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Introduction: E-cigarettes are the most popular tobacco product among adolescents and young adults ("AYA") and are available in many flavors. The e-cigarette industry argues that flavors are not meant to appeal to youth, yet no study has asked youth what age group they think ads for flavored e-liquids are targeting. We asked AYA which age group they thought ads for flavored e-liquids targeted., Methods: In 2016 as part of a larger survey, a random sample of 255 youth from across California (62.4% female, mean age = 17.5, SD = 1.7) viewed eight ads, presented in randomized order, for fruit-, dessert-, alcohol-, and coffee-flavored e-liquids and indicated the age group they thought the ads targeted: younger, same age, a little older, or much older than them. Population means and 95% confidence intervals were estimated using bootstrapping (100,000 replicate samples)., Results: Most participants (93.7%) indicated the cupcake man flavor ad targeted an audience of people younger than they. Over half felt ads for smoothy (68.2%), cherry (63.9%), vanilla cupcake (58%), and caramel cappuccino (50.4%) targeted their age and for no flavor ad did most feel the primary target age group was much older., Conclusions: Youth believe ads for flavored e-liquids target individuals about their age, not older adults. Findings support the need to regulate flavored e-liquids and associated ads to reduce youth appeal, which ultimately could reduce youth use of e-cigarettes., (Copyright © 2018 Elsevier Ltd. All rights reserved.)

Introduction: E-cigarette dependence measures largely focus on e-cigarette use ("vaping") that is linked to nicotine use, and measures assessing sensory aspects of vaping that may influence use (e.g., taste) are limited in scope. Thus, we developed the novel Sensory E-cigarette Expectancies Scale (SEES)., Methods: In Summer 2017, 610 adult e-cigarette users (48.7% male, 84.9% White, 37.41[±12.15] years old) completed an online survey that included 23 SEES items. Psychometric analyses included evaluating latent structure, internal consistency, measurement invariance, mean differences, and test-criterion relationships., Results: Factor analyses supported a 9-item, 3-subscale structure (taste/smell, pleasure/satisfaction, vapor cloud production). Subscales evidenced internal consistency and scalar invariance by sex, race, smoking status (current/not), vaping status (daily/not), e-liquid nicotine content (yes/no), and device type (cig-a-likes/vape-pens/Advanced Personal Vaporizers [APVs]/Mods). Women and daily e-cigarette users reported stronger SEEs for taste/smell and pleasure than their counterparts. Non-white participants reported stronger SEEs for cloud production than White participants. Cig-a-like users reported the weakest SEEs for taste/smell and weaker SEEs linked to cloud production than APV/mod users. SEES scores evidenced convergence with nicotine dependence (mean r = .36). Finally, SEES scores predicted vaping frequency and habitual vaping concurrently and incrementally beyond nicotine dependence., Conclusions: The SEES evidenced good psychometric properties, suggesting that the measure can be used to assess sensory vaping expectancies in adults. Importantly, SEES scores indicated that sensory expectancies are related, yet distinct, from nicotine dependence. Future research should evaluate how SEEs relate to product characteristic preferences and patterns of vaping including the development and maintenance of addiction., (Copyright © 2018. Published by Elsevier Ltd.)

Objective: To understand if providers who had additional electronic health record (EHR) training improved their satisfaction, decreased personal EHR-use time, and decreased turnaround time on tasks., Materials and Methods: This pre-post study with no controls evaluated the impact of a supplemental EHR training program on a group of academic and community practice clinicians that previously had go-live group EHR training and 20 months experience using this EHR on self-reported data, calculated EHR time, and vendor-reported metrics., Results: Providers self-reported significant improvements in their knowledge of efficiency tools in the EHR after training and doubled (significant) their preference list entries (mean pre = 38.1 [65.88], post = 63.5 [90.47], P  < .01). Of the 7 EHR satisfaction variables, only 1 self-reported variable significantly improved after training: Control over my workload in the EHR (mean pre = 2.7 [0.96], post = 3.0 [1.04], P  < .01). There was no significant decrease in their calculated EHR usage outside of clinic (mean pre = 0.39 [0.77] to post = 0.37 [0.48], P  = .73). No significant difference was seen in turnaround time for patient calls (mean pre = 2.3 [2.06] days, post = 1.9 [1.76] days, P  = .08) and results (mean before = 4.0 [2.79] days, after = 3.2 [2.33] days, P  = .03)., Discussion: Multiple sources of data provide a holistic view of the provider experience in the EHR. This study suggests that individualized EHR training can improve the knowledge of EHR tools and satisfaction with their perceived control of EHR workload, however this did not translate into less Clinician Logged-In Outside Clinic (CLOC) time, a calculated metric, nor quicker turnaround on in box tasks. CLOC time emerged as a potential less-costly surrogate metric for provider satisfaction in EHR work than surveying clinicians. Further study is required to understand the cost-benefit of various interventions to decrease CLOC time., Conclusions: This supplemental EHR training session, 20 months post go-live, where most participants elected to receive 2 or fewer sessions did significantly improve provider satisfaction with perceived control over their workload in the EHR, but it was not effective in decreasing EHR-use time outside of clinic. CLOC time, a calculated metric, could be a practical trackable surrogate for provider satisfaction (inverse correlation) with after-hours time spent in the EHR. Further study into interventions that decrease CLOC time and improve turnaround time to respond to inbox tasks are suggested next steps., (© The Author(s) 2019. Published by Oxford University Press on behalf of the American Medical Informatics Association.)

Objectives: E-cigarettes are not FDA-approved smoking cessation aids. Nevertheless, content analyses have shown that e-cigarette companies make claims about cessation efficacy. Some advertisements are explicit (directly mentioning their product can help smokers quit or stop smoking), while others are implicit (not containing cessation-related language, but implying cessation efficacy through subtle wording and imagery). This is the first study to examine directly how adolescents and young adults (AYAs) perceived these ads, and specifically whether they identify the cessation claims in e-cigarette advertisements., Methods: 248 AYAs in California viewed 4 e-cigarette advertisements with cessation claims, then selected claims made by each advertisement. Descriptive statistics and multi-level logistic regression models were used to examine the relationship between the type of claims and perception., Results: The claim "helps me quit smoking" was most frequently selected after viewing advertisements with explicit cessation claims, but not after viewing implicit claims. No significant effect of tobacco use and age on claim selection was observed., Conclusions: E-cigarette manufacturers make claims about cessation efficacy, and AYAs can identify such claims in advertisements, especially the explicit ones. FDA should regulate these advertisements as making therapeutic claims., Competing Interests: Conflict of Interest Statement All authors of this article declare they have no conflicts of interest.

This study examined the effect of exposure to "cigalike" (products resembling cigarettes) e-cigarette advertisements on adolescents' perceptions of cigarettes. A nationally representative sample of 802 adolescents (13-17 years old) was randomly assigned to watch three e-cigarette or three control advertisements. Never-smokers who saw the e-cigarette advertisements (n = 352) reported significantly lower perceived risks of smoking than those in the control condition (n = 320). Ever-smokers (n = 130) did not show significant differences across the conditions. In subgroup analyses, current smokers (reported smoking in the past 30 days, n = 31) in the e-cigarette condition reported significantly lower perceived benefits of smoking than those in the control condition. E-cigarette advertisements can affect adolescents' perceptions of cigarettes. Many advertisements, especially the ones promoting "cigalikes," depict e-cigarettes as being similar to cigarettes (e.g., look, flavor) but also as a solution for cigarettes' shortcomings (e.g., bad smell). While the advertisements include messages about problems posed by cigarettes, proposing e-cigarettes as a solution may decrease the perceived risks of smoking among never-smokers. It may also not be clear to adolescents whether advertisements are for cigarettes or e-cigarettes. Regulating e-cigarette advertisements to minimize adolescents' exposure may prevent potential harmful effects on never-smokers' perception of smoking.

•Youth interpret cigarette pack-colors in line with industry-intended associations.•Product-packaging restrictions may be circumvented by use of colors that misrepresent product harms.•43.2% of participants attributed extra strong to the black cigarette pack.•35.6% of participants ascribed rich to gold .•31.1% of participants ascribed menthol to green .

Problem Identification: Involvement in treatment decision making (TDM) is considered a key element of patient- and family-centered care and positively affects outcomes. However, for adolescents and young adults (AYAs) with cancer, little is known about the current state of knowledge about their perspective on and involvement in TDM or the factors influencing AYAs' TDM involvement., Literature Search: Integrative review focused on AYAs aged 15-21 years, their involvement in TDM, and factors influencing their involvement using the MEDLINE®, PsycINFO®, CINAHL®, and Web of Science databases., Data Evaluation: 4,047 articles were identified; 21 met inclusion criteria., Synthesis: Five factors were identified., Implications for Research: Research is needed to understand AYAs' preferences for TDM, the type and degree of their involvement, and the interactions between factors that contribute to or impede TDM.

Background: Chronic nonbacterial osteomyelitis (CNO) is an autoinflammatory bone disorder that if left untreated can result in bone destruction and severe continuing pain due to persistent inflammation. The impact this chronic disease has on the daily lives of affected children and their families is not well known. The purpose of this study is to understand the disease burden and socioeconomic and psychological impact of CNO from the patients' and families' perspectives and identify areas of improvement for patient care and reduced disease burden based on patients' and families' responses., Methods: Participants were invited through a social media platform group and at clinic visits at Stanford Children's Health. An online survey was administered to patients with a diagnosis of CNO made at < 22 years of age and/or the parent/guardian of a patient with CNO diagnosis made at < 22 years of age., Results: There was a total of 284 survey participants. The median age at CNO diagnosis was 10 years (range 2-22+). Median time from first CNO symptom to diagnosis was 2 years. Antibiotics were used in 35% of patients prior to CNO diagnosis; of these, 24% received antibiotics for greater than 6 months. Between 25 and 61% reported a negative effect of CNO on relationships, school/work performance, or finances; and 19-50% reported effects on psychosocial well-being. The majority agreed patients' performance with daily tasks and hobbies was challenged by pain, fatigue and physical limitation related to CNO., Conclusions: Patients with CNO experienced on average a 2-year delay in diagnosis and receiving effective treatments. At least 25% reported problems with relationships, school, work, finances and well-being due to CNO. Recognition of these challenges emphasizes the need to increase awareness of this disease and address the socioeconomic stressors and mental health issues in order to provide optimal care of children with CNO.

Introduction: While evidence suggests positive opinions of smokers are associated with tobacco use, research exploring adolescents' opinions of e-cigarette users is nascent. We hypothesized that adolescents harbor positive opinions of e-cigarette users, and that these opinions will be more positive among adolescents willing to try or who have used e-cigarettes., Methods: Participants were 578 U.S. adolescents (ages 14 to 20) recruited from ten California schools. An online survey assessed their attitudes toward and opinions of adolescents who use e-cigarettes in 2015-2016. Analyses examined whether these variables were associated with willingness to try and use (ever vs. never) of e-cigarettes., Results: The majority (61%) of participants had negative overall opinions toward adolescent e-cigarette users. Few participants ascribed positive traits (i.e., sexy, cool, clean, smart, and healthy) to e-cigarette users. Participants who were willing to try or had used e-cigarettes endorsed positive traits more than those unwilling to try and never-users (all p < .01). Participants sometimes endorsed negative traits (i.e., unattractive, trashy, immature, disgusting, and inconsiderate) to describe e-cigarette users. Unwilling and never-users viewed negative traits as more descriptive of e-cigarette users than willing or ever-users (all p < .01)., Conclusions: Adolescents generally had somewhat negative opinions of other adolescents who use e-cigarettes. Building on adolescents' negativity toward adolescent e-cigarette users may be a productive direction for prevention efforts, and clinicians can play an important role by keeping apprised of the products their adolescent patients are using and providing information on health effects to support negative opinions or dissuade formation of more positive ones., Competing Interests: The authors have declared that no competing interests exist.

Background: Philip Morris International (PMI) continually expands and diversifies their nicotine product portfolio, which includes IQOS, a heated tobacco product. In December 2016, PMI filed a modified risk tobacco product (MRTP) application with the US Food and Drug Administration (FDA), seeking authorisation to market IQOS in USA with three claims of reduced harm: 'switching completely from conventional cigarettes to the IQOS system…' (1) 'can reduce the risks of tobacco-related diseases;' (2) 'significantly reduce[s] your body's exposure to harmful or potentially harmful chemicals;' and (3) 'presents less risk of harm than continuing to smoke cigarettes.' Consumers may misunderstand what is meant by 'switching completely'., Methods: We critically reviewed study reports submitted to FDA by PMI in support of proposed marketing claims in its MRTP application for IQOS and focused on the statement that switching completely to IQOS reduces risk., Results: We found deficiencies with evidence provided by PMI supporting their assertions that: current smokers will understand what is meant by the phrase 'switching completely'; the proposed claims will not decrease smokers' intentions to quit; and IQOS users will in fact 'switch completely' from smoking cigarettes to using IQOS. The studies and measurement instruments employed by PMI suffer from design flaws and their reporting of associated findings is misleading., Conclusion: Consumers will not understand the condition of the claims-that they must quit using cigarettes completely to achieve the inferred health benefits of IQOS. Rather, they are likely to misunderstand the unsupported claims of reduced risks to mean IQOS are harm-free., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2018. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: Beginning in the 1960s in the USA and globally since 1998, tobacco companies have beenaggressively promoting heated tobacco products (HTP). In 2016, Philip Morris International (PMI) applied to the US Food and Drug Administration (FDA) seeking authorisation to market their IQOS HTP system and flavoured 'HeatSticks' in the USA as a modified-risk tobacco product (MRTP)., Methods: We systematically evaluated the publicly available data PMI submitted to FDA in its MRTP application to determine whether PMI's IQOS product meets the US Tobacco Control Act's standard for MRTP claims. We examined whether PMI provided sufficient data showing tobacco users will not initiate with IQOS, that youth will not misperceive the MRTP-related claims being made concerning IQOS, and how youth perceive health risks associated with IQOS., Results: PMI's own studies failed to provide evidence that youth, including non-users and former users, will not find IQOS appealing, will not initiate use of IQOS and will not perceive these products as risk-free. Further, PMI did not refer to independent studies conducted among adolescents which could influence their conclusions. Finally, their studies suffered from design and implementation flaws and cannot be relied on to support the proffered claims., Conclusion: PMI's own data and available evidence from scientific studies conducted independent of the tobacco industry regarding how novel tobacco products are currently being marketed suggest that introduction of IQOS will result in adolescent and young adult non-users initiating tobacco use with IQOS and could also increase poly-use of IQOS along with other tobacco products., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2018. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Importance: Electronic cigarettes (e-cigarettes) are the most commonly used tobacco product among adolescents and young adults, and the new pod-based e-cigarette devices may put adolescents and young adults at increased risk for polytobacco use and nicotine dependence., Objective: To build an evidence base for perceptions of risk from and use of pod-based e-cigarettes among adolescents and young adults., Design, Setting, and Participants: In a survey study, a cross-sectional analysis was performed of data collected from April 6 to June 20, 2018, from 445 California adolescents and young adults as part of an ongoing prospective cohort study designed to measure the use and perceptions of tobacco products., Exposures: Use of pod-based e-cigarettes, e-cigarettes, and cigarettes., Main Outcomes and Measures: Ever use, past 7-day use, and past 30-day use and co-use of pod-based e-cigarettes, e-cigarettes, and cigarettes; use of flavors and nicotine in pod-based e-cigarettes and e-cigarettes; and associated perceptions of risks, benefits, and nicotine dependence., Results: Among 445 adolescents and young adults (280 females, 140 males, 6 transgender individuals, and 19 missing data; mean [SD] age, 19.3 [1.7] years) who completed wave 6 of the ongoing prospective cohort study, ever use information was provided by 437 respondents, of which 68 (15.6%) reported use of pod-based e-cigarettes, 133 (30.4%) reported use of e-cigarettes, and 106 (24.3%) reported use of cigarettes. The mean (SD) number of days that pod-based e-cigarettes were used in the past 7 days was 1.5 (2.4) and in the past 30 days was 6.7 (10.0). The mean (SD) number of days that other e-cigarettes were used in the past 7 days was 0.8 (1.8) and in the past 30 days was 3.2 (7.4). The mean (SD) number of days that cigarettes were used in the past 7 days was 0.7 (1.8) and in the past 30 days was 3.0 (7.6). Among ever users of pod-based e-cigarettes, 18 (26.5%) reported their first e-liquid was flavored menthol or mint and 19 (27.9%) reported fruit (vs 13 [9.8%] and 50 [37.6%] for other e-cigarettes). The mean perceived chance of experiencing social risks and short-term and long-term health risks from the use of either pod-based e-cigarettes or other e-cigarettes was 40% and did not differ statistically by e-cigarette type. Among 34 adolescents and young adults reporting any loss of autonomy from nicotine, there was no difference in mean (SD) Hooked On Nicotine Checklist scores between those using pod-based e-cigarettes (2.59 [3.14]) and other e-cigarettes (2.32 [2.55])., Conclusions and Relevance: Use by adolescents and young adults of newer types of e-cigarettes such as pod-based systems is increasing rapidly, and adolescents and young adults report corresponding misperceptions and lack of knowledge about these products. Rapid innovation by e-cigarette manufacturers suggests that public health and prevention efforts appear to be needed to include messages targeting components common to all current and emerging e-cigarette products to increase knowledge and decrease misperceptions, with the goal to try to ultimately reduce e-cigarette use among adolescents and young adults.

Measuring perceptions associated with e-cigarette use can provide valuable information to help explain why youth and adults initiate and continue to use e-cigarettes. However, given the complexity of e-cigarette devices and their continuing evolution, measures of perceptions of this product have varied greatly. Our goal, as members of the working group on e-cigarette measurement within the Tobacco Centers of Regulatory Science (TCORS) network, is to provide guidance to researchers developing surveys concerning e-cigarette perceptions. We surveyed the 14 TCORS sites and received and reviewed 371 e-cigarette perception items from seven sites. We categorized the items based on types of perceptions asked, and identified measurement approaches that could enhance data validity and approaches that researchers may consider avoiding. The committee provides suggestions in four areas: (1) perceptions of benefits, (2) harm perceptions, (3) addiction perceptions, and (4) perceptions of social norms. Across these 4 areas, the most appropriate way to assess e-cigarette perceptions depends largely on study aims. The type and number of items used to examine e-cigarette perceptions will also vary depending on respondents' e-cigarette experience (i.e., user vs. non-user), level of experience (e.g., experimental vs. established), type of e-cigarette device (e.g., cig-a-like, mod), and age. Continuous formative work is critical to adequately capture perceptions in response to the rapidly changing e-cigarette landscape. Most important, it is imperative to consider the unique perceptual aspects of e-cigarettes, building on the conventional cigarette literature as appropriate, but not relying on existing conventional cigarette perception items without adjustment., (Copyright © 2017 Elsevier Ltd. All rights reserved.)

Objectives: To assess pediatric providers' attitudes and barriers to initiating a contraceptive method in the inpatient setting., Methods: Pediatric attending physicians and trainees from 5 academic institutions were surveyed about contraceptive prescribing practices, attitudes, and potential barriers to initiating contraception in the inpatient setting., Results: In 2016, 271 pediatric providers (34.0% were attending physicians, 18.1% fellows, and 47.9% residents) completed the survey; the response rate was 19.2%. Most participants practiced in both inpatient and outpatient settings (95.7% and 85.0%, respectively). More providers felt confident screening for sexual activity among young adults as compared with adolescents (71.9% vs 65.6%). The same was true for discussing contraceptive options (44.0% vs 38.8%, respectively). Inpatient providers reported seeing adolescents and young adults privately, discussing confidentiality, and asking about sex less than half of the time. More than 80% of providers agreed that it would be appropriate to initiate a contraceptive method for inpatients; 35.8% had done so, and 85.2% indicated that having additional consultation would increase initiation of a contraceptive method in the hospital (88.1% felt similarly for long-active reversible contraception methods). General barriers to initiating contraception included insufficient training, insufficient exposure to adolescents and young adults to maintain skills, and lack of time. Barriers specific to the inpatient setting included concerns about follow-up, confidentiality, and interference with the treatment plan., Conclusions: Initiation of a contraceptive method in the inpatient setting is acceptable to providers. In our findings, it is suggested that strategies are needed to enhance provision of these services by addressing confidentiality concerns and educating providers., Competing Interests: POTENTIAL CONFLICT OF INTEREST: The authors have indicated they have no potential conflicts of interest to disclose., (Copyright © 2018 by the American Academy of Pediatrics.)

Background: A recent study of adult smokers who vape found that disposable/cigalike electronic (e-) cigarette devices were more commonly used than later generation devices. However, whether these trends reflect patterns among adolescents and young adults, many of whom have limited or no history of combustible cigarette use, has not been studied., Methods: Participants were drawn from eight locally, regionally, and US nationally representative studies. Surveys took place between Fall 2014 and Spring 2016; participants were residents of California (3 studies), Texas (2 studies), Connecticut (1 study), or randomly selected from the US population (2 studies). Data were collected from middle and high school students (4 studies), young adults under 30 (3 studies), or a mixture (1 study) to assess type of e-cigarette device used among past-30 day e-cigarette users: disposable/cigalike, or later generation e-cigarette device., Results: Fewer than 15% of participants in each study reported primarily using a disposable/cigalike device in the past month (across all studies: 7.5%; 95%CI: 4.9%, 10.5%). The proportion using later generation devices ranged from 58% to 86% across studies; overall, 77.0% (95%CI: 70.5%, 82.9%) reported primary use of a later generation device. Combined, 13.2% (95%CI: 5.9%, 22.8%) reported "don't know" or were missing data., Conclusions: Among adolescent and young adult e-cigarette users, primary use of disposable/cigalike devices was rare. Future research should continue to evaluate the type of device used by adolescents and young adults, as these data may be relevant to regulatory oversight of e-cigarettes recently acquired by the Food and Drug Administration Center for Tobacco Products., Implications: In this pooled analysis of adolescent and young adult vapers, primary use of later generation e-cigarette devices was substantially more common than use of disposable/cigalike devices. The type of device predominantly used by adolescents and young adults has regulatory implications for policy to reduce adolescent use of e-cigarettes., (© The Author 2017. Published by Oxford University Press on behalf of the Society for Research on Nicotine and Tobacco. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Purpose: The purpose of the study was to determine from whom and where adolescents obtained tobacco, including cigarettes, e-cigarettes, and hookah., Methods: California adolescents (N = 772; 63.19% female; mean age = 16.13 years, SD = 1.61; 26.44% white, 22.12% Asian/Pacific Islander, 36.65% Hispanic, and 14.79% other) were surveyed about their access to different tobacco products., Results: Adolescents were significantly more likely to obtain tobacco from friends (54.9%) than family members or direct purchasing (p < .001). Smoke shops were the most common purchase location across products (44.3%), with adolescents significantly more likely to purchase hookah and e-cigarettes from smoke shops than gas stations, liquor stores, or drug stores (p < .02)., Conclusions: The effective characterization of tobacco access patterns is critical to the development of comprehensive tobacco control. By demonstrating peers and smoke shops as the primary social and retail outlets, this study identifies targets for the optimization of regulation and messaging aimed at reducing adolescents' access to tobacco., (Copyright © 2017 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.)

Background: Across cancers, the decision to pursue genetic testing is influenced more by subjective than objective factors. However, skin cancer, which is more prevalent, visual, and multifactorial than many other malignancies, may offer different motivations for pursuing such testing., Objectives: The primary objective was to determine factors influencing the decision to receive genetic testing for skin cancer risk. A secondary objective was to assess the impact of priming with health questions on the decision to receive testing., Methods: We distributed anonymous online surveys through ResearchMatch.org to assess participant health, demographics, motivations, and interest in pursuing genetic testing for skin cancer risk. Two surveys with identical questions but different question ordering were used to assess the secondary objective., Results: We received 3783 responses (64% response rate), and 85.8% desired testing. Subjective factors, including curiosity, perceptions of skin cancer, and anxiety, were the most statistically significant determinants of the decision to pursue testing (P < .001), followed by history of sun exposure (odds ratio 1.85, P < .01) and history of skin cancer (odds ratio 0.5, P = .01). Age and family history of skin cancer did not influence this decision. Participants increasingly chose testing if first queried about health behaviors (P < .0001)., Limitations: The decision to pursue hypothetical testing may differ from in-clinic decision-making. Self-selected, online participants may differ from the general population. Surveys may be subject to response bias., Conclusion: The decision to pursue genetic testing for skin cancer is primarily determined by subjective factors, such as anxiety and curiosity. Health factors, including skin cancer history, also influenced decision-making. Priming with consideration of objective health factors can increase the desire to pursue testing., (Copyright © 2016 American Academy of Dermatology, Inc. Published by Elsevier Inc. All rights reserved.)

Purpose: To evaluate the effect of behavioral, empowerment-focused interventions on the incidence of pregnancy-related school dropout among girls in Nairobi's informal settlements., Method: Retrospective data on pregnancy-related school dropout from two cohorts were analyzed using a matched-pairs quasi-experimental design. The primary outcome was the change in the number of school dropouts due to pregnancy from 1 year before to 1 year after the interventions., Results: Annual incidence of school dropout due to pregnancy decreased by 46% in the intervention schools (from 3.9% at baseline to 2.1% at follow-up), whereas the comparison schools remained essentially unchanged ( p < .029). Sensitivity analysis shows that the findings are robust to small levels of unobserved bias., Conclusions: Results suggest that these behavioral interventions significantly reduced the number of school dropouts due to pregnancy. As there are limited promising studies on behavioral interventions that decrease adolescent pregnancy in low-income settings, this intervention may be an important addition to this toolkit.

Purpose: The purpose of this study was to determine whether a history of overweight, weight suppression, and weight gain during treatment have an effect on return of menses (ROM) in adolescents with eating disorders (EDs)., Methods: Retrospective chart review of female adolescents presenting to an ED program from January 2007 to June 2009., Results: One hundred sixty-three participants (mean age, 16.6 ± 2.1 years) met eligibility criteria. The mean median body mass index percent at ROM for those previously overweight was 106.1 ± 11.7 versus 94.2 ± 8.9 for those not previously overweight (p < .001). Both groups needed to gain weight for ROM. Greater weight suppression (odds ratio, 0.90; 95% confidence interval, 0.84-0.98; p = .013) was associated with lower likelihood of ROM, and greater weight gain during treatment (odds ratio, 1.20; 95% confidence interval, 1.07-1.36; p = .002) was associated with higher likelihood of ROM in those not previously overweight., Conclusions: Previously overweight amenorrheic patients with EDs needed to be at a higher median body mass index percent for ROM compared to those who were not previously overweight., (Copyright © 2016 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.)

Purpose: The aim of the study was to determine whether adolescents' intentions to smoke, cigarette smoking behavior, and specific perceptions of cigarette smoking are different in 2015 versus 2001., Methods: Data from two California school-based studies (X age  = 14) were compared: one conducted in 2001-2002 ("2001"), N = 395; the second in 2014-2015 ("2015"); N = 282., Results: In 2015, more participants reported it was very unlikely they would smoke (94% vs. 65%) and that they never smoked (95% vs. 74%); they reported perceiving less likelihood of looking more mature (17% vs. 28%) and greater likelihood of getting into trouble (86% vs. 77%), having a heart attack (76% vs. 69%), and contracting lung cancer (85% vs. 78%) from smoking (p < .001). Perceptions of short-term health problems and addiction were similar in 2001 and 2015., Conclusions: Findings suggest that adolescents in 2015 perceived greater risks compared to those in 2001 even amidst the rapidly changing tobacco product landscape. In addition to continuing messages of long-term health risks, prevention efforts should include messages about addiction and short-term health and social risks., Competing Interests: Declaration of Interests: KM and BHF have no competing interests., (Copyright © 2016 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.)

E-cigarette use has dramatically increased. While studies have examined adolescents' attitudes towards smoking, few have extended this research to adolescents' attitudes towards e-cigarettes. The goal of this study was to examine adolescents' attitudes regarding e-cigarette ingredients, safety, addictive properties, social norms, accessibility, price, and regulation; and determine whether attitudes differ by past cigarette/e-cigarette use. Participants were 786 9th and 12th graders from California (63.21% females; mean age=16.10years [SD=1.6]; 26.61% White, 21.98% Asian/Pacific Islander, 29.82% Hispanic, and 21.59% other). Results indicated that 19.05% of participants believed smoke from e-cigarettes is water; 23.03% believed e-cigarettes aren't a tobacco product; 40.36% considered e-cigarettes to be for cessation, and 43.13% felt they were safer than cigarettes. Participants felt it was more acceptable to use e-cigarettes indoors and outdoors compared to cigarettes (p<0.0001), 23.13% felt raising e-cigarette taxes is a bad idea, 63.95% thought e-cigarettes were easier to get than cigarettes, 54.42% felt e-cigarettes cost too much, 64.33% felt the age for buying e-cigarettes should be raised, and 64.37% favored e-cigarette regulation. Adolescents who used e-cigarettes and/or cigarettes had significantly more favorable e-cigarette attitudes than non-users. This study indicates that adolescents are aware of some of the risks of e-cigarettes, although many harbor misperceptions and hold more favorable attitudes towards e-cigarettes than cigarettes. Of concern is the relationship between favorable e-cigarette attitudes and use. Findings suggest the need to provide adolescents with correct information about e-cigarette ingredients, risks, and the insufficient evidence of their role in cigarette cessation., (Copyright © 2016 Elsevier Inc. All rights reserved.)

Despite consistent declines in rates of cigarette use among adolescents in the last five years, rates of marijuana use have remained constant, with marijuana being the most widely used illegal drug among adolescents. More work is needed to understand how social norms, perceived risks and benefits, and social media messaging impact use of marijuana. This study compared perceptions and social norms related to marijuana, blunts and cigarettes. Additionally, we assessed how perceptions related to social norms, risks and benefits, and exposure to pro- versus anti-marijuana messaging is related to use. Participants were 786 adolescents from Southern and Northern California (36.7% male, 63.21% females; mean age=16.1years; SD=1.6). Participants came from diverse ethnic backgrounds, with 207 (26.61%) White, 171 (21.98%) Asian/Pacific Islander, 232 (29.82%) Hispanic, and 168 (21.59%) other. Results indicated that marijuana and blunts were consistently perceived as more socially acceptable and less risky than cigarettes (p<0.01). Participants who reported that their friends used marijuana had a 27% greater odds of using marijuana themselves. Further, seeing messages about the good things or benefits of marijuana use was associated with a 6% greater odds of use [OR 1.06 (CI 1.00, 1.12)]. This study's findings offer a number of important public health implications, particularly as states move towards legalization of marijuana for recreational use. As this occurs, states need to take adolescents' perceptions of risks, benefits, social norms, and peer influences into account as they implement strategies to reduce youth use of marijuana and blunts., (Copyright © 2016 Elsevier Inc. All rights reserved.)

Objective: This study assesses perceptions of overall harm, short-term health and social risks, long-term health risks, and benefits associated with various tobacco products including conventional cigarettes, e-cigarettes, cigars, chew, and hookah. This study also assesses whether and how perceptions differ by age, gender, race/ethnicity, and previous experience with tobacco., Methods: A total of 722 high school students completed an online survey, answering questions about their use and perceptions of a variety of tobacco products. Differences in perceptions across products were assessed using a generalized estimation equation with an exchangeable correlation structure., Results: Adolescents rated the various tobacco products as conferring significantly different levels of risks and benefits. Generally, adolescents rated cigarettes as most risky, followed by cigars and chew, with hookah and e-cigarettes rated as least risky. Adolescents rated hookah followed by cigarettes and e-cigarettes as most likely to make them look cool or fit in and cigars and chew as least likely to confer these benefits. There were interaction effects by age and use, with older adolescents and those with tobacco experience holding lower perceptions of risk. There were no significant interaction effects by race/ethnicity or gender., Conclusion: Given the significant differences in adolescents' perceptions of risks and benefits of using different tobacco products and research showing the predictive relationship between perceptions and behavior, there is a need for comprehensive messaging that discusses risks of all tobacco products, particularly hookah and e-cigarettes. There is also a need to address perceived benefits of tobacco products, especially hookah and e-cigarettes., Competing Interests: The authors have no potential conflicts of interest., (Copyright © 2016 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.)

This study used mixed methods to examine the experiences and health of rural, young adult women (N = 100) who self-reported past experience of physical, emotional and verbal, sexual, and relational abuse in adolescent dating relationships. Few studies have examined the lasting health ramifications of adolescent dating abuse adolescent dating abuse in rural populations, and almost no mixed methods studies have explored adolescent dating abuse. Participants completed questionnaires on demographics, relationship behaviors, and mental health symptoms. A subsample (n = 10) of participants also completed semi-structured, in-depth interviews with the primary investigator. Results suggest that depressive symptoms and self-rating of health in these women are associated with particular kinds and severity of abusive experiences, and that adolescent dating abuse has ramifications for health and development beyond the duration of the original relationship. Self-rated health (SRH) was inversely associated with abusive behaviors in the relationship, whereas depressive symptoms were positively correlated with such behaviors. Self-rated health was also negatively correlated with depressive symptoms. The results of this study represent an important step toward establishing lifetime health risks posed by adolescent dating abuse., (© The Author(s) 2014.)

Purpose: Although rates of adolescent cigarette use have remained constant or decreased, rates of marijuana and e-cigarette use are rising. Knowledge and perceptions of risks and benefits of tobacco products impact adolescents' decisions to use these products. However, little is known regarding adolescents' knowledge and perceptions of risks of e-cigarettes and marijuana nor how these perceptions are formed. This study uses qualitative techniques to assess and compare adolescents' perceptions of the risks and benefits of cigarettes, e-cigarettes, and marijuana., Methods: Twenty-four adolescents (nine females and 15 males) from Northern California participated in six small-group discussions. Adolescents were asked what good or bad things might happen from using these products. To assess how perceptions and knowledge of risks and benefits were formed, participants were asked where and from whom they had learned about these products., Results: Adolescents described negative consequences of cigarette use but were much less sure regarding risks of marijuana and e-cigarette use. Conversely, they described few benefits of cigarettes but described a number of benefits of e-cigarette and marijuana use. Adolescents described learning about these products from the media, from family and friends, and from the school environment., Conclusions: Adolescents have learned from multiple sources about risks of using cigarettes, but they receive much less and often incorrect information regarding marijuana and e-cigarettes, likely resulting in their positive and often ambivalent perceptions of marijuana and e-cigarettes., (Copyright © 2015 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.)

Objective: To determine Latino parents' beliefs regarding the effects of television viewing on infants and toddlers., Methods: We conducted interviews with 26 Latino parents of infants and toddlers. We evaluated parents' beliefs about the health effects of television viewing, sources of information on this topic and facilitators and barriers to following the American Academy of Pediatrics (AAP) screen-time guidelines., Results: Parents believed that television viewing was educational for children but were concerned that watching television could worsen children's vision. Parents would be motivated to limit television viewing by children if it were recommended by a health care provider. Most parents were confident that they could limit their children's television viewing, although some perceived logistical challenges to following guidelines., Conclusions: Parents in our study had limited knowledge of the effects of television. Counseling on television by health care providers for Latino parents may decrease Latino infants and toddlers' television exposure.

Objectives: To adapt an established instrument for measuring adolescents' cigarette-related perceptions for new application with electronic cigarettes (e-cigarettes)., Methods: In this exploratory study, 104 male high school students (40% tobacco ever-users) estimated the probability of potential e-cigarette risks (eg, lung cancer) or benefits (eg, look cool). We calculated associations between risk/benefit composite scores, ever-use, and use intention for e-cigarettes, and analogously, for combustible cigarettes., Results: E-cigarette ever-use was associated with lower perceived risks, with adjusted differences versus never-users greater for e-cigarettes than for cigarettes. Risk composite score was inversely associated, and benefit score positively associated, with e-cigarette ever-use and use intention., Conclusion: Conditional risk assessment characterized adolescents' perceived e-cigarette risk/benefit profile, with potential utility for risk-perception measurement in future studies.

To determine Latino parents' beliefs on the health effects of beverages on infants and toddlers, their sources of information on beverages and perceived barriers to following guidelines for healthy beverage consumption by children. We conducted 29 interviews with parents of Latino children ages 6-36 months. Parents were recruited in three community health centers in Northern California. The interviews were recorded, transcribed and analyzed using standard qualitative methods. The following dominant themes emerged. Parents believed that water and milk were healthy beverages for children and that sugar-sweetened beverages (SSBs) were unhealthy. Views on 100% fruit juice were mixed. Parents distinguished between homemade beverages such as "agua fresca" which they considered healthy, despite containing added sugar, and beverages from stores which were viewed as unhealthy. Participants' main source of information on beverages was the federal nutrition program for Women, Infants, and Children (WIC). Parents were confused, however, as to why WIC provides juice yet counseled parents to avoid giving their children juice. Parents preferred to receive information on beverages from experts. Differing practices among family members regarding which beverages they provide to children was the most important barrier to following beverage guidelines. Our study suggests that Latino parents are receptive to counseling on beverages from expert sources. Such counseling should address both store-bought and homemade beverages. The WIC program is a key source of information on beverages for Latino parents; thus counseling offered by WIC should be evidence-based and avoid mixed messages.

Adolescents and young adults (ages 13-24) in the USA are frequently exposed to violence in their community and home. While studies have examined the prevalence and impact of violence exposure among adolescents, there is a lack of data focusing specifically on adolescent men of color who have sex with men. Eight demonstration sites funded through a Special Projects of National Significance (SPNS) Initiative recruited 363 HIV-positive racial/ethnic minority young men who have sex with men (YMSM) for a longitudinal study between 2006 and 2009. Over two-thirds of participants (83.8%) had witnessed community violence, 55.1% in the prior three months. Witnessing violence committed with a deadly weapon was significantly associated with being African-American, having ever used drugs, and drinking alcohol in the prior two weeks. Fear of violence in the community was significantly associated with depressive symptomatology, having less than a high school degree, not possessing health insurance, and site of enrollment. Having been emotionally or physically abused by a parent or caretaker was significantly associated with depressive symptomatology, attempting suicide, site of enrollment, and increased age. Witnessing violence with a deadly weapon was significantly associated with alcohol and drug use but not with high-risk sexual behaviors. As this was one of the first studies on the prevalence and correlates of violence exposure among racial/ethnic minority YMSM living with HIV, the findings can be used to inform the development of culturally appropriate resilience-focused interventions to address the aftereffects of violence exposures and help develop social support systems outside of the family.

The mental health impact of abusive adolescent dating relationships has not been well described, but fear related to abuse has been reported. We elaborate the theme of fear in women's descriptions of a history of adolescent dating abuse. A sample of community-based women, ages 19-34, who experienced an abusive dating relationship during adolescence (ages 11-20) was used. Data were analyzed via thematic analysis. Fear was a consistent and resonant theme. Three types of fear were identified: fear for self, fear for other relationships, and fearful expectation. These results offer important insights into the impact of abusive adolescent relationships on women's mental health.

Objectives: The purpose of this study was to assess the applicability of a simple mathematical formula for prediction of individual child linear growth. The formula describes a square root dependence of height on age with only two constants, k and C., Methods: Retrospective serial height measurements of 137 healthy children (61 female), who attended clinic in the Pediatrics Department at the University of California, San Francisco were used. For each child, two of the initial measurements and their corresponding measurement times were used to determine the values of k and C. By substituting the determined values of k and C into the formula, the formula was then used to predict the trajectory of the child's growth., Results: The 137 children were comprised of 20% Hispanic, 23% African-American, 27% Caucasian and 30% Asian. The formula predicted growth trajectories of 136 out of the 137 children with minimal discrepancies between the measured data and the corresponding predicted data. The mean of the discrepancies was 0.8 cm., Conclusions: Our proposed formula is very easy to use and predicts individual child growth with high precision irrespective of gender or ethnicity. The formula will be a valuable tool for studying human growth and possibly growths of other animals., (Copyright © 2013 Wiley Periodicals, Inc.)

The HIV epidemic in the United States has disproportionately affected young racial/ethnic minority men who have sex with men (YMSM). However, HIV testing rates among young men of color remain low. Within this sample of racial/ethnic minority YMSM (n = 363), the first HIV test was a median of 2 years after men who have sex with men sexual debut. Individuals with less than 1 year between their first negative and first positive HIV test were significantly more likely to identify the reason for their first negative test as being sick (OR = 2.99; 95 % CI 1.23-7.27). This may suggest that these YMSM may have experienced symptoms of acute HIV infection. Of major concern is that many YMSM in our study tested positive for HIV on their first HIV test. Given recommendations for at least annual HIV testing, our findings reveal that medical providers YMSM need to know the importance of regular testing.

The average reported age of sexual debut for youth in the United States is 14.4 years, with approximately 7% reporting their sexual debut prior to age 13. While the research literature on sexual debut for youth addresses gender and ethnic differences (with males and African-American youth experiencing earlier sexual debut), there is limited data regarding factors associated with sexual debut for young men who have sex with men (YMSM). Early sexual debut poses potential health risks, such as contracting HIV with an increased risk of unprotected intercourse. Given current high HIV infection rates for racial/ethnic minority YMSM, learning more about their sexual debuts and associated risk factors of this population is of great importance. This study investigated risk behaviors and emotional distress, and their association with MSM sexual debut for a multisite cohort of racial/ethnic minority YMSM living with HIV. We hypothesized that a MSM sexual debut younger than age 16 would be associated with engagement in more high-risk sexual behaviors (unprotected sex and exchange sex), substance use, and emotional distress than a MSM sexual debut at age 16 or older. Results indicated that participants having a MSM sexual debut before the age of 16 reported more exchange sex; drug use (specifically marijuana); emotional/psychological problems related to substance use; and a history of suicide attempts, compared to participants with later MSM sexual debuts. Comprehensive interventions that are racially/ethnically sensitive, inquire about initial sexual experiences, and focus on sexual health and healthy relationships are needed to improve health outcomes for this population.

Aims: Adolescent dating abuse is not specifically described by any current nursing theory, and this article presents discussion of some existing theories that could inform a nursing theory of adolescent dating abuse. To account for the effects of gender, this discussion is limited to young women., Background: Adolescent dating abuse is an important and understudied international issue for nursing. Theoretical frameworks can support development of nursing scholarship for such issues. No single theory yet exists in nursing to explain the experiences and health ramifications of dating abuse among young women., Data Sources: A summary table of theories is provided. Literature was gathered via database search and bibliographic snowballing from reference lists of relevant articles. Included literature dates from 1982 through 2010., Discussion: Theories of relationship formation and function are discussed, including attachment, investment, feminist and gender role conflict theories. Betrayal trauma theory is considered as a mechanism of injury following an abusive dating experience., Implications for Nursing: Gender, relationship and adolescence combine in a complex developmental moment for young women. To improve nursing care for those at risk for or in the throes of abusive relationships, it is critical to develop specific nursing approaches to understanding these relationships., Conclusion: Existing theories related to relationship and traumatic experiences can be combined in the development of a nursing theory of adolescent dating abuse among young women., (© 2011 The Authors. Journal of Advanced Nursing © 2011 Blackwell Publishing Ltd.)

Purpose: Intertemporal tradeoffs characterize the decision to use drugs: pleasure now traded off against the possibility of pain later. Traditional approaches have examined whether individuals use drugs because they either seek immediate benefit or fail to appreciate long-term risk. We asked whether risk taking might also result from failing to appreciate benefits. We refer to this as risk in the benefits (RIBs), an understanding that one's first drug experience can be so good, that a person may not want (or be able) to stop, putting him/her on a path that leads directly to addiction., Methods: In total, 304 participants, 160 adolescents and 144 young adults, participated in a longitudinal study on marijuana use and other risky health behaviors., Results: The failure to perceive the RIBs of marijuana use led to increased risk taking 1 year later within 3 different health behaviors: alcohol, tobacco, and sexual risk-taking. Greater appreciation of RIBs predicted significantly less future risk taking over-and-above all the traditional cognitive and behavioral predictors, and RIBs were the only significant cognitive predictor when all were included in 1 model. RIBs also partially mediated the relationship between past and future risk taking, over and above the strongest predictors of risk taking., Conclusions: Failing to appreciate the impact of short-term benefits within the context of long-term risk increased future risk taking. Interventions that enhance the salience of RIBs may represent a new approach to reducing the likelihood that individuals will take risks with their health.

This study sought to describe clinician practices for the management of amenorrhea in the adolescent and young adult athlete. Clinicians adhered to certain guidelines but did not have a uniform "standard of care" for amenorrheic athletes. Almost 80% of clinicians reported insufficient guidelines for the management of this population.

This study used conditional risk assessments to examine the role of behavioral experiences in risk judgments. Adolescents and young adults (ages 10-30; N = 577) were surveyed on their risk judgments for natural hazards and behavior-linked risks, including their personal experiences with these events. Results indicated that participants who had experienced a natural disaster or engaged in a particular risk behavior estimated their chance of experiencing a negative outcome resulting from that event or behavior as less likely than individuals without such experience. These findings challenge the notion that risk judgments motivate behavior and instead suggest that risk judgments may be reflective of behavioral experiences. The results have implications for health education and risk communication.

Objective: To determine whether pediatricians in managed care settings adhere to national guidelines concerning the provision of clinical preventive services., Design: Surveys were mailed between September 1996 and April 1997 to all pediatricians practicing in a California group-model health maintenance organization. The survey asked pediatricians about their screening and education practices on 34 recommended services and the actions taken with adolescent patients who have engaged in risk behavior., Results: The response rate was 66.2% (N = 366). Pediatricians, on average, screened 92% of their adolescent patients for immunization status and blood pressure; 85% for school performance; 60% to 80% for obesity, sexual intercourse, cigarette use, alcohol use, drug use, and seat belt and helmet use; 30% to 47% for access to handguns, suicide, eating disorders, depression, and driving after drinking alcohol; fewer than 20% for use of smokeless tobacco, sexual orientation, sexual and physical abuse, and riding a bike or swimming after drinking alcohol; and 26% to 41% for close friends' engagement in risk behavior. Pediatricians' assessment and education with adolescent patients who screened positive for risk behavior was particularly low. Female physicians, physicians who saw a greater proportion of older adolescents, and recent medical school graduates were more likely to provide preventive services., Conclusions: Pediatricians in this health maintenance organization provide preventive services to adolescent patients at rates below recommendations but at rates greater than physicians in other practice settings. Improvement is especially needed in the areas that contribute most to adolescent mortality and for patients who screen positive for a risk behavior.

This observational study examined the development and use of communication in a pair of deaf and hearing monozygotic twins from 13 months of age until 36 months of age. One twin contracted meningitis at 7 months, leaving her profoundly deaf but without other measurable sequelae. The other twin is normal in all respects. The prelingual twins were enrolled in a total communication preschool program where, with their parents, they participated in activities designed to enhance the language skills of deaf children. The twins were videotaped monthly, first at their preschool program and later at home. All forms of communication were recorded, including signs, vocalizations, and hand and body gestures. Additionally, eye gaze direction and body positions during communication were noted. Comparisons between the deaf and hearing twins showed that although both children were able to learn language and communicate successfully, the hearing twin preferred a vocal form of language, whereas the deaf twin used mostly sign language. Moreover, the hearing twin's communication was usually responsive, while the deaf twin's communication was comprised mostly of imitative signs and gestures. Methods of teaching a profoundly deaf child to communicate are discussed.