomized controlled trial (RCT) to study a form of repetitive transcranial magnetic stimulation (rTMS) called intermittent theta burst stimulation (iTBS). iTBS has the advantage of allowing for a patterned form of stimulation delivery that we will administer at 90% of the subject's resting motor threshold (rMT) applied over a region in the right post-central gyrus most functionally connected to the right posterior insula. We hypothesize that by increasing functional connectivity between the right post-central gyrus and the right posterior insula, withdrawal symptoms and short-term smoking cessation outcomes will improve. Fifty eligible veterans with comorbid TUD and PTSD will be randomly assigned to active-iTBS + cognitive behavioral therapy (CBT) + nicotine replacement therapy (NRT) (n = 25) or sham-iTBS + CBT + NRT (n = 25). The primary outcome, feasibility, will be determined by achieving a recruitment of 50 participants and retention rate of 80%. The success of iTBS will be evaluated through self-reported nicotine use, cravings, withdrawal symptoms, and abstinence following quit date (confirmed by bioverification) along with evaluation for target engagement through neuroimaging changes, specifically connectivity differences between the insula and other regions of interest. [ABSTRACT FROM AUTHOR]

Although allostatic load (AL) is a key concept to reflect physiologic wear and tear from stress, older adults are underrepresented in AL-related research, especially the oldest old (≥80). Further, attenuative factors are often unaccounted for. This longitudinal analysis using data from National Health and Aging Trends Study investigated relationships of AL in 2017 and multi-wave (1) comorbidity accumulation using multilevel Poisson modeling and (2) mortality risk using survival analysis. By year five (2022), each incremental AL increase that older adults (n = 3614) experienced was associated with a 47% increase in comorbidity (p <.001), and a 33% increased mortality risk (p <.001). This research supports a shift to a more proactive, health promotion/risk mitigation paradigm through informing intervention research targeting AL, which is currently scarce. Identifying potentially modifiable and key driving factors influencing the relationship between AL and health among older adults is an important next step to inform intervention design. [ABSTRACT FROM AUTHOR]

Background and aims: Smoking is a risk factor for multiple sclerosis (MS) development, symptom burden, decreased medication efficacy, and increased disease‐related mortality. Veterans with MS (VwMS) smoke at critically high rates; however, treatment rates and possible disparities are unknown. To promote equitable treatment, we aim to investigate smoking cessation prescription practices for VwMS across social determinant factors. Methods: We extracted data from the national Veterans Health Administration electronic health records between October 1, 2017, and September 30, 2018. To derive marginal estimates of the association of MS with receipt of smoking‐cessation pharmacotherapy, we used propensity score matching through the extreme gradient boosting machine learning model. VwMS who smoke were matched with veterans without MS who smoke on factors including age, race, depression, and healthcare visits. To assess the marginal association of MS with different cessation treatments, we used logistic regression and conducted stratified analyses by sex, race, and ethnicity. Results: The matched sample achieved a good balance across most covariates, compared to the pre‐match sample. VwMS (n = 3320) had decreased odds of receiving prescriptions for nicotine patches ([Odds Ratio]OR = 0.86, p <.01), non‐patch nicotine replacement therapy (NRT; OR = 0.81, p <.001), and standard practice dual NRT (OR = 0.77, p <.01), compared to matches without MS (n = 13,280). Men with MS had lower odds of receiving prescriptions for nicotine patches (OR = 0.88, p =.05), non‐patch NRT (OR = 0.77, p <.001), and dual NRT (OR = 0.72, p <.001). Similarly, Black VwMS had lower odds of receiving prescriptions for patches (OR = 0.62, p <.001), non‐patch NRT (OR = 0.75, p <.05), and dual NRT (OR = 0.52, p <.01). The odds of receiving prescriptions for bupropion or varenicline did not differ between VwMS and matches without MS. Conclusion: VwMS received significantly less smoking cessation treatment, compared to matched controls without MS, showing a critical gap in health services as VwMS are not receiving dual NRT as the standard of care. Prescription rates were especially lower for male and Black VwMS, suggesting that under‐represented demographic groups outside of the white female category, most often considered as the "traditional MS" group, could be under‐treated regarding smoking cessation support. This foundational work will help inform future work to promote equitable treatment and implementation of cessation interventions for people living with MS. [ABSTRACT FROM AUTHOR]

This article discusses the need for targeted smoking cessation interventions for individuals with multiple sclerosis (MS). Smoking is a significant risk factor for developing MS and can worsen disease progression and symptoms. However, there is a lack of resources and interventions to support smoking cessation in this population. The article highlights key considerations for intervention development, such as addressing medication interactions, stress, MS-associated symptoms, combustion effects, timing of interventions, and the use of digital or telehealth formats. Further research is needed to determine the effectiveness of cessation interventions and the optimal strategies for engaging individuals with MS. [Extracted from the article]

Objectives: The Coronavirus-2019 (COVID-19) pandemic presents a unique burden specifically for workers in service industries. However, limited research on service worker's experience during the onset of COVID-19 exists. We aimed to describe the experiences and concerns of service industry workers during the pandemic's onset. Methods: This is a mixed-method study. Participants were recruited through social media and completed either a survey or a phone interview during May and June 2020. The survey and transcribed interview data were analyzed using the SPSS software and content analysis, respectively. Results: Twenty-seven individuals completed audio-recorded phone interviews and 28 completed the survey. Participants were mostly women between 19 and 65 years old. Participants worked in food retail (n = 23), restaurant (n = 25), and hospitality (n = 7) industries. There was discordance in perceived threat level of COVID-19. Most participants reported that their workplace complied with their state's mandates for protection measures, while others reported lacking basic supplies such as soap, hand sanitizer, and masks. Job insecurity, change of job tasks, and work hours were the most common ways that COVID-19 affected the workers. Worker's assertiveness to self-protect while at work was influenced by their perceived severity of the pandemic. Conclusion/Application to Practice: This study highlights the vulnerability of service workers relating to job security and job tasks during the pandemic. Organizational processes are needed to promote safe work environments and facilitate access to resources for these workers. In addition, occupational health practitioners need to be aware of and address the emerging health risks and worker needs. [ABSTRACT FROM AUTHOR]

Sickle cell disease (SCD) remains a public health priority in the United States because of its association with complex health needs, reduced life expectancy, lifelong disabilities, and high cost of care. A cross-sectional analysis was conducted to calculate the crude and race-specific birth prevalence for SCD using state newborn screening program records during 2016-2020 from 11 Sickle Cell Data Collection program states. The percentage distribution of birth mother residence within Social Vulnerability Index quartiles was derived. Among 3,305 newborns with confirmed SCD (including 57% with homozygous hemoglobin S or sickle β-null thalassemia across 11 states, 90% of whom were Black or African American [Black], and 4% of whom were Hispanic or Latino), the crude SCD birth prevalence was 4.83 per 10,000 (one in every 2,070) live births and 28.54 per 10,000 (one in every 350) non-Hispanic Black newborns. Approximately two thirds (67%) of mothers of newborns with SCD lived in counties with high or very high levels of social vulnerability; most mothers lived in counties with high or very high levels of vulnerability for racial and ethnic minority status (89%) and housing type and transportation (64%) themes. These findings can guide public health, health care systems, and community program planning and implementation that address social determinants of health for infants with SCD. Implementation of tailored interventions, including increasing access to transportation, improving housing, and advancing equity in high vulnerability areas, could facilitate care and improve health outcomes for children with SCD., Competing Interests: All authors have completed and submitted the International Committee of Medical Journal Editors form for disclosure of potential conflicts of interest. Sophia S. Horiuchi reports ownership of Natera stock and stock options and of Roche stock by her spouse. Mariam Kayle reports institutional support from Agios Medical Education Program and Novo Nordisk Independent Medical Education Activity to support the 11th Annual Sickle Cell Conference, September 8–9, 2023; receipt of consulting fees from Loyola University; receipt of honorarium for being an ad hoc reviewer from the National Institutes of Health (NIH), Center for Scientific Review, Social and Environmental Determinants of Health Study Section; and uncompensated membership in the American Society of Hematology Research Collaborative Data Hub Oversight Group, Sickle Cell Disease Subcommittee. Carri S. Polick reports support from the Veterans Administration and Duke University Clinical and Translational Science Institute. Ashima Singh reports institutional support from NIH, National Heart, Lung, and Blood Institute, the National Institute of Neurological Disorders and Stroke, and the Health Resources and Services Administration (HRSA) Sickle Cell Treatment Demonstration Program. John J. Strouse reports institutional support from the HRSA Southeast Region Coordinating Center Sickle Cell Treatment Demonstration Program and the North Carolina State Department of Health Sickle Cell Syndrome Program for the Duke Adult and Pediatric Sickle Cell Program; royalties from UpToDate for preparation of guidance on the use of hydroxyurea for sickle cell disease (SCD); consulting fees for GLG telephone consultation on SCD and Guidepoint telephone consultation on SCD; receipt of honoraria from the University of Rochester-Equity in Sickle Cell Disease Care; payment for medical legal expert testimony from Emory University in a case involving emergency department care of an adult with sickle beta thalassemia; travel support from the American Society of Hematology Sickle Cell Learning Community Meeting and Sickle Cell Disease Association of America Meeting to speak on behalf of the American Society of Hematology and travel support from the American Thrombosis Hemostasis Network Data Summit as an invited speaker on gene therapy for SCD: Design for Equity; payment for participation on a data safety monitoring board for disc medicines for phase 1 trial planning for bitopertin for SCD; and service as vice president of the Sickle Cell Adult Provider Network. No other potential conflicts of interest were disclosed.