Quitting smoking with smoke? Unauthorized claims used by herbal cigarette manufacturers.

INTRODUCTION: Herbal cigarettes are made with non-tobacco plant materials (e.g., tea leaves, hemp), are typically sold pre-rolled in packs and with filters, and are combusted and smoked like tobacco cigarettes. Herbal cigarette manufacturers have a history of making misleading health claims and at least one company has previously settled with the US Federal Trade Commission over deceptive advertising. This study examined current claims and product characteristics of herbal cigarettes sold by a popular online retailer. METHODS: We searched Amazon.com for "herbal cigarettes" and "hemp cigarettes" and identified all herbal cigarette products sold on the first page of search results (n=51). Two coders independently content analyzed each product's Amazon page for claims (e.g., smoking cessation, health), product characteristics (e.g., flavors), and presence of disclaimers and warnings. RESULTS: Overall, 78.4% of product pages made smoking cessation claims (e.g., "A more scientific way to quit smoking", "…decreases nicotine craving symptom and helps to quit tobacco smoking"). Further, 45.1% of product pages included claims describing lower risk/exposure compared to tobacco products (e.g., "…without the addictive nicotine and toxic chemicals found in tobacco cigarettes"). Some herbal products were available in multiple flavors, including menthol (21.6%) and fruit (17.7%). Only 35.3% of products included visible health warnings on product packaging. CONCLUSIONS: Many herbal cigarette products sold on Amazon.com make unauthorized cessation and health claims. Regulatory agencies must act decisively to stop the misleading advertising of these products and develop appropriate warnings to educate the public about the potential harms of herbal cigarettes. IMPLICATIONS: This content analysis documents the use of unauthorized and misleading claims made in the marketing of herbal cigarettes.These findings highlight the need for enforcement of existing federal regulations, which prohibit deceptive advertising.Research is needed to inform the development of appropriate warning labels that can be used to inform consumers of the potential harms of smoking herbal cigarettes.

Not-so-disposable e-cigarettes: Methods young people use to discard single-use e-cigarettes.

BACKGROUND AND AIMS: To date, most tobacco product waste research focuses on cigarettes. Less is known about single-use 'disposable' e-cigarette waste, which contains several hazardous and toxic materials. This exploratory study examines self-reported methods for discarding disposables among a national sample of US adolescents and young adults. DESIGN, SETTING, PARTICIPANTS AND MEASUREMENTS: Data were obtained from a weekly cross-sectional survey of US residents aged 15-24 years. The analytical sample consisted of data collected from November 2022 to August 2023 from respondents who reported past-30-day use of disposables (n = 1313). Weighted multinomial logistic regressions examined the association between tobacco use behaviors and respondents' primary self-reported method for discarding disposables (reference group: 'throw them in the regular trash'), controlling for socio-demographic variables. FINDINGS: Approximately half of respondents discarded their empty disposables in the regular trash (52.9%). On average, respondents reported throwing away 3.1 disposables monthly [95% confidence interval (CI) = 2.83, 3.29]. Second most commonly, respondents reported keeping or collecting empty disposables (21.4%). Respondents who reported 10-30 days (versus 1-9) of past-month vaping were more likely to primarily keep or collect disposable e-cigarettes (relative risk reduction = 1.64, 95% CI = 1.20, 2.24) compared to discarding in the trash. CONCLUSIONS: Young people in the United States who use disposable e-cigarettes report primarily discarding their disposable e-cigarettes in the regular trash or keeping them. All reported disposal methods raise safety and environmental concerns.

The Effect of State and Local Flavored Cigar Sales Restrictions, on Retail Sales of Large Cigars, Cigarillos, and Little Cigars in Massachusetts, California, Illinois, and New York.

INTRODUCTION: In 2009, the Family Smoking Prevention and Tobacco Control Act prohibited flavored cigarettes but allowed for flavored cigars. Since, there has been a 34% increase in youth cigar use and widened racial disparities. State and local jurisdictions have increasingly enacted flavored tobacco product sales restrictions. As more jurisdictions consider implementing flavor restrictions, it is important to understand their effect on tobacco markets that have high flavor proliferation, including the cigar market. AIMS AND METHODS: This study uses data from Truth Initiative's flavor policy database and NielsenIQ retailer scanners for California, Illinois, Massachusetts, and New York. We use a three-way fixed-effect model to assess the impact of the percentage of the population covered by a flavored cigar sales restriction on per capita unit sales of cigars. RESULTS: We find that population coverage by cigar sales restrictions was significantly associated with decreases in per capita cigar sales. More specifically, a 25% increase in the percentage of the population covered by a flavored cigar sales restriction was associated with a decrease in per capita all cigar sales of 15%-19%, 4%-10% for large cigars, 17%-21% for cigarillos, and 2%-41% for little cigars. CONCLUSION: Flavored cigar sales restrictions are an effective policy to reduce per capita cigar sales. The Food and Drug Administration (FDA)'s proposed product standards would increase population covered by a flavored cigar sales restriction to 100%, leading to potential significant reductions in cigar sales, especially little cigar, and cigarillo sales. This may also substantially reduce youth cigar use and racial disparities in cigar use. IMPLICATIONS: In April 2022, the U.S. FDA published a proposed rule to prohibit characterizing flavors in all cigars and menthol cigarettes. Besides this proposed rule, there has been little federal action to date to reduce sales of flavored cigars. However, as of March 31, 2022, Massachusetts and 333 localities across 10 states have enacted policies that restrict the sale of flavored cigars and other tobacco products. We find that population coverage by cigar sales restrictions is significantly associated with decreases in per capita cigar sales.

Patient Motivation to Reduce or Discontinue Opioids for Chronic Pain: Self-efficacy, Barriers, and Readiness to Change.

OBJECTIVES: This study aimed to assess levels and predictors of self-efficacy and motivation to change opioid use among a community sample of patients using opioids for chronic pain, as well as patient-reported barriers to pursuing opioid discontinuation. METHODS: Participants with a variety of chronic pain conditions, recruited from ResearchMatch.org , completed a battery of electronic, self-report questionnaires assessing demographic and medical characteristics, pain treatment history, and levels of readiness, self-efficacy, and other attitudes toward reducing or discontinuing opioid use. Multiple regression analyses and analyses of variance were conducted to examine predictors of readiness and self-efficacy to change opioid use. A modified version of rapid qualitative analysis was utilized to analyze themes in participant responses to an open-ended item about "what it would take" to consider opioid discontinuation. RESULTS: The final sample included N=119 participants, the majority of whom were female (78.2%), Caucasian (77.3%), and well-educated. Readiness and self-efficacy to decrease or stop opioid use were fairly low on a 0 to 10 Visual Analog Scale (2.6 to 3.8) and significantly higher to decrease than stop ( P <0.01). Higher readiness to change was predicted by lower pain severity and higher concern about opioids, whereas higher self-efficacy was predicted by shorter pain duration. Results from the qualitative analyses revealed that the availability of an alternative treatment option was the most commonly cited requirement to consider opioid discontinuation. DISCUSSION: Patients with lower pain severity, shorter duration of pain, and higher concerns about opioids may be a prime target from a motivation standpoint for interventions addressing opioid tapering and discontinuation.

Illuminating a Path Forward for Tobacco Nation: Projected Impacts of Recommended Policies on Geographic Disparities.

Introduction: This study quantifies the impacts of strengthening 2 tobacco control policies in "Tobacco Nation," a region of the United States (U.S.) with persistently higher smoking rates and weaker tobacco control policies than the rest of the US, despite high levels of support for tobacco control policies. Methods: We used a microsimulation model, ModelHealthTM:Tobacco, to project smoking-attributable (SA) outcomes in Tobacco Nation states and the U.S. from 2022 to 2041 under 2 scenarios: (1) no policy change and (2) a simultaneous increase in cigarette taxes by $1.50 and in tobacco control expenditures to the CDC-recommended level for each state. The simulation uses state-specific data to simulate changes in cigarette smoking as individuals age and the health and economic consequences of current or former smoking. We simulated 500 000 individuals for each Tobacco Nation state and the U.S. overall, representative of each population. Results: Over the next 20 years, without policy changes, disparities in cigarette smoking will persist between Tobacco Nation and other U.S. states. However, compared to a scenario with no policy change, the simulated policies would lead to a 3.5% greater reduction in adult smoking prevalence, 2361 fewer SA deaths per million persons, and $334M saved in healthcare expenditures per million persons in Tobacco Nation. State-level findings demonstrate similar impacts. Conclusions: The simulations indicate that the simulated policies could substantially reduce cigarette smoking disparities between Tobacco Nation and other U.S. states. These findings can inform tobacco control advocacy and policy efforts to advance policies that align with evidence and Tobacco Nation residents' wishes.

Effect of e-cigarette taxes on e-cigarette and cigarette retail prices and sales, USA, 2014-2019.

OBJECTIVE: To use a standardised e-cigarette tax measure to examine the impact of e-cigarette taxes on the price and sales of e-cigarettes and cigarettes in the USA. DESIGN: We used State Line versions of NielsenIQ Retail Scanner data from quarter 4 of 2014 through quarter 4 of 2019 to calculate e-cigarette and cigarette prices and sales in 23 US states. We then estimated how these outcomes are associated with standardised state-level e-cigarette taxes, controlling for state fixed effects, quarter-by-year fixed effects, cigarette taxes, other tobacco control policies and other state-level time-varying characteristics. RESULTS: A real $1 increase in the e-cigarette standardised tax increases the price of 1 mL of e-liquid between $0.43 and $0.59 depending on specification. Controlling for fixed effects and cigarette taxes, a 10% increase in e-cigarette taxes is estimated to reduce e-cigarette sales by 0.5% and increase cigarette sales by 0.1%, though both results are attenuated and statistically insignificant in a model with full controls. CONCLUSIONS: Our study finds that e-cigarette taxes increase e-cigarette retail prices by approximately half of the tax. Further, e-cigarette taxes are associated with reduced sales of e-cigarettes and increased sales of cigarettes in some specifications. Our estimates are sizably lower than from other studies using sales and survey data.

Youth E-Cigarette Initiation After the Food and Drug Administration's Missed Deadline.

INTRODUCTION: The U.S. Food and Drug Administration was ordered to evaluate electronic nicotine delivery system (ENDS) products by September 9, 2021, but missed the court-ordered deadline. This study provides an estimate of electronic cigarette (E-cigarette) use initiation among youth and young adults after the U.S. Food and Drug Administration's missed deadline. METHODS: Data were obtained from the Truth Longitudinal Cohort, a probability-based longitudinal sample of youth and young adults aged between 15 and 24 years (N=1,393). Respondents were surveyed at baseline (July-October 2021) and at follow-up (January-June 2022). Individuals who had not previously used any E-cigarette products were included in analyses conducted in 2022. RESULTS: Results indicate that 6.9% of youth and young adults had initiated E-cigarette use, suggesting that about 900,000 youth aged 15-17 years and 320,000 young adults aged 18-20 years initiated E-cigarette use after the U.S. Food and Drug Administration's missed court-ordered deadline. CONCLUSIONS: Over a million youth and young adults initiated E-cigarette use after the U.S. Food and Drug Administration's missed court-ordered deadline. The U.S. Food and Drug Administration needs to continue evaluating premarket tobacco product applications, enforce decisions on premarket tobacco product applications, and remove E-cigarettes that are deemed harmful to public health to effectively address the E-cigarette epidemic among young people.

Barriers and Facilitators to Psychologists' Telepsychology Uptake during the Beginning of the COVID-19 Pandemic.

The COVID-19 pandemic transformed the delivery of psychological services as many psychologists adopted telepsychology for the first time or dramatically increased their use of it. The current study examined qualitative and quantitative data provided by 2619 practicing psychologists to identify variables facilitating and impeding the adoption of telepsychology in the U.S. at the beginning of the COVID-19 pandemic. The top five reported barriers were: inadequate access to technology, diminished therapeutic alliance, technological issues, diminished quality of delivered care or effectiveness, and privacy concerns. The top five reported facilitators were: increased safety, better access to patient care, patient demand, efficient use of time, and adequate technology for telepsychology use. Psychologists' demographic and practice characteristics robustly predicted their endorsement of telepsychology barriers and facilitators. These findings provide important context into the implementation of telepsychology at the beginning of the pandemic and may serve future implementation strategies in clinics and healthcare organizations attempting to increase telepsychology utilization.

Examining the Comprehensiveness of Amended Flavored Tobacco Product Sales Restrictions.

CONTEXT: Flavored tobacco products contribute significantly to youth tobacco initiation and tobacco use disparities. In the last decade, 362 jurisdictions have enacted policies restricting the sale of flavored tobacco products; however, many policies are not fully comprehensive due to menthol and adult-only retailer exemptions. Although several of these restrictions have been amended since their original passage, to date, little is known about how amendments have affected policy comprehensiveness. OBJECTIVE: To describe how amendments to flavored tobacco product sales restrictions affect policy comprehensiveness. DESIGN: We identified flavored tobacco product sales restrictions that had been amended at least once using an internal database of US state and local flavored tobacco product sales restrictions. To characterize policy comprehensiveness, we applied a 6-level flavored tobacco policy classification scheme-level 6 being most comprehensive-to amended restrictions. We conducted a descriptive analysis of each initial policy and its most recent amendment to identify changes in retailer, product, and flavor inclusions, as well as overall comprehensiveness. MAIN OUTCOME MEASURES: Comprehensiveness of amended flavored tobacco product sales restrictions. RESULTS: As of March 31, 2022, no states and 50 localities had amended their flavored tobacco product sales restriction. Amendments largely increased policy comprehensiveness; most laws prior to amendment were categorized as level 1 (n = 28, 56.0%), while after amendment, the plurality were categorized as level 6 (n = 25, 50.0%). Most commonly, amendments removed menthol exemptions (n ≥ 30, 60.0%) and adult-only retailer exemptions (n = 12, 24.0%). CONCLUSIONS: Several local flavored tobacco product sales restrictions have been amended. Nearly all amendments increased policy comprehensiveness, primarily by removing exemptions for menthol products and exemptions for adult-only retailers. While policy advocates remain focused on passing comprehensive policies at initial passage, amendments have served as a tool to strengthen existing sales restrictions. This study along with ongoing flavored tobacco product sales restriction surveillance can inform policy advocacy and evaluation efforts.

E-cigarette Device Type, Source, and Use Behaviors of Youth and Young Adults: Findings from the Truth Longitudinal Cohort (2020-2021).

Background: E-cigarette device types vary in the amount of nicotine delivered to users. Given that youth and young adults are using pod-based and disposable e-cigarettes with high nicotine concentrations, it is important to determine how e-cigarette use behaviors associated with nicotine dependence may differ across e-cigarette device type. Methods: Baseline information was collected from September 2020 to March 2021 and follow-up information was collected from July to October 2021 from the Truth Longitudinal Cohort. The final analytic sample included respondents (aged 15-24) who reported current use of e-cigarettes at either baseline or follow-up and provided information on the 4-item E-cigarette Dependence Scale (EDS). Differences in endorsement of items from the EDS by e-cigarette device type (pod-based, disposable, or tank) were assessed using chi-square tests. Results: Participants (N = 308) were evenly split on age (15-20, 21+) and gender. Most 15-20-year-olds used disposable e-cigarettes, while those 21+ years primarily used tank devices. Although EDS score did not differ by e-cigarette device type, positive endorsement of two items from the EDS significantly differed by e-cigarette device type. More tank users endorsed reaching for a device without thinking about it (tank: 92.6%; pod-based: 79.0%; disposables: 79.9%, p = 0.04) and vaping more before going into a situation where vaping is not allowed (tank: 92.9%; pod-based: 71.0%; disposables: 73.0%, p < 0.01). Conclusions: Findings have the potential to inform policy implementation by providing evidence for specific targets for regulatory action that can help to reduce the burdens of e-cigarette use among youth and young adults, as results suggest that tank device users are more likely to endorse use behaviors associated with nicotine dependence.

Underage Youth Continue to Obtain E-Cigarettes from Retail Sources in 2022: Evidence from the Truth Continuous Tracking Survey.

(1) Background: This study aims to describe the primary sources of e-cigarettes among young people and to explore how these sources may differ by individual-level characteristics. (2) Methods: Data were obtained from a cross-sectional, continuous tracking survey of participants. The analytic sample includes current e-cigarette users (aged 15-20 years) surveyed from January to August 2022 (N = 1296). Respondents provided information on e-cigarette source of acquisition, device type, and flavors used, as well as sociodemographic and residential characteristics. Chi-square tests were used to determine differences in source of acquisition by age, gender, race/ethnicity, United States (US) census region, urban-rural classification, flavors used, and device type. (3) Results: Although most current e-cigarette users obtained their devices through a social source (56.9%), a considerable proportion obtained e-cigarettes from a retail source (43.1%). The primary retail sources of e-cigarette acquisition were vape shops (22.0%) and gas station/convenience stores (15.9%). Source of e-cigarette acquisition differed by age, gender, US census region, flavors used, and device type, such that a lower proportion of those who were younger, female, residing in the West, and used vape pens had reported obtaining e-cigarettes via retail sources. (4) Conclusions: Results indicate that a significant proportion of youth report obtaining e-cigarettes from retail sources, despite the federal, state, and local policies that prohibit the sale of any tobacco products to those under the age of 21. Comprehensive retail regulations to help restrict tobacco product access are needed to reduce e-cigarette use among young people.

The EVALI outbreak and tobacco sales in the USA, 2014-2020.

BACKGROUND: The E-cigarette, or Vaping Product-Use Associated Lung Injury (EVALI) Outbreak of 2019 hospitalised thousands and killed dozens of people in the USA and raised perceptions of the dangers posed to health by electronic cigarettes (e-cigarettes). These illnesses along with continued increases in youth vaping rates lead to the passage of many state and federal laws intended to curtail the sale of flavoured e-cigarettes. Little is known about the impact of these events on US e-cigarette and cigarette retail sales. METHODS: Using Nielsen Scantrack sales data from January 2014 to January 2020 for 23 US states, we evaluate the effect of the EVALI outbreak. First-differenced state-panel regressions tracking unit sales of total-level and category-level e-cigarettes and cigarette sales controlling for price, Tobacco 21 policy coverage, product distribution, seasonality, EVALI-attributable deaths, and state-level e-cigarette policies affecting the availability of e-cigarettes (non-tobacco flavoured and total) were employed. RESULTS: Dollar sales of e-cigarettes declined 29% from their pre-EVALI peak by January 2020. Total sales of e-cigarettes declined in response to EVALI deaths and the total e-cigarette sales ban put in place in Massachusetts adopted in its wake. Cigarette sales were largely unchanged by either the direct or indirect policy effects of the EVALI outbreak, except for in Massachusetts, where cigarette sales-particularly those smoked by young people-rose temporarily after a total ban on e-cigarette sales. CONCLUSION: Sales of e-cigarettes declined in response to the EVALI outbreak and from the most restrictive regulatory policies that were adopted in response, while sales of cigarettes were affected less.

Comparison of two relative motion extension approaches (RME with versus without an additional overnight orthosis) following zones V-VI extensor tendon repairs: A randomized equivalence trial.

STUDY DESIGN: Multi--center randomized controlled trial with two intervention parallel groups. An equivalence trial. INTRODUCTION: Relative motion extension (RME) orthoses are widely used in the postoperative management of finger extensor tendon repairs in zones V-VI. Variability in orthotic additions to the RME only (without a wrist orthosis) approach has not been verified in clinical studies. PURPOSE OF THE STUDY: To examine if two RME only approaches (with or without an additional overnight wrist-hand-finger orthosis) yields clinically similar outcomes. METHODS: Thirty-two adult (>18 years) participants (25 males, 7 females) were randomized to one of two intervention groups receiving either 1) a relative motion extension orthosis for day wear and an overnight wrist-hand-finger orthosis ('RME Day' group), or 2) a relative motion extension orthosis to be worn continuously ('RME 24-Hr' group); both groups for a period of four postoperative weeks. RESULTS: Using a series of linear mixed models we found no differences between the intervention groups for the primary (ROM including TAM, TAM as a percentage of the contralateral side [%TAM], and Millers Criteria) and secondary outcome measures of grip strength, QuickDASH and PRWHE scores. The models did identify several covariates that are correlated with outcome measures. The covariate 'Age' influenced TAM (P = .006) and %TAM (P = .007), with increasing age correlating with less TAM and recovery of TAM compared to the contralateral digit. 'Sex' and 'Contralateral TAM' are also significant covariates for some outcomes. DISCUSSION: With similar outcomes between both intervention groups, the decision to include an additional night orthosis should be individually tailored for patients rather than protocol-based. As the covariates of 'Age' and 'Sex' influenced outcomes, these should be considered in clinical practice. CONCLUSIONS: A relative motion extension only approach with or without an additional overnight wrist-hand-finger orthosis yielded clinically similar results whilst allowing early functional hand use, without tendon rupture.

Measuring the impact of state and local Tobacco 21 policies in the United States: A longitudinal study of youth and young adults ages 15-21.

INTRODUCTION: Tobacco 21 (T21) policies, which prohibit tobacco sales to individuals under 21, aim to reduce youth tobacco use by limiting youth access to these products. Little, however, is known about the longitudinal effect of T21 policies on youth tobacco use behaviors at the national level. METHODS: Participants aged 15-21 years from a longitudinal study conducted between May 2014 and May 2019 (n = 13,990) were matched to geocoded T21 policies. Generalized linear mixed models examined the association of direct and bordering T21 policy exposure and cigarette and e-cigarette use and intention to use, accounting for individual characteristics. RESULTS: Controlling for sociodemographic and psychosocial covariates, there were statistically significant positive associations between T21 exposure and e-cigarette use (OR = 1.45 [1.03,2.06], p < .003) and intention to use e-cigarettes (OR = 1.54 [1.05,2.26], p < .027). We found no association between T21 policy exposure and cigarette use or intention to use cigarettes. Furthermore, exposure to T21 policies did not significantly modify the relationship between age and either cigarette outcome. CONCLUSIONS: This is the first longitudinal study to evaluate state and local T21 policies at the national level. Our analyses demonstrate that existing T21 policies are not sufficient to reduce youth tobacco use and intentions to use, and suggest that T21 policies need to be a part of a comprehensive tobacco policy landscape. Our findings suggest further research is warranted on state and local T21 policy enforcement and implementation, including how T21 may differentially impact cigarette and e-cigarette use, and may have implications for the federal T21 policy. IMPLICATIONS: This research evaluates state and local T21 policies in the United States longitudinally, finding that T21 policies are not sufficient to stem e-cigarette use among adolescents and young adults. These findings support further policy action and suggest that local and state T21 policies are not sufficient to reduce tobacco use and rather, need to be part of a broader, more comprehensive set of tobacco control policies. Further research on enforcement and implementation challenges of T21 policies and the impacts of the new federal T21 policy is warranted.

Transcatheter Aortic Valve Replacement Patient Care Improvements; It Takes a Team.

Team-based care has been recommended by numerous cardiovascular organizations involving the treatment of valvular heart disease. Utilization of the cardiovascular team (CVT) in valvular programs has been discussed but there is a paucity of data involving team roles, backgrounds, or expectations. This article will describe a single health system and the roles of the CVT involved in the transcatheter aortic valve replacement (TAVR) program.

Sex Specific Sleep Parameters Among People With Substance Use Disorder.

Introduction: Sleep can have substantial impacts in substance use disorder (SUD) pathogenesis, treatment, and recovery. Sex differences exist in both sleep and SUD, but how sleep is uniquely associated with SUD by sex is not known. The study objective was to compare, within sex, sleep parameters between individuals with SUD and non-substance misusing controls. Methods: Secondary analyses of a parent cross-sectional study examining the feasibility and acceptability of a novel neurocognitive phenotyping assessment battery were completed. SUD and control subjects were recruited through local advertising and an established research registry. Subjects with SUD were also recruited through a university-based outpatient SUD treatment clinic. Self-reported sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI). Sex-stratified t-tests compared sleep between SUD and control subjects while Crosstab analyses explored group differences in the proportion of individuals reporting poor sleep (defined as PSQI ≥ 5). Results: Data from 162 males (44 controls, 118 SUD) and 146 females (64 controls, 82 SUD) were included in the present study. For females only, a significantly lower proportion of controls reported PSQI-defined poor sleep than individuals with any SUD or specifically with opioid use disorder. Male, but not female, controls reported shorter sleep latency, longer sleep duration, and less sleep disturbance than males with each SUD type. Discussion/Implications: Sleep holds promise as an avenue to address SUD within a biopsychosocial model. Future work at the intersection of SUD and sleep should prioritize investigations of their interplay with sex to identify targets for tailored SUD interventions.

Insomnia Treatment Preferences Among Primary Care Patients.

PURPOSE: Sleep disturbance is common in primary care. The main treatment options include medication and cognitive behavioral therapy for insomnia. Best practice guidelines recommend a collaborative decision-making approach to treatment. This study examined differences in insomnia treatment preferences based on demographic and clinical characteristics among primary care patients. METHODS: A total of 200 patients (mean [SD] age, 54.92 [12.48] years) at a university medical center and community health clinic participated in brief screenings for insomnia, depression, anxiety, and insomnia treatment preference. Insomnia symptoms were measured with the Insomnia Severity Index, whereas depressive and anxiety symptoms were measured with the Patient Health Questionnaire 2 and Generalized Anxiety Disorder 2. χ2 analyses were performed to detect significant differences in preference between groups. FINDINGS: A total of 46.5% of participants preferred medication and 56.0% preferred behavioral treatment (ratings not exclusionary). Preference for behavioral treatment was highest among severe insomnia presentations (15.2% preferred to 4.5% disliked; P = 0.002). Medication preference was higher among patients with elevated anxiety (57.3% preferred to 42.7% disliked; P = 0.017). Preference for behavioral treatment (66.7% preferred to 33.3% disliked; P = 0.012) and medication (56.8% preferred to 43.2% disliked; P = 0.016) was highest among those with elevated depression. Treatment preference only differed by age for behavioral treatment (P = 0.008). Preference was highest among patients ≤51 years of age (67.2% preferred to 32.8% disliked). IMPLICATIONS: Primary care patients preferred behavioral and medication strategies for insomnia treatment. In addition, as mental health and sleep worsen, patients were more likely to prefer behavioral treatment. Knowledge of patient treatment preference may facilitate shared decision making, which increases patient satisfaction with care and engagement with treatment.

E-cigarette school policy and staff training: Knowledge and school policy experiences with e-cigarette products among a national sample of US middle and high school staff.

BACKGROUND: As youth e-cigarette use has surged in the last several years, teachers and school administrators have reported challenges addressing student use of emerging e-cigarette products on school property. While federal policy prohibits smoking in U.S. schools that receive federal funding, school e-cigarette bans only exist where states or localities have acted. Little is known about school staff experiences with implementing these relatively new policies; this study examines associations between school e-cigarette policies and trainings on school staff awareness and intervention on student e-cigarette use. METHODS: A national convenience sample of 1,526 U.S. middle- and high-school teachers and administrators was surveyed in November-December 2018. Among respondents who provided their job title and indicated that they worked in a school rather than a district (n = 1,480, response rate = 97.0%), separate logistic regressions examine associations of school policies and policy training with e-cigarette awareness and intervention on student e-cigarette use. RESULTS: Despite being the most popular e-cigarette at the time, fewer than half (47.5%) of respondents identified an image of a JUUL device as an e-cigarette. However, respondents reporting the presence of e-cigarette policies in their schools had higher odds of recognizing e-cigarettes (OR = 3.85, p<0.01), including photo recognition of JUUL (OR = 1.90, p<0.001). Respondents reporting e-cigarette policies also had higher odds of reporting intervention on student e-cigarette use (communicating with students about e-cigarette avoidance: OR = 2.32, p<0.001; reporting students had been caught using e-cigarettes at school: OR = 1.54, p<0.05). Among respondents reporting a school e-cigarette policy, those trained on the policy had higher odds of JUUL photo recognition (OR = 1.54, p<0.01). Respondents trained on e-cigarette policies also had higher odds of reporting intervention (communicating: OR = 3.89, p<0.001; students caught using e-cigarettes: OR = 2.71, p<0.001). CONCLUSIONS: As new tobacco products enter the market, school policies may be important tools to raise school personnel awareness of and intervention on emerging e-cigarette product use. However, policy adoption alone is not sufficient; policy training may further aid in recognition and intervention upon student use of e-cigarettes at school.

Policy Support for Smoke-Free and E-Cigarette Free Multiunit Housing.

PURPOSE: Estimate public support for prohibiting multiunit housing (MUH) e-cigarette and cigarette use. DESIGN: Cross-sectional study. SETTING: Data from an online panel survey. SAMPLE: A Fall 2018 nationally representative sample of 3,415 (99.3% response rate) United States (US) adults 18-64 years old. MEASURES: Policy support for prohibiting MUH smoking and e-cigarette use, sociodemographics, and tobacco perceptions and behaviors. ANALYSIS: Weighted multivariate logistic regression examined predictors of support for prohibiting 1) cigarette use and 2) e-cigarette use in MUH. RESULTS: Most respondents expressed support for prohibiting smoking (76.9%) and e-cigarette use (74.0%) in MUH. About 17% (n = 588) of the sample lived in MUH, and living in MUH was not predictive of support for either policy. For both cigarette and e-cigarette policies, current smokers (n = 630; OR = 0.44, p < 0.001; OR = 0.59, p < 0.01) and current e-cigarette users (n = 305; OR = 0.42, p < 0.001; OR = 0.22, p < 0.001) had lower odds of support. Notably, while most smokers supported prohibiting cigarette (51.4%) and e-cigarette use in MUH (51.1%), there was less support among current e-cigarette users for prohibiting cigarette (48.1%) and e-cigarette use in MUH (34.5%). CONCLUSION: Majority support for prohibiting smoking and e-cigarette use in MUH is promising for policy adoption; however, lower support of both policies among e-cigarette users needs to be examined, as increasing use of e-cigarettes may be shifting social norms away from support for smoke free housing policies.

Insomnia symptoms during the COVID-19 pandemic: an examination of biopsychosocial moderators.

OBJECTIVE/BACKGROUND: Healthy sleep is vital for physical and psychological health, and poor sleep can result in a myriad of negative physical and psychological outcomes. Insomnia symptoms often manifest as a result of acute life stressors or changes, and COVID-19 experiences may be one such stressor. Other known predisposing factors to insomnia may moderate the impact of COVID-19 experiences on sleep. The present study aimed to determine current levels of insomnia severity in a US sample, to investigate the relation of COVID-19 experiences to insomnia symptoms, and to determine which individuals are most susceptible to this association. METHODS: Data were drawn from a larger online survey investigating sleep and health outcomes across the lifespan. COVID-19 experiences were assessed with the exposure and impact subscales of the CAIR Pandemic Impact Questionnaire (C-PIQ). The Insomnia Severity Index (ISI) measured insomnia symptoms. Biological, psychological, and social moderators were measured using other brief self-report measures. RESULTS: Insomnia symptoms prevalence was as follows: moderate-to-severe symptoms (25.5%), subthreshold symptoms (37.7%), and no symptoms (36.7%). Individuals' COVID-19 experiences significantly predicted insomnia symptom severity [F(1,997) = 472.92, p < 0.001, R2 = 0.32]. This association was moderated by race, anxiety symptoms, depressive symptoms, physical somatization, and social loneliness, but not age, gender, or education. CONCLUSIONS: Although negative experiences with COVID-19 are associated with worse insomnia symptoms, this relationship is not the same for everyone.