Identifying Novel Motivation Phase-Specific Cessation Targets for Youth Experiencing Homelessness in the United States.

INTRODUCTION: Of youth experiencing homelessness (YEH; 14-24 years old), 70%+ smoke combustible, commercial tobacco. Though many have tried to quit, most use ineffective methods. Drop-in centers for YEH are opportune places to link YEH to evidence-based treatment. Using the Phase-Based Model (PBM) for Cessation Research, the aim of this study was to identify "Motivation" phase-specific challenges impacting YEH's willingness to make a quit attempt-the goal of this cessation phase. AIMS AND METHODS: Surveys were interview administered with 96 past-week combusted tobacco users accessing drop-in services. Regression models were fit to confirm hypothesized challenges impacting YEH's willingness to quit. RESULTS: Moderate nicotine dependence was noted-a key Motivation phase cessation mechanism targeted-and was associated with population challenges including, but not limited to, replacing food with tobacco, accidental oxygen-deprivation events, and smoking to socialize. While 67.1% of participants made a past-year quit attempt, 45.8% expressed 30-day quit interest. Dimensions of coping with housing were associated with quit attempts and quit interest. Quit attempts were also associated with nicotine dependence, working, and smoking to socialize. Whereas, quit interest was associated with less endorsement of smoking to regulate affect and more endorsement to avoid danger. CONCLUSIONS: Though common challenges targeted in Motivation phase cessation exist among YEH, other challenges may also need to be addressed to promote quitting. IMPLICATIONS: Future research in optimizing evidence-based cessation access for YEH through drop-in centers may consider addressing the challenges of housing, food security, social context, violence, and neurotrauma sequela to bolster YEH willingness to make a quit attempt.

The CARE Health Advocacy Intervention Improves Trauma-Informed Practices at Domestic Violence Service Organizations to Address Brain Injury, Mental Health, and Substance Use.

OBJECTIVE: The aim of this study was to evaluate the impact that domestic violence (DV) service organizations' (SO) agency-wide adoption of CARE had on improving DVSO trauma-informed care (TIC) practices, overall, and in relation to addressing brain injury and mental health. CARE is an advocacy intervention designed to raise DVSOs' capacity to C ONNECT with survivors; A CKNOWLEDGE that head trauma, strangulation, and mental health challenges are common; R ESPOND by accommodating needs in services and providing targeted referrals; and E VALUATE effectiveness of response to meet survivors' stated concerns. We hypothesized that TIC would significantly improve among DVSO staff with the agency's use of CARE. SETTING/PARTICIPANTS/DESIGN: Pre- ( n = 53) and 1-year post-CARE ( n = 60) implementation online surveys were completed by staff at 5 DVSOs in Ohio from 2017 to 2019. MAIN MEASURES: Trauma-Informed Practice Scales (TIPS) were used to assess agency support and overall staff impression of implementing TIC; scales were modified to assess the use of TIC-practices related to head trauma, strangulation, mental health, suicide, and substance use. Attitudes Regarding Trauma-Informed Care (ARTIC-45) subscales assessed DVSO staff's endorsement of personal and organizational support in implementing TIC practices. Response options on the Survivor Defined Practice Scale (SDPS) were modified to gain staff insight into DVSO's ability to facilitate survivor empowerment. Differences in endorsement of TIC practices between pre- and post-CARE implementation were evaluated using regression models. RESULTS: DVSO agency environment ( P < .01) and overall staff impression ( P < .001) regarding implementing TIC practices, and in respect to head trauma ( P < .01), strangulation ( P < .01), mental health ( P < .01), suicide ( P = .04), and substance use ( P < .01), significantly improved with the agency's use of CARE. CARE increased DVSO staff's belief in personal and organizational support to implement TIC ( P < .01 and P = .02, respectively) and in their agency's ability to foster survivor empowerment ( P < .01). CONCLUSION: CARE improved TIC practices of DVSOs, overall, and to address brain injury and mental health.

The Role of Cigarillo Flavor in the Co-Use of Cigarillos and Cannabis among Young Adults.

Background: Research suggests flavor facilitates cigarillo use, but it is unknown if flavor impacts patterns of co-use of cigarillos and cannabis ("co-use"), which is common among young adult smokers. This study's aim was to determine the role of the cigarillo flavor in co-use among young adults. Methods: Data were collected (2020-2021) in a cross-sectional online survey administered to young adults who smoked ≥2 cigarillos/week (N = 361), recruited from 15 urban areas in the United States. A structural equation model was used to assess the relationship between flavored cigarillo use and past 30-day cannabis use (flavored cigarillo perceived appeal and harm as parallel mediators), including several social-contextual covariates (e.g., flavor and cannabis policies). Results: Most participants reported usually using flavored cigarillos (81.8%) and cannabis use in the past 30 days ("co-use") (64.1%). Flavored cigarillo use was not directly associated with co-use (p = 0.90). Perceived cigarillo harm (ß = 0.18, 95% CI = 0.06, 0.29), number of tobacco users in the household (ß = 0.22, 95% CI = 0.10, 0.33), and past 30-day use of other tobacco products (ß = 0.23, 95% CI = 0.15, 0.32) were significantly positively associated with co-use. Living in an area with a ban on flavored cigarillos was significantly negatively associated with co-use (ß = -0.12, 95% CI = -0.21, -0.02). Conclusions: Use of flavored cigarillos was not associated with co-use; however, exposure to a flavored cigarillo ban was negatively associated with co-use. Cigar product flavor bans may reduce co-use among young adults or have a neutral impact. Further research is needed to explore the interaction between tobacco and cannabis policy and use of these products.

Cancer disparities in the context of rurality: risk factors and screening across various U.S. rural classification codes.

PURPOSE: Prior cancer research is limited by inconsistencies in defining rurality. The purpose of this study was to describe the prevalence of cancer risk factors and cancer screening behaviors across various county-based rural classification codes, including measures reflecting a continuum, to inform our understanding of cancer disparities according to the extent of rurality. METHODS: Using an ecological cross-sectional design, we examined differences in cancer risk factors and cancer screening behaviors from the Behavioral Risk Factor Surveillance System and National Health Interview Survey (2008-2013) across rural counties and between rural and urban counties using four rural-urban classification codes for counties and county-equivalents in 2013: U.S. Office of Management and Budget, National Center for Health Statistics, USDA Economic Research Service's rural-urban continuum codes, and Urban Influence Codes. RESULTS: Although a rural-to-urban gradient was not consistently evident across all classification codes, the prevalence of smoking, obesity, physical inactivity, and binge alcohol use increased (all ptrend < 0.03), while colorectal, cervical and breast cancer screening decreased (all ptrend < 0.001) with increasing rurality. Differences in the prevalence of risk factors and screening behaviors across rural areas were greater than differences between rural and urban counties for obesity (2.4% vs. 1.5%), physical activity (2.9% vs. 2.5%), binge alcohol use (3.4% vs. 0.4%), cervical cancer screening (6.8% vs. 4.0%), and colorectal cancer screening (4.4% vs. 3.8%). CONCLUSIONS: Rural cancer disparities persist across multiple rural-urban classification codes, with marked variation in cancer risk factors and screening evident within rural regions. Focusing only on a rural-urban dichotomy may not sufficiently capture subpopulations of rural residents at greater risk for cancer and cancer-related mortality.

Micro-scale Experimental System Coupled with Fluorescence-based Estimation of Fungal Biomass to Study Utilisation of Plant Substrates.

The degradation capacity and utilisation of complex plant substrates are crucial for the functioning of saprobic fungi and different plant symbionts with fundamental functions in ecosystems. Measuring the growth capacity and biomass of fungi on such systems is a challenging task. We established a new micro-scale experimental setup using substrates made of different plant species and organs as media for fungal growth. We adopted and tested a reliable and simple titration-based method for the estimation of total fungal biomass within the substrates using fluorescence-labelled lectin. We found that the relationship between fluorescence intensity and fungal dry weight was strong and linear but differed among fungi. The effect of the plant organ (i.e. root vs. shoot) used as substrate on fungal growth differed among plant species and between root endophytic fungal species. The novel microscale experimental system is useful for screening the utilisation of different substrates, which can provide insight into the ecological roles and functions of fungi. Furthermore, our fungal biomass estimation method has applications in various fields. As the estimation is based on the fungal cell wall, it measures the total cumulative biomass produced in a certain environment.

"I Smoked That Cigarette, and It Calmed Me Down": A Qualitative Analysis of Intrapersonal, Social, and Environmental Factors Influencing Decisions to Smoke Among Youth Experiencing Homelessness.

INTRODUCTION: Approximately 70% of youth experiencing homelessness smoke cigarettes; many try to quit and are interested in formal smoking cessation programs. The purpose of this study was to describe the intrapersonal, social, and environmental contexts associated with the most recent smoking experience among youth experiencing homelessness and (2) identify differences in contextual factors by age and willingness to quit. METHODS: Thirty-six youth experiencing homelessness aged 14-24 years and who reported current smoking were recruited from a drop-in center in a Midwestern city. Semi-structured in-person interviews were analyzed to understand smoking behaviors. RESULTS: Two-thirds of participants reported stress and nicotine dependence as primary reasons for smoking, and older youth (aged 18-24 years) reported smoking to de-escalate negative emotions associated with stressful events. For 25% of participants, and especially older youth, smoking was described as part of a routine. Over 80% of participants smoked outside at the homeless drop-in center or the places they lived. Social prompts from drop-in center peers regularly preempted smoking. Younger youth (aged 14-17 years) reported smoking socially while older youth were more likely to smoke alone. CONCLUSIONS: For youth experiencing homelessness, smoking is integrated into daily life and is often used to manage stress associated with homelessness and engage socially with homeless peers. Multicomponent interventions to reduce structural stressors specific to homelessness, change social smoking norms (environmental and social context), and address stress management and nicotine dependence (intrapersonal context) are needed to support smoking cessation among youth experiencing homelessness. IMPLICATIONS: Youth experiencing homelessness overwhelmingly described how daily stressors associated with homelessness and nicotine dependence preceded recent smoking. Older youth (aged 18-24 years) also reported smoking as "routine", which likely underscores nicotine dependence in this group. Younger youth (aged 14-17 years) described social smoking. Researchers must develop optimized multilevel interventions to support youth experiencing homelessness who want to quit smoking. Interventions directly targeting social determinants of stress (e.g., poverty, housing instability, food insecurity) and linkages to supportive services are needed. Complementary strategies to address stress coping and nicotine dependence (intrapersonal context) and social smoking norms (social and environmental context) are also necessitated.

How CARE Tools Are Being Used to Address Brain Injury and Mental Health Struggles With Survivors of Domestic Violence.

INTRODUCTION: CARE (Connect, Acknowledge, Respond, and Evaluate) is an advocacy framework developed for domestic violence service organization (DVSO) providers to address and accommodate domestic violence (DV) survivors with brain injury and mental health struggles. The CARE tools were designed for use by advocates and include the Just Breathe booklet, the Head Injury education card, and the Invisible Injuries booklet. OBJECTIVE: The purpose of this study was to report findings on how CARE tools are being used by DVSO providers as well as their impact on DVSO advocacy practice. METHODS: Post-CARE retrospective process evaluation online surveys (n = 60) and focus groups (n = 10 groups; 57 advocates) were conducted with consenting staff at 5 DVSOs in Ohio who partnered with the state coalition to develop and evaluate CARE, overseen by a university research partner. Rigorous, iterative coding qualitative analysis methods, endorsed by the Centers for Disease Control and Prevention, were used (Cohen's κ = 0.903 [stage 1] and 0.810 [stage 2]). RESULTS: The use of CARE tools has been integral to DVSO providers' implementation of the CARE advocacy framework. DVSO advocates are using CARE tools to Connect with self, survivors, and other systems; to Acknowledge that head trauma and mental health struggles are common among survivors and that ongoing education and self-care are necessary for advocates. Advocates have been able to provide a more holistic Response through accommodation within DVSOs and referral to other providers, often by using the CARE tools, including the Head Injury education card. CONCLUSION: CARE tools were designed for lay use to address head trauma, strangulation, and mental health struggles with DV survivors and are free for download at the Center on Partner Inflicted Brain Injury website: https://www.odvn.org/brain-injury. More widespread use of these tools by advocates has the potential to improve services for DV survivors and address what have historically been invisible injuries and mental health struggles in the population.

Characterizing tobacco and marijuana use among youth combustible tobacco users experiencing homelessness - considering product type, brand, flavor, frequency, and higher-risk use patterns and predictors.

BACKGROUND: Cigarette smoking is three times more prevalent among youth experiencing homelessness compared with the general population. Co-use of tobacco and marijuana is also common. The aim of this study is to characterize tobacco and marijuana use among youth experiencing homelessness who use combustible tobacco in a Midwestern city to inform smoking cessation intervention. METHODS: This study included 96 youth (ages 14-24 years; 52% male, 39% female, 5% transgender/non-binary) attending a homeless drop-in center who had used at least one combustible tobacco product in the past week. We assessed past-month use of tobacco products and marijuana, other product use characteristics (e.g., frequency, brand and flavor), and psychosocial predictors of more frequent (i.e., daily) use of combustible tobacco and marijuana. RESULTS: Most youth experiencing homelessness with past-week combustible tobacco use had used cigarettes (n = 85, 88.5%), cigars (n = 89, 92.7%), and marijuana (n = 82, 85.4%) in the past month. One-third (n = 34) used electronic vapor products (EVPs), 19.8% (n = 19) smoked hookah, and 11.5% (n = 11) used smokeless tobacco (ST). Most marijuana users co-administered with tobacco (n = 67, 69.8%). Daily combustible tobacco smoking was associated with having a child and smoking out of boredom/habit. Daily marijuana use was associated with using substances to cope with one's housing situation. Newport (n = 66, 72.5%) and Black & Mild (n = 48, 51.1%) were the most popular brands of cigarettes and cigars among ever users. Most non-combustible tobacco ever users reported not having a usual brand (EVPs: n = 51, 73.9%; ST: n = 16, 57.1%). Cigar smokers reported the most varied selection of flavors. CONCLUSIONS: Young combustible tobacco users experiencing homelessness engage in high-risk use patterns, including poly-tobacco use, co-use of tobacco with marijuana, and frequent combustible product use. Interventions that consider the full context of tobacco and marijuana use are needed to support smoking cessation in this population.

The Type and Timing of Child Maltreatment as Predictors of Adolescent Cigarette Smoking Trajectories.

Background: There is limited research examining the association between child maltreatment and cigarette smoking as a specific type of adolescent substance use, and research examining high-risk samples and variations based on maltreatment type and timing remain sparse. Objectives: The primary aim of the study was to examine the relationship between child maltreatment and cigarette smoking trajectories. Methods: Latent class growth analysis and multinomial logistic regression were performed on 903 youth drawn from the Longitudinal Studies of Child Abuse and Neglect (LONGSCAN). Results: Three distinct classes of cigarette smoking trajectories were identified: (1) Stable no/low cigarette use (61%); (2) Gradually increasing cigarette use (30%); and (3) Sharply increasing cigarette use (9%). Physical abuse during early childhood and adolescence predicted membership in the sharply increasing cigarette use class. Neglect during early childhood predicted membership in the gradually increasing cigarette use class. Conclusions: Findings suggest that interventions for adolescent cigarette smoking should integrate trauma-informed approaches. Further, the results highlight early childhood and adolescence as particularly vulnerable periods with respect to the influence of physical abuse and neglect on cigarette smoking, pointing to the need for additional maltreatment prevention efforts during these developmental stages.

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.

Effectiveness of Two Community Health Worker Models of Tobacco Dependence Treatment Among Community Residents of Ohio Appalachia.

INTRODUCTION: Community health workers (CHW) may be effective in the delivery of tobacco dependence treatment with underserved groups. This study evaluated two evidence-based CHW models of treatment. It was hypothesized that smokers assigned to a CHW face-to-face condition would have higher abstinence at 12-month posttreatment than smokers enrolled in CHW referral to a state-sponsored quitline condition. Intrapersonal and treatment-related factors associated with abstinence at 12 months were determined. METHODS: A group-randomized trial was conducted with residents of 12 Ohio Appalachian counties with counties (n = 6) randomized to either a CHW face-to-face (F2F) or CHW quitline (QL) condition. Both conditions included behavioral counseling and free nicotine replacement therapy for 8 weeks. Follow-up data were collected at 3-, 6-, and 12-month posttreatment. Biochemically validated abstinence at 12 months served as the primary outcome. RESULTS: Seven hundred and seven participants were enrolled (n = 353 CHWF2F; n = 354 CHWQL). Baseline sample characteristics did not differ by condition. Using an intent-to-treat analysis (85.4% retention at 12 months), 13.3% of CHWF2F participants were abstinent at 12 months, compared to 10.7% of CHWQL members (OR = 1.28; 95% confidence interval [CI] = 0.810, 2.014; p = .292). No differences in abstinence were noted at 3 or 6 months by condition. Age, marital status, and baseline levels of cigarette consumption, depressive symptoms, and self-efficacy for quitting in positive settings were associated with abstinence, as was counseling dose during treatment. CONCLUSIONS: This research adds to the body of science evaluating the effectiveness of CHW models of tobacco dependence treatment. Both approaches may offer promise in low-resource settings and underserved regions. IMPLICATIONS: This 12-county community-based group-randomized trial in Ohio Appalachia adds to the body of science evaluating the effectiveness of CHW models of tobacco dependence treatment. Both CHW approaches may offer promise in low-resource settings and underserved regions. These findings are useful to national, state, and local tobacco control agencies, as they expand delivery of preventive health care services postadoption of the Affordable Care Act in the United States.

A Descriptive Report of Electronic Cigarette Use After Participation in a Community-Based Tobacco Cessation Trial.

INTRODUCTION: Smokers are using electronic cigarettes, also known as e-cigarettes, as a cessation aid, despite uncertainty about their efficacy. This report describes the association between use of e-cigarettes before and after cessation treatment and tobacco abstinence at 12 months. It also presents characteristics of e-cigarette users and reasons for use. METHODS: A longitudinal observational secondary analysis of self-reported e-cigarette use was conducted among adult Appalachian smokers enrolled in a community-based tobacco dependence treatment trial (n = 217). Data were collected at baseline, 3, 6, and 12 months following treatment. The primary outcome measure was biochemically-confirmed 7-day point prevalence tobacco abstinence at 12 months post-treatment. RESULTS: One in five participants reported using e-cigarettes post-treatment. Baseline sociodemographic and tobacco-related characteristics did not differ by e-cigarette use. Primary reasons for e-cigarette use included help in quitting, help in cutting down on cigarettes, and not as bad for health. At the 12 month follow-up, tobacco abstinence was significantly lower among post-treatment e-cigarette users (4.7%) than nonusers (19.0%); (OR = 0.21 95% CI: 0.05-0.91, p = .021). Baseline use was not associated with 12-month abstinence. CONCLUSIONS: Among adult Appalachian smokers enrolled in community-based tobacco cessation treatment, use of e-cigarettes post-treatment was associated with lower abstinence rates at 12 months. IMPLICATIONS: This descriptive report of electronic cigarette use after participation in a community-based group randomized tobacco dependence treatment trial adds to the body of science examining e-cigarette use and cessation. Post-treatment e-cigarette use was associated with less success in achieving abstinence at 12 months, as compared to nonuse. At 3 months post-treatment, the majority of those who reported use of e-cigarettes did so to assist with cessation.

Risk perceptions of smokeless tobacco among adolescent and adult users and nonusers.

The recent growth in smokeless tobacco (ST) consumption has raised questions about consumer risk perceptions of ST products, especially in high-risk vulnerable populations. This qualitative study examined risk perceptions of ST among adolescent and adult users and nonusers in Ohio Appalachia. Focus groups and interviews were held with adolescents (n = 53; M age = 17 years) and adults (n = 63; M age = 34 years) from four Ohio Appalachian counties. Participants were asked about their perceptions of ST-related health risks, ST safety, and the relative safety of ST compared with cigarettes. Transcriptions were coded independently by two individuals. Overall, participants were knowledgeable about health problems from ST use (e.g., oral cancers, periodontal disease). Nearly all participants stated that ST use is not safe; however, there was disagreement about its relative safety. Some perceived all tobacco products as equally harmful; others believed that ST is safer than cigarettes for either the user or those around the user. Disagreements about ST relative safety may reflect mixed public health messages concerning the safety of ST. Comprehensive consumer messages about the relative safety of ST compared with cigarettes are needed. Messages should address the effect of ST on the health of the user as well as those exposed to the user.

Adolescent and adult perceptions of traditional and novel smokeless tobacco products and packaging in rural Ohio.

OBJECTIVE: As smokeless tobacco (ST) marketing increases and new products emerge on the market, very little is known about consumer perceptions of ST products. To inform development of future ST counter-marketing approaches, this qualitative study examined consumer perceptions of traditional and novel ST products and packaging. METHODS: Focus groups and qualitative interviews were held with adolescent (n=23; mean age of 17 years) and adult (n=38; mean age of 29 years) male ST users from rural Ohio counties. Participants were shown a variety of traditional (eg, Copenhagen, Timber Wolf) and novel (eg, Camel Snus, Orbs) ST products and asked about perceptions of these products and their packaging. Transcriptions were coded independently for common themes by two individuals. FINDINGS: Adolescents and adults generally had similar beliefs and reactions about ST products. While participants were familiar with a variety of traditional ST products, Copenhagen was the most frequently used product. Perceptions of quality and price of traditional products were closely tied to product taste and packaging material. Colours, design and size of ST packaging appealed to participants and influenced decisions to purchase. Adults believed novel ST products had a weak taste and were targeted at untraditional ST users. While the vast majority was unfamiliar with dissolvable tobacco, adolescents noted that they would be more convenient to use during school than traditional ST. CONCLUSIONS: Packaging has a significant role in shaping perceptions of ST and consumer behaviour. Regulation of product packaging such as shape, size and images should be part of comprehensive tobacco control.

How Advocates Use CARE to Accommodate the Needs of Domestic Violence Survivors Seeking Services With Brain Injuries and Mental Health Challenges: A Process Evaluation.

We evaluated the implementation of Connect, Acknowledge, Respond, and Evaluate (CARE), an organization-level intervention, to accommodate the health needs of survivors, including brain injury. Participants were staff or administrators at agencies serving domestic violence (DV) survivors (n = 57 advocates; n = 5 agencies). Process evaluation focus groups (n = 10 groups) were conducted. Two researchers coded/analyzed focus group transcripts using grounded theory. The use of CARE increased advocate awareness/knowledge of brain injury among survivors leading to improvements to the agencies' provision of structural and functional social support to survivors. CARE is a valuable resource to accommodate survivors, thereby improving staff's perception of their ability to provide trauma-informed service provision for DV survivors.

A Randomized Clinical Trial of a Quitline Vaping Cessation Intervention: Baseline Characteristics of Young Adult Exclusive E-Cigarette Users Seeking Treatment.

Despite interest in quitting vaping among young adults (YAs), little is known about characteristics of e-cigarette (EC) users seeking treatment. In this study, YAs aged 18-24 living in the United States interested in vaping cessation treatment were recruited to complete an online survey regarding demographics and EC use. Primary eligibility criteria were EC use on at least 20 days per month (no other tobacco use), and interest in quitting in the next month. We report descriptive statistics for those who did and did not complete a mandatory coaching call (n = 981). In this sample, most EC users reported high nicotine dependence, a history of unsuccessful quit attempts (including 29.4% with previous NRT use), along with stress, anxiety, and depression. There were few meaningful differences in demographics, EC use behaviors, or behavioral health factors between those who engaged with a phone coaching call (fully enrolled in study; n = 508), and those who did not (n = 473). YAs demonstrated interest in vaping cessation support, but there were no clear characteristics for the half who did not complete a coaching call. Vaping cessation program designers should consider tailoring for the self-reported behavioral health concerns present in this population.

History of dating violence and the association with late adolescent health.

BACKGROUND: The present investigation expands upon prior studies by examining the relationship between health in late adolescence and the experience of physical/sexual and non-physical dating violence victimization, including dating violence types that are relevant to today's adolescents (e.g., harassment via email and text messaging). We examined the relationship between physical/sexual and non-physical dating violence victimization from age 13 to 19 and health in late adolescence/early adulthood. METHODS: The sample comprised 585 subjects (ages 18 to 21; mean age, 19.8, SD = 1.0) recruited from The Ohio State University who completed an online survey to assess: 1) current health (depression, disordered eating, binge drinking, smoking, and frequent sexual behavior); and 2) dating violence victimization from age 13 to 19 (retrospectively assessed using eight questions covering physical, sexual, and non-physical abuse, including technology-related abuse involving stalking/harassment via text messaging and email). Multivariable models compared health indicators in never-exposed subjects to those exposed to physical/sexual or non-physical dating violence only. The multivariable models were adjusted for age and other non-dating abuse victimization (bullying; punched, kicked, choked by a parent/guardian; touched in a sexual place, forced to touch someone sexually). RESULTS: In adjusted analyses, compared to non-exposed females, females with physical/sexual dating violence victimization were at increased risk of smoking (prevalence ratio = 3.95); depressive symptoms (down/hopeless, PR = 2.00; lost interest, PR = 1.79); eating disorders (using diet aids, PR = 1.98; fasting, PR = 4.71; vomiting to lose weight, PR = 4.33); and frequent sexual behavior (5+ intercourse and oral sex partners, PR = 2.49, PR = 2.02; having anal sex, PR = 2.82). Compared to non-exposed females, females with non-physical dating violence only were at increased risk of smoking (PR = 3.61), depressive symptoms (down/hopeless, PR = 1.41; lost interest, PR = 1.36), eating disorders (fasting, PR = 3.37; vomiting, PR = 2.66), having 5+ intercourse partners (PR = 2.20), and having anal sex (PR = 2.18). For males, no health differences were observed for those experiencing physical/sexual dating violence compared to those who did not. Compared to non-exposed males, males with non-physical dating violence only were at increased risk of smoking (PR = 3.91) and disordered eating (fasting, using diet aids, vomiting, PR = 2.93). CONCLUSIONS: For females, more pronounced adverse health was observed for those exposed to physical/sexual versus non-physical dating violence. For both females and males, non-physical dating violence victimization contributed to poor health.

Brain Injury Is Prevalent and Precedes Tobacco Use among Youth and Young Adults Experiencing Homelessness.

70%+ of youth and young adults experiencing homelessness (YYEH; 14-24 years old) smoke combustible tobacco. Little is known about the prevalence of acquired brain injury (ABI) among youth and young adult smokers experiencing homelessness (YYSEH) and its impact on tobacco use progression-the aim of our study. Through an interviewer-administered survey, YYSEH were asked about timing of tobacco use; exposure to causes of ABI; including brain oxygen deprivation (BOD; strangulation; accidental; choking games) and blunt force head trauma (BFHT; intentional; shaken violently; accidental); and perpetrators of intentional assault. Participants (n = 96) were on average 22 years old and from populations who experience structural disparities; including those minoritized by race (84.4%) and gender/sexual orientation (26.0%). In total, 87% of participants reported at least one exposure to BFHT and 65% to BOD. Intentional injury was more common than accidental. Furthermore, 60.4% of participants (n = 59) were classified as having ABI using the Brain Injury Severity Assessment. A significant proportion of YYSEH living with ABI were exposed to both BFHT and BOD prior to trying (68.5%, p = 0.002) and to first regular use (82.8%, p < 0.001) of tobacco. Among YYSEH with ABI; injury exposure occurred a median of 1 and 5 years before age of first regular tobacco use, dependent on injury mechanism. ABI from intentional violence is prevalent and precedes tobacco use among YYSEH.

Dating violence victimization across the teen years: abuse frequency, number of abusive partners, and age at first occurrence.

BACKGROUND: Prior longitudinal studies have shown high cumulative dating violence exposure rates among U.S adolescents, with 36 percent of males and 44 percent to 88 percent of females experiencing victimization across adolescence/young adulthood. Despite promising information characterizing adolescents' dating violence experiences longitudinally, prior studies tended to concentrate on physical and sexual types of violence only, and did not report information on the number of times dating violence was experienced across multiple abusive partners. We used a method similar to the timeline follow-back interview to query adolescents about dating violence victimization from age 13 to 19-including dating violence types (physical, sexual, and psychological), frequency, age at first occurrence, and number of abusive partners. METHODS: A total of 730 subjects were randomly sampled from university registrar records and invited to complete an online survey, which utilized methods similar to the timeline follow-back interview, to retrospectively assess relationship histories and dating violence victimization from age 13 to 19 (eight questions adapted from widely-used surveys covering physical, sexual, and psychological abuse). Then, for each dating violence type, we asked about the number of occurrences, number of abusive partners, and age at first occurrence. Of 341 subjects who completed the survey, we included 297 (64 percent females; 36 percent males) who had a dating partner from age 13 to 19. RESULTS: Fully 64.7 percent of females and 61.7 percent of males reported dating violence victimization between age 13 and 19, with most experiencing multiple occurrences. More than one-third of abused females had two or more abusive partners: controlling behavior (35.6 percent); put downs/name calling (37.0); pressured sex (42.9); insults (44.3); slapped/hit (50.0); and threats (62.5). Males also had two or more abusive partners, as follows: controlling behavior (42.1 percent); insults (51.2); put downs (53.3); threats (55.6); and unwanted calls/texts/visits (60.7). Among abused females, 44.7 percent first experienced controlling behavior between age 13 and 15, whereas the majority (62.5 percent) first experienced pressured sex between age 16 and 17. Among males, for most abuse types, 16 percent to 30 percent of victimization began before age 15. CONCLUSIONS: Our study adds information to a substantial, but still growing, body of literature about dating violence frequency, age of occurrence, and number of abusive partners among adolescents.