Depictions of Firearms and Other Projectile Weapons in Top-Selling Japanese Manga.

Firearm violence is a pressing public health issue in the United States and becoming increasingly so worldwide. This concern has prompted researchers to examine the prevalence of such violence in media entertainment. Japanese manga have a large youth readership in the U.S., yet research on their depictions of firearms is presently lacking. We randomly selected 50 chapters from each of ten top-selling manga series worldwide (N = 500) to identify dialogue, action, and other illustrations involving handguns, rifles, machine guns, other projectile weapons, and bombs. Of the 500 chapters, 129 (25.8%) had at least one depiction of a firearm or other projectile weapon, with 684 instances of characters handling (e.g., carrying, holding, firing, reloading) such a weapon. Of the 384 unique characters so depicted, the vast majority were males (88.3%), adults (92.2%), and "good" characters (73.4%). Manga readers, especially male adolescents and preteens, are frequently exposed to storylines in which one or more characters are using a firearm or other projectile weapon. Working collaboratively, manga publishers and distributors should act to develop and implement a comprehensive rating system to flag content that may be harmful to youth so that parents can more easily monitor what their children are reading.

Community-Level Factors As Positive and Negative Correlates of Sexual Aggression Perpetration Among Adolescent Boys.

Often, perpetrators of sexual violence first aggress in their teens. Presently, very little is known about environmental factors that may influence adolescents' engagement in sexual aggression. Drawing upon data collected at 27 high schools in the Northeast United States, this study is the first to test the association between community-level factors and male adolescents' sexual aggression. A series of backward linear regressions determined that 10 of 19 community variables were associated with males' sexual aggression, which were then used to generate a ratio of positive to negative correlates of sexual aggression for each high school. In multilevel analyzes, as hypothesized, the ratio of positive to negative correlates was positively associated with schools' sexual aggression perpetration rates. We discuss the study's implications for future sexual assault research and prevention interventions.

Effects of High-Potency Cannabis on Psychomotor Performance in Frequent Cannabis Users.

Background: Recently increased access to cannabis products in the United States has been associated with increased rates of driving after cannabis use. Although numerous studies indicate that cannabis impairs psychomotor and neurocognitive functions that can affect driving ability, the determination of cannabis-impaired driving risk is complicated by the extent to which frequent cannabis users develop tolerance to THC's subjective, cognitive, and psychomotor effects, and by the fact that there is no validated behavioral or biological marker of recent cannabis use or cannabis-related impairment. This study examined the psychomotor impairment-related effects experienced by frequent cannabis users in Colorado after naturalistic consumption of smoked cannabis, both immediately and 1 h postuse. Results were then validated in a smaller replication sample from Washington state. Methods: In the primary Colorado study, participants (n=70) used the DRUID® mobile app, a brief measure of psychomotor and cognitive domains that are sensitive to the effects of cannabis. First, participants used DRUID to establish a sober baseline impairment score. During a second appointment, they used DRUID at three time points: preuse, immediately after acutely using cannabis, and 1 h postuse. In the Washington replication sample, participants (n=39) used DRUID before acute cannabis consumption and then every half hour for 2.5 h. Results: In both studies, peak DRUID impairment effects were seen immediately after cannabis use, with recovery of performance at 1 h postuse. Specifically, significant quadratic effects of time emerged for both studies (Colorado study: (ß=-0.935, SE=0.204, p<0.001); Washington study: ß=3.0299, SE=1.3085, p<0.01). Domain-specific effects were tested in the larger Colorado study and were observed for reaction time within a complex divided attention task and a postural-stability balance task. Conclusions: These findings demonstrate that psychomotor impairment emerges immediately after acute cannabis use even in regular users, but decreases significantly 1 h postuse. These results underscore the potential utility of the DRUID app for assessing acute cannabis-related psychomotor impairment. Further research is needed to explore whether the DRUID app and/or the specific psychomotor functions it assesses might serve as a tool for measuring cannabis-related driving impairment. Clinical trials registration number for the Colorado Study: NCT03522103.

Determining whether Public Communications Campaigns Based on the The Social Norms Approach are a Viable COVID-19 Prevention Strategy for College Campuses.

The purpose of this study is to (a) outline the formative steps that universities can follow to determine if a media campaign based on the social norms approach (SNA) is a viable method for increasing COVID-19 prevention behaviors among their students, (b) present formative research data collected at a large public land-grant university in the U.S., and (c) as a test case, apply that data to assess the SNA's viability for promoting COVID-19 prevention behaviors among students at that institution. Over time, a series of fast-track surveys were conducted to determine the descriptive and injunctive norms for four COVID-19 prevention strategies: wearing a mask in public, physical distancing, limiting the size of indoor gatherings, and receiving or planning to get a vaccination. The results demonstrated that, at this particular university, an SNA-based public communications campaign would be a promising strategy for promoting these protective behaviors. First, a clear majority of the survey respondents reported engaging in the behaviors. Second, the respondents perceived the behaviors to be less common than was actually the case, with one exception: wearing a mask. In all four cases, they perceived the behaviors to be less approved of than what the surveys documented.

Measuring Global Alcohol Health Literacy: A Narrative Review.

OBJECTIVE: Studies assessing awareness and knowledge of alcohol-attributable causes of death and disease have been conducted across the globe to develop and evaluate public information campaigns to increase alcohol health literacy. Because of variation in measurement, the results of these studies cannot be easily compared to determine relative rates of high versus low alcohol health literacy across countries or regions. This review catalogs the samples and survey items that have been used and presents recommendations for how to improve alcohol health literacy survey research. METHOD: Searches for studies surveying general populations for knowledge of the associations between alcohol and nine alcohol-related health harms--fetal alcohol syndrome, liver cirrhosis, cancer, pancreatitis, tuberculosis, epilepsy, cardiovascular disease, lower respiratory infections, and conduction disorders--were conducted in PubMed and Embase. Survey results published between January 2007 and April 2018 were reviewed for eligibility. Of 791 studies initially identified, 76 were included in the final analysis. RESULTS: Survey items varied substantially in the types of response options used (e.g., yes/no, agree/disagree, Likert scales, multiple choice); terminology for drinking behavior (e.g., alcohol consumption vs. alcohol abuse), risk-factor framing (e.g., cause vs. association), and health harms (e.g., cardiovascular disease vs. stroke); and how their results were presented (e.g., numbers and/or percentages of respondents vs. odds ratios). Very few studies used probability samples. CONCLUSIONS: The current state of the research literature makes it impossible to identify patterns of alcohol health literacy globally or even to compare intra-country studies across time. We recommend that a database of standard, validated questions for assessing knowledge about the relationship between alcohol and several key health outcomes be assembled and made available to the research community.

A Group Randomized Trial of the Stop Service to Obviously-Impaired Patrons (S-STOP) Program to Prevent Overservice in Bars and Restaurants in College Communities.

BACKGROUND: College student drinking in on-premises establishments has been associated with heavy alcohol consumption and a range of problems including assault, fighting, risky sex, and drinking and driving. Although more strictly enforcing overservice laws might reduce heavy drinking in on-premises establishments, law enforcement agencies have few resource-efficient tools for doing so, resulting in these laws seldom being enforced. OBJECTIVES: In this paper, we report the results of an evaluation of the Stop Service to Obviously-impaired Patrons (S-STOP) program that was implemented in 303 bars and restaurants in 18 university communities in California using a randomized cross-over design (early vs. delayed implementation). The S-STOP program: (a) deployed pseudo-intoxicated patrons who attempted to purchase a drink when showing obvious signs of intoxication; (b) provided feedback to owners and managers on staff performance; and (c) offered free online refresher training for staff. RESULTS: Overall, alcohol servers in bars and restaurants in these college communities were willing to serve a pseudo-intoxicated mystery shopper 90% of the time. The study found no evidence that S-STOP reduced the prevalence of alcohol sales to apparently impaired patrons during the two intervention stages of the study. CONCLUSIONS: The findings highlight the need for developing effective interventions to prevent overservice and should prompt college and university leaders to take the lead in addressing the problem of alcohol overservice at on-premises establishments by working with community leaders, law enforcement, and retailers.

Exploring the Potential Campus-Level Impact of Online Universal Sexual Assault Prevention Education.

Campus sexual assault is a long-standing challenge and continues to be a severe problem for American higher education. The present study examines the short-term impact of a widely utilized sexual violence prevention course for matriculating college students as a population-level prevention approach. The course focuses on correcting misperceptions of normative behavior, increasing students' likelihood to intervene in disconcerting situations, and encouraging empathy and support for victims. Participants were 167,424 first-year college students from 80 four-year institutions who completed preintervention and postintervention surveys to assess changes in composite factor scores derived from 20 attitudinal, self-efficacy, and behavioral intention items. Employing the composite factor scores as dependent variables, individual ANOVAs were run for each of the institutions to test whether there were significant increases in mean factor scores. High percentages of institutions saw statistically significant increases (p < .05) in self-reported ability and intention to intervene to prevent sexual assault and relationship violence (98%), empathy and support for victims (84%), and corrected perceptions of social norms (75%). Fewer schools saw significant reductions in endorsement of sexual assault myths (34%). These findings suggest that when implemented as a population-level intervention for all first-year college students, the prevention course can foster accurate perceptions of positive social norms, increase empathy and support for victims, and increase students' stated ability and intention to intervene.

Evaluation of a Mystery Shopper Intervention to Reduce Sales of Alcohol to Minors in Zacatecas and Guadalupe, Mexico.

We report the results of a quasi-experimental evaluation of a mystery shopper intervention in Zacatecas and Guadalupe, Mexico. Underage youth attempted to purchase beer at 50 Modelorama stores and 32 Oxxo stores (intervention groups), and at 19 comparison convenience stores in March, July, and August 2018. After each attempt, intervention store operators were informed if a sale was made. Modelorama operators also received training and were warned that repeated sales to minors could jeopardize their franchise. Average sales rates to minors were 63.8% at Modeloramas, 86.5% at Oxxo stores, and 98.2% at comparison stores. The findings suggest that mystery shopper interventions with training, feedback to store operators, and sanctions after repeated sales to underage youth may reduce sales to minors in low- and middle-income countries.

The effectiveness of alternative transportation programs in reducing impaired driving: A literature review and synthesis.

INTRODUCTION: Studies have shown that approximately half of arrested intoxicated drivers had their last alcoholic drink at a licensed bar or restaurant. Current efforts to prevent intoxicated patrons from leaving licensed establishments and driving home have been only partially successful. Since a high proportion of drinkers drive to their drinking destination, promoting the use of alternative transportation (AT) - including safe ride shuttles, free or subsidized taxi and ridesharing services, voluntary or paid designated driver programs, and more accessible public transportation - is an important strategy for preventing impaired driving. The primary goal of this study was to review and synthesize the findings of research studies designed to test the effectiveness of AT programs in reducing alcohol-impaired driving. A secondary goal was to report if using AT has led to any unintended consequences, in particular greater alcohol consumption. METHOD: We identified relevant academic articles, new articles, government reports, and other documents (English only) through the University of Chicago library, Google Scholar, and Google Search. We also included published articles recommended by peers. Key search terms included: alternative transportation; safe rides; designated driver; alcohol-impaired driving; alcohol consumption, cost effectiveness; and reduce drunk driving. Initially, we identified 168 potentially relevant sources, of which only 57 were academic articles. After a thorough review, we narrowed down the number of relevant articles to 125 including some background articles and government reports. RESULTS: Some AT programs produced reductions in one or more of the following outcomes: (1) impaired driving; (2) impaired driving crashes; (3) driving under the influence (DUI) arrests; and (4) traffic crashes in general, but others were not shown to be effective. A few programs resulted in greater self-reported alcohol use, but there were no significant findings indicating that drinking when using AT led to an increase in alcohol-related harms such as public intoxication, assaults, or other alcohol-related crime. Of the studies that conducted a cost-benefit analysis, most showed that AT programs yielded a positive benefit, but these studies did not include a sufficient number of variables to be considered true cost-benefit analyses. CONCLUSIONS: There is mixed evidence regarding the effectiveness of AT programs. Evaluations with more rigorous quasi-experimental and experimental designs are needed to identify which types of AT programs work best for different types of communities and target groups. Practical Applications: The literature review and synthesis revealed that the most successful AT programs typically have some of these attributes: (1) social acceptance; (2) high level of public awareness; (3) low cost; (4) year-round availability; (5) provide rides to and from drinking venues; (6) several sponsors that provide funding); (7) user convenience; and (8) perceived safety.

Depictions of Tobacco and Alcohol Use in Contemporary Japanese Shonen Manga: A Content Analysis.

Japanese manga, which present dramatic and imaginative stories in comic book form, have a growing readership in Asia, Europe, and North America. We investigated depictions of tobacco and alcohol use in a sample of contemporary shonen manga, which have a primary readership of males ages 8-18, but also appeal to young females and adults. Large number of characters were shown smoking cigarettes and drinking alcohol, especially males, adults, and those categorized as "good" characters. Compared to the shonens' early chapters (initiated in 1990-2003, depending on the series), more recently published chapters (2011-2016) portrayed fewer characters overall using a tobacco product and fewer minors using an alcohol product. The later chapters also presented significantly fewer depictions of tobacco-related behavior, consumption of both beer and other/unknown alcoholic beverages, and alcohol-related paraphernalia. Antitobacco and antialcohol behaviors or dialogue were rare. These findings raise legitimate concerns about the influence of these depictions on young readers' beliefs, attitudes, and behavioral choices. Future research should explore whether those concerns are warranted, but in the interim, government agencies and watchdog groups in Japan should consider applying increased public pressure on manga artists and producers to curtail these depictions and to offer positive role models in their place.

Vape Factor Fast Find-Adult (VF3-A): a prototype survey method for recording brand-specific vaping factors in adult populations.

BACKGROUND: In population studies, vaping is often treated as a dichotomous exposure (present/absent) without consideration of specific vaping devices and materials being used. A survey instrument is needed to record specific vaping devices and materials. METHODS: We developed a database of 613 vaping device models and 3196 vaping liquid products, indexed by device brand, device type, liquid brand, liquid name and liquid flavour type. We developed a survey instrument to allow participants to report their vaping device and liquid from the indexed lists. The survey was pilot tested with a convenience sample of 208 adults (≥age 21). We validated the vaping device and liquid responses with a recontact survey. We report the proportion of respondents finding their products, characteristics of people finding their products and survey response times. RESULTS: Devices used most frequently in the past 30 days were electronic cigarettes (33% of respondents), vaping pens (28%) and vaping mods (16%). Fifty-seven per cent used liquids containing nicotine most frequently in the past 30 days, followed by liquids without nicotine (20%) and marijuana or hashish (10%). Most (85%) participants found their vaping device successfully (median 19.7 s) and 74% found their vaping liquid (median 19.8 s). Females and older adults were less likely to find their devices and liquids. Responses were validated for 91% and 76% of devices and e-liquids, respectively. CONCLUSIONS: This study demonstrated the feasibility of an internet-based survey instrument to record specific vaping factors for use in studies of vaping and health.

What "Moves" the Populations Most Likely to Be Physically Inactive-Women and Older Adults? Evidence From Mueller, a Mixed-Use Neighborhood in Austin, Texas.

BACKGROUND: Older age groups are less likely than their younger counterparts to be regularly active and women are even less active. Ecological models suggest that multiple levels of influence with each level influencing the next level impacts physical activity behaviors. METHODS: Hierarchical multiple regressions were used to determine factors within and across the ecological model that predicted both total physical activity and walking for recreation. FINDINGS: The overall predictors of total physical activity were different than those of walking for recreation, with the exception of dog ownership and perceived barriers. Gender and age were significant predictors of walking for recreation, but these associations were not present for total physical activity. Women and older adults walked more for recreation in a mixed-use community, Mueller, (and thus engaged in more total physical activity) compared with men and younger adults. CONCLUSION: Behavior-specific physical activity as well as total physical activity led to a better understanding of factors that may impact behavior among an overall aging population, especially women. This level of specificity is important in understanding specific factors that are associated with physical activity among vulnerable populations and can help guide the development of tailored, cost-effective, and efficient policies and interventions.

Effects of a responsible retailing mystery shop intervention on age verification by servers and clerks in alcohol outlets: A cluster randomised cross-over trial.

INTRODUCTION AND AIMS: Clerks and servers at alcohol establishments often fail to verify age. Using mystery shoppers to provide performance feedback is one approach to improving age verification. Few controlled studies have evaluated mystery shop interventions. This paper reports on a cluster randomised cross-over trial of a mystery shop intervention in 16 communities in four US states. DESIGN AND METHODS: The intervention comprised monthly mystery shops after which clerks and servers received immediate feedback to reinforce age verification. Managers received monthly reports. Communities in each state were matched into pairs and, following a 3-month baseline, were randomly assigned within each pair to receive the intervention beginning after the fourth (Early Intervention) or the tenth (Delayed Intervention) mystery shop. On average, 17 (range = 14-20) randomly selected on-premises and 18 (range = 11-23) off-premises outlets participated in each community (N = 557). RESULTS: Fixed effects multi-level logistic regressions indicated that the intervention led to a two-fold increase in the odds of age verification, odds ratio (OR) = 2.05; P < 0.001; 95% confidence interval (CI) 1.76, 2.39. Overall, ID-checking increased from an average of 80% pre-intervention to 94-96% by the end of the program. Significant effects were found for on-premises, OR = 1.79; P < 0.001; 95% CI 1.43, 2.24, and off-premises establishments, OR = 2.29; P < 0.001; 95% CI 1.86, 2.82. DISCUSSION AND CONCLUSIONS: Mystery shop interventions can increase age verification for alcohol purchases and may be an effective supplement to compliance checks and responsible beverage service programs.

Alcohol brand use of youth-appealing advertising and consumption by youth and adults.

BACKGROUND: Youth exposure to alcohol marketing has been shown to be an important contributor to the problem of underage drinking in the U.S. More work is needed on identifying and minimizing content with particular appeal to youth. DESIGN AND METHODS: We tested the association between the youth-appeal of marketing content of televised alcohol advertisements and the brand-specific alcohol consumption of both underage youth and adults. We used existing data from three sources: a brand-specific alcohol consumption survey among underage youth (N=1032), a brand-specific alcohol consumption survey among adults (N ~13,000), and an analysis of content appealing to youth (CAY) in a sample of televised alcohol advertisements (n=96) aired during the youth survey. The association between CAY scores for the 96 alcohol ads and youth (age 13-20) versus adult (age 21+) consumption of those ads' brands was tested through bivariate and multivariate models. RESULTS: Brand CAY scores were (a) positively associated with brand-specific youth consumption after controlling for adult brand consumption; (b) positively associated with a ratio of youth-toadult brand-specific consumption; and (c) not associated with adult brand consumption. CONCLUSIONS: Alcohol brands with youth-appealing advertising are consumed more often by youth than adults, indicating that these ads may be more persuasive to relatively younger audiences, and that youth are not simply mirroring adult consumption patterns in their choice of brands. Future research should consider the content of alcohol advertising when testing marketing effects on youth drinking, and surveillance efforts might focus on brands popular among youth.

Assessing Youth-Appealing Content in Alcohol Advertisements: Application of a Content Appealing to Youth (CAY) Index.

Underage drinking is a serious public health problem in the United States, and youth exposure to alcohol advertising has been indicated as a possible contributing factor. Although a number of studies have identified advertising content features that youth find appealing, a key limitation of this research is the absence of a broader tool to examine those features, especially those used by alcohol brands that are popular with underage drinkers. We created an index of content elements found in the research literature to be appealing to youth, and then used this index in a content analysis to identify the degree to which youth-appealing content appeared in a sample of alcohol ads that aired on television shows popular among youth. Finally, using bivariate analysis, we tested the relationship between alcohol brands' use of this content and the popularity of those brands among youth. We found that many of the ads featured youth-appealing content, and that the ads for the alcohol brands most popular among youth had more youth-appealing content than the less popular brands.

The impact of a multi-level maternal health programme on facility delivery and capacity for emergency obstetric care in Zambia.

In 2012, Saving Mothers, Giving Life (SMGL), a multi-level health systems initiative, launched in Kalomo District, Zambia, to address persistent challenges in reducing maternal mortality. We assessed the impact of the programme from 2012 to 2013 using a quasi-experimental study with both household- and health facility-level data collected before and after implementation in both intervention and comparison areas. A total of 21,680 women and 75 non-hospital health centres were included in the study. Using the difference-in-differences method, multivariate logistic regression, and run charts, rates of facility-based birth (FBB) and delivery with a skilled birth provider were compared between intervention and comparison sites. Facility capacity to provide emergency obstetric and newborn care was also assessed before and during implementation in both study areas. There was a 45% increase in the odds of FBB after the programme was implemented in Kalomo relative to comparison districts, but there was a limited measurable change in supply-side indicators of intrapartum maternity care. Most facility-level changes related to an increase in capacity for newborn care. As SMGL and similar programmes are scaled-up and replicated, our results underscore the need to ensure that the health services supply is in balance with improved demand to achieve maximal reductions in maternal mortality.