Differences in young adults' perceptions of e-cigarettes by history of use.

Objective: The current study examined group differences in college students' views on e-cigarettes in terms of safety, popularity, health risks, social acceptability, efficacy as a cessation aid, and promoting combustible cigarette use. Participants: 337 undergraduates (Mage = 20.84, SD = 3.79; 72.1% female; 68.5% White) divided into three groups: Never Users (n = 178), Ever Users (n = 108), and Current Users (n = 51). Methods: Participants completed questionnaires for course credit. Results: Compared to Ever and Never Users, Current Users believed e-cigarettes were safer, healthier, a useful tool to quit smoking, did not lead to combustible cigarette smoking, and that nicotine was less dangerous. Current Users also were less likely to endorse boosting social image as a motive for use. Conclusions: Public health campaigns could benefit from targeting current users' positive beliefs about e-cigarettes to reduce the prevalence of e-cigarette use among college students.

Readability of online e-cigarette cessation information.

INTRODUCTION: Given the growing awareness of the health risks associated with e-cigarettes, many users will access information about how to effectively quit using e-cigarettes, and the internet likely will be a popular source of information. However, little is known about the readability of online e-cigarette cessation information. Therefore, the goal of the current study was to assess the readability of webpage information about e-cigarette cessation. METHODS: A search of webpages was conducted using the following search terms: vaping addiction, quit vaping, quit Juul, stop vaping, stop Juul, and vaping cessation. The 464 webpages identified were coded for target audience, message valence, and source, and then assessed for reading level with the Flesch-Kincaid Grade Level assessment. RESULTS: On average, webpage content was written at a 7th grade reading level (Flesch-Kincaid Grade Level Mean=7.34, SD=2.22) and less than 25% of webpages met readability guidelines (i.e. ≤6th grade reading level). There were no differences in readability by target audience, message valence, or webpage source. CONCLUSIONS: The results suggest that most online content related to e-cigarette cessation is not written at a level that is easily understood by general audiences. Thus, tobacco control advocates should assess the reading level of their messaging to ensure wide accessibility of information.

Time spent outdoors and sleep normality: A preliminary investigation.

INTRODUCTION: Sleep deficiency is associated with health risks, and time outdoors is related to health benefits. This study assessed time outdoors and its association with sleep normality. METHODS: As part of a health study in Louisville, Kentucky, 735 participants completed questionnaires on their health status, behaviors, neighborhoods, and demographics in 2018-2019. The measures included information on sleep, time outdoors, and mental and physical health. Participant characteristics were assessed by dichotomized sleep normality (N=728), and logistic regression (N=709) examined potential associations between time outdoors and sleep. RESULTS: As time spent outdoors increased from ≤4 hours to >4 - ≤8 hours (OR=1.04; 95% CI: 0.65-1.64) and >8 - ≤12 hours (OR=1.17; 95% CI: 0.63-2.17), odds of normal sleep increased; however, those who spent >12 - ≤16 hours (OR=0.63; 95% CI: 0.31-1.27) or >16 hours (OR=0.83; 95% CI: 0.45-1.53) outdoors had a lower likelihood of normal sleep. No associations between time outdoors and sleep were significant. There was a significant trend of less bodily pain associated with normal sleep (p<0.001) and in the association of depression and sleep, where odds of normal sleep decreased as depression severity increased (p<0.001). CONCLUSIONS: Consistent with extant literature, findings indicate associations between less pain and increased odds of normal sleep and between higher severity of depression and lower odds of normal sleep. Findings for an overall association between time outdoors and sleep normality were not significant. Future work should seek to better explicate the predictor variables to assess how greenness and activity type shape associations with sleep.

The importance of urban planning: Views of greenness and open space is reversely associated with self-reported views and depressive symptoms.

INTRODUCTION: Exposure to green spaces is beneficial to mental health in a variety of ways, ranging from stress reduction to increased attentiveness and elevated self-esteem. The impact of views of greenness, as opposed to direct exposure, has been examined, but the association between self-reported views and depressive symptoms is not known. The purpose of this study is to examine the relationship between views of greenness and Patient Health Questionnaire-9 (PHQ-9) score. METHODS: Questionnaire responses from 191 participants in the Health, Environment, and Action in Louisville (HEAL) study were examined. Univariate statistical analyses included Mann-Whitney U, Kruskal-Wallis, and Spearman rank tests. Inferential statistical analysis was linear regression. RESULTS: Participant satisfaction with residential greenness was significantly associated with reduced PHQ-9 score (partially adjusted: linear coefficient = -0.42; 95% CI: -0.70 - -0.14; fully adjusted: linear coefficient = -0.21; 95% CI: -0.44 - 0.02). Additionally, being satisfied with local greenness was significantly associated with having views of greenness from home (linear coefficient = 1.97; 95% CI: 1.23-2.68). CONCLUSIONS: Though views of greenness were not directly associated with depression, satisfaction with local greenness was associated with reduced PHQ-9 score, and having views of greenness from home was crudely associated with increased greenness satisfaction. The findings suggest urban greening interventions that focus on greenness satisfaction may be a strategy to reduce depression. Further research is necessary to better understand these relationships.

The Influence of Friends on Teen Vaping: A Mixed-Methods Approach.

Vaping is popular among adolescents. Previous research has explored sources of information and influence on youth vaping, including marketing, ads, family, peers, social media, and the internet. This research endeavors to expand understanding of peer influence. Our hypothesis is that friends' influence on teen vapers' first electronic nicotine delivery systems (ENDS) use varies by demographic variables and awareness of ENDS advertising. In August-October 2017, youth (n = 3174) aged 13-18 completed an online survey to quantify ENDS behaviors and attitudes and were invited to participate in follow-up online research in November-December 2017 to probe qualitative context around perceptions and motivations (n = 76). This analysis focused on the ENDS users, defined as having ever tried any ENDS product, from the survey (n = 1549) and the follow-up research (n = 39). Among survey respondents, friends were the most common source of vapers' first ENDS product (60%). Most survey respondents tried their first ENDS product while "hanging out with friends" (54%). Among follow-up research participants, the theme of socializing was also prominent. ENDS advertising and marketing through social media had a strong association with friend networks; in fact, the odds of friends as source of the first vaping experience were 2 times higher for those who had seen ENDS ads on social media compared with other types of media. The influence of friends is particularly evident among non-Hispanic Whites, Hispanics/Latinos, those living in urban areas, those living in high-income households, those with higher self-esteem, and those who experiment with vaping. These findings support the premise that peer influence is a primary social influencer and reinforcer for vaping. Being included in a popular activity appears to be a strong driving force.

Associations between tobacco use patterns and demographic characteristics of sexual minority and heterosexual youth: Results from a nationwide online survey.

INTRODUCTION: Youth are at risk for tobacco use, and previous research has pointed to increased vulnerabilities associated with sexual minority identity. For example, LGB youth have increased odds for using tobacco than their heterosexual peers, and bisexual youth have higher odds of smoking than other sexual identity groups. As new tobacco products proliferate and health risks from dual/poly use grow, increased understanding of tobacco use patterns by sexual minority youth is needed. METHODS: For 3117 youth, aged 13-18 years, who completed an online questionnaire in 2017 and identified their sexual orientation [minority (e.g. lesbian/gay, bisexual, or pansexual) vs majority (heterosexual)] and gender, we classified current tobacco use into four categories: e-cigarette only, other product only (such as cigarette, cigar, or smokeless tobacco; not an e-cigarette), dual/poly use, and no use. Analyses were conducted separately for male and female participants. Multinomial logistic regression was employed. RESULTS: Female sexual minority youth had nearly twofold odds of dual/ poly tobacco use (OR=1.95; 95% CI: 1.12-3.40), compared to their heterosexual counterparts. For male youth, sexual minority identification was not significantly associated with dual/poly use. No significant differences were found in sexual minority and heterosexual youth e-cigarette only or other tobacco only use groups. Tobacco use patterns also significantly differed by age, race, place of residence, and parental education level. CONCLUSIONS: Study findings reveal greater odds of dual/poly tobacco use for female sexual minority youth. Tailored tobacco prevention and cessation programs or interventions are needed for sexual minority youth most at risk of tobacco use, especially multiple product use.

Sociodemographic differences in single, dual, and poly tobacco use among Appalachian youth.

INTRODUCTION: Patterns of youth tobacco use, including use of multiple products, have likely shifted as e-cigarettes have grown in popularity. However, there is limited understanding of dual and poly tobacco use and the associated disparities, especially among Appalachian youth. METHODS: We analyzed Youth Appalachian Tobacco Study data (n=1116) to estimate prevalence of current (past-30 day) cigarette, e-cigarette, and smokeless tobacco use by gender, race/ethnicity, age, school type, state, smartphone use, and number of household tobacco users. We created a pattern of tobacco use variable (i.e. never, former, single, dual, poly) based on all possible combinations of the included products. Using multivariable multinomial logistic regression (outcome reference: never use), we evaluated associations between sociodemographic characteristics and patterns of tobacco use. RESULTS: Former (16.2%) was the most common tobacco use group, followed by single (10.8%), dual (4.5%), and poly (2.4%) use. Dual and poly use were more prevalent among males, Whites/Caucasians, older participants, and participants living in households with tobacco users. Kentucky residents (vs New York) had higher odds of dual use (OR=5.15; 95% CI: 1.72-15.44), and youth who used smartphones for ≥20hours/week (vs <20 hours/week) had greater odds of poly use (OR=3.02; 95% CI: 1.34-6.80). CONCLUSIONS: Differences in single, dual, and poly tobacco use were evidenced by sociodemographic characteristics. Additional inquiry should further examine these disparities so that tobacco prevention interventions can be appropriately tailored.

Cigarette smoking, ENDS use and dual use among a national sample of lesbians, gays and bisexuals.

INTRODUCTION: Historically, lesbian, gay and bisexual (LGB) individuals have higher rates of cigarette smoking, often attributed to targeted tobacco advertising, exposure to stressors, and psychological distress. Elevated use of electronic nicotine delivery systems (ENDS) among LGB individuals has been documented recently. However, the LGB groups are not homogeneous and differences may exist between the use of tobacco by men and women within the LGB groups. The purpose of this research was to examine cigarette smoking, ENDS use and dual use (cigarettes plus ENDS) among LGB subgroups. METHODS: We classified 2087 participants completing a national online survey based on tobacco-use status (i.e. cigarette only, ENDS only, dual use) and sexual orientation. Multinomial logistic regression was employed to assess group differences. RESULTS: After adjusting for demographics and socioeconomic status, bisexual women were 1.85 times (95% CI: 1.19-2.87) more likely to report current dual use, in contrast to cigarette only use, compared to heterosexual women. No significant differences were found between lesbian and heterosexual women, or between gay or bisexual men and their heterosexual counterparts. CONCLUSIONS: This study describes significantly greater dual use by bisexual women and is one of the first reports of elevated dual use in this group compared to heterosexual women. These findings suggest that targeted health messages may be needed to raise awareness of risk in specific LGB groups and that future research with these populations is necessary to better understand differences in tobacco perceptions and use.

Sexual assault services coverage on Native American land.

Native American women experience higher rates of sexual assault than other women in the United States, yet there is limited information on the accessibility of forensic services for Native American victims of sexual violence. This study used geographic information systems technology to map known sexual assault examiner (SAE) and sexual assault response team (SART) programs in the United States (n = 873) in proximity to 650 census-designated Native American lands. Analysis was repeated for 29 Indian Health Service and tribal-operated facilities that self-identified that they provide sexual assault examinations. Network analysis showed that 30.7% of Native American land is within a 60-minute driving distance of a facility offering SAE or SART services. Indian Health Service and tribal-operated facilities increased accessibility to SAE services on 35 Native American lands. This study shows gaps in coverage for more than two thirds of Native American lands, including 381 lands with no coverage, highlighting the need for expanded SAE and SART services near or on Native American land.

Continuing bonds after suicide bereavement in childhood.

It has been argued that the grieving process after suicide bereavement has unique properties (e.g.,J. R.Jordan, 2001). A qualitative study was conducted to explore one aspect of the grieving process--continuing bonds--after suicide bereavement in childhood. Data were collected through semi-structured interviews with 10 suicide-bereaved children and analyzed using Interpretative Phenomenological Analysis (Smith & Osborn, 2003). Three themes are discussed: thinking about the deceased, coping strategies, and ongoing connections to the deceased. The findings highlight potentially unique qualities of continuing bonds after childhood suicide bereavement and factors that might influence their adaptiveness. Theoretical and clinical implications are outlined.

Preventing venous thromboembolism through risk assessment approaches.

Venous thromboembolism (VTE) is a significant cause of morbidity and mortality in hospitalized patients. Recent guidelines from the Department of Health and the National Institute for Health and Clinical Excellence recommend mandatory, universal VTE risk assessment for hospitalized patients and the provision of appropriate prevention measures (thromboprophylaxis). Careful selection of a suitable VTE risk assessment approach is required to improve the chance of its successful implementation in hospital. At-risk patients need to be identified, counselled and the most appropriate thromboprophylaxis selected, prescribed and delivered. Nurses are ideally placed to play a central role in the implementation of this change in clinical practice through leadership and education. Extended pharmacological thromboprophylaxis has been recommended in certain high-risk groups. New oral anticoagulants are being evaluated, which could change the way thromboprophylaxis is administered in future, benefiting both patients and nurses.

Effectiveness of two tinidazole regimens in treatment of bacterial vaginosis: a randomized controlled trial.

OBJECTIVE: To assess the effectiveness at 21-30 days after treatment of tinidazole administered orally at 1 g once daily for 5 days and 2 g once daily for 2 days, compared with placebo, in the treatment of bacterial vaginosis, using rigorous U.S. Food and Drug Administration (FDA)-recommended criteria to define cure. METHODS: A total of 235 women at 10 U.S. centers participated in this prospective, randomized, double-blinded, placebo-controlled trial. Presence or absence of all five following criteria was required to define diagnosis or cure of bacterial vaginosis: 1) clue cells were at least 20% of squamous cells in microscopic examination of vaginal fluid; 2) positive potassium hydroxide whiff test; 3) a homogeneous, thin, white-gray vaginal discharge; 4) vaginal pH greater than 4.5; and 5) Nugent score greater than or equal to 4 on Gram-stained vaginal fluid. Compliance, tolerability, and safety were assessed using patient diaries and interviews at 8-10 days and 21-30 days after treatment. Cochran-Mantel-Haenszel statistical analysis with Bonferroni adjustment was used to compare outcomes. RESULTS: Superior efficacy was demonstrated by tinidazole for the 1 g once daily for 5 days regimen (36.8% cured, P<.001, number needed to treat 3.2) and for the 2 g once daily for 2 days regimen (27.4% cured, P<.001, number needed to treat 4.5), when compared with placebo (5.1% cured) in the primary endpoint analysis. Using more traditional criteria for cure, efficacy was greater. Compliance with study therapy and tolerability were comparable in the three treatment groups. CONCLUSION: Both tinidazole regimens studied provided effective treatment for bacterial vaginosis. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov, www.clinicaltrials.gov, NCT00229216 LEVEL OF EVIDENCE: I.

Therapeutic efficacy and safety of red blood cells treated with a chemical process (S-303) for pathogen inactivation: a Phase III clinical trial in cardiac surgery patients.

BACKGROUND: A randomized, double-blind trial is reported of the clinical efficacy of red blood cells (RBCs) treated for pathogen inactivation with S-303, a synthetic labile alkylating agent. STUDY DESIGN AND METHODS: Patients undergoing complex cardiac surgeries were randomly assigned to receive either S-303-treated (test) or conventional (control) RBC transfusion during surgery and for 6 days thereafter. Efficacy was evaluated by comparing the occurrence of a composite primary endpoint of treatment-related morbidity (myocardial infarction and renal failure) and mortality. RESULTS: Two-hundred twenty-three patients were randomly assigned and 148 patients who received transfusions (74 with S-303-treated RBCs and 74 with control RBCs) were evaluable. The incidence of the primary endpoint was equivalent between the two groups (22 and 21% in the S-303-treated and control RBC groups, respectively). Secondary endpoints, including hemoglobin increment (mean, 1.4 vs. 1.5 g/dL), number of RBC transfusions (mean, 4.4 vs. 3.8 units), and other blood product support, were also comparable. The adverse event profile was similar between groups; however, patients who received S-303 RBCs were significantly more likely to develop constipation and less likely to suffer supraventricular extrasystoles. Four patients (2 test and 2 control) demonstrated positive indirect antiglobulin tests with reactivity for S-303 RBCs at one or more time points before or after transfusion, without evidence of hemolysis. CONCLUSION: S-303-treated and conventional RBCs were equivalent with respect to clinical efficacy and safety in supporting the transfusion needs of cardiac surgery patients. Investigations are under way to ascertain the significance of S-303 RBC antibodies and to prevent their occurrence.