Daily Stress, Drinking Motives and Alcohol Co-Use with Other Drugs.

Background: Recent evidence indicates that alcohol and other substance co-use, compared to alcohol-only use, might be more closely associated with negative reinforcement processes, and thus more likely during periods of increased stress. The present study examined this possibility by using data from an intensive longitudinal (daily) study of college student drinkers (N = 1461, 54% women). We also examined individual differences in coping and enhancement drinking motives as predictors of alcohol and other substance co-use. Results: We used multilevel multinomial logistic regression to predict, relative to alcohol-only days, the likelihood of alcohol co-use with either cigarettes or marijuana, along with alcohol use with multiple substances and other substance-only use from daily interpersonal and academic stress, day-of-the-week, sex, and individual differences in coping and enhancement drinking motives. We found that, relative to alcohol-only, alcohol and marijuana co-use was more likely, and non-alcohol related substance use was less likely, on weekends. Alcohol and marijuana co-use was less likely, and other substance-only use was more likely, on days characterized by greater academic stress, whereas alcohol and cigarette co-use was more likely on days characterized by greater interpersonal stress. Individuals with higher levels of drinking to cope motivation were more likely to engage in alcohol and cigarette co-use, other substance-only use, and alcohol plus multiple substances, relative to alcohol-only. Individuals with higher levels of enhancement motives were more likely to engage in all types of alcohol and other substance co-use and other substance-only use relative to alcohol-only. Conclusions: Findings are discussed in terms of the complex nature of different patterns of co-use patterns when evaluating indicators of positive- and negative-reinforcement processes.

Manipulation of Menthol and Nicotine Content in Cigarettes: Effects on Smoking Behavior and Toxicant Exposure in Women Menthol Smokers.

BACKGROUND: The purpose of this study was to determine the effects of smoking and other outcomes of assigning cigarettes with reduced nicotine and/or no menthol to female menthol smokers. AIMS AND METHODS: Nontreatment-seeking female menthol smokers (N = 263) participated in a randomized controlled trial in which levels of menthol and nicotine in cigarettes were manipulated using experimental cigarettes. After a baseline period, participants were assigned to the following conditions for 6 weeks: (1) their own brand of cigarette (conventional nicotine with menthol), (2) a conventional nicotine cigarette with no menthol, (3) a cigarette with reduced nicotine (RNC) with menthol, or (4) a RNC cigarette and no menthol. Participants then returned to using their own brand and were followed for another 6 weeks. Outcomes included cigarettes smoked, biomarkers of exposure, and dependence measures. RESULTS: Results indicated that, after an initial increase, rates of smoking of all three experimental cigarettes were at or below baseline rates of smoking of one's own brand. Levels of biomarkers also decreased during the experimental phase but rebounded somewhat after participants resumed smoking their own brand. There was evidence that the overall amount of smoking decreased similarly among women who switched to non-menthol and/or RNC cigarettes. CONCLUSIONS: These results suggest that no detrimental effect will occur in nicotine or toxicant exposure levels with a ban on characterizing menthol and/or a product standard on nicotine content in cigarettes. IMPLICATIONS: The implication of this work is that there would be no risk to women menthol smokers associated with regulations restricting nicotine and eliminating menthol in cigarettes.

Does Diagnostic Certainty Matter?: Pain-Related Stigma in Adolescents with Juvenile Idiopathic Arthritis.

OBJECTIVES: Childhood chronic pain conditions are common and vulnerable to stigma. Adolescents with chronic primary pain experience diagnostic uncertainty and describe pain-related stigma experiences across multiple social contexts. Juvenile idiopathic arthritis (JIA) is a childhood autoimmune, inflammatory condition with associated chronic pain, but with well-defined diagnostic criteria. The current study examined pain-related stigma experiences in adolescents with JIA. METHODS: Four focus groups of 3-7 adolescents with JIA (N = 16), ages 12-17 (Mage = 15.42, SD = 1.82), and parents (N = 13) were conducted to examine experiences of, and reaction to, pain-related stigma. Patients were recruited from an outpatient pediatric rheumatology clinic. Focus group length ranged from 28 to 99 minutes long. Two coders used directed content analysis resulting in 82.17% inter-rater level of agreement. RESULTS: Adolescents with JIA described pain-related stigma experiences predominantly from school teachers and peers, and less from medical providers (e.g., school nurses), and family members after a diagnosis. The primary categories that emerged were (1) Felt Stigma, (2) Internalized Stigma, (3) Anticipatory Stigma/Concealment, and (4) Contributions to Pain-Related Stigma. A common experience of pain-related stigma was the perception by others that the adolescent was too young to have arthritis. CONCLUSIONS: In common with adolescents with unexplained chronic pain, our findings indicate that adolescents with JIA experience pain-related stigma in certain social contexts. Diagnostic certainty may contribute to greater support among medical providers and within families. Future research should investigate the impact of pain-related stigma across childhood pain conditions.

"There's Nothing Wrong With You": Pain-Related Stigma in Adolescents With Chronic Pain.

OBJECTIVE: Adolescents with chronic pain often experience symptom disbelief and social rejection by others secondary to "medically unexplained" symptoms. Although chronic pain is common in adolescents, limited research has conceptualized these social experiences as pain-related stigma in this population. The purpose of this study was to identify and describe pain-related stigma among adolescents with chronic pain and their parents using focus group methodology. METHODS: Five adolescent focus groups (N = 18; Age M = 15.33 years, SD = 1.28) and three parent focus groups (N = 9) were conducted. Directed content analysis was used to analyze focus group transcripts. Stigma categories were developed a priori (Felt Stigma, Anticipated Stigma, Internalized Stigma, Concealment, and Controllability) and new categories emerged during analysis. Two coders reached 87.16% agreement for all groups (adolescent group: 90.34%; Parent group: 79.55%) and consensus was achieved for discordant codes. RESULTS: Adolescents and their parents endorsed pain-related stigma across all social domains. Analyses revealed four main categories for both groups (a) Felt Stigma (subcategories: pain dismissal, faking or exaggerating, and mental health stigma), (b) Anticipated Stigma and Concealment, (c) Internalized Stigma, and (d) Sources of Pain-Related Stigma (subcategories: pain invisibility, lack of chronic pain knowledge, lack of understanding, and controllability). CONCLUSIONS: Adolescents with chronic pain experience pain-related stigma from medical providers, school personnel, family members, and peers, which may have negative social and health implications. More research is needed to evaluate the link between pain-related stigma and health outcomes for adolescents with chronic pain. Clinical approaches targeting pain-related stigma are discussed.

Relation of social network support to child health behaviors among children in treatment for overweight/obesity.

PURPOSE: Little is known about the influence of social network support on child health behaviors in the context of weight-loss interventions. This study examined the associations between a child's co-participation (i.e., network support) in weight-related health behaviors (i.e., physical and sedentary activity, eating behavior) and the child's own health behaviors during family-based behavioral treatment (FBT). METHODS: Children (n = 241) with overweight/obesity (mean age = 9.4 ± 1.3y; 63% female) completed semi-structured interviews assessing network support for healthy/unhealthy eating and physical/sedentary activity, and a 3-day dietary recall. Physical activity was assessed with accelerometry, and sedentary activity was measured via parent-reported child screen time use. All assessments were taken at baseline and after 4 months of FBT. Hierarchical linear regressions examined changes in network support as they related to changes in health behaviors from baseline to the end of FBT. RESULTS: Changes in network support for healthy eating were related to changes in vegetable, but not fruit, intake across FBT, while changes in network support for unhealthy eating were negatively related to changes in diet quality. Changes in network support for sedentary activity were negatively related to changes in minutes of physical activity and positively related to changes in screen time. CONCLUSION: The present findings suggest that a child's network support for health behaviors may relate to behavior change among children during FBT and provide opportunities for targeted intervention. LEVEL OF EVIDENCE: III. cohort study.

Chronic Cigarette Smoking Associates Directly and Indirectly with Self-Reported Olfactory Alterations: Analysis of the 2011-2014 National Health and Nutrition Examination Survey.

INTRODUCTION: Population-based studies show inconsistent effects of cigarette smoking on olfactory function. We aimed to identify direct and indirect associations between measures of smoking exposure/nicotine dependence and altered olfaction in a nationally representative sample of adults. METHODS: NHANES 2011-2014 (n = 7418) participants (mean age = 57.8 ± 12.2 years) self-reported olfaction and related health and demographic risks. Affirmative answers to three questions defined altered olfaction (olfactory problems in the past years; worse ability since age 25; phantom smells). Smoking (never, former, current) was self-reported by chronicity (pack years, PY) and dependency (time to first cigarette upon waking) and verified by serum cotinine. Associations were tested with logistic regression, reporting odds ratios (ORs) and 95% confidence intervals (CIs), and mediation models. RESULTS: Estimated prevalence of altered olfaction was 22.3%, with age-related increases. Nearly half of the sample were former/current smokers (47.4%). Controlling for olfactory-related risks, ≥10 PY smokers had significantly greater odds of altered olfaction versus never smokers (OR 1.36, CI: 1.06-1.74). The odds of altered olfaction were heightened among current smokers (≥10 PY) who also had high nicotine dependence (smoked ≤30 min of waking) (OR 1.41, CI: 1.01-1.99). Light smokers (≤10 PY smokers) did not show increased odds versus never smokers. Current smokers who also were heavy drinkers (≥4 drinks/day) had the highest odds for altered olfaction (OR 1.96, CI: 1.20-3.19). Olfactory-related pathologies (sinonasal problems, serious head injury, tonsillectomy, xerostomia) partially mediated the association between smoking and altered olfaction. CONCLUSIONS: Chronic cigarette smoking was associated with increased odds of self-reported olfactory alterations, directly and indirectly via olfactory-related pathologies. IMPLICATIONS: Analysis of the US nationally representative data revealed significant positive associations between chronic smoking and alterations in the sense of smell. Rates of smell alteration (self-reported problems in the past year, losses with aging, and phantom smells) increased from 23% among adults to 33% for chronic smokers and 38% for chronic smokers who also reported heavy drinking. Chronic smoking showed associations with smell alteration that were direct and indirect through exposure to olfactory-related pathologies (naso-sinus problems, dry mouth, head/facial injury). Smell alteration can impact smokers' quality of life by challenging the ability to sense warning odors, food flavor, and olfactory-stimulated emotions and memories.

Describing Perceived Racial Bias Among Youth With Sickle Cell Disease.

Objectives: Sickle cell disease (SCD) predominately affects Black Americans. This is the first study of its kind to describe the racial bias experiences of youth with SCD and their reactions to these experiences. Methods: Participants were 20 youth with SCD (ages 13-21 years) who were asked to describe any racial bias events they experienced, as recorded on the Perception of Racism in Children and Youth measure (PRaCY). Interviews were recorded, transcribed, and analyzed by two independent raters using a conventional content analysis approach. Results: All participants reported at least one incident of racial bias. Content analysis of racial bias events (n = 104) yielded 4 categories and 12 subcategories as follows: Perpetrator (Peers, Authority Figures, and General Public), Type of Racial Bias (Explicit, Implicit), Behavioral Reaction (Approach, Avoidant), and Emotional Response (Dysphoria, Anger, Unconcerned, Inferior, Anxious). Discussion: This study provides a description of racial bias experiences within community and medical settings and highlights the need for further evaluation of the impact of racial bias among youth with SCD.

Cigarette smoking and electronic cigarette vaping patterns as a function of e-cigarette flavourings.

INTRODUCTION: The present study examined the influence of flavouring on the smoking and vaping behaviour of cigarette smokers asked to adopt e-cigarettes for a period of 6 weeks. METHODS: Participants were 88 current male and female smokers with no intention to stop smoking, but who agreed to substitute e-cigarettes for their current cigarettes. On intake, participants were administered tests of taste and smell for e-cigarettes flavoured with tobacco, menthol, cherry and chocolate, and were given a refillable e-cigarette of their preferred flavour or a control flavour. Participants completed daily logs of cigarette and e-cigarette use and were followed each week. RESULTS: Analyses over days indicated that, during the 6-week e-cigarette period, cigarette smoking rates dropped from an average of about 16 to about 7 cigarettes/day. e-Cigarette flavour had a significant effect such that the largest drop in cigarette smoking occurred among those assigned menthol e-cigarettes, and the smallest drop in smoking occurred among those assigned chocolate and cherry flavours. e-Cigarette vaping rates also differed significantly by flavour assigned, with the highest vaping rates for tobacco- and cherry-flavoured e-cigarettes, and the lowest rates for those assigned to chocolate. CONCLUSIONS: The findings suggest that adoption of e-cigarettes in smokers may influence smoking rates and that e-cigarette flavourings can moderate this effect. e-Cigarette vaping rates are also influenced by flavourings. These findings may have implications for the utility of e-cigarettes as a nicotine replacement device and for the regulation of flavourings in e-cigarettes for harm reduction.

Nicotine concentrations with electronic cigarette use: effects of sex and flavor.

INTRODUCTION: This study examined overall changes in nicotine concentrations when using a popular e-cigarette and 18 mg/mL nicotine e-Juice, and it further explored effects of sex and flavorings on these concentrations. METHODS: We recruited nontreatment-seeking smokers who were willing to try e-cigarettes for 2 weeks and abstain from cigarette smoking. Subjects were randomized to either menthol tobacco or non-menthol tobacco-flavored e-cigarette use for 7-10 days, and the next week they were crossed over to the other condition. On the last day of e-cigarette use of each flavor, subjects completed a laboratory session in which they used the e-cigarette for 5 min ad libitum. Nicotine concentrations were obtained 5 min before and 5, 10, 15, 20, and 30 min after the onset of e-cigarette use. RESULTS: Twenty subjects completed at least 1 monitoring session. Nicotine concentrations significantly increased from baseline to 5 min by 4 ng/mL at the first laboratory session (p < .01) and by 5.1 ng/mL at the second laboratory session (p < .01). Combining sessions, there were no main effects of sex or preferred flavor (based on smoking history) on changes in nicotine concentrations. After adding preferred flavor, sex, and visit order to the model, there was a significant preferred flavor by sex interaction (p < .01), such that women who received nonpreferred flavors had lower nicotine concentrations and rated their e-cigarette as less likeable (p < .01). CONCLUSION: We found nicotine concentrations significantly increase after e-cigarette use for 5 min, and flavor may impact nicotine concentrations with e-cigarette use in women.

Effects of varenicline, nicotine or placebo on depressive symptoms in postmenopausal smokers.

BACKGROUND: Varenicline carries a black box warning for neuropsychiatric adverse events. OBJECTIVE: We examined varenicline use and past history of major depressive disorder (MDD) on depressive symptoms during smoking cessation. METHOD: This is a secondary analysis of two smoking cessation studies in 152 postmenopausal women who received placebo or nicotine patch, or 78 women who received varenicline with relaxation. Lifetime history of MDD (LH-MDD) was assessed at baseline and women with current MDD were excluded. Center for Epidemiologic Study Depression scale (CESD) measured depressive symptoms at baseline, 6 and 12 weeks. RESULTS: Baseline CESD scores were 5.3 + 4.4. Those with a LH-MDD reported higher CESD scores (p > .001). Those taking varenicline reported lower scores over all time periods compared to nicotine or placebo (p < .01). The differences between varenicline and the other treatments remained when controlling for LH-MDD, indicating an independent effect. CESD scores were associated with concurrent smoking status (p < .001), and with withdrawal symptoms (p < .001). CONCLUSION: CESD score were lower in those receiving varenicline, whether this is due to an anti-depressant effect, subject selection, use of relaxation or another cause is unknown. Varenicline does not increase depressive symptoms during smoking cessation in postmenopausal women without current MDD. Subjects with a LH-MDD are susceptible to developing depressive symptoms during smoking cessation, regardless of pharmacologic aid. SCIENTIFIC SIGNIFICANCE: Pharmacologic aids did not increase depression symptoms in this select population of postmenopausal women without current depression. Smoking cessation does increase depressive symptoms in those with LH-MDD, though the degree of increase was not clinically meaningful.

The efficacy of contingency management for adolescent cannabis use disorder: a controlled study.

BACKGROUND: This study was performed to investigate the efficacy of a voucher-based reinforcement therapy (VBRT) rewarding drug-free urine for adolescents with cannabis use disorder. METHODS: A controlled 10-week study where 59 adolescents aged 14-18 years were assigned by cohorts into groups of either an integrated cognitive-behavioral therapy (CBT) and VBRT or CBT with attendance-based reward program. Substance use was monitored by twice-weekly urinalysis. Other measures were collected at pre- and posttreatment and at 3-month follow-up. RESULTS: There was no significant difference in the linear change between conditions for cannabis use either from Sessions 1 to 10 or between end-of-treatment to 3-month follow-up. Also, self-efficacy and coping response did not show improvement during treatment. CONCLUSIONS: In this study, the addition of contingency management (CM) to CBT in youth was not found to be more efficacious than similar compensation rewarding attendance only. Continued examination of the efficacy of CM and its interaction with the associated mechanisms of behavior change of CBT in youth is necessary. Examination of the effect of the magnitude of the reward as well as considering the emotional and cognitive developmental differences from adults is warranted.

Individualized Assessment and Treatment Program (IATP) for alcohol use disorder: Comparison with conventional cognitive-behavioral treatment and examination of coping skills as a mediator of treatment.

OBJECTIVE: This study tested a highly individualized cognitive-behavioral coping skills treatment for alcohol use disorder (AUD). Recent studies have indicated that coping skills training programs are not always effective. A possible explanation is that the training provided in these programs may not address the specific needs of the patient. The Individualized Assessment and Treatment Program (IATP) was intended to provide a highly individualized approach to the training of skills most relevant for each individual. METHOD: Men and women with AUD (N = 173) were randomly assigned to one of three, manualized, 12-session treatments: IATP, a conventional (Packaged) cognitive-behavioral program (PCBT), or a Case Management control condition (CaseM). An experience sampling (ES) procedure was employed prior to, and during, treatment to record alcohol use and coping behaviors in all patients. In IATP, this information was used by therapists to plan treatment that would address the specific strengths and weaknesses of each patient in alcohol-use situations. ES data were collected at multiple time points and patients were followed every 3 months out to 21 months posttreatment. RESULTS: Multilevel model analyses indicated that IATP yielded better drinking outcomes than the CaseM or PCBT conditions. Mediation analyses indicated that the effects of IATP versus the other treatments on outcomes were accounted for at least partly by changes in active coping with high-risk situations. CONCLUSION: Due to the limited diversity of the sample, generalizability of the results may be limited. Results are discussed in terms of the importance of tailoring treatment for the individual patient. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Provider Implicit Racial Bias in Pediatric Sickle Cell Disease.

BACKGROUND/OBJECTIVES: This study is to (1) assess implicit racial bias among pediatric providers and (2) use virtual patient (VP) vignettes to determine the impact of implicit racial bias on clinical decision-making in pediatric sickle cell disease (SCD) pain care. DESIGN/METHODS: This cross-sectional study was conducted at a mid-sized, freestanding children's hospital in the northeast. Participants (N = 52) were pediatric SCD providers (87% cisgender female, 90% White, M age = 38.78). Providers completed a demographic questionnaire, the race Implicit Association Test (IAT) with adult and child faces, and a measure of SCD explicit bias (5-point Likert scale). Providers also made clinical decisions for four VP vignettes depicting Black and White youth in the emergency department (ED) with either SCD or cancer pain. Frequency tables were calculated. RESULTS: On the race IAT, providers demonstrated a pro-White implicit bias for both adult (81%) and child (89%) faces. Responses to the explicit bias measure reflected low levels of agreement with negative stereotypes about SCD patients. No significant differences emerged in providers' pain treatment decisions for Black vs. White, or SCD vs. cancer VPs. CONCLUSIONS: Findings indicate pediatric providers harbor implicit racial bias similar to the general population. Findings from VP vignettes did not demonstrate that pain treatment decision-making differed based on race or diagnosis. This may be due to standardized protocols and procedures in the pediatric emergency setting. Future research is needed to clarify the role of implicit bias in clinical decision-making and the potential efficacy of treatment protocols in preventing biases from interfering with pediatric SCD pain care.

Daily drinking and social network interactions in network support treatment.

OBJECTIVE: Social networks can be powerful determinants of drinking. Network Support (NS) treatment was designed to help persons with alcohol use disorder alter their social network to be more supportive of abstinence and less supportive of drinking. The present study was intended to determine how NS treatment altered behavior on a daily basis. It was expected that, relative to those treated in a packaged cognitive-behavioral treatment (PCBT), NS patients would report fewer daily contacts with drinking persons and increased contacts with nondrinking persons. METHOD: Patients (N = 193) treated in our second NS trial provided daily recordings of drinks consumed, urge to drink, and self-efficacy for not drinking, as well as reports of associations with drinking and nondrinking friends, via an interactive voice response system. Daily recordings (N = 146) were collected during the first 6 months of the 27-month study. Multilevel modeling was used to analyze daily network variables over time by treatment. Time-varying effect model (TVEM) analyses were also conducted to assess the influence of daily-varying social contacts on daily drinking, drinking urges, and self-efficacy. RESULTS: Consistent with hypotheses, NS patients reported significantly less daily drinking associated with contacts with drinkers than did PCBT patients. Patients in both treatments reported increases in self-efficacy and decreases in urges to drink over days as a function of contact with nondrinkers. CONCLUSIONS: NS treatment was successful in helping patients change their social networks, as well as their responses to social influences, and those changes had effects on day-to-day drinking levels. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Prospective predictors of electronic nicotine delivery system initiation in tobacco naive young adults: A machine learning approach.

The use of electronic nicotine delivery systems (ENDS) is increasing among young adults. However, there are few studies regarding predictors of ENDS initiation in tobacco-naive young adults. Identifying the risk and protective factors of ENDS initiation that are specific to tobacco-naive young adults will enable the creation of targeted policies and prevention programs. This study used machine learning (ML) to create predictive models, identify risk and protective factors for ENDS initiation for tobacco-naive young adults, and the relationship between these predictors and the prediction of ENDS initiation. We used nationally representative data of tobacco-naive young adults in the U.S drawn from the Population Assessment of Tobacco and Health (PATH) longitudinal cohort survey. Respondents were young adults (18-24 years) who had never used any tobacco products in Wave 4 and who completed Waves 4 and 5 interviews. ML techniques were used to create models and determine predictors at 1-year follow-up from Wave 4 data. Among the 2,746 tobacco-naive young adults at baseline, 309 initiated ENDS use at 1-year follow-up. The top five prospective predictors of ENDS initiation were susceptibility to ENDS, increased days of physical exercise specifically designed to strengthen muscles, frequency of social media use, marijuana use and susceptibility to cigarettes. This study identified previously unreported and emerging predictors of ENDS initiation that warrant further investigation and provided comprehensive information on the predictors of ENDS initiation. Furthermore, this study showed that ML is a promising technique that can aid ENDS monitoring and prevention programs.

Momentary coping and marijuana use in treated adults: Exploring mechanisms of treatment.

OBJECTIVE: This study was designed to test the hypothesis that an Individualized Assessment and Treatment Program (IATP) for cannabis use disorder (CUD) that utilized experience sampling (ES) data to individualize treatment would be more effective at eliciting adaptive coping responses in high-risk situations than a more conventional cognitive-behavioral treatment. It was further expected that increases in momentary adaptive coping, positive affect, and self-efficacy expectancies would mediate the effects of treatment on momentary drug use in the hours following a temptation-to-use episode. METHOD: The participants were 198 adults seeking treatment for CUD, randomized to receive either a conventional motivational enhancement + cognitive-behavioral treatment (MET-CBT) with or without contingency management (CM) or an IATP with or without CM. Treatment took place over nine individual sessions, and follow-ups were conducted out to 14 months post-intake. ES data were recorded in all treatments at pretreatment, and at various points during and after treatment. RESULTS: Analyses of ES data indicated that the IATP conditions yielded greater increases in use of adaptive coping skills during temptation episodes than did the MET-CBT conditions. Mediation analyses supported the hypothesis that momentary use of coping skills mediates the effects of IATP on use or non-use of marijuana in the hours following a temptation episode. CONCLUSIONS: Use of an individualized coping treatment approach results in lower use of marijuana in high-risk situations, and actual utilization of adaptive coping appears to be a mechanism of that effect. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

"If It Ever Really Hurts, I Try Not to Let Them Know:" The Use of Concealment as a Coping Strategy Among Adolescents With Chronic Pain.

OBJECTIVE: Despite considerable evidence of chronic pain in adolescents, and its adverse consequences for their health and well-being, less is known about pain-related stigma that these youth face, such as pain disbelief by others. Adolescents with chronic pain may conceal their symptoms as a coping strategy to avoid pain-related stigma, contributing to further social isolation and disruptions in medical treatment. In the current study, we used focus group methodology to examine adolescent motivations for using concealment and the possible benefits and harmful consequences of this form of coping. MATERIALS AND METHODS: Five focus groups of 3-5 adolescents (ages 12-17) with chronic pain conditions (N = 18) were conducted as a part of a larger study to evaluate the impact of, and reaction to, pain-related stigma. Patients were recruited from an outpatient pediatric pain management clinic. Transcripts of focus group sessions were analyzed using directed content analysis for the main study, yielding anticipatory stigma and concealment categories. These categories were then explored using inductive content analysis for the current study. RESULTS: Adolescents described engaging in concealment of their pain symptoms. Our analysis revealed three social motivations for concealment: (1) avoidance of judgment; (2) avoidance of being a social burden; and (3) desire to be treated normally, and two harmful consequences of concealment: (1) social isolation and (2) cognitive burden. CONCLUSION: Disbelief of pain symptoms may exacerbate the social isolation and disease-related burden in this population. Clinical implications of concealing pain symptoms are discussed, and points of intervention are proposed.

E-Cigarette Use in Young Adult Never Cigarette Smokers with Disabilities: Results from the Behavioral Risk Factor Surveillance System Survey.

Young adult never cigarette smokers with disabilities may be at particular risk for adopting e-cigarettes, but little attention has been paid to these people. This study examines the associations between different types of disability and e-cigarette use in this population. Young adult never-smokers from the 2016-2017 Behavioral Risk Factor Surveillance System (BRFSS) survey who were either never or current e-cigarette users (n = 79,177) were selected for the analysis. The Least Absolute Shrinkage and Selection Operator (LASSO) algorithm was used to select confounders for multivariable logistic regression models. Multivariable logistic regression models were used to determine the associations between current e-cigarette use and different types of disability after incorporating BRFSS survey design and adjusting for confounders. Young adult never-smokers who reported any disability had increased odds (OR 1.44, 95% CI 1.18-1.76) of e-cigarette use compared to those who reported no disability. Young adult never-smokers who reported self-care, cognitive, vision, and independent living disabilities had higher odds of e-cigarette use compared to those who reported no disability. There was no statistically significant difference in the odds of e-cigarette use for those reporting hearing and mobility disabilities compared to those who reported no disability. This study highlights the need for increased public education and cessation programs for this population.

Caregivers' Barriers to Dental Care for Children with Autism Spectrum Disorder.

Purpose: To investigate caregivers' perspective on barriers to dental care for children with autism spectrum disorder (ASD).
Methods: A cross-sectional survey assessing perceived barriers to dental care was administered to 46 caregivers who had a child with ASD (study group) and 37 who had children without ASD (control group) but with chronic health issues.
Results: The barriers most frequently reported in the study group were difficulty finding a dentist who would treat their child (32 percent) and the child's uncooperative behavior (39 percent). A significantly higher number of caregivers of children with ASD agreed that their child was uncooperative and that such behavior was a barrier to finding care (chi-square=15.22, P =0.0001). The number of barriers reported by caregivers of children with ASD was greater than that reported by the other caregivers. Caregivers of children with severe ASD perceived having the most barriers to care.
Conclusion: There are many barriers faced by caregivers in getting dental treatment for their children with ASD. Understanding the difficulty caregivers have in securing dental care for their children with ASD may help dentists and agencies work to improve access.