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IntroductionLocal e-cigarette sales restrictions (ESRs) may impact e-cigarette use. This study examined the associations between living in localities with various ESR policies and changes in e-cigarette use among young adults in Los Angeles (LA) County, California, USA.MethodsData were from a cohort of LA County young adults (18–21 years; n=2100) who completed two waves of surveys (Fall 2018–Summer 2019 and Summer–Fall 2020). Local flavoured (n=9) and comprehensive (n=2) ESRs in LA County implemented between June 2019 and May 2020 were identified, coded and merged with the baseline data. Multivariable logistic regressions were used to examine the associations between living in ESR localities and e-cigarette use at follow-up, controlling for covariates and stratified by cigarette smoking at baseline.ResultsOverall, 20.9% and 14.3% of participants lived in localities with flavoured and comprehensive ESRs, respectively. Participants who were non-Hispanic, had higher socioeconomic statuses and were currently using e-cigarettes were generally more likely to live in ESR localities than their counterparts. The associations between living in ESR localities and e-cigarette use at follow-up were not found among baseline non-e-cigarette users regardless of their cigarette smoking status; a positive relationship was found among baseline e-cigarette users who also smoked cigarettes but not among non-smokers.DiscussionParticipants who lived in localities with various ESR policies were different in their baseline e-cigarette use and socioeconomic backgrounds. Future research examining the potential impact of ESRs on e-cigarette use change should consider the localities’ overall sociodemographic and tobacco-using characteristics and individuals’ cigarette smoking histories. more...

BACKGROUND: The packaging and marketing of nicotine gums, lozenges, and pouches can influence users’ perceptions about which products are evidence-based for tobacco cessation and which are designed for nicotine maintenance—which could keep people nicotine dependent. Lucy, a company that produces flavored nicotine gums, lozenges, and pouches, could cause confusion by mimicking the packaging of traditional chewing gum and using similar marketing for its approved smoking cessation products and non-approved products. METHODS: This commentary describes Lucy’s marketing practices that could prolong nicotine dependence rather than aid cessation. RESULTS: Lucy’s marketing as “FDA approved for smoking cessation” (true for the lozenges but not the gum or pouches) and “PMTA [Premarket Tobacco Product Application] accepted” could create a false narrative of regulatory acceptance. Its scientific conference presentations could imply that it is endorsed by the scientific community. Its colorful pack design, emphasizing flavors and minimizing nicotine warnings, may attract youth and non-nicotine-users to initiate nicotine use. CONCLUSION: Lucy’s promotion of its products as safe alternatives to other forms of tobacco, its packaging that recalls innocuous chewing gum, and its use of social media to advertise its products should be explored by researchers and considered by policymakers for potential population-level health effects. more...

PURPOSE: Ethnic disparities in childhood cancer survivor (CCS) mental health have been identified, although prior survivorship research has focused predominantly on non-Hispanic/Latinx (H/L) white survivors. METHODS: This study examined the association of acculturation with depressive symptoms and wellbeing among 582 young adult H/L CCS recruited to a population-based study of CCS in Southern California. RESULTS: In multivariable regression models adjusted for covariates, greater identification with both the Hispanic and Anglo cultures was positively associated with wellbeing (p = 0.007 and p more...

OBJECTIVE Acculturation discrepancy occurs when the rate of host culture acquisition and/or heritage culture retention between non-native parents and their children diverges. The resulting conflict may exacerbate mental health conditions in already vulnerable populations. The present study examined discrepancies between Hispanic and Anglo-American acculturation, as two separate constructs, and mental health symptomology in Hispanic childhood cancer survivors (HCCS) and their parents. METHODS Participants were 68 matched parent-child dyads (HCCS (Mage = 19.4 (2.77) years., 50.0% female); and parent (Mage = 46.3 (6.07) years., 89.7% female)). Study variables were HCCS posttraumatic-growth (PTG) and quality-of-life (PedsQL); parent posttraumatic stress (PTSD); and parent/HCCS depressive symptoms (CESD) and acculturation orientations. Discrepancy was calculated as the dyadic difference between like acculturation measures. RESULTS After controlling for covariates, Hispanic acculturation discrepancy and HCCS psychosocial health (a subset of PedsQL) was negatively correlated (r = -0.26, p more...

Background: Psychosocial sequelae are common for individuals with physical injuries to the upper extremity. However, psychosocially oriented interventions are not common in this occupational therapy practice area. Purpose: This study implemented an online survey of hand therapy patients’ psychological symptoms. Second, it explored patients’ interest in one psychosocially oriented intervention: mindfulness meditation. Methods: The design was a cross-sectional survey of 120 consecutively recruited hand therapy patients. Survey measures included functioning, psychosocial factors, and trait mindfulness. Findings: Anxiety was prevalent in this sample, and moderately correlated with trait mindfulness (r = −0.542, p < .001). While most participants (77%) indicated mindfulness meditation would be an acceptable intervention, women were 2.8 times as likely to be interested ( p = .044). Implications: Psychosocially oriented interventions are indicated in hand therapy based on the prevalence of these symptoms. Further examination of using mindfulness meditation in hand therapy is warranted due to patient interest. more...

Background Most research and health education efforts to address the opioid crisis have focused on white populations. However, opioid use, opioid use disorder, and opioid overdose deaths also have increased among Hispanics. Methods This study conducted four focus groups in a Hispanic community in Southern California ( N = 45) to assess opioid-related knowledge, perceptions, and preventive behaviors among Hispanic residents. Focus group questions assessed medication storage, disposal, and sharing; opioid-related knowledge; how to recognize a drug problem; perceptions of the extent of the opioid use problem in the community; and sources of help for drug problems. Results Qualitative analysis revealed that most participants were aware of the potential dangers of opioids and the importance of keeping them out of the reach of children. However, participants reported stockpiling, sharing, and borrowing prescription medications for financial reasons. They perceived marijuana use as a larger problem in the community than opioids. They were familiar with the behavioral indicators of opioid addiction, but they were unaware of the availability of naloxone to reverse overdoses. They were ambivalent about searching for information about opioids and treatment options because they lacked self-efficacy to find accurate information on the internet. Conclusions Findings identify some knowledge gaps about opioids among Hispanics and suggest opportunities for culturally accessible health education to provide Hispanics with information about opioid use disorder, overdose reversal, and treatment options. more...

PurposeTo evaluate the association between lifetime personal cigarette smoking and young-onset breast cancer (YOBC; diagnosed

Depression among pregnant women living with HIV (WLWH) in sub-Saharan Africa leads to poor pregnancy and HIV outcomes. This cross-sectional analysis utilized enrollment data from a randomized trial (Mobile WAChX, NCT02400671) in 6 Kenyan public maternal and child health clinics. Depressive symptoms were assessed with the Patient Health Questionnaire-9 (PHQ-9), stigma with the Stigma Scale for Chronic Illness, and intimate partner violence (IPV) with the Abuse Assessment Screen. Correlates of moderate-to-severe depressive symptoms (“depression”, PHQ-9 score ≥10) were assessed using generalized estimating equation models clustered by facility. Among 824 pregnant WLWH, 9% had depression; these women had more recent HIV diagnosis than those without depression (median 0.4 versus 2.0 years since diagnosis, p=0.008). Depression was associated with HIV-related stigma (adjusted Prevalence Ratio [aPR]:2.36, p=0.025), IPV (aPR:2.93, p=0.002), and lower social support score (aPR:0.99, p=0.023). Using population-attributable risk percent to estimate contributors to maternal depression, 81% were attributable to stigma (27%), recent diagnosis (24%), and IPV (20%). Integrating depression screening and treatment in prevention of mother-to-child HIV transmission programs may be beneficial, particularly in women recently diagnosed or reporting stigma and IPV. more...

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, pDiscussionFlavour preference was negatively related to intention to continue to vape within a hypothetical flavour ban. Our results also highlight the importance of e-cigarette dependence and use of e-cigarettes as smoking cessation methods. Implications for future flavour bans are discussed. more...

Background The prevalence of electronic-cigarette (e-cigarette) product placement in music videos is on the rise and currently unregulated. This promotional activity is concerning given the popularity of music videos among young adults. Aims We examined associations between self-reported levels of exposure to music videos with any e-cigarette product placement or imagery and susceptibility to use e-cigarettes and e-cigarette use. Method A representative sample of young adults (18–24 years of age), residing in California ( n = 1,280), completed online surveys assessing self-reported exposure to music videos with e-cigarette product placement or imagery and susceptibility to use e-cigarettes and e-cigarette use. Adjusted and weighted regression analyses were used for statistical analyses. Results Participants exposed to any e-cigarette product placement or imagery in music videos were more likely to report lifetime e-cigarette use (relative risk ratio [ RRR]: 2.81) and past 30-day use ( RRR: 3.64) compared with participants with no exposure. Additionally, participants with greater levels of exposure were more likely to report lifetime e-cigarette use ( RRR: 1.13) and past 30-day use ( RRR: 1.20) compared with participants with lower levels of exposure. Among those with any exposure, participants younger than 21 years of age (i.e., under the tobacco purchasing age in the United States) were more likely to report lifetime e-cigarette use ( RRR: 4.68) compared with those aged 21 years and older. Discussion and Conclusion Restricting e-cigarette product placement or imagery in music videos may minimize marketing exposure and risk for vaping among young adults, especially among those under the tobacco purchasing age. more...

BACKGROUND AND OBJECTIVES Flavored non-tobacco oral nicotine products (eg, nicotine pouches and nontherapeutic nicotine gum, lozenges, tablets, gummies), are increasingly marketed in the United States. Prevalence of non-tobacco oral nicotine product use among adolescents is unknown. METHODS We calculated prevalence of ever and past 6-month use of nicotine pouches, other non-tobacco oral nicotine products (ie, gum, lozenges, tablets, and/or gummies), e-cigarettes, cigarettes, hookah or waterpipe, cigars, cigarillos, and snus among high school students in Southern California between September and December 2021. Generalized linear mixed models tested associations of sociodemographic factors and tobacco-product use with use of any non-tobacco oral nicotine product. RESULTS Among the sample (n = 3516), prevalence was highest for e-cigarettes (ever: 9.6%, past 6-month: 5.5%), followed by non-tobacco oral nicotine products (ever: 3.4%, past 6-month: 1.7%), and CONCLUSIONS Non-tobacco oral nicotine products were the second most prevalent nicotine product used by adolescents. They were disproportionately used by certain racial or ethnic, sexual, or gender minority groups, and those with a history of nicotine use. Adolescent non-tobacco oral nicotine product use surveillance should be a public health priority. more...

American Indian Alaska Native (AIAN) youth have disproportionately higher rates of commercial tobacco product use compared to other racial and ethnic groups in the U.S. These rates underscore a need for commercial tobacco product cessation interventions that are culturally informed. This project studied the development, implementation, and some impact data of an adapted version of Project EX, an evidence-based intervention for teen smoking cessation. Implementation challenges resulted in a change from a three-arm to a single-arm trial with 37 AIAN youth who participated in an eight-week curriculum. Intent-to-treat analysis with biochemical validation results indicated that 32% (N = 12/37) of youth quit smoking at the three-month follow-up. Participants reported being satisfied with the program overall and enjoying the culturally adapted activities. This study detailed the program's adaptation and lessons learned during implementation. more...

Background Starting in 2019 policies restricting the availability of flavored e-cigarette products were proposed or implemented in the United States to curb vaping by youth. People took to Twitter to voice their opposition, referencing the phrase “Flavors Save Lives.” This study documented the emerging themes pertaining to “Flavors Saves Lives” over a 12-month period. Methods The study period was from May 1, 2019, to May 1, 2020. A stratified sampling procedure supplied 2500 tweets for analysis. Posts were classified by one or more of the following themes: (1) Political Referendum; (2) Institutional Distrust; (3) Individual Rights; (4) Misinformation; (5) THC Vaping is the Real Problem; (6) Smoking Cessation; (7) Adult Use; and (8) Not a Bot. The temporal pattern of tweets over the year was examined. Results Political Referendum (76.5%) and Institutional Distrust (31.3%) were the most prominent themes, followed by Not a Bot (11.0%), Individual Rights (10.4%), Adult Use (8.0%), Smoking Cessation (6.6%), Misinformation (5.9%), and THC Vaping is the Real Problem (3.5%). Total tweet frequencies increased in September 2019 and peaked in November 2019 before returning to relatively low numbers. Political Referendum and Institutional Distrust were consistently the most prevalent themes over time. Conclusion Twitter posts with the phrase “Flavors Save Lives” commonly discussed voting against political incumbents and mentioned distrust of government representatives. Findings demonstrated the possibility of near real-time Twitter monitoring of public opposition to flavor bans. These data may be valuable for designing tobacco control information campaigns in the future. Implications (a) Starting in 2019 policies restricting the availability of flavored e-cigarette products were proposed or implemented in the United States to curb vaping by youth. (b) This study content analyzed Twitter posts with the phrase “Flavors Save Lives” from a 12-month period to understand opposition to flavor restrictions. (c) Twitter posts commonly discussed voting against political incumbents and mentioned distrust of government representatives. (d) Findings demonstrated the possibility of near real-time Twitter monitoring of public opposition to flavor bans, and contribute to a more comprehensive assessment of different sub-population's responses to current and proposed tobacco control information policies. more...

Introduction The U.S. immigrant paradox shows worsening health across generations, with U.S.-born Latinx having poorer health outcomes than immigrants. Adverse childhood experiences are associated with increased health risk over the life course, warranting further investigation. This study examines adverse childhood experience distribution across generations in a community sample of first-, second-, and +third-generation Latinx youth. Methods Survey data were collected at 7 timepoints from 2005 to 2016; 1,303 participants completed follow-ups, including adverse childhood experiences, at Timepoint 5 (mean age=21.6 years). These analyses were performed in 2019. Adverse childhood experiences measured psychological, physical, and sexual abuse, and parental domestic violence, divorce, alcohol/drug use, mental illness, and incarceration. Adverse childhood experiences were operationalized as a continuous variable (number) and by 2 groups: household dysfunction and maltreatment. Associations between immigrant generation and adverse childhood experiences were analyzed in adjusted logistic and multiple regression models. Results Compared with +third-generation youth, first- (OR=0.49, 95% CI=0.27, 0.89) and second- (OR=0.43, 95% CI=0.26, 0.72) generation youth had lower odds of reporting household dysfunction. For first-generation youth, this was specific to living with an alcohol/drug user (OR=0.49, 95% CI=0.29, 0.81). In contrast to other adverse childhood experiences, first-generation youth had twice the odds of reporting sexual abuse (OR=2.01, 95% CI=1.04, 3.88) compared with +third-generation youth. Conclusions Preventing health disparities among immigrant-origin youth requires understanding the impact of adverse childhood experiences on Latinx youth across generations. Results highlight associations among a Latinx youth community sample, suggesting variations in experiences across generations. Household factors in childhood may be key targets for interventions aimed at improving the outcomes observed in later generations for Latinx families. more...

Introduction Given the increasing use of electronic cigarettes (e-cigarettes) among young adults, it is crucial to identify possible sources of e-cigarette marketing exposure in media popular among young adults. However few studies document e-cigarette product placement (eg, visible logo, branded merchandise or gear such as a branded hat or shirt) in music videos. The objective of this study was to determine the extent of e-cigarette product placement and imagery in popular music videos. Methods Songs on the Billboard Hot 100 list during the weeks of June 16 through September 22, 2018 with official music videos were identified (n = 180) and coded for e-cigarette product placement and imagery (including aerosol clouds), visible brand names, number of views (as of October 25, 2018), music genre, video themes, and combustible tobacco content. Results E-cigarette product placement and imagery appeared in 7 (3.8%) music videos which were viewed over a billion times, providing billions of e-cigarette impressions. Among music videos with e-cigarette product placement and imagery, the most prevalent theme was Image/Lifestyle/Sociability (eg, ostentatious lifestyle, partying) and the most prevalent genre was Hip Hop. The e-cigarette companies KandyPens and Mig Vapor were identified. Conclusion While e-cigarette product placement or imagery appeared in a relatively low number of music videos in this study, these videos received views in the billions. Music videos should be considered when assessing e-cigarette marketing exposure among priority populations. Future research should examine how viewing e-cigarette product placement and imagery in music videos influences susceptibility to use such products among young adults. Implications While e-cigarette product placement (eg, scenes with visible branding, a visible logo, branded merchandise or gear such as a branded hat or shirt) or imagery appeared in a relatively low number of popular music videos in this study, these videos received views in the billions on YouTube. KandyPens and Mig Vapor were the companies responsible for the majority of the product placement identified in this study. The predominant music genre of videos featuring any e-cigarette product placement or imagery was Hip Hop, while the predominant theme of videos was Image/Lifestyle/Sociability. Music videos appear to be a potential source of exposure to e-cigarette products. Future research should examine how viewing e-cigarette product placement and imagery in music videos influences susceptibility to use such products among priority populations. more...

Introduction The rapidly evolving landscape of vaping devices has complicated analyses of use patterns among youth and young adults. The current study describes the prevalence of use, substances vaped, and purchasing behaviors across five different vaping device categories. Aims and Methods Participants (n = 2505; mean age = 19.2, SD = 0.46) from a cohort in the Los Angeles area completed web-based surveys from June 2018 to October 2019. For each of four device type categories depicted via digital images (any pod-style vape, cigalike, box-mod, vape pen) and for JUUL specifically, participants reported ever and past 30-day use, substance vaped (mostly nicotine, nicotine and tetrahydrocannabinol [THC], mostly THC, neither), ownership of device (yes/no), where they obtained that device (eg, purchased themselves, from a friend), and if purchased, purchase location (eg, vape shop, online). Results Overall, 44.9% reported ever use, and 26.2% reported past 30-day use of at least one of the devices. The prevalence of past 30-day use was highest for pod-style vapes (any pod = 17.0%; JUUL = 15.1%). Among respondents who reported ever owning any device (n = 643 [25.7%]), 59.9% reported purchasing the device themselves, despite not being of legal purchasing age (15.4% of total sample); across all device types, products were most often purchased in vape shops or online. Conclusions Across all devices, the prevalence of self-purchase of vaping devices among underage young adults in the Los Angeles area was high, and most were purchased from a vape shop or online. Tobacco control policies to prevent underage purchase of tobacco products—particularly among never smokers—are needed. Implications A high proportion of underage young adults reported owning their own vaping device and having purchased it themselves from a vape shop or online. Stronger tobacco control policies and better enforcement efforts are needed to successfully prevent underage purchase of tobacco products. more...

PURPOSE: To examine associations between parents and adolescent and young adult (AYA) childhood cancer survivors’ (CCS) mental health, and differences by Hispanic ethnicity. SAMPLE: Participants were 129 CCS (M(age) = 19.5 yrs.; 49.9% female) and their parents (M(age) = 49.0 yrs.; 87.6% female); 52.7% identified as Hispanic. METHODS: CCS completed assessments of Depressive Symptoms (CES-D), Posttraumatic Growth (PTG) and Pediatric Quality of Life (PedsQL), while parents completed CES-D, Perceived Stress (PSS) and Posttraumatic Stress Disorder (PTSD) measures. RESULTS: After controlling for covariates, all three negative parental mental health measures (Parent CES-D, PSS, and PTSD), were positively associated with CCS CES-D indicating that higher depressive symptoms and stress in parents was associated with higher depressive symptoms in CCS. Parent CES-D was negatively associated with CCS PedsQL and parent PSS was negatively associated with CCS PTG. Moderation analysis revealed parent PSS to be negatively associated with PedsQL and positively related to CES-D among Hispanic families only. CONCLUSION: Higher parental negative mental health measures may adversely affect CCS levels of depression, while lower values for parental negative health measures were associated with positive CCS mental health outcomes in AYA. Hispanics parents experience more associations with stress than non-Hispanics. IMPLICATIONS FOR PSYCHOSOCIAL PROVIDERS: Long-term survivorship follow-up care guidelines should address the mental health needs of both parents and CCS, paying particular attention to perceived stress in Hispanic families. more...

Objective The present study introduces a daily, micro-level perspective on acculturation using a sample of Hispanic college students in Miami. Methods We conducted a 12-day diary study with a sample of first- and second-generation Hispanic college students in Miami. Outcome variables were measured on Days 1 and 12, and acculturation components (practices, identities, and values) were measured on Days 2-11. Daily fluctuations in acculturation components between Days 2 and 11 were examined as predictors of well-being, internalizing symptoms, and externalizing problems on Day 12. Results Fluctuations in comfort with speaking English negatively predicted three of the four well-being outcomes and positively predicted all of the internalizing and externalizing indicators. Fluctuations in collectivist values predicted two of the well-being outcomes and both anxiety and depressive symptoms, and fluctuations in ethnic identity predicted anxiety and depressive symptoms. Conclusion Daily volatility in comfort with English, collectivist values, and ethnic identity appear to be most distressing. more...

Given the rapidly changing political rhetoric and policies concerning immigration, and the likely impact of this rhetoric on immigrants' adjustment, it is essential to understand the experiences of recently arrived immigrant individuals and families. This article describes methods to recruit and retain recently arrived Hispanic families in longitudinal research and clinical practice. Barriers to continued engagement with recent-immigrant families include residential mobility, wariness toward authority figures (including researchers and practitioners), and unpredictable work schedules. These barriers can lead to challenges related to recruitment/engagement, logistics, establishing trust, and retention. This article describes decisions made, experiences, and lessons learned in a longitudinal study of Hispanic families in two cities. We also provide implications for clinical practice. more...

Objective: This paper examines substance and behavioral addictions among American Indian and Alaska Natives (AIAN) to identify the structural and psychosocial risk and cultural protective factors that are associated with substance use and behavioral addictions. Methods: Five databases were used to search for peer reviewed articles through December 2021 that examined substance and behavioral addictions among AIANs. Results: The literature search identified 69 articles. Numerous risk factors (i.e., life stressors, severe trauma, family history of alcohol use) and protective factors (i.e., ethnic identity, family support) influence multiple substance (i.e., commercial tobacco, alcohol, opioid, stimulants) and behavioral (e.g., gambling) addictions. Conclusions: There is a dearth of research on behavioral addictions among AIANs. Unique risk factors in AIAN communities such as historical trauma and socioeconomic challenges have interfered with traditional cultural resilience factors and have increased the risk of behavioral addictions. Future research on resilience factors and effective prevention and treatment interventions could help AIANs avoid behavioral addictions. more...

The present study was designed to examine the extent to which, in a sample of 873 Hispanic college students, daily levels of, and variability in, well-being would mediate the predictive effects of culturally related stressors (discrimination, negative context of reception, and bicultural stress) on internalizing and externalizing symptoms 11 days later. A 12-day daily diary design was utilized, where reports of cultural stressors were gathered on Day 1, daily well-being reports were gathered on Days 2-11, and outcomes were measured on Day 12 (with controls for Day 1 levels of these same outcomes). Structural equation modeling results indicated that daily means of, and variability in, well-being significantly mediated the predictive effect of Day 1 ethnic/racial discrimination, negative context of reception, and bicultural stress on Day 12 symptoms of anxiety and depression. No effects emerged for externalizing symptoms. When we decomposed the latent well-being variability construct into its component indicators (self-esteem, life satisfaction, psychological well-being/self-acceptance, and eudaimonic well-being), daily variability in life satisfaction and self-acceptance appeared to be primarily responsible for the mediated predictive effects we observed. These results are discussed in terms of implications for further research, for counseling practice, and for the development of more inclusive university practices and policies. (PsycInfo Database Record (c) 2022 APA, all rights reserved). more...

Although adverse childhood experiences (traumatic events such as maltreatment and household dysfunction) are associated with increased risk for sleep difficulties among adults, the association between adverse childhood experiences and poor sleep health among young adult college populations is understudied. This study examined the adverse childhood experience-sleep health (self-reported sleep difficulty and diagnosis of insomnia or "other" sleep disorder) association among college students. Data are from the 2018/2019 American College Health Association-National College Health Assessment II (ACHA-NCHA-II) survey administered at public universities in California (n = 3606) and Texas (n = 407). Logistic regression models investigated the relative effect of adverse childhood experiences (maltreatment only, household dysfunction only, and maltreatment + household dysfunction) on three sleep health indicators. Approximately 40% of the sample reported adverse childhood experiences: 11% maltreatment only, 14% household dysfunction only, and 17% both. Compared with students with no adverse childhood experience history, students who reported only household dysfunction or only maltreatment had higher odds of experiencing sleep difficulty in the past year [adjusted odds ratios: 1.52-2.40; 95% confidence intervals: 1.26-2.97]. Additionally, students who reported maltreatment only had 2.47 times the odds of receiving an insomnia diagnosis [95% confidence interval: 1.52, 4.01]. However, students who reported both had higher odds of all three sleep health indicators: past-year sleep difficulty, insomnia diagnosis, and "other" sleep disorder diagnosis [adjusted odds ratios: 2.53-3.10; 95% confidence intervals: 1.51-4.66]. Sleep is an important facet of health among the college student population, and plays a crucial role in overall well-being, psychosocial processes, attention and academic success. Results point toward a need for sleep health programmes and interventions on college campuses focused on healthy sleep behaviours in order to mitigate further negative health effects. more...

To evaluate the association between lifetime personal cigarette smoking and young-onset breast cancer (YOBC; diagnosed 50 years of age) risk overall and by breast cancer (BC) subtype, and whether risk varies by race or socioeconomic position (SEP).Data are from the Young Women's Health History Study (YWHHS), a population-based case-control study of non-Hispanic Black (NHB) and White (NHW) women, ages 20-49 years (n = 1812 cases, n = 1381 controls) in the Los Angeles County and Metropolitan Detroit Surveillance, Epidemiology, and End Results (SEER) registry areas, 2010-2015. Lifetime personal cigarette smoking characteristics and YOBC risk by subtype were examined using sample-weighted, multivariable-adjusted polytomous logistic regression.YOBC risk associated with ever versus never smoking differed by subtype (PFindings confirm prior reports of a positive association between cigarette smoking and Luminal A YOBC and identify a novel association between smoking and HER2-type YOBC. more...

School-based COVID-19 testing is a potential strategy to limit COVID-19 transmission among youth in congregate settings such as schools, sports programs, and summer camps. The purpose of this study is to evaluate the feasibility and effectiveness of frequent rapid antigen testing at a supervised distance-learning setting for elementary and middle school children while their schools were closed.This evaluation examines participation rates and testing data in addition to qualitative analysis of focus groups from a Los Angeles City-sponsored rapid antigen testing pilot program. In total, 434 children and staff were enrolled in the 13-week pilot program in the spring of 2021.In this pilot program, 2482 rapid antigen tests were administered, resulting in 3 positive test results, 1 of which was a false positive (confirmed by polymerase chain reaction testing) and 0 outbreaks or community spread.Throughout this pilot program, implementing rapid antigen tests allowed for the quick identification and isolation of potentially COVID-19-positive children, improved perceived safety for parents and staff who interact with children, and demonstrated the ability for staff and non-health care professionals in a school-based setting to implement a widespread COVID-19 screening program with minimal training. more...

Cannabis use among adolescents may have detrimental effects and use among this age group is increasing. It is important to understand how expansion of laws permitting cannabis sales may impact adolescent use. Much of the current research has explored how state-level policy decisions may impact adolescents' use behaviors; however, there is a gap in the understanding of how differences in local jurisdictional policies may also influence underage cannabis use.Local policy allowing cannabis retail was associated with adolescents' significantly higher past 30-day use of cannabis (β = 0.25 95% CI = 0.08, 0.42) and perceived access (β = 0.60 95% CI = 0.27, 0.94).Results highlight the impact of local cannabis policies on adolescent cannabis use and perception. Considering the effects of cannabis use on adolescent development, this is an important public health concern because 14 states have already legalized recreational retail sales and growing numbers of local jurisdictions are allowing the retail sale of recreational cannabis. more...

Introduction Machine learning presents a unique opportunity to improve electronic cigarette (vaping) monitoring in youth. Here we built a random forest model to predict frequent vaping status among Californian youth and to identify contributing factors and vulnerable populations. Methods In this prospective cohort study, 1281 ever-vaping twelfth-grade students from metropolitan Los Angeles were surveyed in Fall and in 6-month in Spring. Frequent vaping was measured at the 6-month follow-up as nicotine-containing vaping on 20 or more days in past 30 days. Predictors (n = 131) encompassed sociodemographic characteristics, substance use and perceptions, health status, and characteristics of the household, school, and neighborhood. A random forest was developed to identify the top ten predictors of frequent vaping and interactions by sociodemographic variables. Results Forty participants (3.1%) reported frequent vaping at the follow-up. The random forest outperformed a logistic regression model in prediction (C-Index = 0.87 vs. 0.77). Higher past-month nicotine concentration in vape, more daily vaping sessions, and greater nicotine dependence were the top three of the ten most important predictors of frequent vaping. Interactions were found between age and perceived discrimination, and between age and race/ethnicity, as those who were younger than their classmates and either reported experiencing discrimination frequently or identified as Asian or Native American/Pacific Islander were at increased risk of becoming frequent vapers. Conclusions Machine learning can produce models that accurately predict progression of vaping behaviors among youth. The potential association between frequent vaping and perceived discrimination warrants more in-depth analyses to confirm if discrimination constitutes a cause of increased vaping. Implications This study demonstrates the utility of machine learning in predicting status of frequent vaping over 6 months and understanding predictors and nuanced intersectionality by sociodemographic attributes. The high performance of the random forest model has practical implications for a personalized risk calculator that supports vaping prevention program. Public health officials need to recognize the importance of social factors that contribute to frequent vaping, particularly perceived discrimination. Youth subpopulations, including younger high school students and Asians or Native Americans/Pacific Islanders, might require specially designed interventions to help prevent habit-forming in vaping. more...

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

Adolescent hope can promote the emotional and behavioral well-being of Latinx families. Positive family functioning may foster adolescent hope, whereas cultural stress may compromise adolescent hope and well-being. We examined how adolescent hope changed over time, and whether cultural stress and family functioning predicted emotional and behavioral health via adolescent hope intercept and slope. Recent Latinx immigrant adolescents (M(age) = 14.51) and parents (M(age) = 41.09; N = 302; n = 150 from Los Angeles; n = 152 from Miami) completed measures of above constructs over 3 years (Summer 2010 to Spring 2013). Latent growth curve modeling indicated that adolescent hope increased over time. Higher cultural stress predicted lower initial hope. Higher family functioning predicted higher initial levels of and less steep increase in hope. Increase in hope predicted better emotional and behavioral health. Family functioning predicted better health outcomes by way of hope. more...

COVID-19 vaccines have been available for over a year, yet 26% of U.S. young adults remain unvaccinated. This study examines racial and ethnic disparities in young adult vaccine hesitancy and attitudes/beliefs that mediate disparities in vaccine hesitancy. Young adults (n = 2041;Mean[SD]:21.3[0.7] years-old) from a Los Angeles, CA, USA cohort were surveyed online in January-May 2021 and classified as vaccine hesitant (those who reported "Not at all likely"/"Not very likely" /"Slightly likely" to get vaccinated) versus non-hesitant (those who reported "Moderately likely"/"Very likely"/"Definitely likely" to get vaccinated or already vaccinated). Multivariable logistic regression was performed to examine racial/ethnic disparities in vaccine hesitancy. Factor analysis was conducted to create three subscales toward vaccination: positive, negative, and lack-of-access beliefs. Mediation analyses were performed to assess pathways from attitude/belief subscales to racial disparities in vaccine hesitancy. Overall 33.0% of respondents reported vaccine hesitancy. Black vs. White young adults had a higher prevalence of vaccine hesitancy (AOR[95%CI] = 4.3[2.4-7.8]), and Asians vs. Whites had a lower prevalence (AOR[95%CI] = 0.5[0.3-0.8]). Mediators explained 90% of the Black (vs. White) disparity in vaccine hesitancy, including significant indirect effects through positive belief-reducing (β = 0.23,p .001) and negative belief-enhancing (β = 0.02,p = .04) effects. About 81% of the Asian (vs. White) disparity in vaccine hesitancy was explained by the three combined subscales, including significant positive belief-reducing (β = -0.18,p .001) indirect effect. Substantial racial and ethnic disparities in young adult COVID-19 vaccine hesitancy were found, which were mediated by differences in attitudes and beliefs toward vaccination. Targeted education campaigns and messages are needed to promote equitable utilization of the effective vaccine. more...

BACKGROUND: Mindfulness-based interventions (MBIs) may offer a means for Latinx families to ameliorate stress, enhance emotion regulation, and foster social support. METHODS: We assessed pilot data from Latinx parents in Eastside Los Angeles (n = 27) matched with their children aged 10–16 (n = 32) to determine whether participation in a community-derived MBI was associated with greater improvements in dispositional mindfulness, perceived stress, emotion regulation, and family social support compared to a control condition. RESULTS: Compared to the control group, parents in the MBI group showed greater reductions in perceived stress scale (PSS) scores (B = −2.94, 95% CI [−5.58, −0.39], p = .029), while their children reported greater increases in perceived social support from family (B = 2.32 , 95% CI [0.26, 4.38], p = .027). DISCUSSION: Findings show a community-derived MBI may improve stress in Latinx parents and social support for their children. more...

Adverse childhood experiences (ACE), including maltreatment and household dysfunction, are consistent predictors of health compromising behaviors in adulthood. While most ACE studies have focused on adults, there is an emerging body of research focusing on young adulthood.This review describes research focused on the relationship between ACE and substance use among young adults. Two databases were searched for studies published from 1998 to 2021 that assess the relationship between ACE and substance use among young adults. Of the 1474 articles identified in the search, 43 met the inclusion criteria.Consensus across reviewed studies is that the relationship between ACE and substance use demonstrated in the general adult population is evident in young adults, although effects varied by demographic variables such as gender and ethnic background.The need for standardized measures across studies, racial/ethnic considerations, and the importance of building trauma informed prevention programs targeting this age group are discussed. more...

BackgroundTobacco 21 (T21) laws, which raise the minimum legal age of sale of tobacco products to 21, have been proposed and implemented in states and cities across the USA. However, limited data are available on the effect of T21 laws on youth tobacco purchasing behaviours and access to tobacco products.MethodsParticipants in a population-based prospective cohort in southern California completed questionnaires before (n=1609, age=18–19 y) and after (n=1502, age=19–20 y) T21 was implemented in California (June 2016). We examined the prevalence of past 30-day cigarette and e-cigarette use, and among past 30-day users, purchase location of tobacco products before (pre-) versus after (post-) T21. We also examined whether, post-T21, participants were refused purchase of tobacco products due to their age, and the perceived relative ease of purchasing cigarettes and e-cigarettes (vs pre-T21).ResultsNegligible changes in cigarette and e-cigarette use were observed pre-T21 versus post-T21. At both time points, the majority of past 30-day users purchased cigarettes from gas stations and e-cigarettes from vape shops. Post-T21, the proportion of participants who reported purchasing cigarettes at gas stations decreased. Post-T21, most past 30-day cigarette or e-cigarette users were not refused purchase of cigarettes (65.4%) or e-cigarettes (82.0%) in the past 30 days, despite being under 21; half of the participants felt it was harder to purchase cigarettes (54.3%) and e-cigarettes (43.6%) post-T21.ConclusionPost-T21, few participants were refused purchase of any tobacco product, despite the illegality of such sales. Better enforcement of T21 is needed to improve the efficacy of T21 legislation. more...

Eleven US states and Washington, DC, legalized recreational (adult use) cannabis. Seven states—Alaska, California, Colorado, Massachusetts, Nevada, Oregon, and Washington—allow cannabis sales. A public health concern is that exemptions in state or local smoke-free laws for public cannabis smoking or vaping will weaken smoke-free laws, expose the public to secondhand cannabis, and renormalize smoking. We describe the experience of the seven states and challenges faced in maintaining smoke-free laws. Using elements of a tobacco control framework, we identify best practices in cannabis regulation by comparing each state’s smoke-free laws and allowances for public cannabis use. All states prohibit public cannabis use; two lack 100% smoke-free protections; one lacks vaping devices in its smoke-free law; three allow cannabis use in retailers; two allow cannabis use in social consumption lounges; and two allow cannabis use in tourism venues. States should close gaps in smoke-free laws and not expand where cannabis use is permitted to ensure public health. more...

Background The “cigarette susceptibility index” has been adapted for other products, yet, the validity of these adapted measures–particularly among youth who have used other tobacco products–has not been evaluated. Methods We used prospective data from the Southern California Children's Health Study to evaluate the association of questionnaire measures assessing susceptibility to e-cigarette, cigarette, hookah and cigar/cigarillo/little cigar use at wave 1 (W1; 11th/12th grade) with subsequent initiation between W1 and W2 (16 months later, N = 1453). We additionally examined whether each effect estimate differed by use of other tobacco products at W1. Results Odds ratios, attributable risk%, and risk differences for product initiation among susceptible vs. non-susceptible youth were consistently higher among never users of any tobacco product than among youth with any tobacco use history. For example, susceptible (vs. non-susceptible) youth with no prior tobacco use had 3.64 times the odds of subsequent initiation of e-cigarettes (95%CI:2.61,5.09), while among users of another product, susceptible (vs. non-susceptible) youth had 1.95 times the odds of e-cigarette initiation (95%CI:0.98,3.89; p-interaction = 0.016). 60.4% of e-cigarette initiation among never users of any product could be attributed to susceptibility, compared to 19.8% among users of another product. The e-cigarette absolute risk difference between susceptible and non-susceptible youth was 21.9%(15.2,28.6) for never users, vs. 15.4%(0.2,30.7) for users of another product. Conclusion Tobacco product-specific susceptibility associations with initiation of use at W2 were markedly attenuated among prior users of other products, demonstrating reduced utility for these measures among subjects using other products. more...

Energy drinks (EDs) have become popular worldwide. Despite growing concerns about negative health effects of ED, they are increasingly popular among adolescents, yet little is known about the context and patterns of ED use in adolescents.This study examined the prevalence and correlates of ED use as well as initiation rates and predictors among German adolescents over a one-year period.A school-based longitudinal study of 6902 adolescents ages 9-19 years was conducted in 44 schools in six Federal states of Germany in 2016-2018. Demographics, ED use, drug use behavior, advertising exposure, intrapersonal, interpersonal, and community factors were assessed.Lifetime ED use was reported by 61.7% of the participants, while 21.4% reported past 30-day use. In two multilevel models, lifetime and past 30-day ED use were positively associated with male sex, older age, drug use, poor dietary habits, higher BMI, sensation seeking, worse school performance, and more frequent ad exposure (p .01). One quarter of the non-users initiated ED use in 12 months. ED initiation was positively associated with male sex (AOR, 1.50 [95% CI, 1.11-2.03]), greater sensation seeking traits (AOR, 1.25 [95% CI, 1.08-1.43]), more frequent ED ad exposure (AOR, 1.31 [95% CI, 1.12-1.53]), and curiosity about trying EDs (AOR, 2.31 [95% CI, 1.74-3.07]), while inversely associated with better school performance (AOR, 0.84, [95% CI, 0.73-0.97]) and attending a gymnasium-type school (AOR, 0.69 [95% CI, 0.50-0.96]).ED consumption is common among German adolescents. The association between EDs and negative health and lifestyle outcomes and risky behaviors is concerning. Parents, school officials, and healthcare providers should be aware of signs and consequences of excessive ED consumption and limit their use by adolescents. Adopting policies that limit the direct marketing to minors under the age of 18 years can be also beneficial in curbing this epidemic. more...

Background Manufacturers of e-cigarette-related products are using cartoons as a marketing strategy, despite restrictions on cartoon marketing for combustible cigarettes. Here, we examined associations between exposure to e-liquid packaging with cartoons (operationally defined as recognition of actual marketing images) and e-cigarette use, susceptibility to use, and expectations of benefits and risks of use. Methods U.S. adults completed online surveys assessing e-cigarette use. In Study 1, participants (N = 778; Mean age = 23.5 years; 62% women) completed a questionnaire assessing expectations about benefits and risks of use. Then they were presented with 22 e-liquid package images (with and without cartoons) and were asked to endorse whether they recognized the products. In Study 2, participants (N = 522; Mean age = 30.4; 55% women) were presented with 24 e-liquid images (with and without cartoons) and asked to rate product appeal. Results For Study 1, among never users, cartoon recognition was associated with greater likelihood of being susceptible to use e-cigarettes, and with expectations of taste enjoyment and social facilitation. For Study 2, there was no significant difference between cartoon and non-cartoon images on appeal ratings. Conclusions Cartoon-based marketing exposure – as measured by recognition of e-liquid package images – was associated with susceptibility to use e-cigarettes, which is consistent with previous research on the use of cartoons to promote combustible cigarettes. These data suggest that restrictions on the use of cartoon-based marketing strategies for e-cigarettes should be similar to those for cigarettes, to reduce susceptibility and perceived benefits among non-users. more...

Attention-deficit/hyperactivity disorder (ADHD) is a highly heritable neurodevelopmental disorder. However, no study has examined genetic and environmental influences in the longitudinal developmental course of ADHD symptoms in a non-Western population. This study investigated changes of genetic and environmental influences and their contributions to the stability and change of ADHD symptoms of hyperactivity/impulsivity and inattention in Chinese adolescent twins. A prospective sample of 602 twin pairs (48% male) self-reported both DSM-IV ADHD symptom subscales three times at the approximate age of 12, 13, and 15 years. Longitudinal multivariate genetic analyses through structural equation modelling examined genetic and environmental contributions to the developmental course of ADHD symptoms. From early (time 1 and 2) to middle adolescence (time 3), both symptoms showed modest and non-significant genetic influences that became substantial and significant, whereas shared environmental influences were substantial and significant and became modest and non-significant. The same genetic factors influenced ADHD symptoms throughout adolescence, while shared and non-shared environmental influences largely came from new emerging factors. In early adolescence, genetic factor contributed to the stability of inattention, whereas shared environmental factor contributed to the stability of hyperactivity/impulsivity. Genetic influences of ADHD tended to be smaller, whereas shared environmental influences tended to be larger in Chinese than in Western populations. Genetic factors played a large role in the stability of ADHD throughout adolescence, while shared and non-shared environment primarily contributed to its change. Findings highlight the importance of shared family, neighbourhood, and community experiences on child psychopathology in a collectivistic culture such as the Chinese society. more...

The Tobacco Regulatory Science Program is a collaborative research effort between the National Institutes of Health (NIH) and the Food and Drug Administration (FDA). In 2013, the NIH funded 14 Tobacco Centers of Regulatory Science (TCORS), which serve as partners in establishing research, training, and professional development programs to guide FDA. Each of the fourteen TCORS, and two other NIH-funded research programs, the Center for the Evaluation of Nicotine in Cigarettes (CENIC) and the Consortium on Methods Evaluating Tobacco (COMET), pursued specific research themes relevant to FDA’s priorities. A key mandate for FDA is to reduce tobacco use among young people. This article is a review of the peer-reviewed research, including published and in-press manuscripts, from the TCORS, CENIC, and COMET, which provides specific data or other findings on youth (ages 10–18 years) and/or young adults (ages 18–34 years), from 2013 to 2018. Citations of all TCORS, CENIC, and COMET articles from September 2013 to December 2017 were collected by the TCORS coordinating center, the Center for Evaluation and Coordination of Training and Research. Additional citations up to April 30, 2018 were requested from the principal investigators. A scoring rubric was developed and implemented to assess study type, primary theme, and FDA priority area addressed by each article. The major subareas and findings from each priority area are presented. There were 766 articles in total, with 258 (34%) focusing on youth and/or young adults. Findings relevant to FDA from this review concern impact analysis, toxicity, health effects, addiction, marketing influences, communications, and behavior. Implications The Tobacco Centers of Regulatory Science, CENIC, and COMET have had a high output of scientific articles since 2013. These Centers are unique in that the FDA supports science specifically to guide future regulatory actions. The 258 articles that have focused on youth and/or young adults are providing data for regulatory actions by the FDA related to the key priority areas such as the addictiveness of non-cigarette products, the effects of exposure to electronic cigarette marketing on initiation and cessation, and the impact of flavored products on youth and young adult tobacco use. Future regulations to reduce tobacco use will be guided by the cumulative evidence. These Centers are one innovative mechanism to promote important outcomes to advance tobacco regulatory science. more...

Suicide is a leading cause of death among young adults; however, contextual risks and cultural factors are rarely studied in the context of ethnic minority suicidal ideation (SI) and suicidal attempt (SA). This study assessed the association between familial incarceration and suicide behaviors and examined ethnic identity as a potential moderator. Data from a longitudinal study of health among Hispanics (n = 1,094) in California were used to test associations between familial incarceration, ethnic identity, and SA and SI, adjusting for demographic factors and covariates. Approximately 18% and 8% of respondents reported SI and SA, respectively. Compared to no incarceration, or the incarceration of a relative, parental incarceration was associated with higher odds (AOR: 2.09, 95% CI: 1.23-3.34) of SI whereas higher affective ethnic identity reduced the odds (AOR: 0.52, 95% CI: 0.31-0.89) of SA. Ethnic identity moderated the association between parental incarceration and SI (AOR: 0.33, 95% CI: 0.13-0.79). Incarceration of a family member can set the stage for exclusion from critical institutions and can have long-term consequences for adult mental health. Promoting a positive ethnic identity may be a promising prevention strategy that could bolster resilience among at-risk, urban minority youth. more...

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

This study describes key topics of discussions on Twitter at the intersection of vaping and COVID-19 and documents public reactions to announcements from authoritative health agencies. Twitter posts containing vaping and COVID-19-related terms were collected from 1 December 2019 to 3 May 2020 (n = 23,103 posts). Text classifiers and unsupervised machine learning were used to identify topics in posts. Predominant topics included COVID-19 Respiratory Health (18.87%), COVID-19 Susceptibility (17.53%), Death (10.07%), Other COVID-19 Health Effects (9.62%), and Severity of COVID-19 (7.72%), among others. Public conversations on topics, such as Severity of COVID-19, Transmission, Susceptibility, Health Effects, Death, and Smoking cessation, were shaped by announcements from U.S. and international health agencies. Armed with the insights from this study, medical providers should be prepared to discuss vaping-related health risks with their patients in the era of COVID-19. Misconceptions around vaping as a protective behavior from, and an effective treatment against, COVID-19 should also be corrected. more...

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. more...

Introduction It is established that higher prediagnostic circulating androgen and estrogen levels are associated with increased breast cancer risk in premenopausal and postmenopausal women. Pooled analyses in postmenopausal women report higher androgen and estrogen levels in current heavy cigarette smokers compared to nonsmokers. However, evidence among premenopausal women has been inconsistent. Aims and Methods We conducted a systematic review and meta-analysis to estimate differences in standardized mean hormone levels among current premenopausal smokers compared to nonsmokers. We reviewed and collated publications with sex hormone levels by smoking status among healthy, premenopausal women who were nonusers of exogenous hormones, including oral contraceptives, using PubMed through December 2019. A random effects meta-analysis was conducted to combine the standardized mean differences (SMD) and 95% confidence intervals (CIs) for estradiol, progesterone, testosterone, dehydroepiandrosterone, dehydroepiandrosterone-sulfate, and sex hormone-binding globulin by smoking status. Findings were summarized by menstrual cycle phase and overall. Results Nineteen published peer-reviewed articles were included. Significantly increased testosterone levels among smokers compared to nonsmokers were identified from cross-sectional studies with varied menstrual phase timing (SMD 0.14; 95% CI 0.0005, 0.29) and significantly increased dehydroepiandrosterone-sulfate levels were found over all phases (SMD 0.12; 95% CI 0.01, 0.22). However, substantial heterogeneity existed in these studies. Conclusions This meta-analysis suggests that smoking may increase blood androgen levels in healthy premenopausal women which may increase breast cancer risk; however, the differences were modest. Larger and covariate-adjusted studies with standardized collection over the menstrual cycle are needed to better understand this relationship and to reduce heterogeneity. Implications Existing research has described associations between high prediagnostic estradiol and androgen levels with breast cancer risk among premenopausal women and has established active smoking as a breast cancer risk factor. However, the smoking and circulating sex hormone associations among premenopausal women remain inadequately studied. In this meta-analysis, we identified an association between smoking and higher mean testosterone and dehydroepiandrosterone-sulfate levels with consideration of menstrual phase, providing additional information on smoking’s potential pathway to premenopausal breast cancer. more...

Background Cultural trends in the United States, the nicotine consumer marketplace, and tobacco policies are changing. Objective The goal of this study was to identify and describe nicotine-related topics of conversation authored by the public and social bots on Twitter, including any misinformation or misconceptions that health education campaigns could potentially correct. Methods Twitter posts containing the term “nicotine” were obtained from September 30, 2018 to October 1, 2019. Methods were used to distinguish between posts from social bots and nonbots. Text classifiers were used to identify topics in posts (n=300,360). Results Prevalent topics of posts included vaping, smoking, addiction, withdrawal, nicotine health risks, and quit nicotine, with mentions of going “cold turkey” and needing help in quitting. Cessation was a common topic, with mentions of quitting and stopping smoking. Social bots discussed unsubstantiated health claims including how hypnotherapy, acupuncture, magnets worn on the ears, and time spent in the sauna can help in smoking cessation. Conclusions Health education efforts are needed to correct unsubstantiated health claims on Twitter and ultimately direct individuals who want to quit smoking to evidence-based cessation strategies. Future interventions could be designed to follow these topics of discussions on Twitter and engage with members of the public about evidence-based cessation methods in near real time when people are contemplating cessation. more...

IntroductionModified risk tobacco product (MRTP) claims for heated tobacco products (HTPs) that convey reduced exposure compared with conventional cigarettes may promote product initiation and transition among young people. We assessed the effects of a hypothetical MRTP claim for HTPs on young adults’ intention and perceptions of using HTPs and whether these effects differed by their current cigarette and e-cigarette use.MethodsWe embedded a randomised between-subjects experiment into a web-based survey administered among a cohort of 2354 Southern California young adults (aged 20–23) in 2020. Participants viewed depictions of HTPs with an MRTP claim (n=1190) or no claim (n=1164). HTP use intention and HTP-related harm and use perceptions relative to cigarettes and e-cigarettes were assessed.ResultsOverall, participants who viewed versus did not view the claim did not differ in HTP use intention (28.5% vs 28.7%) but were more likely to perceive HTPs as less harmful than cigarettes (11.4% vs 7.0%; pDiscussionThe hypothetical MRTP claim may lower young adults’ HTP harm perceptions compared with cigarettes but may not change HTP use intention overall or differentially for cigarette smokers. The larger effect on HTP use intention among e-cigarette users than non-users raises the question of whether MRTP claims may promote HTP use or HTP and e-cigarette dual use among young e-cigarette users. more...

The present study investigated the prevalence and co-occurrence of addictions to tobacco, alcohol, other drugs, food/eating, the internet, texting, video games, shopping, love, sex, exercise, work, and gambling among American Indian (AI) youth in California. As with previous work in other cultural groups, the most prevalent addictions were love, internet, and exercise, though prevalence and co-occurrence of these addictions were relatively high among AI youth. A negative life events measure was associated with all the addictions, suggesting that life stressors are associated with high rates of multiple types of addictions among AI youth. There is a need for more research to better understand the relations of life stressors with multiple addictions among AI youth as well as how to remediate these behaviors. more...

Purpose The COVID-19 pandemic has exacerbated several existing health disparities in the U.S. Sexual and gender minority (SGM) health disparities may also be widening during the pandemic, though few studies have assessed this question. This study examined SGM young adult disparities in health-related behaviors to cope with isolation during the pandemic. Methods Respondents from a prospective cohort of Southern California young adults (N = 2,298) reported whether they engaged in various strategies (e.g., substance use, diet, exercise, relaxation) to cope with isolation during the pandemic (each: yes/no). Differences in coping were assessed across five SGM subgroups: heterosexual men and women, lesbian, gay, bisexual, pansexual, queer (LGBQ) men and women, transgender/nonbinary (TNB) respondents. Negative binomial regressions estimated sexual/gender identity differences in the number of positive or negative behaviors endorsed, adjusting for sociodemographic characteristics and prepandemic health behaviors. Differences were also tested across individual coping behaviors. Results Heterosexual women (IRR = 1.11 [1.01–1.21]), LGBQ men (IRR = 1.31 [1.12–1.54]), LGBQ women (IRR = 1.33 [1.19–1.49]), and TNB respondents (IRR = 1.29 [1.03–1.61]) engaged in more negative coping behaviors than heterosexual men. LGBQ men (IRR = 1.19 [1.02–1.39]) and LGBQ women (IRR = 1.20 [1.08–1.34]) also reported more negative coping behaviors versus heterosexual women. Generally, LGBQ men reported the highest prevalence of substance use, while LGBQ women and TNB reported the highest prevalence of adverse eating behaviors and self-harm. Conclusions SGM young adults may be disproportionately, adversely impacted by the COVID-19 pandemic. Tailored public health and clinical interventions are needed to decrease pandemic-related SGM health disparities. more...

Introduction A holistic public health surveillance approach can help capture the public’s tobacco and marijuana-related attitudes and behaviors. Using publicly available data from Twitter, this is one of the first studies to describe key topics of discussions related to each intersection (e-cigarette, combustible tobacco, and marijuana) of the Triangulum framework. Aims and Methods Twitter posts (n = 999 447) containing marijuana, e-cigarette, and combustible tobacco terms were collected from January 1, 2018 to December 23, 2019. Posts to Twitter with co-occurring mentions of keywords associated with the Triangulum were defined as an intersection (e-cigarettes and combustible tobacco, combustible tobacco and marijuana, e-cigarettes and marijuana, and marijuana, e-cigarettes and combustible tobacco). Text classifiers and unsupervised machine learning were used to identify predominant topics in posts. Results Product Features and Cartridges were commonly referenced at the intersection of e-cigarette and marijuana-related conversations. Blunts and Cigars and Drugs and Alcohol were commonly referenced at the intersection of combustible tobacco and marijuana-related discussions. Flavors and Health Risks were discussed at the intersection of e-cigarette and combustible-related conversations, while discussions about Illicit products and Health risks were key topics of discussion when e-cigarettes, combustible tobacco, and marijuana were referenced all together in a single post. Conclusion By examining intersections of marijuana and tobacco products, this study offers inputs for designing comprehensive FDA regulations including regulating product features associated with appeal, improving enforcement to curb sales of illicit products, and informing the FDA’s product review and standards procedures for tobacco products that can be used with marijuana. Implications This study is the first to leverage the Triangulum framework and Twitter data to describe key topics of discussions at the intersection of e-cigarette, combustible tobacco, and marijuana. Real-time health communication interventions can identify Twitter users posting in the context of e-cigarettes, combustible tobacco, and marijuana by automated methods and deliver tailored messages. This study also demonstrates the utility of Twitter data for surveillance of complex and evolving health behaviors. more...

This cross-sectional study estimates the association of political party affiliation with physical distancing behaviors among young adults during the coronavirus disease 2019 pandemic.