Measuring disability among U.S. adolescents and young adults: A survey measurement experiment.

Objective: Disability is identified in surveys using various question sets, with little understanding of reliability across these measures, nor how these estimates may vary across age groups, including adolescents and young adults (AYA). The purpose of this study was to assess AYA prevalence of disability using two disability question sets and reliability of these measures. Methods: AYA participants in the Policy and Communication Evaluation (PACE) Vermont Study completed a single-item disability question used in the National Survey on Health and Disability (NSHD) and Urban Institute's Health Reform Monitoring Survey (HRMS) and a six-item set on functioning (Washington Group-Short Set, WG-SS) from the National Health Interview Survey (NHIS) and National Survey on Drug Use and Health (NSDUH) in 2021. Prevalence was estimated for any disability and each disability domain in adolescents (ages 12-17) and young adults (ages 18-25) and compared with U.S. national estimates in NHIS and NSDUH. Results: Using the WG-SS, the prevalence of any disability was 17.0 % in PACE Vermont adolescents and 22.0 % in young adults, consistent with the national prevalence of adolescents in NSDUH (17.9 %) but higher than estimates of young adults in NHIS (3.9 %) and NSDUH (12.9 %). The single-item question provided lower estimates of disability (adolescents: 6.9 %; young adults: 18.5 %) than the WG-SS, with low positive agreement between measures. Discussion: The prevalence of disability in AYAs varies depending on measures used. To improve disability surveillance, it may be necessary to validate new disability questions, including among AYAs, to capture a broader range of disability domains.

Patterns of Alcohol, Marijuana, and Tobacco Use Among U.S. Adolescents and Young Adults by Disability Status: 2015-2019.

PURPOSE: To estimate the national prevalence of tobacco, marijuana, and alcohol use among U.S. adolescents (age 12-17) and young adults (aged 18-25; adolescents and young adults [AYAs]) with a disability and examine associations between disability and substance use from 2015 to 2019. METHODS: Data from the 2015-2019 National Survey on Drug Use and Health were used to estimate the prevalence of tobacco, marijuana, and alcohol use among AYAs with disabilities. Modified Poisson regression models evaluated linear time trends in past-month substance use and estimated adjusted prevalence ratios (aPRs) for past-month cigarette, any tobacco, alcohol, and marijuana use. RESULTS: Adolescents with any disability had a higher prevalence of past-month cigarette (aPR = 1.87; 95% CI 1.67-2.09), alcohol (aPR = 1.21; 95% CI 1.11-1.31), and marijuana use (aPR = 1.47; 95% CI 1.36-1.60) compared to those without disabilities. Cigarette smoking among adolescents decreased over this time period; however, the decline among adolescents without a disability was greater than those with any disability. Young adults with any disability had a higher prevalence of past-month cigarette (aPR = 1.42; 95% CI 1.35-1.48) and marijuana use (aPR = 1.39; 95% CI 1.34-1.45), but a lower prevalence of past-month alcohol use (aPR = 0.93; 95% CI 0.90-0.95) than those without disabilities. Alcohol use remained constant among young adults with any disability but decreased for those without disabilities. DISCUSSION: Population-level disparities in cigarette and marijuana use exist in AYAs with disabilities. Future studies should identify strategies tailored to AYAs with disabilities to encourage smoking cessation and prevent cannabis use disorder.

Latent Classes of Perceived Addictiveness Predict Marijuana, Alcohol, and Tobacco Use in Youth and Young Adults.

Background: Mass media substance use prevention efforts target addiction perceptions in young people. This study examined youth and young adults' (YAs) perceived addictiveness across several substances and the associations between addiction perceptions and substance use. Methods: Data were collected in 2019 in an online cohort study of Vermonters aged 12-25. Latent class analyses grouped participants by perceived addictiveness of nicotine, caffeine, alcohol, marijuana, cigarettes, electronic vapor products (EVPs), and opioids. Bivariate multinomial logistic and modified Poisson regression estimated associations between sociodemographics, substance use correlates, and subsequent use across latent classes. Results: Four latent classes captured addiction perceptions: high perceived addictiveness of EVPs, cigarettes, marijuana, and alcohol (Class 1: n = 317; 31.3%), low perceived addictiveness of marijuana, alcohol, and caffeine (Class 2: n = 151; 14.3%), low perceived addictiveness of marijuana (Class 3: n = 581; 46.5%), and low perceived addictiveness of nicotine, cigarettes, and EVPs (Class 4: n = 83; 7.9%). For each year increase in age, there was a 36% increased likelihood of being in Class 2 (vs. Class 1) and a 148% increased likelihood of belonging to Class 3 (vs. Class 1). Low perceived addictiveness classes were associated with ever and past 30-day marijuana and alcohol use and predicted past 30-day alcohol use at three-month follow-up. Membership in Classes 2 and 3 also predicted past 30-day marijuana use at Wave 3. Discussion: The strong association between age and latent classes defined by low perceived addictiveness suggests age group differences in addiction perceptions. Findings suggest that YAs may benefit from prevention messaging on addictiveness.

A systematic review and meta-analysis of interventions to induce attempts to quit tobacco among adults not ready to quit.

The prevalence of past-year smoking cessation remains below 10% in the U.S. Most who smoke are not ready to quit in the near future. Cessation requires both (a) initiating a quit attempt (QA) and (b) maintaining abstinence. Most research has focused on abstinence among people already motivated to quit. We systematically reviewed interventions to promote QAs among people not motivated to quit tobacco. We searched PubMed, CENTRAL, PsycINFO, Embase, and our personal libraries for randomized trials of tobacco interventions that reported QAs as an outcome among adults not ready to quit. We screened studies and extracted data in duplicate. We pooled findings of the 25 included studies using Mantel-Haenszel random effects meta-analyses when ≥ 2 studies tested the same intervention. Most (24) trials addressed cigarettes and one addressed smokeless tobacco. Substantial heterogeneity among trials resulted in a series of small meta-analyses. Findings indicate varenicline may increase QAs more than no varenicline, n = 320; RR = 1.4, 95% CI [1.1, 1.7]; I² = 0%, and nicotine replacement therapy (NRT) may increase QAs more than no NRT, n = 2,568; RR = 1.1, 95% CI [1.02, 1.3]; I² = 0%. Pooled effects for motivational counseling, reduction counseling, and very low nicotine content cigarettes showed no clear evidence of benefit or harm. The evidence was judged to be of medium to very low certainty due to imprecision, inconsistency, and risk of bias, suggesting that further research is likely to change interpretation of our results. Findings demonstrate the need for more high-quality research on interventions to induce QAs among adults not ready to quit tobacco. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Effects of Vaping Prevention Messages on Electronic Vapor Product Beliefs, Perceived Harms, and Behavioral Intentions among Young Adults: A Randomized Controlled Trial.

Youth have been the focus of electronic vapor product (EVP) prevention efforts though young adults had similar increases in current EVP use from 2015-2019. This study tested messages to reduce EVP use in young adults. Eight messages on vaping related harms and addictiveness combined with themes on social use and flavors were selected for inclusion in an online randomized controlled trial. Vermont young adults aged 18-24 (n = 569) were randomized to view the eight vaping prevention messages (n = 295) or eight messages on sun safety (n = 274). After completing baseline measures, participants viewed study messages and completed measures on message perceptions and perceived message effectiveness (PME), EVP-related beliefs, and EVP-related harm perceptions. Participants completed EVP-related beliefs and harm perception measures again at 1-month follow-up, as well as measures on tobacco and EVP-related behavioral intentions and behavior (ever and past 30-day use). Intervention participants reported positive impacts on vaping-related message responses. However, findings suggested no effect of vaping prevention messages on EVP-related beliefs, harm perceptions, or behaviors in the full sample. Exploratory analyses in the intervention condition showed that greater PME was associated with lower odds to intent to try cigarettes in the next year at follow-up.

Wellness and Coping of Physicians Who Worked in ICUs During the Pandemic: A Multicenter Cross-Sectional North American Survey.

OBJECTIVES: Few surveys have focused on physician moral distress, burnout, and professional fulfilment. We assessed physician wellness and coping during the COVID-19 pandemic. DESIGN: Cross-sectional survey using four validated instruments. SETTING: Sixty-two sites in Canada and the United States. SUBJECTS: Attending physicians (adult, pediatric; intensivist, nonintensivist) who worked in North American ICUs. INTERVENTION: None. MEASUREMENTS AND MAIN RESULTS: We analysed 431 questionnaires (43.3% response rate) from 25 states and eight provinces. Respondents were predominantly male (229 [55.6%]) and in practice for 11.8 ± 9.8 years. Compared with prepandemic, respondents reported significant intrapandemic increases in days worked/mo, ICU bed occupancy, and self-reported moral distress (240 [56.9%]) and burnout (259 [63.8%]). Of the 10 top-ranked items that incited moral distress, most pertained to regulatory/organizational ( n = 6) or local/institutional ( n = 2) issues or both ( n = 2). Average moral distress (95.6 ± 66.9), professional fulfilment (6.5 ± 2.1), and burnout scores (3.6 ± 2.0) were moderate with 227 physicians (54.6%) meeting burnout criteria. A significant dose-response existed between COVID-19 patient volume and moral distress scores. Physicians who worked more days/mo and more scheduled in-house nightshifts, especially combined with more unscheduled in-house nightshifts, experienced significantly more moral distress. One in five physicians used at least one maladaptive coping strategy. We identified four coping profiles (active/social, avoidant, mixed/ambivalent, infrequent) that were associated with significant differences across all wellness measures. CONCLUSIONS: Despite moderate intrapandemic moral distress and burnout, physicians experienced moderate professional fulfilment. However, one in five physicians used at least one maladaptive coping strategy. We highlight potentially modifiable factors at individual, institutional, and regulatory levels to enhance physician wellness.

Tailored text message and web intervention for smoking cessation in U.S. socioeconomically-disadvantaged young adults: A randomized controlled trial.

The prevalence of cigarette smoking in young adults is higher among those with socioeconomic disadvantage than those without. Low treatment-seeking among young adult smokers is compounded by few efficacious smoking cessation interventions for this group, particularly socioeconomically-disadvantaged young adults (SDYA) who smoke cigarettes. The goal of this study was to test a tailored smoking-cessation intervention for SDYA. 343 SDYA aged 18-30 living in the U.S. (85% female) who smoke cigarettes with access to a smartphone and interest in quitting smoking in the next six months were recruited online in Spring 2020 and randomized to referral to online quit resources (usual care control; n = 171) or a 12-week tailored text message smoking-cessation program with a companion web-based intervention (n = 172). Intent to treat analyses examined associations between study condition, self-reported 30-day point prevalence abstinence (PPA), and confidence to quit smoking at 12 weeks, controlling for potential confounders. Intervention group participants had greater self-reported 30-day PPA at 12-weeks than controls (adjusted relative risk 3.93, 95% CI 2.14-7.24). Among those who continued smoking, the intervention increased confidence to quit (0.81 points, 95% confidence interval 0.08-1.53). Weekly engagement in the intervention predicted greater cessation. A tailored text message intervention for SDYA increased smoking abstinence and confidence to quit at the end-of-treatment. Findings may have been influenced by recruitment at the start of the COVID pandemic but suggest that text messaging is an acceptable and efficacious cessation strategy for SDYA smokers. Future studies should examine the impact on longer-term smoking-cessation and importance of intervention tailoring for SDYA.

Exploring Definitions of "Addiction" in Adolescents and Young Adults and Correlation with Substance Use Behaviors.

(1) Background: Young people engage in addictive behaviors, but little is known about how they understand addiction. The present study examined how young people describe addiction in their own words and correlations between their definitions and substance use behaviors. (2) Methods: Young adults (n = 1146) in the PACE Vermont Study responded to an open-ended item "what does "addiction" mean?" in 2019. Responses were coded using three inductive categories and fifteen subcategories. Quantitative analyses examined correlations between addiction theme definitions, demographics, and substance use behaviors. (3) Participants frequently defined addiction by physiological (68%) and psychological changes (65%) and less by behavioral changes (6%), or all three (3%); young adults had higher odds of defining addiction as physiological or behavioral changes than adolescents. Participants who described addiction as "psychological changes" had lower odds of ever electronic vapor product use (OR 0.75, 95% CI 0.57−1.00) than those using another definition, controlling for age and sex. (4) Perceptions of addiction in our sample aligned with existing validated measures of addiction. Findings discriminated between familiar features of addiction and features that may be overlooked by young adults. Substance users may employ definitions that exclude the symptoms they are most likely to experience.

Disparities in Tobacco Use by Disability and Type: Findings From the 2019 National Health Interview Survey.

INTRODUCTION: People with disabilities report a higher prevalence of cigarette use than people without disabilities. However, evidence is limited on the relationships between disability type, degree of functional difficulty, and other tobacco product use. METHODS: Data from the 2019 U.S. National Health Interview Survey were used to estimate the prevalence and odds of tobacco product use for 6 disability types and degree of functional difficulty. Bivariate and multivariable analyses conducted in 2021 examined the associations between tobacco product use and disability type. RESULTS: Compared to adults who reported no difficulty, current cigarette use prevalence was higher for adults who reported a lot of difficulty/cannot do at all to vision (21.5% vs 13.1%), hearing (19.6% vs 13.6%), mobility (20.0% vs 12.9%), and cognitive (25.4% vs 12.9%) disability questions. The odds of current cigarette (AOR=1.32), pipe (AOR=1.85), and smokeless tobacco (AOR=1.57) use were significantly higher for adults who reported a lot of difficulty/cannot do at all to any disability question and significantly higher for current cigarette (AOR=1.24), e-cigarette (AOR=1.33), pipe (AOR=1.45), and smokeless tobacco (AOR=1.29) use for adults who reported some difficulty to any disability question than those who reported no difficulty. Pipe use was correlated with mobility difficulty (AOR=1.68), and smokeless tobacco use was correlated with hearing difficulty (AOR=1.95). CONCLUSIONS: People who reported difficulty with vision, hearing, mobility, or cognition had a higher cigarette use prevalence than people without disabilities. Other tobacco use differed by disability type. Future research should tailor tobacco interventions to reduce these disparities.

COVID-related distress, mental health, and substance use in adolescents and young adults.

BACKGROUND: This study examined the impact of COVID-related disruptions on mental health and substance use in young people residing in a state with an initially lower COVID burden and earlier reopening of in-person learning than other states. METHODS: Data come from Waves 3 (Fall 2019) and 4 (Fall 2020) of the Policy and Communication Evaluation (PACE) Vermont, an online cohort study of adolescents (ages 12-17) and young adults (ages 18-25). Participants in Wave 4 (212 adolescents; 662 young adults) completed items on COVID-related stressors, the impact of the pandemic on their substance use, brief mental health scales, and past 30-day substance use. Analyses examined correlational and longitudinal relationships between COVID-related stressors, mental health symptoms, and substance use. RESULTS: More than 60% of participants noted negative effects of the pandemic on their physical, emotional, and social well-being, with greater impacts of COVID-related stressors in young adults than adolescents. There were significant increases in depressive (OR 1.31, 95% CI 1.03, 1.66) and anxiety symptoms (OR 1.34; 95% CI 1.10, 1.64) in young adults between Fall 2019 and Fall 2020. Higher overall COVID Impact scores were associated with higher odds of depressive and anxiety symptoms, as well as past 30-day electronic vapor product use, in adjusted cross-sectional and longitudinal models. CONCLUSIONS: Robust associations between COVID-related distress, mental health, and substance use outcomes in young people signal the opportunity to increase evidence-based interventions while adding novel approaches to minimize longer-term harms of the pandemic on mental health in adolescents and young adults.

A Risk Management Perspective on Climate Change: Lessons Learned from the Nuclear Industry.

Despite the widely acknowledged role of the anthropogenic drivers of climate change, there has been little success in developing a clear overview of the strengths and weaknesses of counter-measures or developing a consensus on their application. Problems with conventional approaches arise from the strongly coupled, multidisciplinary issues involved and the long timescales (centuries or more) over which some key processes operate. Here we outline an alternative approach based on experience gained in risk assessment for an area with similar challenges-the geological disposal of radioactive waste. Utilization of such risk assessment approaches and tools to facilitate a holistic, top-down synthesis of the interactions between the key features, events and processes driving climate change and constraining responses to it, are illustrated. We especially focus on visual presentations that encourage dialog between both specialists and non-technical stakeholders. These can thus form a basis to assist balancing responses in terms of energy policy, modified socio-economic boundary conditions and environmental management.

Young Adults' Knowledge of State Cannabis Policy: Implications for Studying the Effects of Legalization in Vermont.

Objectives: Cannabis policy evaluations commonly assume equal policy exposure across a state's population using date of implementation as the key independent variable. This study aimed to explore policy knowledge as another measure of exposure and describe the sociodemographic, cognitive, and behavioral correlates of cannabis policy knowledge in young adults in Vermont. Methods: Data are from the PACE Vermont Study (Spring 2019), an online cohort study of Vermonters (12-25). Bivariate and multivariable analyses estimated prevalence ratios (PR) for correlations between knowledge of Vermont's cannabis policy (allowed possession for adults 21 and older) and sociodemographics, cannabis use, and harm perceptions in 1,037 young adults (18-25). Results: Overall, 60.1% of participants correctly described the state's cannabis policy. Being younger, Hispanic, non-White race, and less educated were inversely correlated with policy knowledge. Ever (PR=1.37; 95% CI 1.16-1.63) and past-30-day cannabis use (PR=1.27; 95% CI 1.12-1.45) were positively correlated with policy knowledge. Policy knowledge was more prevalent among young adults who perceived slight risk of harm from weekly cannabis use (vs. no risk; aPR=1.28; 95% CI 1.11-1.48) or agreed that regular cannabis use early in life can negatively affect attention (vs. disagree; aPR=1.55; 95% CI 1.22-1.97). Conclusion: Findings suggest that 40% of Vermont young adults in the study were unaware of current state cannabis policy and that policy knowledge was lower in younger, less educated, Hispanic, and non-White young adults. Future research should explore using a measure of policy knowledge as an exposure or moderator variable to better quantify the effects of changes in cannabis legal status on perceptions and use in young people.

Optimizing Images for an E-Cigarette Messaging Campaign: Liking and Perceived Effectiveness.

INTRODUCTION: Given the prevalence of electronic vapor product (EVP) use among young people in the US, there is a need for effective vaping education campaigns. This study tested 32 images for liking and perceived effectiveness (PE) to identify optimal images for a messaging campaign. METHOD: Images were selected from current campaigns, warning labels, and other images based on young adult reasons for use. Images were coded for the presence of (1) people, (2) vapor, (3) device, (4) color, and (5) similarity to warning label image. Young adults (n = 200) were recruited from the Amazon Mechanical Turk platform. Participants were randomly assigned to view and rate six of the 32 images on liking as well as PE, which measured the potential impact of the image to discourage vaping appeal and use. RESULTS: Images containing vapor and/or a device or e-liquid were not well-liked but were perceived as effective in discouraging vaping (ps < 0.05). Images from warning labels were also not well-liked but were perceived as significantly more effective than those not from a warning (p < 0.01). Liking and effectiveness of features was similar for both EVP users and non-users. DISCUSSION: Images with specific features were rated as less likable but rated as higher on PE. However, the consistency of image features rated as effective by EVP users and non-users supports the utility of similar imagery for vaping prevention and reduction efforts.

Risk management for pandemics: a novel approach: "Hindsight is 20/20" English proverb.

The impacts of the current COVID-19 pandemic illustrate the global-level sensitivity to such threats. As understanding of major hazards is generally based on past experience and there is a lack of good historical precedents, approaches and models currently employed to assess risks and guide responses generally lack transparency and are often associated with huge, unspecified uncertainties. Fundamental challenges arise from the strongly coupled nature of the impacts of a pandemic (i.e. not only on health, but also on the entire socio-economic infrastructure) and their long-term evolution with recovery likely to take many years or, potentially, decades. Here, we outline experience gained in risk assessment within the nuclear industry, which has experience facing similar challenges (assessing long-term impacts in a strongly coupled technical system subject to socio-economic constraints), and assess options for knowledge transfer that may help manage future pandemics and other high-impact threats.

Tobacco and Nicotine Use Among US Adult "Never Smokers" in Wave 4 (2016-2018) of the Population Assessment of Tobacco and Health Study.

INTRODUCTION: A common criterion for being labeled a "never smoker" is having smoked <100 lifetime cigarettes. This category is often used as an unexposed reference group to estimate the relative harm from cigarettes. We examined the amount of current and past cigarette and non-cigarette tobacco/nicotine use among adults who met this "never smoker" criterion. METHODS: We analyzed cross-sectional data from 17 179 adult "never smokers" (ie, reported <100 lifetime cigarettes) in Wave 4 (2016-2018) of the Population Assessment of Tobacco and Health (PATH) Study, a United States nationally representative sample. We used PATH-derived variables to describe "never smokers'" demographics as well as cigarette and non-cigarette tobacco/nicotine use. RESULTS: Approximately half of "never smokers" were young adults (49.3%). Most were white (68.6%) with some college or more (64.4%). Most "never smokers" had tried any cigarette or non-cigarette tobacco/nicotine in their lifetime (66.7%), 8.5% smoked cigarettes in the past 30 days, and 5.3% were current experimental (ie, some days or every day) cigarette smokers. By definition, "never smokers" reported smoking <100 lifetime cigarettes. One fifth (22.8%) had a lifetime history of established regular non-cigarette tobacco/nicotine use and 8.6% were current established regular non-cigarette tobacco/nicotine users. In total, 9.4% of "never smokers" were current experimental or established regular users of combustible tobacco. CONCLUSIONS: The 100-cigarette lifetime threshold includes substantial amounts of current and past tobacco use and thus does not represent lack of exposure to cigarette or non-cigarette tobacco. "Never smoker" reference groups may produce underestimates of the relative harms from cigarettes. IMPLICATIONS: The <100 lifetime cigarettes criterion may not capture what many would consider true "never smokers." Relying on the current definition of "never smokers" as a reference group will include a substantial number of those currently and recently using combustible tobacco and thus produce data that may underestimate the relative harm from cigarettes. Prospective longitudinal research is needed to compare how the 100-cigarette lifetime threshold versus other definitions of regular cigarette smoking differ in predictive validity of clinically meaningful outcomes and health harms to determine the optimal criteria to define established cigarette smoking.

Both reducing cigarettes per day and transitioning to very low-nicotine-content cigarettes decreases demand for usual-brand cigarettes.

Reducing cigarettes per day (CPD) and transitioning to very low-nicotine-content (VLNC) cigarettes appear to decrease nicotine dependence. Other well-accepted measures of the addictiveness of cigarettes involve behavioral economic simulation models, such as the cigarette purchase task (CPT), which characterizes the reinforcing efficacy of cigarettes. Currently it is unclear whether reducing CPD or reducing nicotine through VLNC cigarettes leads to greater reductions in the reinforcing efficacy of cigarettes. The current paper reports a secondary analysis of a 5-week, 2-arm unblinded randomized trial, in which participants were instructed to gradually reduce to 70%, 35%, 15%, and 3% of baseline nicotine over 4 weeks by either (a) reducing CPD (n = 32) or (b) switching to VLNC cigarettes (n = 36). Participants completed the CPT for their usual-brand cigarettes at baseline and again at a 1-month follow-up. Demand was significantly reduced for participants' usual-brand cigarettes in both the CPD, t(18) = 7.65, p < .0001, and the VLNC groups, t(18) = 7.39, p < .0001, from prereduction procedure to the 1-month follow-up. Maximum consumption at zero price (intensity), and maximum expenditure (Omax), were reduced significantly for both the CPD group, t(16) = 3.23, p = .005; t(16) = 3.71, p = .002, respectively, and the VLNC group, t(22) = 3.62, p = .002; t(22) = 3.14, p = .005, respectively, prereduction procedure to the 1-month follow-up. Thus, despite the different mechanisms by which the value of cigarettes was manipulated, both interventions reduced the reinforcing efficacy of cigarettes. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

A Novel Use of Topical Ketamine for the Treatment of Oral Pemphigus: A Case Report.

BACKGROUND: Paraneoplastic pemphigus (PNP) is a rare autoimmune blistering disease often associated with lymphoproliferative disorders. PNP causes hemorrhagic stomatitis of the lips, tongue, and cheeks which can be painful and difficult to treat. CASE HISTORY: A 54-year-old man was referred to our hospital for treatment of Stage IV lymphoma and paraneoplastic pemphigus. Due to pain from oral stomatitis, he required a gastrostomy tube for delivery of nutritional tube feeds. He was placed on steroids and received both lidocaine mouthwash and opioids, but his pain persisted. CASE MANAGEMENT AND OUTCOME: A palliative care consult was obtained for management of his pain. The palliative team recommended topical ketamine for the treatment of the painful lip lesions. The patient felt immediate relief with the application of ketamine and his pain level was reduced to a 5/10. The following day, his pain was 0/10. Five days later, the opioids were discontinued and the pain relief continued. CONCLUSION: Painful stomatitis from PNP may be refractory to standard treatment. We found that the application of topical ketamine was very effective in this patient with hemorrhagic stomatitis from PNP.

Identifying message content to reduce vaping: Results from online message testing trials in young adult tobacco users.

INTRODUCTION: Young adults' e-cigarette use is associated with perceptions that e-cigarettes are less harmful or addictive than cigarettes, socially acceptable, and appealing. This study developed and tested vaping educational messages addressing these factors: 1) Harm Perceptions, 2) Addictiveness, 3) Social Use, and 4) Flavors. METHODS: Two message trials were conducted in U.S. Amazon Mechanical Turk workers aged 18-24 using a 2 (content: addiction, harm) × 3 (theme: alone, + flavors, + social) design with multiple messages in each of the six categories. Participants were assigned to view a random subset of messages and report on likeability and perceived message effectiveness (PME). Phase 1 (n = 200) tested 33 messages and 32 images. Phase 2 (n = 769) tested combinations of Phase 1's 24 most effective messages with 6 images rated most likeable or effective. Linear mixed effects models assessed the effect of content, theme, image, and their interactions on message response. RESULTS: In both trials, most participants were past 30-day tobacco users. Harm content messages produced higher PME ratings than addiction content messages, and flavor theme messages were correlated with higher likeability scores than "content alone" theme messages. In Phase 2, flavor and social message themes decreased the PME of harm messages. There was no effect of images on either outcome controlling for the independent or interaction effects of content, theme, and image. CONCLUSIONS: Messages conveying the harms of vaping may be best for reducing vaping in young adult tobacco users; flavor and social themes may diminish their effectiveness.

Prospective associations between nicotine beliefs and tobacco-related susceptibility, curiosity, and use in U.S. adults.

Low harm perceptions of tobacco products have been associated with use of those products in youth and adults, but this relationship has not been assessed for nicotine beliefs. This study used data from a national sample of adults aged 18-40 in Wave 9 (Spring 2016) of the Truth Initiative Young Adult Cohort Study to examine correlations and prospective associations between the latent classes of nicotine beliefs and susceptibility, curiosity, and use of tobacco products in 3122 adults who also completed Wave 10 (Fall 2016). At Wave 9, four latent classes of beliefs characterized the role of nicotine in the health risks of smoking: Class 1, large role, 51%; Class 2, large role/don't know, 9.4%; Class 3, small role in health, 32.5%; and Class 4, none/small role in cancer, 7.5%. Latent classes of nicotine beliefs were highly correlated with susceptibility and curiosity to use cigarettes, e-cigarettes, and hookah, as well as past 30-day use of a range of tobacco products at Wave 9 among never users. Classes 3 and 4 had the highest prevalence of past 30-day tobacco use; never users in these classes reported the greatest susceptibility to try cigarettes, hookah, and e-cigarettes at Wave 9. Class 4 had higher odds of increased e-cigarettes use at follow-up compared to Class 1. There were few prospective associations between nicotine beliefs latent class, susceptibility, and curiosity at Wave 10. Nicotine beliefs are associated with tobacco-related outcomes and, if assessed, may provide novel information to guide tobacco prevention and intervention efforts.

Impact of alcohol and drug use on smoking and cessation in socioeconomically disadvantaged young adults.

INTRODUCTION: Population studies highlight that alcohol and marijuana use are correlated with cigarette smoking and other tobacco use. The aim of our study was to describe the ways in which alcohol and drug use may affect cigarette smoking and cessation in socioeconomically-disadvantaged young adult (SDYA) smokers. METHODS: Thirty-six SDYA smokers aged 18-29 participated in eight focus groups and two individual interviews in Burlington, Vermont in 2018. Structured focus groups addressed poly-tobacco use, other substance use and co-use with tobacco, and the contexts and facilitators that cue SDYA smoking. Participants were also asked their reasons for smoking, barriers to cessation, and messages or modalities that would make smoking cessation more novel or relevant. Three coders implemented the Framework Method to systematically code focus group transcripts. RESULTS: In this sample of SDYA smokers, four key themes emerged around the relationships between alcohol and drug use and smoking: 1) frequent co-use of tobacco and other substances, 2) changes in frequency of smoking when using other substances, including chain smoking when drinking and substituting cigarettes with marijuana, 3) cigarettes as a last remaining addiction for those in recovery from other substance use and, 4) fears that quitting smoking would cause relapse to other substances. DISCUSSION: Co-use of other substances emerged as a reason for smoking and a barrier to quitting, including a concern that quitting smoking would trigger drug or alcohol relapse. Findings support demand for interventions that address substance co-use to improve smoking cessation in SDYA smokers.