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Introduction In response to high rates of youth tobacco use, many states and localities are considering regulations on flavored tobacco products. The purpose of this study was to assess whether flavored tobacco restrictions (FTRs) in Massachusetts curb youth tobacco use over time and whether a dose–response effect of length of policy implementation on tobacco-related outcomes exists. Aims and Methods Using a quasiexperimental design, two municipalities with a FTR (adopting municipalities) were matched to a comparison municipality without a FTR. Surveys were administered before (December 2015) and after (January and February 2018) policy implementation to high school students in these municipalities (more than 2000 surveys completed at both timepoints). At follow-up, adopting municipalities had a policy in place for 1 and 2 years, respectively. In 2019, focus groups were conducted with high school students in each municipality. Results Increases seen in current tobacco use from baseline to follow-up were significantly smaller in adopting municipalities compared to the comparison (−9.4% [−14.2%, −4.6%] and −6.3% [−10.8%, −1.8%], respectively). However, policy impact was greater in one adopting municipality despite shorter length of implementation. Focus groups indicated reasons for differential impact, including proximity to localities without FTRs. Conclusions Restrictions implemented in adopting municipalities had positive impacts on youth tobacco awareness and use 1–2 years postimplementation. Policy impact varies depending on remaining points of access to flavored tobacco, as such policy effectiveness may increase as more localities restrict these products. Implications In response to high rates of youth flavored tobacco use (including flavored vape products), federal, state, and localities have passed FTRs that reduce availability of flavored tobacco in youth-accessible stores. Previous research has found that FTRs may curb youth tobacco use in the short-term; however, the long-term effectiveness remains unknown. This is the first study to show FTRs can curb youth tobacco use and reduce youth awareness of tobacco prices and brands even 2 years after policy passage. Municipality-specific factors, including proximity to localities without FTRs, may attenuate policy impact, highlighting the importance of widespread policy adoption.

Lesbian, gay, bisexual, and questioning (LGBQ) youth are overrepresented among youth experiencing homelessness (YEH), and health disparities among LGBQ youth are well-documented. LGBQ youth are typically aggregated as a single sexual minority group; however, research suggests that bisexual youth may have greater mental health, substance use, and physical health risks relative to their gay and lesbian peers. In a probability sample of LGBQ YEH in Los Angeles County (n = 183), we examined subgroup differences in homelessness severity, depression, physical health, and substance use, focusing on differences between bisexual and gay/lesbian youth due to the small subsample of questioning youth. Indicators of homelessness severity were standalone outcomes, and also were integrated as control variables with gender, age, race/ethnicity, and education in multivariable models. Bisexual youth were more likely to have become unaccompanied homeless persons as minors (OR = 4.35, 95% CI 1.85–10.23), and to have not recently utilized emergency shelters or transitional housing at least once in the past month (OR = 6.41; 95% CI 2.41–17.03). Bisexual youth were more likely to have probable depression (OR = 4.06, 95% CI 1.41–11.68). Among sexual minority YEH, bisexual youth may be at elevated risk for depression, in addition to more severe homelessness.

To counter the high prevalence of flavored tobacco use among youth, many U.S. localities have passed policies that restrict youth access to these products. This study aims to evaluate the short-term impact of a flavored tobacco restriction policy on youth access to, and use of, flavored tobacco products in a Massachusetts community.A community with the policy (Lowell) was matched to a community without the policy (Malden) with similar demographics, retailer characteristics, and point-of-sale tobacco policies. Product inventories were assessed in tobacco retailers in the 2 communities, and surveys were administered to high school-aged youth in those communities. Inventories and surveys were conducted around the time the policy took effect in October 2016 (baseline) and approximately 6 months later (follow-up); all data were analyzed in 2017. Chi-squared tests and difference-in-difference models were used to estimate the impact of the policy on flavored tobacco availability and youth perceptions and behaviors related to flavored tobacco use.Flavored tobacco availability decreased significantly in Lowell from baseline to follow-up periods by 70 percentage points (p0.001), whereas no significant changes in flavored tobacco availability were seen in Malden. In addition, current use of both flavored and non-flavored tobacco decreased in Lowell, but increased in Malden from baseline to follow-up; these changes were significantly different between communities (flavored tobacco: -5.7%, p=0.03; non-flavored tobacco: -6.2%, p=0.01).Policies that restrict the sale of flavored tobacco have the potential to curb youth tobacco use in as few as 6 months.

IntroductionCigarette smoking is highly prevalent among young people experiencing homelessness, and many of these smokers are motivated to quit. However, there is a lack of readily available cessation services for this population, which is highly mobile and can be challenging to engage in services.AimsWe describe the development of a smoking cessation text messaging intervention (TMI) for homeless youth who are interested in quitting smoking.MethodsParticipants were 18–25 years old and recruited from drop-in centers serving homeless youth. Three focus groups (N = 18) were conducted with smokers to refine the TMI content, and a separate sample of smokers (N = 8) provided feedback on the TMI after using it for 1 week. Survey data assessed the TMI's acceptability and feasibility.ResultsParticipants generally rated the TMI as helpful and relevant, and nearly all had cell phone plans that included unlimited texting and were able to view TMI content with few difficulties. Qualitative feedback on strengths/limitations of the TMI in terms of content, tone, and delivery parameters was used to finalize the TMI for a future evaluation.ConclusionsResults suggest that a TMI is a feasible and acceptable option for young people experiencing homelessness who are interested in quitting smoking.

We develop an effect persistence model for intensive longitudinal data under a general assumption of an exponential loss of association between exposure and outcome over time. The working model proposed may be useful for understanding the complexity of phenomena where subjects can be repeatedly exposed to an intervention or a naturally occurring event while at the same time, the effect of any one exposure is expected to diminish over time. Under the main assumption, we specify a semi-linear model with extensions to generalized linear models. These methods are motivated by, and applied to, data from a study of adolescent exposure to pro-smoking advertisement where the impact of pro-smoking media exposure on young adults’ susceptibility to smoking is assessed along with the decay of the effect over time. We investigate the performance of the proposed method when the model assumptions are correctly specified or not. Supplementary materials for this article are available online.

OBJECTIVES: Use of alternative tobacco products, as well as regular cigarettes, is widespread among unaccompanied youth experiencing homelessness. However, little is known about their level of motivation for quitting use of these products, factors associated with motivation to quit, or how these might vary by type of tobacco product. METHODS: Unaccompanied homeless youth were sampled from 25 street and service sites in Los Angeles County (N=469). All participants were past month tobacco users who completed a survey on their tobacco-related behaviors and cognitions, including motivation to quit, as well as background characteristics. RESULTS: Among self-reported users of each product, motivation to quit in the next 30 days was highest for regular cigarettes (33%), followed by e-cigarettes/vaporizers (30%), little cigars/cigarillos (25%), cigars (20%), and natural cigarettes (20%). Between 33-49% of youth, depending on product, were not thinking about quitting at all. Correlates of lower motivation to quit differed somewhat by product type, with the most consistent being race, more frequent use, lower perceived riskiness of the product, and using the product because of its good taste or smell. CONCLUSIONS: Results from this study identify a set of psychosocial and behavioral factors, some that are common across tobacco products and others that are product-specific, that may be particularly important to address in efforts to reduce tobacco use among youth experiencing homelessness. Future regulations on the sale of flavored tobacco products may also serve to increase motivation to quit in this population.

PURPOSE: Adolescents who report having mental health problems, including depression and anxiety, are at greater risk of alcohol use. We examined the longitudinal association between mental health and alcohol use six months later in a diverse adolescent sample attending a primary care appointment. The primary care setting provides a unique opportunity to reach this younger age group and address risk factors, including mental health problems and substance use. METHODS: Adolescents aged 12–18 (n = 668) recruited from waiting rooms at four primary care clinics in Los Angeles, California and Pittsburgh, Pennsylvania completed a baseline web-based survey (April 2013 to November 2015) and another survey six months later. Bivariate analysis and multi-variable regression assessed associations between baseline mental health and 6-month alcohol use outcomes (any use, heavy use, and maximum quantity). RESULTS: Adolescents were stratified by mental health scores using the Mental Health Inventory-5 (MHI-5) cut off at baseline. In unadjusted analyses of alcohol outcomes at six months, adolescents with more mental health problems reported higher alcohol use across all three measures (p < .01 for heavy use; p < .05 for any use and maximum quantity used). Adolescents’ reports of better mental health at baseline were associated with fewer heavy drinking episodes (p < .05) and lower maximum number of drinks (p < .05) at six months, after adjusting for baseline alcohol use, intervention group, site, and demographic characteristics. CONCLUSIONS: Addressing mental health in primary care may be important for decreasing alcohol problems in adolescents. Strategies for facilitating screening and intervention with adolescents at-risk of alcohol use are warranted.

This experiment tested whether the presence of graphic health warning labels on cigarette packages deterred adult smokers from purchasing cigarettes at retail point-of-sale (POS), and whether individual difference variables moderated this relationship. The study was conducted in the RAND StoreLab (RSL), a life-sized replica of a convenience store that was developed to evaluate how changing POS tobacco advertising influences tobacco use outcomes during simulated shopping experiences. Adult smokers (n = 294; 65% female; 59% African-American; 35% White) were assigned randomly to shop in the RSL under one of two experimental conditions: graphic health warning labels present on cigarette packages versus absent on cigarette packages. Cigarette packages in both conditions were displayed on a tobacco power wall, which was located behind the RSL cashier counter. Results revealed that the presence of graphic health warning labels did not influence participants’ purchase of cigarettes as a main effect. However, nicotine dependence acted as a significant moderator of experimental condition. Graphic health warning labels reduced the chances of cigarette purchases for smokers lower in nicotine dependence but had no effect on smokers higher in dependence.

OBJECTIVES This paper evaluated whether a 2-item assessment of alcohol use risk, developed by the National Institute on Alcohol Abuse and Alcoholism (NIAAA SG), prospectively predicted smoking status among a sample of adolescents visiting their primary care physician. METHODS We analyzed a sample of 651 adolescents (57.80% female; 56.53% Hispanic, 22.73% African American, 14.44% White, 6.30% other) who completed the NIAAA SG at a baseline appointment and were assessed for future smoking risk. We obtained prospective data on smoking status using data from the 6-month post-baseline follow-up assessment. RESULTS Logistic regression analyses revealed that adolescents who were identified as at risk by the NIAAA SG were more likely to report smoking within 6 months. However, the association between the NIAAA SG and future smoking status became non-significant after controlling for future smoking risk measured at baseline. CONCLUSIONS Questions that ask about past smoking and future smoking intentions are best used to screen adolescents in primary care for smoking risk.

Objectives: Research demonstrates a link between alcohol and tobacco use in the development of cancer, but limited research exists regarding substance use after a cancer diagnosis. In this study, we examine the rates of alcohol and tobacco use in advanced cancer patients, investigate the link between depression and tobacco and alcohol use pre- and post-diagnosis, and determine the relationship between illness perception and tobacco and alcohol use post-diagnosis.Methods: We performed a secondary data analysis on 2 prospective studies of patients with advanced gastrointestinal cancers. We administered a battery of questionnaires to assess substance use, depression, and illness perception. Results: Patients who reported tobacco use post-diagnosis had higher levels of depressive symptoms when compared to patients with a history of tobacco use or no alcohol or tobacco use (Kruskal-Wallis = 25.77, p < .0125). Patients who reported being more emotionally affected by their illness reported greater tobacco use (Mann-Whitney U = 17, 284.5, p < .003). Conclusions: Tobacco use post-diagnosis was associated with higher levels of depression.

OBJECTIVES: This study examined perceptions of factors that influence use and non-use of Alternative Tobacco Products (ATPs) among unaccompanied youth experiencing homelessness. METHODS: Focus groups were conducted with 30 homeless 18–24 year olds (80% men, 50% Hispanic, 30% Black, 17% White, 20% multi-racial/other) recruited from drop-in centers in Los Angeles. Discussion focused on several ATPs (hookah, electronic cigarettes/vaping devices, cigarillos/little cigars, smokeless tobacco, snus, natural cigarettes, clove cigarettes), soliciting participants’ experiences using each ATP and motivations for using or not using each ATP. RESULTS: Focus group transcripts were subjected to a rigorous coding procedure and 8 themes relating to the reasons that participants may or may not use ATPs emerged. Each ATP was associated with distinctive characteristics that motivated use and non-use. For example, hookah use was viewed positively with positive sensory and social features dominating the discussion, whereas electronic cigarettes were viewed largely negatively (i.e., that they were expensive and harmful to health). Homelessness characterized participants’ responses to the extent that cost was a factor in their choice of ATP. CONCLUSIONS: These data provide important, first look insights into factors that may influence the use and non-use of ATPs among unaccompanied youth experiencing homelessness.

Introduction Cigarette smoking and associated high-risk behaviors are prevalent among youth experiencing homelessness (YEH), making appropriately tailored interventions targeting smoking behavior important for this group. We pilot tested a brief text-messaging intervention (TMI) as an adjunct to standard care for YEH who smoke and found promising preliminary effects of the intervention on smoking cessation. The purpose of the present study was to test the TMI’s effect on the secondary outcomes of other substance use (including use of other tobacco/nicotine devices) and mental health symptoms. Methods A total of 77 participants completed the pilot randomized controlled trial, with 40 receiving the TMI (174 automated text messages plus a group smoking counseling session and provision of nicotine patches). They completed an assessment at baseline and another three months later that evaluated use of other tobacco/nicotine devices, alcohol, marijuana, and anxiety and depression symptoms. Results We found that the TMI helped to reduce secondary substance use behaviors and mental health symptoms among the participants; mainly there were medium effects of the intervention on changes in other tobacco/nicotine use, drinking, and anxiety and depression symptoms. The intervention did not have an effect on number of marijuana use days in the past month; however, past 30-day marijuana users who received the intervention benefited by reducing the number of times they used marijuana per day. Conclusions In addition to helping reduce cigarette smoking, we found that a TMI for YEH was helpful in improving secondary outcomes, suggesting the promise of the TMI on benefiting YEH even beyond targeted smoking behavior. Implications This pilot study demonstrates that by targeting cigarette smoking using a text message-based intervention among youth experiencing homelessness, effects may be seen in other areas of functioning such as other substance use and mental health. Trial registration ClinicalTrials.gov Identifier NCT03874585. Registered March 14, 2019, https://clinicaltrials.gov/ct2/show/record/NCT03874585.

Introduction Smoking rates are alarmingly high among young people experiencing homelessness (YEH), yet there are no evidence-based cessation programs for this population. This paper presents results from a pilot evaluation of a text messaging-based smoking cessation treatment, as an adjunct to brief group cessation counseling, to improve abstinence rates among 18–25-year-old smokers experiencing homelessness. The goal of this study was to estimate effect sizes for a larger trial and it was not powered to detect group differences. Aims and Methods YEH smokers who had a working cell phone with them at recruitment were randomized to receive a group counseling session, nicotine patches, and written material on quitting (n = 37) or a similar program that also included a 6-week automated text messaging intervention (TMI) to provide ongoing support for quitting (n = 40). Smoking outcomes were evaluated through a 90-day follow-up. Results Seven-day point prevalence abstinence at 90-day follow-up was higher in the TMI condition than standard condition (17.50% vs. 8.11%, respectively; Cohen’s h = .37); however, the 90-day continuous abstinence rate was not statistically different from zero in either condition. Reductions in the number of days smoked in the past 30 days from baseline to follow-up were greater in the TMI condition than the standard condition (−14.24 vs. −8.62, respectively; Cohen’s d = .49). Conclusions Adding a 6-week TMI support to a brief group counseling and pharmacotherapy protocol holds promise for smoking reduction and abstinence among YEH smokers. Results indicate that further development and evaluation of the TMI in this population is warranted. Trial Registration ClinicalTrials.gov Identifier NCT03874585. Registered March 14, 2019, https://clinicaltrials.gov/ct2/show/record/NCT03874585. Implications This is the first study to evaluate the feasibility of using a text messaging-based intervention (TMI) for behavior change with 18–25 year olds experiencing homelessness, and more specifically, the first to test a TMI to provide ongoing support for smoking cessation. Small to medium effect sizes for the TMI are promising in terms of implementing a TMI using participants’ own cell phones, as well as the efficacy of this approach as an adjunct to standard care (brief group counseling and pharmacotherapy) for smoking cessation among YEH.

Background Smoking rates are significantly higher among young people experiencing homelessness than in the general population. Despite a willingness to quit, homeless youth have little success in doing so on their own, and existing cessation resources tailored to this population are lacking. Homeless youth generally enjoy the camaraderie and peer support that group-based programs offer, but continuous in-person support during a quit attempt can be prohibitively expensive. Objective This study aimed to assess the feasibility and acceptability of an automated text messaging intervention (TMI) as an adjunct to group-based cessation counseling and provision of nicotine patches to help homeless youth quit smoking. This paper outlines the lessons learned from the implementation of the TMI intervention. Methods Homeless youth smokers aged 18 to 25 years who were interested in quitting (n=77) were recruited from drop-in centers serving homeless youth in the Los Angeles area. In this pilot randomized controlled trial, all participants received a group-based cessation counseling session and nicotine patches, with 52% (40/77) randomly assigned to receive 6 weeks of text messages to provide additional support for their quit attempt. Participants received text messages on their own phone rather than receiving a study-issued phone for the TMI. We analyzed baseline and follow-up survey data as well as back-end data from the messaging platform to gauge the acceptability and feasibility of the TMI among the 40 participants who received it. Results Participants had widespread (smart)phone ownership—16.4% (36/219) were ineligible for study participation because they did not have a phone that could receive text messages. Participants experienced interruptions in their phone use (eg, 44% [16/36] changed phone numbers during the follow-up period) but reported being able to receive the majority of messages. These survey results were corroborated by back-end data (from the program used to administer the TMI) showing a message delivery rate of about 95%. Participant feedback points to the importance of carefully crafting text messages, which led to high (typically above 70%) approval of most text messaging components of the intervention. Qualitative feedback indicated that participants enjoyed the group counseling session that preceded the TMI and suggested including more such group elements into the intervention. Conclusions The TMI was well accepted and feasible to support smoking cessation among homeless youth. Given high rates of smartphone ownership, the next generation of phone-based smoking cessation interventions for this population should consider using approaches beyond text messages and focus on finding ways to develop effective approaches to include group interaction using remote implementation. Given overall resource constraints and in particular the exigencies of the currently ongoing COVID-19 epidemic, phone-based interventions are a promising approach to support homeless youth, a population urgently in need of effective smoking cessation interventions. Trial Registration ClinicalTrials.gov NCT03874585; https://clinicaltrials.gov/ct2/show/NCT03874585 International Registered Report Identifier (IRRID) RR2-10.1186/s13722-020-00187-6

OBJECTIVE The primary care (PC) setting provides a unique opportunity to address adolescent alcohol and other drug (AOD) use. METHOD We conducted a randomized controlled trial in 4 PC clinics from April 2013 to November 2015 to determine whether a 15-min brief motivational interviewing (MI) AOD intervention, delivered in PC, reduced alcohol and marijuana use and consequences. Adolescents ages 12-18 who came for an appointment during the 2.5-year study period were asked to be in the study and screened using the National Institute of Alcohol Abuse and Alcoholism Screening Guide. Those identified as at risk were randomized to the CHAT intervention or usual care (UC). Adolescents completed 4 web-based surveys at baseline and 3, 6, and 12 months postbaseline. RESULTS The sample (n = 294) was 58% female and 66% Hispanic, 17% Black, 12% White, 5% multiethnic or other, with an average age of 16 years. Compared to UC adolescents, CHAT adolescents reported significantly less perceived peer use of alcohol and marijuana at 3 months (alcohol: p < .0001; marijuana p = .01) and 6 months (alcohol: p = .04; marijuana p = .04). CHAT adolescents also reported marginally fewer negative alcohol consequences experienced at 6 months (p = .08). At 12 months, compared to UC, CHAT adolescents reported less perceived peer alcohol (p = .04) and marijuana (p < .01) use and fewer negative consequences from alcohol (p = .03) and marijuana (p = .04) use. CONCLUSIONS A brief MI intervention delivered in PC reduced negative consequences from alcohol and marijuana use 1 year later. Findings emphasize that adolescents can benefit from PC interventions that briefly and effectively address both alcohol and marijuana use. (PsycINFO Database Record

The National Institute on Alcohol Abuse and Alcoholism (NIAAA) screening guide (SG) uses a 2-question screening process to identify adolescents at risk for alcohol use. The aim of this study was to identify the optimal screening rule in terms of identifying adolescents with alcohol use disorder (AUD) using the NIAAA questions by examining whether the cutpoint should vary by gender, race/ethnicity, grade, and/or age. Youth aged 12 through 18 years (N = 1,573; 27% Black, 51% Hispanic) were screened using the NIAAA SG, and then completed a survey. We used receiver operating characteristic curve analyses to identify the optimal cutpoint for the NIAAA screener question on self-use with AUD as the outcome. We compared the resulting screening rule with the NIAAA SG rule. We found that the optimal cutpoint depended on age and grade of adolescents. The resulting screening rule was the same as the NIAAA SG, and thus independently validated the NIAAA SG, with the exception of screening for adolescents 18 years of age, for which a lower cutpoint was indicated. The performance of both screening rules was highly similar when applied to the study sample, with a sensitivity of 0.89 for the optimal screening rule and a sensitivity of 0.87 for the NIAAA SG. In settings in which the cost of a false positive is relatively low (depending on available resources and cost of the intervention), lower cutpoints for older adolescents should be considered, as this may increase sensitivity of identifying these individuals at risk for AUD. (PsycINFO Database Record

Objectives This experiment tested whether introducing graphic antitobacco posters at point-of-sale (POS) had any effect on adolescents' susceptibility to future cigarette smoking and whether these effects were moderated by adolescents' baseline risk of cigarette smoking. Methods The study was conducted in the RAND StoreLab, a life-sized replica of a convenience store that was developed to experimentally evaluate how changing aspects of tobacco advertising displays in retail POS environments influence tobacco use risk and behavior during simulated shopping experiences. In this study, 441 adolescents were randomized to one of the four conditions in a 2 (graphic antismoking poster placed near the tobacco power wall: no, yes) × 2 (graphic antismoking poster placed near the cash register: no, yes) experimental design. The outcome of interest was susceptibility to future cigarette smoking. Results The addition of antismoking posters at POS led to a significant increase in future smoking susceptibility among those adolescents who already were at high risk for smoking in the future (p < .045). The introduction of graphic antismoking posters had no impact on committed never smokers, regardless of poster location; never smokers' susceptibility to future smoking was uniformly low across experimental conditions. Conclusions Introducing graphic antismoking posters at POS may have the unintended effect of further increasing cigarette smoking susceptibility among adolescents already at risk.

Ecological momentary assessment (EMA) is a popular assessment method in psychology that aims to capture events, emotions, and cognitions in real time, usually repeatedly throughout the day. Because EMA typically involves more intensive monitoring than traditional assessment methods, missing data are commonly an issue and this missingness may bias results. EMA can involve two types of missing data: known missingness, arising from nonresponse to scheduled prompts, and hidden missingness, arising from nonreporting of focal events (e.g., an urge to smoke or a meal). Prior research on missing data in EMA has focused almost exclusively on nonresponse to scheduled prompts. In this study, we introduce a scaled inverse probability weighting approach to assess the risk of bias due to nonreporting of events due to fatigue on estimates of exposure or correlates of exposure. In our proposed approach, the inverse probability is the estimated probability of compliance with random prompts from a model that uses participant and contextual factors to predict this compliance and a fatigue factor that adjusts for attrition in event reporting over time. We demonstrate the use and utility of our bias assessment method with the Tracking and Recording Alcohol Communications Study, an EMA study of adolescent exposure to alcohol advertising.

Self-efficacy has been associated with smoking cessation outcomes in many correlational research studies, but strong causal inferences are lacking. This study tested whether self-efficacy affects initial smoking cessation in a laboratory experiment, which will allow for stronger causal inferences in this domain of inquiry. Participants (n = 103 motivated adult smokers) were provided with brief cessation treatment over three days in preparation for quitting on a target quit day (TQD). In addition, participants were randomized to one of two standard self-efficacy manipulations in the form of bogus feedback about their chances of quitting smoking. Participants in the Average Chances of Quitting (ACQ) condition took a computerized test and were told (falsely) that the test showed that they had the same chances of quitting as everyone else in the study. Participants in the High Chances of Quitting (HCQ) condition took the same computerized test and were told (falsely) that the test showed that they had a greater chance of quitting compared to everyone else in the study. The main outcome was whether participants were able to quit for 24 hours on the TQD. Results revealed that HCQ participants had a significantly greater chance of quitting smoking compared to ACQ participants. However, these effects were not attributable to changes in self-efficacy brought about by the manipulation. An exploration of other potential mediators showed that the manipulation actually influenced smoking outcome expectancies, and changes in these outcome expectancies influenced initial smoking cessation. The results highlight the conceptual and empirical challenges with manipulating self-efficacy in the smoking literature.

Up to 70% of homeless youth smoke, but there is little information available on their smoking cessation experiences and perceptions to guide cessation intervention efforts. This study exami...

Little is known about the extent and nature of youth exposure to online alcohol advertising, or factors that may be associated with exposure. The current study recruited middle school students who completed a paper survey and then logged each alcohol advertisement that they encountered over a 2-week period using cell phones as part of an ecological momentary assessment design. We examined the percentage of youth who reported exposure to online alcohol advertising in the past 2 weeks, average weekly rate of exposure, types of online alcohol advertisements youth reported seeing, and factors that increased youths' risk of exposure to online alcohol advertising. Analyses are based on 485 participants (47% female; 25% Hispanic, 25% White, 27% Black; 6% Asian, 16% other). Youth logged exposures to a total of 3,966 (16,018 weighted for underreporting) alcohol advertisements across the monitoring period; 154 (568 weighted) or 3.6% were online ads. Seventeen percent of youth reported seeing any online alcohol ad; the majority of online ads seen were video commercials (44.8%) and banner/side ads (26.6%). Factors associated with greater ad exposure were being older, rebellious, and Black race; greater parental monitoring and more hours spent on social media were associated with less exposure. Findings provide important information about adolescents' exposure to online alcohol advertising and what might contribute to a greater likelihood of exposure. Given that online ad exposure is linked to drinking behavior, prevention programming for younger adolescents should continue to address this issue to help youth make healthy choices regarding alcohol use. (PsycINFO Database Record

Nicotine replacement therapy is an effective intervention for smoking cessation, but adherence tends to be low. This article presents results from a pilot evaluation of a brief smoking cessation treatment to improve adherence to the nicotine patch among Latino smokers living with HIV/AIDS. Forty smokers were randomized to receive either a standard 5 As counseling session and 8-week treatment of nicotine patch, or a similar intervention that added a 10-min module to the 5 As counseling that focused on improving adherence to the nicotine patch. Smoking outcomes (breath carbon monoxide monitoring verified 7-day point prevalence and continuous abstinence) were evaluated through a 3-month follow-up. Patch usage during the follow-up period was also assessed. Intention to treat analyses indicated that abstinence rates were 2 to 3 times higher in the adherence condition compared with the standard condition (7-day point prevalence abstinence: 35.0% vs. 15.0%; continuous abstinence: 30.0% vs. 10.0%). Nicotine patch compliance over an 8-week period was also higher in the adherence condition than in the standard condition (44% vs. 25%). Although this small pilot was conducted to estimate effect sizes and was not powered to detect group differences, results are promising and suggest that adding a 10-min module focused on nicotine patch adherence to a standard 5 As protocol can increase abstinence rates. Given that this smoking cessation treatment was not specifically tailored to either HIV-positive smokers or Latino smokers, future research should examine whether it may be a promising approach for improving nicotine patch adherence in the general population of smokers. (PsycINFO Database Record

INTRODUCTION. Tobacco and marijuana co-use among young people in the U.S. is a public health concern that deserves greater attention. This study addresses a significant gap in the literature by examining the prevalence and correlates of tobacco and marijuana co-use among young people experiencing homelessness. METHODS. The analytic sample consisted of 449 unaccompanied homeless youth (mean age=22; 72% male) who had used any type of tobacco product in the past 30 days. Participants were recruited from 12 service sites and 13 street sites in Los Angeles County. RESULTS. Over 90% of young homeless tobacco users reported past month marijuana and tobacco co-use: 65% reported any co-administration (mixing both substances in a cigarette, joint, blunt, bong, hookah, pipe or bowl) and 27% reported only using them separately. Analysis of covariance tests found that co-administrators reported greater quantity and frequency of tobacco cigarette use, more frequent marijuana use, and, in some cases, poorer functioning and more severe homelessness compared to other tobacco users (p

Purpose:Virtually nothing is known about the potential effects of tobacco advertising on tobacco use among youth experiencing homelessness, a vulnerable population with high tobacco use rates. This study examines associations between the appeal of advertising for 5 classes of tobacco product (electronic cigarettes, hookah, cigars, cigarillos, and smokeless tobacco) and future intentions to use those products again among homeless youth who had indicated any level of lifetime use.Design:A cross-sectional design was used.Setting:Settings were 25 service and street sites in Los Angeles County.Participants:A probability sample of 469 young tobacco users experiencing homelessness (mean age = 22; 71% male; 29% non-Hispanic White) was recruited.Measures:Assessments included product-specific tobacco advertising appeal and future intentions to use the product again, as well as a range of covariate controls (eg, demographics, homelessness severity, current tobacco use, general advertising exposure).Analysis:Linear regression tested for associations between the appeal of advertising for a specific tobacco product and intentions to use that product again in the future, controlling for myriad covariates.Results:Advertising appeal was positively associated with future intentions to use again for electronic cigarettes ( P = .006) and hookah ( P = .001), but not cigars ( P = .486), cigarillos ( P = .126), or smokeless tobacco ( P = .109).Conclusion:Results suggest that advertising appeal may increase use of certain tobacco products among youth experiencing homelessness. However, differences in themes emphasized by advertising for specific tobacco products could differentially influence use in this population.

BACKGROUND AND OBJECTIVES: The primary care (PC) setting provides an opportunity to address adolescent alcohol and marijuana use. We examined moderators of effectiveness for a PC brief motivational intervention on adolescents’ alcohol and marijuana use and consequences 1 year later. METHODS: We conducted a randomized controlled trial in 4 PC clinics from April 2013 to November 2015 and followed adolescents using Web-based surveys. We examined whether demographic factors and severity of use moderated 12-month outcomes. Adolescents aged 12 through 18 were screened by using the National Institute on Alcohol Abuse and Alcoholism Screening Guide. Those identified as at risk were randomly assigned to the intervention (CHAT) or to usual care (UC). RESULTS: The sample (n = 294) was 58% female, 66% Hispanic, 17% African American, 12% white, and 5% multiethnic or of other race with an average age of 16 years. After controlling for baseline values of outcomes, teens in CHAT who reported more negative consequences from drinking or had an alcohol use disorder at baseline reported less alcohol use, heavy drinking, and consequences 1 year later compared with teens in UC. Similarly, teens in CHAT with more negative consequences from marijuana use at baseline reported less marijuana use 1 year later compared with teens in UC; however, teens in CHAT who reported fewer marijuana consequences at baseline reported greater marijuana use 1 year later compared with teens in UC. CONCLUSIONS: A brief intervention can be efficacious over the long-term for adolescents who report problems from alcohol and marijuana use. Findings emphasize the importance of both screening and intervention in at-risk adolescents in PC.

BackgroundFlavoured tobacco products are widely available in youth-accessible retailers and are associated with increased youth initiation and use. The city of Boston, Massachusetts restricted the sale of flavoured tobacco products, including cigars, smokeless tobacco and e-cigarettes, to adult-only retailers. This paper describes the impact of the restriction on product availability, advertisement and consumer demand.MethodsBetween January and December 2016, data were collected in 488 retailers in Boston at baseline and 469 retailers at 8-month follow-up, measuring the type, brand and flavour of tobacco products being sold. Process measures detailing the educational enforcement process, and retailer experience were also captured. McNemar tests and t-tests were used to assess the impact of the restriction on product availability.ResultsAfter policy implementation, only 14.4% of youth-accessible retailers sold flavoured products compared with 100% of retailers at baseline (pConclusionTobacco retailers across Boston were largely in compliance with the regulation. Availability of flavoured tobacco products in youth-accessible retailers declined city-wide after policy implementation. Strong educational and enforcement infrastructure may greatly enhance retailer compliance.

Author(s): Golinelli, Daniela; Tucker, Joan S; Shadel, William G | Abstract: IntroductionSeveral studies have reported pronounced racial/ethnic differences in smoking behavior among homeless youth. Better understanding the factors underlying racial/ethnic differences in daily smoking among homeless youth may help inform programs to reduce smoking in this population.MethodsData come from a probability sample of homeless youth in Los Angeles County collected between 2008 and 2009. The sample includes 116 African American, 99 Hispanic, and 119 White youth with ages ranging from 13 to 24 years. Chi-square tests were used to test the differences in daily smoking among African American, Hispanic, and White youth. Propensity score and doubly robust methods were used to produce a less biased estimate of the association between daily smoking and race/ethnicity after having removed the effect of potential confounders.ResultsThe daily smoking rate for White youth was 70.1%, more than 31 percentage points than the rates for either African American or Hispanic youth. Propensity score analysis revealed that the majority of the racial/ethnic differences in smoking rates could be explained by differences in homelessness severity, although background characteristics and comorbidity were relevant as well.ConclusionsAs programs are developed to reduce smoking among homeless youth, results suggest that additional outreach may be needed to engage White youth in services. Also, smoking prevention programs may benefit from incorporating a social network-based approach that assists youth in fostering relationships with lower-risk peers, as well as addressing other forms of substance use. Incorporating these elements may help reduce the large racial/ethnic disparities in daily smoking among homeless youth.ImplicationsThis report extends the small existing literature on racial/ethnic differences in smoking among homeless youth in two important respects. First, it confirms differences in daily smoking, an important indicator of dependence, across racial/ethnic groups. Second, it seeks to understand the extent to which differences in smoking can be explained by demographic characteristics (other than race/ethnicity), background factors, homelessness severity, and comorbidity characteristics known to be associated with substance use among homeless youth.

Objective China issued a nationwide "Tobacco-Free Campus" Policy (TFCP) in January 2014, but it is unclear how well it was implemented across China's 2138 college campuses. We conducted an Internet survey of Beijing college students to evaluate the implementation of the TFCP in Beijing. Methods An Internet survey of 711 students from 37 colleges in Beijing was conducted in May 2015. Respondents reported on secondhand smoking (SHS) exposure on campus, knowledge on and actions taken against SHS, and tobacco marketing exposure on campus. Results Almost 90% of respondents were exposed to SHS on campus at least once in the past month. Approximately 37% of nonsmokers and 61% of smokers reported seeing a teacher smoking, and the majority of both smokers and nonsmokers reported seeing a classmate smoking in campus buildings. The likelihood and location of SHS exposure depend on the participant's demographics and own smoking behavior. Nonsmokers were more likely to be aware of the health risk of SHS than smokers. Although most participants were aware of the harms, only 13% and 9% tried to stop their last SHS exposure indoors and outdoors, respectively. Forty-seven students from 14 colleges noticed tobacco marketing activities on campus. Conclusions The TFCP on Chinese college campuses was only partially enforced, particularly with regard to SHS. Implications On January 29, 2014, the Chinese Ministry of Education issued the TFCP. A major barrier to effective tobacco control in China is the difficulty in implementing policies issued by the central government. At this point, it is unclear whether the TFCP was successfully implemented on China's college campuses. Major tobacco use monitoring efforts do not include college students. The present research describes the current tobacco control environment on Beijing's college campuses 15 months after the TFCP took effect. To our knowledge, this is the first paper in the English literature on tobacco environment and exposure (rather than a prevalence survey) of college students in China.

Objective To examine the relationship between physician advice to quit smoking and patient care experiences. Data Source The 2012 Medicare Consumer Assessment of Healthcare Providers and Systems (MCAHPS) surveys. Study Design Fixed-effects linear regression models were used to analyze cross-sectional survey data, which included a nationally representative sample of 26,432 smokers aged 65+. Principal Findings Eleven of 12 patient experience measures were significantly more positive among smokers who were always advised to quit smoking than those advised to quit less frequently. There was an attenuated but still significant and positive association of advice to quit smoking with both physician rating and physician communication, after controlling for other measures of care experiences. Conclusions Physician-provided cessation advice was associated with more positive patient assessments of their physicians.

Purpose To evaluate the momentary association between exposure to alcohol advertising and middle-school students' beliefs about alcohol in real-world settings and to explore racial/ethnic differences in this association. Methods Middle-school students (N = 588) carried handheld data collection devices for 14 days, recording their exposures to all forms of alcohol advertising during the assessment period. Students also responded to three investigator-initiated control prompts (programmed to occur randomly) on each day of the assessment period. After each exposure to advertising and at each control prompt, students reported their beliefs about alcohol. Mixed-effects regression models compared students' beliefs about alcohol between moments of exposure to alcohol advertising and control prompts. Results Students perceived the typical person their age who drinks alcohol (prototype perceptions) more favorably and perceived alcohol use as more normative at times of exposure to alcohol advertising than at times of nonexposure (i.e., at control prompts). Exposure to alcohol advertising was not associated with shifts in the perceived norms of black and Hispanic students, however, and the association between exposure and prototype perceptions was stronger among non-Hispanic students than among Hispanic students. Conclusions Exposure to alcohol advertising is associated with acute shifts in adolescents' perceptions of the typical person that drinks alcohol and the normativeness of drinking. These associations are both statistically and substantively meaningful.

Advances in mobile technology and mobile applications (apps) have opened up an exciting new frontier for behavioral health researchers, with a "second generation" of apps allowing for the simultaneous collection of multiple streams of data in real time. With this comes a host of technical decisions and ethical considerations unique to this evolving approach to research. Drawing on our experience developing a second-generation app for the simultaneous collection of text message, voice, and self-report data, we provide a framework for researchers interested in developing and using second-generation mobile apps to study health behaviors. Our Simplified Novel Application (SNApp) framework breaks the app development process into four phases: (1) information and resource gathering, (2) software and hardware decisions, (3) software development and testing, and (4) study start-up and implementation. At each phase, we address common challenges and ethical issues and make suggestions for effective and efficient app development. Our goal is to help researchers effectively balance priorities related to the function of the app with the realities of app development, human subjects issues, and project resource constraints.

Introduction Most young people experiencing homelessness smoke cigarettes, but little is known about use of alternative tobacco products (ATPs) such as e-cigarettes or other electronic nicotine delivery systems (ENDS) and little cigars/cigarillos (LCCs). This study examines past month use and correlates of cigarettes and ATP among young tobacco users experiencing homelessness. Methods We surveyed a probability sample of N = 469 unaccompanied homeless 13–25 year olds (mean age = 22; 71% male), who reported past month use of any type of tobacco product, from 25 service and street sites in Los Angeles County. Results Nearly all (90%) participants reported smoking regular cigarettes, and 78% reported using at least one tobacco product other than regular cigarettes. The most commonly used of these other products was natural cigarettes (55%), followed by LCCs (43%), ENDS (34%), cigars (31%), hookah (14%), chewing tobacco (7%), and snus (5%). Multivariable models indicated that correlates of past month use differed by product, but included sociodemographic characteristics, homelessness severity, depression, exposure to other people who used the product, and product perceptions (e.g., relative access, cost, and harm compared to cigarettes). Conclusion Use of cigarettes and ATPs are both widespread among young homeless tobacco users, suggesting that efforts to reduce tobacco use in this population should have a broad focus that includes a variety of products. The effectiveness of these efforts may be enhanced by addressing their considerable exposure to other tobacco users, as well as their perceptions of certain products as being less harmful or more cost-effective options than regular cigarettes.

Introduction Identifying distinct patterns of tobacco product use can inform efforts to reduce poly-tobacco use among young people, but little is known regarding patterns of use among youth experiencing homelessness. This study identified patterns of using tobacco/nicotine products among youth experiencing homelessness, and assessed whether certain subgroups of youth were more likely than others to engage in specific patterns of use. Methods Data were collected from a probability sample of 469 homeless youth who used tobacco in the past month, recruited from 25 service and street sites in Los Angeles County. Participants reported on lifetime and past month use of natural cigarettes, cigars, little cigars/cigarillos, electronic nicotine delivery systems, hookah, and chewing tobacco. Latent class analysis was used to identify patterns of tobacco product use. Results We identified four main classes of use: traditional cigarettes smokers (34.7% of the sample), poly-tobacco experimenters (24.9%), current users of combustible products (natural cigarettes, cigars, little cigars/cigarillos; 27.1%), and current poly-tobacco users (13.1%). Youth who were male, slept outdoors, and screened positive for substance abuse disorder were more than twice as likely as their counterparts to be current poly-tobacco users relative to traditional cigarettes smokers. Conclusions Rates of poly-tobacco experimentation and current use among youth experiencing homelessness are high. This suggests that efforts to reduce the use of tobacco products in this population should focus on the combined use of these products, and further, that users with the greatest poly-use may have competing unmet needs such as substance use disorders and more severe homelessness.

Introduction Roll-your-own (RYO) cigarette smoking is uncommon among young smokers in the U.S. but may be more widespread among those experiencing homelessness as it is a less expensive source of cigarettes. This study examines the prevalence and correlates of RYO use among young cigarette smokers experiencing homelessness. Methods The analytic sample consisted of 433 unaccompanied homeless youth who reported past month use of factory-manufactured cigarettes. Participants were sampled from 25 street and service sites in Los Angeles County, and completed a survey on their tobacco-related behaviors and cognitions. Results RYO use was reported by 43% of cigarette smokers. Among those who filled RYOs with tobacco, 87% rolled them with used tobacco (typically mixed with new tobacco). Most RYO smokers reported engaging in high-risk smoking practices, such as smoking discarded cigarettes. Although RYO smokers were more likely than other smokers to perceive RYOs as less risky in general, these groups did not differ in the perceived relative harm, expense, and ease of access of RYOs compared to regular cigarettes. Multivariable analyses indicated that RYO use was associated with older age, less perceived riskiness of RYOs, greater exposure to RYO smokers, and stronger future intentions to smoke. Conclusion RYOs may encourage continued tobacco use among youth experiencing homelessness and pose additional health risks despite users’ beliefs to the contrary. Future research is needed to obtain more detailed information on RYO practices and motivations for use, as well as how to address RYOs in efforts to reduce tobacco use in this population.

The purpose of this correlational study was to evaluate the association between attention paid by adolescents to the tobacco power wall and their susceptibility to future smoking. The study was conducted in the RAND Store Lab (RSL), a life-sized replica of a convenience store designed to investigate how tobacco advertising displays in retail point-of-sale environments relate to tobacco use risk and behaviors. In this study, middle and high school students (N = 80) shopped in the RSL while their attention to the tobacco power wall was measured covertly. Before and after shopping in the RSL, participants completed a measure of susceptibility to smoking in the future. Controlling for baseline cigarette smoking susceptibility and other potential confounders, attention toward the tobacco power wall was found to be significantly associated with future smoking susceptibility, p = .046. This finding suggests that policies aimed at decreasing the prominence of power walls in retail outlets should be given careful consideration as ways to reduce the impact of point-of-sale tobacco advertising and promotion on youth smoking susceptibility.

OBJECTIVE: The purpose of this study was to quantify the persistence of immediate changes in adolescents’ alcohol-related beliefs associated with exposure to alcohol advertising. METHOD: Middle school students (N = 606) carried handheld devices for 14 days and logged all of their exposures to alcohol advertisements as they naturally occurred. Perceptions of the typical person one’s age who drinks (“prototype perceptions”) and perceived norms regarding alcohol use were assessed after each exposure to advertising and at random prompts issued daily throughout the assessment period. Generalized additive modeling was used to determine how long pro-drinking shifts in beliefs persisted after exposure to advertising. RESULTS: Following exposure to advertisements, positivity of youth’s prototype perceptions immediately increased (β = .07, 95% CI [.06, .09]) and then decreased (β = -.05, 95% CI [-.07, -.03]) over the subsequent 1.5 days, whereas perceived normativeness of alcohol use immediately increased (β = .04, 95% CI [.01, .06]) and then decreased (β = -.03, 95% CI [-.05, -.01]) over the subsequent 2 days. Changes in beliefs occurring after 1.5 days for prototype perceptions and after 2 days for perceived norms were not statistically significant, suggesting that these beliefs were no longer affected by the advertising exposure. CONCLUSIONS: Findings are consistent with theories of alcohol advertising effects that presume that repeated exposure results in cumulative, enduring effects on beliefs. Given the rate of decay of alcohol advertising effects, it may be important to limit youth exposures to one every 2 days to avoid cumulative, lasting pro-drinking shifts in beliefs or to devise ways to interrupt cumulative effects with counter-messaging through media, parents, or other influential others at similar intervals.

Background Although the association between alcohol use and sexual risk behaviour has been well-documented, there is little understanding of whether marijuana use alone or combining marijuana with alcohol use contributes to sexual risk behaviour among adolescents. Methods: A diverse sample of sexually active adolescents (n = 616) aged 12–18 years (50.32% Hispanic; 31.17% Black) completed a survey on alcohol use, marijuana use and sexual risk behaviour during a visit to a primary care clinic. Results: Adolescents were more likely to report having had two or more sexual partners in the past 3 months if they reported using both alcohol and marijuana (OR = 3.90, P

Aims The U.S. Public Health Service Clinical Practice Guideline on treating tobacco use and dependence recommends providing advice to quit to every tobacco user seen in a healthcare setting. However, the mechanism through which counseling encourages patients to quit has not been adequately studied. This study tests whether the association between receiving healthcare provider counseling and desire to quit is accounted for by negative health and psychosocial outcome expectancies of smoking. Methods Data were collected online from 721 adult smokers who had seen a healthcare provider in the past 12 months. Associations between counseling to quit, negative outcome expectancies of smoking, and desire to quit were tested, as well as whether outcome expectancies and desire to quit differed by type of counseling (counseling only vs. counseling plus assistance) and level of smoking. Results Bivariate associations indicated a stronger desire to quit among patients receiving counseling, particularly when it included healthcare provider assistance to quit. SEM results indicated that the association between counseling and desire to quit was fully accounted for by patients' negative health and psychosocial outcome expectancies for smoking. These associations were found across levels of smoking in the case of health expectancies, but were limited to moderate and heavy smokers in the case of psychosocial expectancies. Conclusion Results suggest that the time devoted to counseling patients about smoking should include providing some assistance to quit, such as recommending a product, prescription or program. Regardless of smoking level, this counseling should incorporate techniques to elicit patients' negative health and psychosocial expectancies of smoking.

Introduction Adolescents’ e-cigarette use is now more prevalent than their combustible cigarette use. Youth are exposed to e-cigarette advertising at retail point-of-sale (POS) locations via the tobacco power wall (TPW), but no studies have assessed whether exposure to the TPW influences susceptibility to future e-cigarette use. Methods The study was conducted in the RAND Store Lab (RSL), a life-sized replica of a convenience store developed to experimentally evaluate how POS advertising influences tobacco use risk under simulated shopping conditions. In a between-subjects experiment, 160 adolescents (M age = 13.82; 53% female, 56% white) were randomized to shop in the RSL under one of two conditions: (1) TPW located behind the cashier (n = 80); or (2) TPW hidden behind an opaque wall (n = 80). Youths rated willingness to use e-cigarettes (“If one of your best friends were to offer you an e-cigarette, would you try it?”; 1 = definitely not, 10 = definitely yes) before and after exposure. Linear regression assessed differences in pre-post changes in willingness to use across conditions. Results Ever-use of e-cigarettes was 5%; use of cigarettes was 8%; use of both e-cigarettes and cigarettes was 4%. There were no differences between TPW conditions on these or other baseline variables (eg, age, gender). Compared to the hidden condition, TPW exposure was associated with greater increases in willingness to use e-cigarettes in the future (B = 1.15, standard error [SE] = 0.50, p = .02). Conclusions Efforts to regulate visibility of the TPW at POS may help to reduce youths’ susceptibility to initiating e-cigarettes as well as conventional tobacco products like cigarettes. Implications Past work suggests that exposure to the TPW in common retail settings, like convenience stores, may increase adolescents’ susceptibility to smoking cigarettes. This experimental study builds upon prior research to show that exposure to the TPW at retail POS similarly increases adolescents’ willingness to use e-cigarettes in the future. Efforts to regulate the visibility of the TPW in retail settings may help to reduce youths’ susceptibility to initiating nicotine and tobacco products, including e-cigarettes.

Background To describe patterns of alcohol and other drug (AOD) use risk and adolescent reported primary care (PC) screening and intervention, and examine associations of AOD risk and mental health with reported care received. Methods We analyzed data from cross-sectional surveys collected from April 3, 2013 to November 24, 2015 from 1279 diverse adolescents ages 12–18 who reported visiting a doctor at least once in the past year. Key measures were AOD risk using the Personal Experience Screening Questionnaire; mental health using the 5-item Mental Health Inventory; binary measures of adolescent-reported screening and intervention. Results Half (49.2%) of the adolescents reported past year AOD use. Of the 769 (60.1%) of adolescents that reported being asked by a medical provider in PC about AOD use, only 37.2% reported receiving screening/intervention. The odds of reported screening/intervention were significantly higher for adolescents with higher AOD risk and lower mental health scores. Conclusions Adolescents at risk for AOD use and poor mental health are most likely to benefit from brief intervention. These findings suggest that strategies are needed to facilitate medical providers identification of need for counseling of both AOD and mental health care for at risk youth. Trials registration clinicaltrials.gov , Identifier: NCT01797835, March 2013.

Youths in this study (ages 11–14) were exposed to an average of three alcohol ads per day; black and Hispanic youths' exposure was roughly double that of white youths. Exposure to alcohol ads led youths to view alcohol and drinking more positively.

Objectives This experiment tested whether changing the location or visibility of the tobacco power wall in a life sized replica of a convenience store had any effect on adolescents’ susceptibility to future cigarette smoking. Methods The study was conducted in the RAND StoreLab (RSL), a life sized replica of a convenience store that was developed to experimentally evaluate how changing aspects of tobacco advertising displays in retail point-of-sale environments influences tobacco use risk and behaviour. A randomised, between-subjects experimental design with three conditions that varied the location or visibility of the tobacco power wall within the RSL was used. The conditions were: cashier (the tobacco power wall was located in its typical position behind the cash register counter); sidewall (the tobacco power wall was located on a sidewall away from the cash register); or hidden (the tobacco power wall was located behind the cashier but was hidden behind an opaque wall). The sample included 241 adolescents. Results Hiding the tobacco power wall significantly reduced adolescents’ susceptibility to future cigarette smoking compared to leaving it exposed (ie, the cashier condition; p=0.02). Locating the tobacco power wall on a sidewall away from the cashier had no effect on future cigarette smoking susceptibility compared to the cashier condition (p=0.80). Conclusions Hiding the tobacco power wall at retail point-of-sale locations is a strong regulatory option for reducing the impact of the retail environment on cigarette smoking risk in adolescents.

Objective Little smoking research in the past 20 years includes persons 50 and older; herein we describe patterns of clinician cessation advice to US seniors, including variation by Medicare beneficiary characteristics. Method In 2012–4, we analyzed 2010 Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey data from Medicare beneficiaries over age 64 ( n = 346,674). We estimated smoking rates and the proportion of smokers whose clinicians encouraged cessation. Results 12% of male and 8% of female respondents aged 65 and older smoke. The rate decreases with age (14% of 65–69, 3% of 85 +) and education (12–15% with no high school degree, 5–6% with BA +). Rates are highest among American Indian/Alaskan Native (16%), multiracial (14%), and African–American (13%) seniors, and in the Southeast (14%). Only 51% of smokers say they receive cessation advice “always” or “usually” at doctor visits, with advice more often given to the young, those in low-smoking regions, Asians, and women. For all results cited p Conclusions Smoking cessation advice to seniors is variable. Providers may focus on groups or areas in which smoking is less common or when they are most comfortable giving advice. More consistent interventions are needed, including cessation advice from clinicians.