Oral health literacy, knowledge, practice and beliefs among Asian Americans: A scoping review.

OBJECTIVES: The Asian American (AsA) population is at high risk for poor oral health outcomes and remains an underserved and understudied community. Low oral health literacy could explain poor oral health behaviours, practices and outcomes in this population. The aims were as follows: (i) provide a scoping review of oral health literacy, knowledge, practice and beliefs among AsA individuals residing in the United States; (ii) identify any instruments or tools translated into participants' language and (iii) determine whether the translated instruments had been assessed for validity and reliability. METHODS: The current study used a scoping review framework based on PRISMA-ScR that included rigorous eligibility criteria, search strategy, independent selection process with adjudication, and standardized reporting of outcomes. The search was conducted on March 14, 2022, and updated on February 25, 2023 and February 13, 2024, in the following databases: Ovid MEDLINE, Embase, Web of Science and CINAHL. Peer-reviewed original research on oral health literacy, knowledge, awareness, practice, and beliefs related to oral health care in AsA subgroups published in English were included. Two reviewers independently assessed whether titles and abstracts should be included for review, with discrepancies adjudicated by a third reviewer. Data extracted from articles used a standard template that included study design, and measurement tools of oral health, knowledge, awareness, practice and beliefs, as well as results and conclusions of the publication. In addition, the template captured whether the translated and original measurement tools were assessed for reliability and validity. RESULTS: Of the 367 papers identified, 10 studies that met eligibility criteria were included in the final review. Of these, four studies used previously validated tools to assess oral health measurements in AsA. Only five of the studies translated the tools into the participants' native language. Although AsA exhibited lower oral health literacy than Whites but higher than Hispanics and African Americans, none of the translated tools were assessed for reliability and validity. Acculturation and country of birth were factors influencing oral health behaviours related to good oral health practice and utilization, with AsA born in the United States exhibiting higher oral health utilization than those born in their country of origin. Oral health beliefs played a significant role in dental care utilization among AsA populations. CONCLUSIONS: The scoping review on oral health in Asian American communities identifies a significant research gap, particularly in the lack of validated tools for assessing oral health literacy, which varies across ethnic groups. It notes that AsA generally have lower oral health literacy compared to Whites, but higher than Hispanics and African Americans. AsA born in the United States shows better oral health practices, influenced by acculturation and birth country. The findings emphasize the need for more thorough and culturally adapted research methods to address oral health disparities in this diverse group.

The Role of Parenting Behaviors and Their Influence on Adolescent Drunk and Drugged Driving: 2016-2019, USA.

Drugged driving, the act of driving a vehicle under the influence of illicit drugs, by adolescents is a serious public health concern. Many factors contribute to this risk behavior, but much less is known regarding the role of parenting behaviors in this phenomenon. The purpose of this study was to examine specific parenting behaviors and their influence among a nationally representative sample of adolescents. Pooled data from the 2016-2019 National Survey on Drug Use and Health (NSDUH) among 17,520 adolescents ages 16-17 years old were analyzed. Differences were found in specific parenting behaviors and adolescent drugged/drunk driving, with parents not checking homework and not telling their children they are proud of them being the most influential. Findings from the present study may inform drugged driving prevention programs for parents and adolescents and enhance road safety interventions.

Suicide Deaths Involving Opioid Poisoning in the United States by Sex, 1999 - 2021.

Suicide remains a leading cause of death in the United States, and recent data suggests that suicide deaths involving opioids are increasing. Given unprecedented increases in drug poisoning deaths, suicidality, and suicide deaths in recent years, an updated examination of the trends in suicide deaths involving opioids is warranted. In this descriptive epidemiologic analysis, we leverage final and provisional mortality data from CDC WONDER to examine trends in suicide deaths involving opioid poisoning from 1999 - 2021 by biological sex. Results reveal complex changes over time: the number and age-adjusted rate of suicide deaths involving opioid poisoning among male and female residents tended to track together, and both increased through 2010, but then diverged with the number and rate of suicide deaths involving opioid poisoning among female residents outpacing that of male residents. However, the number and rate of suicide deaths involving opioid poisoning among male residents then began to stabilize, while that of female residents declined, closing the sex-based gap. Across all years of data, the proportion of suicide deaths that involved opioid poisoning was consistently higher among female decedents (5.8% - 11.0%) compared to male decedents (1.4% - 2.8%). Findings have implications for improved suicide prevention and harm reduction efforts.

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.

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.

Distracted and Impaired Driving Among U.S. Adolescents, 2019, USA.

Distracted driving, the act of focusing on something else while operating a vehicle, is a significant health problem among adolescents. Although some studies have reported on prevalence among adolescents in the United States, limited studies have examined differences by sexual identity status. The purpose of the present study was to examine past 30-day distracted driving by sexual identity status among a large, national sample of adolescents ages 14 to 18 years. A secondary analysis was conducted on the 2019 Youth Risk Behavioral Surveillance System (YRBSS) data, and associations between distracted driving and demographics (e.g., biological sex, age, race/ethnicity) were assessed with weighted logistic regression analyses. A total of 13,590 adolescents ages 14 to 18 years were part of the final analytic sample. Twenty-three percent of adolescents reported distracted driving in the past 30 days. Compared with heterosexual adolescents, gay/lesbian (14.3%), bisexual (18.1%), and questioning (12.9%) adolescents reported lower distracted driving in the past 30 days. Findings through a health equity approach may inform harm reduction efforts and behavioral interventions.

The most common types of nontraumatic dental conditions among emergency department visits in North Carolina before and during the COVID-19 pandemic.

BACKGROUND: This study aimed to identify the most common types of nontraumatic dental conditions (NTDCs) before and during the COVID-19 pandemic and assess the variations in the most common NTDCs by patient age groups and rural or urban locations and the impact of COVID-19 on emergency department (ED) visits for NTDCs in North Carolina. METHODS: The authors conducted a retrospective data analysis of ED data from the North Carolina Disease Event Tracking and Epidemiology Collection Tool. The authors estimated the proportions of NTDCs of all ED visits in 2019 and 2021 and ranked the proportions of the major categories of NTDCs by age groups and rural or urban locations. They used a multiple logistic regression model to assess the impact of COVID-19 on NTDCs. RESULTS: By the first diagnosis, the proportion of NTDCs dropped from 1.1% in 2019 to 0.99% in 2021 (P < .001). Caries was specified as the third most common NTDC. Oral infection was the top NTDC among young (≤ 17 years) and older patients (≥ 65 years). No significant differences were found in NTDCs between rural and urban areas (P = .68). Children younger than 2 years (adjusted odds ratio, 4.36) and adults aged 18 through 44 years (adjusted odds ratio, 4.54) were more likely to visit the ED for NTDCs than those 75 years and older. CONCLUSIONS: The proportion of NTDCs seen at the ED was lower during the COVID-19 pandemic in 2021 than in 2019. The common NTDCs varied by age group but were similar in rural and urban areas. The most common NTDCs were related to toothache, oral infection, and caries. PRACTICAL IMPLICATIONS: More efforts are needed to reduce ED visits for NTDCs.

The Sexual and Gender Minority Adverse Childhood Experiences Scale.

INTRODUCTION: Sexual and gender minority (SGM) adverse childhood experiences (ACEs) are identity-based forms of early life adversity. Exposure to SGM ACEs is associated with increased odds of depression, anxiety, and post-traumatic stress disorder in SGM adults. The purpose of this study was to further test a revised version of the measure in a U.S. sample with more robust and clinically relevant mental health outcomes. METHODS: In May and June 2022, a national sample of SGM adults (N=4,445) was recruited from a Qualtrics Panel to complete a 20-minute online survey that included questions regarding ACEs, SGM ACEs, depression, anxiety, and post-traumatic stress disorder. Exploratory factor analysis and confirmatory factor analysis were used to examine factor structure. Multivariable regression was used to assess criterion validity, and a sensitivity analysis was conducted. Data were analyzed in February 2023. RESULTS: Respondents indicate that vicarious trauma (81%) and school bullying (67%) were the most common experiences and that all SGM ACEs were frequently occurring before adulthood. Confirmatory factor analysis determined a 1-factor solution. Participants with more SGM adverse childhood experiences exposure had worse anxiety, depression, and post-traumatic stress disorder symptoms (ß=0.16, ß=0.18, ß=0.26, respectively, p<0.0001) after controlling for ACEs exposure and demographic factors. A sensitivity analysis indicated that estimates were similar in terms of magnitude and direction. CONCLUSIONS: SGM ACEs commonly and frequently occur before adulthood and impact adult SGM mental health. Overall, the measure had good-to-excellent psychometric properties. Future research should consider integrating SGM ACEs and Minority Stress Theory.

Network analysis of posttraumatic stress disorder in a treatment-seeking sample of US firefighters and emergency medical technicians.

BACKGROUND: First responders, including firefighters and emergency medical technicians (EMTs), are under extreme stress from repeated exposure to potentially traumatic events. To optimize treatment for this population, it is critical to understand how the various posttraumatic stress disorder (PTSD) symptom factors are associated with one another so these relations may be targeted in treatment. METHOD: Using a sample of treatment-seeking firefighters/EMTs (N = 342), we conducted a partial correlation network analysis of the eight-factor model. A Bayesian directed acyclic graph (DAG) was used to estimate causal associations between clusters. RESULTS: Approximately 37 % of the sample screened positive for probable PTSD. Internal re-experiencing and external re-experiencing had the strongest edges. In the DAG, internal re-experiencing was the parent node and was potentially predictive of external re-experiencing, negative affect, dysphoric arousal, and avoidance. LIMITATIONS: Data were drawn from a treatment-seeking sample that may not generalize to all firefighters/EMTs. CONCLUSIONS: The current findings are consistent with prior research suggesting re-experiencing plays a critical role in developing and maintaining PTSD symptoms. Future research should investigate non-treatment-seeking first responders, as well as EMTs and firefighters as individual populations.

School Factors Associated With Past 30-Day E-Cigarette Use Among Hispanic Youth.

E-cigarettes are a popular type of nicotine product among youth in the United States. Hispanic youth, one of the fastest growing populations in the United States, are second only to white youth for e-cigarette use. Analysis of the Parents' Resource Institute for Drug Education data was conducted to determine past 30-day e-cigarette use among Hispanic youth (n = 4,602) and also examined school factors related to such use. Findings indicated that 13.8% of Hispanic youth used e-cigarettes in the past 30 days. Multivariate logistic regression analysis determined several school factors (e.g., poor grades, grade level) related to e-cigarette use. School-based prevention programs are needed to reduce and eliminate e-cigarette use among Hispanic youth.

A national examination of suicidal ideation, planning, and attempts among United States adults: Differences by military veteran status, 2008-2019.

There is a widening disparity in suicide deaths between United States (U.S.) military veterans and nonveterans. However, it is unclear if there are similar differences in suicidal ideation, planning, and attempts that often precipitate these deaths. A better understanding of trends in suicidal thoughts and behaviors could illuminate opportunities for prevention. We examined pooled cross-sectional data (N = 479,801 adults) from the 2008 to 2019 National Survey on Drug Use and Health. We examined differences in past-year suicidal ideation, suicide planning, and suicide attempts between U.S. veterans (n = 26,508) and nonveterans (n = 453,293). We conducted post hoc analyses to examine for differences in these relationships by race/ethnicity and sex. Lastly, we examined trends in these outcomes over time and tested for differences in trends by veteran status. Overall, veterans had significantly greater odds of past-year suicidal ideation (aOR = 1.33, 95% CI 1.20 to 1.47) and suicide planning (aOR = 1.52, 95% CI 1.30 to 1.78) compared to nonveterans. However, the association between veteran status and past-year suicide attempt was not statistically significant (aOR = 1.29, 95% CI 1.00 to 1.68). These relationships did not differ by race/ethnicity or sex (ps > 0.05). Among all adults, there were significant linear increases in past-year suicidal ideation, planning, and attempts (ps < 0.001). However, these trends did not differ between veterans and nonveterans (ps > 0.05). Veterans may be more likely to experience suicidal thoughts and behaviors than nonveteran adults. Upward trends in suicidal thoughts and behaviors among both veterans and nonveterans from 2008 to 2019 highlight opportunities for intervention.

Validation of the PCL-5, PHQ-9, and GAD-7 in a Sample of Veterans.

OBJECTIVE: Veterans can present at nongovernment (Department of Defense, Department of Veterans Affairs) mental health agencies with complex symptom constellations that frequently include posttraumatic stress disorder, depression, and generalized anxiety. To date, no veteran study has validated these measures on a treatment-seeking sample of veterans outside the DoD and VA. METHODS: We used a treatment-seeking sample of veterans ( N = 493) to validate measures that assess these constructs (PTSD Checklist 5, Patient Health Questionnaire-9, and Generalized Anxiety Disorder-7). RESULTS: The seven-factor posttraumatic stress disorder hybrid configuration was the best fit. The best fitting model of the depression measure was a two-factor structure, cognitive-affective, and somatic depression. The measure of generalized anxiety was a unidimensional model. LIMITATIONS: Follow-up studies should validate these measures on nontreatment-seeking discharged veterans. CONCLUSIONS: We interpret these findings within the veteran scholarship and explore clinical implications for providers.

National Trends in Past-Year Marijuana Use among Veterans in the United States, 2013-2019.

Background: The legal landscape surrounding marijuana use in the United States (US) is ever changing. Although substantial research has investigated risk factors of use among different populations, much is to be gleaned among veteran populations, who are at heightened risk for mental and physical health problems, which may be precipitated or relieved by marijuana use. The present study investigated correlates and trends of recreational and medical marijuana use among a large national sample of US Veterans. Methods: Data from the National Survey on Drug Use and Health (2013-2019) comprised of 16,350 veterans 18 years or older were analyzed. We tested for weighted linear and quadratic trends in past-year use. Results: Weighted analyses revealed a significant increase (56%) in overall marijuana use from 2013-2019, with nearly one in 10 veterans (9.79%) reporting past-year marijuana use. Compared to 18 to 25-year-old veterans, veterans who were aged 35-49 years (aPR: 1.44, 95% CI 1.05, 1.97), 50-64 years (aPR: 1.68, 95% CI 1.11, 2.55), and 65 years or older (aPR: 1.90, 95% CI 1.24, 2.90) were more likely to report using medical marijuana in the past year. Conclusions: This increase, in the context of federal VA provider restrictions, has implications for issues of care coordination and safe supply for veterans. Given the rapidly changing and heterogenous landscape of recreational and medical marijuana policy in the US, the present study may inform harm reduction efforts and behavioral interventions.

Psychometric Properties of Scales Measuring Resilience in U.S. Latinx Populations: A Systematic Review.

Objectives: Instruments used to measure resilience have typically been developed in European or Anglosphere countries and emphasize personal factors of resilience. In addition to being a quickly growing ethnic minority group in the United States, Latinx individuals face unique stressors and protective factors that may contribute to resilience. This review sought to determine the extent to which instruments measuring resilience have been validated in U.S. Latinx populations and what domains of resilience those scales capture. Methods: A systematic literature review was conducted using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) standards and included studies describing psychometric properties of resilience scales for Latinx individuals living in the United States. Articles were assessed for quality of psychometric validation; scales used in the final studies were assessed for representation of domains of the social ecological resilience model. Results: Nine studies were included in the final review examining eight separate resilience measures. The populations of these studies were heterogeneous geographically and demographically; more than half the studies only included Latinx populations as a subgroup. The breadth and quality of psychometric validation were variable across studies. The domains represented by the scales in the review most heavily assessed individual domains of resilience. Conclusion: The literature to date on psychometric validation of resilience measures in Latinx populations in the United States is limited and does not robustly capture aspects of resilience that may be particularly meaningful for Latinx populations, such as community or cultural factors. Instruments that are developed with and for Latinx populations are necessary to better understand and measure resilience in this population.

Validation of the PCL-5, PHQ-9, and GAD-7 in a Sample of First Responders.

OBJECTIVE: First responders (FRs) commonly present for treatment with complex symptom constellations that frequently include posttraumatic stress disorder, depression, and generalized anxiety. To date, no FR study has validated these measures on a treatment-seeking sample. METHODS: Confirmatory factor analysis was utilized to validate measures that assess these constructs (Posttraumatic Stress Disorder Checklist for DSM-5, Patient Health Questionnaire-9, and Generalized Anxiety Disorder-7) on a treatment-seeking sample of FRs ( N = 390). RESULTS: The seven-factor posttraumatic stress disorder hybrid configuration was the best fit. The best fitting factor model of the depression measure was a two-factor structure, cognitive-affective and somatic depression. Lastly, generalized anxiety was a unidimensional construct. LIMITATIONS: Follow-up studies should validate these measures on each FR subtype. CONCLUSION: We position these findings within the FR literature, review clinical implications for providers, and offer recommendations for future research.

Typical Sources and Locations of Marijuana among US Young Adults: Differences by Sexual Minority Status.

Background: With the widespread legalization of cannabis and use among all age groups, location and source of cannabis remains to be researched, especially among minority populations. Methods: We pooled data from the 2018-2019 National Survey on Drug Use and Health and investigated differences by sexual minority status of where individuals obtained cannabis. Results: Results found that gay/lesbian and bisexual individuals who reported use were more likely to get marijuana from buying it, trading it for something else and getting it for free or sharing someone else's, compared to heterosexual individuals. Furthermore, more than one in five lesbian/gay individuals reported obtaining marijuana from someone they just met while nearly 25% of bisexual women reported obtaining marijuana from a friend. Conclusions: Findings from the present study may inform harm reduction and policy initiatives.

Predictors of Suicide and Differences in Attachment Styles and Resilience Among Treatment-Seeking First-Responder Subtypes.

OBJECTIVE: To identify the predictors of suicide for firefighters (FFs), emergency medical technicians (EMTs), and law enforcement officers (LEOs). METHODS: We used baseline data from FFs/EMTs (n = 69) and LEOs (n = 81) to investigate the unique predictors for both first-responder subtypes. We conducted confirmatory factor analysis on validated assessments of posttraumatic stress disorder (PTSD) and depression. Measures of attachment, resilience, PTSD, depression, generalized anxiety, trauma history, and substance use were the independent variables in two backward stepwise regressions predicting suicide. RESULTS: Substance use and somatic depression were significant predictors for LEOs, whereas affective depression, anhedonia, externalizing behaviors, trauma history, and generalized anxiety were significant predictors for FFs/EMTs. LIMITATIONS: These data are cross-sectional and should be modeled longitudinally over the course of treatment. CONCLUSION: Separate constructs influence suicide for LEOs and FFs/EMTs.

Past-Year Ketamine Use: Evidence from a United States Population, 2015-2019.

Ketamine is an analgesic that has gained notoriety in nightclub scenes. Yet, a paucity of research exists on the prevalence and associated factors in the United States (US). The present study estimated the prevalence of past-year ketamine use among a national sample of US adults and investigated sociodemographic characteristics and past-year use of other substances associated with past-year ketamine use. Data from the 2015-2019 National Survey on Drug Use and Health was conducted among 210,392 adults over the ages of 18 years old. An estimated 0.13% of adults used ketamine in the past year, with males more likely to use. Significant risk factors included past-year drug use and sexual minority status, with sexual minority males reporting more than use of one substance at highest risk for ketamine use. Findings from the present study may inform harm reduction efforts and policy initiatives.

Digital screen time and suicidality during high school: How important is cyberbullying? A mediation analysis using the youth risk behavioral surveillance survey, 2011-2019.

Elevated digital screen time (i.e., 2+ hours per day) is associated with suicidal ideations, planning, and attempts during adolescence. Recent studies suggest quality, rather than duration, of digital screen time is most impactful on adolescent mental health. We investigate the role of cyberbullying victimization on the relationship between elevated digital screen time and risk factors for completed suicide. We pooled five years of biennial Youth Risk Behavioral Surveillance (YRBS) survey data (2011-2019). Participants were n = 73,011 high school students in the United States (US). Elevated digital screen time reflected spending 3 h (or more) per day on leisure, digital media. Outcome variables were: (1) feeling sad/hopeless; (2) suicidal ideation; (3) suicidal planning; and (4) suicide attempt. Structural equation models (SEMs) tested the mediating effects of self-reported online bullying victimization (i.e., cyberbullying) on the effect of elevated digital screen time on suicidality. We controlled for age, sex, race/ethnicity, and survey year. Subsample analyses stratified by sex were also conducted. Overall, 40.5% of high school students reported elevated digital screen time and 15.4% reported cyberbullying. Cyberbullying mediated a substantial proportion of the relationship between digital screen time and feeling sad/hopeless (16%), suicidal ideation (18%), planned suicide attempt (18%), and past suicide attempt (26%), among high school students, controlling for covariates. Similar mediating effects were observed in models stratified by sex. Findings reinforce prior research demonstrating that the quality of leisure, digital media strongly influences the relationship between digital screen time and mental health during adolescence. Findings need replication via longitudinal designs.