A replication of extended implementation and social interaction during the Step it UP! Game for adults with disabilities.

The purpose of the present experiments was to systematically replicate Step it UP! Game interventions with adults with disabilities. Participants were divided into two competing teams, and the team with the highest step count participated in a prize drawing. Experiment 1 (N = 9) evaluated the efficacy of an extended version of the Step it UP! Game that included additional and longer sessions. Experiment 2 (N = 8) evaluated the addition of contingent experimenter attention during the Step it UP! Game. Baseline, Step it UP! Game, and Step it UP! Game plus interaction sessions were evaluated in a multielement design. The Step it UP! Game was effective with additional and longer sessions, and all participants took more steps during Step it UP! Game sessions. Adding experimenter interaction to the Step it UP! Game did not increase the efficacy of the intervention.

Moral injury among women military veterans and demand for cigarettes: A behavioral economic investigation using a hypothetical purchase task.

OBJECTIVES: Unlike the United States general population, veteran women - as opposed to veteran men - have greater smoking prevalence; yet, little is known regarding factors that influence smoking in veteran women. The purpose of this study was to begin examining the relationship between a psychological concept known as moral injury and demand for cigarettes among veteran women. METHODS: Veteran women who smoke (n = 44) were recruited for this cross-sectional study from Amazon MTurk, Reddit, and a veteran-serving non-profit organization in June-July 2023. Consenting participants received $2 for completing the cigarette purchase task (CPT), Fagerstrom Test for Nicotine Dependence (FTND), and the military version of the Moral Injury Symptom Scale (MISS-M-SF). We examined five CPT demand indices and calculated a modified exponential demand model stratified by moral injury severity status (i.e., probable vs. unlikely). RESULTS: Probable morally injured women exhibited significantly higher relative reinforcing value (RRV) for smoking than unlikely morally injured women (F1, 920 = 9.16, p = 0.003). Average cigarette consumption at $0 (i.e., Q0) was 48.56% higher (M = 22.24 vs. M = 13.55) in probable compared to unlikely morally injured women (p = 0.04, Hedge's g = 0.74). FTND scores were significantly correlated with Pmax (i.e., demand elasticity point) and Omax (i.e., maximum expenditure) values in both populations (rs = 0.42-0.68, ps < 0.05). CONCLUSIONS: We provide preliminary evidence of the relatively high RRV of smoking in morally injured veteran women. Continued research is needed to refine the characterization of this relationship.

Punishment-induced resurgence.

The phenomenon of extinction-induced resurgence is well established, but there is comparatively little experimental evidence for punishment-induced resurgence. Punishment-induced resurgence can by tested by contingent shocks following the alternative response. The purpose of Experiment 1 was to test whether low-intensity shocks, that do not decrease rate of reinforcement, result in resurgence. Four rats served as subjects. Rats were exposed to three sequential conditions: (a) variable-interval (VI) 30-s food delivery for a lever press (target response); (b) VI 30-s food delivery for a nose poke (alternative response) and extinction of the lever press; (c) VI 30-s reinforcement for a nose poke with superimposed VI 60-s shock delivery. In the final condition, shocks increased gradually from 0.1 to 0.5 mA. Experiment 2 evaluated whether an abrupt introduction of a high-intensity shock would result in resurgence. Three rats served as subjects and were exposed to three sequential conditions: (a) VI 30-s food delivery for a lever press; (b) VI 30-s food delivery for a nose poke and extinction of the lever press; (c) continued VI 30-s reinforcement for a nose poke with superimposed VI 60-s 0.6 mA shock delivery. Resurgence was observed in all subjects, including in situations in which rate of responding, but not rate of reinforcement, decreased. The present study provides additional evidence for punishment-induced resurgence, but future studies are warranted to determine the extent to which punishment can produce resurgence with or without decreases in rates of reinforcement.

Substance Use Overdose Deaths Among Black and Indigenous Women in Wisconsin: A Review of Death Certificate Data From 2018 to 2020.

OBJECTIVES: We are in the midst of an overdose epidemic that has grown during the concurrent COVID-19 pandemic. In Wisconsin, overdose deaths increased 11-fold from 2000 to 2020, with over 1200 deaths in 2020. Because of disparities in substance use initiation, relapse, and treatment success among racially minoritized women, this study's purpose was to investigate overdose death rates among Black and Indigenous women in Wisconsin from 2018 to 2020. METHODS: Overdose death rates were examined under the following parameters: sex, race (Black, Indigenous, White), age, year, and manner of death. Logistic regression analysis was also conducted looking at death count data, with race, age, and year as potential predictor variables. RESULTS: Death rates (per 100,000) in 2018 were 14.1 (12.6-15.5) for White women, 20.8 (14.7-26.9) for Black women, and 26.5 (10.0-42.9) for Indigenous women; these rates increased in 2020 to 16.4 (14.8-17.9), 32.5 (25.0-40.0), and 59.9 (35.8-84.0) for White, Black, and Indigenous women, respectively. Regression findings illustrated that being Black or Indigenous and aged 15 to 44 or 45 to 64 years were significantly more likely to die from most causes of death (any drug, any opioid, prescription opioid, heroin, synthetic opioids, and cocaine; adjusted odds ratios > 1.25, P s < 0.001). CONCLUSIONS: This study confirms that deaths in Wisconsin are disproportionately higher in female minoritized populations. Understanding the complex intricacies between the impacts of the COVID-19 pandemic coupled with barriers to treatment access or acceptability in these populations is urgently needed. It will take a multipronged approach to address the overdose epidemic and better serve these marginalized, vulnerable populations.

Moral Injury is a Risk Factor for Substance Use and Suicidality Among US Military Veterans with and without Traumatic Brain Injury.

A national survey of United States veterans was conducted, yielding 252 veterans with Traumatic Brain Injury (TBI) and 1235 veterans without TBI. Participants were asked questions about moral injury, suicidality, substance use, and other sociodemographic variables. Multivariable linear regression analysis was used to examine the previously described relationships. Increasing severity of moral injury was associated with higher scores on the substance use tool (b = 0.02, p = 0.04), although the magnitude of effect was not different from those without TBI (Z = - 0.57, p = 0.72). Increasing severity of moral injury was positively associated with suicidal behavior scores (b = 0.10, p < 0.01). The strength of this relationship was stronger in veterans with TBI than those without TBI (Z = 1.78, p = 0.04). Rehabilitation programs that treat veterans for TBI may need to consider the evaluation of moral injury given its association with adverse events in this population.

Step it UP! Game increases steps of adults with disabilities.

Engaging in regular physical activity has been shown to decrease the risk of health conditions such as diabetes, heart disease, and high blood pressure. Several studies have shown that physical activity is lower among individuals with neuro-atypical developmental and intellectual disabilities as compared to neurotypical individuals. The current study evaluated the effects of the Step it UP! Game on the mean number of steps taken per minute with adults with disabilities. Participants were divided into 2 competing teams, and the team with the highest step count at the end of each session participated in a prize drawing. The Step it UP! Game was compared to baseline conditions using a multielement design. Mean step count increased from 24.35 steps per minute during baseline to 54.76 steps per minute during the intervention. All 10 participants took more steps during the Step it UP! Game.

Pay Equity Among Behavior-Analytic Practitioners Who Serve Children.

Pay disparities have numerous adverse effects upon organizations, employees, and clients, which can affect the organization's ability to deliver services, including culturally responsive services. Evidence is accumulating that pay inequity, particularly among females and males, is present within the field of behavior analysis (Li et al., 2018; Vance & Saini, 2022). The purpose of the present study was to examine the annual income of Board Certified Behavior Analysts (BCBA) and doctoral-level BCBAs (BCBA-Ds) who work with children, with a particular focus on the impact that salary practices have on the provision of services to this age group. A survey was distributed to collect information regarding annual income, demographics, and various aspects of service delivery. The sample included 236 (96.7%) BCBAs and eight (3.3%) BCBA-Ds who had been in the field an average of 11.3 years (N = 244). Annual income for female BCBAs and male BCBAs was $74,888 and $79,140, respectively. For those who served children and adolescents, female respondents earn an annual average of $75,840, while male respondents earn an average of $74, 673. The annual incomes of female BCBAs that served urban, rural, and combined rural and urban regions were $76,931, $69,198, and $77,199, respectively. The observed differences between service regions were statistically significant, whereas the difference observed between females and males was not. Considering this, females made less than male counterparts in nearly every comparison, which is alarming. The present study adds to the growing list of observations indicating that a change in salary practices is needed to improve behavior-analytic service delivery to clients.

Examination of a Telehealth-Based Parent Training Program in Rural or Underserved Areas for Families Impacted by Autism.

Families of children with disabilities in rural areas face challenges accessing services due to location and lack of health-care providers. Telehealth-based intervention can mitigate challenges in accessing services. The present study sought to replicate and extend the telehealth-based, behavioral parent-training program, the Online and Applied System for Intervention Skills (OASIS), utilizing a multiple-baseline approach. Four parent-child dyads participated, with all children diagnosed with autism spectrum disorder. All dyads resided in rural/underserved areas. All dyads demonstrated an improvement on skill and knowledge assessments. The mean gain from baseline-to-treatment completion on skills assessments was 80.9% (range: 67.6%-95.5% points). The mean gain on knowledge assessments was 35.3% (range: 19.0%-49.0% points). It should be noted that parent skill gains were maintained over time. The present results provided additional empirical evidence demonstrating the effectiveness of OASIS, a telehealth-based parent-training model.

Resurgence increases with repetition.

Resurgence refers to a behavioral process in which a recent response is extinguished (or reinforcement conditions worsen) and a previously extinguished response recurs. In previous research, resurgence has been reliably produced when the resurgence procedure is repeated. Changes in the degree of increase of the resurging response across iterations of the procedure have been inconsistent, however, with some studies showing increases and some showing no changes or decreases in resurgence magnitude. The present study examined the nature of resurgence across repeated iterations of the conventional resurgence procedure by exposing four pigeons to the resurgence procedure six times in succession. In the first condition of the resurgence procedure, pecks on one key (e.g., the left) were reinforced under a variable-interval (VI) 30-s schedule. In the second condition pecks on that key were extinguished, and pecks on another key (e.g., the right) were reinforced under the same schedule. In the final condition there were no programmed consequences for either response. Resurgence was observed in 21 of 24 opportunities (87.5%). Iteration-over-iteration increases in resurgence were observed in 15 of 20 opportunities (75.0%), and this increase was found to be statistically significant. These findings demonstrate that, under certain conditions, resurgence generally increases in magnitude with repeated exposure to the procedures that generate it.

Tobacco Product Harm Perceptions and New Use.

: media-1vid110.1542/5839992833001PEDS-VA_2018-1505Video Abstract BACKGROUND: Researchers in several studies have examined correlations between tobacco harm perceptions and tobacco use in youth, but none have prospectively addressed the association between harm perceptions and subsequent new use across multiple noncigarette products. METHODS: Product-specific absolute and relative harm perceptions for cigarettes, electronic cigarettes (e-cigarettes), cigars, pipes, hookah, and smokeless tobacco were collected at wave 1 (W1) (2013-2014) among youth in the nationally representative US Population Assessment of Tobacco and Health Study (12-17 years of age; n = 10 081). At wave 2 (W2) (2014-2015), product-specific new use was calculated. Adjusted relative risks were used to estimate if harm perceptions at W1 predicted W2 new tobacco use. RESULTS: The proportion of youth who endorsed "a lot of harm" was highest for cigarettes (84.8%) and lowest for e-cigarettes (26.6%); the proportion of youth who thought products were "more harmful" than cigarettes was highest for cigars (30.6%) and lowest for e-cigarettes (5.1%). Among youth who had not used those products at W1, product-specific new use at W2 ranged from 9.1% (e-cigarettes) to 0.6% (pipes). Youth who believed that noncombustible tobacco products posed "no or little harm" at W1 were more likely to have tried those products at W2 (P < .05). Youth who viewed e-cigarettes, hookah, and smokeless tobacco as "less harmful" than cigarettes at W1 were more likely to try those tobacco products at W2 (P < .05). CONCLUSIONS: Low harm perceptions of noncigarette tobacco products predict new use of these products by youth within the next year. Targeting product-specific harm perceptions may prevent new tobacco use among youth.

Smoking prevalence and trends among a U.S. national sample of women of reproductive age in rural versus urban settings.

U.S. smoking prevalence is declining at a slower rate in rural than urban settings and contributing to regional health disparities. Cigarette smoking among women of reproductive age is particularly concerning due to the potential for serious maternal and infant adverse health effects should a smoker become pregnant. The aim of the present study was to examine whether this rural-urban disparity impacts women of reproductive age (ages 15-44) including pregnant women. Data came from the ten most recent years of the U.S. National Survey on Drug Use and Health (2007-2016). We estimated prevalence of current smoking and nicotine dependence among women categorized by rural-urban residence, pregnancy status, and trends using chi-square testing and multivariable modeling while adjusting for common risk factors for smoking. Despite overall decreasing trends in smoking prevalence, prevalence was higher among rural than urban women of reproductive age overall (χ2(1) = 579.33, p < .0001) and among non-pregnant (χ2(1) = 578.0, p < .0001) and pregnant (χ2(1) = 79.69, p < .0001) women examined separately. An interaction between residence and pregnancy status showed adjusted odds of smoking among urban pregnant compared to non-pregnant women (AOR = .58, [.53 -.63]) were lower than those among rural pregnant compared to non-pregnant women (AOR = 0.75, [.62 -.92]), consistent with greater pregnancy-related smoking cessation among urban pregnant women. Prevalence of nicotine dependence was also higher in rural than urban smokers overall (χ2(2) = 790.42, p < .0001) and among non-pregnant (χ2(2) = 790.58, p < .0001) and pregnant women examined separately (χ2(2) = 63.69, p < .0001), with no significant changes over time. Associations involving residence and pregnancy status remained significant in models adjusting for covariates (ps < 0.05). Results document greater prevalence of smoking and nicotine dependence and suggest less pregnancy-related quitting among rural compared to urban women, disparities that have potential for direct, multi-generational adverse health impacts.

Patterns of Single and Multiple Tobacco Product Use Among US Women of Reproductive Age.

Introduction: Understanding patterns of single and multiple tobacco product use among reproductive-aged women is critical given the potential for adverse health effects on mother and infant should a woman become pregnant. Methods: Patterns of tobacco use over a 2-year period were examined among all women (18-44 years) who completed wave 1 (W1) and wave 2 (W2) of the US Population Assessment of Tobacco and Health (PATH, 2013-2014, 2014-2015) Study. We examined the most common patterns of single and multiple tobacco product use in W1, and longitudinal trajectories of women engaged in each of these patterns of use from W1 to W2, among women not pregnant in either wave (n = 7480), not pregnant in W1 and pregnant in W2 (n = 332), and pregnant in W1 and not pregnant in W2 (n = 325). Results: The most prevalent patterns of tobacco use in W1 among all three subgroups were using cigarettes alone followed by using cigarettes plus e-cigarettes. In all three subgroups, women using multiple products in W1 were more likely to adopt new use patterns in W2 relative to single-product users, with the new patterns generally involving dropping rather than adding products. The majority of multiple product use included cigarettes, and transitions to single product use typically involved dropping the noncigarette product. The most common trajectory among tobacco users transitioning to or from pregnancy was to use cigarettes alone in W2. Discussion: This study contributes new knowledge characterizing tobacco use patterns across time and reproductive events among reproductive-aged women.

Examining the relationship between pregnancy and quitting use of tobacco products in a U.S. national sample of women of reproductive age.

This study examined quit rates longitudinally for cigarettes, e-cigarettes, hookah, cigars, and all tobacco products in a U.S. national sample of women aged 18-44 who completed both Wave 1 (W1) and Wave 2 (W2) of the Population Assessment of Tobacco and Health (PATH, 2013-2014, 2014-2015) study (N = 7814). Quit rates were examined among women who transitioned into pregnancy across survey waves, and among a comparable sample of non-pregnant women to provide contextual information about quitting among the broader population of reproductive-aged women. Multiple logistic regression modeling was used to estimate the associations of pregnancy and quitting adjusting for other demographic and psychosocial characteristics. Quit rates among women who were pregnant in W2 were highest for hookah (98.3%), followed by cigars (88.0%), e-cigarettes (81.3%), and lowest for tobacco cigarettes (53.4%). Slightly more than half (58.7%) of women reported quitting use all tobacco products while pregnant. Pregnancy was independently associated with increased odds of quitting hookah (AOR = 52.9, 95%CI = 3.4, 830.2), e-cigarettes (AOR = 21.0, 95%CI = 2.6, 170.3), all tobacco products (AOR = 9.6, 95%CI = 6.4, 14.5), and cigarettes (AOR = 6.5, 95%CI = 4.2, 10.1), although not cigars. Relative to other demographic and psychosocial characteristics, pregnancy was the strongest predictor of quitting use of each tobacco product. While these data indicate that pregnancy has strong, independent associations with quitting a variety of commercially available tobacco products, the comparatively lower quit rates for cigarettes versus other tobacco products underscores the long-standing need for more intensive, multipronged clinical and regulatory interventions to reduce cigarette use among reproductive-aged women.

Application of a Brief Incentive Treatment for Cigarette Smoking.

The application of financial incentives has proved to be a gainful treatment for cigarette smoking, yet the cost of delivering financial incentives has been a barrier to its widespread implementation. The goal of the present study is to test this treatment (with counseling) in a brief 3-week format, thereby reducing the cost. Results indicated that for one participant incentives were effective at promoting long-term abstinence from cigarette smoking. Though more research is needed, this treatment appears to be effective and can be delivered at a relatively low cost. • Financial incentives can be utilized to promote abstinence from cigarette smoking. • Regular monitoring of biomarkers of cigarette smoking is required in this treatment. • One low-cost feature of this treatment is that a participant that does not abstain from smoking does not receive incentives, as was the case for one participant in this study. • Abstinence is achieved through a combination of skill-training and reinforcing the absence cigarette smoking (differential reinforcement of other behavior; DRO).

Tobacco use in cardiac patients: Perceptions, use, and changes after a recent myocardial infarction among US adults in the PATH study (2013-2015).

Smoking status following cardiac events strongly predicts future morbidity and mortality. Using a nationally representative sample of United States adults, aims of this study were (1) to estimate use of, and attitudes towards, tobacco products as a function of level of cardiac risk, and (2) to explore changes in attitudes and tobacco use among adults experiencing a recent myocardial infarction (MI). Data were obtained from the first and second waves of the Population Assessment of Tobacco and Health (PATH) study. Use and attitudes towards tobacco products were examined at Wave 1 among adults with no chronic health condition (n = 18,026), those with risk factors for heart disease (n = 4593), and those who reported ever having had an MI (n = 643). Changes in perceived risk of tobacco and use between the two waves and having an MI in the last 12 months (n = 240) were also examined. Those who reported lifetime MI were more likely to believe that smoking/using tobacco was causing/worsening a health problem. Having had a recent MI event increased perceived tobacco-related risk and attempts at reduction/quitting, but did not significantly impact combusted tobacco cessation/reduction or uptake of non-combusted tobacco products. Sociodemographic characteristics and use of other tobacco products were associated with change in use of tobacco products. Those who have an MI are sensitized to the harm of continued smoking. Nonetheless, having an MI does not predict quitting combusted tobacco use or switching to potentially reduced harm products. Intense intervention is necessary to reduce combusted use in this high-risk population.

Tobacco and nicotine delivery product use in a U.S. national sample of women of reproductive age.

This study examined prevalence and correlates of using cigarettes, e-cigarettes, and other tobacco/nicotine delivery products in a U.S. national sample of women of reproductive age. Weighted data were obtained from women aged 15-44 years who were not currently pregnant in the first wave of the Population Assessment of Health and Tobacco (PATH, 2013-2014) study (N = 12,848). 20.1% of women were current cigarette smokers, 5.9% current e-cigarette users, 4.9% current cigar smokers, and 6.5% current hookah users. Prevalence of current use of other tobacco products was <1.0%. Current cigarette smoking was the strongest correlate of current e-cigarette use (OR = 65.7, 95% CI = 44.8-96.5), cigar smoking (OR = 19.2, 95% CI = 14.1-26.1), and hookah use (OR = 6.6, 95% CI = 5.1-8.5). Among former cigarette smokers, 3.8%, 6.9%, and 3.2% were also currently using e-cigarettes, hookah, and cigars, respectively. Use of other tobacco and nicotine delivery products was low among those who never smoked tobacco cigarettes: 2.5% used hookah and <1.0% used other products. Cigarette smoking prevalence remains relatively high among women of reproductive age and strongly correlated with use of other tobacco products. Monitoring tobacco and nicotine use in this population is important due to the additional risk of adverse health impacts should they become pregnant. Clinicians working with cigarette smokers should assess for use of other tobacco products. Among women of reproductive age, use of emerging tobacco and nicotine products appears to be largely, although not exclusively, restricted to current cigarette smokers.

Rural Versus Urban Use of Traditional and Emerging Tobacco Products in the United States, 2013-2014.

OBJECTIVES: To examine urban-rural differences in US prevalences of traditional and emerging tobacco product use as well as dual or polytobacco use of these products. METHODS: Our data were derived from wave 1 (2013-2014) of the Population Assessment of Tobacco and Health (PATH) Study. We estimated weighted prevalences of adult tobacco use across urban-rural geographies and examined prevalences classified by gender, poverty level, and region of the country. RESULTS: Nationally, cigarette use and smokeless tobacco use, as well as dual or polytobacco use of traditional products, were more prevalent in rural than in urban areas. Conversely, cigarillo and hookah use and dual or polytobacco use of emerging products were higher in urban areas. There was no significant urban-rural difference in use of e-cigarettes. Gender, poverty, and region of the country did not seem to be driving most urban-rural differences, although differences related to cigarillo use and dual or polytobacco use of emerging products became nonsignificant after control for covariates. CONCLUSIONS: Our findings highlight important urban-rural differences in tobacco use. Whether the changing tobacco product landscape will contribute to a continuation of rural health disparities remains to be seen.

Use of higher-nicotine/tar-yield (regular full-flavor) cigarettes is associated with nicotine dependence and smoking during pregnancy among U.S. women.

The present study examined full-flavor cigarette use among women of reproductive age to assess whether use is associated with greater nicotine dependence and smoking during pregnancy. We used data from the National Survey on Drug Use and Health (2005-2014). Consecutive years were combined to assure sufficient numbers of pregnant women. We examined whether use of full-flavor cigarettes was associated with greater odds of nicotine dependence using the Fagerstrom Test for Nicotine Dependence and Nicotine Dependence Syndrome Scale (NDSS), controlling for other smoking characteristics. We next compared prevalence of smoking and use of full-flavor versus lower-yield cigarettes among non-pregnant versus pregnant women and across trimesters. Lastly, we examined whether pregnancy was associated with greater odds of using full-flavor cigarettes after controlling for potential confounders. Use of full-flavor cigarettes was associated with greater adjusted odds of nicotine dependence compared to lower yields among non-pregnant (Fagerstrom: 2.50, 95% CI: 2.32,2.70; NDSS: 1.75, 95% CI: 1.62,1.88) and pregnant (Fagerstrom: 1.53, 95% CI: 1.13,2.05; NDSS: 1.53, 95% CI: 1.12,2.10) smokers. As smoking prevalence decreased among pregnant compared to non-pregnant women (14.31±0.55% versus 22.73±0.17%), prevalence of using full-flavor cigarettes increased (54.82±1.63% versus 38.86±0.35%). Similarly, as smoking prevalence decreased from 1st to 3rd trimester (19.65±1.2%, 12.50±0.84%, 11.3±0.83%), prevalence of using full-flavor cigarettes increased (53.12±2.53%, 50.57+2.92%, 63.63±3.19%). Overall, pregnancy was associated with 1.43 (95% CI: 1.22, 1.68) greater adjusted odds of full-flavor cigarette use. These results indicate that users of full-flavor cigarettes have greater nicotine-dependence risk and lower likelihood of quitting smoking during pregnancy, relationships with potential for serious adverse maternal-infant health impacts.

Tobacco and nicotine delivery product use in a national sample of pregnant women.

Monitoring use of tobacco products among pregnant women is a public health priority, yet few studies in U.S. national samples have been reported on this topic. We examined prevalence and correlates of using cigarettes, e-cigarettes, and other tobacco/nicotine delivery products in a U.S. national sample of pregnant women. Data were obtained from all pregnant women (≥18 years) in the first wave of the Population Assessment of Tobacco and Health (PATH, 2013-2014) Study (N=388). Prevalence of current and prior use of tobacco/nicotine products was examined overall and among current cigarette smokers. Multiple logistic regression was used to examine correlates of use of cigarettes, e-cigarettes, hookah and cigars. Overall prevalence was highest for cigarettes (13.8%), followed by e-cigarettes (4.9%), hookah (2.5%) and cigars (2.3%), and below 1% for all other products. Prevalence of using other tobacco products is much higher among current smokers than the general population, with e-cigarettes (28.5%) most prevalent followed by cigars (14.0%), hookah (12.4%), smokeless (4.7%), snus (4.6%), and pipes (2.1%). Sociodemographic characteristics (poverty, low educational attainment, White race) and past-year externalizing psychiatric symptoms were correlated with current cigarette smoking. In turn, current cigarette smoking and past year illicit drug use were correlated with using e-cigarettes, hookah, and cigars. These results underscore that tobacco/nicotine use during pregnancy extends beyond cigarettes. The results also suggest that use of these other products should be included in routine clinical screening on tobacco use, and the need for more intensive tobacco control and regulatory strategies targeting pregnant women.

Disparities in US Healthcare Provider Screening and Advice for Cessation Across Chronic Medical Conditions and Tobacco Products.

BACKGROUND: Disparities in tobacco use are worsening in the United States, disproportionately affecting those with chronic medical conditions. One possible contributor is that physicians may not screen and advise cessation uniformly across patients and/or tobacco products. OBJECTIVE: This study examined provider communications regarding cigarette and non-cigarette tobacco products among adults with chronic conditions. DESIGN: Cross-sectional study drawn from two waves (2013-2014) of the National Survey on Drug Use and Health (NSDUH). PARTICIPANTS: Adults (≥ 18 years) who used tobacco in the past year. MAIN MEASURES: Prevalence of tobacco use included past-year use of cigarettes, cigars, or smokeless tobacco among those with and without chronic conditions. Chronic conditions included asthma, anxiety, coronary heart disease, depression, diabetes, hepatitis, HIV, hypertension, lung cancer, stroke, and substance abuse. Odds ratio of receipt of screening and advice to quit across chronic condition and tobacco product type were reported. Data were analyzed using logistic regression, controlling for basic sociodemographic factors and number of provider visits. KEY RESULTS: Adults with anxiety, depression, and substance use disorders had the highest prevalence of past-year cigarette (37.2-58.2%), cigar (9.1-28.0%), and smokeless tobacco (3.1-11.7%) use. Patients with any chronic condition were more likely to receive advice to quit than those without a condition (OR 1.21-2.37, p < 0.01), although the odds were lowest among adults with mental health and substance use disorders (OR 1.21-1.35, p < 0.01). Cigarette smokers were more likely to report being screened and advised to quit than non-cigarette tobacco users (OR 1.54-5.71, p < 0.01). CONCLUSIONS: Results support the need for provider training to expand screening and cessation interventions to include the growing spectrum of tobacco products. Screening and referral to interventions are especially needed for those with mental health and substance use disorders to reduce the disparate burden of tobacco-related disease and death.