Point-of-sale marketing of little cigars and cigarillos on and near California Tribal lands.

INTRODUCTION: American Indians have the highest cigarette smoking prevalence of any racial/ethnic group in the USA. Tobacco marketing at point-of-sale is associated with smoking, possibly due to easy access to cheap tobacco products. The sale of novel tobacco products like little cigars/cigarillos (LCCs) has increased in recent years which may further increase combustible tobacco use among American Indians. METHODS: Between October 2015 and February 2017, trained community health workers collected LCC product and price information by conducting audits of tobacco retailers on Tribal lands (n=53) and retailers within a 1-mile radius of Tribal lands (n=43) in California. Χ2 analyses were performed to examine associations among the availability and advertising of LCCs, including indoor price promotions and store location. RESULTS: Overall, 85.4% of stores sold LCCs, 76.0% sold flavoured LCCs and 51.0% sold LCCs for less than $1. Indoor price promotions were displayed at 45 (46.9%) stores. Stores within a 1-mile radius of Tribal lands sold significantly more LCC (p<0.01) and flavoured LCCs (p=0.01) than stores on Tribal lands. Stores within a 1-mile radius of Tribal lands also displayed significantly more LCCs priced at less than $1 (p<0.01) than stores on Tribal lands. CONCLUSIONS: LCCs are widely available in stores on and near California Tribal lands. Stores located a short distance away from Tribal lands were more likely to sell LCCs, including flavoured versions, more likely to sell LCCs priced below $1, and more likely to advertise little LCC price promotions than stores on Tribal lands. Policy-makers and Tribal leaders should consider regulations that would limit access to LCCs at point of sale to help prevent youth initiation and reduce smoking-related morbidity and mortality among American Indians.

Risk factors associated with subsequent initiation of cigarettes and e-cigarettes in adolescence: A structural equation modeling approach.

BACKGROUND: Previous youth tobacco research has identified multiple correlated risk factors for initiation of cigarette and e-cigarette use; whether these factors are independently associated with initiation is not known, due to challenges with disentangling the independent effects of these correlated risk factors. METHODS: Students in 11th/12th grade enrolled in the Southern California Children's Health Study were surveyed in 2014 (baseline) and again in 2015 (N = 1553). Structural equation models (SEM) were developed to investigate associations of susceptibility, marketing, and the social environment (as latent factors), and other tobacco use at baseline with cigarette or e-cigarette initiation between baseline and follow-up. Analyses were restricted to baseline never cigarette users (N = 1293) for models evaluating cigarette initiation, and to never e-cigarette users (N = 1197) for models evaluating e-cigarette initiation. RESULTS: In fully-adjusted prospective SEM models, latent factors for cigarette susceptibility, marketing, and the social environment, along with ever e-cigarette use and ever hookah use at baseline were independently associated with cigarette initiation between baseline and follow-up (P < 0.05). Similarly, latent factors for e-cigarette susceptibility, marketing, and the social environment, along with ever hookah use at baseline were associated with e-cigarette initiation between baseline and follow-up (P < 0.05); however, cigarette use at baseline was not associated with e-cigarette initiation in SEM models (P = 0.16). CONCLUSIONS: We identified independent effects of multiple risk factors in SEM models on initiation of cigarettes and e-cigarettes. E-cigarette use was associated with cigarette initiation, but cigarette use was not associated with e-cigarette initiation in fully adjusted models. Research to identify underlying causal mechanisms is warranted.

Disparities in retail marketing for little cigars and cigarillos in Los Angeles, California.

INTRODUCTION: Evidence of a concentration of cigarette advertising in predominantly low-income, non-White neighborhoods underscores the need to examine retail marketing and promotions for novel tobacco products like little cigars and cigarillos (LCCs). We sought to investigate neighborhood racial/ethnic disparities in LCC marketing at retail, including availability, advertising, price promotions, and product placement in Los Angeles, California. METHODS: Between January 2016 and April 2017, community health workers (n = 19) conducted in-person observational audits from tobacco retail stores (n = 679) located in zip codes with a high percentage of non-Hispanic White (n = 196), Black (n = 194), Hispanic/Latino (n = 189), or Korean American (n = 100) residents. To account for clustering effect of zip codes, multilevel modeling approach for a dichotomized outcome was conducted to evaluate the association between racial/ethnic neighborhood sample and dependent variables. RESULTS: Stores located in zip codes with a high percentage of non-Hispanic Blacks had more than eight times higher odds of selling LCCs (OR = 8.10; 95% CI = 3.10-21.11 vs. non-Hispanic White), more than five times higher odds of selling flavored LCCs (OR = 5.20; 95% CI = 2.33-11.61 vs. non-Hispanic White), and more than six times higher odds of displaying storefront exterior LCC signage (OR = 6.03; 95% CI = 2.93-12.40 vs. non-Hispanic White). Stores in Hispanic/Latino and Korean American communities had about three times higher odds of selling LCCs (OR = 3.02; 95% CI = 1.15-7.93 vs. non-Hispanic White; OR = 2.99; 95% CI = 1.33-6.71 vs. non-Hispanic White). CONCLUSIONS: LCCs are heavily marketed in retail establishments in Los Angeles, with disproportionate targeting of predominantly non-White neighborhoods, especially stores in neighborhoods with a higher proportion of African Americans. Local, state, and federal flavor restrictions, minimum pack size standards, preventive messages, and campaigns could counter the influence of LCC marketing in retail establishments.

Retail marketing for chewing tobacco in Los Angeles, California.

INTRODUCTION: Retail marketing for chewing tobacco may be different across racial/ethnic neighborhoods, possibly leading to diverging patterns of use and disparate health risks relating to consumption. This study aimed to compare the frequencies of available chewing tobacco, available flavored chewing tobacco, price promotions, and exterior advertisements in tobacco retail stores in Los Angeles, California. METHODS: In-person observational audits from tobacco retail stores (n=679) located in predominantly non-Hispanic White (n=196), non-Hispanic Black/African American (n=194), Hispanic/Latino (n=189), or Korean American (n=100) neighborhoods were conducted between January 2016 and April 2017. RESULTS: There were statistically significant associations (p<0.001) between racial/ethnic neighborhood and chewing tobacco marketing, where retailers located in non-Hispanic White neighborhoods sold and advertised chewing tobacco and flavored chewing tobacco, used price promotions, and displayed exterior advertisements more frequently than retailers located in African American, Korean American, and Hispanic/Latino neighborhoods. CONCLUSIONS: Stronger restrictions on chewing tobacco, price promotions and flavored versions could mitigate exposure and access to these products in the retail environment.

Retailers' Perceptions of FDA Tobacco Regulation Authority.

OBJECTIVES: Research is limited on tobacco retailers' perceptions of the Food and Drug Administration's (FDA) tobacco regulatory authority overall, and less exists related to retailers in predominantly African-American or other racial/ethnic neighborhoods. We assessed differences in perceptions of the FDA's tobacco regulatory authority and barriers to compliance among retailers in African-American and non-African-American neighborhoods in Los Angeles, California. METHODS: Overall, 700 tobacco retailer interviews assessed demographic characteristics and perceptions of the FDA. RESULTS: Retailers in African-American neighborhoods self-identified as Hispanic/Latino (43.9% vs 39.6% non-African-American), African-American (21.2% vs 2.6% non-African-American) or Asian (19.7% vs 19.5% non-African-American). Retailers in African-American neighborhoods were significantly less likely to perceive the FDA as a trustworthy source (p = .03; vs non-African-American), but more likely to report that they do not know the federal rules (p = .002), do not understand the federal rules (p = .004), and that tobacco companies encourage them not to follow the federal rules (p = .04). CONCLUSIONS: Tobacco control agencies can use this information about retailer perceptions to design education/training materials in order to increase trust, mitigate barriers, and enhance compliance.

Tobacco regulatory compliance with STAKE Act age-of-sale signage among licensed tobacco retailers across diverse neighborhoods in Southern California.

INTRODUCTION: The California Stop Tobacco Access to Kids Enforcement (STAKE) Act requires licensed tobacco retailers to post minimum age-of-sale signage at the point of sale. This study investigated STAKE Act compliance in licensed tobacco retailers across four racial/ethnic communities in Southern California. METHODS: The sample consisted of 675 licensed tobacco retailers (excluding chain store supermarkets and pharmacies) randomly selected based on zip codes from predominantly non-Hispanic White (n=196), African American (n=193), Hispanic/Latino (n=186), and Korean American (n=100) communities. A protocol for assessing signage was completed at each store by community health workers (promotoras de salud). The law changed from a minimum age of 18 to 21 years (Tobacco 21) during data collection, as of 9 June 2016. Differences in signage compliance were evaluated before and after changes in the State law. RESULTS: Overall, 45% of the stores were compliant with posting the required age-of-sale signage (which varied in minimum age by date of collection); 14% of stores did not have any store interior age-of-sale signs, and 41% of stores had some type of age-of-sale sign but were not compliant with the STAKE Act (e.g. 29.5% of the stores had non-compliant tobacco industry We Card signs but not STAKE Act signs). Stores observed after the 2016 implementation of Tobacco 21 had significantly lower STAKE Act signage compliance rates (38.6%) compared to stores observed before the change in the State law (70.9%) (z=6.8623, p<0.001). The difference in STAKE Act sign compliance between stores located in AA communities (16.9%) and stores located in NHW communities (41.5%) observed within the first three months after the change in law was statistically significant (χ2(1)=20.098, p<0.001). CONCLUSIONS: Findings suggest the need for prompt, educational outreach to licensed tobacco retailers on age-of-sale signage changes, multiple compliance checks, and enforcement.

Treadmill exercise modifies dopamine receptor expression in the prefrontal cortex of the 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine-lesioned mouse model of Parkinson's disease.

Parkinson's disease (PD) is the second most common neurodegenerative disorder for which there is no cure. PD is a dopamine (DA)-deficit disorder marked by progressive motor and nonmotor disturbances, including cognitive impairment. Executive function (EF) is the most common subtype of cognitive impairment in PD and consists of deficits in number of processes including behavioral flexibility. The prefrontal cortex (PFC) is an important brain region subserving EF. Furthermore, DA plays a key neuromodulatory role in the PFC and altered DA neurotransmission is believed to contribute toward EF deficits in PD. The mechanisms underlying PFC dysfunction are not fully understood and there are no effective treatments for EF deficits in PD. Exercise is a promising therapeutic strategy that may exert beneficial effects on PFC function in PD. Our previous work suggests that exercise improves motor function and restores striatal DA-D2 receptor (DA-D2R) expression after DA depletion. This study builds upon our previous work by exploring whether exercise modulates PFC function, specifically DA levels and DA receptor expression in the 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP)-mouse model of DA depletion. We found that exercise restores PFC DA levels, reverses the MPTP-induced increase in DA-D1R and decrease in DA-D4R, and exerts differential effects on D2Rs. The modest effect of exercise in PFC function may suggest that other types of exercise, such as those that are more skill based, would be required to target these cognitive behavioral circuits.

Communication Delays Impact Behavior and Performance Aboard the International Space Station.

INTRODUCTION: Long-duration space explorations will involve significant communication delays that will likely impact individual and team outcomes. However, the extent of these impacts and the appropriate countermeasures for their mitigation remain largely unknown. This study examined the feasibility and acceptability of utilizing the International Space Station (ISS) as a research platform to assess the impacts of communication delays on individual and team behavior and performance. METHODS: For this study, 3 ISS crewmembers and 18 mission support personnel performed 10 tasks identified by subject matter experts as meeting study criteria, 6 tasks without a delay in communication and 4 tasks with a 50-s one-way delay. Assessments of individual and team performance and behavior were obtained after each task. The completion rate of posttask assessments and postmission interviews with astronauts were used to assess feasibility and acceptability. RESULTS: Posttask assessments were completed in 100% of the instances where a crewmember was assigned to a task and in 83% where mission support personnel were involved. Qualitative analysis of postmission interviews found the study to be important and acceptable to the three astronauts. However, they also reported the study was limited in the number and type of tasks included, limitations in survey questions, and preference for open-ended to scaled items. DISCUSSION: Although the ISS is considered a high fidelity analog for long-duration space missions, future studies of communication delays on the ISS must take into considerations the constraints imposed by mission operations and subject preferences and priorities. Kintz KM, Palinkas LA. Communication delays impact behavior and performance aboard the International Space Station. Aerosp Med Hum Perform. 2017; 87(11):940-946.

Prevalence of neurobehavioral, social, and emotional dysfunction in patients treated for childhood craniopharyngioma: a systematic literature review.

BACKGROUND: Craniopharyngiomas (CP) are locally invasive and frequently recurring neoplasms often resulting in neurological and endocrinological dysfunction in children. In addition, social-behavioral impairment is commonly reported following treatment for childhood CP, yet remains to be fully understood. The authors aimed to further characterize the prevalence of neurobehavioral, social, and emotional dysfunction in survivors of childhood craniopharyngiomas. MATERIALS AND METHODS: A systematic literature review was conducted in PubMed to identify studies formally assessing neurobehavioral, social, and emotional outcomes in patients treated for CP prior to 18 years of age. Studies published between the years 1990-2012 that reported the primary outcome (prevalence of neurobehavioral, social, emotional/affective dysfunction, and/or impaired quality of life (QoL)) in ≥ 10 patients were included. RESULTS: Of the 471 studies screened, 11 met inclusion criteria. Overall neurobehavioral dysfunction was reported in 51 of 90 patients (57%) with available data. Social impairment (i.e. withdrawal, internalizing behavior) was reported in 91 of 222 cases (41%). School dysfunction was reported in 48 of 136 patients (35%). Emotional/affective dysfunction was reported in 58 of 146 patients (40%), primarily consisting of depressive symptoms. Health related quality of life was affected in 49 of 95 patients (52%). Common descriptors of behavior in affected children included irritability, impulsivity, aggressiveness, and emotional outbursts. CONCLUSIONS: Neurobehavioral, social, and emotional impairment is highly prevalent in survivors of childhood craniopharyngioma, and often affects quality of life. Thorough neurobehavioral/emotional screening and appropriate counseling is recommended in this population. Additional research is warranted to identify risk factors and treatment strategies for these disorders.