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BACKGROUND: Exposure to tobacco, e-cigarette, or cannabis marketing is associated with adolescent use. Few studies have examined advertising exposure prevalence and patterns across these products concurrently. METHODS: This study assessed past 30-day recalled exposure to promotional messages about tobacco, e-cigarettes ("vapes" on the survey), and cannabis ("marijuana") from various sources among California adolescents (ages 12-17) in the 2022 Teens, Nicotine, and Tobacco Online Survey (N = 2530). Principal components analysis (PCA) was conducted to examine the underlying structure and patterns in advertising exposure sources. Multivariable logistic regression was used to evaluate associations between any advertising exposure and future use expectations (a susceptibility measure) in one year and at age 25 among current never-users. RESULTS: Overall, 65.9% of participants recently noticed at least one tobacco (52.5%), vape (51.5%), or marijuana (45.6%) advertisement. Gas stations or convenience stores were the most common source for tobacco or vape ads; billboards were for marijuana ads. In PCA, advertising exposure patterns correlated with advertising source, not the type of product. Exposures from tobacco-specific sources and nearer point of sale were associated with current use, older age, LGBTQ + identity, and sensation seeking. Among never-users, advertising exposure was associated with one-year and age-25 use expectations for cigarettes (one-year expectations adjusted odds ratio: 1.7; 95% CI: 1.1, 2.5), vapes (2.3; 1.5, 3.5), and marijuana (2.1; 1.5, 3.0). CONCLUSION: California adolescents' exposure to tobacco, e-cigarette, and cannabis marketing is common, follows similar patterns, and is associated with use susceptibility. Comprehensive restrictions on marketing accessible to adolescents could help prevent youth use.
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Publicidade , Sistemas Eletrônicos de Liberação de Nicotina , Vaping , Humanos , Adolescente , California/epidemiologia , Feminino , Masculino , Publicidade/estatística & dados numéricos , Sistemas Eletrônicos de Liberação de Nicotina/estatística & dados numéricos , Criança , Vaping/epidemiologia , Vaping/psicologia , Comportamento do Adolescente/psicologia , Produtos do Tabaco , Adulto Jovem , Adulto , Cannabis , Inquéritos e QuestionáriosRESUMO
INTRODUCTION: This discrete choice experiment (DCE) identified Asian American and Pacific Islander (AAPI) adults' preferences for recruitment strategies/messaging to enroll in the Collaborative Approach for AAPI Research and Education (CARE) registry for dementia-related research. METHODS: DCE recruitment strategy/messaging options were developed in English, Chinese, Korean, and Vietnamese. AAPI participants 50 years and older selected (1) who, (2) what, and (3) how they would prefer hearing about CARE. Analyses utilized conditional logistic regression. RESULTS: Participants self-identified as Asian Indian, Chinese, Filipino, Japanese, Korean, Samoan, or Vietnamese (N = 356). Overall, they preferred learning about CARE from the healthcare community (vs. community champions and faith-based organizations), joining CARE to advance research (vs. personal experiences), and hearing about CARE through social media/instant messaging (vs. flyer or workshop/seminar). Preferences varied by age, ethnic identity, and survey completion language. DISCUSSION: DCE findings may inform tailoring recruitment strategies/messaging to engage diverse AAPI in an aging-focused research registry.
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Asiático , População das Ilhas do Pacífico , Seleção de Pacientes , Sistema de Registros , Adulto , Humanos , Inquéritos e Questionários , EnvelhecimentoRESUMO
Caries indices, the basis of epidemiologic caries measures, are not easily obtained in clinical settings. This study's objective was to design, test, and validate an automated program (Valid Electronic Health Record Dental Caries Indices Calculator Tool [VERDICT]) to calculate caries indices from an electronic health record (EHR). Synthetic use case scenarios and actual patient cases of primary, mixed, and permanent dentition, including decayed, missing, and filled teeth (DMFT/dmft) and tooth surfaces (DMFS/dmfs) were entered into the EHR. VERDICT measures were compared to a previously validated clinical electronic data capture (EDC) system and statistical program to calculate caries indices. Four university clinician-researchers abstracted EHR caries exam data for 45 synthetic use cases into the EDC and post-processed with SAS software creating a gold standard to compare the -VERDICT-derived caries indices. Then, 2 senior researchers abstracted EHR caries exam data and calculated caries indices for 24 patients, allowing further comparisons to VERDICT indices. Agreement statistics were computed among abstractors, and discrepancies were resolved by consensus. Agreement statistics between the 2 final-phase abstractors and the VERDICT measures showed extremely high concordance: Lin's concordance coefficients (LCCs) >0.99 for dmfs, dmft, DS, ds, DT, dt, ms, mt, FS, fs, FT, and ft; LCCs >0.95 for DMFS and DMFT; and LCCs of 0.92-0.93 for MS and MT. Caries indices, essential to developing primary health outcome measures for research, can be reliably derived from an EHR using VERDICT. Using these indices will enable population oral health management approaches and inform quality improvement efforts.
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Algoritmos , Cárie Dentária/diagnóstico , Registros Eletrônicos de Saúde , Automação , Índice CPO , Dentição Permanente , Feminino , Humanos , MasculinoRESUMO
BACKGROUND: Use of smokeless tobacco (ST, moist snuff and chewing tobacco) is elevated among male rural youth, particularly participants in certain sports, including baseball. OBJECTIVES: This study aimed to assess factors associated with adolescent male athletes' ST-related behaviors over time, including: baseline use, initiation, and progression in use intensity in a school-based longitudinal cohort. METHODS: Baseline and one-year follow-up questionnaires assessed sociodemographic characteristics, environmental factors, and tobacco-related perceptions and behaviors among 9- to12th-grade interscholastic baseball players in 36 rural California schools. Population characteristics were compared among ST use categories (never, experimental, and experienced users). Multivariable models using generalized estimating equations were estimated for outcomes among baseline ST never-users (ST susceptibility and future initiation) and experimenters (ST expectations and progression in ST use). RESULTS: Of 594 participants, over half (57%) had ever tried a tobacco product and the most common products tried were ST (36%) and electronic cigarettes (36%). Being older, perceiving less ST harm, being Non-Hispanic White, using alcohol or other tobacco products, having family or friends who use ST, and being receptive to advertising were associated with greater baseline ST use. Baseline alcohol consumption, lower perceived ST harm, peer use, and susceptibility and expectations were predictive of ST initiation and/or progression at one-year follow-up. Conclusion/Importance: Certain environmental, socio-demographic, cognitive, and behavioral factors predict ST susceptibility and later initiation and progression in use. Interventions addressing these factors have potential to prevent ST uptake and continued use within this high-risk adolescent population.
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Comportamento do Adolescente/psicologia , Beisebol/psicologia , Progressão da Doença , População Rural/estatística & dados numéricos , Tabaco sem Fumaça/estatística & dados numéricos , Adolescente , Publicidade , California/epidemiologia , Estudos de Coortes , Sistemas Eletrônicos de Liberação de Nicotina/estatística & dados numéricos , Humanos , Masculino , Grupo Associado , Fatores de Risco , Inquéritos e Questionários , Produtos do Tabaco/estatística & dados numéricosRESUMO
BACKGROUND: Individual child-level risk factors for Early Childhood Caries (ECC) have been studied, but broader family- and community-level influences on child oral hygiene behaviors are less well understood. This study explored multiple levels of influence on oral hygiene behaviors for young children in Early Head Start (EHS) to inform a future behavioral intervention targeting children from low-income families. METHODS: Twenty-four semi-structured interviews were conducted with mothers of children under 4 years old, enrolled in the home visitor (HV) component of one EHS program in Los Angeles, CA, who participated in the BEhavioral EConomics for Oral health iNnovation pilot study (BEECON) in 2016-7. Audio-recordings of interviews were translated if needed, and transcribed in English, and coding and analysis was facilitated by Dedoose qualitative software. This investigation used general thematic analysis guided by the Fisher-Owens child oral health conceptual framework to identify influences on oral hygiene behaviors for the young children. RESULTS: Many mothers reported brushing their children's teeth twice/day, and concern that most children frequently resisted brushing. They identified children being sick or tired/asleep after outings as times when brushing was skipped. Several child-, family-, and community-level themes were identified as influences on child oral hygiene behaviors. At the child-level, the child's developmental stage and desire for independence was perceived as a negative influence. Family-level influences included the mother's own oral hygiene behaviors, other family role models, the mother's knowledge and attitudes about child oral health, and mothers' coping skills and strategies for overcoming challenges with brushing her child's teeth. Overall, mothers in the EHS-HV program were highly knowledgeable about ECC risk factors, including the roles of bacteria and sugar consumption, which motivated regular hygiene behavior. At the community-level, mothers discussed opportunities to connect with other EHS-HV families during parent meetings and playgroups that HV coordinated. A few mothers noted that EHS-HV playgroups included brushing children's teeth after snacking, which can be a potential positive influence on children's hygiene practices. CONCLUSION: Child-, family- and community-level factors are important to consider to inform the development of tailored oral health preventive care programs for families in EHS-HV programs.
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Cárie Dentária/prevenção & controle , Conhecimentos, Atitudes e Prática em Saúde , Higiene Bucal , Adulto , Criança , Pré-Escolar , Intervenção Educacional Precoce , Feminino , Visita Domiciliar , Humanos , Entrevistas como Assunto , Los Angeles , Masculino , Pessoa de Meia-Idade , Mães , Projetos Piloto , Pesquisa QualitativaRESUMO
INTRODUCTION: This study evaluated the relationship between serum Rheumatoid Factor (RF) levels and tooth loss in a community-dwelling elderly Japanese women. It was hypothesised that women with high baseline RF levels would experience greater tooth loss over 10 years than age-matched women with lower baseline serum RF levels. MATERIALS AND METHODS: The study population consisted of 197 women aged 70 years with ≥12 teeth at baseline. One hundred and twenty-four participants completed a 10-year follow-up and were divided into 2 groups according to their baseline serum RF levels as follows: RF negative (<15 U/mL; n = 114) and RF positive (>15 U/mL; n = 10). Negative binomial regression was used to investigate the relationship between baseline RFs and tooth lost over the 10-year period. RF and its interaction with the baseline number of teeth were independent variables, with 9 other adjustment covariates. RESULTS: Baseline RFs were significantly associated with tooth loss (P = .035). In addition, a statistical interaction between baseline RFs and baseline number of teeth was identified (P = .023), modifying the association between RFs and tooth loss. The adjusted incidence rate ratio (IRR) for RF-positive participants with 21 baseline teeth was 1.88 (95% confidence interval (95% CI): 0.76, 4.65). IRRs obtained for participants who had 25 baseline teeth (3.02; 95% CI: 1.03, 8.83) or 30 baseline teeth (5.47; 95% CI: 1.29, 23.13) suggested that RF-positive participants with a high number of baseline teeth would exhibit greater tooth loss than RF-negative participants. CONCLUSION: High serum RF levels were associated with a greater IRR for future tooth loss in elderly Japanese women.
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INTRODUCTION: Fluoride varnish is an effective prevention intervention for caries in young children. Its routine use in clinical care is supported by meta-analyses and recommended by clinical guidelines, including the US Preventive Services Task Force (B rating). This report is the first prospective systematic assessment of adverse events related to fluoride varnish treatment in young children. METHODS: We determined the incidence of adverse events related to fluoride varnish treatment in 3 clinical trials on the prevention of early childhood caries, conducted under the auspices of the Early Childhood Caries Collaborating Centers, an initiative sponsored by the National Institute of Dental and Craniofacial Research. Each trial incorporated use of fluoride varnish in its protocol and systematically queried all children's parents or legal guardians about the occurrence of acute adverse events after each fluoride varnish treatment. RESULTS: A total of 2,424 community-dwelling, dentate children aged 0 to 5 years were enrolled and followed for up to 3 years. These children received a cumulative total of 10,249 fluoride varnish treatments. On average, each child received 4.2 fluoride varnish treatments. We found zero fluoride varnish-related adverse events. CONCLUSION: Fluoride varnish was not associated with treatment-related adverse events in young children. Our findings support its safety as an effective prevention intervention for caries in young children.
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Cárie Dentária/prevenção & controle , Fluoretos Tópicos/administração & dosagem , Fluoretos Tópicos/efeitos adversos , Cariostáticos/administração & dosagem , Cariostáticos/efeitos adversos , Cariostáticos/uso terapêutico , Criança , Pré-Escolar , Fluoretos Tópicos/uso terapêutico , Humanos , Estados UnidosRESUMO
BACKGROUND: We describe development of the Early Childhood Caries (ECC) Basic Research Factors Questionnaire (BRFQ), a battery of measures assessing common potential predictors, mediators, and moderators of ECC. Individual-, family-, and community-level factors that are linked to oral health outcomes across at-risk populations are included. Developing standard measures of factors implicated in ECC has the potential to enhance our ability to understand mechanisms underlying successful prevention and to develop more effective interventions. METHODS: The Early Childhood Caries Collaborating Centers (EC4), funded by National Institute of Dental and Craniofacial Research, developed the BRFQ, which was used across four randomized trials to develop and test interventions for reducing ECC in at-risk populations. Forty-five investigators from across the centers and NIDCR were involved in the development process. Eight "measures working groups" identified relevant constructs and effective measurement approaches, which were then categorized as "essential" or "optional" common data elements (CDEs) for the EC4 projects. RESULTS: Essential CDEs include 88 items, with an additional 177 measures categorized as optional CDEs. Essential CDEs fell under the following domains: oral health knowledge, oral health behavior, utilization/insurance and cost, parent/caregiver dental self-efficacy, quality of life, caregiver and family characteristics, and child characteristics. CONCLUSIONS: The BRFQ makes available a battery of measures that support efforts to understand population risk factors for ECC and to compare oral health outcomes across populations at risk. The BRFQ development process may be useful to other clinical research networks and consortia developing CDEs in other health research fields. TRIAL REGISTRATION: All the trial that used the BRFQ were registered at Clinicaltrial.gov NCT01116726 , April 29, 2010; NCT01116739 , May 3, 2010; NCT01129440 , May 21, 2010; and NCT01205971 , September 19, 2010.
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Ensaios Clínicos como Assunto , Cárie Dentária/prevenção & controle , Pesquisa em Odontologia , Projetos de Pesquisa , Inquéritos e Questionários , Criança , Letramento em Saúde , Humanos , Estados UnidosRESUMO
This study aimed to confirm whether the well-known income disparities in oral health seen over the life course are indeed absent in 9- to 11-yr-old children, and to explore the role of access to dental care in explaining the age-profile of the income gradient in child oral health. We used data from the 2007 United States National Survey of Children's Health. Income gradients in parental reports of children's decayed teeth or cavities, toothache, broken teeth, bleeding gums, and fair/poor condition of teeth were assessed in stratified analyses according to age of child (1-5, 6-8, 9-11, 12-14, and 15-17 yr), using survey logistic regression to control for family-, parental-, and child-level covariates. Health insurance status and use of preventive dental care were the indicators for children's access to dental care. The adjusted ORs for the effect of family income on having decayed teeth or cavities, toothache, and fair/poor condition of teeth were not significant in 9- to 11-yr-old children. Different age-patterns were found for broken teeth and bleeding gums. The attenuation of the income gradients in having decayed teeth or cavities, toothache, and fair/poor condition of teeth, previously seen in 9- to 11-yr-old children, was also seen in 15- to 17-, 12- to 14-, and 6- to 8-yr-old children, respectively, after controlling for children's access to dental care. This study supports the attenuation of income inequalities in oral health in 9- to 11-yr-old children. Access to dental care could attenuate income gradients in oral health in other age groups.
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Saúde da Criança/estatística & dados numéricos , Disparidades nos Níveis de Saúde , Renda/estatística & dados numéricos , Saúde Bucal/estatística & dados numéricos , Adolescente , Fatores Etários , Criança , Pré-Escolar , Assistência Odontológica/estatística & dados numéricos , Cárie Dentária/epidemiologia , Feminino , Hemorragia Gengival/epidemiologia , Acessibilidade aos Serviços de Saúde/estatística & dados numéricos , Humanos , Lactente , Seguro Saúde/estatística & dados numéricos , Masculino , Pobreza/estatística & dados numéricos , Fraturas dos Dentes/epidemiologia , Odontalgia/epidemiologia , Estados Unidos/epidemiologiaRESUMO
BACKGROUND: Four trials of interventions designed to prevent early childhood caries are using community-engagement strategies to improve recruitment of low-income, racial/ethnic minority participants. The trials are being implemented by 3 centers funded by the National Institute of Dental and Craniofacial Research and known as the Early Childhood Caries Collaborating Centers (EC4): the Center for Native Oral Health Research at the University of Colorado, the Center to Address Disparities in Children's Oral Health at the University of California San Francisco, and the Center for Research to Evaluate and Eliminate Dental Disparities at Boston University. COMMUNITY CONTEXT: The community contexts for the EC4 trials include urban public housing developments, Hispanic communities near the US-Mexican border, and rural American Indian reservations. These communities have a high prevalence of early childhood caries, suggesting the need for effective, culturally acceptable interventions. METHODS: Each center's intervention(s) used community-based participatory research approaches, identified community partners, engaged the community through various means, and developed communication strategies to enhance recruitment. OUTCOME: All 3 centers have completed recruitment. Each center implemented several new strategies and approaches to enhance recruitment efforts, such as introducing new communication techniques, using media such as radio and newspapers to spread awareness about the studies, and hosting community gatherings. INTERPRETATION: Using multiple strategies that build trust in the community, are sensitive to cultural norms, and are adaptable to the community environment can enhance recruitment in underserved communities.
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Ensaios Clínicos como Assunto , Cárie Dentária/prevenção & controle , Disparidades em Assistência à Saúde , Seleção de Pacientes , Centros Médicos Acadêmicos , Boston , Criança , Pré-Escolar , Colorado , Pesquisa Participativa Baseada na Comunidade , Relações Comunidade-Instituição , Comportamento Cooperativo , Cárie Dentária/diagnóstico , Cárie Dentária/epidemiologia , Pesquisa em Odontologia/organização & administração , Etnicidade , Feminino , Acessibilidade aos Serviços de Saúde , Disparidades nos Níveis de Saúde , Humanos , Masculino , Grupos Minoritários , National Institute of Dental and Craniofacial Research (U.S.) , São Francisco , Estados UnidosRESUMO
OBJECTIVES: Individual-level social determinant of health (SDOH) measures alone may insufficiently explain disparities in edentulism among seniors. Therefore, the authors examined the correlation of census tract-level SDOH and residential racial segregation measures with edentulism in Californian adults aged ≥65 years old. METHODS: Explanatory variables were obtained from Healthy Places Index (HPI), the National Cancer Institute and diversitydatakids.org. The edentulism outcome variable was obtained from CDC's PLACES small area estimates from the 2018 Behavioral Risk Factor Surveillance System data. Pearson and Spearman rank correlations were estimated. Multiple linear regression and multi-collinearity evaluations were performed. The Global Moran's I statistic assessed partial autocorrelation within census tracts. RESULTS: Pearson and Spearman correlations were similar, supporting robustness. HPI, an area measure of advantage, strongly negatively correlated with edentulism prevalence [correlation coefficient: -0.87; 95% confidence interval (CI): -0.87, -0.86]. A change of 1.0 in HPI corresponded to an estimated decrease in edentulism prevalence of 5.9% (linear model adjusted R2 = 0.78). Racially segregated census tracts with Hispanics or Blacks alone were positively correlated with edentulism prevalence [0.60, 95% CI: 0.58, 0.62; and 0.33, 95% CI: 0.31, 0.35, respectively]. The converse was seen in census tracts with non-Hispanic Whites alone [-0.57, 95% CI: -0.58, -0.55]. Global Moran's I statistic for edentulism (0.13) and HPI scores (0.19) were significant (both p < .001) indicating geospatial autocorrelation. CONCLUSIONS: Higher disadvantage and minority racial segregation within census tracts were positively correlated with edentulism prevalence. Future research and policy should consider possible interventions improving SDOH to reduce oral health inequities.
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INTRODUCTION: Electronic cigarettes (also termed e-cigarette or vapes) often contain nicotine, an addictive psychoactive substance, which can have harmful effects during adolescence. Frequent experiences of discrimination are one risk factor shown to increase susceptibility to tobacco use, especially for individuals that identify as a social minority. Applying Intersectionality Theory, this research examined the relationship between youth experiences of discrimination and vape use at the intersection of race/ethnicity and sexual orientation. METHOD: Cross-sectional survey data from 4747 youth (ages 12-17) that participated in the 2022 Teens, Nicotine, and Tobacco Project (TNT) online survey were used to evaluate the impact of discrimination on vape use for lesbian, gay, bisexual, and/or queer/questioning (LGBQ+) youth of color. RESULTS: Multivariable regression analyses showed that identifying as both a sexual and racial/ethnic minority was a risk factor for experiencing discrimination. Frequent discrimination and reporting discrimination due to sexual orientation was associated with a greater likelihood of ever and current vaping. Path models supported that discrimination mediated the relationship between intersectional identity and vape use. LGBQ+ youth of color reported more frequent discrimination, which was associated with a greater likelihood of ever/current vape use. CONCLUSIONS: Intersectionality Theory aids in understanding how discrimination can exacerbate tobacco-related disparities for youth with multiple minority identities. Findings corroborate the importance of measuring discrimination in public health surveys. Effective tobacco interventions could incorporate strategies to cope with discrimination-related stress.
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Minorias Sexuais e de Gênero , Vaping , Humanos , Adolescente , Masculino , Feminino , Vaping/psicologia , Estudos Transversais , Criança , Minorias Sexuais e de Gênero/psicologia , Discriminação Social/psicologia , Etnicidade/psicologiaRESUMO
Introduction: In 2015, the National Institute of Dental and Craniofacial Research (NIDCR) launched the Multidisciplinary Collaborative Research Consortium to Reduce Oral Health Disparities in Children, supporting four randomized trials testing strategies to improve preventive care. A Coordinating Center provides scientific expertise, data acquisition and quality assurance services, safety monitoring, and final analysis-ready datasets. This paper describes the trials' economic analysis strategies, placing these strategies within the broader context of contemporary economic analysis methods. Methods: The Coordinating Center established a Cost Collaborative Working Group to share information from the four trials about the components of their economic analyses. Study teams indicated data sources for their economic analysis using a set of structured tables. The Group meets regularly to share progress, discuss challenges, and coordinate analytic approaches. Results: All four trials will calculate incremental cost-effectiveness ratios; two will also conduct cost-utility analyses using proxy diseases to estimate health state utilities. Each trial will consider at least two perspectives. Key process measures include dental services provided to child participants. The non-preference-weighted Early Childhood Oral Health Impact Scale (ECOHIS) will measure oral health-related quality of life. All trials are measuring training, implementation, personnel and supervision, service, supplies, and equipment costs. Conclusions: Consistent with best practices, all four trials have integrated economic analysis during their planning stages. This effort is critical since poor quality or absence of essential data can limit retrospective analysis. Integrating economic analysis into oral health preventive intervention research can provide guidance to clinicians and practices, payers, and policymakers.
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BACKGROUND: Certain product characteristics, such as flavor, may increase adolescents' willingness to try vaped nicotine and cannabis (marijuana) products. METHODS: A discrete choice experiment embedded within the 2021-2022 California Teens Nicotine and Tobacco Project Online Survey was administered to a non-probability sample of N = 2342 adolescents ages 12-17. Participants were sequentially presented four randomly-generated pairs of hypothetical vape products that varied in device type (disposable, refillable), content (nicotine, marijuana, "just vapor"), and flavor (seven options) and asked which of these (or neither) they would be more willing to try if a best friend offered. Conditional logistic regression quantified associations between product characteristics and participants' selections, including interactions by past 30-day use of e-cigarettes, marijuana, or both. RESULTS: Candy/dessert, fruit, and fruit-ice combination flavors were all associated with greater willingness to try a vape product (versus tobacco flavor) among participants not using e-cigarettes or marijuana, those using only e-cigarettes, and those co-using e-cigarettes and marijuana. Among participants only using marijuana, the most preferred flavors were no flavor, candy/dessert, and icy/frost/menthol. Among participants not using e-cigarettes or marijuana, model-predicted willingness to try a displayed vape product was greater when products were sweet or fruit flavored than tobacco or unflavored, regardless of whether displayed options contained nicotine (fruit/sweet: 21 %, tobacco/unflavored: 4 %), marijuana (fruit/sweet: 18 %, tobacco/unflavored: 6 %), or "just vapor" (fruit/sweet: 29 %, tobacco/unflavored: 16 %). CONCLUSIONS: In this online non-probability sample, flavors in nicotine and cannabis vape products increased adolescents' willingness to try them. Comprehensive bans on flavored vapes would likely reduce adolescent use.
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Cannabis , Sistemas Eletrônicos de Liberação de Nicotina , Alucinógenos , Produtos do Tabaco , Vaping , Humanos , Adolescente , Criança , Nicotina , AromatizantesRESUMO
PURPOSE: This study assessed flavored tobacco use among adolescent e-cigarette, cigarette, cigar, hookah, and smokeless tobacco users; specific e-cigarette flavor preferences; risk profiles of youth that use various flavors; and the impact of survey question wording on prevalence. METHODS: Cross-sectional data from 4,956 California adolescent participants (aged 12-17 years) in the Teens, Nicotine, and Tobacco 2021-2022 online panel survey estimated the survey-weighted prevalence of flavored tobacco use. An embedded randomized experiment assessed survey wording effects (i.e., any vs. "usual" flavor use). Qualitative data from four contemporaneous cycles of Teens, Nicotine, and Tobacco focus groups with California adolescents (N = 63) added themes relevant to the quantitative findings. RESULTS: 88.1% of current any tobacco users reported flavored tobacco use in the past 30 days. Flavor use was lowest for cigarettes (66.7%) and highest for hookah (92.8%). Fruit was the most popular e-cigarette flavor (51.6% any use; 28.8% usual use). E-cigarette users also commonly reported use of candy and cooling flavors. Sweet flavors were used most often among adolescents otherwise at low risk of tobacco use. Survey item format did not meaningfully affect overall prevalence of flavored product use but did impact reports of specific e-cigarette flavors. Focus group participants described sweet and fruity flavors as a motivating factor in their own e-cigarette use and as designed to appeal to children. DISCUSSION: Despite local policies, flavored tobacco use remains common among California adolescents. Survey items asking about any flavor use rather than usual use provide more information without affecting the overall prevalence of flavored tobacco use.
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Sistemas Eletrônicos de Liberação de Nicotina , Produtos do Tabaco , Criança , Adolescente , Humanos , Nicotina , Estudos Transversais , Aromatizantes , California/epidemiologiaRESUMO
OBJECTIVES: The Simplified Oral Hygiene Index for Maxillary Incisors (OHI-MIS) is a novel plaque scoring system adapted for young children. This study describes calibration training and testing used to establish the inter- and intra-rater reliability for OHI-MIS measured from clinical photographs. METHODS: Two raters from the Coordinated Oral Health Promotion Chicago (CO-OP) and one from the Behavioral EConomics for Oral health iNnovation (BEECON) randomized controlled trials (RCTs) underwent calibration with gold standard raters, followed by annual re-calibration. Raters from CO-OP also completed inter-rater reliability testing; all three raters completed intra-rater reliability testing rounds. Photographs were obtained from children aged 9-39 months. RESULTS: All three raters achieved greater than 0.77 Lin's Concordance Correlation (LCC) versus gold standard consensus during calibration. All three raters had LCC ≥0.83 at recalibration 1 year later. CO-OP trial raters scored 604 photos (151 sets of 4 photographs); mostly both raters were somewhat/very confident in their scoring (≥89%), describing the most photos as "clear" (90% and 81%). The CO-OP inter-rater LCC for total OHI-MIS score was 0.86, changing little when low quality or confidence photos were removed. All three raters demonstrated high intra-rater reliability (≥0.83). CONCLUSIONS: The OHI-MIS plaque scoring system on photos had good reliability within and between trials following protocol training and calibration. OHI-MIS provides a novel asynchronous plaque scoring system for use in young children. Non-clinicians in field or clinical settings can obtain photographs, offering new opportunities for research and clinical care.
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Calibragem , Humanos , Criança , Pré-Escolar , Reprodutibilidade dos TestesRESUMO
AIMS: To compare prevalence of self-reported comorbid temporomandibular joint muscle disorder-type, neck, back, and joint pains in people with severe headache or migraine; and analyze these self-reported pains in the 2000-2005 US National Health Interview Survey by gender and age for non-Hispanic whites, Hispanics, and non-Hispanic blacks (African Americans). METHODS: National Health Interview Survey data included information on gender, age, race, ethnicity, health status, and common pain types: severe headache or migraine, temporomandibular joint muscle disorder-type, neck, and low back in the last 3 months, as well as prior-month joint pains. Analyses included survey prevalence estimation and survey logistic regression to obtain odds ratios and 95% confidence intervals. RESULTS: The study included 189,967 adults: 48% males, 52% females; 73% white, 12% Hispanic, and 11% black. Of the entire sample, 29,712 (15%) reported severe headache or migraine, and 19,228 (64%) had severe headache or migraine with at least 1 comorbid pain. Two or more comorbid pains were reported in 10,200 (33%), with no gender difference, and with Hispanics (n = 1847 or 32%) and blacks (n = 1301 or 30%) less likely to report 2 or more comorbid pains than whites (n = 6747 or 34%) (odds ratio = 0.91, P = .032; OR = 0.82, P < .001, respectively). This group also reported significantly lower ratings of self-rated health (P < .001). Differences in type of comorbid pain by age patterns were found. CONCLUSIONS: Severe headache or migraine is often associated with other common pains, seldom existing alone. Two or more comorbid pains are common, similarly affecting gender and racial/ethnic groups.
Assuntos
Artralgia/epidemiologia , Dor nas Costas/epidemiologia , Cefaleia/epidemiologia , Cervicalgia/epidemiologia , Transtornos da Articulação Temporomandibular/epidemiologia , Adulto , Negro ou Afro-Americano/estatística & dados numéricos , Distribuição por Idade , Comorbidade , Feminino , Cefaleia/etnologia , Hispânico ou Latino/estatística & dados numéricos , Humanos , Masculino , Prevalência , Autorrelato , Distribuição por Sexo , População Branca/estatística & dados numéricosRESUMO
BACKGROUND: Mexican-American children have a higher caries prevalence than the U.S. average. The Mothers and Youth Access (MAYA) study was a randomized clinical trial initiated to address this problem. AIM: Comparison of the efficacy of two prevention interventions in reducing early childhood caries (ECC). DESIGN: All 361 randomized mother-child dyads received oral health counselling. Beginning at 4 months postpartum, intervention mothers received chlorhexidine (CHX) mouthrinse for 3 months beginning 4 months postpartum and children received fluoride varnish (FV) every 6 months from age 12-36 months. Control group children received FV if precavitated lesions developed. Salivary mutans streptococci (MS) and lactobacilli were assessed. RESULTS: No significant difference in children's 36-month caries incidence between groups; 34% in each group developed caries [(d(2+) fs) > 0]. About half of control group developed precavitated lesions and received therapeutic FV. Maternal MS levels declined during CHX use, but increased when discontinued. CONCLUSIONS: Maternal postpartum CHX regimen, oral health counselling and preventive child FV applications were not more efficacious than maternal counselling with child therapeutic FV for precavitated lesions for ECC prevention. FV for young children with brief maternal CHX use and oral health counselling may need to be combined with additional or longer-term therapies to significantly reduce ECC in high-risk populations.
Assuntos
Anti-Infecciosos Locais/uso terapêutico , Cariostáticos/uso terapêutico , Clorexidina/uso terapêutico , Aconselhamento , Cárie Dentária/prevenção & controle , Fluoretos Tópicos/uso terapêutico , Antissépticos Bucais/uso terapêutico , Adolescente , Adulto , Carga Bacteriana/efeitos dos fármacos , California , Pré-Escolar , Índice CPO , Feminino , Seguimentos , Humanos , Lactente , Lactobacillus/efeitos dos fármacos , Lactobacillus/isolamento & purificação , Americanos Mexicanos , Saliva/microbiologia , Streptococcus mutans/efeitos dos fármacos , Streptococcus mutans/isolamento & purificação , Streptococcus sobrinus/efeitos dos fármacos , Streptococcus sobrinus/isolamento & purificação , Resultado do Tratamento , Adulto JovemRESUMO
PURPOSE: Although changes in blood perfusion have been described as being associated with temporomandibular disorder (TMD) myofascial pain, very little is known about blood flow levels in the deep and superficial masseter muscle. This study investigated blood flow in deep and superficial sites of six healthy female participants at baseline and during intermittent and continuous biting exercises and recovery. MATERIALS AND METHODS: Blood flow was monitored unilaterally using a single-fiber probe laser Doppler flowmeter. The blood flow was continuously monitored at baseline and during two biting exercises: (a) intermittent at 25%, 50%, and 100% maximum voluntary bite force for 30 seconds each followed by 90 seconds rest between each biting level and (b) continuous biting at similar maximum voluntary bite force levels followed by 90 seconds rest. RESULTS: There was significantly higher blood flow in the deep sites compared to the superficial sites (p < 0.001) and a significant increase in blood flow during biting compared to baseline (p < 0.001). There were no significant changes in blood flow among the three levels of biting, between the intermittent and continuous exercises, or from baseline blood flow compared to recovery. CONCLUSIONS: This study showed regional differences in masseter muscle blood flow, perhaps related to differences in muscle fiber type and pattern of muscle fiber recruitment.
Assuntos
Músculo Masseter/anatomia & histologia , Músculo Masseter/irrigação sanguínea , Adulto , Análise de Variância , Força de Mordida , Feminino , Humanos , Fluxometria por Laser-Doppler , Músculo Masseter/fisiologia , Microcirculação , Análise de Regressão , MulheresRESUMO
The study's purpose was to determine if parental dental functional health literacy related to child oral health. A secondary aim was to assess if errors in completing the questionnaire related to FHL and child oral health. Parents of pediatric clinic children (N = 101) completed questionnaires and dental caries indices were recorded. Higher FHL was negatively correlated with worse child caries (r = -0.23), but not subjective oral health. Mean FHL seemed to differ by skip pattern (p = 0.087), indicating it may be a potential FHL proxy.