Developing medical simulations for opioid overdose response training: A qualitative analysis of narratives from responders to overdoses.

Medical simulation offers a controlled environment for studying challenging clinical care situations that are difficult to observe directly. Overdose education and naloxone distribution (OEND) programs aim to train potential rescuers in responding to opioid overdoses, but assessing rescuer performance in real-life situations before emergency medical services arrive is exceedingly complex. There is an opportunity to incorporate individuals with firsthand experience in treating out-of-hospital overdoses into the development of simulation scenarios. Realistic overdose simulations could provide OEND programs with valuable tools to effectively teach hands-on skills and support context-sensitive training regimens. In this research, semi-structured interviews were conducted with 17 individuals experienced in responding to opioid overdoses including emergency department physicians, first responders, OEND program instructors, and peer recovery specialists. Two coders conducted qualitative content analysis using open and axial thematic coding to identify nuances associated with illicit and prescription opioid overdoses. The results are presented as narrative findings complemented by summaries of the frequency of themes across the interviews. Over 20 hours of audio recording were transcribed verbatim and then coded. During the open and axial thematic coding process several primary themes, along with subthemes, were identified, highlighting the distinctions between illicit and prescription opioid overdoses. Distinct contextual details, such as locations, clinical presentations, the environment surrounding the patient, and bystanders' behavior, were used to create four example simulations of out-of-hospital overdoses. The narrative findings in this qualitative study offer context-sensitive information for developing out-of-hospital overdose scenarios applicable to simulation training. These insights can serve as a valuable resource, aiding instructors and researchers in systematically creating evidence-based scenarios for both training and research purposes.

Resident Support for the Federally Mandated Smoke-Free Rule in Public Housing: 2018-2022.

This study examines support for the Department of Housing and Urban Development's (HUD) mandatory smoke-free rule up to four years post-rule among smokers and non-smokers. A repeated cross-sectional design was used where District of Columbia public housing residents aged 18+ (n = 529) completed surveys during three time points: July 2018 (pre-rule), November 2018-March 2020 (post-rule), and September 2020-December 2022 (post-rule + COVID-19). Full support for the rule was indicated by agreeing that smoking should not be allowed in all indoor locations and within 25 feet of buildings. Descriptive statistics showed significant differences in support across time for smokers (5.3%, 30.7%, and 22.5%, respectively) and similar support across time for nonsmokers (48.2%, 52.2%, and 40.0%, respectively). In unstratified regression analysis, pre-rule support was lower than when the rule was in effect (aOR = 0.47, 95% CI = 0.25, 0.90), and tobacco users were less likely to support the rule (aOR = 0.34, 95% CI = 0.23, 0.50). Stratified logistic regression results showed that pre-rule support was lower among smokers compared to post-rule support (aOR = 0.14, 95% CI = 0.03, 0.59); support among nonsmokers did not vary by time. Findings overall indicate low support for the smoke-free rule up to 4 years post-implementation. Engaging residents with the rule and promoting health and well-being may further enhance policy effectiveness and acceptance.

Prevalence and Correlates of Cardiovascular, Pulmonary, Cancer, and Mental Health Comorbidities Among Adults With HIV Who Smoke.

ABSTRACT: Using data from the D.C. Cohort Longitudinal HIV Study, we examined (a) diagnosed mental health and (b) cardiovascular, pulmonary, or cancer (CPC) comorbidity among adults with HIV who smoked. Among 8,581 adults, 4,273 (50%) smoked; 49% of smokers had mental health, and 13% of smokers had a CPC comorbidity. Among smokers, non-Hispanic Black participants had a lower risk for mental health (prevalence ratio [PR]: 0.69; 95% confidence interval [CI] [0.62-0.76]) but a higher risk for CPC (PR: 1.17; 95% CI [0.84-1.62]) comorbidity. Male participants had a lower risk for mental health (PR: 0.88; 95% CI [0.81-0.94]) and CPC (PR: 0.68; 95% CI [0.57-0.81]) comorbidity. All metrics of socioeconomic status were associated with a mental health comorbidity, but only housing status was associated with a CPC comorbidity. We did not find any association with substance use. Gender, socioeconomic factors, and race/ethnicity should inform clinical care and the development of smoking cessation strategies for this population.

Evaluating rescuer performance in response to opioid overdose in a community setting: Evidence for medically appropriate process measures.

Overdose education and naloxone distribution (OEND) programs are widely accepted to reduce opioid overdose deaths. However, there is currently no validated instrument to evaluate the skills of learners completing these programs. Such an instrument could provide feedback to OEND instructors and allow researchers to compare different educational curricula. The aim of this study was to identify medically appropriate process measures with which to populate a simulation-based evaluation tool. Researchers conducted interviews with 17 content experts, including healthcare providers and OEND instructors from south-central Appalachia, to collect detailed descriptions of the skills taught in OEND programs. Researchers used three cycles of open coding, thematic analysis, and consulted currently available medical guidelines to identify thematic occurrences in qualitative data. There was consensus among content experts that the appropriate nature and sequence of potentially lifesaving actions during an opioid overdose is dependent on clinical presentation. Isolated respiratory depression requires a distinct response compared to opioid-associated cardiac arrest. To accommodate these different clinical presentations, raters populated an evaluation instrument with the detailed descriptions of overdose response skills, such as naloxone administration, rescue breathing, and chest compressions. Detailed descriptions of skills are essential to the development of an accurate and reliable scoring instrument. Furthermore, evaluation instruments, such as the one developed from this study, require a comprehensive validity argument. In future work, the authors will integrate the evaluation instrument in high-fidelity simulations, which are safe and controlled environments to study trainees' application of hands-on skills, and conduct formative assessments.

Are excluding e-cigarettes a loophole in the smokefree public housing rule?

The U.S. Department of Housing and Urban Development (HUD) required all Public Housing Authorities to become smokefree in July 2018, following an 18-month implementation period that began February 2017. The HUD rule included all combustible tobacco products; e-cigarettes were not included. This purpose of this study is to characterize e-cigarette use overall and initiation after the implementation of the smokefree rule among tobacco users living in public housing. Data were collected from 396 adult (18+ years) current tobacco users at the time of rule implementation residing in the District of Columbia Housing Authority between July 2018 and November 2021. Measures include e-cigarette use, age of initiation, reasons for e-cigarette use, e-cigarette use susceptibility (among non-users), and sociodemographic characteristics. Descriptive and crosstab statistics were calculated to characterize e-cigarette use. Nearly-one-quarter of tobacco users reported lifetime use of e-cigarettes (24 %, n = 95) and 4.8 % (n = 19) indicated past 30-day e-cigarette use. Of the lifetime users, twenty-two (23.2 %) initiated their use after the smoke-free rule went into effect, with only two of those residents indicating they did so because of the rule. Of those who never used an e-cigarette, 23.5 % (n = 70) indicated being curious about e-cigarettes and 10.7 % (n = 40) said they may use e-cigarettes in the next year. Results indicate low use of e-cigarette products and low uptake due to the rule. Few tobacco users who never used e-cigarettes indicated intentions to use. Results suggest that omitting e-cigarettes from the HUD rule has not led to significant use of these products in this sample.

Tobacco use among Appalachian adolescents: An urgent need for virtual scale out of effective interventions.

Tobacco use, typically initiated during adolescence, can escalate into young adulthood, even among experimenting or intermittent users. Despite declines in cigarette smoking among US adolescents, use of other tobacco products and poly-tobacco are on the rise among Appalachian adolescents. Unfortunately, Appalachian adolescent tobacco users also are less likely to receive effective tobacco interventions due to various barriers: a) accessibility (e.g. service and provider shortages, affordability, and transportation; b) acceptability (e.g. issues of privacy and stigma); and c) cultural relevance. The present review provides critical considerations synthesized from an extensive body of literature on the suitability of virtual tobacco interventions, the need for well-timed interventions that address complex tobacco use, and the rationale for leveraging and scaling evidence-based interventions inform novel interventions for Appalachian adolescent tobacco users. Borrowing strength from existing in-person evidence-based adolescent tobacco interventions and state-of-the-art virtual health services, a well-planned virtual scale out of tobacco interventions holds potential to minimize barriers unique to Appalachia.

Effect of menthol on nicotine reduction: Pooled results from two double-blind randomized controlled trials.

BACKGROUND: Menthol upregulates nicotinic acetylcholine receptors and is associated with tobacco dependence. The effects of menthol when smoking cigarettes with varying low nicotine content up to 98 % (e.g., non-addicting) less than commercial cigarettes is not well understood. The U.S. Food and Drug Administration is considering two tobacco product standards in cigarettes including banning menthol and reducing nicotine content. These new standards have the potential to significantly reduce smoking initiation and maintenance by limiting the mechanistic effects of nicotine and menthol on the brain. METHODS: We conducted two parallel randomized clinical trials of gradually reduced nicotine in cigarettes from 11.6 mg down to 0.2 mg nicotine/cigarette (very low nicotine content; VLNC) vs. usual nicotine content (11.6 mg; UNC) over an 18-week period in people who smoke cigarettes with low socioeconomic status (SES) and mental health conditions. RESULTS: Compared to UNC, VLNC was associated with significant reductions in cotinine, cigarettes per day, expired carbon monoxide levels, nicotine dependence and symptomology. These associations did not differ between menthol and non-menthol cigarettes, except people who smoke menthol cigarettes had less of a cotinine reduction in the SES trial. The pooled odds ratio of being adherent with using only VLNC study cigarettes in the gradual nicotine reduction arm for people who smoke non-menthol vs. menthol cigarettes was 2.6 (95 % CI:1.0, 6.4; p-value: 0.04). CONCLUSIONS: When nicotine is lowered to non-addicting levels, the results indicate an independent effect of menthol on the need to sustain nicotine intake in addicted people who smoke cigarettes.

Behavioural intentions in response to a potential menthol cigarette sales ban: a survey examining smokers in Washington, DC public housing.

OBJECTIVES: Local, national and international policies are being proposed to ban the sale of menthol-flavoured tobacco products. With more bans being implemented, it is increasingly important to understand reactions to these bans among smokers of low socioeconomic status. This study examined public housing residents' behavioural intentions if menthol-flavoured cigarettes were no longer sold. SETTING: 15 District of Columbia Housing Authority properties between March 2019 and March 2021. PARTICIPANTS: 221 District of Columbia Housing Authority residents ages 18-80 years who reported smoking menthol cigarettes (83.3% African-American/black). PRIMARY AND SECONDARY OUTCOMES: Cigarette quitting and switching intentions due to a hypothetical menthol-flavoured cigarette sales ban. RESULTS: Nearly one-half (48.0%) of residents said they intended to quit cigarette use if menthol-flavoured products were no longer sold, while 27.2% were unsure if they would quit, and 24.9% reported they would not quit. Older residents (OR 0.94 per year, 95% CI 0.91 to 0.97), senior/disabled building versus family building residents (OR 0.50, 95% CI 0.25 to 0.97), those who smoked within 30 min of waking (OR 0.48, 95% CI 0.23 to 0.98) and daily smokers (OR 0.42, 95% CI 0.21 to 0.84) had lower odds of reporting quit intentions associated with a menthol ban. Of those not intending to quit, 40.7% reported they would switch to non-menthol cigarettes, 20.4% to another non-menthol product, 13.0% to menthol e-cigarettes and 20.4% to another menthol product. CONCLUSIONS: Results suggest banning the sale of menthol-flavoured products has the potential to impact cigarette smoking cessation. Nearly three-quarters of smokers in public housing indicated a possibility of quitting smoking because of a menthol cigarette ban. Bans that include all flavours in all tobacco products may be most effective for facilitating overall tobacco cessation.

Individual Health Determinants That Predict Low Risk of Transitioning to Tobacco Use During Young Adulthood: An In-Depth Examination of Race and Ethnicity.

INTRODUCTION: The present study examines the contributions of individual-level health determinants on young adult tobacco use initiation to improve understanding of racial and ethnic distinctions and to inform effective tobacco prevention strategies. METHODS: Using time-to-event analyses, the 10-wave (2011-2016) Truth Initiative Young Adult Cohort, a probability-based, nationally representative sample of the US young adults aged 18-34 years (N = 7 665), provides data to examine differences in variables that influence tobacco uptake, by race and ethnicity. RESULTS: Among Non-Hispanic White young adults, having fewer peers who smoke cigarettes is protective against any tobacco initiation, whereas hazard of tobacco initiation increases for males, having low confidence to resist smoking, and having higher proclivity for sensation seeking. Depressive and anxiety symptoms increase uptake hazard most in the Non-Hispanic All Other Races group and least among Non-Hispanic Black individuals. Among Hispanic young adults, being female and perceiving tobacco as harmful are notably protective while being male is a notable uptake hazard. Unlike other groups, higher income levels do not lower hazards among Hispanic individuals. Cannabis use and overestimating the smoking rate among peers increase hazard least among Hispanic individuals. In the Non-Hispanic All Other Races group, aging is least protective; hazard increases notably if individuals engage in regular alcohol or cannabis use. CONCLUSIONS: Tobacco prevention efforts are critical during young adulthood. Specific tobacco uptake hazard and protective factors exist by race and ethnicity and should be considered when developing selective young adult prevention, particularly among groups with the highest risk for tobacco initiation during this life stage. IMPLICATIONS: Rising rates of tobacco initiation among the US young adults necessitate expanded efforts to prevent tobacco use initiation and progression beyond youth. Results highlight nuanced and differential tobacco uptake hazards by race and ethnicity for late initiation and sustained non-tobacco use among young adults. The study confirms existing evidence on tobacco use patterns and contributes to new knowledge on risk and protective factors. Tobacco prevention and control interventions, including policies, tailored in more meaningful ways could reduce tobacco use disparities among those most disproportionately affected.

Changes in young adult substance use during COVID-19 as a function of ACEs, depression, prior substance use and resilience.

Background: Given the potential for increased substance use during COVID-19, we examined (1) young adults' changes in cigarette, e-cigarette, marijuana, and alcohol use from pre- to during COVID-19; and (2) related risk/protective factors. These findings could inform intervention efforts aimed at curbing increases in substance use during periods of societal stress. Methods: We analyzed Wave 3 (W3; September-December 2019) and Wave 4 (W4; March-May 2020) from the Vape shop Advertising, Place characteristics and Effects Surveillance (VAPES), a 2-year, five-wave longitudinal study of young adults across six metropolitan areas. We examined risk/protective factors (i.e. adverse childhood experiences [ACEs], depressive symptoms, resilience) in relation to changes in past 30-day substance use frequency. Results: In this sample (N = 1084, Mage=24.76, SD = 4.70; 51.8% female; 73.6% White; 12.5% Hispanic), W3/W4 past 30-day use prevalence was: 29.1% cigarettes (19.4% increased/26.4% decreased), 36.5% e-cigarettes (23.2% increased/28.6% decreased), 49.4% marijuana (27.2% increased/21.2% decreased), and 84.8% alcohol (32.9% increased/20.7% decreased). Multivariate regressions indicated that, greater increases were predicted by: for e-cigarettes, greater ACEs; and for alcohol, greater depression. Among those with low resilience, predictors included: for e-cigarettes, greater depression; and for marijuana, greater ACEs. Conclusions: Interventions to reduce substance use during societal stressors should target both risk and protective factors, particularly resilience.

Implementation of the Department of Housing and Urban Development's Smoke-Free Rule: A Socio-Ecological Qualitative Assessment of Administrator and Resident Perceptions.

In July 2018, the United States Department of Housing and Urban Development (HUD) implemented a mandatory smoke-free rule in public housing. This study assessed administrator and resident perceptions of rule implementation during its initial year in the District of Columbia Housing Authority (DCHA). Assessment included nine focus groups (n = 69) with residents and in-depth interviews with administrators (n = 7) and residents (n = 26) from 14 DCHA communities (family = 7 and senior/disabled = 7). Semi-structured discussion guides based on the multi-level socio-ecological framework captured dialogue that was recorded, transcribed verbatim, and coded inductively. Emerging major themes for each socio-ecological framework level included: (1) Individual: the rule was supported due to perceived health benefits, with stronger support among non-smokers; (2) Interpersonal: limiting secondhand smoke exposure was perceived as a positive for vulnerable residents; (3) Organizational: communication, signage, and cessation support was perceived as a need; (4) Community: residents perceived mobility, disability, weather, and safety-related issues as barriers; and (5) Public Policy: lease amendments were perceived as enablers of rule implementation but expressed confusion about violations and enforcement. A majority of administrators and residents reported favorable implications of the mandated HUD rule. The novel application of a socio-ecological framework, however, detected implementation nuances that required improvements on multiple levels, including more signage, cessation support, clarification of enforcement roles, and addressing safety concerns.

A pilot randomized controlled trial of a tailored smoking cessation program for people living with HIV in the Washington, D.C. metropolitan area.

OBJECTIVE: Morbidity and mortality from smoking-related diseases among people living with HIV (PLWH) in the U.S. surpasses that due to HIV itself. Conventional smoking cessation treatments have not demonstrated strong efficacy among PLWH. We conducted a pilot randomized controlled trial (RCT) to evaluate a tailored smoking cessation intervention based on the minority stress model. We compared standard of care counseling (SOC) to a tailored intervention (TI) including one face-to-face counseling session incorporating cognitive behavioral therapy to build resilience, and 30 days of 2-way text messaging. RESULTS: The primary outcome was smoking cessation. Secondary outcomes included cigarettes per day (CPD), exhaled carbon monoxide (CO), and cessation self-efficacy. A total of 25 participants were enrolled (TI:11, SOC:14), and 2 were lost to follow-up. There were no significant differences in quit rates between study groups. However, there was a significantly greater decrease in CPD in the TI versus SOC (13.5 vs. 0.0, p-value:0.036). Additionally, self-efficacy increased in both groups (TI p-value:0.012, SOC p-value:0.049) and CO decreased in both groups (TI p-value: < 0.001, SOC p-value:0.049). This intervention shows promise to support smoking cessation among PLWH. A larger study is needed to fully evaluate the efficacy of this approach. CLINICAL TRIAL: Trial Registration: Retrospectively registered (10/20/2020) NCT04594109.

Campus tobacco control policies and cessation interventions in college students: a commentary calling for research and action to address tobacco-related health disparities.

Tobacco-related health disparities (TRHDs) have a significant impact on population health in the USA. Effectively preventing and controlling TRHDs among young adult populations require multiple prevention and cessation points, including within college/university contexts. This commentary addresses current campus tobacco control policies and cessation interventions for U.S. college students, with an emphasis on TRHDs and opportunities for research and research translation to reduce these disparities. This commentary is informed by literature published between 2010 and 2020 regarding (a) prevalence and impact of campus tobacco control policies; and/or (b) behavioral outcomes from cessation interventions for young adults attending colleges. Despite a doubling of college campuses adopting tobacco-free policies from 2012 to 2017, roughly two-thirds continue to operate without such policies. Few policies address alternative tobacco products (e.g., e-cigarettes, cigars/cigarillos, and hookah), and communication about and enforcement of existing policies is extremely limited. A broad range of cessation intervention strategies have targeted individuals in this age group, but with little focus on TRHDs and limited intervention dissemination. Importantly, college students representing populations at risk for TRHDs (e.g., racial/ethnic/sexual/gender minorities, low socioeconomic status) are less likely to be exposed to strong tobacco control policies or supports for cessation. There are untapped opportunities for behavioral medicine approaches to reduce TRHDs in college settings. Research findings regarding multilevel (policy, community-level, and individual-level) interventions must be translated to policy/practice in order to address tobacco use, particularly among vulnerable college student populations.

Smoking cessation intentions and attempts one year after the federally mandated smoke-free housing rule.

The present study examines public housing residents' smoking cessation intentions, expectancies, and attempts one year after implementation of the Department of Housing and Urban Development's mandatory smoke-free rule in public housing. The sample includes 233 cigarette smokers, ages 18-80, who reside in the District of Columbia Housing Authority. Data collection occurred between March and August 2019. Descriptive statistics, chi-square, and Wilcoxon two-sample test analyses assessed smoking cessation intentions, expectancies, and attempts across resident demographics and characteristics. Findings showed 17.2% of residents reported not thinking about quitting, 39.1% reported thinking about quitting, and 48.6% reported thinking about quitting specifically because of the rule. Residents ages 60-80 were more likely to consider quitting because of the rule, compared to residents ages 18-59. Of those thinking of quitting, 58.6% were sure they could quit if they tried. Those thinking of quitting due to the rule (62.0%) were more likely to have made at least one quit attempt in the past 3 months than those i not attributinging thinking of quitting to the rule. Res Residents trying to quit reported an average of 2.7 attempts in the last 3 months;; most perceived evidence-based cessation supports as not helpful. A A majority reported thinking about quitting and attempting to quit but continuing to smoke, indicating a significant gap between intent to quit and successfully quitting. Results suggest that the rule positively influenced smoking behaviors. However, additional interventions are needed to assist public housing residents with successfully quitting smoking.

Switching to Progressively Reduced Nicotine Content Cigarettes in Smokers With Low Socioeconomic Status: A Double-Blind Randomized Clinical Trial.

INTRODUCTION: The Food and Drug Administration issued an advanced notice of proposed rulemaking for setting a product standard for nicotine levels in cigarettes, with an emphasis on minimally or non-addicting very low nicotine content (VLNC). METHODS: A 33 week, two-arm, double-blind randomized trial conducted in Hershey, Pennsylvania, USA and Washington, DC, USA included adult daily cigarette smokers (≥5 cigarettes per day) with less than a college degree, and who had no plans to quit within the next six months. Participants were randomized to either reduced nicotine content (RNC) study cigarettes tapered every three weeks to a final VLNC (0.2 mg/cigarette) for six weeks or to usual nicotine content (UNC) study cigarettes (11.6 mg/cigarette). Outcomes included acceptability of study cigarettes measured by attrition (primary outcome), compliance, reduction in cigarette dependence and tobacco biomarkers, and post-intervention cessation. RESULTS: The RNC (n = 122) versus UNC (n = 123) group had higher attrition (adjusted Hazard Ratio 3.4; 95% confidence interval [CI] 1.99 to 5.81). At the end of the intervention, cotinine levels were 50% lower in the RNC group (mean group difference -137 ng/mL; 95% CI -172, -102). The RNC group smoked fewer CPD (-4.1; 95% CI -6.44, -1.75) and had lower carbon monoxide levels (-4.0 ppm; 95% CI -7.7, -0.4). Forty seven percent (29/62) of the RNC group were biochemically-confirmed compliant with smoking VLNC cigarettes (mean cotinine = 8.9 ng/ml). At three month follow-up, only compliant VLNC smokers quit with an assisted quit attempt (N = 6/22, 27%). CONCLUSIONS: This study supports a VLNC standard in cigarettes. IMPLICATIONS: Differential dropout and noncompliance indicate some smokers had difficulty transitioning to cigarettes with reduced nicotine. These smokers will benefit from supplemental nicotine in medicinal or noncombustible tobacco products if a nicotine reduction standard is established. Other smokers successfully transitioned to very low nicotine content cigarettes exclusively and substantially reduced their exposure to nicotine.

A review of performance assessment tools for rescuer response in opioid overdose simulations and training programs.

Since the 1990s, more than 600 overdose response training and education programs have been implemented to train participants to respond to an opioid overdose in the United States. Given this substantial investment in overdose response training, valid assessment of a potential rescuers' proficiency in responding to an opioid overdose is important. The aim of this article is to review the current state of the literature on outcome measures utilized in opioid overdose response training. Thirty-one articles published between 2014 and 2020 met inclusion criteria. The reviewed articles targeted laypersons, healthcare providers, and first responders. The assessment tools included five validated questionnaires, fifteen non-validated questionnaires, and nine non-validated simulation-based checklists (e.g., completion of critical tasks and time to completion). Validated multiple choice knowledge assessment tools were commonly used to assess the outcomes of training programs. It is unknown how scores on these assessment tools may correlate with actual rescuer performance responding to an overdose. Seven studies reported ceiling effects most likely attributed to participants' background medical knowledge or experience. The inclusion of simulation-based outcome measures of performance, including the commission of critical errors and the time to naloxone administration, provides better insight into rescuer skill proficiency.

Comparison between Gradual Reduced Nicotine Content and Usual Nicotine Content Groups on Subjective Cigarette Ratings in a Randomized Double-Blind Trial.

In 2018, the United States Food and Drug Administration (FDA) issued an advanced notice of proposed rulemaking to reduce nicotine in tobacco products to produce a minimally addictive or nonaddictive effect, but there was a research gap in the subjective responses of reduced-nicotine-content cigarettes. We compared the responses of the modified cigarette evaluation questionnaire (mCEQ) and cigarette-liking scale (CLS) between the gradually reduced nicotine content (RNC) group and the usual nicotine content (UNC) group. Linear mixed-effects models for repeated measures were used to analyze and compare the change over time for the mCEQ and CLS across the two treatment groups (RNC and UNC). We found that the change over time for the mCEQ and CLS was significant between the RNC and the UNC treatment groups at the beginning of visit 6 with 1.4 mg nicotine/cigarette. At visits 8 and 9, the RNC group reported significantly lower satisfaction scores compared to UNC. Subscale analysis showed that smoking satisfaction decreased in RNC while other measures, such as cigarette enjoyment, did not change. Understanding the impact of nicotine reduction on cigarette subjective responses through evaluation and liking scales would provide valuable information to the FDA on nicotine reduction policies for cigarettes.

Clinical trial recruitment of adult African American smokers from economically disadvantaged urban communities.

This investigation evaluated the effectiveness and challenges of multiple recruitment methods, described as proactive, reactive, and combination methods, among adult African American smokers (N = 527) from economically disadvantaged urban communities enrolled to test progressively reduced nicotine content investigational cigarettes. The study evaluated success using descriptive statistics to measure the volume of phone calls and percentage of eligible participants per method. Reactive and combination strategies effectively prompted participants to call about the study. Combination methods yielded the highest eligibility rates. Findings demonstrate the unique recruitment successes within this population across a range of recruitment methods and may inform improved methods to recruit and engage African Americans in clinical trials.

Receptivity to Tobacco Advertising among Young Adults with Internalizing Problems: Findings from the Population Assessment of Tobacco and Health Study.

Background: Many risk factors for tobacco use among the general young adult population, such as tobacco advertising receptivity, have gone unexamined among those with internalizing problems, despite disproportionately high rates of tobacco use. Objective: The objective of this study was to examine the interrelationship of internalizing problems, tobacco advertising receptivity, and tobacco use among young adults using data from Wave 1 of the Population Assessment for Tobacco and Health Study. Methods: The sample included 9,110 young adults (ages 18-24). Multivariable logistic regression models examined the association between internalizing problems and advertising receptivity and tobacco use. Separate models were run for cigarettes, cigars, e-cigarettes, smokeless tobacco and any tobacco use. An interaction term (receptivity × internalizing problems) was added to each model. Results: Except for smokeless tobacco, individuals with high internalizing problems reported greater odds of product use compared to those with low internalizing problems. There was no association between internalizing problems and use of smokeless tobacco. For all products, receptivity was positively associated with tobacco use. A borderline significant interaction was detected between cigarette advertising receptivity and internalizing problems, such that the magnitude of the relationship between receptivity to cigarette advertising and cigarette use was stronger for those with high internalizing problems compared those with low internalizing problems. Conclusions/Importance: The relationship between cigarette advertising receptivity and cigarette use may differ for those with and without internalizing problems. Disproportionate receptivity to risk-promoting messages among young adults with internalizing problems could exacerbate disparities in cigarette use.

Tobacco use and the interplay of internalizing, externalizing and substance use problems: A latent class analysis of data from the Population Assessment of Tobacco and Health Study.

BACKGROUND: Cigarette smoking is disproportionately high among adults with two or more psychiatric disorders (psychiatric comorbidities), yet research on non-cigarette tobacco use among this population is scant. Additionally, most studies on tobacco use this among this population rely on psychiatric diagnoses rather than individual symptoms, potentially excluding individuals with symptom-specific issues that increase their risk for tobacco use but do not meet the criteria for diagnosis. The objectives of this study were to identify unique classes of individuals based on symptoms of psychiatric disorders and to assess differences in demographic characteristics and tobacco use behaviors between classes. METHODS: This study used data from Wave 2 of the Population Assessment of Tobacco and Health Study adult dataset. Latent class analysis was used to classify individuals based on internalizing, externalizing and substance use problems. Bivariate and multivariable models examined the association between latent class membership and current use of cigarettes, cigar products, electronic nicotine delivery systems, pipe, hookah and smokeless tobacco products. Poly tobacco use was also examined. RESULTS: Three latent classes were identified. The "normative" class reported low prevalence of all symptoms, the "severe internalizing and non-violent externalizing" class reported severe internalizing problems and non-violent externalizing problems and the "severe" class reported high prevalence of all symptoms. Tobacco use was highest for the "severe" class and lowest for the "normative" class across products. CONCLUSIONS: Individuals in the "severe" class may be at elevated risk of tobacco-related morbidity and mortality and would likely benefit from targeted tobacco control interventions.