Identifying Patterns of Smoking Cessation App Feature Use That Predict Successful Quitting: Secondary Analysis of Experimental Data Leveraging Machine Learning.

BACKGROUND: Leveraging free smartphone apps can help expand the availability and use of evidence-based smoking cessation interventions. However, there is a need for additional research investigating how the use of different features within such apps impacts their effectiveness. OBJECTIVE: We used observational data collected from an experiment of a publicly available smoking cessation app to develop supervised machine learning (SML) algorithms intended to distinguish the app features that promote successful smoking cessation. We then assessed the extent to which patterns of app feature use accounted for variance in cessation that could not be explained by other known predictors of cessation (eg, tobacco use behaviors). METHODS: Data came from an experiment (ClinicalTrials.gov NCT04623736) testing the impacts of incentivizing ecological momentary assessments within the National Cancer Institute's quitSTART app. Participants' (N=133) app activity, including every action they took within the app and its corresponding time stamp, was recorded. Demographic and baseline tobacco use characteristics were measured at the start of the experiment, and short-term smoking cessation (7-day point prevalence abstinence) was measured at 4 weeks after baseline. Logistic regression SML modeling was used to estimate participants' probability of cessation from 28 variables reflecting participants' use of different app features, assigned experimental conditions, and phone type (iPhone [Apple Inc] or Android [Google]). The SML model was first fit in a training set (n=100) and then its accuracy was assessed in a held-aside test set (n=33). Within the test set, a likelihood ratio test (n=30) assessed whether adding individuals' SML-predicted probabilities of cessation to a logistic regression model that included demographic and tobacco use (eg, polyuse) variables explained additional variance in 4-week cessation. RESULTS: The SML model's sensitivity (0.67) and specificity (0.67) in the held-aside test set indicated that individuals' patterns of using different app features predicted cessation with reasonable accuracy. The likelihood ratio test showed that the logistic regression, which included the SML model-predicted probabilities, was statistically equivalent to the model that only included the demographic and tobacco use variables (P=.16). CONCLUSIONS: Harnessing user data through SML could help determine the features of smoking cessation apps that are most useful. This methodological approach could be applied in future research focusing on smoking cessation app features to inform the development and improvement of smoking cessation apps. TRIAL REGISTRATION: ClinicalTrials.gov NCT04623736; https://clinicaltrials.gov/study/NCT04623736.

Characterizing perceived usability and its correlation with smoking cessation: An analysis of user assessments of the smoking cessation app quitSTART.

Background: As smartphone ownership has become common in all demographic groups in the United States, smartphone applications (apps) for smoking cessation have grown in popularity due to their potential for supporting the diverse populations in the United States who are attempting to quit smoking. Usability is commonly assessed in mobile health (mHealth) technology as an important aspect of the user experience that could influence users' adherence to a health app and health outcomes. However, the variation of perceived usability across demographic groups, and the implications of that variation for app success, have not been well studied. Objective: The aims of this study were to characterize variation in the perceived usability of the National Cancer Institute Smokefree.gov Initiative smoking cessation app quitSTART across demographic groups, and to assess the correlation between perceived usability and short-term smoking cessation. Methods: We conducted a secondary analysis of data from a randomized controlled trial conducted from 2020 to 2021, which used a 16-item modified version of the mHealth App Usability Questionnaire (MAUQ) to quantify perceived usability four weeks after app download among 131 smokers attempting to quit. Responses were coded on a 5-point Likert-type scale ranging from strongly disagree (1) to strongly agree (5) and total perceived usability was calculated as the sum of all 16 items (range: 16-80). Associations between participant demographic characteristics (gender, race, education level, age, etc.) and total usability were determined using an ANCOVA model. A multivariable logistic regression model was used to assess the association between usability and smoking cessation, also assessed 4 weeks after app download. Results: The ANCOVA model demonstrated that race was associated with perceived usability, with participants from a racial minority group reporting higher total usability than White participants (p < 0.001). White participants had an adjusted mean total usability of 55.8 (95 % CI: 52.8, 58.8) while racial minority group participants had an adjusted mean total usability of 66.5 (95 % CI: 61.2, 71.6). Other participant demographic characteristics, such as gender and sexual minority status, were not associated with mean total usability. Total usability was positively associated with smoking cessation (OR: 1.04, 95 % CI: 1.00, 1.08, p = 0.031). Conclusions: Total perceived usability of quitSTART was higher among adults from a racial minority group compared to White adults, and perceived usability was positively associated with cessation success. These findings emphasize the importance of ensuring high usability of mHealth smoking cessation apps for diverse populations.

Equitable implementation of lung cancer screening: avoiding its potential to mirror existing inequities among people who use tobacco.

PURPOSE: Lung cancer is the leading cause of cancer death, but the advent of lung cancer screening using low-dose computed tomography offers a tremendous opportunity to improve lung cancer outcomes. Unfortunately, implementation of lung cancer screening has been hampered by substantial barriers and remains suboptimal. Specifically, the commentary emphasizes the intersectionality of smoking history and several important sociodemographic characteristics and identities that should inform lung cancer screening outreach and engagement efforts, including socioeconomic considerations (e.g., health insurance status), racial and ethnic identity, LGBTQ + identity, mental health history, military experience/veteran status, and geographic residence in addressing specific community risk factors and future interventions in efforts to make strides toward equitable lung cancer screening. METHODS: Members of the Equitable Implementation of Lung Cancer Screening Interest Group with the Cancer Prevention and Control Network (CPCRN) provide a critical commentary based on existing literature regarding smoking trends in the US and lung cancer screening uptake to propose opportunities to enhance implementation and support equitable distribution of the benefits of lung cancer screening. CONCLUSION: The present commentary utilizes information about historical trends in tobacco use to highlight opportunities for targeted outreach efforts to engage communities at high risk with information about the lung cancer screening opportunity. Future efforts toward equitable implementation of lung cancer screening should focus on multi-level implementation strategies that engage and work in concert with community partners to co-create approaches that leverage strengths and reduce barriers within specific communities to achieve the potential of lung cancer screening.

The longitudinal association between coupon receipt and established cigarette smoking initiation among young adults in USA.

INTRODUCTION: Tobacco companies frequently distribute coupons for their products. This marketing tactic may be particularly effective among young adults, who tend to be especially price-sensitive. Young adulthood is also a stage during which many individuals initiate established cigarette smoking and are especially vulnerable to the effects of tobacco marketing. METHODS: We used five waves of data from the US Population Assessment on Tobacco and Health Study (2013-2019) to assess the longitudinal relationship between cigarette coupon receipt and initiation of established cigarette smoking among young adults (18-24 years) who did not report current smoking and had smoked <100 cigarettes in their lifetime at baseline. Initiation of established cigarette smoking was defined as reporting current cigarette use and having smoked ≥100 cigarettes at follow-up. To test this relationship, we fit four discrete time survival models to an unbalanced person-period data set. The first model included our time-varying coupon receipt variable, which was lagged one wave. Subsequent models added sociodemographic, cigarette smoking exposure and other tobacco use variables. RESULTS: Adopting the model adjusting for sociodemographic variables, respondents who received a coupon were found to be more likely to initiate established cigarette smoking at follow-up (adjusted HR (aHR): 2.31, 95% CI 1.41 to 3.80). This relationship remained significant when controlling for all covariates in the fully adjusted model (aHR: 1.96, 95% CI 1.18 to 3.26). CONCLUSIONS: These findings show that receiving tobacco coupons may increase the likelihood that young adults will initiate established cigarette smoking, underscoring the need to address the effects of this tobacco marketing tactic.

The Longitudinal Association Between Cigarette Coupon Receipt and Short-term Smoking Cessation Among US Adults.

INTRODUCTION: To help offset the increased price of cigarettes and promote brand loyalty, tobacco companies distribute coupons, particularly to price-sensitive consumers. Few studies, however, have examined the longitudinal association between coupon receipt and smoking cessation. AIMS AND METHODS: Using adult data from waves 1-5 (2013-2019) of the Population Assessment of Tobacco and Health Study, we examined the longitudinal association between coupon receipt and short-term smoking cessation. Multivariable discrete-time survival models were fit to an unbalanced person-period dataset for adult respondents (≥18 years) with current established smoking status at baseline (person n = 9472, risk period n = 29 784). Short-term smoking cessation was measured as discontinued cigarette use (no past 30-day cigarette use at follow-up) and self-reported complete quitting. Coupon receipt was measured as a time-varying exposure, measured in the wave preceding the outcome. Tobacco dependence and time-varying cigarette use intensity were controlled as potential confounders. Effect modification by age, sex, race-ethnicity, and education was assessed by examining interaction terms. RESULTS: We found that adults who received a coupon were 19% less likely to quit smoking compared to adults who did not receive a coupon, adjusting for covariates (adjusted hazard rate [aHR]: 0.81, 95% CI: 0.74-0.89). None of the interaction terms were statistically significant, suggesting that the association between coupon receipt and short-term smoking cessation may not differ across the sociodemographic groups that we examined. CONCLUSIONS: Taken together, our results reveal that coupon receipt reduces the likelihood of short-term smoking cessation, and that this association does not differ by age, sex, race-ethnicity, or education. IMPLICATIONS (97/100): Tobacco companies distribute coupons for tobacco products to price-sensitive customers in the United States, and these coupons can be particularly effective in partly offsetting the impact of a tax increases and promoting brand loyalty. This study provides longitudinal evidence that coupon receipt is associated with a decrease in short-term smoking cessation among US adults who smoke cigarettes after adjusting for covariates and tobacco-related confounders. The findings from this study suggest that coupons are an effective tool for tobacco companies to prevent adults who smoke from quitting, and a national ban on coupons may help to facilitate smoking cessation.

The Effects of Tobacco Coverage in the Public Communication Environment on Young People's Decisions to Smoke Combustible Cigarettes.

In today's complex media environment, does media coverage influence youth and young adults' (YYA) tobacco use and intentions? We conceptualize the "public communication environment" and effect mediators, then ask whether over time variation in exogenously measured tobacco media coverage from mass and social media sources predicts daily YYA cigarette smoking intentions measured in a rolling nationally representative phone survey (N = 11,847 on 1,147 days between May 2014 and June 2017). Past week anti-tobacco and pro-tobacco content from Twitter, newspapers, broadcast news, Associated Press, and web blogs made coherent scales (thetas = 0.77 and 0.79). Opportunities for exposure to anti-tobacco content in the past week predicted lower intentions to smoke (Odds ratio [OR] = 0.95, p < .05, 95% confidence interval [CI] = 0.91-1.00). The effect was stronger among current smokers than among nonsmokers (interaction OR = 0.88, p < .05, 95% CI = 0.77-1.00). These findings support specific effects of anti-tobacco media coverage and illustrate a productive general approach to conceptualizing and assessing effects in the complex media environment.

Do Longitudinal Trends in Tobacco 21-Related Media Coverage Correlate with Policy Support? an Exploratory Analysis Using Supervised and Unsupervised Machine Learning Methods.

Media coverage can impact support for health policies and, ultimately, compliance with those policies. Prior research found consistent, high support for Tobacco 21 policies, which raise the minimum legal age of tobacco purchase to 21, among adults and nonsmoking youth. However, a recent study found support (i.e., agreement with the statement: "The legal age to buy tobacco cigarettes should be increased from 18 to 21") among 13-20-year-old smokers increased from 2014 until mid-2016 and then declined steadily through mid-2017. To assess whether media coverage could be related to young smokers' changing support, we conducted an exploratory content analysis to identify texts about Tobacco 21 in a large corpus of tobacco texts (N = 135,691) published in four popular media sources from 2014 to 2017. For this content analysis, we developed a novel methodological approach that combined supervised and unsupervised machine learning methods and could be useful in other areas of communication research. We found that the prevalence of Tobacco 21 media coverage and Tobacco 21 support among young smokers exhibited similar temporal patterns for much of the study period. These findings highlight the need for continued research into the effects of media coverage on Tobacco 21 support among young smokers, a group that must comply with Tobacco 21 policies in order to ensure maximum effectiveness. This research is of particular utility following the 2019 passage of a federal Tobacco 21 regulation, as the public health impact of this regulation could be limited by low public support, and thus low rates of policy compliance.

Gender Differences in Moral Influences on Adolescents' Eyewitness Identification.

In this study, 232 (89 11- to 12-year-olds, 71 13- to 14-year-olds; 72 15- to 16-year-olds) students recruited from grades 6th-11th in an urban public high school participated in a study of eyewitness identification. The focus of this study was on the effects of age, gender and moral orientation on decisional bias and, as a secondary outcome, on accuracy (using signal detection analysis).The primary purpose of this and previous studies in this series is to uncover implicit moral decision-making in decisional bias. In this study the perpetrator, the bystanders and the foil were all females. Prior to completing the eyewitness identification task, participants were given instructions that emphasized either (a) fairness and crime prevention, or (b) neither. These instructions had no discernible effect on accuracy but, as in past studies, younger participants (below the age of 13) had lower decisional criteria, resulting in a higher rate of false alarms/positives. Further, those who judged the transgression as worse had a lower decisional criterion, indicating more false alarms. Females were more accurate than the males in identifying the female perpetrator and scored significantly higher on how bad they would feel if they were the victim than did the males.

Association of COVID-19 Misinformation with Face Mask Wearing and Social Distancing in a Nationally Representative US Sample.

Wide-spread misinformation about the COVID-19 pandemic has presented challenges for communicating public health recommendations. Should campaigns to promote protective behaviors focus on debunking misinformation or targeting behavior-specific beliefs? To address this question, we examine whether belief in COVID-19 misinformation is directly associated with two behaviors (face mask wearing and social distancing), and whether behavior-specific beliefs can account for this association and better predict behavior, consistent with behavior-change theory. We conducted a nationally representative two-wave survey of U.S. adults from 5/26/20-6/12/20 (n = 1074) and 7/15/20-7/21//20 (n = 889; follow-up response 83%). Scales were developed and validated for COVID-19 related misinformation beliefs, social distancing and face mask wearing, and beliefs about the consequences of both behaviors. Cross-lagged panel linear regression models assessed relationships among the variables. While belief in misinformation was negatively associated with both face mask wearing (B = -.27, SE =.06) and social-distancing behaviors (B = -.46, SE =.08) measured at the same time, misinformation did not predict concurrent or lagged behavior when the behavior-specific beliefs were incorporated in the models. Beliefs about behavioral outcomes accounted for face mask wearing and social distancing, both cross-sectionally (B =.43, SE =.05; B =.63, SE =.09) and lagged over time (B =.20, SE = 04; B =.30, SE =.08). In conclusion, belief in COVID-19-related misinformation is less relevant to protective behaviors, but beliefs about the consequences of these behaviors are important predictors. With regard to misinformation, we recommend health campaigns aimed at promoting protective behaviors emphasize the benefits of these behaviors, rather than debunking unrelated false claims.

Leveraging immersive technology to expand access to opioid overdose reversal training in community settings: Results from a randomized controlled equivalence trial.

BACKGROUND: Immersive video (e.g. virtual reality) poses a promising and engaging alternative to standard in-person trainings and can potentially increase access to evidence-based opioid overdose prevention programs (OOPPs). Therefore, the objective of this equivalence study was to test whether the immersive video OOPP was equivalent to a standard in-person OOPP for changes in opioid overdose knowledge and attitudes. METHODS: A team of nurses and communication researchers developed a 9-minute immersive video OOPP. To test whether this immersive video OOPP (treatment) demonstrated equivalent gains in opioid overdose response knowledge and attitudes as in-person OOPPs (standard of care control), researchers deployed a two-day field experiment in Philadelphia, Pennsylvania, USA. In this equivalence trial, 9 libraries were randomly assigned to offer treatment or control OOPP to community members attending naloxone giveaway events. In this equivalence design, a difference between treatment and control groups pre- to post-training scores within -1.0 to 1.0 supports equivalence between the trainings. RESULTS: Results demonstrate participants (N = 94) exposed to the immersive video OOPP had equivalent improvements on posttest knowledge (ß=-0.18, p = .61) and more favorable attitudes about responding to an opioid overdose (ß=0.26, p = .02) than those exposed to the standard OOPP. However, these minor differences in knowledge and attitudes were within the equivalence interval indicating that the immersive video OOPP remained equivalently effective for community members. CONCLUSIONS: Community partnerships, like those between public health departments and libraries, can provide opportunities for deploying novel immersive video OOPP that, alongside standard offerings, can strengthen community response to the opioid crisis.

An Investigation of Low COVID-19 Vaccination Intentions among Black Americans: The Role of Behavioral Beliefs and Trust in COVID-19 Information Sources.

Developing a COVID-19 vaccine is a critical strategy for combatting the pandemic. However, for vaccination efforts to succeed, there must be widespread willingness to vaccinate. Prior research has found that Black Americans, who are disproportionately impacted by COVID-19, report lower intentions to get a vaccine than do other populations. We investigate two potential contributors to this disparity: COVID-19 vaccine-related behavioral beliefs and trust in four COVID-19 information sources (mainstream media, social media, President Trump, and public health officials and agencies). Using a nationally-representative survey (n= 889), we demonstrate that differences in vaccination beliefs explain the lower vaccination intentions reported by Black participants, compared to non-Black participants. However, while trust in information sources is associated with vaccination beliefs, differences in trust do not account for the observed differences in vaccination beliefs by race. Furthermore, we find that race moderates the relationships between trust in two sources (Trump and public health officials and agencies) and vaccination beliefs. The effects of trusting these sources on COVID-19 vaccine-related beliefs are smaller among Black participants; thus trust in these sources is less consequential to their pro-vaccination beliefs. Our results suggest that trust in information sources alone does not explain the observed relationship between race and vaccination beliefs.

Combining Crowd-Sourcing and Automated Content Methods to Improve Estimates of Overall Media Coverage: Theme Mentions in E-cigarette and Other Tobacco Coverage.

Exposure to media content can shape public opinions about tobacco. Accurately describing content is a first step to showing such effects. Historically, content analyses have hand-coded tobacco-focused texts from a few media sources which ignored passing mention coverage and social media sources, and could not reliably capture over-time variation. By using a combination of crowd-sourced and automated coding, we labeled the population of all e-cigarette and other tobacco-related (including cigarettes, hookah, cigars, etc.) 'long-form texts' (focused and passing coverage, in mass media and website articles) and social media items (tweets and YouTube videos) collected May 2014-June 2017 for four tobacco control themes. Automated coding of theme coverage met thresholds for item-level precision and recall, event validation, and weekly-level reliability for most sources, except YouTube. Health, Policy, Addiction and Youth themes were frequent in e-cigarette long-form focused coverage (44%-68%), but not in long-form passing coverage (5%-22%). These themes were less frequent in other tobacco coverage (long-form focused (13-32%) and passing coverage (4-11%)). Themes were infrequent in both e-cigarette (1-3%) and other tobacco tweets (2-4%). Findings demonstrate that passing e-cigarette and other tobacco long-form coverage and social media sources paint different pictures of theme coverage than focused long-form coverage. Automated coding also allowed us to code the amount of data required to estimate reliable weekly theme coverage over three years. E-cigarette theme coverage showed much more week-to-week variation than did other tobacco coverage. Automated coding allows accurate descriptions of theme coverage in passing mentions, social media, and trends in weekly theme coverage.

Toward an Aggregate, Implicit, and Dynamic Model of Norm Formation: Capturing Large-Scale Media Representations of Dynamic Descriptive Norms Through Automated and Crowdsourced Content Analysis.

Media content can shape people's descriptive norm perceptions by presenting either population-level prevalence information or descriptions of individuals' behaviors. Supervised machine learning and crowdsourcing can be combined to answer new, theoretical questions about the ways in which normative perceptions form and evolve through repeated, incidental exposure to normative mentions emanating from the media environment. Applying these methods, this study describes tobacco and e-cigarette norm prevalence and trends over 37 months through an examination of a census of 135,764 long-form media texts, 12,262 popular YouTube videos, and 75,322,911 tweets. Long-form texts mentioned tobacco population norms (4-5%) proportionately less often than e-cigarette population norms (20%). Individual use norms were common across sources, particularly YouTube (tobacco long-form: 34%; Twitter: 33%; YouTube: 88%; e-cigarette long form: 17%; Twitter: 16%; YouTube: 96%). The capacity to capture aggregated prevalence and temporal dynamics of normative media content permits asking population-level media effects questions that would otherwise be infeasible to address.

Harms to Consumers of Inpatient Psychiatric Facilities in the United States: An Analysis of News Articles.

Inpatient psychiatric facilities in the United States lack systematic regulation and monitoring of a variety of patient safety concerns. We conducted a qualitative analysis of 61 news articles to identify common causes and types of harms within inpatient psychiatric facilities, with a focus on physical harm. The news articles reported on patient self-harm, patient-patient violence, and violence between patients and staff, noting that youth, older adults, and veterans were especially vulnerable. Harms occurred throughout the care continuum - at admission, during the inpatient stay, and at discharge - and retaliation towards whistleblowers deterred facility accountability. We recommend 1) addressing staffing shortages, 2) instituting systematic monitoring of critical incidents and the experiences of consumers and staff, 3) improving both inpatient safety and post-discharge community supports, and 4) continued journalistic coverage of harms within inpatient psychiatric facilities.