Polymer scaffolds delineate healthy from diseased states at sites distal from the pancreas in two models of type 1 diabetes.

Type 1 diabetes (T1D) prevention is currently limited by the lack of diagnostic tools able to identify disease before autoimmune destruction of the pancreatic ß cells. Autoantibody tests are used to predict risk and, in combination with glucose dysregulation indicative of ß cell loss, to determine administration of immunotherapies. Our objective was to remotely identify immune changes associated with the disease, and we have employed a subcutaneously implanted microporous poly(e-caprolactone) (PCL) scaffold to function as an immunological niche (IN) in two models of T1D. Biopsy and analysis of the IN enables disease monitoring using transcriptomic changes at a distal site from autoimmune destruction of the pancreas, thereby gaining cellular level information about disease without the need for a biopsy of the native organ. Using this approach, we identified gene signatures that stratify healthy and diseased mice in both an adoptive transfer model and a spontaneous onset model of T1D. The gene signatures identified herein demonstrate the ability of the IN to identify immune activation associated with diabetes across models.

The Development and Testing of a Point-of-Sale E-Cigarette Health Communication Campaign.

Adolescents and young adults continue to use e-cigarettes, and communication campaigns are needed to decrease use among these populations. We developed and tested a point-of-sale communication campaign focused on e-cigarette chemical exposure. We developed messages based on formative research and tested them (versus text-only messages) in a nationally-representative online survey among adolescents and young adults (16-25) (Phase 1). Based on survey findings, we selected a message focused on nicotine and brain development for the point-of-sale trial (Phase 2). We then conducted a cluster-randomized trial at six gas stations with convenience stores, randomly assigned to the intervention (messages displayed) or no message control condition. We conducted intercept surveys with repeated cross-sectional samples of 50 participants (ages 16-25) per store, at baseline and a four-week follow-up. Phase 1 included 1,636 participants in the online study. Intervention messages were rated as more attention grabbing than plain text messages (p < .05), though were rated similarly on other outcomes. Exposure to intervention messages resulted in larger changes from pre- to posttest for beliefs about addiction and relative harms versus cigarettes (p < .05). Phase 2 included 586 participants in the point-of-sale study. Real-world campaign exposure was low (31.8%), and no differences were found between conditions. E-cigarette prevention messages focused on nicotine's impact on brain development show promise. However, garnering attention for communication campaigns in saturated point-of-sale environments, often dominated by tobacco advertising, is challenging. Future efforts should utilize additional communication channels to directly target adolescents and young adults.

Point-of-Sale Health Communication Campaigns for Cigarillos and Waterpipe Tobacco: Effects and Lessons Learned from Two Cluster Randomized Trials.

Many adolescents and young adults hold erroneous beliefs that cigarillos and waterpipe tobacco (WT) are safer than cigarettes, contributing to use. Communication campaigns can correct misperceptions and increase risk beliefs. We tested point-of-sale (POS) communication campaigns focused on chemical exposure for cigarillos and WT. We conducted two cluster randomized trials at 20 gas stations with convenience stores (10 stores for cigarillos, 10 for WT) in North Carolina between June and November 2017. Within each trial, stores were randomly assigned to either the intervention (campaign messages displayed) or a no message control condition. We conducted intercept surveys with repeated cross-sectional samples of 50 adolescents and young adults (ages 16-25) per store, at baseline and follow-up. There were 978 participants (mean age = 20.9 years) in the cigarillo trial, and 998 participants (mean age = 21.0 years) in the WT trial. Rates of campaign exposure were low (26% for cigarillos; 24.3% for WT). The cigarillo campaign increased knowledge that ammonia is in cigarillo smoke (p < .01). There were also significant increases in knowledge about ammonia and cyanide in cigarillo smoke and arsenic in WT smoke (p < .05) in the sub-sample who reported exposure to the campaign. No differences were found in outcome expectancies, product attitudes, worry about chemical exposure, or behavioral intentions in either campaign. Garnering attention for communication campaigns in saturated POS environments, often dominated by tobacco advertising, is challenging. Our study demonstrates the feasibility of anti-tobacco campaigns at the POS and points to several lessons learned for future POS campaigns.

Responses to pictorial versus text-only cigarillo warnings among a nationally representative sample of US young adults.

BACKGROUND: The US Food and Drug Administration requires six text-only warnings for cigar products, including cigarillos. Research has demonstrated the superiority of pictorial over text-only cigarette warnings, yet the relative effectiveness of pictorial warnings for cigarillos has not been examined. We examined the impact of pictorial cigarillo warnings compared with text-only warnings. METHODS: Data were collected from a nationally representative sample of US young adult (18-29) cigarillo users and susceptible non-users. Participants were randomised to one of three experimental conditions: text-only or one of two pictorial conditions (combined for analyses). For each warning, we assessed negative emotional reactions, cognitive elaboration (ie, thinking about cigarillo risks) and perceived message effectiveness (PME). RESULTS: Participants (N=661) were 46.5% female, 64.7% white and 21.9% Hispanic; 34.1% reported past 30-day cigarillo use; 41.4% were lifetime users (excluding past 30-day use); and 24.4% were susceptible non-users. Pictorial warnings elicited more negative emotional reactions and higher PME than text-only warnings (p values<0.01), with interactions showing the largest effects for past 30-day users (emotional reactions: d=0.99, PME: d=0.63). For cognitive elaboration, there was no main effect of warning type, but an interaction revealed effects for past 30-day users (p<0.05, d=0.46). CONCLUSIONS: Pictorial cigarillo warnings elicited greater negative emotional reactions and PME compared with text-only warnings. These effects and the effects on cognitive elaboration were strongest for past 30-day users. Our findings extend research on cigarette warnings to cigarillos, demonstrating that pictorial warnings are superior to text-only warnings for cigarillos in eliciting beneficial responses.

Fas Ligand-Modified Scaffolds Protect Stem Cell Derived ß-Cells by Modulating Immune Cell Numbers and Polarization.

Stem cell derived ß-cells have demonstrated the potential to control blood glucose levels and represent a promising treatment for Type 1 diabetes (T1D). Early engraftment post-transplantation and subsequent maturation of these ß-cells are hypothesized to be limited by the initial inflammatory response, which impacts the ability to sustain normoglycemia for long periods. We investigated the survival and development of immature hPSC-derived ß-cells transplanted on poly(lactide-co-glycolide) (PLG) microporous scaffolds into the peritoneal fat, a site being considered for clinical translation. The scaffolds were modified with biotin for binding of a streptavidin-FasL (SA-FasL) chimeric protein to modulate the local immune cell responses. The presence of FasL impacted infiltration of monocytes and neutrophils and altered the immune cell polarization. Conditioned media generated from SA-FasL scaffolds explanted at day 4 post-transplant did not impact hPSC-derived ß-cell survival and maturation in vitro, while these responses were reduced with conditioned media from control scaffolds. Following transplantation, ß-cell viability and differentiation were improved with SA-FasL modification. A sustained increase in insulin positive cell ratio was observed with SA-FasL-modified scaffolds relative to control scaffolds. These results highlight that the initial immune response can significantly impact ß-cell engraftment, and modulation of cell infiltration and polarization may be a consideration for supporting long-term function at an extrahepatic site.

Cancer Risk Perceptions Among People Who Check Their Skin for Skin Cancer: Results from the 2017 U.S. Health Information National Trends Survey (HINTS).

When detected early, melanoma is highly treatable and rarely fatal. Self-skin checks can identify changes in moles that could be an indicator of melanoma. Cancer risk perceptions may influence the uptake of important preventive health behaviors such as self-skin checks. The purpose of this study is to examine cancer risk perception factors associated with those who have checked their skin for signs of skin cancer using the 2017 HINTS data. Retrospective cross-sectional analysis of a nationally representative sample of U.S. adults using the Health Information National Trends Survey (HINTS). Logistic regressions were performed to identify associations between having checked skin for signs of skin cancer, risk perceptions, and demographic variables. White women over the age of 45 with a college degree and annual incomes greater than $75,000 were more likely to check their skin for signs of skin cancer. More than a third reported they would rather not know if they had cancer and more than 60% had some level of worry about having cancer. Those with a personal or family history of cancer were more likely to check. HINTS is a cross-sectional survey which provides only a glimpse of behavioral predictors. Self-skin checks are simple and cost-effective to detect melanoma early and improve outcomes. Fear and worry about cancer were significant factors in the likelihood of checking skin for signs of skin cancer. Population-based strategies could be developed to reduce concerns about early detection.

Reasons for Pack Size Purchase among US Adults Who Purchase Cigars.

With municipalities across the US establishing minimum cigar pack size regulations, it is critical to understand what drives pack size preference. The purpose of this exploratory study was to identify reasons for cigar pack size purchase. We used Amazon's Mechanical Turk to survey adults who had purchased cigars and reported past 30 day use. Participants responded to an open-ended item asking their reasons for purchasing their usual pack size. Responses were double-coded and categorized. Of 152 respondents, 61 used traditional cigars, 85 used cigarillos, and 36 used filtered cigars. Across all cigar types, most participants (73.7%) purchased boxes rather than singles; 5-9-packs were the most popular pack size category (19.7%), followed by 20+-packs (18.4%). We identified 16 reasons for pack size purchase across seven categories: price, consumption, social aspect, convenience, product characteristics, availability, and general preferences. Reasons varied according to whether the consumer purchased larger or smaller pack sizes. In this exploratory study to identify reasons for cigar pack size purchases, findings were consistent with those identified through tobacco industry documents and in the cigarette literature. Future research should examine the prevalence of these reasons, including as a function of demographic and use characteristics, to help inform the understanding of potential minimum cigar pack regulations.

Trends in sexual orientation disparities in cigarette smoking: Intersections between race/ethnicity and sex.

Cigarette smoking is disproportionately high among sexual minority populations, but it is unclear whether these disparities exist among race/ethnicity subgroups. This study examined trends in sexual orientation disparities in cigarette smoking by race/ethnicity. Data are from the 2014-2019 Behavioral Risk Factor Surveillance System (N = 1,194,768). Trend analyses compared cigarette smoking by race/ethnicity (non-Hispanic White, non-Hispanic Black, Hispanic, non-Hispanic other) and sexual orientation (straight, lesbian or gay, bisexual, something else/don't know/refused). Multivariable analyses examined associations between sexual orientation and cigarette use for each race/ethnicity, controlling for other sociodemographic characteristics. Between 2014 and 2019, lesbian or gay, and bisexual populations consistently had higher smoking rates than straight populations, which held across race/ethnicity. Among non-Hispanic White adults, lesbians (OR = 1.51, 95% CI = 1.29, 1.76), bisexual females (OR = 1.56, 95% CI = 1.39, 1.75), gay (OR = 1.38, 95% CI = 1.22, 1.55), and bisexual males (OR = 1.22, 95% CI = 1.04, 1.43) had higher odds of smoking compared those self-identifying as straight. Among non-Hispanic Black adults, lesbians (OR = 1.90, 95% CI =1.33, 2.73) and bisexual females (OR = 1.85, 95% CI =1.42, 2.41) were more likely to currently smoke. Among Hispanic adults, those self-identifying as lesbian or gay (OR = 1.58, 95% CI = 1.19, 2.09) or bisexual (OR = 2.40, 95% CI = 1.88, 3.07) were more likely to currently smoke, though the associations were not significant in Hispanic males. Disparities in cigarette smoking by race/ethnicity and sexual orientation suggest that aggregating these groups mask important differences and limit efforts to target those most at risk.

Associations between Black and Mild Cigar Pack Size and Demographics and Tobacco Use Behaviors among US Adults.

Pack size is an important pricing strategy for the tobacco industry, but there is limited data on how users differ based on preferred pack size for cigar products. Using data from Wave 4 of the Population Assessment of Tobacco and Health Study, this study identified differences in adult cigar user characteristics based on pack size purchasing behavior among users of a top cigar brand, Black and Mild. Weighted chi-square tests were used to examine the associations between Black and Mild pack size and sociodemographic, cigar and other substance use characteristics. Overall, our study found that users of Black and Mild cigars differ by demographic, cigar and other tobacco use characteristics based on preferred pack size, with smaller packs appealing to younger, female, less-experienced and less-established smokers, and larger packs appealing to older, male, more experienced, and more dependent cigar smokers. Dual use of cigarettes and cigars was also higher among users of smaller packs. While this study is cross-sectional, findings suggest that minimum packaging laws for cigars may impact younger adults who are purchasing smaller pack sizes and likely experimenting with new cigar products and styles.

Adolescent Use and Perceptions of JUUL and Other Pod-Style e-Cigarettes: A Qualitative Study to Inform Prevention.

JUUL, a discrete pod-style e-cigarette, popular among adolescents, delivers high levels of nicotine. Limited research has assessed social and environmental influences that contribute to use of JUUL and other pod-style devices. We examined how these factors, as well as individual characteristics, shape adolescent use. Twenty-nine middle and high school students participated in six focus groups in June 2019 (58.6% female, 65.5% White, 27.6% Hispanic). Groups were stratified by e-cigarette use status and grade to understand perceptions and experiences among groups. Transcripts were coded using thematic analysis for individual, social, and environmental factors contributing to use. Users (n = 13) described their first experience with JUUL as mostly negative, mentioning reactions such as burning in the throat, coughing, wheezing, and headaches. Despite a negative first experience, stress relief and addiction were mentioned as reasons for continued use. Users and non-users identified vaping as a source of disruption to their daily life. Social factors included peer and parental influences, lack of support for quitting, and accessibility. Environmental factors included contrasting messages about long- and short-term health effects of e-cigarettes, as well as a lack of school vaping policy enforcement, health education, medical screenings, and cessation resources. Findings highlight the complex social system that influences adolescent e-cigarette use and have important implications for school and community responses. Strategies to prevent or reduce use may include reviewing existing school tobacco policies, providing counseling and cessation resources, training staff, and increasing knowledge through public education campaigns.

The Impact of Varying Warning Color on E-Cigarette Advertisements: Results From an Online Experiment Among Young Adults.

INTRODUCTION: Advertisement warnings are often overlooked, which reduces the opportunity for risk communication. METHODS: We used Prolific to survey 1131 young adults (18-35) who currently used e-cigarettes or tobacco products. We randomized participants to one of four warning conditions: black text on white background (BW), white on black (WB), black on yellow (BY), and yellow on black (YB). We examined associations between condition and attention, recall, ad appeal, perceived message effectiveness (PME), and intentions to use e-cigarettes using chi-square and analysis of variance (ANOVA) where appropriate. We conducted logistic regressions by condition for attention and recall controlling for demographics and tobacco use. RESULTS: The warning was selected as the most attention-capturing area of the advertisement more often by those exposed to yellow warnings than white (59.9% vs. 46.8%), even after controlling for demographics and tobacco use (p < .05). Recall was greater among those exposed to yellow warnings than white (44.2% vs. 37.3%), which held in controlled models. There were no significant differences between yellow and white warnings for ad appeals, PME, or intentions to use. In subanalyses, WB warnings generated higher PME (10.1 vs. 9.5) and lower intentions to use e-cigarettes (3.0 vs. 3.3) than black on white (BW) (each p < .05). CONCLUSIONS: Yellow warning color increases attention and recall of the warning, but this increase in attention did not translate to differences in downstream effects. Among currently mandated warning variations, the white text on black background warning appears more effective than the BW. Future research should examine whether differences translate to behavior change. IMPLICATIONS: We tested color variations of the FDA-mandated nicotine text warning on e-cigarette advertisements. Yellow variations (yellow text on black background and BY) better-captured attention and increased warning recall compared to the mandated black and white warnings. Among the FDA-mandated BW and WB warnings, the WB variation appears more effective, generating higher perceived message effectiveness and lower intentions to use e-cigarettes. Given the difficulty in implementing pictorial warnings in the United States, color might represent an alternative to improve warning effectiveness. Findings may also be applicable to those designing tobacco-related health communications.

Characteristics differ based on usual cigar-type use among U.S. adults: Analysis from the tobacco use supplement to the current population survey.

The tobacco products landscape is continually shifting, and there are concerns about the increased popularity of non-cigarette tobacco products, including cigars. This study examines characteristics associated with usual cigar-type use. Data are from the 2018-19 Tobacco Use Supplement to the Current Population Survey. Multinomial logistic regression was used to assess the association between sociodemographic characteristics and cigar-type use (i.e., large cigars, cigarillos, and little filtered cigars). Analyses also examined factors relative to large cigar use and further stratified by sex. Of 137,221 adults included in the study, 1467 used large cigars most often, 513 used cigarillos most often, 446 used little filtered cigars most often, and the remaining 134,795 did not use cigars. In adjusted models, males had greater odds for using all types of cigars relative to non-use. In contrast, males were less likely to use cigarillos (AOR 0.28, 95% CI 0.20-0.41) and filtered cigars (AOR 0.20, 95% CI 0.14-0.28) relative to large cigars. Black adults had greater odds of using all types of cigars relative to non-use, and cigarillos (AOR 3.55, 95% CI 2.47-5.08) and filtered cigars (AOR 2.50, 95% CI 1.70-3.68) relative to large cigars. Education, income, and other tobacco use also varied according to cigar type. Characteristics of those who usually use large cigars differed significantly from those who usually use cigarillos, little filtered cigars, or reported no cigar use.

Who Purchases Tobacco Online? Findings from Waves 1 and 4 of the Population Assessment of Tobacco and Health Study.

Objectives: We examined the prevalence of and factors associated with usually purchasing tobacco online. Methods: We analyzed Waves 1 (2013-14) and 4 (2016-17) of the US Population Assessment of Tobacco and Health adult (18+) and youth (12-17) studies: 15,450 adults and 495 youth in 2013-14 and 15,037 adults and 465 youth in 2016-17. Z-tests compared the prevalence of usually purchasing tobacco online between waves and weighted multivariable regressions identified associations between purchasing online and sociodemographics. Results: The prevalence of usually purchasing tobacco online increased from 2.5% to 3.3% among adults (p < .05) and from 2.5% to 4.4% among youth (p < .05), generalizing to a US population of 2,000,000 adults and 35,000 youth. E-cigarettes and cigars and e-cigarettes and waterpipe tobacco were the most common products among adults and youth, respectively. Men, adults with greater education, adults with higher income, and non-Hispanic black youth had greater odds of purchasing tobacco online (p < .05). Conclusions: Usually purchasing tobacco online remains low, although ever purchasing was not assessed. Efforts should be made to expand Internet tobacco purchasing surveillance and extend and enforce restrictions broadly across tobacco products to reduce youth access.

Changes in knowledge, perceptions and use of JUUL among a cohort of young adults.

OBJECTIVE: E-cigarettes have gained popularity, most recently with pod-style devices, such as JUUL. We examined changes in JUUL awareness, use, perceptions, nicotine content knowledge, number of days a pod lasts and exposure to JUUL retail advertising over a 6-month period in a cohort of young adults. METHODS: In spring and fall 2018, 1836 young adults completed online surveys on tobacco use, including JUUL perceptions and use behaviours. Demographics, tobacco use and JUUL advertising exposure in spring 2018 were examined as predictors of current JUUL use in fall 2018. RESULTS: Ever and current JUUL use doubled in 6 months (5.9% vs 12.7%, p<0.001; 1.6% vs 3.4%, p<0.001). The number of days a JUUL pod lasts significantly changed (p=0.049). Although there was an increase in those reporting JUUL has as much or more nicotine than a pack of cigarettes, 58% are 'not sure' of JUUL's nicotine content. Exposure to JUUL's advertising significantly increased (31.8% to 46.4%; p<0.001). In multivariable models, those perceiving JUUL as or more harmful than cigarettes, and former and never cigarette smokers had significantly lower odds of current JUUL use at 6 months compared with their respective counterparts (p<0.0001). Those reporting exposure to JUUL's advertising had significantly increased odds of current JUUL use 6 months later (p<0.03). CONCLUSIONS: Findings demonstrate changes in knowledge of JUUL's nicotine content, perceptions and use over a short period of time, suggesting frequent measurement is necessary. Additionally, efforts are needed to regulate retail advertising and ensure consumer education about product risks as they are associated with current use.

Developing Pictorial Cigarillo Warnings: Insights From Focus Groups.

INTRODUCTION: The Food and Drug Administration (FDA) selected six text-only warnings for cigarillos to be implemented on packaging and advertising. Pictorial warnings are more effective at discouraging cigarette use than text-only warnings, yet no research exists for cigarillos. We sought to understand what types of images might be most effectively paired with the cigarillo text warnings to inform broad principles for developing pictorial warnings, with a focus on young adults, who have the highest rate of cigarillo use. METHODS: We conducted five focus groups with a total of N = 30 young adult cigarillo users and susceptible nonusers (53% female, 50% White, and 33% Black). Participants were shown four to eight unique images for each of the six text statements and were asked about visual-verbal congruency, emotional and cognitive reactions, and perceived effectiveness of each image. Sessions were recorded and transcribed; two investigators independently coded transcripts for emergent themes. RESULTS: Participants reported images that were graphic or "gross" would best grab attention and discourage use of cigarillos. Participants preferred images that were a direct illustration of the information in the warning text, rather than abstract images that required more cognitive effort to understand. Participants also highlighted that including people in the images, especially youth and young adults making eye contact, helped them relate to the warnings, garner their attention, and positively influence their reactions. CONCLUSIONS: We identified several principles to inform the selection of images to pair with the FDA-required cigarillo text statements. These insights may also apply to pictorial warnings for other tobacco products. IMPLICATIONS: This focus group study identified principles for selecting images to develop pictorial warnings for the six FDA text-only cigarillo warnings. We found that young adult cigarillo users and susceptible nonusers preferred images that were graphic and gross, believable, congruent to the warning text, and included people. Images that match young adults' visual expectations of a disease and are emotion-provoking may be most effective in pictorial warnings and highlight challenges for developing pictorial warnings for health effects that do not have a visible health consequence.

Are Waterpipe Café, Vape Shop, and Traditional Tobacco Retailer Locations Associated with Community Composition and Young Adult Tobacco Use in North Carolina and Virginia?

PURPOSE: We examined whether waterpipe café, vape shop, and traditional tobacco retailer (e.g. stores selling cigarettes, cigars, smokeless tobacco) locations were associated with census tract composition and tobacco use among young adults in North Carolina and Virginia. Methods: We identified waterpipe cafés, vape shops, and traditional tobacco retailers in North Carolina and Virginia and conducted multivariable analyses between community characteristics (gender, race, ethnicity, education, college enrollment, and poverty) and density per 1000 population. Using fall 2017 data from 1099 young adults residing in North Carolina and Virginia, we conducted logistic regression analyses to determine whether tobacco retailer density and proximity were associated with tobacco use. Results: Waterpipe café, vape shop, and traditional retailer density were higher in communities with more people who were Hispanic, college-educated, and college-enrolled (each p < .05). Waterpipe café and traditional retailer density were higher in communities with more people living below the poverty level (each p < .05). Waterpipe café density was higher in communities with more people who were male (p < .05), while traditional retailer density was lower (p < .05). Waterpipe café and vape shop proximity were associated with increased likelihood of waterpipe tobacco use in the past 6 months (each p < .05; unadjusted). Traditional retailer proximity and waterpipe café, vape shop, and traditional retailer density were not associated with tobacco use. Conclusions: Waterpipe cafés and vape shops are located in both impoverished and college-educated communities in North Carolina and Virginia, similar to where traditional tobacco retailers are located. Further research is needed to examine associations with tobacco use.

Integration of Islet/Beta-Cell Transplants with Host Tissue Using Biomaterial Platforms.

Cell-based therapies are emerging for type I diabetes mellitus (T1D), an autoimmune disease characterized by the destruction of insulin-producing pancreatic ß-cells, as a means to provide long-term restoration of glycemic control. Biomaterial scaffolds provide an opportunity to enhance the manufacturing and transplantation of islets or stem cell-derived ß-cells. In contrast to encapsulation strategies that prevent host contact with the graft, recent approaches aim to integrate the transplant with the host to facilitate glucose sensing and insulin distribution, while also needing to modulate the immune response. Scaffolds can provide a supportive niche for cells either during the manufacturing process or following transplantation at extrahepatic sites. Scaffolds are being functionalized to deliver oxygen, angiogenic, anti-inflammatory, or trophic factors, and may facilitate cotransplantation of cells that can enhance engraftment or modulate immune responses. This local engineering of the transplant environment can complement systemic approaches for maximizing ß-cell function or modulating immune responses leading to rejection. This review discusses the various scaffold platforms and design parameters that have been identified for the manufacture of human pluripotent stem cell-derived ß-cells, and the transplantation of islets/ß-cells to maintain normal blood glucose levels.

Cannabidiol (CBD): Perspectives from Pinterest.

BACKGROUND: Pinterest, a widely used social media platform, has shaped how people seek and share health information. Cannabidiol (CBD), a non-psychoactive component of cannabis is marketed as a treatment for many conditions and sales rose to more than 820 million in 2017. Yet CBD is mostly unregulated, legality is murky, and many of the health claims are not scientifically proven. Purpose: This content analysis examined how CBD products were portrayed on Pinterest. Methods: In 2018, using the search terms cannabidiol and CBD, researchers sampled every fifth pin to collect 226 relevant pins. A codebook was developed, pilot tested, and used to code pins. Results: The majority (91.6%) of pins positively portrayed CBD with many claiming a physical or mental benefit including anxiety, depression, pain, and inflammation relief. Most pins did not (98.2%) address potential side effects or recommend dosage. In this sample, user engagement was high with 85.2% of pins being saved and links to commercial sites selling CBD products, personal blogs, and social media accounts. Conclusions: Social media has become a powerful source of health information. This study revealed widespread acceptance of the use of CBD products with minimal information from reliable public health sources represented.

Association between purchasing behaviors and cigar use: A longitudinal analysis of Waves 1-3 of the Population Assessment of Tobacco and Health (PATH) Study.

INTRODUCTION: Over 120 US jurisdictions have implemented policies mandating minimum cigar pack quantities, yet little empirical research exists on the relationship between pack quantity and use. We examined whether cigar use was associated with purchasing cigars by the box/pack or as singles, purchase quantity, and price paid per cigar. METHODS: Data are from Waves 1-3 (2013-2016) of the Population Assessment of Tobacco and Health (PATH) Study, analyzed in 2019. The sample included adults who reported current use of any type of cigars (cigarillos [N = 3,051], traditional cigars [N = 2,586], and filtered cigars [N = 1,295], including with marijuana) at Wave 1. For each cigar type, a generalized estimating equation model was used to examine the population-averaged effects of purchasing behavior on cigar use. RESULTS: Cigar users of each type who purchased by the box or pack smoked more per day than users who purchased singles (cigarillos: ß = 1.02, p<0.0001; traditional cigars: ß = 1.40, p<0.0001; filtered cigars: ß = 2.55, p<0.01). Cigar users who purchased larger quantities smoked more per day (cigarillos: ß = 0.16, p<0.0001; traditional cigars: ß = 0.04, p<0.0001; filtered cigars: ß = 0.24, p<0.0001). Higher price per cigar was significantly associated with smoking fewer traditional cigars (ß = -0.12, p<0.01) and filtered cigars (ß = -0.86, p = 0.02), but not cigarillos (ß = 0.08, p = 0.62). CONCLUSIONS: Smaller pack quantities and higher price per cigar were associated with smoking fewer cigars per day. Given the authority of the Food and Drug Administration and local jurisdictions over cigar pack quantity, this study provides data pertinent to potential minimum and maximum package quantity regulations and policies.