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Cannabis users use different forms of cannabis, which are associated with distinct public health concerns. Policies that aim to regulate one specific form may have unintended impacts on other forms. This study examined the behavioral economic relationship between flower and concentrates, the two most common forms of cannabis. We surveyed 605 adult cannabis users (21+) who lived in one of the U.S. states that had legalized recreational cannabis by the time of interview in 2019. The participants completed simulated purchase tasks, which asked how much cannabis flower and concentrates they would purchase in the next 30 days at escalating prices. We estimated (a) demand indices and own-price elasticities using nonlinear exponential demand models and (b) group- and individual-level cross-price elasticities using log-linear demand models. The estimated rate of change in demand elasticity (α) was 0.00066 for cannabis flower (

Objective. The treatment of choledocholithiasis with duodenal stenosis is a clinical difficult problem. This study aimed to investigate the efficacy and safety of ERCP via gastroscopy in the treatment of choledocholithiasis and duodenal stenosis. Methods. From January 2015 to December 2020, 21 patients with choledocholithiasis with duodenal stenosis who underwent ERCP treatment under gastroscopy in our hospital were enrolled. The patients’ case characteristics, ERCP status, and complication rate were analyzed. Results. Among the 21 patients, 17 cases were successful in ERCP, and a total of 29 times ERCPs were performed, with an average of 1.71 times per patient. Among the failures of ERCP, selective deep intubation of common bile duct was unsuccessful in 4 cases. Six patients underwent multiple lithotomies, after the operation, of which 4 patients underwent secondary ERCP lithotomy and 2 patients underwent triple ERCP lithotomy. All patients successfully completed the balloon dilation without serious complications. Two patients developed mild acute pancreatitis after ERCP, and all recovered after medication. Conclusion. In patients with choledocholithiasis and duodenal stenosis, ERCP treatment by gastroscopy has a higher success rate and does not increase the incidence of complications, but there is a problem of cholecystolithiasis recurrence.

Stable and sensitive ctDNA biosensing in complex biological fluid is highly important but still remains a challenge. Herein, we develop a spherical nucleic acid reporter-based cascade CRISPR/Cas12a amplifier with improved stability and sensitivity (5 orders of magnitude).

ImportanceRecreational cannabis legalization (RCL) has been advocated as a way to reduce the number of individuals interacting with the US criminal justice system; in theory, however, cannabis decriminalization can achieve this objective without generating the negative public health consequences associated with RCL. It is still unclear whether RCL can bring additional benefits in terms of reducing cannabis possession arrests in states that have already decriminalized cannabis.ObjectiveTo examine whether RCL was associated with changes in cannabis possession arrests in US states that had already decriminalized cannabis during the study period and whether these changes differed across age and racial subgroups.Design, Setting, and ParticipantsThis repeated cross-sectional study used cannabis possession arrest data from the Federal Bureau of Investigation Uniform Crime Reporting Program (UCRP) for US states from 2010 through 2019. Statistical analysis was conducted from October 6, 2021, to October 12, 2022.ExposuresImplementation of statewide RCL.Main Outcomes and MeasuresCannabis possession arrest rates per 1000 population per year were assessed with a quasi-experimental difference-in-differences design and were used to estimate the association of RCL with arrest rates in RCL states that had or had not decriminalized cannabis before RCL. This association was also examined in subgroups for age (adults vs youths) and race (Black vs White).ResultsThis study included UCRP data for 31 US states, including 9 states that implemented RCL during the study period (4 without and 5 with decriminalization) and 22 non-RCL states. In the 4 states that had not decriminalized cannabis before legalization, RCL was associated with a 76.3% decrease (95% CI, −81.2% to −69.9%) in arrest rates among adults. In the 5 states that had already decriminalized cannabis, RCL was still associated with a substantial decrease in adult arrest rates (−40.0%; 95% CI, −55.1% to −19.8%). There was no association of RCL with changes in arrest rates among youths. In addition, changes in arrest rates associated with RCL did not differ among Black and White individuals.Conclusions and RelevanceIn this repeated cross-sectional study, RCL was associated with a sizable reduction in cannabis possession arrests among adults in states that had already decriminalized cannabis during the study period (2010-2019), albeit the magnitude was smaller compared with states that had not decriminalized cannabis before RCL. In addition, RCL did not seem to be associated with changes in arrest rates among youths or disparities in arrest rates among Black and White individuals.

Background In the past two decades, the U.S. saw an alarmingly increasing trend of benzodiazepine prescribing. Mandatory use of Prescription Drug Monitoring Programs (PDMPs) was suggested to have the potential to reduce opioid prescribing, but little is known about its impacts on benzodiazepines. This study examined whether PDMP data use mandates were associated with changes in benzodiazepine prescribing in the U.S. Methods Aggregate state quarterly prescription drug records of benzodiazepines for Medicaid enrollees during 2010–2017 were obtained from the U.S. Medicaid State Drug Utilization Data. Three population-adjusted outcome variables were evaluated, including quantity, dosage, and Medicaid spending of benzodiazepine prescriptions per quarter per 100 Medicaid enrollees. The primary policy variable was the state-wide implementation of PDMP data use mandates for benzodiazepines. To account for between-state variations in mandates, an additional policy variable was considered to indicate strong mandates on PDMP data use, which required all prescribers to query a patient's PDMP records for first prescribing and subsequent prescribing at least every 12 months. Linear regressions with difference-in-difference approach were used to assess the associations between PDMP data use mandates and benzodiazepine prescribing, controlling for state-level time-varying policy and socioeconomic covariates. Results The state-wide implementation of PDMP data use mandates for benzodiazepines was not associated with quantity, dosage, or Medicaid spending of benzodiazepine prescriptions. Strong mandates on PDMP data use were not associated with any benzodiazepine prescribing outcomes, either. Conclusions There was no evidence for the associations between PDMP data use mandates for benzodiazepines and changes in benzodiazepine prescribing among Medicaid enrollees. Future research is warranted to replicate the study in other populations using individual patient records and continuously monitor the trends in benzodiazepine prescribing in association with PDMPs.

OBJECTIVES Our aim was to compare the effect of 2 treatment models on attendance and child weight status: a less intense guided self-help (GSH) program delivered in the primary care setting versus traditional family-based behavioral treatment (FBT) delivered in an academic center. METHODS We conducted a randomized clinical trial among 164 children between 5 and 13 years old with a BMI ≥85th percentile and their parents. The intervention group (GSH) received 14 individual sessions over 6 months, with 5.3 hours of treatment. The control group (FBT) received 20 group-based sessions over 6 months, with 20 hours of treatment. Main outcomes included proportion of sessions families attended and change in child BMI z-score (BMIz), percentage from the 95th BMI percentile, difference from the 95th BMI percentile at the end of treatment, and 6-month follow-up. RESULTS Mean age of children was 9.6 years, BMI z-score 2.1, 49% female, and >90% Latino. The odds of attending GSH compared to FBT was 2.2 (P < 0.01). Those assigned to GSH had a 67% reduced risk of attrition (hazard ratio = 0.33, 95% confidence interval 0.22–0.50, P < .001). Intent-to-treat analysis showed no between-group differences in change in BMIz and percentage from the 95th BMI percentile over time. Combined, there was a significant reduction in BMIz from baseline to posttreatment (β = −0.07 (0.01), P < .01, d: 0.60) and a slight increase from posttreatment to follow-up (β = 0.007 (0.13), P = .56). CONCLUSIONS This study provides support for a novel, less intense GSH model of obesity treatment, which can be implemented in the primary care setting. Future studies should examine effective approaches to dissemination and implementation of GSH in different settings to increase access to treatment.

The uptake rate of COVID-19 vaccines among children remains low in the U.S. This study aims to 1) identify sociodemographic and behavioral factors influencing parental refusal of vaccinating children, and 2) quantify the relative importance of vaccine characteristics in parental hesitancy of vaccinating children. An online survey was conducted from October to November 2021 among a probability-based, representative sample of 1456 parents with children under age 18. The survey included a discrete choice experiment asking parents to choose between two hypothetical COVID-19 vaccine alternatives with varying levels of characteristics in 10 hypothetical scenarios. Logistic regressions were used to estimate parental refusal (refused to choose any vaccine alternatives in all hypothetical scenarios) and random parameter logit regressions were used to estimate parental hesitancy (choice of vaccine alternatives depended on vaccine characteristics) of vaccinating children. About 20% parents refused to vaccinate children. The refusal is predicted by parents' sociodemographic characteristics, political orientation, vaccination status, and parents' and children's previous exposure with COVID-19. Among parents who were willing to consider vaccinating children, the most important vaccine characteristics are risk of severe side effects (31.2% relative importance) and effectiveness (30.7%), followed by protection duration (22.6%), local coverage (9.4%), and hospitalization rate of unvaccinated children (6.1%). Our findings imply that policymakers and public health professionals could develop outreach programs at community level to encourage specific subgroups and focus on vaccination depoliticization. Effectively communicating the low risk of severe side effects and high effectiveness of the vaccines may relieve some of the parental hesitancy.

In the United States (U.S), cannabis policies have been increasingly liberalized whereas tobacco policies have been increasingly stringent. Given the high prevalence of cannabis and tobacco dual use, there are concerns that a policy regulating one substance may unintendedly influence the other. This study examined the responsiveness of the demand for cannabis joints and cigarettes when price varied.The study included 338 adult participants (21+) who used both cannabis and tobacco and lived in one of the U.S. states with recreational cannabis legalized by the time of interview in 2019. They completed hypothetical purchase tasks to indicate the quantity desired of cannabis joints and cigarette packs 1) when only one substance was available with escalating prices and 2) when both substances were concurrently available with escalating prices of cannabis joints and a fixed price of cigarette packs. We estimated 1) the own-price elasticity of demand for each substance using nonlinear exponential demand model, and 2) the cross-price elasticity of demand at aggregate level using nonlinear exponential demand model and at individual level using log-linear demand model.The estimates for the rate of change of own-price elasticity (α) were 0.0011 (SE = 0.000039, p 0.001) for cannabis joints and 0.00095 (SE = 0.000037, p 0.001) for cigarette packs. The aggregate-level estimates of cross-price elasticity (I = 13.032, SE = 0.34, p 0.001; β = 0.0029, SE = 0.0021, p 0.05) suggest an independent relationship between the two substances. At individual level, 78.70% of the participants treated the two substances as independent, 17.46% as complements, and 3.85% as substitutes.For most adults who used both cannabis and tobacco in the U.S., cannabis joints and cigarettes had an independent relationship. Policies regulating the price of cannabis may not have large unintended consequences on cigarette use.

BACKGROUND AND AIMS. Different cannabis administration methods have differential impacts on health. This study aimed to describe administration methods among cannabis users in the US categorized by 1) use purpose and 2) state legalization status. DESIGN. Cross-sectional, probability-based online survey in 2020. SETTING. All 50 states and Washington DC in the US. PARTICIPANTS. A total of 21,903 adults (18+) were recruited from a probability-based online panel to provide nationally representative estimates. METHODS. Eleven administration methods were grouped into combustion, vaporization, ingestion, and topicals. Weighted prevalence was reported among 1) medical-only, recreational-only, and dual-purpose users based on self-reported purposes and 2) users in states that legalized both recreational and medical cannabis (RCL states), legalized medical cannabis only, and did not legalize cannabis. DESCRIPTIVE FINDINGS. Among past-year users, the proportions of medical-only, recreational-only, and dual-purpose users were 25.55%, 43.81%, and 30.64%, respectively. The most common primary methods were combustion (42.08%) and topicals (28.65%) for medical purposes and combustion (72.07%) and ingestion (15.05%) for recreational purposes. Dual-purpose users were more likely to report combustion and vaporization but less likely to report ingestion and topicals as primary methods for medical use than medical-only users (Ps.05). CONCLUSION. Cannabis users whose purposes are medical, recreational or both tend to differ in their selected administration methods.

BackgroundThere is an expanding unregulated market for a psychotropic compound called ∆8-Tetrahydrocannabinol (delta-8-THC) that is being derived from hemp, but there are no empirical estimates of public interest in this compound.MethodsTo measure public interest, we obtained yearly Google query fractions (QFs) that mentioned delta-8-THC (i.e., "delta 8," "delta-8," or "Δ8") for the past decade (from January 2011 through August 2021) for every country and territory in the world and every state in the United States (US) from Google Trends. We also obtained the same trends for the last complete month of data for all US states (July 2021) to compare across cannabis use policies. We summarized QFs across years, countries, US states and cannabis policies in US states using linear regression, means and ratios. We estimated raw search counts for the US using comscore.com.ResultsThe global rate of delta-8-THC searches was stable between 2011 and 2019 before increasing by 257.0% from 2019 to 2020 and 705.0% from 2020 to 2021. In 2021, the rate of delta-8-THC searches in the US was at least 10 times higher than the rates in other countries or territories. In absolute terms, there were 22.3 million delta-8-THC searches in the US in the first 8 months of 2021 alone. Increases in delta-8-THC searches from 2020 to 2021 occurred in all 50 US states and the District of Columbia (Mean 854.2%; range=256.4% - 2831.2%) but continued to vary substantially between states in 2021. In July 2021, the legal status of delta-9-THC use across US states explained 49.0% of the variance in delta-8-THC QFs between US states (R2=0.490; p < 0.001) and was inversely associated, where delta-8-THC QFs were higher in jurisdictions with stricter cannabis use policies.ConclusionPublic interest in delta-8-THC increased rapidly in 2020 and 2021 and was particularly high in US states that restricted delta-9-THC use. Jurisdictions should clarify whether delta-8-THC can be sold as a hemp product.

BACKGROUND Since early 2016, an increasing number of states passed legislations that limit the duration and/or dosage of initial opioid prescriptions or opioids for acute pain. OBJECTIVE The objective of this study was to assess changes in the number of opioid prescriptions covered by Medicaid and received by Medicaid patients associated with state implementation of legislative limits on initial opioid prescriptions. RESEARCH DESIGN We explored the natural experiment resulting from the staggered implementation of state legislative limits. The analysis adopted a Difference-in-Differences framework and controlled for other major state policies bearing implications for prescription opioid use. The main analysis included 26 states that implemented limits from early 2016 to late 2018. A secondary analysis included all 50 states and the District of Columbia. MEASURES Population-adjusted state-quarter level counts of Schedule II and III opioid prescriptions received by Medicaid patients, based on data from the Medicaid State Drug Utilization Data and state Medicaid enrollment reports for 2013-2018. RESULTS Implementation of legislative limits on initial opioid prescriptions was associated with a 7% reduction in the number of opioid prescriptions per 100 Medicaid enrollees. Such reduction was largely attributable to a reduction in Schedule II opioid prescriptions. Secondary analysis by including all jurisdictions and sensitivity checks supported the robustness of results. CONCLUSION The recent implementation of state legislative limits on initial opioid prescriptions was associated with meaningful reductions in the volume of Schedule II opioid prescriptions received by Medicaid patients.

Background and aims Recreational cannabis has been legalized in 11 states and District of Columbia (DC) in the United States. Among these, 10 states further permitted retail sale to provide a legal supply to adults. This study examined the associations of cannabis exposures with recreational cannabis legalization and commercialization. Design Secondary data analysis of state-quarter level cannabis exposures during 2010-17 in the United States. Linear regressions with a difference-in-differences design were used to compare pre- and post-legalization trends in states that legalized recreational cannabis to contemporaneous trends in states that did not legalize recreational cannabis. Setting United States, including all 50 states and DC. Cases Cannabis exposures reported to the US National Poison Data System. Measurements The primary outcome was state age-adjusted cannabis exposures reported to the US National Poison Data System per 1 000 000 population per quarter. The two policy variables of interest included (1) the enactment of recreational cannabis legalization (i.e. removing penalties for adults' possession of cannabis in a small amount for recreational use) and (2) the initiation of recreational cannabis commercialization (i.e. providing a legal supply of cannabis to adults through licensed dispensaries). Findings The association between a state's enactment of recreational cannabis legalization and its changes in cannabis exposures was statistically non-significant overall. After controlling for recreational cannabis legalization, however, the initiation of recreational cannabis commercialization was associated with 5.06-5.80 more exposures per 1 000 000 population per quarter (67-77% increase relative to the pre-legalization average), depending on the composition of comparison states. The increase associated with commercialization was higher among minors than adults (7.97-9.53 versus 3.83-4.21 more exposures), higher among males than females (6.16-7.56 versus 3.76-3.91 more exposures) and higher among exposures with medical consequences than those without medical consequences (4.09-4.79 versus 0.97-1.01 more exposures). Conclusion An increase in cannabis exposures reported to the US National Poison Data System was observed following recreational cannabis commercialization in the United States.

Background and aimsCannabis use disorder (CUD) during pregnancy has increased dramatically in the United States (US). This study examined the associations between prenatal CUD and adverse neonatal outcomes and heterogeneities in the associations by mothers' tobacco use status and race/ethnicity.DesignPopulation-based, retrospective cohort study.SettingCalifornia, USA.ParticipantsA total of 4.83 million mothers who delivered a live singleton birth during 2001 to 2012 and their paired infants. Data were obtained from mother-infant linked hospital discharge records and birth and death certificates. Identified by ICD-9 codes recorded at delivery, 20 237 mothers had prenatal CUD.MeasurementsNeonatal outcomes included length of gestation, preterm birth, birth weight, admission into neonatal intensive care unit, hospitalization within 1year of birth, and death within 1year of birth. Propensity score matching was used to balance maternal, paternal, and infant characteristics in the comparisons between infants exposed and unexposed to prenatal CUD.FindingsCUD increased from 2.8 to 6.9 per 1000 deliveries during 2001 to 2012. Multivariable regressions in matched samples estimated that prenatal CUD was associated with greater odds of being small for gestational age (OR=1.13, 95% CI=1.08, 1.18), preterm birth (OR=1.06, 95% CI=1.01, 1.12), low birth weight (OR=1.13, 95% CI=1.07, 1.20), and death within 1year of birth (OR=1.35, 95% CI=1.12, 1.62). Compared with infants whose mothers were tobacco non-users, infants whose mothers were tobacco users had greater odds of preterm birth, low birth weight, hospitalization, and death in association with prenatal CUD. Compared with infants whose mothers were non-Hispanic White, infants whose mothers were Hispanic had greater odds of hospitalization and death and infants whose mothers were non-Hispanic Black had greater odds of being small for gestational age in association with prenatal CUD.ConclusionPrenatal cannabis use disorder appears to be associated with escalated odds of major adverse neonatal outcomes, with heterogeneities in the associations by mothers' tobacco use status and race/ethnicity.

BACKGROUND: There is an expanding unregulated market for a psychotropic compound called Δ(8)-Tetrahydrocannabinol (delta-8-THC) that is being derived from hemp, but there are no empirical estimates of public interest in this compound. METHODS: To measure public interest, we obtained yearly Google query fractions (QFs) that mentioned delta-8-THC (i.e., “delta 8,” “delta-8,” or “Δ8”) for the past decade (from January 2011 through August 2021) for every country and territory in the world and every state in the United States (US) from Google Trends. We also obtained the same trends for the last complete month of data for all US states (July 2021) to compare across cannabis use policies. We summarized QFs across years, countries, US states and cannabis policies in US states using linear regression, means and ratios. We estimated raw search counts for the US using comscore.com. RESULTS: The global rate of delta-8-THC searches was stable between 2011 and 2019 before increasing by 257.0% from 2019 to 2020 and 705.0% from 2020 to 2021. In 2021, the rate of delta-8-THC searches in the US was at least 10 times higher than the rates in other countries or territories. In absolute terms, there were 22.3 million delta-8-THC searches in the US in the first 8 months of 2021 alone. Increases in delta-8-THC searches from 2020 to 2021 occurred in all 50 US states and the District of Columbia (Mean 854.2%; range = 256.4% – 2831.2%) but continued to vary substantially between states in 2021. In July 2021, the legal status of delta-9-THC use across US states explained 49.0% of the variance in delta-8-THC QFs between US states (R(2) = 0.490; p < 0.001) and was inversely associated, where delta-8-THC QFs were higher in jurisdictions with stricter cannabis use policies. CONCLUSION: Public interest in delta-8-THC increased rapidly in 2020 and 2021 and was particularly high in US states that restricted delta-9-THC use. Jurisdictions should clarify whether delta-8-THC can be sold as a hemp product.

This cross-sectional study examines the compliance of recreational cannabis dispensaries with underage access and exposure to products and marketing in California.

As cannabis use is being legalized in an increasing number of states, it is important to understand the changing dynamic of the risk in cannabis use disorder (CUD). Shape-based time-series clustering was used to identify ZIP Code Tabulation Areas (ZCTAs) with similar changing pattern in CUD over time. We conducted a cross-sectional logistic regression analysis to investigate the most recent ZCTA socio-demographic characteristics in relation to the changing CUD rates. The emergency discharge rates generally increased during 2010-2016. Increase during 2017-2019 was found in Sacramento and Santa Barbara County. Approximately 13% of ZCTAs showed an increasing trend of hospitalization discharge during 2017-2019. Males and non-Hispanic Black had larger increase than other groups during 2017-2019. The recent growing trend was found associated with greater racial diversity and rural ZCTAs. The findings from this study hold promise for local public health officials to adjust the cannabis intervention strategies in target districts and improve overall health outcomes.

This study estimated the likelihoods of individuals transitioning to different cannabis use status following recreational cannabis legalization (RCL) in the United States.Secondary analysis of a nationally representative longitudinal cohort in the United States. We used propensity score matching to balance individual characteristics between RCL and comparison states and generalized mixed regressions to estimate behavioral transitions in matched samples.A longitudinal cohort of 21 863 individuals (6925 youths and 14 938 adults) participating in the Population Assessment of Tobacco and Health waves 3 and 4.Four RCL states that implemented RCL between waves 3 and 4 (California, Massachusetts, Nevada and Maine) and comparison states in the United States.Transitions in cannabis use over the two waves: (1) from non-users to users; (2) from non-users to weekly users; (3) from users to non-users. Individuals in RCL states were compared with matched individuals in (1) states with medical cannabis legalization (MCL), (2) states not legalizing cannabis (non-legalizing) and (3) MCL and non-legalizing states combined.Among youths, the association between RCL and greater odds of transition from non-users to users was seen in comparison with non-legalizing states [odds ratio (OR) = 2.18, 95% confidence interval (CI) = 1.37-3.45] and combined states (OR = 1.73, 95% CI = 1.23-2.42). Evidence was lacking regarding the associations between RCL and transitions from non-users to weekly users and from users to non-users. Among adults, RCL was associated with greater odds of transitions from non-users to users and non-users to weekly users if RCL states were compared with non-legalizing states (OR = 1.68, 95% CI = 1.15-2.46; OR = 1.82, 95% CI = 1.00-3.31, respectively) or combined states (OR = 1.51, 95% CI = 1.11-2.07; OR = 2.09, 95% CI = 1.19-3.66, respectively). RCL was also associated with lower odds of transition from users to non-users if RCL states were compared with non-legalizing states (OR = 0.54, 95% CI = 0.35-0.81).There appears to be some evidence that recreational cannabis legalization in the United States is associated with elevated odds of transition to cannabis use among both youths and adults.

Background and aims In the US, benzodiazepine overdose deaths increased at an alarming rate in the past two decades. Benzodiazepines were also the most common drugs involved in prescription opioid overdose deaths. Benzodiazepine prescribing has been monitored by Prescription Drug Monitoring Programs (PDMPs), but little was known about whether PDMPs reduced drug overdose deaths involving benzodiazepines. Design and methods This study used a difference-in-difference design with state-quarter aggregate data on drug overdose deaths. The primary data source was Mortality Multiple Cause Files in 1999-2016. Three age-adjusted rates of drug overdose deaths were examined, including those involving benzodiazepines, those involving prescription opioids, and those involving both benzodiazepines and prescription opioids. The policy variables included PDMP data access for benzodiazepines and mandatory use of PDMP data for benzodiazepines. Linear multivariable regressions were used to assess the associations of PDMP policies specific to benzodiazepines with drug overdose death rates, controlling for other state-level policy and socioeconomic factors, state and time fixed effects, and state-specific time trends. Results No significant associations were found between PDMP data access for benzodiazepines and changes in drug overdose death rates involving benzodiazepines and/or prescription opioids. Similarly, no significant associations were found between mandatory use of PDMP data for benzodiazepines and changes in drug overdose death outcomes. Discussion and conclusions This study suggested no evidence that PDMP policies specific to benzodiazepines were associated with reduction in benzodiazepine overdose death rates. Future research is warranted to examine detailed features of PDMPs and continuously monitor the impacts of PDMP policies on benzodiazepine-related consequences.

PURPOSE: We provide a US national assessment of youth perceptions of the harm and addictiveness of six separate tobacco products, identifying a continuum of perceived harm associated with a range of products in relation to patterns of current use, former use, and susceptibility to use tobacco products. METHODS: We evaluated youth respondents (N = 13,651) ages 12–17 from Wave 1 (2013–2014) of the Population Assessment of Tobacco and Health (PATH) Study. Analyses (2015–2016) focused on refining measures of perceived harm for each product and delineating youth characteristics (demographic, tobacco use status) associated with beliefs about the harmfulness and addictiveness of tobacco products. RESULTS: Cigars, hookah and e-cigarettes were each perceived as having significantly lower harm (p's < 0.05) than smokeless products, with the lowest ratings of harmfulness and addictiveness observed for hookah and e-cigarettes (p's < 0.001). Incrementally lower levels of harm and addictiveness perceptions were observed among youth at increasing risk for tobacco use (p's < 0.05). CONCLUSIONS: Among U.S. youth, lower perceptions of harm and addictiveness of tobacco products were associated with susceptibility to use tobacco and patterns of tobacco product use. Future longitudinal assessments from the PATH Study can provide key information on youth development of perceptions of harm and addictiveness and influences on patterns of tobacco use.

Background: A recent meta-analysis affirmed the benefit of medicinal cannabis for chronic neuropathic pain, a disabling and difficult-to-treat condition. As medicinal cannabis use is becoming increasingly prevalent among Americans, an exploration of its economic feasibility is warranted. We present this cost-effectiveness analysis of adjunctive cannabis pharmacotherapy for chronic peripheral neuropathy. Materials and Methods: A published Markov model comparing conventional therapies for painful diabetic neuropathy was modified to include arms for augmenting first-line, second-line (if first-line failed), or third-line (if first- and second-line failed) therapies with smoked cannabis. Microsimulation of 1,000,000 patients compared the cost (2017 U.S. dollars) and effectiveness (quality-adjusted life years [QALYs]) of usual care with and without adjunctive cannabis using a composite of third-party and out-of-pocket costs. Model efficacy inputs for cannabis were adapted from clinical trial data. Adverse event rates were derived from a prospective study of cannabis for chronic noncancer pain and applied to probability inputs for conventional therapies. Cannabis cost was derived from retail market pricing. Parameter uncertainty was addressed with one-way and probabilistic sensitivity analysis. Results: Adding cannabis to first-line therapy was incrementally less effective and costlier than adding cannabis to second-line and third-line therapies. Third-line adjunctive cannabis was subject to extended dominance, that is, the second-line strategy was more effective with a more favorable incremental cost-effectiveness ratio of $48,594 per QALY gained, and therefore, third-line adjunctive cannabis was not as cost-effective. At a modest willingness-to-pay threshold of $100,000/QALY gained, second-line adjunctive cannabis was the strategy most likely to be cost-effective. Conclusion: As recently proposed willingness-to-pay thresholds for the United States health marketplace range from $110,000 to $300,000 per QALY, cannabis appears cost-effective when augmenting second-line treatment for painful neuropathy. Further research is warranted to explore the long-term benefit of smoked cannabis and standardization of its dosing for chronic neuropathic pain.

Currently one-third of children in the United States have overweight or obesity (OW/OB). The goal of Healthy People 2020 is to reduce the proportion of children with OW/OB and increase the proportion of primary care visits that include nutrition and weight-related counseling. Unfortunately, many health care providers find it difficult to offer effective weight-related counseling and treatment in the primary care setting. Therefore, new models of care are needed that allow a greater proportion of children with OW/OB and their parents to access care and receive quality weight management treatment. The current paper describes the GOT Doc study which is designed to test the effectiveness of a Guided Self-Help (GSH) model of obesity treatment that can be delivered in the primary care setting compared to a traditional Family-Based Behavioral weight loss treatment (FBT) delivered at an academic center. We will assess the impact of this program on attendance (access to care) and changes in child BMI percentile/z-score. We will also examine the impact of this treatment model on change in child lifestyle behaviors, parent support behaviors, and parent self-efficacy and empowerment to make behavior change. Finally, we will assess the cost-effectiveness of this model on changes in child BMI percentile/z-score. We believe the GSH intervention will be a cost-effective model of obesity management that can be implemented in community practices around the country, thereby increasing access to treatment for a broader proportion of our population and decreasing rates of childhood obesity., Highlights • Effective childhood obesity treatment is not widely available or easily accessible. • Guided Self-Help (GSH) model of treatment has been developed for pediatric obesity. • GSH is easier to implement and can be delivered in the primary care setting. • GSH can increase access to much needed treatment. • Evaluation of its effectiveness in the primary care setting is needed.

Taking advantage of the excellent trans-cleavage activity, CRISPR-based diagnostics (CRISPR-Dx) has shown great promise in molecular diagnostics. However, the single-stranded DNA reporter of the current CRISPR-Dx suffers from poor stability and limited sensitivity, which make their application in complex biological environments difficult. Herein, we, for the first time, explore the trans-cleavage activity of CRISPR/Cas12a toward the substrate on gold nanoparticles and apply the new phenomenon to develop a spherical nucleic acid (SNA) reporter for stable and sensitive CRISPR-Dx biosensing. By anchoring the DNA substrate on gold nanoparticles, we discovered different trans-cleavage activities of different types of the Cas12a system (e.g., LbCas12a and AsCas12a) on a nanoparticle surface. The further study suggests that the trans-cleavage activity of LbCas12a on the nanoparticle surface is highly dependent on the density and length of DNA strands. Based on these interesting discoveries, we furthermore develop SNA reporter-based fluorescent CRISPR-Dx for stable and sensitive biosensing application. Compared to traditional ssDNA reporters, the SNA reporter exhibits improved stability, which enables the stable application in a complex serum environment. In addition, the SNA reporter system with tunable density exhibits high sensitivity with a detection limit of 10 fM, which is about 2 orders of magnitude lower than that of the ssDNA reporter system. Finally, the practical application of SNA reporter-based CRISPR-Dx in clinical serum was successfully achieved. These results indicate their significant potential in future research on biology science and medical diagnoses.

The sensitive and accurate detection of mature miRNA without the signal interference by pre-miRNAs is highly important. Herein, a size-selective DNA nanocage-based activatable CRISPR/Cas12a system was developed to achieve this goal.

lustered regularly interspaced short palindromic repeats (CRISPR) is a new and promising technology in the biological world. As one of the CRISPR-associated (Cas) proteins, Cas12a is an RNA-guided nuclease in the type V CRISPR-Cas system, which has been a robust tool for gene editing. In addition, due to the discovery of target-binding-induced indiscriminate single stranded DNase activity of Cas12a, CRISPR-Cas12a also exhibits great promise in biosensing. This minireview not only gives a brief introduction to the mechanism of CRISPR-Cas12a, but also highlights the recent developments and applications in biosensing and gene regulation. Finally, future prospects of the CRISPR-Cas12a system are also discussed. We expect this minireview will inspire innovative work on CRISPR-Cas12a system by making full use of its features and advantages.

BackgroundHeated tobacco products (HTP) generate nicotine-containing aerosol by heating tobacco rather than burning it. The US Food and Drug Administration (FDA) has recently authorised the sale of one HTP brand, iQOS, in the USA. This study examined the awareness, use and risk perceptions of HTP in the USA following FDA authorisation.MethodsA national probability sample of 20 449 US adults completed an online survey between November 2019 and February 2020. In addition to assessing awareness and use of HTP, two ratios were calculated: the ratio of those who experimented with HTP given that they had heard about it (E/H) and the ratio of those who currently used HTP given experimentation (C/E). These ratios for HTP were compared against those for e-cigarettes from a similar national survey in 2012.ResultsOverall, 8.1% of respondents had heard of HTP. Only 0.55% had tried and 0.10% were current users. The rate of experimentation among those who heard about HTP and the rate of current use among experimenters were, however, similar to those for e-cigarettes in 2012: E/H and C/E for HTP were 6.8% and 18.2%, respectively; and 10.7% and 17.8%, respectively for e-cigarettes. The majority of respondents considered HTP either less harmful than (11.6%), or equally harmful as e-cigarettes (42.7%).ConclusionsOnly a small fraction of US population in 2020 have tried any HTP. However, the similarity in early adoption rates following awareness, suggests that future adoption for HTP may be similar to that for e-cigarettes, if HTP are marketed more aggressively.

Background California Proposition 56 increased cigarette excise tax by $2 per pack with equivalent increases on non-cigarette tobacco products. We estimated the changes in cigarette price, cigarette use, and non-cigarette use following the implementation of Proposition 56 in California in 2017. Methods Seven waves of Tobacco Use Supplements to the Current Population Survey (TUS-CPS) 2011–2019 data were used to obtain state-level aggregate self-reported outcomes, including cigarette price per pack, current and daily cigarette use, cigarette consumption per day, and current and daily use of non-cigarette tobacco products (hookah, pipe, cigar, and smokeless tobacco). A modified version of a synthetic control method was used to create a “synthetic” California that best resembled pre-policy sociodemographic characteristics and outcome trends in California while correcting time-invariant pre-policy differences. Various sensitivity analyses were also conducted. Results The implementation of Proposition 56 was associated with an increase in self-reported cigarette price per pack in California ($1.844, 95%CI: $0.153, $3.534; p = 0.032). No evidence suggested that Proposition 56 was associated with the changes in the prevalence of current or daily cigarette use, cigarette consumption per day, or the prevalence of current or daily use of non-cigarette tobacco products. Conclusion Most of the cigarette tax increase following Proposition 56 in California was passed on to consumers. There is a lack of evidence that the implementation of Proposition 56 was associated with the changes in the use of cigarettes and other tobacco products such as hookah, pipe, cigar, and smokeless tobacco.

Introduction Dehydroepiandrosterone sulfate (DHEAS) has been reported to be associated with sexual function and general psychological health respectively, however, no one has ever examined their mutual relationships in a single study. Aim The aim of the present study was to find out whether DHEAS, general psychological health, and erectile function were all associated with each other. Methods A cross-sectional study was conducted on 34 patients with erectile dysfunction (ED) and 32 healthy controls (HC). The levels of serum DHEAS were assessed by chemiluminescence method. Erectile function and general psychological health were measured by International Index for Erectile Function-5 (IIEF-5) and General Health Questionnaire 20(GHQ-20) respectively. Main Outcome measure The primary outcome measure of this study was the mutual correlations of serum DHEAS levels, general psychological health and erectile function. Results Compared to HC, patients with ED had a significant lower serum levels of DHEAS (6.43 ± 2.70 μmol/L vs 9.48 ± 2.82 μmol/L, P < .001) and higher scores on GHQ-20 (35.06 ± 8.56 vs 24.97 ± 2.55, P < .001). Multivariate binary logistic regression showed that both serum levels of DHEAS (OR = 0.667, 95% CI = 0.512–0.869, P = .003) and psychological distress (scores of GHQ-20 > 28) (OR = 6.921, 95% CI = 1.821–26.305, P = .005) were significantly associated with ED. However, no significant association between psychological distress and serum levels of DHEAS was found (OR = 0.798, 95% CI = 0.623–1.021, P = .072) after controlling for ED. Partial correlation analysis revealed that both scores of GHQ-20 (r = −0.595, P < .001) and DHEAS (r = 0.450, P < .001) were significantly correlated with scores of IIEF-5, while no significant relationship was found between scores of GHQ-20 and DHEAS (r = 0.116, P = .363) after controlling for scores of IIEF-5 and age. Conclusion Both serum levels of DHEAS and general psychological health are significantly associated with erectile dysfunction in sexually active adult men but the relationship between general psychological health and erectile function seems to be independent of DHEAS. Li K, Liang S, Shi Y, et al. The Relationships of Dehydroepiandrosterone Sulfate, Erectile Function and General Psychological Health. Sex Med 2021;9:100386.

Objectives To assess 1) the validity of online crowdsourcing platforms in enumerating licensed brick-and-mortar marijuana dispensaries and 2) the validity of state licensing directory and online crowdsourcing platforms in enumerating active brick-and-mortar marijuana dispensaries in California. Methods We obtained business lists from California Bureau of Cannabis Control (BCC) licensing directory and three online crowdsourcing platforms (Weedmaps, Leafly, and Yelp) in May 2019. Calls were made to verify street address, operation status, dispensary category (recreational-only, medical-only, recreational & medical), and presence of storefronts in May-July 2019. Validity measures, including sensitivity, specificity, positive predictive value, and negative predictive value, were calculated when applicable. Results In identifying licensed dispensaries in BCC, Leafly had the highest sensitivity (.66) and Yelp had the highest specificity (.87). The dispensary category posted on online crowdsourcing platforms in over 25 % licensed dispensaries and the dispensary category claimed in call verification in over 10 % licensed dispensaries disagreed with the approved category in BCC. There were 2121 businesses combined from BCC and online crowdsourcing platforms, among which 826 were verified to be active brick-and-mortar dispensaries. Weedmaps had the highest sensitivity (.80) and Yelp had the highest negative predictive value (.74) in identifying verified dispensaries. Weedmaps overall had the highest sensitivity in all three dispensary categories. Weedmaps had the highest sensitivity in more populated counties whereas BCC had the highest sensitivity in less populated counties. Conclusions Each secondary data source has strengths and limitations. The findings inform surveillance and research regarding how to best strategize data use when resources are limited.

Objectives This study systematically reviewed evidence from interventions on the effect of front-of-package (FOP) nutrition labeling on food purchases. Study design The study design used in this study is a systematic review. Methods Keyword search was performed in PubMed, Web of Science, Scopus, and Cochrane Library. Results Fifteen studies (10 randomized controlled trials, four pre-post studies, and one case-control study) met the eligibility criteria and were included in the review. Five studies were conducted in a controlled setting through the establishment of an online virtual supermarket or physical laboratory food store solely for the intervention. In contrast, the remaining ten studies were conducted in a naturalistic setting where people commonly purchase foods (e.g., supermarket, grocery store, school/hospital cafeteria, or vending machine). FOP labels assessed included traffic lights, health star rating, daily intake guides, health warnings, and high sugar symbol labels. Compared with the control, FOP labels were effective for helping participants make healthier food purchase decisions in five of the 12 studies that assessed traffic lights labels, in one of the two studies that assessed health warning labels, and in one study that assessed high sugar symbol labels. Three assessed health star ratings and one assessed daily intake guide labels, but none revealed an effect on food purchases compared with the control. Conclusions Findings on the effectiveness of FOP nutrition labels in ‘nudging’ consumers toward healthier food purchases remain mixed and inconclusive. Future studies should examine other types of FOP labels beside the traffic lights labels and explore the different effects by consumer affordability, population subgroup, and shopping environment.