Young Adults' Experiences with Cannabis Retailer Marketing and Related Practices: Differences Among Sociodemographic Groups and Associations with Cannabis Use-related Outcomes.

OBJECTIVES: Limited cannabis retail surveillance has been conducted, particularly assessing retailer practices in relation to consumer sociodemographic factors or use-related outcomes. This study examined young adults': exposure to promotions, health claims, warnings, and age restrictions at cannabis retailers; demographic correlates of retail exposures; and retail exposures in relation to use-related outcomes. STUDY DESIGN: This study used the cross-sectional quantitative analysis. METHODS: We analyzed 2023 survey data among 876 young adults in states with legal non-medical cannabis, reporting past-month cannabis use and past-year retailer visits. RESULTS: In this sample (Mage = 27.1, 44.1% male, 31.7% sexual minority, 17.7% Black, 11.2% Asian, 25.1% Hispanic), 46.7% "at least sometimes" noticed free samples, 76.5% price promotions, 37.4% subpopulation-targeted promotions; 72.5% health claims on products/ads, 63.1% signage, and 70.5% from budtenders; 72.5% warnings on labels, 65.5% signage, and 38.9% from budtenders; and > 80% age verifications. Multivariable analyses identified sociodemographic correlates of exposure outcomes: greater promotion exposure was associated with Black race; greater health claim exposure with being heterosexual, Black, and less educated; less warning exposure with less education; and less age restriction exposure with being younger, male, and Black. Retail exposures were associated with use-related outcomes: more frequent cannabis use was associated with less health claim exposure; greater perceived social acceptability with greater promotion and age restriction exposure; greater perceived risk with greater warning and less age restriction exposure; more problematic use and driving after use with greater promotion and less age restriction exposure. CONCLUSIONS: Cannabis retail exposure disparities and their associations with use-related outcomes highlight the importance of regulatory and prevention efforts.

Intoxicating Cannabis Products in Vape Shops: United States, 2023.

INTRODUCTION: Since 2020, many types of intoxicating cannabis products (ICPs) have entered the US market. Hemp-derived ICPs including hexahydrocannabinol (HHC) and delta-8 tetrahydrocannabinol (THC) pose concerns regarding their youth-oriented marketing, potency, and health effects. Some states have attempted to ban, restrict, or regulate their sale. However, the effectiveness of these laws and their enforcement is unclear. The current study provides insights into the retail landscape of ICPs sold across the US. METHODS: In November-December 2023, researchers systematically identified, called, and completed brief surveys with 520 US vape shops: (n=10 per state, n=10 in D.C., n=10 in Puerto Rico). The survey assessed the availability of 6 commonly-sold ICPs. Data were analyzed by regulatory context. Analyses were conducted in 2024. RESULTS: 74% of vape shops sold any ICPs. ICPs were sold in 43% of shops in states with delta-8 THC bans, 53% in states with substantial regulations (intended to support safe use), 90% in states with significant restrictions (intended to limit potency/availability), and 92% in states with limited/no regulations. ICPs were sold in vape shops in each state except Washington and Alaska, both of which banned hemp-derived ICPs and had active retail of legalized non-medical cannabis. CONCLUSIONS: Taking licensed dispensaries into consideration, ICPs can be purchased in retail stores located in all 50 states, Washington DC, and Puerto Rico. ICPs are widely available in vape shops, even in most states with relevant bans/restrictions. Enhanced laws, surveillance, and enforcement are needed. The 2024 Farm Bill and state laws should explicitly prohibit hemp-derived ICPs.

Hidden flaws in e-cigarette industry-funded studies.

Electronic cigarette (e-cigarette) use has increased since e-cigarettes were introduced to the market nearly 20 years ago. Researchers continue to conduct studies to understand the health risks and benefits of e-cigarettes to inform health education and promotion efforts as well as public policy. Studies funded by the tobacco industry examining the potential risks and benefits of e-cigarettes have also been conducted and are sometimes published in the scientific literature. Frequently, tobacco and e-cigarette industry-funded researchers report findings that contradict research funded by other sources. While many industry-funded studies may appear methodologically sound at first glance, in some cases, industry-funded studies include methodological flaws that result in misleading conclusions. The tobacco industry's use of biased research to influence tobacco-related policy decisions in the past is well-documented. This commentary provides specific examples of recent e-cigarette research funded by the tobacco/e-cigarette industry in which methodological flaws result in misleading conclusions that support industry goals. Given the long history of biased research conducted by the tobacco industry, there is a need to assess whether research funded by the e-cigarette industry similarly contains methodological flaws. We emphasise the need for tobacco and e-cigarette-funded research to be scrutinised by non-industry-funded subject matter experts and call for journals to not consider manuscripts that have received support from the tobacco or e-cigarette industry.

Online Retail of Derived Psychoactive Cannabis Products: Age and Shipping Restrictions.

PURPOSE: The 2018 US Farm Bill's definition of hemp resulted in the proliferation of derived psychoactive cannabis products (DPCPs), which appeal to some youth. Despite the importance of restricting youth access, few studies have systematically examined the DPCP retail environment, particularly their online accessibility. METHODS: In May 2023, Google incognito mode was used to search "buy delta thc." Among the first 100 results, data were collected from the 20 most trafficked websites that sold and delivered DPCPs. For each site, we documented the following policy-relevant information: 1) age verification measures for site entry and purchase attempts, 2) adult signature reportedly required upon delivery, and 3) shipping restrictions. RESULTS: Overall, 14 websites (70%) required individuals to indicate their age. Most websites (n = 13, 65%) did not verify age at attempted purchase, nor indicated that an adult signature was required upon delivery (n = 15, 75%). Only three websites (15%) had rigorous age verification procedures during checkout that included contact information as well as an image of their photo ID, which would then be validated through a third-party software. None required age verification upon both purchase and delivery. Thirteen websites (65%) mentioned state shipping restrictions; four of these provided conflicting information across different sections of the website. DISCUSSION: As the e-commerce landscape continues to evolve, clearer regulations regarding DPCP online retail sales and related enforcement are needed. In particular, measures are needed to enforce shipping restrictions and prevent youth access, including increasing the rigor of age verification.

Driving Under the Influence of Alcohol, Cannabis, and Delta-8 THC: Perceived Likelihood, Risk Perceptions, and Behaviors.

Driving under the influence (DUI) of alcohol or cannabis poses public health risks. Little is known about DUI of Delta-8 THC, a newer cannabis product. Using 2022 survey data among 189 U.S. adults ages 18-25 (58.73% male, 59.26% non-Hispanic White), multivariable logistic regression examined substance-specific (alcohol, cannabis, Delta-8) DUI perceived likelihood and risk in relation to past-year DUI among those with past-year use of each. Overall, 72.49% reported past-year alcohol use, 50.53% cannabis, and 22.46% Delta-8. Among those reporting past-year use of each respective substance, 33.58% reported DUI of alcohol, 32.63% cannabis, and 57.14% Delta-8. On average, participants had the same DUI perceived likelihood ("somewhat unlikely") across substances and perceived alcohol DUI as riskiest. Higher alcohol DUI perceived likelihood and lower perceived risk were associated with alcohol-related DUI. Greater cannabis-related perceived likelihood (but not risk) was associated with cannabis-related DUI. Neither Delta-8 DUI perceived likelihood nor risk were associated with Delta-8 DUI. In sum, perceived DUI likelihood for alcohol, cannabis, or Delta-8 tended to be similar. Among those with past-year use of each, the proportion of DUI was highest for Delta-8. Interventions should target DUI-related perceived likelihood and promote protective behavioral strategies that reduce substance-specific DUI risk.

Human papillomavirus vaccination uptake among 27-to-45-year-olds in the United States.

OBJECTIVE: The human papillomavirus (HPV) vaccine prevents six types of cancer. Previously, this vaccine was only approved for 9-26-year-olds. However, in October 2018 the U.S. Food and Drug Administration approved the HPV vaccine for 27- to 45-year-olds (mid-adults). The current study aimed to assess HPV vaccination among a national sample of U.S adults aged 27-45 years. This study also assessed factors associated with HPV vaccine initiation after age 26. METHODS: Data were analyzed using the 2019 National Health Interview Survey. The study included two samples: (1) mid-adults aged 27-45 (n = 8556), and (2) mid-adults who self-reported they had initiated HPV vaccination within the 27-45 age range and those who were unvaccinated (n = 7307). The outcome variables were HPV vaccination status and HPV vaccine initiation. The independent variables represented constructs from Andersen's Behavioral Model of Health Services Use. The odds of HPV vaccination were estimated using weighted multivariable logistic regression models. RESULTS: Overall, 15.6% had ever received the HPV vaccine and 13.1% initiated their first dose of the vaccine after age 26. Hispanic (aOR = 0.73; 95% CI = 0.58, 0.92) and non-Hispanic Asian persons (aOR = 0.59; 95% CI = 0.41, 0.84) had lower odds of ever receiving the vaccine than non-Hispanic White persons. Females (aOR = 2.17; 95% CI = 1.42, 3.32) had higher odds of initiating the vaccine after age 26 than males. CONCLUSIONS: The ACIP recommendation of shared clinical decision-making emphasizes the role of clinical interactions in HPV vaccine decision-making. Study findings highlight the need to further explore contextual factors that may influence HPV vaccine behavior among mid-adults.

Alcohol to-go sales policies at on-premise drinking establishments near large public US universities during the COVID-19 pandemic.

AIMS: Sweeping policy changes during the COVID-19 pandemic increased alcohol availability through permitted to-go sales, potentially posing unique risks to college students. While to-go sales may make binge drinking more convenient, little remains known about these practices. Therefore, this study aimed to assess whether drinking establishments' to-go sales practices are associated with their other operational practices and state policy. METHOD: This cross-sectional analysis included 221 randomly selected bars, nightclubs, and restaurants within two miles of a large public university. Telephone interviews assessed establishment practices, and the Alcohol Policy Information System provided state alcohol to-go laws. Regression models tested whether establishment to-go sales practices were associated with their business practices (logistic regression) and state policy (generalized estimating equations). RESULTS: Nearly one-half (44.8%) of drinking establishments sold alcohol to-go. Establishments with higher vodka prices had nearly 30% higher odds of selling spirits to-go (aOR = 1.29) and establishments offering happy hours specials had more than twice the odds of selling beer (aOR = 2.22), wine (aOR = 2.53), and spirits to-go (aOR = 2.60). Additionally, establishments that implemented physical distance requirements had higher odds of selling wine to-go (aOR = 3.00). State to-go laws were associated with higher odds of selling wine (aOR = 3.99) and spirits to-go (aOR = 5.43) in the full sample and beer to-go (aOR = 4.92) in urban counties. CONCLUSIONS: Establishments that sell alcohol to-go tend to engage in other practices designed to drive sales. Evaluations of alcohol to-go sales laws on risky consumption among priority populations, including college students, are urgently needed to inform decisions about how to appropriately regulate sales.

Derived psychoactive cannabis products and 4/20 specials: An assessment of popular brands and retail price discounts in Fort Worth, Texas, 2023.

BACKGROUND: Retail sales of derived psychoactive cannabis products (DPCPs) have increased in the U.S. since passing the 2018 Farm Bill and is unregulated in most states. This study investigated the types and commonly sold brands of DPCPs as well as promotional pricing on April 20th, a day associated with cannabis use. METHODS: On April 19-20, 2023, investigators conducted telephone surveys with 98 retail stores that sold DPCPs in Fort Worth, Texas (where the market was largely unregulated). RESULTS: Delta-8, Delta-9, and Delta-10 THC products were widely available, with 97%, 72%, and 82% of stores selling each type, respectively. Fifteen additional DPCPs were identified, and selling blends containing multiple types of THC was common. Frequently sold brands included Cake, Medusa/Modus, Torch, Urb, Kik, Tyson, 3Chi, Casper, Hidden Hills, Esco Bars, Happi, Hometown Hero, STNR, Bomb Bars, Baked, Hi On Nature, Looper, and Space God. Overall, 45% reported having 4/20 specials discounting prices on DPCPs, smoking devices/accessories, or everything in the store. Several stores also sponsored 4/20 promotional events including free THC gummies and "live delta demos where people can test cartridges and try smoking flower in the store." CONCLUSIONS: Findings highlight the growing complexity of the DPCP market, including numerous different intoxicating compounds and blends. Policymakers, researchers, and public health professionals should consider these complexities, as well as the commonly sold brands, when developing strategies to regulate DPCPs and protect consumer safety. Pricing policies may be an especially important form of harm reduction during events associated with heavy cannabis use, including 4/20.

Interaction between sleep duration and trouble sleeping on depressive symptoms among U.S. adults, NHANES 2015-2018.

BACKGROUND: This study aims to examine the associations and interaction effects of sleep duration and trouble sleeping on depressive symptoms among U.S. adults. METHODS: National Health and Nutrition Examination Survey (NHANES) data from 2015 to 2018 were analyzed (N = 10,044). Trouble sleeping and sleep duration were self-reported. Sleep duration was defined as short (≤6 h) or long (≥9 h), compared with normal (>6 and < 9 h). Depressive symptoms were determined by the Patient Health Questionnaire-9 score ≥ 10. Both multiplicative interaction and additive interaction were reported. RESULTS: There was a significant positive additive interaction between short sleep duration and trouble sleeping on depressive symptoms in the fully adjusted model (Relative excess risk due to interaction, RERIOR = 4.42, 95 % CI: 1.12, 7.73), with 43 % of the association with depressive symptoms attributed to the interaction (attributable proportion of interaction, AP = 0.43, 95 % CI: 0.22, 0.64). Similarly, a significant positive additive interaction between long sleep duration and trouble sleeping on depressive symptoms was found (RERIOR = 4.17, 95 % CI: 0.96, 7.38), with 41 % of the association with depressive symptoms attributed to the interaction (AP = 0.41, 95 % CI: 0.21, 0.60). No multiplicative interaction was detected between short or long sleep duration and trouble sleeping. LIMITATIONS: The cross-sectional design limits the ability to draw causal inferences. CONCLUSIONS: Findings suggest that different aspects of sleep health interact synergistically, accounting for a substantial portion of the association with depressive symptoms. This underscores the importance of simultaneously considering multiple dimensions of sleep health in relation to depressive symptoms.

Associations between e-cigarette use and sleep health among adults in the United States, NHANES 2015-2018.

OBJECTIVE: To examine the associations between e-cigarette use or dual (e-cigarette and combustible cigarette) use and short sleep duration and trouble sleeping among U.S. adults. METHODS: We used 2015-2018 data from the National Health and Nutrition Examination Survey (NHANES) (n = 11,659). E-cigarette use and dual use were categorized as current, former, and never use. Short sleep duration was defined as sleep duration ≤6 h. Trouble sleeping was self-reported. Weighted logistic regression analyses were performed. RESULTS: Among those with current e-cigarette use, 53.9 % were with current dual use and 23.8 % were with former dual use. Compared to never e-cigarette use, current e-cigarette use was associated with significantly higher odds of trouble sleeping (OR = 2.16, 95 % CI: 1.49-3.13), adjusting for potential confounders. Significant associations were also observed for former e-cigarette use versus never use with trouble sleeping (OR = 1.54, 95 % CI: 1.15-2.07) after full adjustment. Current cigarette use was associated with both short sleep duration (OR = 1.65, 95 % CI: 1.28-2.14) and trouble sleeping (OR = 1.36, 95 % CI: 1.03-1.79) after full adjustment. Additionally, the fully adjusted ORs for short sleep duration and trouble sleeping were 1.64 (95 % CI: 1.06-2.54) and 2.14 (95 % CI: 1.34-3.42) among those with current dual use, and 1.46 (95 % CI: 1.17-1.81) and 2.11 (95 % CI: 1.66-2.67) among those with former dual use, compared to those without dual use. CONCLUSIONS: Current cigarette use or dual use is associated with significantly higher odds of short sleep duration and trouble sleeping. Moreover, former e-cigarette use or dual use is associated with increased odds of trouble sleeping.

Types and Brands of Derived Psychoactive Cannabis Products: An Online Retail Assessment, 2023.

Background: The 2018 Farm Bill led to new types of derived psychoactive cannabis products (DPCPs) being sold throughout the United States. This study describes the new types and brands of DPCPs sold online. Materials and Methods: In May 2023, data were recorded from three top-trafficked U.S.-based DPCP retail websites, including information about each product (N=804). Results: DPCP modalities included disposable vapes (43%), edibles (29%), vape carts (18%), pre-rolls (7%), flower (2%), dabs (1%), and vape pods (<1%). Among the 118 brands, the most common were Exhale, Delta Extrax, Cake, URB, Looper, and TRE House. There were 26 different intoxicating compounds overall, the most prevalent being: Delta-8 tetrahydrocannabinol (THC), THC-P, Delta-9 THC, HHC, THC-A, Delta-10 THC, THC-H, THC-B, THC-JD, THC-X, HHC-P, and Delta-11 THC. Overall, 54% of products were blends, containing two to eight different intoxicating compounds in a single product. Discussion: This is the first study to systematically assess DPCPs sold online. Most of the DPCP market is comprised of vapes and edibles, but these products contain a wide array of compounds and blends. Data from this diverse, rapidly evolving market are needed to examine its consumer impact and inform public health policies and programs.

Valence of YouTube Comments and College Student Reactions Towards Electronic Nicotine Product Counter-Marketing Messages.

Advertisements promoting and discouraging electronic nicotine products (ENPs) are widespread on social media. User interaction is a hallmark feature of social media sites. This study examined how user-comment valence (i.e. positive versus negative comments) influences attitudes toward counter-marketing ads, and determinants of ENP abstinence according to the theory of planned behavior (TPB). College students were randomly assigned to one of three conditions, a positive comment condition (n = 121), in which they were shown a YouTube comment section with eight positive comments and two negative comments; a negative comment condition (n = 126), in which they were shown a YouTube comment section with eight negative and two positive comments; and a control condition (n = 128). Then, all groups were shown a YouTube video advocating for ENP abstinence and completed measures about their attitudes toward the ad (Aad), attitudes toward ENP abstinence, injunctive and descriptive norms about ENP abstinence, perceived behavioral control (PBC) toward ENP abstinence, and intention to abstain from ENPs. Results indicated that exposure to negative comments yielded significantly less favorable Aad when compared to the positive condition, but no difference in Aad was observed between the negative and control conditions, or between the positive and control conditions. Further, there were no differences for any determinants of ENP abstinence. Additionally, Aad mediated the effects of negative comments on attitudes toward ENP abstinence, injunctive norms and descriptive norms about ENP abstinence, and behavioral intention. Findings indicate that negative user comments depress attitudes toward counter-persuasion ads targeting ENP use.

#Delta8: a retailer-driven increase in Delta-8 THC discussions on Twitter from 2020 to 2021.

Background: Delta-8 tetrahydrocannabinol (THC) has experienced significant cultivation, use, and online marketing growth in recent years.Objectives: This study utilized natural language processing on Twitter data to examine trends in public discussions regarding this novel psychoactive substance.Methods: This study analyzed the frequency of #Delta8 tweets over time, most commonly used words, sentiment classification of words in tweets, and a qualitative analysis of a random sample of tweets containing the hashtag "Delta8" from January 1, 2020 to September 26, 2021.Results: A total of 41,828 tweets were collected, with 30,826 unique tweets (73.7%) and 11,002 quotes, retweets, or replies (26.3%). Tweet activity increased from 2020 to 2021, with daily original tweets rising from 8.55 to 149. This increase followed a high-engagement retailer promotion in June 2021. Commonly used terms included "cbd," "cannabis," "edibles," and "cbdoil." Sentiment classification revealed a predominance of "positive" (30.93%) and "trust" (14.26%) categorizations, with 8.42% classified as "negative." Qualitative analysis identified 20 codes, encompassing substance type, retailers, links, and other characteristics.Conclusion: Twitter discussions on Delta-8 THC exhibited a sustained increase in prevalence from 2020 to 2022, with online retailers playing a dominant role. The content also demonstrated significant overlap with cannabidiol and various cannabis products. Given the growing presence of retailer marketing and sales on social media, it is crucial for public health researchers to monitor and promote relevant Delta-8 health recommendations on these platforms to ensure a balanced conversation.

How Are Retailers Describing Delta-8 THC?A Mixed-Methods Study in Fort Worth, Texas.

OBJECTIVE: Delta-8 tetrahydrocannabinol (THC) is a largely unregulated psychoactive substance rising in popularity in the United States. This study aimed to understand how retailers explained Delta-8 THC to potential customers and if these descriptions were associated with socioeconomic deprivation surrounding the retail location. METHOD: In Fort Worth, Texas, stores with retail alcohol, cannabidiol (CBD), or tobacco licenses were called. Among the 133 stores that sold Delta-8 THC, 125 retailers (94%) answered the question "What is Delta-8?" Qualitative methods were used to identify related themes; logistic regression models tested associations between themes and area deprivation index (ADI) scores, a measure of socioeconomic deprivation (1-10; 10 = most deprived areas). RESULTS: Retailers often compared Delta-8 THC to other substances (49%). Although most often described as a type of cannabis (34%), several retailers likened Delta-8 to CBD (19%) or hemp (7%), which are nonpsychoactive. Retailers also described potential effects from use (35%). Some retailers reported that they were unsure of what Delta-8 was (21%), told surveyors to look it up themselves (6%), or withheld information (9%). Higher ADI scores were associated with higher odds of retailers communicating limited information (odds ratio = 1.21, 95% CI [1.04, 1.40], p = .011). CONCLUSIONS: Study findings may inform the development of marketing regulations, as well as informational campaigns for both retailers and consumers.

Delta-8, Delta-10, HHC, THC-O, THCP, and THCV: What Should We Call These Products?

The 2018 U.S. Federal Agriculture Improvement Act ("Farm Bill") resulted in what some have called a "legal loophole" in cannabis regulation. As different types of cannabis products proliferate, so has the terminology used to attempt to categorize them. This article presents a variety of potential descriptors to encourage dialogue about the language used to classify the multitude of psychoactive cannabinoid products that have grown in popularity since the passage of the 2018 Farm Bill. Our recommended term for these products is derived psychoactive cannabis products. The term derived helps distinguish these products from naturally grown cannabis products. Psychoactive makes clear that these products can produce psychoactive effects. Finally, cannabis products balances accuracy and understandability regarding the substance while discouraging perpetuation of the word marijuana because of its racist inception. The resulting term, derived psychoactive cannabis products, is broad enough to encapsulate all related products while being specific enough to exclude other substances. Adopting accurate and consistent terminology will reduce confusion and help establish a more cohesive scientific literature base.

Delta-8 tetrahydrocannabinol: a scoping review and commentary.

BACKGROUND AND AIMS: Delta-8 tetrahydrocannabinol (THC) is a psychoactive substance from the Cannabis plant that has been rising in popularity in the United States since the 2018 US Farm Bill implicitly legalized it. This study reviewed research from peer-reviewed and non-peer-reviewed (e.g. anecdotal and news) reports related to delta-8 THC to summarize current knowledge and implications for public health and safety. METHODS: A scoping review was conducted using PubMed, Scopus, Google Scholar and Google as search engines, leading to the identification of 103 documents that were summarized. The themes that emerged were (1) legality, (2) use (popularity, motives, psychoactivity/potency, benefits/consequences), (3) synthesis (byproducts, laboratory testing) and (4) retail (availability, price, packaging, youth-oriented marketing). A second author independently coded 20% of the documents, which verified the categorization of articles by these emergent themes. RESULTS: Most research used animal/cell models or focused upon ways to identify the chemical structure of delta-8 THC in various products. Findings suggest that people often use delta-8 THC as a substitute for other substances. Anecdotally, delta-8 THC is a less potent psychoactive than delta-9 THC; however, several negative consequences have been reported. There is no federal age restriction for purchase/possession of delta-8 THC products. Delta-8 THC is readily accessible on-line, is typically less expensive than delta-9 THC and is often marketed in ways that would seemingly appeal to children. There are no regulations on synthesis, resulting in products being contaminated and/or yielding inconsistent effects. There have been thousands of calls to US poison control centers due to accidental delta-8 THC exposure among minors. CONCLUSIONS: Most research on delta-8 THC is largely anecdotal, not peer-reviewed and does not involve human subjects. Future research should examine delta-8 THC use using nationally representative samples to more clearly understand the prevalence and consequences of use. Laws are needed to mitigate the risks of using delta-8 THC, particularly quality control of synthesis and minimum purchase age.

Associations between use of specific social media sites and electronic cigarette use among college students.

OBJECTIVE: To examine dose-response associations between use of specific social media sites and the use of electronic cigarettes (e-cigarettes) and traditional cigarettes. METHODS: This was a cross-sectional study of 298 first-year college students enrolled in the fall 2019 semester at a large state university. Heckman selection and Probit model were used to estimate associations between use of specific social media sites and e-cigarette/traditional cigarette use. RESULTS: Each additional hour per day spent on Snapchat was associated with a 4.61% increase in the probability of lifetime e-cigarette use. In addition, among current e-cigarette users, more time spent on Snapchat was associated with more frequent e-cigarette use (marginal effects: 0.13, p = 0.001). Facebook, Twitter, Snapchat and Instagram were not associated with traditional cigarette smoking. CONCLUSION: Snapchat was the only major social media platform associated with both lifetime and current e-cigarette use.

Midwives' knowledge and perceived barriers to screening alcohol use among pregnant women in a southwestern US state.

INTRODUCTION: Alcohol consumption during pregnancy can produce multiple damaging outcomes to the foetus, commonly referred to as fetal alcohol spectrum disorders (FASD). FASD represents the leading non-genetic cause of preventable birth defects in the United States where alcohol guidelines recommend pregnant woman abstain from alcohol use. This study examined: (i) midwives' knowledge, attitude and intent to screen for prenatal alcohol use; and (ii) assessed perceived barriers to communicating alcohol-related information. METHODS: Using an online questionnaire, data were obtained from midwives (n = 61) in a southwestern US state between March and May 2018. Descriptive statistics were used to describe midwives' knowledge, attitude, intent and perceived barriers. RESULTS: Several midwives considered one alcoholic beverage per occasion to be safe for the foetus (20.3%), some thought alcohol was safe during the 3rd trimester (14.8%) only and few thought it was safe in all trimesters. Many midwives (63.3%) were unaware that the TWEAK and T-ACE were validated alcohol screening tools for pregnant women. Furthermore, most midwives (>50%) agreed that limited time with patients, a need for additional training and lack of information on referral resources interfered with their sharing of alcohol abstinence guidelines. Midwives reported highly favourable attitudes and intentions toward sharing alcohol abstinence messages with their pregnant patients. DISCUSSION AND CONCLUSIONS: More in-depth research and larger samples are needed to explore barriers (knowledge gaps, limited time with patients, need for additional training) that hinder midwives' dissemination of abstinence messages to pregnant women and limit the uptake of validated alcohol screening tools.

Trends in prevalence of short sleep duration and trouble sleeping among US adults, 2005-2018.

STUDY OBJECTIVES: To determine trends in prevalence of short sleep duration and trouble sleeping among US adults from 2005 to 2018, and to assess how sleep trends vary by sex and race/ethnicity. METHODS: Seven cycles of the National Health and Nutrition Examination Survey data between 2005-2006 and 2017-2018 were analyzed. Trouble sleeping and sleep duration were self reported. Short sleep duration was defined as sleep duration ≤6 hr. Age-standardized prevalence of reporting trouble sleeping to a health care provider and short sleep duration were estimated among the overall US adult population, and by sex and race/ethnicity. RESULTS: From 2005 to 2014, the age-adjusted prevalence of short sleep duration remained similar in the overall population (p for trend >0.05). Non-Hispanic Black people had the highest prevalence of short sleep duration among all race/ethnicity groups in all seven cycles. The prevalence of short sleep duration appears lower in 2015-2018 than in 2005-2014 due to different measurement methods applied. However, from 2005 to 2018, there were increasing trends in age-adjusted prevalence of reporting trouble sleeping to a health care provider in the overall population, among both men and women, and all race/ethnicity groups (p for trend <0.05). Among all the race/ethnicity groups, non-Hispanic White people had the highest prevalence of reporting trouble sleeping to a healthcare provider. CONCLUSION: Findings depict the persistence of sleep-related issues in the United States and possible risk factors, as well as racial disparities.