Effect of a single one-hour teaching session about environmental pollutants and climate change on the understanding and behavioral choices of adolescents: The BREATHE pilot randomized controlled trial.

BACKGROUND: Despite the wealth of scientific information on the health effects of air pollution, the adult public's lifestyle continues to be largely detrimental towards the environment. OBJECTIVE: The purpose of the study was to determine whether a short interactive teaching session on air pollution could shift reported behavioral choices of adolescents towards environmentally friendlier options. METHODS: We performed a pilot randomized control trial in which eighth-grade students were randomized to receive a one-hour script-based teaching on either the effects of air pollution on lung health (intervention group) or the role of vaccination in public health (active control group). The enrolled students completed a survey (15 multiple-choice questions; five targeting understanding (score range 5 to 20); ten targeting behavioral choices (score range 10 to 38) newly designed for this study to evaluate their understanding and predict their future behavior towards air pollution immediately before, immediately after, and one month after the teaching sessions. RESULTS: Seventy-seven students (age = 13.5±0.6 years; 50.4% female; median annual family income = $25K-$50K with 70.1% <$50K; 39 assigned to intervention group) were enrolled in the study. The teaching sessions did not result in any significant change in the participants' understanding domain scores in either the intervention or the control groups. However, the intervention (air pollution) teaching session resulted in a statistically significant increase in behavior domain score from baseline to immediately post-teaching, which continued to be present at one-month follow-up (mean ± standard deviation of score change immediately after = 1.7±3.3; score change 1-month after = 2.5±3.2; P<0.001; minimally important difference = 1.0). DISCUSSION: This pilot study highlights the potential of a short one-time teaching session in promoting environmentally friendly behavior choices among adolescents.

Educators' Perspectives on Integrating Technology Into Sexual Health Education: Implementation Study.

BACKGROUND: In the last decade, the use of technology-based sexual health education has increased. Multiple studies have shown the feasibility of technology-based interventions, while a subset has also shown efficacy in improving youths' sexual health outcomes such as increased condom use and knowledge. However, little is known about health educators' experiences in integrating technology to augment sexual health curricula. OBJECTIVE: The purpose of this study was to assess the perceptions and experiences of health educators regarding the incorporation of technology into a sexual health education program designed for underserved youth in Fresno County, California, and to identify facilitators and challenges to incorporating technology into the in-person curriculum. METHODS: This implementation study used data collected as part of a cluster randomized controlled trial to evaluate In the Know (ITK), an in-person sexual health education curriculum that includes technology-based content, such as a resource locator, videos, and games, which can be accessed through a mobile app or website. Data from implementation logs from each cohort (n=51) and annual interviews (n=8) with health educators were analyzed to assess the health educators' experiences using the technology and adaptations made during the implementation. RESULTS: The health educators reported that technological issues affected implementation to some degree: 87% of the time in the first year, which decreased to 47% in the third year as health educators' familiarity with the app increased and functionality improved. Technology issues were also more common in non-school settings. Successes and challenges in 3 domains emerged: managing technology, usability of the ITK app, and youth engagement. The health educators generally had positive comments about the app and youth engagement with the technology-based content and activities; however, they also noted certain barriers to adolescents' use of the mobile app including limited data storage and battery life on mobile phones. CONCLUSIONS: Health educators require training and support to optimize technology as a resource for engaging with youth and providing sensitive information. Although technology is often presented as a solution to reach underserved populations, educational programs should consider the technological needs and limitations of the participants, educators, and settings. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.2196/18060.

Effect of ozone on allergic airway inflammation.

Background: Exposure to ozone (O3) is associated with increased risk of exacerbations of asthma, but the underlying mechanisms are not well studied. Objective: We sought to determine whether O3 exposure would enhance airway inflammatory responses to allergen and the GSTM1-null genotype would modulate this enhancement. Methods: In a crossover design, 10 asthmatic participants (5 with GSTM1-null genotype) who had specific sensitization to Dermatophagoides pteronyssinus (DP) were exposed to 160 ppb O3 or filtered air (FA) control for 4 hours on 2 separate days at least 3 weeks apart. At 20 hours after exposure, endobronchial challenge with DP allergen, and sham normal saline (NS) instillation, were performed in separate bronchi. Six hours later, a second bronchoscopy was performed to collect bronchoalveolar lavage (BAL) from the DP- and NS-challenged segments for analyses of inflammatory biomarkers. Linear regression compared cell and cytokine responses across the 4 exposure groups (FA-NS, O3-NS, FA-DP, O3-DP). Effect modification by GSTM1 genotype was assessed in stratified regressions. Results: BAL eosinophil counts were increased in segments challenged with DP compared to sham-challenged segments (P < .01). DP challenge compared to sham also caused a significant increase in BAL concentrations of the TH2 cytokines IL-4, IL-5, IL-10, and IL-13 (P < .03 for all comparisons). O3 exposure did not significantly affect BAL cells or cytokine after DP challenge. Compared to GSTM1-present participants, GSTM1-null participants had significantly lower eosinophil (P < .041) and IL-4 (P < .014) responses to DP challenge after O3 exposure. Conclusions: While O3 did not cause a clear differential effect on airway inflammatory responses to allergen challenge, those responses did appear to be modulated by the antioxidant enzyme, GSTM1.

E-cigarettes versus nicotine patches for perioperative smoking cessation: a pilot randomized trial.

INTRODUCTION: Cigarette smoking by surgical patients is associated with increased complications. E-cigarettes have emerged as a potential smoking cessation tool. We sought to determine the feasibility and acceptability of e-cigarettes, compared to nicotine patch, for perioperative smoking cessation in veterans. METHODS: Preoperative patients were randomized to either the nicotine patch group (n = 10) or the e-cigarette group (n = 20). Both groups were given a free 6-week supply in a tapering dose. All patients received brief counseling, a brochure on perioperative smoking cessation, and referral to the California Smokers' Helpline. The primary outcome was rate of smoking cessation on day of surgery confirmed by exhaled carbon monoxide. Secondary outcomes included smoking habits, pulmonary function, adverse events, and satisfaction with the products on day of surgery and at 8-weeks follow-up. RESULTS: Biochemically verified smoking cessation on day of surgery was similar in both groups. Change in forced expiratory volume in one second (FEV1) was 592 ml greater in the e-cigarette group (95% CI [153-1,031] ml, p = 0.01) and change in forced expiratory volume in one second to forced vital capacity ratio (FEV1/FVC ratio) was 40.1% greater in the e-cigarette group (95% CI [18.2%-78.4%], p = 0.04). Satisfaction with the product was similar in both groups. DISCUSSION: E-cigarettes are a feasible tool for perioperative smoking cessation in veterans with quit rates comparable to nicotine replacement patch. Spirometry appears to be improved 8-weeks after initiating e-cigarettes compared to nicotine patch, possibly due to worse baseline spirometry and more smoking reduction in the e-cigarette group. An adequately powered study is recommended to determine if these results can be duplicated.

Inflammatory and repair pathways induced in human bronchoalveolar lavage cells with ozone inhalation.

BACKGROUND: Inhalation of ambient levels of ozone causes airway inflammation and epithelial injury. METHODS: To examine the responses of airway cells to ozone-induced oxidative injury, 19 subjects (7 with asthma) were exposed to clean air (0ppb), medium (100ppb), and high (200ppb) ambient levels of ozone for 4h on three separate occasions in a climate-controlled chamber followed by bronchoscopy with bronchoalveolar lavage (BAL) 24h later. BAL cell mRNA expression was examined using Affymetrix GeneChip Microarray. The role of a differentially expressed gene (DEG) in epithelial injury was evaluated in an in vitro model of injury [16HBE14o- cell line scratch assay]. RESULTS: Ozone exposure caused a dose-dependent up-regulation of several biologic pathways involved in inflammation and repair including chemokine and cytokine secretion, activity, and receptor binding; metalloproteinase and endopeptidase activity; adhesion, locomotion, and migration; and cell growth and tumorigenesis regulation. Asthmatic subjects had 1.7- to 3.8-fold higher expression of many DEGs suggestive of increased proinflammatory and matrix degradation and remodeling signals. The most highly up-regulated gene was osteopontin, the protein level of which in BAL fluid increased in a dose-dependent manner after ozone exposure. Asthmatic subjects had a disproportionate increase in non-polymerized osteopontin with increasing exposure to ozone. Treatment with polymeric, but not monomeric, osteopontin enhanced the migration of epithelial cells and wound closure in an α9ß1 integrin-dependent manner. CONCLUSIONS: Expression profiling of BAL cells after ozone exposure reveals potential regulatory genes and pathways activated by oxidative stress. One DEG, osteopontin, promotes epithelial wound healing in an in vitro model of injury.