Detection and Characterization of Online Substance Use Discussions Among Gamers: Qualitative Retrospective Analysis of Reddit r/StopGaming Data.

BACKGROUND: Video games have rapidly become mainstream in recent decades, with over half of the US population involved in some form of digital gaming. However, concerns regarding the potential harms of excessive, disordered gaming have also risen. Internet gaming disorder (IGD) has been proposed as a tentative psychiatric disorder that requires further study by the American Psychological Association (APA) and is recognized as a behavioral addiction by the World Health Organization. Substance use among gamers has also become a concern, with caffeinated or energy drinks and prescription stimulants commonly used for performance enhancement. OBJECTIVE: This study aimed to identify substance use patterns and health-related concerns among gamers among a population of Reddit users. METHODS: We used the public streaming Reddit application programming interface to collect and analyze all posts from the popular subreddit, r/StopGaming. From this corpus of posts, we filtered the dataset for keywords associated with common substances that may be used to enhance gaming performance. We then applied an inductive coding approach to characterize substance use behaviors, gaming genres, and physical and mental health concerns. Potential disordered gaming behavior was also identified using the tentative IGD guidelines proposed by the APA. A chi-square test of independence was used to assess the association between gaming disorder and substance use characteristics, and multivariable logistic regression was used to analyze whether mental health discussion or the mention of any substance with sufficient sample size was significantly associated with IGD. RESULTS: In total, 10,551 posts were collected from Reddit from June 2017 to December 2022. After filtering the dataset for substance-related keywords, 1057 were included for further analysis, of which 286 mentioned both gaming and the use of ≥1 substances. Among the 286 posts that discussed both gaming and substance use, the most mentioned substances were alcohol (n=132), cannabis (n=104), and nicotine (n=48), while the most mentioned genres were role-playing games (n=120), shooters (n=90), and multiplayer online battle arenas (n=43). Self-reported behavior that aligned with the tentative guidelines for IGD was identified in 66.8% (191/286) posts. More than half, 62.9% (180/286) of the posts, discussed a health issue, with the majority (n=144) cited mental health concerns. Common mental health concerns discussed were depression and anxiety. There was a significant association between IGD and substance use (P<.001; chi-square test), and there were significantly increased odds of IGD among those who self-reported substance use (odds ratio 2.29, P<.001) and those who discussed mental health (odds ratio 1.64, P<.03). CONCLUSIONS: As gaming increasingly becomes highly prevalent among various age groups and demographics, a better understanding of the interplay and convergence among disordered gaming, substance use, and negative health impacts can inform the development of interventions to mitigate risks and promote healthier gaming habits.

Serum 25-Hydroxyvitamin D and Five-Year Survival in Primary Colon Cancer: A Retrospective Cohort Study.

This study examined the link between serum 25-hydroxyvitamin D (25(OH)D) and mortality in patients with colon cancer. Using a clinical database from the University of California, serum 25(OH)D measures were averaged for the time following diagnosis until either the time of death or 5 years had elapsed. Analytical methods included the use of Generalized Additive Models (GAM), logistic regression, and Cox proportional hazards models to examine non-linear relationships and the impact of 25(OH)D on 5-year mortality. This study assessed 1,602 patients with colon cancer having a median 25(OH)D of 31.8 ng/mL and a 5-year mortality rate of 22.7%. A significant association between higher post-diagnosis vitamin D levels and decreased 5-year mortality was observed. This association persisted after adjusting for disease severity and significant demographic confounders, in both a logistic regression model for 5-year mortality (OR = 0.79, 95% CI: 0.66-0.92, p < 0.001) and a cox proportional hazards model for survival (HR = 0.94, CI: 0.88-0.99, p = 0.048). GAM illustrated a steep increase in survival probability up to a plateau, suggesting a threshold effect beyond roughly 50.0 ng/mL. This study found a potential protective role of vitamin D in the survival of colon cancer patients, supporting the correction of levels below 25 ng/mL but ideally above 50 ng/mL.

The Mediating Role of Comorbidities on the Relationship Between Serum Vitamin D and Five-Year Mortality Risk in Colon Cancer Patients.

This retrospective cohort study explores the relationship between vitamin D levels and 5-year mortality risk among 1,549 colon cancer patients seen at University of California health centers between 2012 and 2019, with a particular focus on the mediating role of comorbidities. Methods leveraged structural equation modeling to assess both direct and indirect pathways linking vitamin D to mortality risk. This analysis revealed a protective direct effect of higher vitamin D levels against mortality risk. Additionally, this study uncovered an indirect pathway, demonstrating that vitamin D lowers mortality risk by mitigating comorbidity, which subsequently influence mortality risk. Study results indicate that approximately 9.2% of the beneficial effect of vitamin D on mortality risk is attributable to its capacity to reduce comorbidity burden. In disaggregated and confounder-adjusted structural modeling, there were significant indirect effects for 25(OH)D on mortality risk through its effects on depression and obesity but not on anxiety, diabetes, or chronic kidney disease. These results suggest that the protective effects of vitamin D in colon cancer etiology appear to be through direct action on cancer progression, though patients who also suffer from depression and obesity would especially benefit from achieving adequate levels of serum vitamin D.

Abortion pill marketing and sourcing on twitter following Dobbs v. Jackson supreme court ruling.

OBJECTIVE: This study examines abortion-related discourse on Twitter (X) pre-and post-Dobbs v. Jackson ruling, which eliminated the constitutional right to abortion. STUDY DESIGN: We used a custom data collection tool to collect tweets directly from Twitter using abortion-related keywords. We used the BERTopic language model and examined the top 30 retweeted and top 30 textually similar tweets from relevant topic clusters using an inductive coding approach. We also conducted statistical testing to assess potential associations between abortion themes. RESULTS: 166,799 unique tweets were collected from December 2020-December 2022. 464 unique tweets were coded for abortion-related themes with 154 identified as relevant. Of these, 66 tweets marketed abortion pills, 17 tweets were identified as offering consultations, and 91 tweets were relevant to self-managed abortion. All marketing and consultation tweets were posted post-Dobbs decision and 7 (7.69%) of self-managed tweets were posted pre-Dobbs versus 84 (92.30%) posted post-Dobbs. A positive association was found between tweets offering a medical consultation with tweets marketing abortion pills and discussing self-managed abortion. CONCLUSION: This study detected online marketing of abortion pills, consultations and discussions about self-managed abortion following the Dobbs v. Jackson ruling. These results provide more context to the type of abortion-related information that is available online.

This study examined tweets occurring both pre and post Dobbs decision and identified relevant discussions about self-managed abortion services, marketing and sale of abortion pills, and offering purported medical consultations. These findings indicate that abortion-related tweets, particularly those marketing abortion medications, increased after the Dobbs v. Jackson ruling. These findings highlight the evolving abortion information environment in the United States on Twitter, which represents a platform where health and politicised issues are commonly discussed.

Digital technologies used in clinical trial recruitment and enrollment including application to trial diversity and inclusion: A systematic review.

Background: Many clinical trials fail because of poor recruitment and enrollment which can directly impact the success of biomedical and clinical research outcomes. Options to leverage digital technology for improving clinical trial management are expansive, with potential benefits for improving access to clinical trials, encouraging trial diversity and inclusion, and potential cost-savings through enhanced efficiency. Objectives: This systematic review has two key aims: (1) identify and describe the digital technologies applied in clinical trial recruitment and enrollment and (2) evaluate evidence of these technologies addressing the recruitment and enrollment of racial and ethnic minority groups. Methods: We conducted a cross-disciplinary review of articles from PubMed, IEEE Xplore, and ACM Digital Library, published in English between January 2012 and July 2022, using MeSH terms and keywords for digital health, clinical trials, and recruitment and enrollment. Articles unrelated to technology in the recruitment/enrollment process or those discussing recruitment/enrollment without technology aspects were excluded. Results: The review returned 614 results, with 21 articles (four reviews and 17 original research articles) deemed suitable for inclusion after screening and full-text review. To address the first objective, various digital technologies were identified and characterized, which included articles with more than one technology subcategory including (a) multimedia presentations (19%, n = 4); (b) mobile applications (14%, n = 3); (c) social media platforms (29%, n = 6); (d) machine learning and computer algorithms (19%, n = 4); (e) e-consenting (24%, n = 5); (f) blockchain (5%, n = 1); (g) web-based programs (24%, n = 5); and (h) virtual messaging (24%, n = 5). Additionally, subthemes, including specific diseases or conditions addressed, privacy and regulatory concerns, cost/benefit analyses, and ethnic and minority recruitment considerations, were identified and discussed. Limited research was found to support a particular technology's effectiveness in racial and ethnic minority recruitment and enrollment. Conclusion: Results from this review illustrate that several types of technology are currently being explored and utilized in clinical trial recruitment and enrollment stages. However, evidence supporting the use of digital technologies is varied and requires further research and evaluation to identify the most valuable opportunities for encouraging diversity in clinical trial recruitment and enrollment practices.

Health disparities in time to diagnosis and survival post-diagnosis of cirrhosis in individuals with alcohol use disorder: A retrospective cohort study.

OBJECTIVE: This study investigates the impact of race, gender, and ethnicity on the progression from diagnosis to cirrhosis and subsequent survival in patients with alcohol use disorder, with a specific focus on identifying potential disparities in health outcomes. METHOD: Employing a STROBE-compliant, retrospective cohort design, we analyzed data from patients diagnosed with alcohol use disorder from January 2000 to December 2022, using the University of California Health Data Warehouse. We estimated survival functions using the Kaplan-Meier method and assessed demographic associations using both bivariate and multivariate Cox proportional hazards models. RESULTS: The analysis highlighted a significant association between Hispanic ethnicity and an accelerated timeline for both the diagnosis of alcohol-related cirrhosis following diagnosis of alcohol use disorder and mortality post-cirrhosis diagnosis. The former was evident only in bivariate analysis, but the latter association persisted in multivariate analysis. Gender did not demonstrate a significant correlation with the time to these outcomes, though multiracial identification emerged as a protective factor. CONCLUSIONS: The study reveals critical health disparities in the progression and outcomes of cirrhosis, particularly between Hispanic and non-Hispanic patients. These findings underscore the urgent need for targeted healthcare interventions and policies that address these disparities. Future research should delve deeper into the multifaceted factors influencing these outcomes, facilitating the development of more nuanced and effective prevention and treatment strategies for alcohol use disorder and its severe complications.

Rates of adverse events and related risk factors following e-cigarette use.

BACKGROUND: E-cigarettes have emerged as popular products, especially for younger populations. However, concerns regarding health effects exist and there is a notable gap in understanding the prevalence and nature of adverse events. This study aims to examine the rate of adverse events in individuals who use e-cigarettes in a large sample. METHODS: A cross-sectional survey was conducted with a sample of 4695 current and former e-cigarette users with a median age of 34 years. The survey collected data on e-cigarette use, adverse events experienced, product characteristics, related behaviors, sociodemographic factors and presence of medical comorbidities. Statistical analyses were conducted using Pearson's chi-squared tests and logistic regression. RESULTS: A total of 78.9% of respondents reported experiencing an adverse event within 6 h of using a vaping device, with the most common events being headache, anxiety and coughing. Product characteristics and related behaviors significantly influenced the risk of adverse events. There were also sociodemographic disparities, with Hispanic respondents and those with at least college-level education reporting higher rates of adverse events. CONCLUSIONS: Our study found a high rate of adverse events among e-cigarette users. We identified that certain e-cigarette product characteristics, behaviors and medical comorbidities significantly increased the risk of these events.

Identification and Characterization of Illegal Sales of Cannabis and Nicotine Delivery Products on Telegram Messaging Platform.

INTRODUCTION: Unregulated and potentially illegal sales of tobacco, nicotine, and cannabis products have been detected on various social media platforms, e-commerce sites, online retailers, and the dark web. New end-to-end encrypted messaging services are popular among online users and present opportunities for marketing, trading, and selling of these products. The purpose of this study was to identify and characterize tobacco, nicotine, and cannabis selling activity on the messaging platform Telegram. METHODS: The study was conducted in three phases: (1) identifying keywords related to tobacco, nicotine, and cannabis products for purposes of detecting Telegram groups and channel messages; (2) automated data collection from public Telegram groups; and (3) manual annotation and classification of messages engaged in marketing and selling products to consumers. RESULTS: Four keywords were identified ("Nicotine," "Vape," "Cannabis," and "Smoke") that yielded 20 Telegram groups with 262 506 active subscribers. Total volume of channel messages was 43 963 unique messages that included 3094 (7.04%) marketing/selling messages. The most commonly sold products in these groups were cannabis-derived products (83.25%, n = 2576), followed by tobacco/nicotine-derived products (6.46%, n = 200), and other illicit drugs (0.77%, n = 24). A variety of marketing tactics and a mix of seller accounts were observed, though most appeared to be individual suppliers. CONCLUSIONS: Telegram is an online messaging application that allows for custom group creation and global connectivity, but also includes unregulated activities associated with the sale of cannabis and nicotine delivery products. Greater attention is needed to conduct monitoring and enforcement on these emerging platforms for unregulated and potentially illegal cannabis and nicotine product sales direct-to-consumer. IMPLICATIONS: Based on study results, Telegram represents an emerging platform that enables a robust cannabis and nicotine-selling marketplace. As local, state, and national tobacco control regulations continue to advance sales restrictions and bans at the retail level, easily accessible and unregulated Internet-based channels must be further assessed to ensure that they do not act as conduits for exposure and access to unregulated or illegal cannabis and nicotine products.

Detection and Characterization of Web-Based Pediatric COVID-19 Vaccine Discussions and Racial and Ethnic Minority Topics: Retrospective Analysis of Twitter Data.

Background: Despite pediatric populations representing a smaller proportion of COVID-19 cases and having a less severe prognosis, those belonging to racial and ethnic minority groups are at an increased risk of developing more severe COVID-19-related outcomes. Vaccine coverage is crucial to pandemic mitigation efforts, yet since the start of the COVID-19 pandemic, vaccine hesitancy has increased and routine pediatric immunizations have decreased. Limited research exists on how vaccine hesitancy may contribute to low pediatric COVID-19 vaccine uptake among racial and ethnic minority populations. Objective: This study aimed to characterize COVID-19 vaccine-related discussion and sentiment among Twitter users, particularly among racial and ethnic minority users. Methods: We used the Twitter application programming interface to collect tweets and replies. Tweets were selected by filtering for keywords associated with COVID-19 vaccines and pediatric-related terms. From this corpus of tweets, we used the Biterm Topic Model to output topics and examined the top 200 retweeted tweets that were coded for pediatric COVID-19 vaccine relevance. Relevant tweets were analyzed using an inductive coding approach to characterize pediatric COVID-19 vaccine-related themes. Replies to relevant tweets were collected and coded. User metadata were assessed for self-reporting of race or ethnic group affiliation and verified account status. Results: A total of 863,007 tweets were collected from October 2020 to October 2021. After outputting Biterm Topic Model topics and reviewing the 200 most retweeted tweets, 208,666 tweets and 3905 replies were identified as being pediatric COVID-19 vaccine related. The majority (150,262/208,666, 72.01%) of tweets expressed vaccine-related concerns. Among tweets discussing vaccine confidence, user replies expressing agreement were significantly outweighed by those expressing disagreement (1016/3106, 32.71% vs 2090/3106, 67.29%; P<.001). The main themes identified in the Twitter interactions were conversations regarding vaccine-related concerns including adverse side effects, concerns that the vaccine is experimental or needs more testing and should not be tested on pediatric populations, the perception that the vaccine is unnecessary given the perceived low risk of pediatric infection, and conversations associated with vaccine-related confidence (ie, the vaccine is protective). Among signal tweets and replies, we identified 418 users who self-identified as a racial minority individual and 40 who self-identified as an ethnic minority individual. Among the subcodes identified in this study, the vaccine being protective was the most discussed topic by racial and ethnic minority groups (305/444, 68.7%). Conclusions: Vaccine-related concerns can have negative consequences on vaccine uptake and participation in vaccine-related clinical trials. This can impact the uptake and development of safe and effective vaccines, especially among racial and ethnic minority populations.

Improving Cancer Patient Outcomes and Cost-Effectiveness: A Markov Simulation of Improved Early Detection, Side Effect Management, and Palliative Care.

I employed a Markov model to simulate outcomes for a cohort of 1,000 hypothetical patients, comparing improvements in early detection, side effect management, and palliative care over a ten-year period. This model showed benefits in early detection and proactive health management, improving disease stability and reducing mortality rates. This protocol resulted in an 85.8% five-year survival rate, compared to 69.5% under standard protocol. Cost-effectiveness analysis showed significantly reduced costs and improved quality-adjusted life years. Our findings underscore the importance of comprehensive cancer care. These improvements not only reduce simulated healthcare costs but also significantly improve patient outcomes.

Identification and Characterization of Synthetic Nicotine Product Promotion and Sales on Instagram Using Natural Language Processing.

INTRODUCTION: There has been a rapid proliferation of synthetic nicotine products in recent years, despite newly established regulatory authority and limited research into its health risks. Previous research has implicated social media platforms as an avenue for nicotine product unregulated sales. Yet, little is known about synthetic nicotine product content on social media. We utilized natural language processing to characterize the sales of synthetic nicotine products on Instagram. METHODS: We collected Instagram posts by querying Instagram hashtags (e.g., "#tobaccofreenicotine) related to synthetic nicotine. Using BERT, collected posts were categorized into thematically related topic clusters. Posts within topic clusters relevant to study aims were then manually annotated for variables related to promotion and selling (e.g., cost discussion, contact information for offline sales). RESULTS: A total of 7,425 unique posts were collected with 2,219 posts identified as related to promotion and selling of synthetic nicotine products. Nicotine pouches (52.9%, n=1174), ENDS (30.6%, n=679), and flavored e-liquids (14.1%, n=313) were most commonly promoted. 16.1% (n=345) of posts contained embedded hyperlinks and 5.8% (n=129) provided contact information for purported offline transactions. Only 17.6% (n=391) of posts contained synthetic nicotine specific health warnings. CONCLUSIONS: In the United States, synthetic nicotine products can only be legally marketed if they have received premarket authorization from the FDA. Despite these prohibitions, Instagram appears to be a hub for potentially unregulated sales of synthetic and "tobacco-free" products. Efforts are needed by platforms and regulators to enhance content moderation and prevent unregulated online sales of existing and emerging synthetic nicotine products. IMPLICATIONS: There is limited clinical understanding of synthetic nicotine's unique health risks and how these novel products are changing over time due to regulatory oversight. Despite synthetic nicotine specific regulatory measures, such as the requirement for premarket authorization and FDA warning letters issued to unauthorized sellers, access to and promotion of synthetic nicotine is widely occurring on Instagram, a platform with over 2 billion users and one that is popular among youth and young adults. Activities include direct-to-consumer sales from questionable sources, inadequate health warning disclosure, and exposure with limited age restrictions, all conditions necessary for the sale of various tobacco products. Notably, the number of these Instagram posts increased in response to the announcement of new FDA regulations. In response, more robust online monitoring, content moderation, and proactive enforcement is needed from platforms who should work collaboratively with regulators to identify, report, and remove content in clear violation of platform policies and federal laws. Regulatory implementation and enforcement should prioritize digital platforms as conduits for unregulated access to synthetic nicotine products and other future novel and emerging tobacco products.

Tobacco Product Marketing Orders and Online Marketing and Sale of Unauthorized ENDS Products.

This study characterizes online marketing of unauthorized electronic nicotine delivery systems (ENDS).

Tobacco/nicotine dependence as a risk factor for substance use disorders and related mental health conditions among cancer patients.

BACKGROUND: Cancer patients often face multiple comorbidities and are at risk for various mental health conditions and substance use disorders. Tobacco/nicotine dependence (TND) is a known risk factor for poor health outcomes and has been associated with psychiatric disorders including substance use disorder. However, the specific relationship between TND and the risk of substance use disorder and mental health conditions among cancer patients remains underexplored. This study aimed to assess the association between TND and the risk of comorbid conditions among cancer patients. METHODS: Data were obtained from a database of electronic health records for patients from the University of California health system. The odds for every condition among cancer patients with TND were calculated and compared with those for cancer patients without TND. ORs were adjusted for gender, ethnicity, and race. RESULTS: Three thousand seven hundred and ninety-one cancer patients with TND had 252,619 total conditions, and 51,711 cancer patients without TND had 2,310,880 conditions. After adjusting for confounders, the condition for which TND most exacerbated risk was psychoactive substance-induced organic anxiety disorder (OR = 16.3, p < 0.001). This appeared consistent with the second, third, and fifth most-exacerbated conditions: stimulant use disorder (OR = 12.8, p < 0.001), cocaine induced mental disorder (OR = 11.0, p < 0.001), and cocaine use disorder (OR = 11.0, p < 0.001). Different conditions exacerbated by TND include acute alcoholic intoxication (OR = 11.4, p < 0.001), opioid use disorder (OR = 7.6, p < 0.001), schizoaffective disorder (OR = 7.4, p < 0.001), and cannabis use disorder (OR = 6.3, p < 0.001). CONCLUSIONS: Our findings reveal a strong association between TND and an increased risk of substance use disorder and mental health conditions among cancer patients. Specifically, cancer patients with TND were at an elevated risk for psychoactive substance-induced organic anxiety disorder, stimulant use disorder, and cocaine-related disorders. Additionally, TND was associated with an increased risk of acute alcoholic intoxication, opioid use disorder, schizoaffective disorder, and cannabis use disorder. These findings underscore the need for comprehensive screening and interventions to address TND and comorbid conditions among cancer patients.

The Influence of News Consumption Habits and Dispositional Traits on Trust in Medical Scientists.

Public trust in medical institutions is essential for ensuring compliance with medical directives. However, the politicization of public health issues and the polarized nature of major news outlets suggest that partisanship and news consumption habits can influence medical trust. This study employed a survey with 858 participants and used regression analysis to assesses how news consumption habits and information assessment traits (IATs) influence trust in medical scientists. IATs included were conscientiousness, openness, need for cognitive closure (NFCC), and cognitive reflective thinking (CRT). News sources were classified on the basis of factuality and political bias. Initially, readership of liberally biased news was positively associated with medical trust (p < 0.05). However, this association disappeared when controlling for the news source's factuality (p = 0.28), while CRT (p < 0.05) was positively associated with medical trust. When controlling for conservatively biased news sources, factuality of the news source (p < 0.05) and NFCC (p < 0.05) were positively associated with medical trust. While partisan media bias may influence medical trust, these results suggest that those who have higher abilities to assess information and who prefer more credible news sources have a greater trust in medical scientists.

Assessing Characteristics and Compliance of Online Delta-8 Tetrahydrocannabinol Product Sellers.

Introduction: The debate over the legal status of many cannabis- and hemp-derived products, including delta-8 tetrahydrocannabinol (THC), is in question. Although low concentrations of delta-8 THC are legal at the Federal level, many states have implemented their own regulations to both allow and restrict its use and sale. Of concern, sellers with unknown legal credentials have appeared online and are actively selling this product. Materials and Methods: We characterized the marketing, sale, and compliance of online delta-8 THC sellers using (1) data collected from the Twitter Application Programming Interface with delta-8 THC-related keywords; (2) unsupervised topic modeling using the Biterm Topic Model to identify clusters of tweets involved in marketing and selling; (3) inductive coding to identify marketing and selling characteristics; and (4) web forensics and simulated shopping to determine compliance with state restrictions for delta-8 THC sales. Results: In total, 110 unique hyperlinks associated with 7085 tweets that included marketing and selling activity for delta-8 THC were collected. From these links, we conducted simulated purchasing in January 2021 to identify compliant and noncompliant websites. Among the vendors, age verification was not found in over half of websites (59, 53.63%); 60 (54.55%) did not report a physical address; and 74 (65.45%) sold delta-8 products direct-to-consumer. Sixty-seven (90.54%) of detected vendors shipped delta-8 products to addresses in states that prohibit sales. Forty-three (64.18%) of Internet Protocol addresses were located within the United States; all others were international. Conclusion: Our analysis suggests that online storefronts are illegally selling and shipping cannabinoid derivatives to U.S. consumers. Further research is needed to understand downstream health and regulatory impacts from this unregulated access.

Examining the association between California tobacco licensed retail density and public support or opposition to state anti-tobacco legislation.

INTRODUCTION: The state of California has enacted progressive anti-tobacco policies, including Proposition 56 in 2016. In response, the alternative and emerging tobacco product (ATP) industry has increased its political activity. This study explores the association between the proportion of people voting against Proposition 56 and tobacco/ATP retail density. METHODS: We conducted a retrospective analysis using data on licensed California tobacco retailers, which were then cross-referenced for categorization using Yelp. Proportion voting against Proposition 56 was obtained from the Secretary of State's website. A series of linear regression tests were performed between population-normalized retailer density and voting proportion at the county level before and after adjusting for covariates such as age, gender, race/ethnicity and median household income. RESULTS: The total number of licensed tobacco retailers increased by 29.31% from 2015 to 2019. Association between proportion voting against Proposition 56 and retail density was significant during voting and during periods of policy implementation and post-implementation (2016-2018) for non-specialized tobacco retailers. For specialized/ATP retailers, significance was only detected during the post-implementation period (2018-2019) after normalization. Proportion voting against Proposition 56 was also a significant predictor of increase in total number of non-specific (ß=0.48, p=0.008) as well as specialized tobacco and/or ATP retail storefronts (ß=0.21, p=0.001) from 2016 to 2018. CONCLUSIONS: This study provides initial evidence of the association between tobacco retail density and voting patterns for anti-tobacco policy. Future research should examine the role of tobacco retail density on variation in local support for state tobacco control initiatives, including tailoring outreach to specific voting census blocks in communities with heavy retail presence.

Predictors of Time to Coronavirus Disease 2019 Infection in the National Basketball Association: A Retrospective Case-Control Study.

A case-control study was conducted between 1 December 2021 and 31 January 2022 to identify factors, which increase risk for coronavirus disease 2019 (COVID-19) among athletes in the National Basketball Association (NBA). Behavioral factors and stadium attendance significantly decreased time to COVID-19 infection, but local COVID-19 rates were not associated in a multivariable model.

Longitudinal analysis of tobacco and vape retail density in California.

INTRODUCTION: Tobacco retailer density may be associated with greater youth initiation and reduced success during quit attempts; however, the extent to which tobacco retailer density has changed overtime across multiple categories of retailers has not been reported. METHODS: Data on licensed tobacco retailers within California from 2015-2019 were obtained from the California Department of Tax and Fee Administration. Store type was categorized by automated cross-referencing with Yelp. Geolocations were aggregated at county level for analyzing longitudinal trends in changes in tobacco retail density including demographic characteristics. RESULTS: The number of active CA tobacco retailer licenses increased from 19825 in 2015 to 25635 in 2019. The highest percent increase in tobacco retailer licenses (9.1%) was observed in 2017. The number of specialized tobacco stores was highest in Los Angeles, San Diego, and Riverside counties. We observed a significant increase in the number of active licenses for non-specialized and specialized tobacco stores, both overall and after controlling for the size of populations within each region. Time was a statistically significant predictor for the number of active licenses for only non-specialized stores, after adjusting for covariates. Regional volume of retailers was positively associated with higher proportion of women, lower median household income, and higher proportion of Hispanic residents. CONCLUSIONS: Monitoring the changes in tobacco retail density and associated sociodemographic factors over time can help to identify communities at higher risk for tobacco and nicotine product exposure and access, and its associated health disparities.

A systematic review of digital technology and innovation and its potential to address anti-corruption, transparency, and accountability in the pharmaceutical supply chain.

INTRODUCTION: The urgent need to acquire medical supplies amidst the COVID-19 pandemic has led to bypassing of controls that govern the global pharmaceutical supply chain, increasing the risk of corruption. Hence, promoting anti-corruption, transparency, and accountability (ACTA) in supply chain and procurement has never been more important. The adoption of digital tools, if designed and implemented appropriately, can reduce the risks of corruption. AREAS COVERED: Following PRISMA guidelines, we conducted an interdisciplinary systematic review of health/medicine, humanities/social sciences, engineering, and computer science literature, with the aims of identifying technologies used for pharmaceutical supply chain and procurement optimization and reviewing whether they address ACTA mechanisms to strengthen pharmaceutical governance. Our review identified four distinct categories of digital solutions: e-procurement and open contracting; track-and-trace technology; anti-counterfeiting technology; and blockchain technology. EXPERT OPINION: Findings demonstrate an increase in research of technologies to improve pharmaceutical supply chain and procurement functions; however, most technologies are not being leveraged to directly address ACTA or global health outcomes. Some blockchain and RFID technologies incorporated ACTA mechanisms and mentioned specific policy/governance frameworks, but more purposeful linkage is needed. Findings point to the need for targeted policy development and governance to activate these innovative technologies to improve global health .

Content and trend analysis of user-generated nicotine sickness tweets: A retrospective infoveillance study.

INTRODUCTION: Exposure to pro-tobacco and electronic nicotine delivery system (ENDS) social media content can lead to overconsumption, increasing the likelihood of nicotine poisoning. This study aims to examine trends and characteristics of nicotine sickness content on Twitter between 2018-2020. METHODS: Tweets were collected retrospectively from the Twitter Academic Research Application Programming Interface (API) stream filtered for keywords: 'nic sick', 'nicsick', 'vape sick', 'vapesick' between 2018-2020. Collected tweets were manually annotated to identify suspected user-generated reports of nicotine sickness and related themes using an inductive coding approach. The Augmented Dickey-Fuller (ADF) test was used to assess stationarity in the monthly variation of the volume of tweets between 2018-2020. RESULTS: A total of 5651 tweets contained nicotine sickness-related keywords and 18.29% (n=1034) tweets reported one or more suspected nicotine sickness symptoms of varied severity. These tweets were also grouped into five related categories including firsthand and secondhand reports of symptoms, intentional overconsumption of nicotine products, users expressing intention to quit after 'nic sick' symptoms, mention of nicotine product type/brand name that they consumed while 'nic sick', and users discussing symptoms associated with nicotine withdrawal following cessation attempts. The volume of tweets reporting suspected nicotine sickness appeared to increase throughout the study period, except between February and April 2020. Stationarity in the volume of 'nicsick' tweets between 2018-2020 was not statistically significant (ADF= -0.32, p=0.98) indicating a change in the volume of tweets. CONCLUSIONS: Results point to the need for alternative forms of adverse event surveillance and reporting, to appropriately capture the growing health burden of vaping. Infoveillance approaches on social media platforms can help to assess the volume and characteristics of user-generated content discussing suspected nicotine poisoning, which may not be reported to poison control centers. Increasing volume of user-reported nicotine sickness and intentional overconsumption of nicotine in twitter posts represent a concerning trend associated with ENDS-related adverse events and poisoning.