Contextualizing experiences of cultural stress: A qualitative exploration among Hispanic/Latinx youth in Miami and Los Angeles.

OBJECTIVES: Hispanic/Latinx youth vary in their immigration heritage (e.g., country of origin, familial migration history, etc.) and the structure of their communities. This study is a qualitative exploration of Hispanic/Latinx youth experiences of cultural stress in Miami and Los Angeles in 2021. METHOD: A total of 23 Hispanic/Latinx adolescents in Los Angeles (n = 12) and Miami (n = 11) provided in-depth interviews to assess: (a) appraisals of family immigration history and (b) experiences across three cultural stressors: sociopolitical, language brokering, and intragroup marginalization. Interviews were analyzed using a general inductive analytic approach and case comparison methodology to assess differences across sites. RESULTS: For appraisals of family immigration history, gratitude and hope emerged as positive emotions experienced when youth reflected on their immigrant origins. Miami participants reported perceived worsening of sociopolitical stress as a result of changes in political administration whereas participants in Los Angeles felt a sense of relief. Participants in Miami and Los Angeles reported similar strengths and challenges in language brokering with COVID-19 variedly impacting youth's perceived language brokering stress. Last, to youth intragroup marginalization experienced from family members was experienced as more detrimental than from peers, and they reported the use of cognitive reframes to cope. CONCLUSION: Cultural stressors are dynamic and diverse. This study further informs cultural stress theory by cataloging how families' immigration history and national current events inform experiences of stress among youth. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Vaping Devices with Video Games.

The United States Food and Drug Administration (FDA) and other agencies have warned e-cigarette to companies to stop selling vaping products that look like toys because these products could attract youth to nicotine use. The vaping industry has gone a step further, producing vaping devices that are fully functional video games. We have observed several new vaping devices that contain youth-oriented video games such as Pac-Man, Tetris, Mario, Q*bert, and virtual pets. Some of these games reward users for each puff of nicotine. The incorporation of video games into vaping devices raises public health concerns regarding the potential appeal to younger users and the potential to escalate nicotine use and dependence. It is crucial to address these devices through robust policy, educational initiatives, and enforcement of existing policies.

Disentangling the directionality among cultural stressors and psychosocial outcomes in recently immigrated Hispanic families: A random intercept cross-lagged panel model approach.

Research shows the impact of cultural stressors (e.g. perceived discrimination, bicultural stressors, negative context of reception) on adolescents' psychosocial outcomes. Given the presence of multiple cultural stressors in many Hispanic adolescents' lives, it is essential to examine the (a) developmental sequencing of cultural stressors among recent immigrant youth and (b) predictive effects of cultural stressors on adolescents' psychosocial outcomes. We employed a random intercept cross-lagged panel model to examine the longitudinal interplay among cultural stressors and their effects on youth outcomes using longitudinal data with six waves among 302 recently immigrated Hispanic adolescents (47% girls, Mage = 14.51, SD = .88). We observed bidirectional within-person relations and between-person associations among cultural stressors. At the within-person level, bidirectional cross-lagged effects emerged between perceived discrimination and bicultural stress, between perceived discrimination and negative context of reception, and between negative context of reception and bicultural stress. At the between-person level, bidirectional cross-lagged effects emerged only between perceived discrimination and bicultural stressors. Our findings indicate that cultural stressors explain heterogeneity in psychosocial outcomes: self-esteem was inversely predicted by all cultural stressors, whereas depressive symptoms were predicted only by perceived discrimination. In addition, optimism was predicted only by bicultural stressors, and externalizing behavior was predicted by both bicultural stressors and perceived discrimination. These results suggest that the longitudinal relationships among cultural stressors are (partly) bidirectional. Additionally, cultural stressors demonstrated differential predictive effects on psychosocial outcomes, indicating the added value of considering multiple cultural stressors and their longitudinal effects on adolescents' psychosocial outcomes.

The 123s and affective, behavioral, and cognitives of unaccompanied Latinx Minors: A trauma-informed composite case study.

OBJECTIVES: This article explores the stages where trauma is experienced (123s) and its physiopsychological impact (affect, behavior, and cognitions [ABCs]) in unaccompanied Latinx Minors through the analysis of a composite case study. Unaccompanied Latinx Minors represent a unique and growing population in the United States that warrants careful consideration from a trauma-informed and resilience-based framework. METHOD: A detailed case study was implemented, triangulating caregiver and client therapy records to illustrate the framework of stages of trauma exposure (123s) and physiopsychological impact (ABCs). RESULTS: Latinx children often encounter various potentially traumatic experiences and adverse childhood experiences at the following stages (123s): (1) Preimmigration; (2) During immigration; and (3) Postimmigration. The extended traumas experienced by immigrant youth may easily constitute toxic stress. Moreover, once in the destination country, youth may lack coping resources or encounter stressful circumstances that prolong or exacerbate the impact of previous traumas. This continuous physiological hyperarousal can also result in changes in brain neurobiology, which further compounds the experience of other symptoms (Krupnik, 2021). These potentially complex trauma responses may manifest for these children through ABCs. The cumulative impact of these incidents may have significant effects on minors' A. Affective, B. Behavioral, and C. Cognitive functioning. CONCLUSIONS: Relevant clinical implications and policy recommendations for addressing the multifaceted needs of unaccompanied Latinx minors. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Fentanyl harm reduction strategies among Latinx communities in the United States: a scoping review.

PURPOSE: Fueled by the prescription opioid overdose crisis and increased influx of illicitly manufactured fentanyl, fentanyl overdoses continue to be a public health crisis that has cost the US economy over $1 trillion in reduced productivity, health care, family assistance, criminal justice, and accounted for over 74,000 deaths in 2023. A recent demographic shift in the opioid crisis has led to a rise in overdose deaths among the Latinx population. Harm reduction interventions, including the use of naloxone and fentanyl test strips, have been shown to be effective measures at reducing the number of opioid overdose deaths. The aim of this scoping review is to summarize naloxone and fentanyl test strip interventions and public health policies targeted to Latinx communities. METHODS: PubMed, CINHAL, Web of Science, Embase, and PsycINFO research databases using the keywords "fentanyl," "Latinx," "Harm Reduction," "Naloxone," and "Fentanyl Test Strips'' to identify studies published between January 1, 2013 and December 31, 2023. Endnote and Covidence software were used to catalog and manage citations for review of studies. Subsequently, studies that met inclusion criteria were then summarized using resulting themes. RESULTS: Twenty-seven articles met the inclusion criteria and were further abstracted for the scoping review. Of these articles, 77.7% (n = 21) included a naloxone intervention, while only 11.1% (n = 3) included a fentanyl test strip intervention. Furthermore, 30.1% (n = 8) of these studies were Latinx targeted, and 7.7% (n = 2) of the studies were adapted for Latinx populations. Four themes, including an overall lack of knowledge and awareness, a lack of access to harm reduction or opioid overdose prevention resources, an overall lack of culturally adapted and/or targeted interventions, and restrictive and punitive policies that limit the effectiveness of protective factors were highlighted in this scoping review. CONCLUSION: Limited published research exists on the use of emerging harm reduction behaviors, such as the use of naloxone and fentanyl test strips as community intervention strategies to prevent opioid overdose deaths. Even fewer publications exist on the targeting and cultural adaptation of harm reduction interventions responsive to Latinx communities, especially those using theoretical approaches or frameworks to support these interventions. Future research is needed to assess the unique needs of Latinx populations and to develop culturally responsive programs to prevent opioid-related overdose deaths among this population.

Recall of Flavor at First E-cigarette Use and Its Association with E-cigarette Progression: The Mediating Effects of First Sensory Experience.

OBJECTIVE: To test whether the association between flavor at first vape and continued use is mediated through subjective experience at first vape. STUDY DESIGN: In a 2020 cross-sectional survey, 955 young adult ever-vapers recalled their first flavor vaped, subjective experiences at first use, current vaping behavior, nicotine dependence, and quit attempts. A latent class model grouped first-use subjective experiences into classes. Two-part negative binomial hurdle models for each vaping behavior evaluated whether the association of first flavor used with vaping outcomes was mediated by positive experience. RESULTS: Four latent classes (positive, positive and negative, negative, and minimal experience) were further reduced to "any positive experience" (only positive, positive and negative) vs "no positive experience" (negative or minimal). Class membership mediated the association of first flavor used (mint/menthol/ice [ie, "cooling"] or sweet vs other) with each vaping outcome. For example, cooling flavor (vs. other) was associated with positive class membership (OR = 3.5; 95% CI: 1.5, 8.1), which was then associated with any past 30-day vaping (OR = 3.9; 95% CI: 2.7, 5.8) and greater number of vaping days among current vapers (RR = 1.9; 95% CI: 1.3, 2.7) in the two-part hurdle model. Similar results were observed for nicotine dependence and quit attempts, and for sweet (vs other) flavor for any dependence or quit attempts, but not number of dependence symptoms or quit attempts. CONCLUSIONS: Use of a cooling or sweet flavor at first use was associated with having a positive first vaping sensory experience, and then greater likelihood as a young adult of reporting past 30-day vaping, more vaping days, and greater risk for nicotine dependence, suggesting a key mediating role of first use experience.

Identifying the intersection of parental HPV and COVID-19 vaccine hesitancy to inform health messaging interventions in community-based settings.

PURPOSE: Parental human papillomavirus (HPV) vaccine hesitancy contributes to delays or refusals in adolescent uptake. It is unclear if COVID-19 vaccine hesitancy has further impacted the low HPV vaccine uptake trends among underrepresented minorities. This study examines the relationship between COVID-19 vaccine intent and HPV vaccine hesitancy among parents for their adolescents in communities with low vaccine uptake in Los Angeles County. METHODS: Parents from a school-based academic enrichment program serving low-income, first-generation immigrant families completed an online cross-sectional survey to understand parental HPV vaccine hesitancy, adolescent HPV vaccine behavior, and attitudes towards other vaccines, including intent to receive COVID-19 vaccines. In March 2021, parents with children ages 9-17 years completed online surveys. Using multivariate logistic regression models, we examined whether low parent intent to vaccinate their adolescent against COVID-19 was associated with hesitancy to vaccinate against HPV. RESULTS: A total of 291 surveys were completed. Among parents with high HPV vaccine hesitancy for their adolescent, 33 % did not intend to vaccinate their adolescent against COVID-19 compared to 7 % among parents with low HPV vaccine hesitancy. Low parent intention to vaccinate adolescent against COVID-19 was associated with higher HPV vaccine hesitancy (p < 0.01) after controlling for parent nativity status, medical mistrust, receiving the flu vaccination and negative HPV information. DISCUSSION: Our findings indicate associations between low parental COVID-19 vaccine intent and higher HPV vaccine hesitancy for their adolescent. Identifying community-relevant health interventions to address parental vaccine hesitancy across multiple child and adolescent vaccines may help to achieve equitable vaccine uptake.

Health Care Workers' Reflections, Experiences, and Sequela throughout the COVID-19 Pandemic.

OBJECTIVE: Health care workers (HCW) experienced significant stress during the COVID-19 pandemic. This qualitative study describes how they contextualized the experience several years later. METHODS: In August 2023, 1832 HCW at an academic medical center completed a confidential electronic survey; 443 of them responded to an open-ended question about their experiences during the pandemic. The statements were analyzed qualitatively, using a grounded theory approach to allow themes to emerge from the data. RESULTS: Common themes included fear/anxiety (22%), burnout (15%), protecting family from risk (11%), lack of employer support (11%), fear of illness (8%), increased appreciation for life (8%), and exposure to death/illness (5%). CONCLUSION: HCW experienced substantial stress during the pandemic. Mental health services and structural changes in the health care system are needed to protect HCW during future public health emergencies.

The differential impacts of COVID-19 mortality on mental health by residential geographic regions: The Los Angeles Pandemic Surveillance Cohort Study.

OBJECTIVE: This study examines the association between changes in mental health before and during the COVID-19 pandemic and COVID-19 mortality across geographic areas and by race/ethnicity. METHODS: A cross-sectional survey was conducted in Los Angeles County between April and May 2021. The study used the Patient Health Questionnaire-2 to assess major depression risk. Participants' home ZIP codes were classified into low, middle, and high COVID-19 mortality impacted areas (CMIA). RESULTS: While there were existing mental health disparities due to differences in demographics and social determinants of health across CMIA in 2018, the pandemic exacerbated the disparities, especially for residents living in high CMIA. Non-White residents in high CMIA reported the largest deterioration in mental health. Differences in mental health by CMIA persisted after controlling for resident characteristics. CONCLUSIONS: Living in an area with higher COVID-19 mortality rates may have been associated with worse mental health, with Non-White residents reporting worse mental health outcomes in the high mortality area. POLICY IMPLICATIONS: It is crucial to advocate for greater mental health resources in high COVID-19 mortality areas especially for racial/ethnic minorities.

Effects of exposure to snus marketing with versus without modified risk tobacco product claims on snus use intention and perceived harm among young adults.

BACKGROUND: We tested whether snus marketing with modified risk tobacco product (MRTP) claims: (a) promotes accurate knowledge about snus's health effects in young adults and (b) encourages use intentions in only those who use combustible tobacco without attracting other young adult populations. METHODS: A randomised between-subjects experiment was embedded in a 2020 web survey of participants from Los Angeles (aged 19-23 years). Participants viewed mass-marketed snus advertising materials with (n=1212) vs without (n=1225) US Food and Drug Administration-authorised MRTP claims. After advertising exposure, snus use intention and perceptions of snus harms relative to cigarettes or e-cigarettes were measured. RESULTS: Advertisements with versus without MRTP claims did not affect snus use intention (18.0% vs 19.4%) but produced a higher prevalence of perceptions that snus was less harmful than cigarettes (12.6% vs 9.1%; p=0.007) and e-cigarettes (8.0% vs 5.8%; p=0.04). MRTP claim exposure effects did not differ by past 30-day e-cigarette or combustible tobacco use. Snus use intentions after marketing exposure, collapsed across MRTP claim conditions, were higher in those who did versus did not report past 30-day use of e-cigarettes (38.4% vs 14.3%; adjusted OR (95% CI) 2.95 (2.28 to 3.81); p<0.001) or combustible tobacco (44.0% vs 16.2%; adjusted OR (95% CI) 2.26 (1.62 to 3.16); p<0.001). CONCLUSION: Although some young adults who vape or smoke may have snus use intentions, snus MRTP claims might not affect young adults' snus use intentions, regardless of whether they vape/smoke. MRTP claims might modestly increase the accuracy of perceived harms of snus relative to cigarettes while also slightly causing unsubstantiated perceptions of lower harm than e-cigarettes.

A Community-based Intervention to Improve Health Outcomes for Vietnamese Americans.

Vietnamese Americans experience significant health disparities compared with other groups, but their health care utilization is suboptimal. Boat People SOS (BPSOS), a nationwide Vietnamese-serving community-based organization, implemented a community health worker and community-clinical linkage electronic referral system to improve health care utilization. Three sites (in Alabama, California, and Virginia) received the intervention; Mississippi was the comparison site. The intervention included bridging between communities and health systems, culturally appropriate health education, informal counseling and social support, advocating for individual and community needs, direct services, and building individual and community capacity through partnerships with service providers. Compared with the comparison site, clients at the intervention sites reported better overall perceived health after the intervention. Past-year medical checkups declined in both groups during the COVID-19 pandemic but declined less in the treatment group. The intervention did not reduce emergency room visits. Findings suggest that this intervention can improve health care utilization and health status among Vietnamese Americans.

The underrepresentation of racial/ethnic minorities in research on co-use of nicotine, alcohol, and/or cannabis via ecological momentary assessment methods: A narrative review.

BACKGROUND: Co-use of nicotine, alcohol and/or cannabis is common among adults in the United States. Co-use may represent greater addiction severity than single substance use. Recent studies have examined the extent to which the frequency, order, simultaneity, motivations, and contextual factors associated with co-use differ from that of single use. Co-use has become prevalent among racial/ethnic minority individuals who exhibit distinct co-use patterns and related outcomes; however, most of these studies rely on cross-sectional or sparse longitudinal observations. Ecological momentary assessment (EMA) can illuminate such patterns and associations with time-varying contexts. This review summarizes EMA studies on co-use published from 2008 to 2023 involving racial/ethnic minority individuals and point to gaps. Our review addresses: 1) whether use of one substance leads to substitution or complementary use of another, 2) whether antecedents/contexts differ by co-use patterns and minority status, and 3) what consequences of co-use have been documented across co-use patterns or minority status. METHODS: Search results yielded 465 articles, with 33 meeting inclusion criteria. We extracted study-level characteristics and synthesized the findings. RESULTS: The findings largely focused on co-use patterns, categories of co-use, proximal antecedents and contexts, and consequences. Variations by minority status were rarely examined; few examined acute effects of unique experiences that may contribute to co-use among racial/ethnic minority adults. CONCLUSIONS: The EMA literature on co-use is burgeoning in recent years and supports complementary hypothesis. More research to capture time-intensive data on experiences to contextualize the co-use among racial/ethnic minority groups with greater diversity in race/ethnicity is warranted.

Alcohol Use and Life Stressors During the COVID-19 Pandemic: A Longitudinal Study of Young Adults.

Objective: To estimate the extent to which drinking to cope with the COVID-19 pandemic and experiencing pandemic-related life stressors are associated with alcohol use escalation among young adults. Methods: Respondents in Los Angeles, CA, USA (N=2,130) completed prospective cohort study surveys before (baseline; October 2018-November 2019; mean age: 19.7[SD=0.4) and during (follow-up; May-August 2020) the COVID-19 outbreak. Past 30-day drinking days and number of drinks per drinking day were assessed from baseline to follow-up. At follow-up, participants reported drinking to cope with social isolation and pandemic-related stressors. Results: Pandemic-related stressor prevalence ranged from 5.5% (evicted/lost home) to 72.6% (worried about education) and 27.1% drank to cope with social isolation during the pandemic. Respondents who did (vs. did not) report pandemic-related coping drinking were more likely to increase past 30-day drinking days and drinks per drinking day from baseline to follow-up after adjustment for possible confounders. Employment loss/reduction, financial problems, and perceived likelihood of contracting COVID-19 or handling the pandemic poorly were each associated with increases in drinking days or drinks per drinking day. Conclusions: Experiencing certain life stressors and drinking to cope with social isolation may be associated with drinking escalation among young adults during the COVID-19 pandemic.

Young adults' visual attention to features of social media marketing for disposable e-cigarettes and associated perceptions.

BACKGROUND AND AIMS: E-cigarette marketing exposure on social media influences perceptions; however, limited knowledge exists regarding marketing features attracting the most visual attention. This study examined visual attention to features of social media marketing for disposable e-cigarettes and related product perceptions. DESIGN, SETTING AND PARTICIPANTS: Participants viewed 32 disposable marketing post images from social media (Instagram) using computer-based eye-tracking technology to assess standardized attention metrics of marketing features. They then completed a survey assessing positive product perceptions. The study took place in New Jersey, USA, June-September 2022, comprising young adults (aged 18-29) who do not use tobacco (n = 72) or who smoke cigarettes (n = 42). MEASUREMENTS: We examined associations between 14 marketing features (e.g. product package, personal item, fruit/candy descriptor, social media account) and standardized attention metrics of dwell time (fixation duration) and entry time (time to first fixation). Then, we assessed attention metrics for each feature in relation to positive product perceptions (appeal and positive use expectancy). FINDINGS: Among all participants, dwell time was the longest for the product descriptor [marginal means (MM) = 1.77; 95% confidence interval (CI) = 1.69, 1.86], social media account (MM = 1.76; 95% CI = 1.67, 1.85) and fruit/candy descriptor features (MM = 1.56; 95% CI = 1.41, 1.70); entry time was the shortest for the social media account (MM = 0.35; 95% CI = 0.26, 0.46), personal item (MM = 0.36; 95% CI = 0.17, 0.56) and human model features (MM = 0.40; 95% CI = 0.08, 0.72). Two use status groups had comparable dwell and entry times, except for the product descriptor feature. Longer dwell time for the product package feature increased positive product perceptions among both use status groups [regression coefficient (ß) = 0.44 and 2.61]. Longer dwell time for fruit/candy descriptor (ß = 1.80) and price promotion features (ß = 4.04) increased positive product perceptions among those who smoke. CONCLUSIONS: US young adults appear to be particularly visually engaged by disposable e-cigarette marketing that uses social media account features (account profile pictures, information about the products marketed and relevant hashtags) and features enhancing the products' personal relatability. Disposable product packages, fruit/candy descriptors and price promotions may increase the influence of social media marketing among various use status groups.

Factors associated with exclusive breastfeeding by maternal HIV status: a population-based survey in Kenya.

BACKGROUND: Exclusive breastfeeding (EBF) in the first six months remains low globally, despite known benefits of lower morbidity and mortality among breastfed infants. It is important to understand factors associated with breastfeeding to support optimal breastfeeding practices, particularly in settings with a high burden of HIV. METHODS: We analyzed data from a population-level survey of mother-infant pairs attending 6-week or 9-month immunizations at 141 clinics across Kenya. Primary outcomes included maternal report of (1) EBF at 6-week visit, defined as currently feeding the infant breast milk only, (2) EBF for the first 6-months of life, defined as breastfeeding or feeding the infant breast milk only with no introduction of other liquids or solid foods until 6 months, and (3) continued breastfeeding with complementary feeding at 9-months. Correlates of breastfeeding practices were assessed using generalized Poisson regression models accounting for facility-level clustering. RESULTS: Among 1662 mothers at 6-weeks, nearly all self-reported breastfeeding of whom 93% were EBF. Among 1180 mothers at 9-months, 99% had ever breastfed, 94% were currently breastfeeding and 73% reported 6-month EBF. At 6-weeks, younger age (< 25 years) (adjusted Prevalence Ratio (aPR) 0.96; 95% CI 0.93, 0.99), lower education (aPR 0.96; 95% CI 0.93, 0.99) and recent infant illness (aPR 0.97; 95% CI 0.94, 1.00) were associated with lower EBF prevalence while women living with HIV (WLWH) had higher EBF prevalence (aPR 1.06; 95% CI 1.02, 1.10) than women without HIV. 6-month EBF prevalence was 26% higher in WLWH (aPR 1.26; 95% CI 1.15, 1.35) than women without HIV, 14% lower in women reporting mild or above depressive symptoms (aPR 0.86; 95% CI 0.76, 0.99) than those with none or minimal depressive symptoms, and 15% lower in women with versus without history of intimate partner violence (aPR 0.85; 95% CI 0.74, 0.98). At 9-months, WLWH had a lower prevalence of continued breastfeeding with complementary feeding (aPR 0.73; 95% CI 0.64, 0.84) than women without HIV. CONCLUSION: WLWH had higher EBF prevalence in the first 6-months, but lower prevalence of continued breastfeeding at 9-months. Strategies to support EBF and continued breastfeeding beyond 6-months postpartum, particularly among WLWH, are needed.

Evaluating trends in recruitment challenges in vape shop research, e-cigarette product characteristics and use among shop customers from 2019 to 2023: A mixed-methods study.

INTRODUCTION: Brick-and-mortar vape shops specialize in the sale of e-cigarettes and remain a primary source for purchasing emerging e-cigarette products. New regulatory policies have been implemented at local-, state- and federal-level; the retail environment at vape shops and product preferences among vape shop customers shifted accordingly. METHODS: From 2019 to 2023, we collected anonymous interview data from vape shop customers (n=572) from 83 vape shops in Southern California. We aggregated the data by month and treated each month as the unit of analysis to document changes in recruitment efforts among the vape shops in relation to major policy implementations over 4 years. We also examined the systematic fluctuations and trends in customers' e-cigarette product preferences and nicotine content in these products. RESULTS: The monthly average shop-level consent rate was 52.9% (SD=8.7), with an overall decreasing trend over time. It was necessary for our data collection team to approach a greater number of vape shops to obtain consent with implementation of various state and federal tobacco regulations and following COVID-19. We observed an increase in the purchase of disposable products and nicotine concentrations in the products, while the average use frequency remained the same. CONCLUSIONS: Our findings demonstrated that user preferences, product characteristics and challenges in research involving vape shops are closely associated to changes in regulations. We documented a dramatic increase in nicotine concentration in products. Future policies restricting the amount of nicotine in tobacco products at the federal level are necessary to protect consumers from further nicotine addiction. This study provides documentation over time of the drastic increases in nicotine concentration among e-cigarette users as a result of the fluctuations in the product market. Regulating nicotine content in tobacco products could safeguard against further unsafe modifications in e-cigarettes and other types of tobacco products.

US adolescents' response to nicotine warning labels in influencer e-cigarette marketing social media posts: a survey-based randomised between-subject experiment.

BACKGROUND: E-cigarette promotional posts with misleading nicotine warning labels on social media may lower adolescents' risk perceptions of e-cigarettes. A between-subject experiment assessed effects of influencers' e-cigarette promotional posts with different nicotine warning labels on adolescents' e-cigarette harm perceptions, susceptibility to e-cigarette use and perceptions of influencer credibility. METHODS: In 2022, adolescents (N=1864, Mage=17 (SD=0.6)) were randomised to view six images and videos featuring influencers promoting e-cigarettes in one of five experimental conditions: two conditions with a 'tobacco-free nicotine' warning label (placed on an e-cigarette in the post or at the top of the post), two conditions with the US Food and Drug Administration (FDA) nicotine warning label (on an e-cigarette in the post or at the top of the post (control)) and one no-label condition. Participants rated influencers' credibility (eg, honesty). Harm perceptions of, and susceptibility to use, e-cigarettes were then assessed. RESULTS: Participants who viewed posts with the FDA warning label at the top of the post perceived influencers as more honest, trustworthy and informed than in all the other conditions. E-cigarette never-users who viewed posts with a 'tobacco-free nicotine' warning label pictured on an e-cigarette (compared with the FDA label at the top of a post) were more likely to report susceptibility to e-cigarette use (adjusted OR 1.79, 95% CI 1.17 to 2.73). CONCLUSIONS: Alterations of the required nicotine warning labels can make them less effective in deterring e-cigarette use behaviour. Tobacco control authorities could increase enforcement of the FDA-required nicotine warning labels and harness influencers for antitobacco messaging.

Mobile solutions to Empower reproductive life planning for women living with HIV in Kenya (MWACh EMPOWER): Protocol for a cluster randomized controlled trial.

BACKGROUND: Women living with HIV (WLWH) face unique reproductive health (RH) barriers which increase their risks of unmet need for contraception, contraceptive failure, unintended pregnancy, and pregnancy-related morbidity and mortality and may prevent them from achieving their reproductive goals. Patient-centered counseling interventions that support health care workers (HCWs) in providing high-quality RH counseling, tailored to the needs of WLWH, may improve reproductive health outcomes. METHODS AND DESIGN: We are conducting a non-blinded cluster randomized controlled trial (cRCT) of a digital health intervention for WLWH (clinicaltrials.gov #NCT05285670). We will enroll 3,300 WLWH seeking care in 10 HIV care and treatment centers in Nairobi and Western Kenya. WLWH at intervention sites receive the Mobile WACh Empower intervention, a tablet-based RH decision-support counseling tool administered at baseline and SMS support during two years of follow-up. WLWH at control sites receive the standard of care FP counseling. The decision-support tool is a logic-based tool for family planning (FP) counseling that uses branching logic to guide RH questions based on participants' reproductive life plans, tailoring counseling based on the responses. Follow-up SMSs are based in the Information-Motivation-Behavioral (IMB) Skills model of behavioral change and are tailored to participant characteristics and reproductive needs through separate SMS "tracks". Follow-up visits are scheduled quarterly for 2 years to assess plans for pregnancy, pregnancy prevention, and contraceptive use. The primary outcome, FP discontinuation, will be compared using an intent-to-treat analysis. We will also assess the unmet need for FP, dual method use, viral load suppression at conception and unintended pregnancy. DISCUSSION: The Mobile WACh Empower intervention is innovative as it combines a patient-centered counseling tool to support initial reproductive life decisions with longitudinal SMS for continued RH support and may help provide RH care within the context of provision of HIV care.

Adult harm perceptions, purchase, and use related to synthetic vs. tobacco-derived nicotine vaping products: A mixed-methods study.

Objective: Synthetic nicotine (SN) e-cigarettes emerged on the market as an alternative to tobacco-derived nicotine (TDN) vaping products. It is critical to understand the harm perceptions, purchase, and use of SN vs. TDN e-cigarettes. Methods: From November 2021 to February 2023, we conducted intercept interviews with 263 adult customers at 37 vape shops in Southern California. Self-reported use and harm perceptions towards SN vs TDN e-cigarettes were examined. A qualitative analysis of researcher-obtained photographs of vaping items just purchased by customer participants was conducted. Results: Past 30-day SN e-cigarette use was reported by 44 (16.7 %) customers. Past 30-day SN e-cigarette users vs. non-users reported vaping on more days in the past month (29.3 vs. 26.1 days, p = 0.02). Overall, 23.8 % of participants perceived SN e-cigarettes as less harmful than TDN ones; never-smoking vapers and dual users perceived SN e-cigarettes as less harmful than salt-based TDN e-cigarettes. Among 44 customers who purchased SN products (verified through qualitative analysis of photographs), only 13 (29.6 %) self-reported using SN products in the past month, while 5 (11.4 %) indicated they were not aware of the existence of SN products. Most SN vaping products (71.4 %) displayed a modified "tobacco-free" warning label. Conclusions: Misperceptions about SN e-cigarettes were documented in this study, including the perception that SN is either less or more harmful than TDN. Further, some customers may be unknowingly purchasing and using SN e-cigarettes. Regulating "tobacco-free nicotine" terminology in SN vaping products marketing is suggested. SN product labeling should not imply that SN is safe/safer than TDN.

Disposable E-Cigarette Use and Subsequent Use Patterns in Adolescents and Young Adults.

BACKGROUND AND OBJECTIVES: Disposable electronic cigarettes (e-cigarettes) are widely used by adolescents and young adults (AYAs). Whether using disposable devices is associated with future e-cigarette use patterns is unknown but important for informing e-cigarette regulation. METHODS: Prospective longitudinal study combining data from adolescent (14-17 years) and young adult (21-24 years) cohorts from Southern California surveyed at baseline and approximately 8-month follow-up during 2021 to 2022. The analyses included AYAs who used e-cigarettes in the past 30 days at baseline and had exposure and outcome data (N = 403; adolescent n = 124, young adult n = 279). RESULTS: In the pooled sample of AYAs who used e-cigarettes at baseline (57.2% cis-gender female, 56.2% Hispanic), 278 (69.0%) reported past 30-day disposable e-cigarette use, and 125 (31.0%) used only nondisposable e-cigarettes. Baseline use of disposable (versus only nondisposable) devices was associated with higher odds of continued e-cigarette use (adjusted odds ratio = 1.92; 95% confidence interval = 1.09-3.42) and a greater number of times used e-cigarettes per day at follow-up (adjusted incidence rate ratio = 1.29; 95% confidence interval = 1.02-1.63). In supplemental analyses, disposable e-cigarette use was associated with greater odds of no changes (versus reductions) in e-cigarette use frequency and puffs per episode from baseline to follow-up but was not associated with increases in use frequency and intensity. No differences in e-cigarette use outcomes were found between those with poly-device (disposable and nondisposable) versus only disposable device use. CONCLUSIONS: Use of disposable e-cigarette devices among AYAs may be associated with higher risks for persistent e-cigarette use patterns, which should be considered in tobacco product regulation designed to protect AYAs.