Moderation Effects of Gender on the Association between Intimate Partner Violence and Suicidal Ideation or Attempt among Adolescents: A Secondary Analysis of the 2017 YRBS.

OBJECTIVE: Physical and sexual intimate partner violence (IPV) among adolescents leads to adverse health behaviors, particularly suicidal ideation and attempts. Studies demonstrated the link between IPV and suicidal ideation and attempts among adolescents, yet there is conflicting evidence regarding differences between adolescent males and females; research evaluating the interaction of gender and the association between IPV and suicidal ideation and attempts is limited. The present study used a nationally representative sample from the Youth Behavioral Risk Surveillance questionnaire to determine whether there is an interaction of gender on the relationship between physical IPV, sexual IPV, and suicidal ideation and suicidal attempts. METHOD: Weighted logistic regressions were fit using Stata 15.1 and multiple imputations were used to account for missing data. RESULTS: There is a significant gender by sexual IPV interaction (AOR = 0.66, CI = 0.51-0.84, p = 0.002) such that at low levels of sexual IPV there were no differences between genders in reported suicide attempts (t[33] = 1.19, p = 0.242). However, at moderate and high instances of sexual IPV, adolescent females were significantly less likely than males to report attempting suicide in the past year (t[33] = -2.71, p = 0.011; t[33] = -3.17, p = 0.003, respectively). CONCLUSIONS: The present study demonstrates the vital need for IPV and suicidal ideation and attempt screening, tailored multi-level interventions, and advocacy for adolescents. Policies are essential to increase screening among medical providers, and increase school- and community-based interventions and IPV and suicide awareness to decrease rates among adolescents.HIGHLIGHTSFemale students were more likely than males to report suicidal ideation.Significant interaction between sex and sexual IPV on suicide attempts.Gender differences at medium and high levels of sexual IPV on suicide attempts.

Longitudinal patterns of cannabis and tobacco co-administration and concurrent use among young adult college students.

INTRODUCTION: Co-use, including concurrent use or co-administration, of cannabis and tobacco is most prevalent in young adulthood and associated with worse health outcomes than use of either substance alone. This study examined latent classes of tobacco and cannabis concurrent use and co-administration, and transitions between classes from 2016 to 2019, among a sample of young adult college students in Texas. METHODS: Participants included 4,448 young adults (64.2% female, 64.7% non-white, mean age = 20.5) in a longitudinal cohort study. Measures included past 30-day use of cigarettes. hookah, cigars, ENDS, cannabis, and cannabis and tobacco co-administration. Latent Markov models were used to estimate latent class membership and transitions between classes from 2016 to 2017 and 2017 to 2019. RESULTS: Four latent classes emerged: non-use (58% of students) characterized by low/no probability of any use; general use (19%) characterized by some level of use of all behaviors; blunt and cannabis use class (13%) characterized by high probabilities of cannabis use and co-administration with blunts; and concurrent and co-administration use (10%) with high probabilities of cigarette, cannabis, blunt, and spliff use. Most students remained in the same latent class from 2016 to 2019. CONCLUSIONS: While most students reported low/no tobacco and cannabis co-use, those who used cannabis and/or tobacco remained in their use classes over the course of the study (2016 to 2019). Public health advocates on college campuses should consider prevention and cessation programs that incorporate the constellation of behaviors related to cannabis and tobacco co-use and educate students about the health consequences of co-use.

Identification and Management of Thyroid Dysfunction Using At-Home Sample Collection and Telehealth Services: Retrospective Analysis of Real-World Data.

BACKGROUND: Programs aimed at modernizing thyroid care by pairing at-home sample collection methods with telehealth options may serve an important and emerging role in thyroid care. OBJECTIVE: The primary objective of this analysis was to evaluate telehealth use, demographics, and clinical characteristics of a cohort of consumer-initiated at-home laboratory thyroid test users who were also offered the option of follow-up telehealth consultations. METHODS: This was a retrospective analysis of real-world data from a deidentified consumer database of home-collected, mail-in thyroid tests used from March to May 2021 (N=8152). The mean age was 38.6 (range 18-85) years, and 86.6% (n=7061) of individuals identified as female. RESULTS: In total, 7% (n=587) of test takers fell into a thyroid dysfunction category (overt hypothyroidism: n=75, 0.9%; subclinical hypothyroidism: n=236, 2.9%; overt hyperthyroidism: n=5, 0.1%; and subclinical hyperthyroidism: n=271, 3.3%). Overall, 12% (n=984) of the overall sample opted into a telehealth consultation, with 91.8% (n=903) receiving a nontreatment telehealth consultation and 8.2% (n=81) receiving a treatment telemedicine consultation. Furthermore, 16% (n=96) of individuals with overt or subclinical thyroid dysfunction engaged in telehealth consultations. The majority of treatment consultations (59.3%, n=48) were conducted with people reporting a history of thyroid issues, with 55.6% (n=45) of people indicating wanting to discuss their current thyroid medication and 48% (n=39) receiving a prescription medication. CONCLUSIONS: The combination of at-home sample collection and telehealth is an innovative model for screening thyroid disorders, monitoring thyroid function, and increasing access to care, which can be implemented at a large scale and across a wide range of age groups.

Real-world evidence: Telemedicine for complicated cases of urinary tract infection.

Telemedicine programs for the treatment of urinary tract infections (UTIs) offer an opportunity to reduce burdens on patients and providers. However, these programs are typically restricted to patients with uncomplicated UTIs. This real-world analysis evaluated treatment and resolution rates in a large-scale, national UTI telemedicine program inclusive of patients with uncomplicated and complicated UTIs. We conducted a retrospective analysis of data obtained from a commercially available telemedicine program for the treatment of UTIs among adult women in the US between 2017 and 2021 (n = 51,474). The primary outcomes were the number of women who presented with symptoms of uncomplicated UTI, complicated UTI, and vaginal infection; prescription use and antibiotic type; symptom resolution within seven days after appointment; and treatment failure or relapse. Most patients reported frequent urination (94.4%), urgency (94.5%), and dysuria (97.6%). Those with uncomplicated UTI symptoms represented the majority of patients (61.6%); however, a substantial number of patients (36.5%) also reported at least one symptom associated with a complicated UTI. One-fifth of patients (19.2%) reported at least one co-occurring symptom of vaginal infection or sexually transmitted infection. Across all treated patients, 94.0% received recommended antibiotics according to the clinical protocol. Of the treated patients who provided follow-up data (n = 3,521), 89.7% reported seven-day symptom resolution. Symptom resolution rates were similar between patients with uncomplicated UTI symptoms (90.8%) and complicated UTI symptoms (87.9%), and symptom resolution among all treated patients (89.7%) was similar to reports for in-person standard of care. These findings suggest that large-scale telemedicine programs for the treatment of UTIs can be effective in the treatment of complicated UTIs.

Evaluation of sexual minority identity as a moderator of the association between intimate partner violence and suicidal ideation and attempts among a national sample of youth.

Sexual minority (SM) youth are at high risk for intimate partner violence (IPV) and suicidal ideation/attempts compared to their heterosexual peers. We examined whether SM identity enhanced the relationship between experiences of IPV and suicidal ideation/attempts. Weighted logistic regression models were run using the 2017 Youth Risk Behavior Survey. All main effects were significant; each SM identity and both physical and sexual IPV were significantly associated with suicidal ideation and suicide attempts. The interaction between bisexual identity and physical IPV was significant for suicidal ideation; as physical IPV experiences increased, the difference between bisexual identity and heterosexual youth was non-significant. Findings suggest exploring trauma and suicidal ideation by aggregate groups and increasing support for SM youth in schools and communities.

Bidirectional associations between young adults' reported exposure to e-cigarette marketing and e-cigarette use.

AIMS: To examine bidirectional associations between self-reported exposure to electronic nicotine delivery system (ENDS) marketing and ENDS use, over four 6-month follow-up surveys, among young adults. DESIGN: The Marketing and Promotions Across Colleges in Texas project (M-PACT) is a cohort study that examined exposure to tobacco marketing and tobacco use behaviors among college students in Texas, United States. SETTING AND PARTICIPANTS: Participants were 5478 students from 24 2-year and 4-year Texas colleges. Approximately 64% (n = 3506) of the cohort were non-white, 64% were female and the average age was 20 years. MEASUREMENTS: Students completed a baseline survey in Fall 2014/Spring 2015 and three subsequent surveys 6 months apart. Items assessed current ENDS use and self-reported exposure to ENDS marketing through the point-of-sale, on television, on the radio, on the internet and on billboards. A multi-level cross-lagged path model was used to examine the bidirectional associations between self-reported exposure to ENDS marketing and current ENDS use across the four waves, controlling for socio-demographics. FINDINGS: Self-reported exposure to ENDS marketing at each previous wave predicted ENDS use at each subsequent wave (ß = 0.07-0.10, P < 0.001). ENDS use at waves 2 and 3 predicted self-reported exposure to ENDS marketing at wave 3 and 4, respectively (ß = 0.07-0.09, P < 0.001). Although ENDS users were more likely than non-users to report exposure to ENDS marketing, self-reported exposure to ENDS marketing predicted subsequent ENDS use controlling for prior ENDS use. CONCLUSION: Self-reported exposure to electronic nicotine delivery system (ENDS) marketing was bidirectionally associated with past 30-day use of ENDS among young adult college students in Texas, USA from 2014/15 to 2016.

Exposure to ENDS advertising and use of marijuana in ENDS among college students.

BACKGROUND: Factors associated with marijuana use in electronic nicotine delivery systems (ENDS) are largely unknown. ENDS advertising, through subtle normative cues as well as explicit and implicit messages suggesting ENDS products are socially condoned and healthier alternatives, may influence the use of marijuana in ENDS. The aim of our study was to examine the association between exposure to ENDS advertising and subsequent use of ENDS with marijuana among college students. METHODS: Data for this study were from waves 2 and 4 of the Marketing and Promotions across Colleges in Texas (M-PACT) study. Participants included 3720 college students (mean age = 21.4, SD = 2.3; 35.78% white; 35.7% male) across 24 colleges in Texas who completed online tobacco behavior surveys one year apart. Multilevel logistic regression was conducted to examine the association between ENDS advertising exposure at wave 2 (spring 2015) and use of marijuana in ENDS one year later at wave 4 (spring 2016), controlling for age, sex, race/ethnicity, and wave 2 sensation-seeking, impulsivity, current tobacco use, current marijuana use, and ever use of ENDS with marijuana. Use of ENDS to consume marijuana in the past six months was the outcome variable and ENDS advertising exposure was the independent variable. RESULTS: Nearly half of participants reported ever ENDS use at waves 2 and 4, and 10% used marijuana in ENDS in the past 6-months at wave 4. Multilevel logistic regression analyses indicated that for every unit increase in ENDS advertising exposure, the odds of subsequently using ENDS with marijuana one year later were 1.08 times (95% CI = 1.01-1.14) greater. CONCLUSIONS: ENDS advertising uniquely contributed to the subsequent use of marijuana in an ENDS, over and above the effects of other risk factors.

Exposure to tobacco and nicotine product advertising: Associations with perceived prevalence of use among college students.

OBJECTIVE: The purpose of this study was to examine the relationship between exposure to tobacco marketing and perceptions of peer tobacco use among college students. PARTICIPANTS: Participants were 5,767 undergraduate students from 19 colleges/universities in the State of Texas. METHODS: Students completed an online survey, in the spring of 2016, that assessed past 30 day exposure to e-cigarette, cigar, smokeless tobacco, and traditional cigarette advertising across multiple marketing channels, past 30 day use of each product, and perceived prevalence of peer use. Multi-level linear regression models were run to examine the associations between exposure to tobacco advertising and perceptions of peer tobacco use controlling for age, gender, race/ethnicity, use and school. RESULTS: Greater exposure to advertising was associated with greater perceived prevalence of peer use. CONCLUSIONS: Given the normative effects of advertising on perceived peer tobacco use, college tobacco initiatives should include descriptive norms education to counteract inaccurate perceptions.

"Social Networkout": Connecting Social Features of Wearable Fitness Trackers with Physical Exercise.

Despite widespread understanding of the benefits of physical activity, many adults in the United States do not meet recommended exercise guidelines. Burgeoning technologies, including wearable fitness trackers (e.g., Fitbit, Apple watch), bring new opportunities to influence physical activity by encouraging users to track and share physical activity data and compete against their peers. However, research has not explored the social processes that mediate the relationship between the use of wearable fitness trackers and intention to exercise. In this study, we applied the Theory of Planned Behavior (Ajzen, 1991) to explore the effects of two communicative features of wearable fitness devices-social sharing and social competing-on individuals' intention to exercise. Drawing upon surveys from 238 wearable fitness tracker users, we found that the relationship between the two communication features (social sharing and competing) and exercise intention was mediated by attitudes, subjective norms, and perceived behavioral control. The results suggest that the ways in which exercise data are shared significantly influence the exercise intentions, and these intentions are mediated by individuals' evaluation of exercise, belief about important others' approval of exercise, and perceived control upon exercise.