Partners in vaccination: A community-based intervention to promote COVID-19 vaccination among low-income homebound and disabled adults.

BACKGROUND: Care managers (CM) for low-income disabled clients may address COVID-19 vaccine hesitancy with specific training. OBJECTIVE: To assess the Partners in Vaccination (PIV) that trained CMs of a homecare program for disabled adults to promote COVID-19 vaccination. METHODS: We randomized 78 CMs to PIV intervention (N = 38) or control (N = 40). PIV featured motivational interviewing (MI) skills and educational materials for unvaccinated clients. The primary outcome was first COVID-19 vaccination between December 1, 2021 and June 30, 2022 for clients of intervention CMs versus control CMs. Mixed method analysis included key informant interviews conducted from 5/24/22 to 7/25/22 with CMs, administrators, and clients about the PIV intervention. RESULTS: Among 1939 clients of 78 study CMs, 528 (26.8 %) were unvaccinated by December 1, 2021 (274 clients of intervention CMs; 254 clients of control CMs). These clients' mean age was 62.3 years old (SD = 22.4) and 54 % were Black or Hispanic/Latino. First vaccination rate did not differ for intervention and control groups (6.2 % vs. 5.9 %, p = .89) by 6/30/2022. Barriers to addressing COVID-19 vaccination from interviews with 7 CMs and administrators were competing responsibilities and potentially antagonizing clients. Seven interviewed clients (five vaccinated and two unvaccinated) cited concerns about vaccination they heard from their family/friends and belief that risks of COVID-19 infection may be less than vaccination. Yet, some clients were receptive to physician recommendations. CONCLUSION: Training CMs to promote COVID-19 vaccination for disabled clients did not increase first vaccination rates. CMs preferred their usual role of coordinating care and, even after the training, expressed discomfort with this potentially polarizing topic.

Proximity to Cannabis Retailers and Recent Cannabis Use among a Diverse Sample of California Adolescents.

Background: As of May 2023, 23 states and Washington, DC have legalized the sale of cannabis for adults aged 21+, and 38 states, three territories, and D.C. have legalized medical cannabis. Exposure to cannabis retailers could increase adolescent cannabis use. Few studies have examined the impact of residential proximity to cannabis retailers on adolescent cannabis use, and previous findings are inconsistent. Methods: This study examined associations between proximity to cannabis retailers and past 30-day cannabis use. Data were from Project Cal Teens, a statewide survey of California adolescents regarding cannabis-related opinions/behaviors (N = 1406, mean age = 15.5 years, 48% female, 38% Hispanic/Latinx, 33% White, 15% Asian/Pacific Islander, 10% Black/African American, 5% Other/Multiracial). Participants were recruited via schools/social media in 2018-2020. Results: For every additional 5 driving miles to the nearest cannabis retailer, the risk of past 30-day cannabis use was reduced by 3.6% [IRR: 0.964; 95% CI: 0.935-0.994]. For every additional 5 miles from a licensed retailer, the risk of past 30-day cannabis use was reduced by 4.3% [IRR: 0.957; 95% CI: 0.926-0.989]. Interaction analyses revealed that among Hispanic/Latinx students, every 5 miles from a licensed retailer was associated with an 11.9% reduction in the risk of past 30-day cannabis use [IRR: 0.881; 95% CI: 0.820-0.945]. Conclusions: As the number of cannabis retailers in the U.S. increases with the continued legalization of adult cannabis use, research examining the effects of these policies on underage use is crucial. Interventions could include enforcement of zoning laws in/near residential areas to reduce accessibility of adolescents to cannabis retailers.

Surveying Adolescents During a Pandemic: Comparison of Adolescents Recruited via Social Media vs. Schools.

School-based surveys of adolescents can be logistically difficult and exclude students who do not attend school. Social media recruitment could be a promising strategy to recruit representative samples of adolescents. However, few studies have compared adolescent survey data collected via different methodologies. Our team was conducting a school-based survey when the COVID-19 pandemic closed all schools, necessitating a shift to online adolescent recruitment. To achieve our goal of obtaining a sample of high school students throughout California, we placed ads on social media. We compared the adolescents recruited in schools with those recruited on social media on demographic characteristics, mental health, and substance use. The sample of students recruited in schools (N = 737) and adolescents recruited via social media (N = 953) did not differ significantly on gender or substance use. However, compared with school-based recruitment, social media recruitment yielded a higher proportion of boys, whites, and Asians and a lower proportion of girls, Hispanic/Latinx adolescents, and those who spoke other languages at home. The social media sample had significantly higher levels of depression and anxiety symptoms and perceived stress than the school-based sample. Results indicate that social media can be useful for recruiting adolescents for survey research, especially if strategies such as Spanish-language social media ads are used to recruit and consent Hispanic/Latinx adolescents and those with non-English-speaking parents. This method could potentially replace school-based surveys in cases where schools are unwilling to participate in research, or it could be used to supplement school-based samples. Advantages and disadvantages of both methods are discussed.

The Impact of Childhood Trauma on Problematic Alcohol and Drug Use Trajectories and the Moderating Role of Social Support.

Adverse childhood experiences (ACE) have a strong association with alcohol and drug use; however, more research is needed to identify protective factors for this association. The present study assesses the longitudinal impact of ACE on problematic alcohol and drug use and the potential moderating effect of perceived social support. Data (n = 1404) are from a sample of Hispanic youth surveyed in high school through young adulthood. Linear growth curve models assessed the effect of ACE and perceived social support over time on problematic alcohol and drug use. Results indicated youth with ACE (vs. those without ACE) report more problematic alcohol and drug use in adolescence and have increased rates into young adulthood. Additionally, findings suggest that social support in high school may moderate the effects of ACE on problematic use over time. Among youth with high levels of support, the association of ACE with problematic alcohol and drug use was diminished. Although ACE can have a persistent impact on problematic alcohol and drug use from adolescence into adulthood, high social support during adolescence may mitigate the negative effects of ACE, lowering early problematic alcohol and drug use, offering the potential for lasting benefits.

Testing mediational processes of substance use relapse among youth who participated in a mobile texting aftercare project.

BACKGROUND: The goal of this paper is to advance the understanding of mechanisms of action involved in behavioral-driven aftercare interventions for substance use disorders (SUDs) among youth populations. This paper reports data from a study that measured the impact of an aftercare intervention on primary substance use relapse among youth who completed treatment in Los Angeles County for SUDs. The aftercare intervention, Project ESQYIR-Educating and Supporting inQuisitive Youth In Recovery, utilized text messaging to monitor relapse and recovery processes, provide feedback, reminders, support, and education among youth from SUD specialty settings during the initial 3-month period following treatment completion.Method: Mediational modeling informed by Baron and Kenny was used to examine the extent to which select recovery processes including participation in extracurricular activities and self-help, were impacted by the texting intervention, and if such processes helped sustain recovery and prevent primary substance use relapse. The data come from a two-group randomized controlled pilot study testing the initial efficacy of a mobile health texting aftercare intervention among 80 youth (Mage= 20.7, SD = 3.5, range: 14-26 years) who volunteered to participate after completing SUD treatment between 2012 and 2013.Results: Among the two recovery processes examined in the mediational modeling, only involvement in extracurricular activities mediated the effects of the texting aftercare intervention on reductions in primary substance use relapse; not self-help participation.Conclusion: Findings from this pilot study offer greater understanding about potential recovery-related mechanisms of action of mobile aftercare interventions. Mobile texting was found to promote increased engagement in recovery-related behaviors such as participation in extracurricular activities, which mediated the effects of the mobile aftercare intervention on decreasing primary substance use relapse. Findings suggest mobile approaches may be effective for increasing adherence to a wide-array of recovery behavioral regiments among youth populations challenged by complex behavioral issues.

Associations between Local Jurisdiction Ordinances and Current Use of Cannabis Products in California Adolescents.

PURPOSE: Cannabis use among adolescents may have detrimental effects and use among this age group is increasing. It is important to understand how expansion of laws permitting cannabis sales may impact adolescent use. Much of the current research has explored how state-level policy decisions may impact adolescents' use behaviors; however, there is a gap in the understanding of how differences in local jurisdictional policies may also influence underage cannabis use.Procedures: The present study cross-sectionally assesses local variation in cannabis policies to explore the potential effects of local policy on underage use behaviors. Data were collected from (N = 1,573) adolescents representing 120 different localities across California, collected as a part of Project Cal Teens. Linear regression models were used to assess associations between local jurisdiction's allowance of retail sale of cannabis for adult-use and past 30-day use of non-medical (adult use) cannabis and perceived access to cannabis products. FINDINGS: Local policy allowing cannabis retail was associated with adolescents' significantly higher past 30-day use of cannabis (ß = 0.25 95% CI = 0.08, 0.42) and perceived access (ß = 0.60 95% CI = 0.27, 0.94). CONCLUSIONS: Results highlight the impact of local cannabis policies on adolescent cannabis use and perception. Considering the effects of cannabis use on adolescent development, this is an important public health concern because 14 states have already legalized recreational retail sales and growing numbers of local jurisdictions are allowing the retail sale of recreational cannabis.

Longitudinal Tracking of Vape Shop Compliance With State Business Regulations Within Southern California Ethnic Neighborhoods During the COVID-19 Pandemic.

The overall aim of this study is to examine vape shop business operations during COVID-19 among a cohort of 88 vape shops in the Greater Los Angeles area in Southern California, located in ethnically diverse communities. A total of six web- and/or phone-based assessments were conducted over a 12-week period (April 1, 2020-June 10, 2020), extending from the mandated closure of nonessential businesses (Stage 1; Assessments 1-3) to the reopening of nonessential sectors (Stage 2; Assessments 4-6), to evaluate business operations (open and closure statuses). The proportion of vape shops found to be noncompliant with the Governor's executive order (i.e., open) during Stage 1 gradually increased from 54 (61.4%) at Assessment 1 (week of April 1, 2020) to 58 (65.9%) at Assessment 3 (week of April 29, 2020). Moreover, vape shops located in Hispanic/Latino and Korean/Asian communities (vs. those in non-Hispanic White and African American communities) were more likely to stay open both during and after the shutdown at Assessments 1 and 6. More specifically, vape shops located in Hispanic/Latino communities were significantly more likely to offer walk-in service during Assessment 1 (during the shutdown), and vape shops in Hispanic/Latino and Korean/Asian were significantly more likely to offer walk-in service during Assessment 6 (after the re-opening). This study demonstrates high rates of noncompliance with shutdown orders among vape shops located in ethnic communities, thus suggesting higher contextual risk factors of COVID-19 exposure among certain ethnic communities.

Locations of licensed and unlicensed cannabis retailers in California: A threat to health equity?

This study examined whether unlicensed and licensed cannabis retailers in California are disproportionately located in neighborhoods with minority populations or populations living below the Federal Poverty Level. We mapped the locations of licensed and unlicensed cannabis retailers in California in October 2018, combining advertisements from cannabis websites with licensing data. Demographic characteristics of neighborhoods with and without licensed and/or unlicensed cannabis retailers were compared. We identified 1110 cannabis retailers in California (448 licensed and 662 unlicensed). Relative to neighborhoods without retailers, neighborhoods with retailers had higher proportions of Hispanics, African Americans, and residents living below the poverty level. Compared with neighborhoods with only licensed retailers, neighborhoods with only unlicensed retailers had higher proportions of Hispanics and African Americans, and lower proportions of non-Hispanic whites. Neighborhoods with both licensed and unlicensed retailers had higher proportions of African Americans, Asian Americans, and people living in poverty, relative to neighborhoods with only licensed retailers. Unlicensed retailers were disproportionately located in unincorporated areas and jurisdictions that allow cannabis retailers. Minority populations in California are disproportionately exposed to unlicensed cannabis retailers, potentially exacerbating health disparities by selling unregulated products or selling to minors.

A Tobacco Control Framework for Regulating Public Consumption of Cannabis: Multistate Analysis and Policy Implications.

Eleven US states and Washington, DC, legalized recreational (adult use) cannabis. Seven states-Alaska, California, Colorado, Massachusetts, Nevada, Oregon, and Washington-allow cannabis sales. A public health concern is that exemptions in state or local smoke-free laws for public cannabis smoking or vaping will weaken smoke-free laws, expose the public to secondhand cannabis, and renormalize smoking.We describe the experience of the seven states and challenges faced in maintaining smoke-free laws. Using elements of a tobacco control framework, we identify best practices in cannabis regulation by comparing each state's smoke-free laws and allowances for public cannabis use. All states prohibit public cannabis use; two lack 100% smoke-free protections; one lacks vaping devices in its smoke-free law; three allow cannabis use in retailers; two allow cannabis use in social consumption lounges; and two allow cannabis use in tourism venues.States should close gaps in smoke-free laws and not expand where cannabis use is permitted to ensure public health.

Tobacco Retail Licensing and Youth Product Use.

BACKGROUND: Restricting youth access to tobacco is a central feature of US tobacco regulatory policy, but impact of local tobacco retail licensing (TRL) regulation on cigarette smoking rates remains uncertain. Effects of TRL on other tobacco product use and use as adolescents reach the age to legally purchase tobacco products has not been investigated. METHODS: Prevalences of ever and past 30-day cigarette, electronic cigarette (e-cigarette), cigar, and hookah use were assessed in a survey of a cohort of 1553 11th- and 12th-grade adolescents (mean age: 17.3 years); rates of initiation were evaluated 1.5 years later. An American Lung Association (2014) youth access grade was assigned to each of 14 political jurisdictions in which participants lived on the basis of the strength of the local TRL ordinance. RESULTS: At baseline, participants living in 4 jurisdictions with "A" grades (ie, with most restrictive ordinances) had lower odds of ever cigarette use (odds ratio [OR] 0.61; 95% confidence interval [CI] 0.41-0.90) and of past 30-day use (OR 0.51; 95% CI 0.29-0.89) than participants in 10 D- to F-grade jurisdictions. At follow-up at legal age of purchase, lower odds of cigarette use initiation (OR 0.67; 95% CI 0.45-0.99) occurred in jurisdictions with stronger TRL policy. Lower odds of e-cigarette initiation at follow-up (OR 0.74; 95% CI 0.55-0.99) and of initiation with past 30-day use (OR 0.45; 95% CI 0.23-0.90) were also associated with better regulation. CONCLUSIONS: Strong local TRL ordinance may lower rates of cigarette and e-cigarette use among youth and young adults.

Implementation of HPV vaccination guidelines in a diverse population in Los Angeles: Results from an environmental scan of local HPV resources and needs.

Research shows that vaccination against human papillomavirus (HPV) infection is one of the most effective methods for reducing risk for cervical cancer; it also protects against other HPV-related cancers. Controversies exist regarding HPV vaccination in several communities; which may in part explain why although rates of HPV vaccination are increasing nationwide, Los Angeles County (LAC) data show that many adolescents are still not vaccinated. These adolescents remain at high-risk for infection. Using community-based participatory principles, we conducted an environmental scan that included a literature review, the development of a community advisory board, community feedback from HPV community meetings, and interviews with stakeholders to understand attitudes toward HPV vaccination and their impact in follow through with HPV vaccines. Twenty-eight key stakeholders participated in our coalition comprised of community organizations and clinics with strong ties to the local community. This is the only coalition dedicated exclusively to improving HPV vaccine uptake in LAC. Of these, twenty-one participated in an environmental scan via qualitative interviews about HPV vaccination programs, service delivery priorities, and proposed steps to increase HPV vaccination uptake in LAC. The environmental scan revealed targets for future efforts, barriers to HPV uptake, and next steps for improving local HPV vaccination uptake rates. The environmental scan also identified local HPV vaccination interventions and resources. Although LAC has developed important efforts for vaccination, some interventions are no longer being implemented due to lack of funds; others have not been evaluated with sufficient outcome data. The risk for cervical and other HPV-related cancers could be greatly reduced in LAC if a multilevel, multicultural, and multilingual approach is taken to better understand rates of HPV vaccination uptake, particularly among racial/ethnic minorities and LGBTQ youth. Our environmental scan provides guidance on attitudes toward vaccination, and how best to address the needs of LAC families and providers.

High Chlamydia and gonorrhea incidence and reinfection among performers in the adult film industry.

BACKGROUND: Adult film industry (AFI) performers engage in unprotected oral, vaginal, and anal sex with multiple partners, increasing the likelihood of acquisition and transmission of human immunodeficiency virus and other sexually transmitted diseases. Current industry practice does not require condom use; instead it relies upon limited testing. We sought to estimate the annual cumulative incidence of chlamydia (CT) and gonorrhea (GC) and assess the rate of reinfection among AFI performers. METHODS: We retrieved all CT and GC cases diagnosed among performers between 2004 and 2008 in Los Angeles, CA and reported to the health department surveillance registry. Using 2008 data, we estimated ranges for CT and GC annual cumulative incidences based on assumptions of the population size of performers. For cases reported between 2004 and 2007, we determined the CT and/or GC reinfection rate within 1 year. RESULTS: Lower bounds for the annual cumulative incidences of CT and GC among AFI performers were estimated to be 14.3% and 5.1%, respectively. The reinfection rate within 1 year was 26.1%. Female performers were 27% more likely to be reinfected as compared with male performers (prevalence ratio, 1.27; 95% confidence interval, 1.09-1.48). CONCLUSION: CT and GC infections are common and recurrent among performers. Control strategies, including promotion of condom use, are needed to protect workers in this industry, as testing alone will not effectively prevent workplace acquisition and transmission. Additional legislation that places more responsibility on the production companies is needed to ensure the safety and health of performers.

Methamphetamine use and high-risk sexual behaviors among incarcerated female adolescents with a diagnosed STD.

Juvenile detention settings provide an important venue for addressing the health-related needs of adolescent populations, who often have high rates of sexually transmitted diseases (STDs) and concomitant drug use. This study examines factors associated with methamphetamine use and risky sexual behaviors among 539 incarcerated female adolescents between ages 12-18 years with an STD diagnosis. Data were obtained from interviews with detainees receiving STD case management services within a California juvenile detention facility in January 2006-June 2007. High-risk behaviors characterized the sample, such as low use of condoms consistently (43.3%), prior STD infection (25%), pregnancy history (26%), arrest charge for prostitution or drug use (23%), and a history of prostitution (18%). Half of the sample reported weekly alcohol or drug use; most commonly used drugs were marijuana (37%), alcohol (21%), and methamphetamine (16%). In multivariate analysis, African Americans had a lower odds of methamphetamine use (odds ratio [OR] = .163) compared with whites. Detainees who reported inconsistent condom use had over twice the odds of methamphetamine use (OR = 2.7) compared with consistent condom users. In addition, those who reported alcohol use had twice the odds of methamphetamine use (2.0). There was a significant interaction between Latina ethnicity and having an arrest charge for drugs or prostitution; Latinas who had this charge had over 11 times the odds of using methamphetamine compared with those with other arrest charges (OR = 11.28). A better understanding of the relationship between drug use and sexual risk behaviors of STD-positive incarcerated female adolescents can inform the development of appropriate corrections and community-based interventions serving this segment of high-risk adolescents.

Prescribed real-ear and achieved real-life differences in children's hearing aids adjusted according to the NAL-NL1 and the DSL v.4.1 prescriptions.

This paper examined how hearing aids adjusted for comparing NAL-NL1 with DSLv.4.1 prescription formulas matched prescriptive targets. The real-ear-to-coupler differences (RECD) of 48 children (24 in Australia and 24 in Canada) were measured and used to derive coupler gain targets. Verification of gain and output were carried out in an HA2-2cc coupler. Electroacoustic measurements revealed a minimal difference between NAL-NL1 and DSLv.4.1 frequency-response slopes due to practical limitations of the devices, even though the prescribed differences were large (up to 13 dB/octave). The difference in overall gain was generally achieved in the hearing aids, with DSLv.4.1 prescribing higher overall gain than NAL-NL1. The mean RECD at 4 kHz was 5 dB higher for children in Australia than in Canada. As the same RECDs were used in deriving targets for both prescriptions, this is unlikely to affect the results of the comparison. The impact of a gain difference between prescriptions on children's performance and preferences in real life is reported in separate papers.

Children's speech perception and loudness ratings when fitted with hearing aids using the DSL v.4.1 and the NAL-NL1 prescriptions.

This paper reports speech and loudness measures on a group of children in a double-blind cross-over trial comparing the NAL-NL1 and DSL[i/o] prescriptions. Twenty-four children with hearing impairment were fitted with digital WDRC hearing aids at each site (Australia, Canada). Speech recognition was measured for nonsense syllables and for the 50% correct threshold for sentence recognition in noise. Loudness ratings for sentences were made on a 7-point scale. Measures were made at fitting and repeated following 8-week trials. Fitting orders were randomized and counterbalanced. Significant differences in consonant recognition occurred for individual children. On average, scores at the 80 dB SPL presentation level were better with the NAL-NL1 fitting. Loudness ratings differed at baseline but did not differ following home trials. Speech recognition scores revealed a small but significant interaction of prescription with level in quiet but not in noise. Individual children had significant performance differences. Loudness ratings showed significant acclimatization effects for children at both sites.

Evaluation of the NAL-NL1 and the DSL v.4.1 prescriptions for children: Paired-comparison intelligibility judgments and functional performance ratings.

This paper reports intelligibility judgments and real-life functional performance of 48 children in a double-blind, cross-over trial comparing the NAL-NL1 and the DSL v.4.1 prescriptions. Intelligibility judgments were obtained by using a paired-comparisons procedure with audiovisual stimuli. Functional performance of children during two eight-week periods, each with hearing aids adjusted to one prescription, was assessed by parents and teachers (PEACH and TEACH) and by children's self reports (SELF). Consistently across reports, performance was significantly better in quiet than in noise. On average, better performance in noise (a higher Noise subscale score) was associated with NAL-NL1 than with DSL v.4.1, both for the PEACH and the SELF. This difference was significant for the SELF in Australia. Intelligibility judgments revealed preferences that were equally split between prescriptions in both countries, on average. In the Australian sample, intelligibility judgments agreed with the questionnaire ratings and with parents' ratings. An increase in preference for NAL was significantly associated with lesser hearing loss. The effect was not significant in the Canadian sample.

Evaluation of the NAL-NL1 and DSL v4.1 prescriptions for children: Preference in real world use.

This paper reports real world preferences of children in a double-blind, cross-over trial comparing NAL-NL1 and DSL v.4.1 prescriptions. Twenty-four children wore digital WDRC hearing aids at each site (Australia, Canada). Multi-memory hearing aids provided the NAL and DSL programs in each of two memories. Diaries were completed during two counterbalanced trials, providing overall preference, situational preference, and preference comments. Ratings were reliable, and situational preferences factored into quiet/low level situations versus noisy/reverberant/high level situations. Children at both sites used DSL v4.1 for hearing low level speech, or when they wanted to hear loudly and clearly. Children used NAL-NL1 when they wished to hear sounds at a lower level, or to reduce background noise. Children expressed strong preferences for having the choice of both programs. Canadian children were more likely to prefer DSL than were the Australian children. Factors such as listening environment and prior listening experience are discussed in interpreting these findings.