Potential risk factors for cigarette use among a sample of college JUUL users.

Objective: To examine the relationship between demographics, other tobacco use, and JUUL dependency on combustible cigarette use among college JUUL users. Participants: Undergraduates (n = 595) at a large southwestern university who used JUUL weekly completed a cross-sectional online survey in March 2019. Methods: Logistic regressions examined associations between covariates and ever use/past 30-day use of cigarettes. Results: As age increased, odds of ever trying a cigarette increased (AOR = 1.87; 95% CI = 1.45-2.41); however, as age of JUUL initiation increased, odds of ever (AOR = 0.80; 95% CI = 0.65-0.99) or past 30-day (AOR = 0.78; 95% CI = 0.63-0.97) cigarette use decreased. Those moderately (AOR = 2.03; 95% CI = 1.07-3.82) or highly (AOR = 8.01; 95% CI = 3.08-20.83) dependent on JUUL were more likely to have tried cigarettes than those not dependent. However, dependence was not associated with past 30-day use. Conclusions: JUUL users may not transition to combustible cigarettes during college. Longitudinal studies are needed to examine transitions in JUUL users' tobacco product use after college.

College Students' Reasons for Using JUULs.

PURPOSE: To identify reasons that college students use JUUL and explore associations between reasons for using JUUL and social and behavioral (tobacco use) factors. DESIGN: On-line, cross-sectional survey. SETTING: Large southwestern university in the US. SUBJECTS: Undergraduate students (n = 605) who owned JUUL and used it weekly. MEASURES: The study measured age of JUUL initiation, JUUL dependence, and use of other e-cigarettes and other tobacco products. Participants described reasons for JUUL use as brief open-ended responses. ANALYSIS: Responses were categorized by 2 researchers using an inductive procedure. Logistic regressions examined associations between demographics and use frequency and categorized reasons for using JUUL. RESULTS: Four reasons for using JUUL emerged: self-help (48.4%), social (30.4%), experience (42.8%), and substance use/addiction (42.3%). Daily JUUL users were 1.66 (95% CI: 1.05-2.63) times as likely to use JUUL for self-help than those who used JUUL 1-3 days/week. Those who had never tried a cigarette were twice (OR = 2.08; 95% CI: 1.22-3.54) as likely as cigarette-first users to use JUUL for social reasons. Males (OR = 1.87; 95% CI: 1.32-2.65) had higher odds of using JUUL for the experience than females, and JUUL and other e-cigarettes users were 4.37 (95% CI: 1.83-10.45) times as likely as JUUL-only users to use JUUL due to substance use/addiction. CONCLUSION: JUUL users report unique reasons for use (e.g., addiction) not previously reported for older models of e-cigarette devices.

Tobacco 21 Policies in the U.S.: The Importance of Local Control With Federal Policy.

INTRODUCTION: In December 2019, the U.S. raised the minimum legal sales age of tobacco to 21 years, a law commonly known as Tobacco 21. This study examines local Tobacco 21 policies for the inclusion of model policy components: comprehensive tobacco definition, age verification and tobacco access, enforcement measures, tobacco retail license, and violation penalties. METHODS: A document analysis of Tobacco 21 local policies passed in the U.S. before July 1, 2019 (N=477) was conducted in May 2020 using a Tobacco 21 policy assessment tool. Policies were coded by 2 independent coders for the inclusion of components. RESULTS: Many localities included model component: comprehensive tobacco definition (65%), appearance age (70.9%), local tobacco retail license (72%), a graduated monetary penalty structure (93%), and tobacco retail license suspensions or revocations (74%) for repeated violations. However, only 17.4% of policies included an appearance age in compliance with federal law (30 years). Furthermore, few policies included enforcement components, such as a mandatory number of inspections (5.9%) or compliance checks (6.7%) per year, or a minimum age for the underage purchasers used during compliance checks (8.4%). CONCLUSIONS: Local policies can play an important role in tobacco control by providing an added layer to ensure adequate enforcement of age-restriction policies and allow an avenue to introduce strict measures that may diffuse into higher branches of government for policy adoption. Although many local Tobacco 21 policies fill regulatory gaps within the state and federal laws, often there is a lack of model components to ensure that policies are implemented as intended.

Addiction vs. dependence: A mixed methods analysis of young adult JUUL users.

OBJECTIVE: JUUL-brand electronic cigarettes (e-cigarettes) contain higher levels of nicotine than other e-cigarettes. The current study examined the relationship between young adults' self-reported addiction and measured JUUL dependence. METHODS: This study used a sequential, explanatory mixed methods design. Data were collected from a large, southwestern college in the US. College students who were weekly JUUL users and owned a JUUL device (n = 595) completed a cross-sectional online survey, then a subsample (n = 51) participated in in-person interviews. All data were collected between March-April 2019. T-tests were used to examine differences between JUUL dependence and self-reported addiction, and logistic regressions were employed to examine factors that may influence self-reported addiction to JUUL, nicotine, and other e-cigarettes. Interviews were independently coded by 2 coders (kappa ranged from 0.46 to 0.99) then analyzed for corresponding themes. RESULTS: Participants who had a higher JUUL dependence were more likely to report addiction to several substances/products, including nicotine, JUULs, cigarettes, other e-cigarettes, alcohol, and marijuana. Interview participants minimized JUUL addiction by comparing JUUL to other socially acceptable addictions and describing JUUL addiction as a habit. Interview participants suggested addiction to nicotine was more stigmatizing than JUUL. The number of days participants used JUUL per week, use of traditional tobacco products, and measured JUUL dependence were each associated with self-reported JUUL addiction. CONCLUSIONS: Social construction of self-reported addictions may be changing young audiences' views of addiction to JUUL. Research is needed to see if using the phrase 'nicotine dependence' rather than 'JUUL addiction' influences young adults' JUUL use.

Development of a tobacco 21 policy assessment tool and state-level analysis in the USA, 2015-2019.

OBJECTIVE: Policies raising the minimum legal sales age (MLSA) of tobacco products to 21 are commonly referred to as tobacco 21. This study sought to identify components of tobacco 21 policies and develop an instrument to examine policy language within 16 state laws adopted by July 2019. METHODS: The multistage tool development process began with a review of established literature and existing tobacco 21 policies. In a series of meetings, tobacco control experts identified key policy components used to develop an initial tool. After testing and revisions, the instrument was used to code the existing tobacco 21 state-level policies. Inter-rater reliability (κ=0.70) was measured and discrepancies were discussed until consensus was met. Policy component frequencies were reported by state. RESULTS: While all 16 states raised the MLSA to 21, the laws varied widely. Two laws omitted purchaser identification requirements. Fifteen laws mentioned enforcement would include inspections, but only three provided justification for conducting inspections. All 16 states provided a penalty structure for retailer/clerk violations, but penalties ranged considerably. Fourteen states required a tobacco retail licence, nine renewed annually. Six laws contained a military exemption, five were phased-in and 10 contained purchase, use or possession laws, which penalised youth. Four states introduced or expanded pre-emption of local tobacco control. CONCLUSIONS: The instrument developed is the first to examine policy components within state-level tobacco 21 laws. Policies that include negative components or omit positive components may not effectively prevent retailers from selling to youth, which could result in less effective laws.

Association between fertilizer-mediated changes in microbial communities and Aedes albopictus growth and survival.

Contamination of aquatic habitats with anthropogenic nutrients has been associated with an increase in mosquito larval populations but the underlying mechanisms remain poorly understood. We examined the individual and combined effects of two synthetic fertilizers (ammonium sulfate and potassium chloride) on Aedes albopictus survival, development time, and sex ratio. The bacterial and fungal communities of water samples from different fertilizer treatments were also characterized by MiSeq sequencing of the 16S rRNA gene (bacteria) and internal transcribed spacer 1 (fungi) and their relationship with mosquito survival and development determined. Mosquitoes from ammonium sulfate treatment had significantly lower survival rates and longer development times compared to those from control, potassium chloride or a mixture of the two fertilizers. Fertilizer treatment had no significant effects on Ae. albopictus sex ratio although ammonium sulfate treatment tended to be more biased towards males relative to the other treatments. There were no significant effects of fertilizer treatment on fungal communities. However, potassium chloride treatments had lower bacterial diversity compared to the other treatments and the bacterial community structure of control and potassium chloride treatments differed significantly from that of ammonium sulfate and a mixture of the two fertilizers. Microbial composition but not diversity was significantly associated with mosquito survival and development. These findings suggest that anthropogenic nutrients can have a profound impact on mosquito survival and development. In addition to any potential direct effects on mosquito physiology, our results suggest that fertilizers can act indirectly by disrupting the microbial communities that provide a critical food resource for mosquito larvae.

Use of viscogens, dNTPalphaS, and rhodium(III) as probes in stopped-flow experiments to obtain new evidence for the mechanism of catalysis by DNA polymerase beta.

The kinetic mechanism and the structural bases of the fidelity of DNA polymerases are still highly controversial. Here we report the use of three probes in the stopped-flow studies of Pol beta to obtain new, direct evidence for our previous interpretations: (a) Increasing the viscosity of the reaction buffer by sucrose or glycerol is expected to slow down the conformational change differentially, and it was shown to slow down the first (fast) fluorescence transition selectively. (b) Use of dNTPalphaS in place of dNTP is expected to slow down the chemical step preferentially, and it was shown to slow down the second (slow) fluorescence transition selectively. (c) The substitution-inert Rh(III)dNTP was used to show for the first time that the slow fluorescence change occurs after mixing of Pol beta.DNA.Rh(III)dNTP with Mg(II). These results, along with crystal structures, suggest that the subdomain-closing conformational change occurs before binding of the catalytic Mg(II) while the rate-limiting step occurs after binding of the catalytic Mg(II). These results provide new evidence to the mechanism we suggested previously, but do not support the results of three recent papers of computational studies. The results were further supported by a "sequential mixing" stopped-flow experiment that used no analogues, and thus ruled out the possibility that the discrepancy between experimental and computational results is due to the use of analogues. The methodologies can be used to examine other DNA polymerases to answer whether the properties of Pol beta are exceptional or general.

Foreign-educated nurses: strangers in a strange land?

Review a model for seemlessly integrating foreign-educated nurses into your unit.