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BackgroundSchools increasingly prioritize social-emotional competence and bullying and cyberbullying prevention, so the development of novel, low-cost, and high-yield programs addressing these topics is important. Further, rigorous assessment of interventions prior to widespread dissemination is crucial. ObjectiveThis study assesses the effectiveness and implementation fidelity of the ACT Out! Social Issue Theater program, a 1-hour psychodramatic intervention by professional actors; it also measures students’ receptiveness to the intervention. MethodsThis study is a 2-arm cluster randomized control trial with 1:1 allocation that randomized either to the ACT Out! intervention or control (treatment as usual) at the classroom level (n=76 classrooms in 12 schools across 5 counties in Indiana, comprised of 1571 students at pretest in fourth, seventh, and tenth grades). The primary outcomes were self-reported social-emotional competence, bullying perpetration, and bullying victimization; the secondary outcomes were receptiveness to the intervention, implementation fidelity (independent observer observation), and prespecified subanalyses of social-emotional competence for seventh- and tenth-grade students. All outcomes were collected at baseline and 2-week posttest, with planned 3-months posttest data collection prevented due to the COVID-19 pandemic. ResultsIntervention fidelity was uniformly excellent (>96% adherence), and students were highly receptive to the program. However, trial results did not support the hypothesis that the intervention would increase participants’ social-emotional competence. The intervention’s impact on bullying was complicated to interpret and included some evidence of small interaction effects (reduced cyberbullying victimization and increased physical bullying perpetration). Additionally, pooled within-group reductions were also observed and discussed but were not appropriate for causal attribution. ConclusionsThis study found no superiority for a 1-hour ACT Out! intervention compared to treatment as usual for social-emotional competence or offline bullying, but some evidence of a small effect for cyberbullying. On the basis of these results and the within-group effects, as a next step, we encourage research into whether the ACT Out! intervention may engender a bystander effect not amenable to randomization by classroom. Therefore, we recommend a larger trial of the ACT Out! intervention that focuses specifically on cyberbullying, measures bystander behavior, is randomized by school, and is controlled for extant bullying prevention efforts at each school. Trial RegistrationClinicaltrials.gov NCT04097496; https://clinicaltrials.gov/ct2/show/NCT04097496 International Registered Report Identifier (IRRID)RR2-10.2196/17900

BackgroundStudents in the United States spend a meaningful portion of their developmental lives in school. In recent years, researchers and educators have begun to focus explicitly on social and emotional learning (SEL) in the school setting. Initial evidence from meta-analyses suggests that curricula designed to promote SEL likely produce benefits in terms of social-emotional competence (SEC) and numerous related behavioral and affective outcomes. At the same time, there are often barriers to implementing such curricula as intended, and some researchers have questioned the strength of the evaluation data from SEL programs. As part of the effort to improve programming in SEL, this paper describes the protocol for a cluster randomized trial of the ACT OUT! Social Issue Theater program, a brief psychodramatic intervention to build SEC and reduce bullying behavior in students. ObjectiveThe objective of this trial is to examine if a short dose of interactive psychodrama can affect SEC metrics and bullying experiences in schoolchildren in either the short (2-week) or medium (6-month) term. MethodsThe ACT OUT! trial is a cluster randomized superiority trial with 2 parallel groups. The unit of measurement is the student, and the unit of randomization is the classroom. For each grade (fourth, seventh, and 10th), an even number of classrooms will be selected from each school—half will be assigned to the intervention arm and half will be assigned to the control arm. The intervention will consist of 3 moderated psychodramatic performances by trained actors, and the control condition will be the usual school day. Outcome data will be collected at baseline (preintervention), 2-week postintervention (short term), and 6-month postintervention (medium term). Outcomes will include social-emotional competency; self-reported bullying and experiences of being bullied; receptivity to the program; and school-level data on truancy, absenteeism, and referrals to school displinary action for bullying. A power analysis adjusted for clustering effect, design effect, and potential attrition yielded a need for approximately 1594 students, consisting of an estimated 80 classrooms split evenly into intervention and control arms. ResultsThis study was funded in June 2019; approved by the Indiana University Institutional review board on September 17, 2019; began subject recruitment on November 5, 2019; and prospectively registered with ClinicalTrials.gov. ConclusionsMany states have issued recommendations for the integration of SEL into schools. The proposed study uses a rigorous methodology to determine if the ACT OUT! psychodramatic intervention is a cost-effective means of bolstering SEC and reducing bullying incidence in schools. Trial RegistrationClinicalTrials.gov NCT04097496; https://clinicaltrials.gov/ct2/show/NCT04097496 International Registered Report Identifier (IRRID)PRR1-10.2196/17900

IntroductionE-cigarette users typically initiate vaping with flavoured e-liquids. People who vape flavours tend to underestimate the harm of vaping. We examined the inter-relationship between flavour preference, vaping for cessation purposes, e-cigarette dependence, e-cigarette harm perception and purchase/use intention, given a hypothetical flavour ban. We hypothesised that non-tobacco flavour preference and vaping for cessation would be negatively associated with harm perception of e-cigarettes and intention to continue vaping if a flavour ban occurred and that these effects would be mediated by e-cigarette dependence.MethodsFrom July 2019 to March 2020, we conducted intercept interviews with 276 customers at 44 vape shops in California. The predictor variables were flavour preference and vaping for cessation. The outcome variables were harm perception of e-cigarettes and intention to purchase/use, given a hypothetical flavour ban. Multilevel structural equation modelling tested whether e-cigarette dependence mediates the effects of flavour preference on hypothetical continued vaping and purchase.ResultsThose who preferred flavours showed significantly lower intention to purchase e-liquids (β=-0.28, p

Background: Schools increasingly prioritize social-emotional competence and bullying and cyberbullying prevention, so the development of novel, low-cost, and high-yield programs addressing these topics is important. Further, rigorous assessment of interventions prior to widespread dissemination is crucial. Objective: This study assesses the effectiveness and implementation fidelity of the ACT Out! Social Issue Theater program, a 1-hour psychodramatic intervention by professional actors; it also measures students' receptiveness to the intervention. Methods: This study is a 2-arm cluster randomized control trial with 1:1 allocation that randomized either to the ACT Out! intervention or control (treatment as usual) at the classroom level (n=76 classrooms in 12 schools across 5 counties in Indiana, comprised of 1571 students at pretest in fourth, seventh, and tenth grades). The primary outcomes were self-reported social-emotional competence, bullying perpetration, and bullying victimization; the secondary outcomes were receptiveness to the intervention, implementation fidelity (independent observer observation), and prespecified subanalyses of social-emotional competence for seventh- and tenth-grade students. All outcomes were collected at baseline and 2-week posttest, with planned 3-months posttest data collection prevented due to the COVID-19 pandemic. Results: Intervention fidelity was uniformly excellent (>96% adherence), and students were highly receptive to the program. However, trial results did not support the hypothesis that the intervention would increase participants' social-emotional competence. The intervention's impact on bullying was complicated to interpret and included some evidence of small interaction effects (reduced cyberbullying victimization and increased physical bullying perpetration). Additionally, pooled within-group reductions were also observed and discussed but were not appropriate for causal attribution. Conclusions: This study found no superiority for a 1-hour ACT Out! intervention compared to treatment as usual for social-emotional competence or offline bullying, but some evidence of a small effect for cyberbullying. On the basis of these results and the within-group effects, as a next step, we encourage research into whether the ACT Out! intervention may engender a bystander effect not amenable to randomization by classroom. Therefore, we recommend a larger trial of the ACT Out! intervention that focuses specifically on cyberbullying, measures bystander behavior, is randomized by school, and is controlled for extant bullying prevention efforts at each school.

ObjectiveThe 2016 FDA's "Deeming Rule" prohibited free samples of vaping products. The purpose of this study was to investigate compliance with or adaptation to this newly established FDA policy.MethodsVape shops were recruited in Southern California between November 2017 and December 2018. Data collectors interviewed 121 vape shop employees who responded to questions pertaining to the sampling protocol at their shop. Nicotine levels used for sampling were also assessed for consideration of future policy adoption.ResultsOnly 7.4% of shops were non-compliant to federal sampling rules. The remaining shops either: 1) charged a fee for samples (58.7%); 2) deducted the fee from the final purchase price (5.8%); or 3) eliminated product sampling (28.1%). Of the shops that charged for sampling (including membership fees), 94.4% initiated a minimal cost protocol (≤$1) for sampling. Half (50.0%) the shops that allowed sampling offered nicotine-containing samples.ConclusionThere was high compliance (92.6%) to the change in policy among vape shops. However, minimal modification of sampling protocol was observed due in part to the lack of specificity on parameters of compliance, which lessened the potential impact of the policy. To further protect consumers, policymakers must develop unambiguous and comprehensive policies to achieve intended results and true compliance. At minimum, future tobacco product sampling policies should consider standardized pricing; alternatively, total elimination of tobacco product sampling is suggested.

Oral nicotine pouches may appeal to young adult current nicotine/tobacco users interested in alternative forms of nicotine that lack pulmonary exposure, but may also appeal to young adult non-users of nicotine/tobacco products. We used data from a 2020 remote digital survey of an ongoing cohort study of young adults from Southern California (aged 19-23) to examine differences in pouch perceptions and use willingness across nicotine/tobacco use statuses. Participants who had never used nicotine pouches (N = 1167) viewed text/imagery from mass-marketed pouch packaging and advertising, then completed measures of willingness to use nicotine pouches, pouch harm perceptions, and hypothetical choice of cigarettes or e-cigarettes over pouches. Willingness to use pouches was significantly higher among non-combustible only (33.8%), combustible only (29.3%), and dual (43.9%) users than non-users (14.7%). Overall, 49.1% of participants were uncertain whether pouches were less harmful than cigarettes and 52.4% were uncertain whether pouches were less harmful than e-cigarettes. Relative harm perceptions did not significantly differ by tobacco use status. Those using non-combustible products (either alone or as part of dual use with combustible tobacco) had greater odds than non-users of reporting that they would use e-cigarettes over nicotine pouches. By contrast, all tobacco product user groups reported greater odds than non-users that they would use cigarettes over pouches. In sum, a sizable minority of young adults might be willing to try using nicotine pouches, but most are uncertain about the relative harm of pouches.

IntroductionPast studies have documented disparities in regulation compliance among tobacco retailers with respect to ethnic diversity in neighbourhoods. This study investigated the association between compliance with the Food and Drug Administration (FDA) and California state rules and neighbourhood ethnic composition of a vape shop location.MethodsWe recruited 122 vape shops located in 'ethnic enclave' neighbourhoods in Southern California. Trained teams of data collectors visited each of the consented vape shops and coded items in the shops that were visible and on display. Location data for the percentages of ethnic composition for a given city were obtained from the U.S. Census Bureau, American FactFinder. Multilevel logistic regression models examined the relationship between the city-level neighbourhood ethnic composition and vape shop rule violation status: not displaying Ask4ID sign and offering free samples.ResultsVape shops located in neighbourhoods/communities with more white residents were significantly less likely to not display Ask4ID sign (p=0.03) and less likely to offer free sampling (p=0.009), controlling for other neighbourhood ethnic characteristics.DiscussionGreater enforcement for proper signage display is needed for vape shops located in racial/ethnic minority locations to ensure that minors are discouraged from purchasing e-products.

Vape shops specialize in the sales of e-cigarettes and other vaping products. In recent studies, young adults who use e-cigarettes have tended to identify with at-risk peer crowds. This is the first study to examine vape shop customers' clientele. Composed primarily of young adults and persons in early middle adulthood, we speculated that a relatively high prevalence of those who appeared to bystanders as radical/extreme (at-risk) customers would be identified as such at these shops. We recruited vape shops throughout Southern California (N = 44 shops), and trained teams of data collectors visited each of the consented vape shops, making note of 451 customers' appearance, including features such as manner of dress, presence of tattoos, and hairstyles. Customers were then coded as either belonging to a conventional, progressive, or radical/extreme crowd based on outward appearance. Of the customers observed, 223 (49%) were rated as appearing to be in the conventional crowd; 169 (38%) were rated as appearing to be in the progressive crowd, and only 59 (13%) were rated as appearing to be in the radical/extreme crowd. The conventional crowd tended to appear older. Clientele may reflect that more conventional young and early middle age adults are tempted to visit vape shops due to perceptions of greater acceptability or safety of e-cigarettes. E-cigarette mass media campaigns aimed at protecting potential vape shop customers from harm may need to depict more conservative-looking characters.

IntroductionThis study examined smoking cessation advice offered by vape shop employees, as well as their perceived awareness of vaping research.Aims and methodsThis cross-sectional study was conducted in 121 vape shops in the Greater Los Angeles area of Southern California in four multiethnic communities (Hispanic/Latino, African American, Korean/Asian, and non-Hispanic White). A 35-minute interview assessed the employee's tobacco product use, perceptions of vaping research, and experience advising customers to quit cigarette smoking.ResultsAmong 121 vape shop employees surveyed, 106 (88%) reported that they provided smoking cessation advice or counseling to customers. Nearly half (45%) reported having no vaping-related research knowledge, while 30% were aware of provaping studies only. Approximately 85% of employees had quit cigarettes by switching to e-cigarettes instead, whereas 15% were dual users. Only 49% believed that vaping products contribute to nicotine addiction among youth. Those who provided advice on quitting cigarette smoking reported significantly lower knowledge of e-cigarette research than those who did not provide advice (p < .01).ConclusionsMost vape shop employees provide advice to customers who desire to quit cigarette smoking and initiate electronic cigarette use. However, they report a low level of awareness about e-cigarette research. Future research is warranted to examine the specifics of advice provided by vape shop employees. Training programs for vape shop employees and educational campaigns about evidence-based scientific findings on vaping may be beneficial.ImplicationsAlmost nine out of 10 surveyed vape shop employees offered cigarette smoking cessation advice to their customers, while almost half of the retailers report not being aware of any vaping-related research studies. Providing employees with training on evidence-based cessation advice could help protect customers. Also, training programs for vape shop employees and educational campaigns about the risk of nicotine addiction could potentially increase their motivation to avoid sales to minors and to warn adults about nicotine addiction.

The overall aim of this study is to examine vape shop business operations during COVID-19 among a cohort of 88 vape shops in the Greater Los Angeles area in Southern California, located in ethnically diverse communities. A total of six web- and/or phone-based assessments were conducted over a 12-week period (April 1, 2020-June 10, 2020), extending from the mandated closure of nonessential businesses (Stage 1; Assessments 1-3) to the reopening of nonessential sectors (Stage 2; Assessments 4-6), to evaluate business operations (open and closure statuses). The proportion of vape shops found to be noncompliant with the Governor's executive order (i.e., open) during Stage 1 gradually increased from 54 (61.4%) at Assessment 1 (week of April 1, 2020) to 58 (65.9%) at Assessment 3 (week of April 29, 2020). Moreover, vape shops located in Hispanic/Latino and Korean/Asian communities (vs. those in non-Hispanic White and African American communities) were more likely to stay open both during and after the shutdown at Assessments 1 and 6. More specifically, vape shops located in Hispanic/Latino communities were significantly more likely to offer walk-in service during Assessment 1 (during the shutdown), and vape shops in Hispanic/Latino and Korean/Asian were significantly more likely to offer walk-in service during Assessment 6 (after the re-opening). This study demonstrates high rates of noncompliance with shutdown orders among vape shops located in ethnic communities, thus suggesting higher contextual risk factors of COVID-19 exposure among certain ethnic communities.

IntroductionThis study examined vape shop customers' behaviors in relation to shop display practices. We hypothesized that display of signs conveying supportive attitude toward vaping at vape shops would be positively associated with customer purchasing and in-shop vaping behaviors.MethodsWe recruited vape shops throughout Southern California (N = 122). Trained teams of data collectors visited each of the consented vape shops, observed customers' characteristics and behaviors (N = 254) and coded items in the shops that were visible and on display. We conducted a multivariate multilevel analysis to account for the data structure where customers were nested within vape shops.ResultsMale customers were more likely to purchase e-liquid at the shop than female customers (p

The novel 2019 Coronavirus Disease (COVID-19) pandemic has led to the closing of all but essential businesses in California. However, several nonessential businesses have remained open in Southern California despite the mandated "stay at home" order issued by the governor. As part of an ongoing vape shop project involving 88 participating shops, this study investigated the number of vape shops that remained open amidst the coronavirus outbreak and related mandates. Examination of shop social media websites and telephone calls to shops revealed that 61.4% (n = 54) have remained open, particularly within Korean/Asian and Hispanic/Latino ethnic locations (32 of the 54 shops). Importantly, walk-in service was much higher within Hispanic/Latino locations compared to African American, Korean/Asian, or non-Hispanic White neighborhoods (p = 0.03). It is not known if shops that stayed open were in direct violation of the order, didn't know all the details of the order, or found a loophole in the order and believed that they were an essential business. Better communication between the vape shop industry and public health officials during this pandemic is needed.

ObjectivesVape shops have proliferated in the United States (US) in recent years. As of May 2016, the US Food and Drug Administration (FDA) asserted its authority to regulate electronic nicotine delivery systems. It is critical to understand how these polices have affected the vape shop industry, as the rise and fall of vape shop proliferation has the potential for influencing public health.MethodsIn this longitudinal study, we examined factors associated with vape shop (N = 77) closure over a 2-1/2-year period in southern California. We assessed predictors of vape shops going out of business using a multivariate logistic regression model.ResultsAmong 77 vape shops assessed at baseline, 44.2% closed over a 2-1/2-year period. The absence of a "bar type" physical environment (OR = 2.64, 95% CI = 1.12-6.20), poorer shop accessibility (OR = 7.11, 95% CI = 1.17-43.24), fewer reports of qualified personnel (OR = 2.28, 95% CI = 1.12-4.64), less average time spent in shop by customers (OR = 4.8, 95% CI = 1.18-19.60), a narrower e-liquid flavor selection (OR = 6.55, 95% CI = 1.56-27.49), and less vape device diversity (OR = 2.36, 95% C = 1.13-4.91) predicted vape shop closure.ConclusionsThe rise and subsequent decline in vape shops could potentially affect public health. However, there needs to be more research on their association with public health..

Prospective longitudinal data collection is an important way for researchers and evaluators to assess change. In school-based settings, for low-risk and/or likely-beneficial interventions or surveys, data quality and ethical standards are both arguably stronger when using a waiver of parental consent--but doing so often requires the use of anonymous data collection methods. The standard solution to this problem has been the use of a self-generated identification code. However, such codes often incorporate personalized elements (e.g., birth month, middle initial) that, even when meeting the technical standard for anonymity, may raise concerns among both youth participants and their parents, potentially altering willingness to participate, response quality, or generating outrage. There may be value, therefore, in developing a self-generated identification code and matching approach that not only is technically anonymous but also appears anonymous to a research-naive individual. This article provides a proof of concept for a novel matching approach for school-based longitudinal data collection that potentially accomplishes this goal.

The vape shop industry is a rapidly growing market sector with a constantly changing product landscape. The rapid evolution of nicotine delivery systems, most notably the emergence of salt nicotine e-juice and pod mod devices, have resulted in a sudden shift in the product market, suggesting new implications for the health professions in addressing electronic cigarette use.

This commentary intends to provide constructive input into the "Ten myths about work addiction" by Griiffiths et al. (2018). I place the information into an appetitive motivation theoretical lens of addiction as well as outline the kernels of truth associated with each myth. Advancement of an understanding of the underlying mechanisms of addiction demands consideration that any number of appetitive-associated behaviors might become disrupted - including those at the workplace.

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

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

After proposing the "Deeming Rule" in 2014, the U.S. Food and Drug Administration (FDA) began regulating the manufacturing, marketing, and sales of electronic cigarette (e-cigarette) products as tobacco products in 2016. The current study conducted vape shop store observations and surveyed Los Angeles-area shop employees (assessing their beliefs, awareness, and perceptions of e-cigarettes and related FDA regulations) at two time points one year apart to better understand what vape shop retailers would do given FDA's soon-to-be-enacted Deeming Rule. The study also compared retailer beliefs/awareness/actions and store characteristics immediately after the Deeming Rule proposal versus a year after the Rule had been proposed, right before its enactment. Two data collection waves occurred before the Deeming Rule enactment, with Year 1 surveying 77 shops (2014) and Year 2 surveying 61 shops (2015-2016). Between the data collection points, 16 shops had closed. Among the shops that were open at both time points, the majority (95% in Year 1; 74% in Year 2) were aware of some FDA regulations or other policies applying to vape shops. However, overall awareness of FDA regulations and state/local policies governing e-cigarettes significantly decreased from Year 1 to Year 2. At both time points, all shops offered customers free puffs of nicotine-containing e-liquids (prohibited by the then upcoming Deeming Rule). Perceptions of e-cigarette safety also significantly decreased between the years. Exploring vape shop retailer perceptions and store policies (i.e., free puffs/samples displays, perceptions of e-cigarette safety, etc.) over time will help the FDA assess the needs of the vape shop community and develop more effective retailer education campaigns and materials targeted to increase compliance with the newly enacted regulations.

BackgroundPrevious literature suggests that trait impulsivity and engagement in non-drug-related behavioral addictions (e.g., Internet addiction, food addiction) are two risk factors for drug use. Here we further investigated the potential impact of having one or both of these risk factors on drug use in Los Angeles area adolescents.MethodHigh school students (N=1612; Mean age=14.1) completed self-report surveys measuring two potential risk factors (impulsivity, lifetime history of several behavioral addictions), and past 6-month use of tobacco, alcohol and marijuana. Participants who reported never using drugs completed questionnaires assessing their susceptibility for future use.ResultsIn general, adolescents who endorsed either impulsivity alone or at least two behavioral addictions alone were more likely to have used tobacco, alcohol, or marijuana compared to individuals who had neither risk factor (OR=2.50-4.13), and individuals who endorsed both impulsivity and three or more behavioral addictions were the most likely to have used these drugs (OR=9.40-10.13). Similarly, among those who had never tried a drug, individuals with this combined set of risk factors were the most likely to be susceptible to future drug use (OR=3.37-5.04).DiscussionThese results indicate that the combination of trait impulsivity and a history of behavioral addictions increases the risk for current and future drug use in adolescents, to a greater extent than either risk factor alone. It may be useful for drug prevention efforts to target impulsive adolescents who also actively engage in other non-drug-related addictive behaviors.

INTRODUCTION:Vape shops are popular brick-and-mortar stores that sell e-cigarette products but are not understood well. Previous analysis of Yelp reviews of vape shops located in various ethnic neighborhoods in Los Angeles, California in 2014 identified characteristics of vape shop as delineated by consumers. In this study, we assessed the associations between these characteristics and vape shops going out of business in 2015. METHODS:Content analysis of Yelp reviews of 72 vape shops in 2014 identified 1) general characteristics of the reviews/reviewers, 2) vape shop, staff, and marketing attributes, 3) physical environment, and 4) health claims. In 2015, in-person visits confirmed that 22% of these vape shops closed permanently. We analyzed whether characteristics/attributes identified in 2014 associated with stores remaining open (n = 56) or permanently closing (n = 16) in 2015. RESULTS:Univariate findings showed that open vape shops relative to closed shops had greater 1) number of reviews, 2) rebuilds/fixings, 3) ratings of staff attributes as "helpful/patient/respectful," and 4) report of the physical environment as "bar type." CONCLUSIONS:Bar type vape shops and those with rebuilding/fixing capabilities were associated with staying open, suggesting the popularity of these attributes. Yelp consumer reviews is a useful research tool to identify consumer-determined important sustaining attributes of vape shops and may be used to identify aspects of enduring shops that need regulations.

BackgroundThe rising popularity of electronic cigarettes (e-cigarettes) has been accompanied by the proliferation of vape shops in the United States. Vape shops are devoted to the sale of e-cigarettes and e-juices. This study aimed to describe the age, gender, and ethnicity of customers who frequent these shops, determine whether conversations transpire between retailers and customers, as well as identify the types of activities taking place while customers are inside the store.MethodsA naturalistic observation study of 186 customers in 59 vape shops in Southern California was completed in locations that were relatively high in Korean, Non-Hispanic white, Hispanic, or African American ethnicity.ResultsAcross all shops, the average estimated age of customers was 30.29 years old (SD = 9.70), 53 % were estimated to be non-Hispanic white, and 79 % were males; few minors entered the shops. Conversations about vaping related topics were prevalent (e.g., sampling e-juices, receiving help on hardware, and talking about vaping). Purchases were commonly observed as well as customers lounging in the shop.ConclusionVape shops provide consumers a place to purchase and discuss e-cigarettes and offer an environment that serves as a place of recreation with customers lounging once inside. Findings should inform local tobacco control efforts and regulatory policies in the future.

The social self-control scale (SSCS), which taps provocative behavior in social situations, was compared with five potentially overlapping measures (i.e., temperament-related impulsivity, psychomotor agitation-related self-control, perceived social competence, and rash action in response to negative and positive affectively charged states) as correlates of tobacco use and other drug use among a sample of 3,356 ninth-grade youth in Southern California high schools. While there was a lot of shared variance among the measures, the SSCS was incrementally associated with both categories of drug use over and above alternate constructs previously implicated in adolescent drug use. Hence, SSC may relate to adolescent drug use through an etiological pathway unique from other risk constructs. Given that youth who tend to alienate others through provocative social behavior are at risk for multiple drug use, prevention programming to modify low SSC may be warranted.

The popularity of electronic (e-) cigarettes has greatly increased recently, particularly in adolescents. However, the extent of psychiatric comorbidity with adolescent e-cigarette use and dual use of conventional (combustible) and e-cigarettes is unknown. This study characterized psychiatric comorbidity in adolescent conventional and e-cigarette use. Ninth grade students attending high schools in Los Angeles, CA (M age = 14) completed self-report measures of conventional/e-cigarette use, emotional disorders, substance use/problems, and transdiagnostic psychiatric phenotypes consistent with the NIMH-Research Domain Criteria Initiative. Outcomes were compared by lifetime use of: (1) neither conventional nor e-cigarettes (non-use; N = 2557, 77.3%); (2) e-cigarettes only (N = 412, 12.4%); (3) conventional cigarettes only (N = 152, 4.6%); and (4) conventional and e-cigarettes (dual use; N = 189, 5.6%). In comparison to adolescents who used conventional cigarettes only, e-cigarette only users reported lower levels of internalizing syndromes (depression, generalized anxiety, panic, social phobia, and obsessive-compulsive disorder) and transdiagnostic phenotypes (i.e., distress intolerance, anxiety sensitivity, rash action during negative affect). Depression, panic disorder, and anhedonia were higher in e-cigarette only vs. non-users. For several externalizing outcomes (mania, rash action during positive affect, alcohol drug use/abuse) and anhedonia, an ordered pattern was observed, whereby comorbidity was lowest in non-users, moderate in single product users (conventional or e-cigarette), and highest in dual users. These findings: (1) raise question of whether emotionally-healthier ('lower-risk') adolescents who are not interested in conventional cigarettes are being attracted to e-cigarettes; (2) indicate that research, intervention, and policy dedicated to adolescent tobacco-psychiatric comorbidity should distinguish conventional cigarette, e-cigarette, and dual use.

In Spain, 44% of 14-18-year-olds have smoked, and 12.5% have smoked cigarettes in the last 30 days. Nicotine is one of the most addictive substances, and can lead to serious addiction in adulthood with adverse consequences to one's health. School plays a relevant role in health promotion and preventing risk behaviors such as tobacco consumption. Despite the fact that some school-based tobacco cessation and prevention interventions prove to be effective for their purposes, there is a lack of understanding as to why these programs succeed or fail. This longitudinal study aims to test the nicotine dependence (ND) as a mediator of Project EX's effect - a tobacco-use cessation program developed for high school youth to reduce tobacco consumption in scholars. Six high schools located in the Mediterranean coast were randomized for the participation of the program (Spanish version of Project EX) or a waiting-list group with baseline, immediate-posttest, and 12-month follow-up assessments. At baseline, 1,546 adolescents aged 14-21 years old (mean age: 15.28; SD = 1.20; 46% were women) were evaluated by self-administered tests on tobacco consumption and ND. A biomarker of smoke inhalation - a measurement of exhaled carbon monoxide (ECM) - was used. Participants who were smokers (N = 501; 32%) were selected for this study. Mediation analyses were conducted using the PROCESS v2.12 macro for Windows. The significant criterion was p ≤ 0.05, and 5,000 samples were used for bias-corrected bootstrap confidence intervals. Results indicated that Project EX indirectly decreased the number of cigarettes smoked in the last month, the number of cigarettes smoked within the last 7 days, the number of daily cigarettes, and ECM level at 12-month follow up through decreasing the level of ND in the short-term. This is the first Spanish study that explores ND as a mediator of the long-term efficacy of Project EX to reduce tobacco consumption in adolescents. Results suggest that interventions that reduce ND at short-term are more likely to be successful to decrease tobacco use at long-term.

IntroductionVape shops sell electronic cigarettes and related products such as e-liquids, which may contain nicotine. Direct contact with nicotine can lead to adverse health effects, and few regulations exist on how nicotine is handled in vape shops. This study examined how customers and employees come into contact with, and handle, nicotine-containing e-liquids in vape shops with the goal of informing potential future regulation of nicotine handling in vape shops.MethodsData were collected from 77 vape shops in the Los Angeles basin. Characteristics of the shops were documented by employee interviews and in store observations. Data collection was focused on shops located in areas with high concentrations of communities of interest; 20 shops from African-American communities, 17 from Hispanic communities, 18 from Korean communities, and 22 from non-Hispanic White communities.ResultsHalf of the vape shops allowed customers to sample e-liquids with nicotine. Most of the shops (83%) provided self-service sampling stations for customers. A majority of shop employees (72%) reported that spills of e-liquids containing nicotine had occurred in the past. While 64% of the shops provided safety equipment, only 34% provided equipment for proper nicotine handling. Furthermore, 62% of shop employees reported handling nicotine without gloves or other safety equipment.ConclusionsRegulation on the handling of nicotine by customers and vape shop employees is important to prevent unsafe practices and subsequent injury. The frequent occurrence of spills and limited availability of safety equipment in vape shops highlights the need for the creation and enforcement of regulations to protect employees and customers. Appropriate safety training and equipment should be provided to employees to prevent accidental exposure to nicotine. Information on ways to safely handle nicotine should be communicated to vape shop employees and customers.

There has been a surge in the number of vape shops in the USA. Research on the marketing practices of e-cigarette manufacturers is scarce and even less known are the practices of vape shop retailers. Past research on tobacco marketing has shown differences in the amount and content of marketing material, based on a community's demographic profile. This study examined marketing strategies in vape shops and explored differences among vape shops located in communities that differ by ethnic composition. Data was gathered in 2014 from a pilot-study on vape shops (n=77) in Los Angeles, which documented the characteristics of shops through employee interviews and in-store observations. Data were collected from shops located in communities that were predominantly, African-American (n=20), Hispanic (n=17), Korean (n=18), or non-Hispanic White (n=22). Sixty-one percent of vape shops had advertisements (print ads and posters) for e-cigarettes and 84% offered discounts. Vape shops in Hispanic communities were more likely to have ethnic specific marketing material compared to shops in other communities. All the shops provided customers with free samples, however those in Korean and non-Hispanic White communities had a significantly higher prevalence of customer accessible free samples. Vape shop marketing practices differed by ethnic community. A large majority of shops provided free samples to their customers, a practice which is now banned by the FDA. It will be important to monitor how vape shops will adjust their marketing strategy because of this ban. Future research should expand on the findings presented here to provide regulators with further crucial information.

Background and aimsRecent work has studied addictions using a matrix measure, which taps multiple addictions through single responses for each type. This is the first longitudinal study using a matrix measure.MethodsWe investigated the use of this approach among former alternative high school youth (average age = 19.8 years at baseline; longitudinal n = 538) at risk for addictions. Lifetime and last 30-day prevalence of one or more of 11 addictions reviewed in other work was the primary focus (i.e., cigarettes, alcohol, hard drugs, shopping, gambling, Internet, love, sex, eating, work, and exercise). These were examined at two time-points one year apart. Latent class and latent transition analyses (LCA and LTA) were conducted in Mplus.ResultsPrevalence rates were stable across the two time-points. As in the cross-sectional baseline analysis, the 2-class model (addiction class, non-addiction class) fit the data better at follow-up than models with more classes. Item-response or conditional probabilities for each addiction type did not differ between time-points. As a result, the LTA model utilized constrained the conditional probabilities to be equal across the two time-points. In the addiction class, larger conditional probabilities (i.e., 0.40-0.49) were found for love, sex, exercise, and work addictions; medium conditional probabilities (i.e., 0.17-0.27) were found for cigarette, alcohol, other drugs, eating, Internet and shopping addiction; and a small conditional probability (0.06) was found for gambling.Discussion and conclusionsPersons in an addiction class tend to remain in this addiction class over a one-year period.

Anhedonia-the reduced capacity to experience pleasure-is a trait implicated in mental and physical health. Yet, psychometric data on anhedonia measures in adolescents are absent. We conducted an in-depth psychometric analysis of the Snaith-Hamilton Pleasure Scale (SHAPS; Snaith et al., 1995 )-a self-report measure of anticipated pleasure response to 14 pleasant experiences-in adolescents. Adolescents (N = 585, M age = 14.5) completed the SHAPS and other paper-and-pencil surveys. Item response theory models were used to evaluate the psychometric performance of each SHAPS item. Correlations of the SHAPS with other personality and psychopathology measures were calculated to evaluate construct validity. Results showed that (a) certain items (e.g., reported pleasure from basic experiences like "seeing smiling faces" or "smelling flowers") provided more information about latent anhedonia than others; and (b) SHAPS scales exhibited construct-consistent convergent and discriminant validity (i.e., stronger correlations with low positive affect constructs, weaker correlations with negative affect). Reporting diminished pleasure from basic pleasant experiences accurately indicates adolescent anhedonia, which is important for future scale development and understanding the phenomenology of anhedonia in teens. These data support using the SHAPS for assessing anhedonia in epidemiological research and school-based universal prevention programming in general adolescent populations.

ImportanceExposure to nicotine in electronic cigarettes (e-cigarettes) is becoming increasingly common among adolescents who report never having smoked combustible tobacco.ObjectiveTo evaluate whether e-cigarette use among 14-year-old adolescents who have never tried combustible tobacco is associated with risk of initiating use of 3 combustible tobacco products (ie, cigarettes, cigars, and hookah).Design, setting, and participantsLongitudinal repeated assessment of a school-based cohort at baseline (fall 2013, 9th grade, mean age = 14.1 years) and at a 6-month follow-up (spring 2014, 9th grade) and a 12-month follow-up (fall 2014, 10th grade). Ten public high schools in Los Angeles, California, were recruited through convenience sampling. Participants were students who reported never using combustible tobacco at baseline and completed follow-up assessments at 6 or 12 months (N = 2530). At each time point, students completed self-report surveys during in-classroom data collections.ExposureStudent self-report of whether he or she ever used e-cigarettes (yes or no) at baseline.Main outcomes and measuresSix- and 12-month follow-up reports on use of any of the following tobacco products within the prior 6 months: (1) any combustible tobacco product (yes or no); (2) combustible cigarettes (yes or no), (3) cigars (yes or no); (4) hookah (yes or no); and (5) number of combustible tobacco products (range: 0-3).ResultsPast 6-month use of any combustible tobacco product was more frequent in baseline e-cigarette ever users (n = 222) than never users (n = 2308) at the 6-month follow-up (30.7% vs 8.1%, respectively; difference between groups in prevalence rates, 22.7% [95% CI, 16.4%-28.9%]) and at the 12-month follow-up (25.2% vs 9.3%, respectively; difference between groups, 15.9% [95% CI, 10.0%-21.8%]). Baseline e-cigarette use was associated with greater likelihood of use of any combustible tobacco product averaged across the 2 follow-up periods in the unadjusted analyses (odds ratio [OR], 4.27 [95% CI, 3.19-5.71]) and in the analyses adjusted for sociodemographic, environmental, and intrapersonal risk factors for smoking (OR, 2.73 [95% CI, 2.00-3.73]). Product-specific analyses showed that baseline e-cigarette use was positively associated with combustible cigarette (OR, 2.65 [95% CI, 1.73-4.05]), cigar (OR, 4.85 [95% CI, 3.38-6.96]), and hookah (OR, 3.25 [95% CI, 2.29-4.62]) use and with the number of different combustible products used (OR, 4.26 [95% CI, 3.16-5.74]) averaged across the 2 follow-up periods.Conclusions and relevanceAmong high school students in Los Angeles, those who had ever used e-cigarettes at baseline compared with nonusers were more likely to report initiation of combustible tobacco use over the next year. Further research is needed to understand whether this association may be causal.

BackgroundTobacco use prevalence rates are high among Spanish adolescents. Programming to counteract tobacco use is needed.Methods and findingsThe current study provides a one-year follow-up outcome evaluation of Project EX, an eight-session classroom-based curriculum. The intervention was tested using a randomized controlled trial with 1,546 Spanish students, involving three program and three control schools. Compared to the control condition, the program condition revealed a greater reduction in nicotine dependence (p < .05) and CO ppm levels (p < .001), and lower consumption of cigarettes at last month (p = .03).ConclusionsLong-term outcomes of the Project EX classroom-based program are promising for adolescent prevention and possibly cessation in Spain.

BackgroundStudies show depressive symptoms are associated with substance use in adolescents, but the mechanism underlying this association is still unclear. This study investigated negative urgency - the disposition to rash action during emotional states - as a factor explaining relations between depressive symptoms and use of several substances.MethodsIn this cross-sectional study, 476 adolescents (mean age 14.5 years) completed self-report surveys. Regression models and products of coefficient analyses examined the overall relation of depressive symptoms to substance use and negative urgency as a statistical mediator of this association.ResultsDepression levels associated with increased likelihood of lifetime use of cigarettes, other forms of tobacco, marijuana, alcohol, inhalants, prescription painkillers, and any substance. Relations between depression levels and lifetime use of alcohol, inhalants, and any substance were accounted for (i.e., statistically mediated) by negative urgency. In adolescents endorsing lifetime use, depression levels associated with younger age of first use of other forms of tobacco and alcohol as well as use frequency of cigarette, alcohol, and composite frequency. Negative urgency accounted for the covariance between depression level and age of first use of alcohol, but did not for other forms of tobacco or frequency of use of any substances.ConclusionsDepression levels are associated with lifetime use of a variety of substances in early adolescence and targeting this risk factor with preventive efforts may be useful in reducing risk. Negative urgency may be an important target for interventions aimed at alcohol and inhalant use.