Massachusetts Prevalence of Opioid Use Disorder Estimation Revisited: Comparing a Bayesian Approach to Standard Capture-Recapture Methods.

BACKGROUND: The National Survey on Drug Use and Health (NSDUH) estimated the prevalence of opioid use disorder (OUD) among the civilian, noninstitutionalized people aged 12 years or older in Massachusetts as 1.2% between 2015 and 2017. Accurate estimation of the prevalence of OUD is critical to the success of treatment and resource planning. Various indirect estimation approaches have been used but are subject to data availability and infrastructure-related issues. METHODS: We used 2015 data from the Massachusetts Public Health Data Warehouse (PHD) to compare the results of two approaches to estimating OUD prevalence in the Massachusetts population. First, we used a seven-dataset capture-recapture analysis under log-linear model parameterization, controlling for the source dependence and effects of age, sex, and county through stratification. Second, we applied a benchmark-multiplier method in a Bayesian framework by linking health care claims data to death certificate data assuming an extrapolation of death rates from observed untreated OUD to unobserved OUD. RESULTS: Our estimates for OUD prevalence among Massachusetts residents (aged 18-64 years) were 4.62% (95% CI = 4.59%, 4.64%) in the capture-recapture approach and 4.29% (95% CrI = 3.49%, 5.32%) in the Bayesian model. Both estimates were approximately four times higher than NSDUH estimates. CONCLUSION: The synthesis of our findings suggests that the disease surveillance system misses a large portion of the population with OUD. Our study also suggests that concurrent use of multiple methods improves the justification and facilitates the triangulation and interpretation of the resulting estimates. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT04111939.

Opioid Use Disorder Among Ohio's Medicaid Population: Prevalence Estimates From 19 Counties Using a Multiplier Method.

The decades-long overdose epidemic in the United States is driven by opioid misuse. Overdoses commonly, although not exclusively, occur in individuals with opioid use disorder (OUD). To allocate adequate resources and develop appropriately scaled public health responses, accurate estimation of the prevalence of OUD is needed. Indirect methods (e.g., a multiplier method) of estimating prevalence of problematic substance-use behavior circumvent some limitations of household surveys and use of administrative data. We used a multiplier method to estimate OUD prevalence among the adult Medicaid population (ages 18-64 years) in 19 Ohio counties that are highly affected by overdose. We used Medicaid claims data and the US National Vital Statistics System overdose death data, which were linked at the person level. A statistical model leveraged opioid-related death rate information from a group with known OUD to estimate prevalence among a group with unknown OUD status given recorded opioid-related deaths in that group. We estimated that 13.6% of the total study population had OUD in 2019. Men (16.7%) had a higher prevalence of OUD than women (11.4%), and persons aged 35-54 had the highest prevalence (16.7%). Our approach to prevalence estimation has important implications for OUD surveillance and treatment in the United States.

Dynamic Interdependence of Advice Seeking, Loaning, and Recovery Characteristics in Recovery Homes.

Recovery homes in the US provide stable housing for over 200,000 individuals with past histories of homelessness, psychiatric co-morbidity and criminal justice involvement. We need to know more about how these settings help those remain in recovery. Our study measured advice seeking and willingness-to-loan relationships and operationalized them as a dynamic multiplex social network-multiple, simultaneous interdependent relationships--that exist within 42 Oxford House recovery homes over time. By pooling relationship dynamics across recovery houses, a Stochastic Actor-Oriented Modeling (SAOM) framework (Snijders et al., 2010) was used to estimate a set of parameters governing the evolution of the network and the recovery attributes of the nodes simultaneously. Findings indicated that advice and loan relationships and recovery-related attitudes were endogenously interdependent, and these results were affected exogenously by gender, ethnicity, and reason for leaving the recovery houses. Prior findings had indicated that higher advice seeking in recovery houses was related to higher levels of stress with more negative outcomes. However, the current study found that recovery is enhanced over time if advice was sought from residents with higher recovery scores. Our study shows that social embedding, i.e. one's position in relationship networks, affects recovery prospects. More specifically, the formation of ties with relatively more recovered residents as an important predictor of better outcomes.

How should we define "rural" when investigating rural tobacco use in the United States?

Purpose: Investigations into rural tobacco-related disparities in the U.S. are hampered by the lack of a standardized approach for identifying the rurality-and, consequently, the urbanicity-of an area. Therefore, the purpose of this study was to compare the most common urban/rural definitions (Census Bureau, OMB, RUCA, and Isolation) and determine which is preferable for explaining the geographic distribution of several tobacco-related outcomes (behavior, receiving a doctor's advice to quit, and support for secondhand smoke policies). Methods: Data came from The Current Population Survey Tobacco Use Supplement. For each tobacco-related outcome, one logistic regression was conducted for each urban/rural measure. Models were then ranked according to their ability to explain the data using Akaike information criterion (AIC). Results: Each definition provided very different estimates for the prevalence of the U.S. population that is considered "rural" (e.g., 5.9% for the OMB, 17.0% for the Census Bureau). The OMB definition was most sensitive at detecting urban/rural differences, followed by the Isolation scale. Both these measures use strict, less-inclusive criteria for what constitutes "rural." Conclusions: Overall, results demonstrate the heterogeneity across urban/rural measures. Although findings do not provide a definitive answer for which urban/rural definition is the best for examining rural tobacco use, they do suggest that the OMB and Isolation measures may be most sensitive to detecting many types of urban/rural tobacco-related disparities. Caveats and implications of these findings for rural tobacco use disparities research are discussed. Efforts such as these to better understand which rural measure is appropriate for which situation can improve the precision of rural substance use research.

Resident interactions when affirming and correcting peers in a therapeutic community for women.

Purpose ­: While recent years have seen a number of studies of social networks in therapeutic communities (TCs) and other residential settings, these have primarily focused on male residents. This paper aims to conduct a longitudinal social network analysis of interpersonal interactions in a TC for women. Design/methodology/approach ­: The data consists of a longitudinal directed social network of instances of feedback between 56 residents of a 16 bed TC for women over a period of 611 days. Mean age of the participants was 33.1 years, mean length of stay was 133.9 days and 91% of the participants were female. Feedback consisted of written affirmations for prosocial behavior and written corrections for contravening TC norms. Data was analyzed using a latent factor longitudinal social network model. Findings ­: Residents react to peer intervention in complex ways. Residents reciprocated affirmations (B = 0.14, 95% confidence interval = 0.10, 0.18) and corrections (B = 0.20, 95% CI = 0.13, 0.25). Controlling for reciprocity, participants who received affirmations were more likely to affirm and correct peers (B = 0.10, 95% CI = 0.06, 0.15; B = 0.17, 95% CI = 0.10, 0.23), suggesting that the encouragement offered by affirmations leads to increased activity. Homophily by admission time occurred in both affirmations and corrections (B = 0.23, 95% CI = 0.10, 0.37; B = 0.51, 95% CI = 0.29, 0.74). Originality/value ­: While affirmations and corrections serve as vehicles for behavioral reinforcement and social learning, they also allow residents to interact in ways that strengthen social bonds.

Recovery homes: A social network analysis of Oxford Houses for Native Americans.

Social network data were collected among residents of an Oxford House (OH) recovery home, which was located on Suquamish Tribal territory. Data were collected on the social connections of eight male residents (including four Native Americans and four non-Native Americans) using a social network instrument. A number of social network relationship types were examined, including friendship, trust, and mentorship. Social network data assessed included diameter, reciprocity, the average path length, cohesion, density, transitivity, and centrality. Findings indicated that the OH provided residents a well-integrated network with multiple sources of friendship, trust, and mentors. This is of importance as recovery from substance abuse is facilitated when recovering individuals are provided stable and well-functioning networks that foster social support, access to resources, and mentorship.

Quitting Behaviors Among Dual Cigarette and E-Cigarette Users and Cigarette Smokers Enrolled in the Tobacco User Adult Cohort.

PURPOSE: We examined quitting behaviors among a cohort of dual users (cigarettes and electronic cigarettes [e-cigarettes]) and exclusive cigarette smokers for: (1) cigarette smoking reduction, (2) quit attempts, (3) abstinence from cigarettes, and (4) abstinence from all tobacco products. METHODS: Participants enrolled in the Tobacco User Adult Cohort and categorized as "daily" user of cigarettes and "daily" or "some days per week" use of e-cigarettes (ie, dual users; n = 88) or "daily" user of cigarettes only (ie, cigarette smokers; n = 617) served as the analytic sample. Participants were interviewed face to face every 6 months, through 18 months. Data on self-reported current product(s) used, cessation interest, quit attempts and abstinence from cigarettes, and all tobacco products were collected. RESULTS: No difference in reduction of cigarette consumption over time was noted between groups. Rates of reporting an attempt to quit all tobacco products (≥ 24 hours of not using any tobacco in an attempt to quit) also did not differ by group. Compared to cigarette smokers, dual users were more likely to report abstinence from cigarettes at 6 months (OR = 2.54, p = .045) but not at 12 or 18 months. There was no significant difference in abstinence from all tobacco products by group at 6, 12, or 18 months. CONCLUSIONS: Although dual use of e-cigarettes has been cited as a potential cessation tool for cigarette smokers, our findings indicated that this association was only observed in the short term. We also found no evidence of any association between dual use and eventual abstinence from all tobacco products. IMPLICATIONS: Our study observed that, in the natural environment, dual users of cigarettes and e-cigarettes were more likely than cigarette smokers to quit cigarettes in the short term but no more likely to quit using cigarettes and all tobacco products over time.

A promising recovery housing model for American Indian communities.

In 2016, two Oxford House (OH) recovery homes were established for the Suquamish Tribal reservation. A group of researchers interviewed house members and key individuals responsible for the creation of these two unique OHs. Because American Indians are an at-risk population for substance use disorders, our study explored whether an OH-type recovery home model could be successfully adapted to this population, given the specific nature of tribal cultures. Findings indicated that the residents, composed of both American Indians and non-American Indians, found these OHs to be supportive of recovery in general and with the values of American Indians. The tribal community's positive attitudes toward these recovery homes may have been due to similarities between the Suquamish Tribal Government and OH's democratic structures, with all individuals having a voice in the decision making process. The overall findings suggest that these types of culturally modified recovery settings on American Indian tribal lands could be an important resource for individuals dealing with substance use disorders.

Variations in support for secondhand smoke restrictions across diverse rural regions of the United States.

Significant disparities exist between rural-urban U.S. POPULATIONS: Besides higher smoking rates, rural Americans are less likely to be protected from SHS. Few studies focus across all regions, obscuring regional-level differences. This study compares support for SHS restrictions across all HHS regions. DATA: 2014/15 TUS-CPS; respondents (n = 228,967): 47,805 were rural residents and 181,162 urban. We examined bi-variates across regions and urban-rural adjusted odds ratios within each. Smoking inside the home was assessed along with attitudes toward smoking in bars, casinos, playgrounds, cars, and cars with kids. Urban respondents were significantly more supportive of all SHS policies: (e.g. smoking in bars [57.9% vs. 51.4%]; support for kids in cars [94.8% vs. 92.5%]. Greatest difference between urban-rural residents was in Mid-Atlantic (bar restrictions) and Southeast (home bans): almost 10% less supportive. Logistic regression confirmed rural residents least likely, overall, to support SHS in homes (OR = 0.78, 95% CI 0.74, 0.81); in cars (OR = 0.87, 95% CI 0.79, 0.95), on playgrounds (OR = 0.88, 95% CI.83, 0.94) and in bars OR = 0.88, 95% CI 0.85, 0.92), when controlling for demographics and smoking status. South Central rural residents were significantly less likely to support SHS policies-home bans, smoking in cars with kids, on playgrounds, in bars and casinos; while Heartland rural residents were significantly more supportive of policies restricting smoking in cars, cars with kids and on playgrounds. Southeast and South Central had lowest policy score with no comprehensive state-level SHS policies. Understanding differences is important to target interventions to reduce exposure to SHS and related health disparities.

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

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

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

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

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

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

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

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

The impact of a federal cigarette minimum pack price policy on cigarette use in the USA.

BACKGROUND: Increasing cigarette prices reduce cigarette use. The US Food and Drug Administration has the authority to regulate the sale and promotion-and therefore the price-of tobacco products. OBJECTIVE: To examine the potential effect of federal minimum price regulation on the sales of cigarettes in the USA. METHOD: We used yearly state-level data from the Tax Burden on Tobacco and other sources to model per capita cigarette sales as a function of price. We used the fitted model to compare the status quo sales with counterfactual scenarios in which a federal minimum price was set. The minimum price scenarios ranged from $0 to $12. RESULTS: The estimated price effect in our model was comparable with that found in the literature. Our counterfactual analyses suggested that the impact of a minimum price requirement could range from a minimal effect at the $4 level to a reduction of 5.7 billion packs sold per year and 10 million smokers at the $10 level. CONCLUSION: A federal minimum price policy has the potential to greatly benefit tobacco control and public health by uniformly increasing the price of cigarettes and by eliminating many price-reducing strategies currently available to both sellers and consumers.

A social-contextual investigation of smoking among rural women: multi-level factors associated with smoking status and considerations for cessation.

INTRODUCTION: The social-contextual model of tobacco control and the potential mechanisms of the maintenance or cessation of smoking behavior among disadvantaged women, including rural residents, have yet to be comprehensively studied. The purpose of this study was to determine the association between selected individual, interpersonal, workplace, and neighborhood characteristics and smoking status among women in Appalachia, a US region whose residents experience a disproportionate prevalence of tobacco-related health disparities. These findings may assist in efforts to design and test scientifically valid tobacco control interventions for this and other disadvantaged populations. METHODS: Women, 18 years of age and older, residing in three rural Ohio Appalachian counties, were recruited using a two-phase address-based sampling methodology for a cross-sectional interview-administered survey between August 2012 and October 2013 (N=408). Multinomial logistic regression was employed to determine associations between select multilevel factors (independent variables) and smoking status (dependent variable). The sample included 82 (20.1%) current smokers, 92 (22.5%) former smokers, and 234 (57.4%) women reporting never smoking (mean age 51.7 years). RESULTS: In the final multivariable multinomial logistic regression model, controlling for all other significant associations, constructs at multiple social-contextual levels were associated with current versus either former or never smoking. At the individual level, for every additional year in age, the odds of being a former or never smoker increased by 7% and 6% (odds ratio (OR) (95% confidence interval(CI)): 1.07 (1.0-1.11) and 1.06 (1.02-1.09)), respectively, as compared to the odds of being a current smoker. With regard to depression, for each one unit increase in the Center for Epidemiologic Studies Depression Scale score, the odds of being a former or never smoker were 5% and 7% lower (OR(95%CI): 0.95(0.91-0.999) and 0.93(0.88-0.98)), respectively. Five interpersonal factors were associated with smoking status. As the social influence injunctive norm score increased by one unit, indicating perception of smoking to be more acceptable, the odds of being a former or never smoker decreased by 23% and 30%, respectively. For every one unit increase in the social participation score, indicating past-year engagement in one additional activity type, the odds of being a former or never smoker increased by 17% and 36%, respectively. For every 10% increase in the percentage of social ties in the participant's advice network who smoked, the odds of being a former or never smoker were 24% and 28% less, respectively. For every 0.1 unit increase in the E/I index, indicating increasing homophily on smoking in one's social network, the odds of being a former or never smoker were 20% and 24% less, respectively, in the time network, and 18% and 20% less, respectively, in the advice network. At the neighborhood level, for every one unit increase in neighborhood cohesion score, indicating increasing cohesion, the odds of being a former smoker or never smoker were 12% and 14% less, respectively. CONCLUSIONS: These findings indicate that a social-contextual approach to tobacco control may be useful for narrowing a widening trajectory of smoking disparity for rural women. Interpersonal context, in particular, must be considered in the development of culturally targeted cessation interventions for Ohio Appalachian women.

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

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

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

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

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

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

Saving My Life: Dynamics of Peer and Staff Corrections Among Therapeutic Community Residents.

BACKGROUND: Therapeutic communities (TCs) maintain order and encourage behavior change through a system of peer corrections. This study is the first quantitative analysis of the dynamics of the exchange of peer corrections at TCs. OBJECTIVES: We applied longitudinal social network analysis to compare the reactions of TC residents to peer versus staff intervention, while analyzing dynamics of correction exchange among residents. METHOD: The data consisted of a large database of staff and peer affirmations and corrections at four therapeutic community units that occurred between the years 2006 and 2008. We modeled the data as a directed temporal social event network, using a generalized linear mixed effects model to analyze predictors of corrections among residents. RESULTS: Residents were more likely to send a correction following peer affirmations and corrections than following staff affirmations and corrections. Residents reciprocated corrections to individual peers. Autocorrelation was evident in both sending and receiving corrections and residents were more likely to send a correction after having sent an affirmation. Residents who arrived at roughly the same time were more likely to exchange corrections. Residents tended to send and receive more corrections in the middle 3 months of their treatment. European American residents and those with higher scores on the LSI-R were more likely to receive corrections than others. CONCLUSIONS: TC residents respond more strongly and more positively to peer than to staff intervention. The pattern of exchange of peer corrections in TCs is complex. This suggests possible paths to improved outcomes.