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Objective: Sugary drink consumption is associated with adverse health outcomes in children, highlighting the need for scalable family interventions that address barriers to water consumption. To inform development of a scalable, health-care-system-based intervention targeting family beverage choice, a formative qualitative study was conducted using semi-structured interviews with parents whose children were identified as over-consuming sugar-sweetened beverages (SSB) and/or fruit juice (FJ). The first goal of these interviews was to understand, in a diverse real-world patient population, what parents viewed as the primary drivers of their family’s beverage choices, and explore how these drivers might need to be addressed in order to make changes to beverage consumption. A second goal was to explore parental preferences for planned intervention components. An exploratory goal of the interviews was to examine whether knowledge, attitudes, and beliefs around family beverage choice differed across racial and ethnic groups in this sample. Design: Semi-structured phone interviews were conducted and interviews audio-recorded and transcribed. Participants: 39 parents/caregivers of children ages 1–8 who over-consumed sugary drinks as determined by screenings at pediatric visits. Phenomenon of Interest: Parents were interviewed about family beverage choices and preferences to inform development of a multi-component intervention. Analysis: Thematic analysis was performed, including comparison of themes across racial/ethnic groups. Results: Parents expressed that sugary drinks were unhealthy and water was a better alternative. Most were familiar with the health consequences of excess sugar consumption. They identified many reasons why sugary drinks are chosen over water despite this knowledge. One common reason was concern about tap water safety. Few differences were noted across racial and ethnic groups in our sample. Parents were enthusiastic about a technology-based intervention to be delivered through their child’s doctor’s office. Conclusions and Implications: Knowledge is not enough to change behavior. Beverage interventions need to be easy to access, make water more appealing, and elevate beverage choice above the “white noise” of everyday life. Delivering an intervention in a clinical setting could provide an extra level of care, while technology would reduce the amount of live contact and decrease the burden for clinicians and parents.

Many adolescents and young adults hold erroneous beliefs that cigarillos and waterpipe tobacco (WT) are safer than cigarettes, contributing to use. Communication campaigns can correct misperceptions and increase risk beliefs. We tested point-of-sale (POS) communication campaigns focused on chemical exposure for cigarillos and WT. We conducted two cluster randomized trials at 20 gas stations with convenience stores (10 stores for cigarillos, 10 for WT) in North Carolina between June and November 2017. Within each trial, stores were randomly assigned to either the intervention (campaign messages displayed) or a no message control condition. We conducted intercept surveys with repeated cross-sectional samples of 50 adolescents and young adults (ages 16-25) per store, at baseline and follow-up. There were 978 participants (mean age = 20.9 years) in the cigarillo trial, and 998 participants (mean age = 21.0 years) in the WT trial. Rates of campaign exposure were low (26% for cigarillos; 24.3% for WT). The cigarillo campaign increased knowledge that ammonia is in cigarillo smoke (

Background Given excellent survival outcomes in breast cancer, there is interest in de‐escalating the amount of chemotherapy delivered to patients. This approach may be of even greater importance in the setting of the COVID‐19 pandemic. Methods This concurrent mixed methods study included (1) interviews with patients and patient advocates and (2) a cross‐sectional survey of women with breast cancer served by a charitable nonprofit organization. Questions evaluated interest in de‐escalation trial participation, perceived barriers/facilitators to participation, and language describing de‐escalation. Results Sixteen patient advocates and 24 patients were interviewed. Key barriers to de‐escalation included fear of recurrence, worry about decision regret, lack of clinical trial interest, and dislike for focus on less treatment. Facilitators included trust in physician recommendation, toxicity avoidance, monitoring for progression, perception of good prognosis, and impact on daily life. Participants reported that the COVID‐19 pandemic made them more likely to avoid chemotherapy if possible. Of 91 survey respondents, many (43%) patients would have been unwilling to participation in a de‐escalation clinical trial. The most commonly reported barrier to participation was fear of recurrence (85%). Few patients (19%) considered clinical trials themselves as a barrier to de‐escalation trial participation. The most popular terminology describing chemotherapy de‐escalation was “lowest effective chemotherapy dose” (53%); no patients preferred the term “de‐escalation.” Conclusions Fear of recurrence is a common concern among breast cancer survivors and patient advocates, contributing to resistance to de‐escalation clinical trial participation. Additional research is needed to understand how to engage patients in de‐escalation trials., Over 40% of patients would not be interested in participating in clinical trials testing de‐escalation, with the most common barriers being fear of recurrence. Common facilitators included toxicity avoidance, trust in the physician, and use of patient‐centric language to describe the trial.

Introduction: Given excellent survival outcomes in breast cancer and new methods to predict treatment response, oncologists are interested in de-escalating the amount of chemotherapy delivered to patients. This is particularly important in the setting of COVID-19, where patient perspectives of de-escalation may be altered by perception of COVID-19 risk.Methods: This concurrent mixed methods study included (1) semi-structured interview data from patients with breast cancer treated at the University of Alabama at Birmingham and patient advocates from nationally representative advocacy organizations (10/2019-5/2020) and (2) cross-sectional survey data from a nationwide sample of women with breast cancer (11/19-12/2019). Questions evaluated interest in de-escalation study participation, perceived barriers/facilitators to participation, and language describing de-escalation. Participant perspectives surrounding COVID-19 impact on de-escalation were elicited in interviews post 3/2020.Results: Quantitative and qualitative findings were synergistic. Interviews were conducted with 40 female participants (24 patients, 16 patient advocates). Participant ages ranged from 33-79 years old; 30% were minorities; 35% didn’t have a college degree. Common barriers to acceptance of de-escalation included fear of recurrence, worry about decision regret, lack of clinical trial interest, and dislike for the focus on less treatment. Fear of recurrence was the most commonly expressed barrier, with one participant stating, “I’m just afraid it wouldn’t get it all”. Common facilitators included trust in the physician, toxicity avoidance, monitoring with the option of increasing treatment intensity, perception of good prognosis, and impact on daily life. Participants interviewed during the COVID-19 pandemic (n=16) expressed substantial virus-related fear, including fear of exposure, fear of infecting their personal contacts or health care team, fear of cancer-related complications, and fear about their immunocompromised state. These fears contributed to participants perspective on de-escalation, as highlighted by participants stating, “I wouldn't worry about getting the chemo as much as I would worry about getting the virus” and “Less is more for me right now”.Of 91 survey respondents (69% response rate), median age was 58 years (interquartile range [IQR] 48-69), 86% had early stage breast cancer. Many (43%) patients were not interested in participation in a study testing lower doses of chemotherapy than standard of care. Patients not interested in participating were more often unmarried (55% vs. 32%, V=.23), disabled (56% vs. 40%, V=.17), or diagnosed with early stage cancer (45% vs. 22%, V=.14). Barriers to participation included fear of cancer recurrence (85%) and regret about the decision to receive less chemotherapy if the cancer were to recur (79%). Few patients (19%) considered clinical trials themselves as a barrier. Patients were interested in participation due to lessened physical side effects of treatment (82%), lessened long-term problems related to treatment (76%), and lessened impact on daily life (72%). The most popular terminology describing chemotherapy de-escalation was “lowest effective chemotherapy dose” (53%); no patients preferred the term “de-escalation.” Conclusion: Fear of recurrence is a common barrier to de-escalation clinical trial participation in patients with breast cancer. Fears may be altered for patients considering treatment during the COVID-19 pandemic. Trust in the physician and use of patient-generated language, such as “customized” instead of “de-escalation”, are potential areas for future interventions engaging patients in trials. Citation Format: Gabrielle Rocque, Courtney P. Williams, Courtney J. Andrews, Kathleen Gallagher, Timothy C. Childers, Kimberly D. Wiseman, Alan Balch, Stacey A. Ingram, Thelma Brown, Tara Kaufman, Nadine Tung, Mary Lou Smith, Antonio C. Wolff, Angela DeMichele, Lynn Wagner. Patient perspectives on chemotherapy de-escalation: “Don’t de-escalate! I don’t want to die!” [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PD3-10.

Background Little is known about the prevalence of adverse symptoms electronic cigarette (e-cigarette) users report experiencing. Methods Between August 2016 and May 2017, we conducted a nationally representative cross-sectional telephone survey of 4964 US adults age 18 and over. Respondents who reported ever trying e-cigarettes were asked whether they ever experienced six symptoms they thought were caused by e-cigarette use. In weighted analyses, we assessed whether symptoms varied by demographics, e-cigarette use frequency, and cigarette smoking status. Results Approximately one-fourth of respondents (n = 1,624, 26.8%) reported ever trying e-cigarettes. Most were current (40.3%) or former (30.7%) cigarette smokers, with 29.0% never smokers. Just over half (58.2%) reported at least one symptom and on average 1.6 (SE = 0.1) symptoms. Symptoms included cough (40.0%), dry or irritated mouth or throat (31.0%), dizziness or lightheadedness (27.1%), headache or migraine (21.9%), shortness of breath (18.1%), change in or loss of taste (12.9%), or other (6.2%; most commonly nausea, tight chest, congestion). Among past 30-day e-cigarette users, current and never cigarette smokers were more likely than former smokers to report any symptoms (AOR = 5.25, CI = 2.05–13.46 and AOR = 2.58, CI = 0.85–7.81, respectively). Conclusions A majority of e-cigarette users reported at least one symptom, most commonly cough or dry or irritated mouth or throat. Former cigarette smokers who used e-cigarettes in the past 30 days were less likely than current or never smokers to report adverse symptoms of e-cigarette use. Future research should examine frequency of symptoms among different user groups to understand how e-cigarettes may influence public health.

Background As the combination of systemic and targeted chemotherapies is associated with severe adverse side effects and long-term health complications, there is interest in reducing treatment intensity for patients with early stage breast cancer (EBC). Clinical trials are needed to determine if it is feasible to reduce treatment intensity while maintaining 3-year recurrence-free survival of greater than 92%. In order to recruit patients for de-implementation trials, it is important to understand patient perspectives on barriers and facilitators to reducing treatment intensity. Methods We collected qualitative interview data from patients with Stage II-III breast cancer (N=24) and patient advocates (N=16). Interviews explored interest in de-implementation trial participation and identified potential barriers and facilitators to participation. 17 participants were asked about the potential impact of COVID-19 on de-implementation efforts. Interviews were audio-recorded and transcribed, and researchers used qualitative content analysis (NVIVO and Atlas.ti) to code for dominant themes. Results 17 participants (42.5%) expressed interest in participating in a trial of reduced chemotherapy. Barriers to reducing chemotherapy included (1) fear of recurrence and inefficacy, (2) preference for aggressive treatment, (3) disinterest in clinical trials, (4) lack of information about expected outcomes, (5) fear of regret, and (6) having young children. Facilitators included (1) avoiding physical toxicity, (2) understanding the scientific rationale of reducing chemotherapy, (3) confidence in providers, (4) consistent monitoring and the option to increase dosage, (5) fewer financial and logistical challenges, and (6) contributing to scientific knowledge. Of those asked, nearly all participants said they would be more motivated to reduce treatment intensity in the context of Covid-19, primarily in order to avoid exposure to the virus while receiving treatment. Conclusions We recommend framing de-implementation strategies and recruitment to trials in terms of customizing treatment to the individual patient and added benefit—reduced toxicities, higher quality of life during treatment and lower risk of long-term complications—rather than in terms of taking treatments away or doing less than the standard of care. Doctor-patient rapport and provider support will be crucial in this process.

Adolescents and young adults smoke waterpipe tobacco (WT) and cigarillos, at least in part, based on erroneous beliefs that these products are safer than cigarettes. To address this challenge, we used a systematic, three-phase process to develop a health communication campaign to discourage WT and cigarillo smoking among at-risk (tobacco users and susceptible non-users) 16- to 25-year-olds. In Phase 1, we used a national phone survey (N = 896) to determine salient message beliefs. Participants reported constituents (i.e., harmful chemicals) emitted by the products were worrisome. In Phase 2, we developed and evaluated four message executions, with varying imagery, tone, and unappealing products with the same constituents, using focus groups (N = 38). Participants rated one execution highly, resulting in our development of a campaign where each message: (1) identified a tobacco product and constituent in the smoke; (2) included an image of an unappealing product containing the constituent (e.g., pesticides, gasoline) to grab attention; and (3) used a humorous sarcastic tone. In Phase 3, we tested the campaign messages (17 intervention and six control) with a nationally representative online survey (N = 1,636). Participants rated intervention and control messages highly with few differences between them. Exposure to messages resulted in significant increases in all risk beliefs from pre to post (p 0.05). For WT, intervention messages increased beliefs about addiction more than control messages (p 0.05). This systematic, iterative approach resulted in messages that show promise for discouraging WT and cigarillo use.

OBJECTIVES: To inform targeted prevention efforts, it is important to understand which tobacco products are used first and associations by demographic characteristics. METHODS: We conducted a nationally-representative random digit-dial telephone survey of 1125 adolescents ages 13-17. Adolescents reported the first tobacco product they tried, and we analyzed associations with demographic variables. RESULTS: Two-hundred nineteen (18.6%) adolescents reported ever using a tobacco product. The most common first product tried was cigarettes (35.4%), followed by electronic nicotine delivery systems (24.3%), smokeless tobacco (17.7%), cigars (11.4%), and waterpipe (11.2%). Weighted multivariable logistic regression analyses showed girls were 2.7 times more likely than boys to report cigarettes as their first product, Hispanic/Latinos were 5.0 times more likely than non-Hispanic/Latinos to report cigarettes, and those whose mothers had at least a 4-year college degree were 6.1 times more likely to report waterpipe compared to those whose mothers had less than a 4-year college degree. CONCLUSIONS: Nearly one in 5 adolescents had tried a tobacco product. Although cigarettes were the most frequently reported product, most youth initiated with a non-cigarette tobacco product, and demographic differences were found. These findings point towards potential regulatory policies, including targeted campaigns, which might deter adolescents from initiating tobacco use.

Cigarillo use has increased among adolescents and young adults and has remained high. Public education efforts are needed to communicate with these populations about cigarillo use risks, but little is known about the implications of using the term “cigarillo” in such efforts. The study goal was to assess adolescent and young adult perceptions of the term “cigarillo”. We conducted a nationally representative online survey of 3517 adolescents and young adults (ages 13–25). We asked participants “what is a cigarillo?” with several response options. Participants were 49.6% female, 69.8% white, 5.2% reported past 30-day cigarillo use, and 11.6% reported lifetime cigarillo use. The most common response to the question “what is a cigarillo” was “I don’t know” (51% of participants), followed by “a thinner and smaller version of a traditional cigar” (30.1% of participants), which was chosen by 19.4% of adolescents and 36.8% of young adults. Among past 30-day cigarillo users, the most common response was “I don’t know” (54.9%) followed by “a thinner and smaller version of a traditional cigar” (45.1%). Cigarillo users were more likely to select the “a thinner and smaller version of a traditional cigar” response than nonusers. Findings suggest that many adolescents and young adults have varied understandings of the term “cigarillo”. Researchers and practitioners need to ensure that terminology used in health communication campaigns is clearly understood by the target audience to maximize effectiveness.

Introduction Most studies have assessed use of "e-cigarettes" or "electronic cigarettes," potentially excluding new electronic nicotine delivery systems (ENDS), such as e-hookahs and vape pens. Little is known about how adolescents and young adults perceive ENDS and if their perceptions vary by sub-type. We explored ENDS perceptions among these populations. Methods Ten focus groups with 77 adolescents and young adults, ages 13-25, were conducted in spring 2014. Participants were users or susceptible nonusers of novel tobacco products. Focus group transcripts were coded for emergent themes. Results Participants reported positive ENDS attributes, including flavor variety; user control of nicotine content; and smoke trick facilitation. Negative attributes included different feel compared to combustible cigarettes, nicotine addiction potential, and no cue to stop use. Participants perceived less harm from ENDS compared to combustible cigarettes, perhaps due to marketing and lack of product regulation, but noted the uncertainty of ingredients in ENDS. Numerous terms were used to describe ENDS, including "e-cigarette," "e-hookah," "hookah pens," "tanks," and "vapes." Although no clear classification system emerged, participants used product characteristics like nicotine content and chargeability to attempt classification. Perceptions differed by product used. E-hookah users were perceived as young and trendy while e-cigarette users were perceived as old and addicted to nicotine. Conclusions Young adults and adolescents report distinct ENDS sub-types with varying characteristics and social perceptions of users. Although they had more positive than negative perceptions of ENDS, prevention efforts should consider highlighting negative attributes as they may discourage use and product trial among young nonusers. Implications Our study underscores the need for a standardized measurement system for ENDS sub-types and additional research on how ENDS sub-types are perceived among adolescents and young adults. In addition, our findings highlight negative product attributes reported by participants that may be useful in prevention and regulatory efforts to offset favorable marketing messages.

Background E-cigarettes are the most prevalent tobacco product among US youth, but little is known about the health symptoms users experience. Methods Between August 2016 and May 2017, we conducted a nationally representative cross-sectional telephone survey of 975 US youth ages 13–17. Respondents who reported ever trying e-cigarettes were asked whether they ever experienced six physical health symptoms they thought were caused by e-cigarette use. We examined whether symptoms varied by demographics and tobacco use. Results Approximately 12.4% of respondents (n = 141) reported ever trying e-cigarettes. Of lifetime e-cigarette users, 37.0% reported past 30-day e-cigarette use, 17.2% reported past 30-day cigarette use, and 23.7% reported past 30-day use of another tobacco product. Most (63.3%) reported a symptom, most often cough (42.3%), followed by dizziness or lightheadedness (31.5%), headache or migraine (25.4%), dry or irritated mouth or throat (14.9%), shortness of breath (13.7%), change in or loss of taste (3.5%), and other (5.7%; nausea, dry eyes, earache, and tight chest). Headaches were more common among past 30-day e-cigarette users than non-users (43.8% vs. 14.6%). Shortness of breath was more common among past 30-day cigarette (33.8% vs. 9.5%) and other tobacco users (31.6% vs. 8.2%). Past 30-day cigarette users were also more likely to report any symptom (86.0% vs. 58.6%). Conclusions Most youth e-cigarette users attribute health symptoms to their e-cigarette use. Past 30-day users were more likely to report certain symptoms than non-users. Findings can educate health practitioners and school nurses about common symptoms youth may experience and inform prevention messages.

Purpose Electronic nicotine delivery systems (ENDS) are adolescents’ most commonly used tobacco product and young adults’ second most used. Little is known about ENDS use alongside other tobacco products (polytobacco use) and whether exclusive ENDS users differ from polytobacco ENDS users. Methods In spring 2016, we surveyed a nationally representative sample of 3,517 13–25-year olds (36.9% 13–17-year olds), and examined sociodemographic and relative risk perceptions between two groups of past 30-day ENDS users: exclusive (only ENDS) and polytobacco (ENDS and at least one other tobacco product). Results 4.5% of adolescents and 10% of young adults reported past 30-day ENDS use (n = 281; analytic sample). ENDS users were 38.8% female and 70.6% white. Over half (55.9%) were polytobacco ENDS users. The most common patterns of polytobacco ENDS use were ENDS and cigarettes (11.5%), ENDS and cigars (7.7%), and ENDS, cigars, and waterpipe (5.2%). Those who perceived ENDS to be less harmful than cigarettes were more likely to be exclusive ENDS users than those who perceived ENDS to be as or more harmful than cigarettes (adjusted odds ratio = 2.6, confidence interval = 1.2, 5.7). There were no differences between ENDS groups on age, race, sex, parental education, sexual orientation, or ENDS use frequency. Conclusions Just over half of ENDS users also used other tobacco products, increasing their risk for nicotine addiction and other health harms. The Food and Drug Administration is responsible for communicating product risk to consumers and should consider common patterns of use and relative risk perceptions in its ENDS public education efforts.

Waterpipe tobacco (WT) smoking remains a significant public health problem. However, few validated measures exist, presenting challenges for obtaining accurate prevalence estimates and making comparisons across studies. We identified items used to measure several WT smoking behaviors in eight U.S. national surveys of youth and adults and two international studies, including the National Youth Tobacco Survey (NYTS), National Adult Tobacco Survey (NATS), Population Assessment of Tobacco and Health (PATH) Adult and Youth Surveys, Monitoring the Future (MTF), National Health Interview Survey (NHIS), Health Styles, Tobacco Use Supplement: Current Population Survey (TUS-CPS), Global Adult Tobacco Survey (GATS), and Global Youth Tobacco Survey (GYTS). We also identified WT survey items across the first 14 FDA-funded Tobacco Centers of Regulatory Sciences (TCORS). Constructs included product description and terminology, ever and current use, quantity and frequency, use of flavors, and reasons for use. There was little consistency in WT measurement, highlighting the need for validated measures.

Three experiments explored how hypocrisy affects attributions of criminal guilt and the desire to punish hypocritical criminals. Study 1 established that via perceived hypocrisy, a hypocritical criminal was seen as more culpable and was punished more than a non-hypocritical criminal who committed an identical crime. Study 2 expanded on this, showing that negative moral emotions (anger and disgust) mediated the relationships between perceived hypocrisy, criminal guilt, and punishment. Study 3 replicated the emotion finding from Study 2 using new scenarios where group agents were clearly aware of the hypocrisy of their actions, yet acted anyway. Again, perceived hypocrisy worked through moral emotions to affect criminal guilt and punishment. The current studies provide empirical support for theories relating hypocrisy and moral transgressions to moral emotions, also informing the literature on the role of moral emotions in moral reasoning and legal decision making.

BACKGROUND/STUDY CONTEXT: This study investigated age-related differences in memory for crime information. Older adults have been found to rely more than young adults on schema- and stereotype-based processing in memory, and such age differences may have implications in the criminal justice system. Some prior research has examined schema-based processing among older adults in legal settings, but no studies have tested for schema effects on older adults' memory for specific details of a crime.Older adults (N = 56, ages 65-93) and young adults (N = 52, ages 18-22) read a passage about a criminal suspect's "bad" or "good" childhood, and then read a crime report containing incriminating, exonerating, and neutral details with regard to the suspect. Participants were subsequently tested on recognition of accurate versus altered details from the crime report. Participants also rated the suspect"s guilt, and completed a battery of neuropsychological tests. Correct and false recognition rates were analyzed with ANOVA to compare means across age group, evidence type, and background type, and guilt ratings were analyzed with linear regression using neuropsychological scores as predictors.Among older adults, an interaction was found between evidence type (incriminating/exonerating) and suspect's background (good/bad childhood) in false recognition of altered details from the crime report, supporting the hypothesis that schema-based processing influenced older adult memory from crime information. Additionally, although guilt ratings were not related to the suspect's background for either age group, they were predicted by older adults' short-delay recall (β = -.37), suggesting that cognitive decline may play a role in older adults' interpretations of evidence.The findings suggest reduced cognitive capacity in older adults increases schema-based processing in memory for crime information, and are consistent with research in other domains that has demonstrated greater schema effects in memory with aging. The results may have implications for criminal justice, and open up possibilities for further research on how young and older adults may differ in memory for specific types of crime information.

Use of hookah and little cigars/cigarillos (LCCs) is high among adolescents and young adults. Although these products have health effects similar to cigarettes, adolescents and young adults believe them to be safer. This study examined adolescent and young adult perceptions of hookah and LCCs to develop risk messages aimed at discouraging use among users and at-risk nonusers. Ten focus groups with 77 adolescents and young adults were conducted to explore their perceptions about the perceived risks and benefits of hookah and LCC use. Participants were users of other (non-cigarette) tobacco products (n = 47) and susceptible nonusers (n = 30). Transcripts were coded for emergent themes on participants' perceptions of hookah and LCCs. Participants did not perceive health effects associated with hookah and LCC use to be serious or likely to happen given their infrequency of use and perceptions that they are less harmful than cigarettes. Participants generally had positive associations with smoking hookah and LCCs for several reasons, including that they are used in social gatherings, come in various flavors, and can be used to perform smoke tricks. Because adolescents and young adults underestimate and discount the long-term risks associated with hookah and LCC use, effective messages may be those that focus on the acute/immediate health and cosmetic effects.

Introduction Novel tobacco products, such as little cigars, cigarillos, hookah, and e-cigarettes, and their smoke or aerosol contain chemicals which the FDA has determined to be Harmful or Potentially Harmful Constituents. We explored adolescents' and young adults' knowledge and beliefs about constituents in novel tobacco products and their smoke or aerosol, in order to inform risk communication messages. Methods Seventy-seven adolescents and young adults (ages 13-25) participated in 10 focus groups, including 47 novel tobacco product users and 30 susceptible nonusers. Participants were asked to discuss 10 pre-selected constituents found in novel tobacco products and their smoke or aerosol. The first author analyzed the discussion for emergent themes. Results Participants were generally familiar with arsenic, carbon monoxide, formaldehyde, and nicotine, but unfamiliar with acetaldehyde, acrolein, 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanon (NNK), and N-nitrosonornicotine (NNN). All participants had negative beliefs about most constituents, although users had positive beliefs about nicotine. "Unfamiliar" constituents were associated with similarly-sounding words (eg, acetaldehyde sounds like acetaminophen), and some participants recognized words in the chemical names of NNK/NNN (eg, "nitro"). "Familiar" constituents were associated with negative health effects and other common products the constituents are found in. All participants wanted more information about the constituents' health effects, toxicity, and other common products. Most participants were unaware the constituents discussed are in novel tobacco products and their smoke or aerosol. Conclusions Risk communication messages could capitalize on negative associations with familiar constituents, or attempt to educate about unfamiliar constituents, to discourage novel tobacco product use among adolescents and young adults. Implications The results of this study have implications for how the FDA and other agencies can communicate about the risks of novel tobacco products to the general public, which will be particularly important once the Deeming Rule is finalized. Our findings suggest it may be effective to capitalize on the public's negative beliefs about and associations with familiar constituents, or to educate about unfamiliar constituents and their health effects, their concentration and toxicity in novel tobacco products and their smoke or aerosol, and other products they are found in.

Most studies have assessed use of "e-cigarettes" or "electronic cigarettes," potentially excluding new electronic nicotine delivery systems (ENDS), such as e-hookahs and vape pens. Little is known about how adolescents and young adults perceive ENDS and if their perceptions vary by sub-type. We explored ENDS perceptions among these populations.Ten focus groups with 77 adolescents and young adults, ages 13-25, were conducted in spring 2014. Participants were users or susceptible nonusers of novel tobacco products. Focus group transcripts were coded for emergent themes.Participants reported positive ENDS attributes, including flavor variety; user control of nicotine content; and smoke trick facilitation. Negative attributes included different feel compared to combustible cigarettes, nicotine addiction potential, and no cue to stop use. Participants perceived less harm from ENDS compared to combustible cigarettes, perhaps due to marketing and lack of product regulation, but noted the uncertainty of ingredients in ENDS. Numerous terms were used to describe ENDS, including "e-cigarette," "e-hookah," "hookah pens," "tanks," and "vapes." Although no clear classification system emerged, participants used product characteristics like nicotine content and chargeability to attempt classification. Perceptions differed by product used. E-hookah users were perceived as young and trendy while e-cigarette users were perceived as old and addicted to nicotine.Young adults and adolescents report distinct ENDS sub-types with varying characteristics and social perceptions of users. Although they had more positive than negative perceptions of ENDS, prevention efforts should consider highlighting negative attributes as they may discourage use and product trial among young nonusers.Our study underscores the need for a standardized measurement system for ENDS sub-types and additional research on how ENDS sub-types are perceived among adolescents and young adults. In addition, our findings highlight negative product attributes reported by participants that may be useful in prevention and regulatory efforts to offset favorable marketing messages.

Objective This study examined changes in physical activity among Hispanics with diabetes and their families who received an 8-week diabetes self-management intervention. Design A quasi-experimental design was used to conduct a secondary analysis of physical activity data from two intervention studies that used the same protocols and measures. Sample A total of 65 patients and 66 family members participated in the studies. Measures Physical activity was measured with the International Physical Activity Questionnaire (IPAQ) and pedometers. Self-report of physical activity was collected pre- and postintervention, and pedometer data for the 8 weeks of the intervention period. Intervention The interventions consisted of 8 weeks of educational sessions. Results IPAQ walking Metabolic Equivalent of Task (MET)-minutes per week significantly increased for patients (p