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Background Breakthrough infections of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) are well documented. The current study estimates breakthrough incidence across pandemic waves, and evaluates predictors of breakthrough and severe breakthrough infections (defined as those requiring hospitalization). Methods In total, 89 762 participants underwent longitudinal antibody surveillance. Incidence rates were calculated using total person-days contributed. Bias-corrected and age-adjusted logistic regression determined multivariable predictors of breakthrough and severe breakthrough infection, respectively. Results The incidence was 0.45 (95% confidence interval [CI], .38–.50) during pre-Delta, 2.80 (95% CI, 2.25–3.14) during Delta, and 11.2 (95% CI, 8.80–12.95) during Omicron, per 10 000 person-days. Factors associated with elevated odds of breakthrough included Hispanic ethnicity (vs non-Hispanic white, OR = 1.243; 95% CI, 1.073–1.441), larger household size (OR = 1.251 [95% CI, 1.048–1.494] for 3–5 vs 1 and OR = 1.726 [95% CI, 1.317–2.262] for more than 5 vs 1 person), rural versus urban living (OR = 1.383; 95% CI, 1.122–1.704), receiving Pfizer or Johnson & Johnson versus Moderna, and multiple comorbidities. Of the 1700 breakthrough infections, 1665 reported on severity; 112 (6.73%) were severe. Higher body mass index, Hispanic ethnicity, vaccine type, asthma, and hypertension predicted severe breakthroughs. Conclusions Breakthrough infection was 4–25 times more common during the Omicron-dominant wave versus earlier waves. Higher burden of severe breakthrough infections was identified in subgroups.

Introduction Parents/guardians can effectively reduce tobacco smoking and secondhand smoke exposure among youth by adopting and enforcing rules against indoor tobacco smoking (ie, home smoke-free policies). We investigate home smoke-free policies from childhood to adolescence in the United States and across rural, suburban, and urban households. Aims and Methods We analyzed 2019–2020 National Survey of Children’s Health data from n = 5,955 parents of youth aged 0–17, living at home with a tobacco smoker in the United States (U.S). Geographical categories were: rural, suburban, and urban. Home smoke-free policy reflected prohibiting tobacco smoking inside the home. Weighted logistic regressions examined the (1) association between youth age and home smoke-free policies, (2) interaction between geographic category and youth age, and (3) differing associations between youth age and home smoke-free policies by geography. Models controlled for youth race, ethnicity, sex, parental education, household annual income, and home structure. Results Approximately 13.2% of U.S. households with a smoker did not have a home smoke-free policy. Stratified analyses found one-year increase in youth age was associated with lower odds of having a home smoke-free policy in rural (aOR:0.91; 95%CI: 0.87–0.95) and urban (aOR: 0.96; 95%CI: 0.92–1.00; p = .039), but not suburban (aOR:1.00; 95%CI: 0.95–1.05) households, controlling for covariates. Conclusion Odds of having a smoke-free home in the U.S. declined significantly in rural (9% per year) and urban (4%) but not suburban (0%) households. We quantify declines in home smoke-free policies as children age and identify geographic disparities for this environmental determinant of health. Implications Health promotion efforts targeting secondhand smoke prevention is needed, particularly for parents of older youth. Furthermore, there is a clear geographic bias in secondhand smoke exposure among all youth particularly older youth. Tailored interventions are needed to address geographic disparities in secondhand smoke exposure among rural and urban youth.

Background In response to SARS-CoV2 (COVID-19), school districts incorporated remote learning as a mitigation strategy. This study examines the association between classroom setting (ie, on-campus versus remote) and e-cigarette susceptibility or ever use among a sample of Texas public middle school students. Methods Data from n = 985 students enrolled in the CATCH My Breath E-Cigarette Prevention Program trial were collected in Spring 2021. Participants were 6th-grade students in urban Texas. E-cigarette use was examined using the “at-risk” definition described by FDA, indicating either: (1) susceptible never user; or (2) experimental ever use. A multilevel, logistic regression model examined the association between classroom setting and e-cigarette susceptibility/ever use. Covariates included sex, race/ethnicity, academic achievement, household e-cigarette use, perceived school connectedness, and school-level economic status. Models account for nesting within school district. Analyses stratified by race/ethnicity were also conducted. Results Overall, 36.3% of the sample were susceptible never users or ever e-cigarette users. The sample was comprised of 55.0% on-campus and 45.0% remote learners. On-campus learners had greater odds of reporting e-cigarette susceptibility or ever use (aOR: 1.45; p = .014). These findings were observed among Latino (aOR: 1.77; p = .026) and White (aOR: 2.10; p = .099) but not African American/Black (aOR: 0.86; p = .728) youth. Conclusions On-campus learning during the Spring 2021 semester was associated with greater risk for e-cigarette susceptibility or ever use among a diverse sample of 6th-grade students. E-cigarette susceptibility and ever use is a risk factor for progression to long-term e-cigarette use in later adolescence. Implications As school districts prepare to return to on-campus learning in 2022, a focused approach to e-cigarette prevention may be needed to prevent widespread e-cigarette initiation and continued use. Further, study findings demonstrate a need for further research on the school environment as a determinant of e-cigarette use.

Objectives: We examined the association between school connectedness (SC) and e-cigarette susceptibility/ ever use in a diverse sample of Texas 6th graders, with a secondary aim to explore the association stratified by gender and classroom setting (in-person vs remote). Methods: A cross-sectional analysis was conducted of CATCH My Breath baseline data, representing 985 6th -graders from 21 public schools. SC was based on National Longitudinal Study of Adolescent Health measures; e-cigarette susceptibility/ever use was based on the FDA's definition of "at-risk" for long-term use. We conducted multi-level logistic regression analyses.Results: Over half the sample was Hispanic (57.6%), with 36.2% reporting susceptibility/ever use. Lower SC was associated with increased odds of e-cigarette susceptibility/ever use (low SC: aOR: 5.17, 95% CI: 3.54, 7.55; medium SC: aOR: 2.15, 95% CI: 1.44, 2.91; high SC= referent). The association held across gender groups, with low SC girls reporting the highest odds of susceptibility/ever use (aOR: 7.83, 95% CI: 4.51, 13.61). Low SC in- person and remote students were 6 and 4 times, respectively, more likely to report susceptibility/ever use as high SC students (p Conclusion: SC protected against e-cigarette susceptibility/ever use in this sample.

Introduction Young adult cigarette smoking behaviors are complex and dynamic. Emerging research suggests a growing rate of switching from non-menthol to menthol cigarettes. Transitions across cigarette smoking states are not well understood. This research longitudinally explores transitions in cigarette smoking behaviors among 18–29 year olds. Methods We applied a Markov model to data collected biannually for 1542 initially 18–29 year old young adults (mean age: 20.9 years; SD = 2.6) in Texas, who provided 7021 total observations from Fall 2014 to Spring 2017. All participants were past 30 day menthol or non-menthol cigarette smokers at first observation. We examined transitions across three states of cigarette smoking (menthol, non-menthol, and nonsmoking) and compared predictors of each transition, during young adulthood. Results Descriptively, 22.2% of menthol and 14.3% of non-menthol smokers switched products while 25.6% of menthol and 26.0% of non-menthol smokers quit smoking. Among quitters, 20.0% relapsed via menthol and 28.2% relapsed via non-menthol cigarettes. Results from Markov model indicated that Hispanic/Latinos (Hazard Ratio [HR]: 3.69) and Asians (HR: 2.85) were significantly more likely to switch from non-menthol to menthol cigarettes, relative to non-Hispanic whites. Among recent quitters, the use of non-cigarette products was associated with increased risk of relapse via menthol (HR: 1.54) and non-menthol (HR: 1.85) cigarettes. Conclusion A substantial proportion of young adult cigarette smokers transitioned across cigarette smoking states over the course of 2.5 years. Other tobacco use and nicotine dependence were impediments to becoming and remaining a non-smoker. Hispanic/Latinos and Asians, relative to non-Hispanic whites, had greater odds of transitioning from non-menthol smoking to both non-smoking and to menthol smoking. Findings suggest racial/ethnic differences in cigarette smoking transitions during young adulthood. Implications This paper examined multidirectional transitions across cigarette smoking, including switching between menthol and non-menthol cigarettes, among young adults. Results indicate that Hispanic/Latino and Asian young adults are at increased risk of transition to menthol cigarette smoking compared with non-Hispanic white young adults. Findings highlight need for further study of Hispanic/Latino and Asian young adult smoking behaviors.

To examine and compare trends in past 30-day cigarette smoking among adolescents in the US from 2002 to 2019, before and after the onset of the "e-cigarette era" in 2014. Using National Youth Tobacco Survey (NYTS) data from 2002 to 2019, we modeled the prevalence of past 30-day cigarette smoking over time. A total of n = 274,551 (weighted N = 340,403,754) middle and high school students were included in this study. Interrupted time series analyses were used to examine changes in cigarette smoking over time and compare trends in cigarette smoking pre- and post-2014. Models were applied to the full sample and stratified by middle (6th-8th grade) and high school (9th-12th grade). The observed number of current adolescent cigarette smokers post-2014 was compared to the predicted number, given trends in cigarette smoking prevalence observed pre-2014. Among all students, past 30-day cigarette smoking declined by approximately 0.75% per year from 2002 to 2013 (p 0.001). Following a significant drop in prevalence from 2013 to 2014 (1.64%; p 0.001), the decline in past 30-day cigarette smoking slowed significantly to approximately 0.37% per year (p 0.001), from 2015 to 2019. We estimate that the onset of the "e-cigarette era" in 2014 corresponded to over 1.66 million (95% CI: 1.57 m - 1.75 m) more past 30-day cigarette smokers from 2015 to 2019, cumulatively. The rate of decline in past 30-day cigarette smoking prevalence among adolescents observed since 2002 slowed with the onset of the "e-cigarette era" in 2014, providing evidence at a population-level for the "gateway effect."

Understanding the duration of antibodies to the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus that causes COVID-19 is important to controlling the current pandemic. Participants from the Texas Coronavirus Antibody Response Survey (Texas CARES) with at least 1 nucleocapsid protein antibody test were selected for a longitudinal analysis of antibody duration. A linear mixed model was fit to data from participants (n = 4553) with 1 to 3 antibody tests over 11 months (1 October 2020 to 16 September 2021), and models fit showed that expected antibody response after COVID-19 infection robustly increases for 100 days postinfection, and predicts individuals may remain antibody positive from natural infection beyond 500 days depending on age, body mass index, smoking or vaping use, and disease severity (hospitalized or not; symptomatic or not).

Background. Recent data suggest the SARS-CoV-2 Delta (B.1.617.2) variant is more transmissible among children compared to the Alpha (B.1.1.7) variant. The true incidence and longitudinal presence of antibody response to SARS-CoV-2 infection is not known, however. We provided estimates of antibody response using Texas Coronavirus Antibody REsponse Survey (Texas CARES) data, a prospective population-based seroprevalence project designed to assess antibody status over time among the general population throughout the state. Methods. In October 2020 Texas CARES began enrolling adults (aged 20-80 years) and children (aged 5-19 years). Participants were offered a series of three SARS-CoV-2 antibody tests over 6-8 months, or every 2-3 months that includes the immunoassay for detection of antibodies to the SARS-CoV-2 nucleocapsid protein (Roche N-test). Descriptive characteristics and COVID-19 infection-related symptom status was determined by questionnaire at the time of enrollment and prior to each successive blood draw. This analysis included participants ages 5-to-19 years old who have completed all three antibody assessments. Results. From our sample (n=159; mean age 12.5 years, SD 3.6), 96% of those with evidence of nucleocapsid antibodies at baseline assessment continued to have antibodies > six months later (mean 7.0 months, SD 0.97). There was no difference in the presence of antibodies by symptom status (asymptotic versus symptomatic) or severity (mild-moderate versus severe), sex, age group, or body mass index group (underweight, healthy weight, overweight, obesity) over the three antibody measurement timepoints. Conclusions. These results suggest that infection-induced antibodies persist and thus may provide some protection against future infection for at least half a year. 57.9% of the sample were negative for infection-induced antibodies at their third measurement point, suggesting a significant proportion of children have still not acquired natural infection.

Objectives: Purpose of study is to explore the roles religiosity and fatalistic beliefs play in diabetes management among newly, currently, and long-term enrolled Mexican-American participants in a Type 2 diabetes mellitus (T2DM) chronic care management program.Methods: In 2017, study participants (n = 15) completed a semi-structured interview in their preferred language (English or Spanish). Sample was stratified by amount of time individual had been enrolled as a participant of the Salud y Vida program: newly, currently, or long-term. Interviews assessed religious beliefs, beliefs concerning the cause(s) of diabetes, perceived relationship between religiosity and fatalistic beliefs with T2DM management, and the appropriateness of discussing such topics with a health professional. Interview responses were analyzed using ATLAS.ti 8.Results: Themes identified included: perceived autonomy over diabetes prognosis, motivators for self-care, discussions of personal beliefs in the healthcare setting, and the church's role in diabetes management.Conclusions: Among this sample, religiosity and religious fatalism played a complex role in coping with and managing diabetes. Long-term enrolled and male participants expressed beliefs of divine control over health, and a connection between religiosity and health behavior. Long-term enrolled participants felt religious and fatalistic beliefs may be suitable and beneficial to discuss in the healthcare setting.

IntroductionSevere acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and immunity remains uncertain in populations. The state of Texas ranks 2ndin infection with over 2.71 million cases and has seen a disproportionate rate of death across the state. The TX CARES project was funded by the state of Texas to estimate the prevalence of SARS-CoV-2 antibody status in children and adults.Materials and MethodsThe TX CARES (Texas Coronavirus Antibody Response Survey) is an ongoing prospective population-based convenience sample from the Texas general population that commenced in October 2020. Volunteer participants are recruited across the state to participate in a 3-time point data collection TX CARES to assess antibody response over time. We use the Roche Elecsys® Anti-SARS-CoV-2 Immunoassay to determine SARS-CoV-2 antibody status.ResultsThe crude antibody positivity prevalence in Phase I was 26.1% (80/307). The fully adjusted seroprevalence of the sample was 31.5%. Specifically, 41.1% of males and 21.9% of females were seropositive. For age categories, 33.5% of those 18-34; 24.4% of those 35-44; 33.2% of those 45-54; and 32.8% of those 55+ were seropositive. In this sample,42.2% (89/211) of those negative for the antibody test reported having had a COVID-19 test.ConclusionsIn this survey we enrolled and analyzed data for 319 participants, demonstrating a high survey and antibody test completion rate, and ability to implement a questionnaire and SARS-CoV-2 antibody testing within FQHC clinical settings. We were also able to determine our capability to estimate the cross-sectional seroprevalence within Texas’s FQHC clinical settings. The crude positivity prevalence for SARS-CoV-2 antibodies in this sample was 26.1% indicating potentially high exposure to COVID-19 for FQHC clinic employees and patients. These methods are being used to guide the completion of a large longitudinal survey in the state of Texas with implications for practice and population health.

Background Subjective experiences (SEs) at initiation of cigarettes, cigars, and smokeless tobacco have been established as predictors of continued use. To date, less is known about the relationships between SEs at e-cigarette initiation and subsequent e-cigarette use behaviors. Methods This study used data from Waves 1–6 of the Texas Adolescent Tobacco and Marketing Surveillance (TATAMS) system; a population-based rapid response study of adolescents in major metropolitan areas of Texas. Participants were adolescents who self-reported ever using e-cigarettes across all 6 waves (n = 1,104; N = 460,069). Factor analyses examined structure of SEs at e-cigarette initiation. Weighted, multilevel, multivariate regression models examined role of SEs at e-cigarette initiation on subsequent past 30-day e-cigarette use behaviors. Results Factor analyses identified a positive (i.e., euphoria, relaxation) and a negative (i.e., dizziness, cough, nausea) domain of SEs. Positive SEs at e-cigarette initiation predicted 1.20 (95% CI: 1.02–1.42) greater odds of subsequent past 30-day e-cigarette use. Similarly, positive SEs at e-cigarette initiation predicted greater relative risk of dual/poly e-cigarette use, relative to non-use (RRR: 1.61; 95% CI: 1.24–2.10) and exclusive e-cigarette use (RRR: 1.68; 95% CI: 1.26–2.24). Conclusion This is the first study to observe longitudinal relationships between SEs at e-cigarette initiation and subsequent e-cigarette use behaviors. Findings highlight the importance of preventing initial e-cigarette use among adolescents.

Introduction Recent literature has demonstrated individuals may be using electronic cigarettes (e-cigarettes) as a method of weight loss and/or management. Furthermore, e-cigarette companies are developing and patenting technologies related to e-cigarettes and weight loss. This study aims to determine the association between intentions to lose weight and e-cigarette use behaviors among a nationally representative sample of high school students. Methods Data were obtained from the 2015 Youth Risk Behavior Surveillance survey. Participants were 12 847 students in grades 9–12 in the United States. Multivariate multinomial logistic regression models assessed the association between past 30-day e-cigarette use and weight loss intentions among 9–12 grade students. Subsample analyses were conducted, stratified by sex. Covariates included perceived weight, sex, race/ethnicity, grade, and past 30-day tobacco use. Results Overall, 23.7% of the sample used e-cigarettes in the past 30 days. E-cigarette use was associated with 1.38 (95% CI = 1.07% to 1.78%) greater risk of intentions to lose weight among the full sample, controlling for covariates. Among girls, e-cigarette use was associated with 1.44 (95% CI = 1.05% to 1.97%) greater risk of intentions to lose weight, controlling for covariates. Among boys, e-cigarette use was associated with 1.40 (95% CI = 1.04% to 1.88%) greater odds of intentions to gain weight, controlling for covariates. Conclusion Findings show a significant association between e-cigarette use and intentions to lose weight among high school students, among the full sample. Interestingly, e-cigarette use was statistically associated with intentions to gain weight among boys. Longitudinal study is needed to further examine this relationship. Implications and Contribution This is the one of the first studies reporting on e-cigarette use and weight loss intentions among adolescents, both highly prevalent among this population. These findings are an important development in the study of e-cigarette use given the established link between conventional cigarette smoking and weight loss and/or management.

BACKGROUND We present results of the development and feasibility testing of CATCH Healthy Smiles, a school-based oral health program, among children in grades K-2 in Houston, Texas. METHODS Study design was cross-sectional (N = 2 schools; N = 125 parent-child dyads; 31 kindergarteners, 42 first graders, and 52 second graders). CATCH Healthy Smiles program was implemented by trained school teachers in the 2016-2017 school year. Trained dentists conducted dental assessments to measure dental caries increment score (d3mfs). Parent-reported 24-hour dietary recalls and surveys assessed child and parent behavioral, environmental, and psychosocial factors. Logistic regression analysis assessed factors associated with caries experience adjusting for covariates. RESULTS Of the 113 children with complete dental assessments, 54% children in grade K, 62% in first grade, and 73% in second grade had caries experience. Children with caries experience had a higher body weight (AdjOR = 1.13, 95% confidence interval [CI]: 1.02-1.29), were less likely to be girls (AdjOR = 0.22, 95% CI: 0.05-0.82), had greater odds of difficulty drinking hot or cold beverages because of dental problems (AdjOR = 13.13, 95% CI: 1.09-275.14), greater frequency of consuming sugar-sweetened beverages (AdjOR = 11.53, 95% CI: 2.10-87.19), greater odds of receiving government assistance (AdjOR = 14.62, 95% CI: 2.74-119.81), and lower odds of seeing a dental provider (AdjOR = 0.11, 95% CI: 0.02-0.45). Process evaluation showed that 100% of the CATCH Healthy Smiles lessons and activities were taught in the two schools with a high degree of program fidelity and acceptability across the schools, children, and parents. CONCLUSIONS These data will be used to conduct a subsequent fully powered cluster randomized controlled trial.

Background: The extent of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in children and adolescents at a population level in 2021 remains unclear. Children and adolescents have been considered to play an important role in transmission regardless of presence of symptoms. The objective of this study was to estimate the prevalence of SARS-CoV-2 antibody status in children ages 5-to-19 years in a sample from the State of Texas in the presence and absence of symptoms. Methods: The TX CARES (Texas Coronavirus Antibody Response Survey) is an ongoing prospective population-based sample from the Texas general population (~29·8 million) that commenced in October 2020. For the current analysis, volunteers ages 5-to-19 years were recruited throughout the state from large pediatric healthcare systems, Federally Qualified Healthcare Centers, urban and rural pediatric and family medicine practices, health insurance providers, and a social media campaign. SARS-CoV-2 antibody status measured via the Roche Elecsys® Anti-SARS-CoV-2 Immunoassay. Prevalence of IgM, IgA, or IgG antibodies were adjusted using sampling weights and post-stratification of age and sex. We report here findings from January 1-June 1, 2021. Findings: This analysis that included 503 children ages 5-to-19 years showed 38·7% (95% CI, 34·5-43·1) of the sample was SARS-CoV-2 antibody positive in fully adjusted estimates. A total of 30·1% (95% CI, 29·4-31·5) of adults (N=6992) in the sample were antibody positive. Over half (55·8%) of those with positive antibody status were reportedly asymptomatic. Headache (25·4%), congestion/runny nose (20·8%), and fatigue (20·3%) and were the most frequently reported symptoms among those with a positive antibody result. The odds of having a positive antibody status was 37% higher in 15-to-19 year olds versus adults (OR 1·37, 95% CI, 1·03-1·83). Interpretation: These results highlight that a majority of the pediatric population remains immunologically naive to SARS-CoV-2, emphasizing the important role vaccines may play in reaching whole population herd immunity. Funding: Texas Department of State Health Services. Declaration of Interest: We declare no competing interests. Ethical Approval: All protocols were reviewed and approved by the University of Texas Health Science Center at Houston Institutional Review Board (IRB), but also deemed public health practice by the Texas Department of State Health Services IRB.

Background This study examines the association between exposure to e-cigarette use on school campus and e-cigarette use behaviors among adolescents in the United States. Methods Data were obtained from the 2019 National Youth Tobacco Survey. First, two multivariate logistic regression models examined the association between in-school exposure to e-cigarette use and ever and past 30-day (i.e., current) e-cigarette use. Next, a multivariate logistic regression model to examine the relationship between in-school exposure to e-cigarette use and susceptibility to use was conducted among a subsample (n = 11,958) of never e-cigarette users. Covariates included grade, race/ethnicity, marketing exposure, and ever use of other tobacco products. Results Approximately 64.3 % of adolescents reported seeing someone use an e-cigarette on school campus; the most common locations being in the bathroom/locker room (34.4 %) and parking lot (34.0 %). In-school exposure to e-cigarette use was associated with greater odds of ever (Adj OR: 2.06; 95 % CI: 1.82–2.33) and current (Adj OR: 1.70; 95 % CI: 1.46–1.98) e-cigarette use among adolescents as well as greater odds of susceptibility to use (Adj OR: 2.00; 95 % CI: 1.82–2.20) among never e-cigarette users. Conclusions Observing e-cigarette use on school campus was associated with greater odds of e-cigarette use and susceptibility. It is plausible that observing e-cigarette use on campus reinforces the social acceptability of adolescent e-cigarette use. Findings inform on the prevalence of e-cigarettes use on-campus as well as how this phenomenon may influence e-cigarette use/susceptibility among youth. The observed relationship highlights the role of schools in the efforts to reduce adolescent e-cigarette use.

BackgroundMultiple tobacco product (MTP) use is common among young adults. Most MTP users are combustible cigarette smokers that use one or more other tobacco products. This study aims to explore menthol as a risk factor for MTP use among a cohort of young adult cigarette smokers.MethodsParticipants were 18–29 years cigarette smokers at 24 Texas colleges in a 6-wave study. Participants (n=4700 observations) were classified as: single product users (ie, exclusive cigarette smoking); dual product users and poly product users. A multilevel, ordered logistic regression model was used to examine the association between menthol cigarette smoking and MTP use. Two longitudinal, multilevel, multinomial logistic regressions were used to examine the relationship between menthol cigarette smoking and number of tobacco products used.ResultsOverall, 40.7% of the sample were single product users, 33.7% were dual product users and 25.6% were poly product users. Menthol was associated with 1.28 greater odds of MTP use. Further, menthol was associated with 1.19 greater risk of dual and 1.40 greater risk of poly product use, relative to single product use. Lastly, menthol cigarette smoking was associated with 1.18 greater risk of poly product use, relative to dual product use.ConclusionsThere was a gradient relationship between menthol cigarette smoking and number of tobacco products used among young adult cigarette smokers. Findings provide for greater regulatory and programmatic efforts to reduce the use of menthol cigarettes.

Purpose This study aims to examine the relationship between self-reported history of concussion and risk factors for completed suicide among middle school students. Methods We analyzed state-level data from the 2017 YRBS. The study sample was n = 19,254 middle school students in 7 States: Delaware, Florida, Hawaii, Kentucky, Nevada, Rhode Island, and Virginia. We conducted multi-level, multivariate logistic regression models to assess the relationship between self-reported concussions and suicidal ideations, planned suicide attempt, and past suicide attempt. Results Approximately 17.8% of the sample self-reported a history of concussion. Self-reported history of concussion was significantly associated with greater odds for history of suicidal ideation (Adj OR: 1.31), planned suicide attempt (Adj OR: 1.36), and past suicide attempt (Adj OR: 1.67). Conclusions This is the first study to examine the relationship between self-reported concussion and risk factor for completed suicide among middle school students. Research findings mirror similar study done among high school students and young adults. Findings suggest the need to expand prevention programs, intervention strategies and education campaigns to include middle school students.

Objectives: From 2017 to 2018, electronic cigarette (e-cigarette) use increased 78% among high school students and 48% among middle school students in the United States. However, few e-cigarette prevention interventions have been evaluated. We determined the feasibility and initial effectiveness of “CATCH My Breath,” an e-cigarette prevention program, among a sample of middle schools in central Texas. Methods: Twelve middle schools in Texas (6 intervention schools and 6 control schools) participated in the CATCH My Breath pilot program during 2016-2017. CATCH My Breath is rooted in social cognitive theory, consists of 4 interactive in-class modules, and is collaboratively administered via classroom and physical education teachers, student–peer leaders, and social messaging (eg, school posters). We collected 3 waves of data: baseline (January 2017), 4-month follow-up (May 2017), and 16-month follow-up (May 2018). Using school as the unit of analysis, we tested a repeated cross-sectional, condition-by-time interaction on e-cigarette ever use, psychosocial determinants of use, and other tobacco use behaviors. Analyses controlled for school-level sociodemographic characteristics (eg, sex, race/ethnicity, and percentage of students eligible for free or reduced-price lunch). Results: From baseline to 16-month follow-up, increases in ever e-cigarette use prevalence were significantly lower among intervention schools (2.8%-4.9%) than among control schools (2.7%-8.9%), controlling for covariates ( P = .01). Intervention schools also had significantly greater improvements in e-cigarette knowledge (β = 0.71; 95% confidence interval [CI], 0.21-1.21; P = .008) and perceived positive outcomes (β = –0.12; 95% CI, –0.23 to –0.02; P = .02) than control schools, controlling for covariates from baseline to 16-month follow-up. Conclusion: Ever e-cigarette use was lower among middle schools that implemented the CATCH My Breath program than among those that did not. Replication of findings among a larger sample of schools, using a group-randomized, longitudinal study design and a longer follow-up period, is needed.

INTRODUCTION: The potential of e-cigarettes to elicit symptoms of nicotine dependence has not been adequately studied, particularly in adolescent populations. The present study examined the prevalence of e-cigarette-specific symptoms of nicotine dependence (“symptoms of e-cigarette dependence”) and the associations between these symptoms, e-cigarette usage group, and e-cigarette cessation-related items among Texas adolescents. METHODS: This study involved a cross-sectional analysis of adolescents from Wave 4 of the Texas Adolescent Tobacco and Marketing Surveillance System (TATAMS) (n=2,891/N=461,069). Chi-Square analyses examined differences in the prevalence of symptoms of dependence by e-cigarette usage group (exclusive versus dual users of e-cigarettes and combustible tobacco products) and demographic characteristics. Weighted multivariable logistic regression analyses examined the associations between symptoms of e-cigarette dependence, e-cigarette usage group, and e-cigarette cessation items. RESULTS: Exclusive e-cigarette users experienced symptoms of e-cigarette dependence, although the prevalence of most of the symptoms was higher for dual users. Adolescents who reported more symptoms of dependence were less likely to report both wanting to quit e-cigarettes and a past-year quit attempt for e-cigarettes (adjusted odds ratio “AOR”=0.61 (95% CI=0.41, 0.92) and AOR=0.52 (95% CI=0.30, 0.92), respectively). CONCLUSIONS: This study is the first to demonstrate that adolescent e-cigarette users are experiencing symptoms of dependence specific to e-cigarettes. In addition, symptoms of dependence may be barriers to e-cigarette cessation. Future research is needed to determine if characteristics of e-cigarette use (e.g. frequency and intensity) are associated with dependence. Keywords: E-cigarettes; adolescents; dependence

Few studies have examined the relation between food consumption and related attitudes and dental pain among children. The objective of this study is to examine the associations of healthy and unhealthy food items, attitudes toward healthy food, and self-efficacy of eating healthy with dental pain among children. A cross-sectional analysis was performed using child survey data from the Texas Childhood Obesity Research Demonstration (TX CORD) project. Fifth-grade students ( n = 1,020) attending 33 elementary schools in Austin and Houston, Texas, completed the TX CORD Child Survey, a reliable and valid survey instrument focused on nutrition and physical activity behaviors. All nutrition questions ask about the number of times food and beverage items were consumed on the previous day. Dental pain was reported as mouth or tooth pain in the past 2 wk that made their mouth hurt so much that they could not sleep at night. Mixed-effects logistic regression models were used to test the association between 10 unhealthy food items, 9 healthy food items, 2 health attitudes, and self-efficacy with dental pain. All models controlled for sociodemographic variables. In total, 99 (9.7%) students reported dental pain. Dental pain was associated with intake of the following unhealthy items: soda, fruit juice, diet soda, frozen desserts, sweet rolls, candy, white rice/pasta, starchy vegetables, French fries/chips, and cereal (adjusted odds ratio [AOR], 1.27–1.81, P < 0.01). The intake of other vegetables (AOR, 1.56; P < 0.01), a healthy item, and the attitude that healthy food tastes good (AOR, 1.59; P = 0.04) were also positively associated with dental pain. The attitude of eating healthier leads to fewer health problems (AOR, 0.50) and self-efficacy for healthy eating (AOR, 0.44) were negatively associated with dental pain ( P < 0.01). Interventions should focus on improving oral health by reducing intake of unhealthy foods and educating children and families on the importance of diet as a means of reducing dental caries. Knowledge Transfer Statement: The results of this study can be used to inform researchers on potential food items and psychosocial measures to examine in low-income, minority populations for longitudinal research. These results would also be useful to educators who could incorporate oral health care and nutrition education into school curriculums.

The goal of this study was to assess the effect of prenatal maternal cigarette smoking on children’s BMI z-score trajectories, and to evaluate whether small-for-gestational-age (SGA) acts as a potential mediator between prenatal maternal cigarette smoking and child’s BMI z-score at 4 years of age. Group-based trajectory modeling (GBTM) methods were employed to describe and classify developmental BMI z-score trajectories (the outcome of interest) in children from 9 months to 4 years of age (n = 5221) in the Early Childhood Longitudinal Study, Birth Cohort (ECLS-B) study (2001–2005). Further analysis examined whether the identified BMI z-score trajectories varied with the exposure, prenatal maternal cigarette smoking. Mediation analyses were utilized to examine whether being SGA (binary measure) acted as a potential mediator in the relationship between prenatal maternal cigarette smoking and BMI z-score among 4-year-old children. Using GBTM, two BMI z-score trajectory groups were identified: normal BMI z-score (57.8%); and high BMI z-score (42.2%). Children of mothers who smoked cigarettes during pregnancy were 2.1 times (RR 95% CI: 1.1–4.0, P value = 0.023) more at risk of being in the high BMI z-score trajectory group. Prenatal cigarette smoking was positively related to SGA at birth, but SGA was inversely related to BMI z-score at 4 years. The direct effect (0.19, 95% CI: 0.18, 0.19; P value

Objective Nicotine exposure among adolescent e-cigarette users remains a public health concern. JUUL, a popular e-cigarette brand among youth, is particularly alarming given the high nicotine delivery (59 mg/mL). This study compares e-cigarette use frequency and symptoms of nicotine dependence among adolescent JUUL and non-JUUL users. Methods We analyzed data from the 2020 National Youth Tobacco Survey. Participants were n = 1713 U.S. middle and high school students who reported past 30-day e-cigarette use. We compared adolescent e-cigarette users who reported JUUL use to those who did not. Outcomes were: (1) symptoms of nicotine dependence (i.e. nicotine cravings; use within 30 min of waking); (2) past 30-day e-cigarette use frequency, categorized as 1–5 days, 6–19 days, and 20–30 days. Covariates were sex, race/ethnicity, other tobacco product use, primary e-cigarette device type (i.e., disposable; pod; mod/tank). Results Overall, 49.5% of adolescent e-cigarette users reported using JUUL in the past 30 days, 40.1% reported symptoms of nicotine dependence, and 36.2% reported using an e-cigarette on 20–30 days. JUUL users were 1.77 (95% CI: 1.36–2.31) times as likely to report symptoms of nicotine dependence and 1.43 (95% CI: 1.02–2.01) time as likely to report using e-cigarettes on 20–30 days, compared to 1–5 days, relative to non-JUUL users, controlling for covariates. Conclusion JUUL use was associated with greater odds of nicotine dependence and more frequent e-cigarette use among adolescents. Greater prevention and regulatory efforts should be made to prevent adolescent use of high dose nicotine devices such as JUUL.

Highlights • Assess weight loss intentions and BMI in an racially diverse sample of adolescents. • E-cigarette use was higher among overweight/obese males intending to lose weight. • Findings reveal motivational correlates of e-cigarette use in youth. • Inform further research and interventions to curtail e-cigarette use in youth., Electronic cigarette use among American adolescents is a major public health concern given the negative health consequences of nicotine in youth. Recent literature has shown that weight control may be one motivation for use in this population. This study examined associations between intention to lose weight and e-cigarette use among adolescents having overweight or obesity from an ethnically diverse sample of Texas youth by gender. We performed a cross-sectional analysis of a state representative sample of 9056 eighth and eleventh grade students from the 2015–2016 Texas School Physical Activity and Nutrition (Texas SPAN) study. Validated survey items assessed weight intentions and e-cigarette use. Staff collected anthropometric measures. Logistic regression analysis was conducted to assess the relationship between e-cigarette use and weight intentions with gender interaction, adjusting for grade, race/ethnicity, economic status, weight-behaviors and stratified by BMI class. More than half (50.9%) of the weighted sample were Hispanic and 12.5% were Non-Hispanic Black; 8.5% used e-cigarettes; and 50.0% intended to lose weight. Of the 40.2% of the sample having overweight or obesity, 82.9% intended to lose weight. Among respondents with obesity, use of e-cigarettes was significantly higher among males intending to lose weight than among females intending to lose weight (12% versus 6%, p = 0.007). These findings contrast with previous research suggesting that e-cigarette use in females is more likely to be motivated by an intent to lose weight. The ethnic diversity of the Texas SPAN population may explain this discrepancy.

Objective This randomized controlled trial was conducted to determine comparative efficacy of a 12-month community-centered weight management program (MEND2-5 for ages 2-5 or MEND/CATCH6-12 for ages 6-12) against a primary care-centered program (Next Steps) in low-income children. Methods Five hundred forty-nine Hispanic and black children (BMI ≥ 85th percentile), stratified by age groups (2-5, 6-8, and 9-12 years), were randomly assigned to MEND2-5 (27 contact hours)/MEND/CATCH6-12 (121.5 contact hours) or Next Steps (8 contact hours). Primary (BMI value at the 95th percentile [%BMIp95]) and secondary outcomes were measured at baseline, 3 months (Intensive Phase), and 12 months (Transition Phase). Results For age group 6-8, MEND/CATCH6-12 resulted in greater improvement in %BMIp95 than Next Steps during the Intensive Phase. Effect size (95% CI) was −1.94 (−3.88, −0.01) percentage points (P = 0.05). For age group 9-12, effect size was −1.38 (−2.87, 0.16) percentage points for %BMIp95 (P = 0.07). MEND2-5 did not differentially affect %BMIp95. Attendance averaged 52% and 22% during the Intensive and Transition Phases. Intervention compliance was inversely correlated to change in %BMIp95 during the Intensive Phase (P

Introduction Subjective experiences (“SEs”) at first cigarette use have been thoroughly examined; however, limited research has examined SEs at first use of non-cigarette products. This study addresses this gap in the literature. Methods Cross-sectional data from 6th, 8th and 10th grade students in four metropolitan areas of Texas (n = 3907/N = 461,069). Nausea, coughing, relaxation, rush/buzz, and dizziness at first use were assessed for cigarettes, e-cigarettes, hookah, and cigar products. Chi-square analyses examined differences in the prevalence of first use SEs by product. Weighted multiple logistic regression analyses examined the association of SEs and current product use. Covariates were grade, gender, race/ethnicity, and current other tobacco product use. Results Exploratory factor analysis of SEs determined differing factor structures across tobacco products. For example, the following items loaded onto the positive SE factor: 1) relaxation, rush, and dizziness for cigarettes, and 2) relaxation and rush for e-cigarettes, hookah, and cigar products. Prevalence of negative SEs (coughing and nausea) were higher for cigarette and cigar products compared to e-cigarettes and hookah. Positive SEs for cigarettes were associated with increased odds of current cigarette use (AOR = 1.51); similarly positive SEs for cigars were associated with increased odds of current cigar use (AOR = 2.11). Feeling nauseous at first use of cigars was associated with decreased odds of current cigar use (AOR = 0.18). No SEs were associated with current e-cigarette or hookah use. Conclusions Subjective experiences at first use differ by tobacco product. Longitudinal studies are needed to examine temporal relationships between SEs at first use and sustained tobacco use.

Background Use of e-cigarettes for tobacco cessation efforts is a growing trend in the United States. However, little is known about the factors that determine the use of e-cigarettes for this specific purpose. Methods This study examined current and former cigarette smokers that reported ever using e-cigarettes. Data were obtained from a 2018 Texas population health assessment survey (n = 569) and weighted to be representative to Texas. A multivariable logistic regression was used to assess the socio-demographic and behavioral correlates of using e-cigarettes for tobacco cessation. Results Overall, 41.3% of e-cigarette users reported using them for tobacco cessation. Among ever e-cigarette users, Non-Hispanic blacks (aOR: 0.21; 95% CI, 0.07–0.64), males (aOR: 0.40; 95% CI, 0.20–0.80), and individuals not confident in obtaining health information (aOR: 0.38; 95% CI, 0.15–0.96) were less likely to use e-cigarettes for tobacco use cessation. Conversely, among ever e-cigarette users, odds of using e-cigarettes for tobacco cessation were higher among those who were 35–44 years old (aOR: 3.68, 95% CI: 1.26–10.71), those who received advice to quit smoking from a healthcare professional (aOR: 2.77, 95% CI, 1.36–5.64), and those with more than 5 years since their last routine checkup (aOR: 3.91; 95% CI, 1.23–12.45). Conclusion Findings from this study suggest that both health behaviors and sociodemographic factors predict use of e-cigarettes for the purpose of tobacco cessation. Furthermore, the relationship between use of e-cigarettes as a cessation device and being advised to quit tobacco use by a healthcare professional calls for additional investigation.

Background Suicide is the third leading cause of death among adolescents. While research has found concussions to be a risk factor for suicide in adults, this relationship is not well studied in nationally representative samples of youth. This study examines the relationship between self-reported history of sports-related concussion and five risk factors for suicide completion. Methods Data were obtained from the 2017 Youth Risk Behavior Surveillance Survey (n=13,353). Multivariate logistic regression models assessed the relationship between self-reported, sports-related concussion and five risk factors for suicide completion. Analyses controlled for sex, race/ethnicity, grade, bullying victimization, and sexual orientation. Subsample analyses were conducted stratified by sex. Interaction models examined biological sex as a possible effect modifier. Results Overall, 15.0% of high school students reported a sports-related concussion in the past 12-months. Self-reported, sports-related concussion was significantly associated with greater odds of feeling sad/hopeless (Adj OR: 1.20; 95% CI:1.02–1.42), suicidal ideations (Adj OR: 1.25; 95% CI:1.02–1.55), suicide attempt (Adj OR: 1.60; 95% CI:1.31–1.96), and suicide attempt treated by a doctor/nurse (Adj OR: 2.35; 95% CI:1.68–3.29), adjusting for covariates. Stratified analyses demonstrated differences by sex, however, no direct evidence of effect modification was observed in interaction models. Limitations Data are cross-sectional, prohibiting causal inferences. Measures were assessed via self-report. No pre-concussion measures of mental health. Conclusion Self-reported sports-related concussion was associated with risk factors for suicide completion. No direct evidence of effect modification was observed but stratified analyses suggest biological sex may impact the observed relationship.