Assessing the Pragmatic Effectiveness and Implementation of Click City®: Tobacco:A School-Based Prevention Program Targeting Youth Cigarette and E-cigarette Use.

INTRODUCTION: Given the rapid increase in the prevalence of e-cigarette use among youth, we updated Click City®: Tobacco, an existing, efficacious, online tobacco prevention program for 5th graders with a 6th-grade booster, to also target e-cigarette use. METHOD: To evaluate the effectiveness of the updated 5th-grade program within a "real world" setting, we conducted a pragmatic randomized trial with 5th grade students in 43 schools across Arizona and Oregon, assessing change in intentions and willingness to use e-cigarettes/cigarettes, from baseline to one-week post-intervention. Students in intervention schools (n = 1327) received the updated version of Click City®: Tobacco; students in control schools (n = 1346) received their usual tobacco prevention curriculum. RESULTS: Students in intervention schools significantly decreased their intentions and willingness to use e-cigarettes and cigarettes, compared to students in control schools. The intervention also significantly changed all targeted etiological mechanisms predictive of intentions and willingness. The intervention was more effective for at-risk students, as defined by student's previous tobacco use, current family use of tobacco, and/or high in sensation-seeking. The effects of the intervention on all outcomes were similar as a function of state, gender, ethnicity, and historical timing (prior to COVID-19 pandemic school closures vs. after schools re-opened). Close to 90% of the students in the intervention condition completed the entire program, supporting fidelity of implementation, and teachers reported satisfaction with the program. CONCLUSIONS: Findings suggest that Click City®: Tobacco is effective for all 5th grade students and can be delivered with fidelity across school settings. IMPLICATIONS: The results of a randomized pragmatic effectiveness trial showed that the updated Click City®: Tobacco program decreased intentions and willingness to both vape e-cigarettes and smoke cigarettes among 5th grade students, particularly for those at high risk. Program effectiveness and lack of differences due to factors such as state, gender, ethnicity, and historical timing has universal implications, suggesting that all students can benefit from this program. Click City®: Tobacco received high ratings of program satisfaction from teachers and was implemented with fidelity. Findings suggest that Click City®: Tobacco is effective and can be easily implemented in schools.

Individual-Level Trajectories of Religiosity during Adolescence and Their Implications for Purpose.

Cohort-comparison studies suggest that adolescent religiosity has been declining over recent decades; however, work is needed on individual differences in patterns of change in religiosity throughout adolescence. The current study seeks to evaluate religiosity trends for adolescents as they transition from 6th to 12th grade, using seven annual waves of data, and whether these patterns of change were associated with later sense of purpose. Participants (n = 824; 50.7% female; 85.1% Caucasian) completed annual measures of religiosity from 6th to 12th grade, and a measure of sense of purpose at age 21 as part of the Oregon Youth Substance Use Project. Findings from latent growth models suggest both a mean-level decline in religiosity as well as individual differences in patterns of change across time. Furthermore, the intercept and change in religiosity throughout adolescence positively predicted sense of purpose at age 21. Results are discussed with respect to how individual differences occur in religiosity, and what that means for purpose development throughout adolescence.

Planning for a pandemic: Mitigating risk to radiation therapy service delivery in the COVID-19 era.

The novel coronavirus (COVID-19) has rapidly impacted all of our lives following its escalation to pandemic status on 11 March 2020. Government guidelines and restrictions implemented to mitigate the risk of COVID-19 community transmission have forced radiation therapy departments to promptly adjust to the significant impact on our ability to deliver best clinical care. The inherent nature of our tri-partied professions relies heavily on multidisciplinary teamwork and patient-clinician interactions. Teamwork and patient interaction are critical to the role of a radiation therapist. The aim of this paper is to describe the experience of the Peter MacCallum Cancer Centre's (Peter Mac) radiation therapy services during the preliminary stages of the COVID-19 pandemic in minimising risk to patients, staff and our clinical service. Four critical areas were identified in developing risk mitigation strategies across our service: (a) Workforce planning, (b) Workforce communication, (c) Patient safety and wellbeing, and (d) Staff safety and wellbeing. Each of these initiatives had a focus on continuum of clinical care, whilst minimising risk of cross infection for our radiation therapy workforce and patients alike. Initiatives included, but were not limited to, establishing COVID-Eclipse clinical protocols, remote access to local applications, implementation of Microsoft Teams, personal protective equipment (PPE) guidelines and virtual 'Division of Radiation Oncology' briefing/updates. The COVID-19 pandemic has dictated change in conventional radiation therapy practice. It is hoped that by sharing our experiences, the radiation therapy profession will continue to learn, adapt and navigate this period together, to ensure optimal outcomes for ourselves and our patients.

Long-term biosolids planning with an operational mega reservoir for combined sewer overflow-impacted stormwater capture.

The Metropolitan Water Reclamation District of Greater Chicago adopted the Tunnel and Reservoir Plan (TARP) to reduce combined sewer overflow (CSO) events in the Chicago region. The Thornton Composite Reservoir (TCR) became operational in 2015 providing an additional 30 million m3 of CSO-impacted stormwater capacity. In the United States, no other mega reservoirs are in operation to provide as a reference to study the long-term impacts of biosolids operations in water resource recovery facilities. The mean daily volume pumped from the Calumet TARP system to the Calumet Plant increased 144-238 m3 from 2012-2014 to 273-360 m3 from 2016-2018. Overall annual digester feed solids for the 2016-2018 post-TCR period were 28,182 Mg, which was 11 percent less than the mean for the 2012-2014 period of 31,745 Mg. Annual digester draw solids for the 2016-2018 post-TCR period were 19,422 Mg, which were 4 percent less than the 2012-2014 pre-TCR period mean of 20,190 Mg. This paper demonstrated a decrease in digester feed loading to the Calumet Plant and, ultimately, a decrease in digester draw solids with an overall increase in plant and TARP flow in the years following operation of the TCR for the capture and treatment of CSO-impacted stormwater. PRACTITIONER POINTS: Reservoirs capturing combined sewer overflow-impacted stormwater improve water quality of local waterways. Mega reservoirs may impact solids loading to water resource recovery facilities. Hydraulic loading to water resource recovery facilities may be substantial with mega reservoirs.

Effect of a Responsiveness-Based Support Intervention on Smokeless Tobacco Cessation: The UCare-ChewFree Randomized Clinical Trial.

INTRODUCTION: Partner behaviors and attitudes can motivate or undermine a tobacco user's cessation efforts. We developed a multimedia intervention, UCare (Understanding-CAring-REspect) for women who wanted their male partner to quit smokeless tobacco (ST), based on perceived partner responsiveness-the empirically based theory that support is best received when the supporter conveys respect, understanding, and caring. METHODS: One thousand one hundred three women were randomized to receive either immediate access to the UCare website and printed booklet (Intervention; N = 552), or a Delayed Treatment control (N = 551). We assessed supportive behaviors and attitudes at baseline and 6-week follow-up, and the ST-using partner's abstinence at 6 weeks and 7.5 months (surrogate report). RESULTS: For partners of women assigned to Intervention, 7.0% had quit all tobacco at 7.5 months, compared with 6.6% for control (χ2 (1, n = 1088) = .058, p = .810). For partners of women completing the intervention, 12.4% had quit all tobacco at 7.5 months, compared with 6.6% for Delayed Treatment (χ2 (1, n = 753) = 6.775, p = .009). A previously reported change in responsiveness-based behaviors and instrumental behaviors at 6 weeks mediated 7.5-month cessation, and change in responsiveness-based attitudes mediated the change in responsiveness-based behaviors, indirectly increasing cessation. CONCLUSIONS: A responsiveness-based intervention with female partners of male ST users improved supportive attitudes and behaviors, leading to higher cessation rates among tobacco users not actively seeking to quit. The study demonstrates the potential for responsiveness as a basis for effective intervention with supporters. This approach may reach tobacco users who would not directly seek help. IMPLICATIONS: This study demonstrates the value of a responsiveness-based intervention (showing respect, understanding, and caring) in training partners to provide support for a loved one to quit ST. In a randomized clinical trial, 1,103 women married to or living with a ST user were randomized to receive the UCare-ChewFree intervention (website + booklet) or a Delayed Treatment control. Women completing the intervention were more likely to improve their behaviors and attitudes, and change in behaviors and attitudes mediated cessation outcomes for their partners, who had not enrolled in the study and may not have been seeking to quit. TRIAL REGISTRATION: ClinicalTrials.gov NCT01885221.

Parent-Child Conflict during Elementary School as a Longitudinal Predictor of Sense of Purpose in Emerging Adulthood.

Having a sense of purpose is viewed as a benchmark of adaptive development. Though adolescence and emerging adulthood are viewed as central periods for the development of a purpose, work still is needed to understand the childhood factors that influence this developmental process. The current study provides an initial investigation into whether parent-child conflict during elementary school predicts later sense of purpose, assessed during emerging adulthood (mean age: 21.01 years; range: 19.97-23.53). The sample included 1074 students (50% female), and their parents, who both reported on their levels of parent-child conflict during grades 1-5. Higher levels of parent-child conflict were associated with lower levels of purpose in emerging adulthood. Moreover, the study examined whether these effects remained when predicting the variance unique to purpose while accounting for other indicators of well-being in emerging adulthood. Bi-factor models demonstrated that the child's perception of mother-child conflict has a unique prospective effect on purpose in emerging adulthood, above and beyond its negative association with general well-being. The findings are discussed with respect to how positive parent-child relationships may prove important for starting youth on the path to purpose.

A Multimedia Support Skills Intervention for Female Partners of Male Smokeless Tobacco Users: Use and Perceived Acceptability.

Background: UCare is a new multimedia (website+booklet) intervention for women who want their male partner to quit their use of smokeless tobacco. The intervention is based on research showing that perceived partner responsiveness to social support is highest when the supporter conveys respect, understanding, and caring in their actions. The website included both didactic and interactive features, with optional video components, and special activities to help women develop empathy for nicotine addiction. The booklet reinforced the website content, encouraged women to use the website, and served both as a physical reminder of the intervention and a convenient way to share the information with her partner. Objective: The objective of this study was to describe the utilization and acceptability of a multimedia intervention among women seeking to support their partner in quitting smokeless tobacco. Lessons learned with respect to design considerations for online interventions are also summarized. Methods: We present the evaluation of the intervention components' use and usefulness in a randomized trial. Results: In the randomized clinical trial, more than 250,000 visits were made to the website in a 2-year period, with the vast majority from mobile devices. Of the 552 women randomized to receive the intervention, 96.9% (535/552) visited the website at least once, and 30.8% (170/552) completed the core website component, "The Basics." About half of the women (287/552) used the interactive "Take Notes" feature, and 37% (204/552) used the checklists. Few women used the post-Basics features. At 6 weeks, 40.7% (116/285) reported reading the printed and mailed booklet. Website and booklet use were uncorrelated. User ratings for the website and booklet were positive overall. Conclusions: Intervention website designers should consider that many users will access the program only once or twice, and many will not complete it. It is also important to distinguish between core and supplemental features and to consider whether the primary purpose is training or support. Furthermore, printed materials still have value. Trial Registration: ClinicalTrials.gov NCT01885221; https://clinicaltrials.gov/ct2/show/NCT01885221 (Archived by WebCite at http://www.webcitation.org/6zdIgGGtx).

Association Between Initial Use of e-Cigarettes and Subsequent Cigarette Smoking Among Adolescents and Young Adults: A Systematic Review and Meta-analysis.

Importance: The public health implications of e-cigarettes depend, in part, on whether e-cigarette use affects the risk of cigarette smoking. Objective: To perform a systematic review and meta-analysis of longitudinal studies that assessed initial use of e-cigarettes and subsequent cigarette smoking. Data Sources: PubMed, EMBASE, Cochrane Library, Web of Science, the 2016 Society for Research on Nicotine and Tobacco 22nd Annual Meeting abstracts, the 2016 Society of Behavioral Medicine 37th Annual Meeting & Scientific Sessions abstracts, and the 2016 National Institutes of Health Tobacco Regulatory Science Program Conference were searched between February 7 and February 17, 2017. The search included indexed terms and text words to capture concepts associated with e-cigarettes and traditional cigarettes in articles published from database inception to the date of the search. Study Selection: Longitudinal studies reporting odds ratios for cigarette smoking initiation associated with ever use of e-cigarettes or past 30-day cigarette smoking associated with past 30-day e-cigarette use. Searches yielded 6959 unique studies, of which 9 met inclusion criteria (comprising 17 389 adolescents and young adults). Data Extraction and Synthesis: Study quality and risk of bias were assessed using the Newcastle-Ottawa Scale and the Risk of Bias in Non-randomized Studies of Interventions tool, respectively. Data and estimates were pooled using random-effects meta-analysis. Main Outcomes and Measures: Among baseline never cigarette smokers, cigarette smoking initiation between baseline and follow-up. Among baseline non-past 30-day cigarette smokers who were past 30-day e-cigarette users, past 30-day cigarette smoking at follow-up. Results: Among 17 389 adolescents and young adults, the ages ranged between 14 and 30 years at baseline, and 56.0% were female. The pooled probabilities of cigarette smoking initiation were 30.4% for baseline ever e-cigarette users and 7.9% for baseline never e-cigarette users. The pooled probabilities of past 30-day cigarette smoking at follow-up were 21.5% for baseline past 30-day e-cigarette users and 4.6% for baseline non-past 30-day e-cigarette users. Adjusting for known demographic, psychosocial, and behavioral risk factors for cigarette smoking, the pooled odds ratio for subsequent cigarette smoking initiation was 3.62 (95% CI, 2.42-5.41) for ever vs never e-cigarette users, and the pooled odds ratio for past 30-day cigarette smoking at follow-up was 4.28 (95% CI, 2.52-7.27) for past 30-day e-cigarette vs non-past 30-day e-cigarette users at baseline. A moderate level of heterogeneity was observed among studies (I2 = 60.1%). Conclusions and Relevance: e-Cigarette use was associated with greater risk for subsequent cigarette smoking initiation and past 30-day cigarette smoking. Strong e-cigarette regulation could potentially curb use among youth and possibly limit the future population-level burden of cigarette smoking.

Postintervention Effects of Click City® : Alcohol on Changing Etiological Mechanisms Related to the Onset of Heavy Drinking.

INTRODUCTION: Alcohol consumption, including heavy drinking, is the fourth leading preventable cause of death in the United States. Youth who engage in heavy drinking are likely to experience a number of problems associated with their use. In 2015, U.S. prevalence of heavy drinking was 17% among 12th graders. These data suggest a clear need for conducting alcohol prevention activities among youth. METHOD: We designed the Click City®: Alcohol program for 7th graders, with a booster in 8th grade. We conducted an efficacy trial in 25 schools in three counties in Oregon. Schools were randomized to either the Click City: Alcohol ( n = 12) or Usual Curriculum condition ( n = 13). We present the results of a short-term evaluation, assessing change in outcomes from baseline to 1 week following the intervention among students in Click City: Alcohol schools versus those in Usual Curriculum schools. RESULTS: Students who used the Click City: Alcohol program significantly decreased their intentions to drink heavily in the future, as compared with students in the Usual Curriculum control condition, although the effect size was small. Changes in the targeted mechanisms were in the expected direction and were significant for all but one mechanism, with moderate effect sizes. CONCLUSION: Our short-term findings provide preliminary support for the efficacy of the Click City: Alcohol program to change adolescents' intentions to engage in heavy drinking. If the results are maintained over time, the program has the potential to prevent the onset of heavy drinking among teens and reduce the negative consequences associated with heavy drinking, including neurological and other health consequences.

Purpose in Life in Emerging Adulthood: Development and Validation of a New Brief Measure.

Accruing evidence points to the value of studying purpose in life across adolescence and emerging adulthood. Research though is needed to understand the unique role of purpose in life in predicting well-being and developmentally relevant outcomes during emerging adulthood. The current studies (total n = 669) found support for the development of a new brief measure of purpose in life using data from American and Canadian samples, while demonstrating evidence for two important findings. First, purpose in life predicted well-being during emerging adulthood, even when controlling for the Big Five personality traits. Second, purpose in life was positively associated with self-image and negatively associated with delinquency, again controlling for personality traits. Findings are discussed with respect to how studying purpose in life can help understand which individuals are more likely to experience positive transitions into adulthood.

Utility of Responsiveness Theory for Classifying Supportive Behaviors to Enhance Smokeless Tobacco Cessation.

INTRODUCTION: Although social support is correlated with successful tobacco cessation, interventions designed to optimize social support have shown mixed results. Understanding the process of providing social support for tobacco cessation may suggest new approaches to intervention. Responsiveness theory provides a new framework for classifying supportive behaviors in the context of tobacco cessation. It proposes three main components to sustaining relationship quality when providing support to an intimate partner: showing respect, showing understanding, and showing caring. METHODS: Interviews were conducted with 35 women whose husbands or domestic partners had quit smokeless tobacco and were analyzed within a responsiveness theory framework: Positive and negative instances of the three supportive components were expressed in terms of beliefs and attitudes, interactions with the chewer, and behaviors outside of the interaction context. RESULTS: Positive activities included respecting the chewer's decision on whether, when, and how to quit; perspective-taking and other efforts to understand his subjective experience; and expressing warmth and affection toward the chewer. Particularly problematic for the women were the challenges of respecting the chewer's autonomy (ie, negative behaviors such as nagging him to quit or monitoring his adherence to his cessation goal) and lack of understanding the nature of addiction. CONCLUSIONS: The findings help to confirm the potential utility of responsiveness theory for elucidating the breadth of both positive and negative forms of partner support that may be useful to guide social support interventions for tobacco cessation. IMPLICATIONS: The study provides a categorization system for positive and negative social support during smokeless tobacco cessation, based on responsiveness theory and interviews with 35 partners of smokeless users.

Association of the OPRM1 Variant rs1799971 (A118G) with Non-Specific Liability to Substance Dependence in a Collaborative de novo Meta-Analysis of European-Ancestry Cohorts.

The mu1 opioid receptor gene, OPRM1, has long been a high-priority candidate for human genetic studies of addiction. Because of its potential functional significance, the non-synonymous variant rs1799971 (A118G, Asn40Asp) in OPRM1 has been extensively studied, yet its role in addiction has remained unclear, with conflicting association findings. To resolve the question of what effect, if any, rs1799971 has on substance dependence risk, we conducted collaborative meta-analyses of 25 datasets with over 28,000 European-ancestry subjects. We investigated non-specific risk for "general" substance dependence, comparing cases dependent on any substance to controls who were non-dependent on all assessed substances. We also examined five specific substance dependence diagnoses: DSM-IV alcohol, opioid, cannabis, and cocaine dependence, and nicotine dependence defined by the proxy of heavy/light smoking (cigarettes-per-day >20 vs. ≤ 10). The G allele showed a modest protective effect on general substance dependence (OR = 0.90, 95% C.I. [0.83-0.97], p value = 0.0095, N = 16,908). We observed similar effects for each individual substance, although these were not statistically significant, likely because of reduced sample sizes. We conclude that rs1799971 contributes to mechanisms of addiction liability that are shared across different addictive substances. This project highlights the benefits of examining addictive behaviors collectively and the power of collaborative data sharing and meta-analyses.

Harsh Environments, Life History Strategies, and Adjustment: A Longitudinal Study of Oregon Youth.

We modeled the effects of harsh environments in childhood on adjustment in early emerging adulthood, through parenting style and the development of fast Life History Strategies (LHS; risky beliefs and behaviors) in adolescence. Participants were from the Oregon Youth Substance Use Project (N = 988; 85.7% White). Five cohorts of children in Grades 1-5 at recruitment were assessed through one-year post high school. Greater environmental harshness (neighborhood quality and family poverty) in Grades 1-6 predicted less parental investment at Grade 8. This parenting style was related to the development of fast LHS (favorable beliefs about substance users and willingness to use substances at Grade 9, and engagement in substance use and risky sexual behavior assessed across Grades 10-12). The indirect path from harsh environment through parenting and LHS to (less) psychological adjustment (indicated by lower life satisfaction, self-rated health, trait sociability, and higher depression) was significant (indirect effect -.024, p = .011, 95% CI = -.043, -.006.). This chain of development was comparable to that found by Gibbons et al. (2012) for an African-American sample that, unlike the present study, included perceived racial discrimination in the assessment of harsh environment.

Perceptions and Use of E-cigarettes across Time among Emerging Adults.

Objectives: We present prevalence estimates of e-cigarette use and conventional cigarette use, and their co-occurrence, among emerging adults across 2 assessments, 11 months apart, conducted in 2013 and 2014. We also report on perceptions of using e-cigarettes and motives for using e-cigarettes and, among e-cigarette users, present data reflecting order of use of conventional tobacco products and e-cigarettes. Methods: Participants (N = 884) in a longitudinal study, the Oregon Youth Substance Use Project, completed at least one of 2 questionnaires, at average age 22.9 and 23.8 years. Following each assessment, a subsample of e-cigarette users completed interviews using timeline follow-back strategies. Results: The prevalence of e-cigarette use increased significantly across the 11 months. Compared to other nicotine products, risk perceptions associated with e-cigarettes are low. Data suggest co-occurrence between smoking conventional cigarettes and e-cigarette use, and that for most individuals, e-cigarettes are added to emerging adults' tobacco use repertoire. Conclusions: Findings emphasize the need for common nomenclature for e-cigarettes, for counter advertising targeting emerging adults who are or were smokers, men, and those with less education. Findings also suggest that smoke-free policies designed to target conventional cigarettes incorporate e-cigarettes, as well.

Prospective Predictors of Novel Tobacco and Nicotine Product Use in Emerging Adulthood.

PURPOSE: The purpose of this study was to investigate whether risk factors for cigarette smoking assessed in adolescence predict the use of novel tobacco and nicotine products (hookah, little cigars, and e-cigarettes) in early emerging adulthood. METHODS: In a longitudinal study (N = 862), risk factors were measured in middle and high school, and novel product use was measured in emerging adulthood (mean age 22.4 years). Structural equation modeling was used to test a model predicting lifetime use of any of hookah, little cigars, and e-cigarettes in early emerging adulthood from distal predictors (gender, maternal smoking through Grade 8; already tried alcohol, cigarettes, or marijuana by Grade 8; and sensation seeking at Grade 8) and potential mediators (intentions to smoke cigarettes, drink alcohol or smoke marijuana at Grade 9, and smoking trajectory across high school). RESULTS: The most prevalent novel tobacco product was hookah (21.7%), followed by little cigars (16.8%) and e-cigarettes (6.6%). Maternal smoking, having already tried substances, and sensation seeking each predicted the use of at least one of these products via an indirect path through intentions to use substances and membership in a high-school smoking trajectory. CONCLUSIONS: Risk factors for cigarette smoking were found to predict novel tobacco use, suggesting that interventions to prevent cigarette smoking could be extended to include common novel tobacco products.

Randomized Controlled Trial of the Combined Effects of Web and Quitline Interventions for Smokeless Tobacco Cessation.

BACKGROUND: Use of smokeless tobacco (moist snuff and chewing tobacco) is a significant public health problem but smokeless tobacco users have few resources to help them quit. Web programs and telephone-based programs (Quitlines) have been shown to be effective for smoking cessation. We evaluate the effectiveness of a Web program, a Quitline, and the combination of the two for smokeless users recruited via the Web. OBJECTIVES: To test whether offering both a Web and Quitline intervention for smokeless tobacco users results in significantly better long-term tobacco abstinence outcomes than offering either intervention alone; to test whether the offer of Web or Quitline results in better outcome than a self-help manual only Control condition; and to report the usage and satisfaction of the interventions when offered alone or combined. METHODS: Smokeless tobacco users (N= 1,683) wanting to quit were recruited online and randomly offered one of four treatment conditions in a 2×2 design: Web Only, Quitline Only, Web + Quitline, and Control (printed self-help guide). Point-prevalence all tobacco abstinence was assessed at 3- and 6-months post enrollment. RESULTS: 69% of participants completed both the 3- and 6-month assessments. There was no significant additive or synergistic effect of combining the two interventions for Complete Case or the more rigorous Intent To Treat (ITT) analyses. Significant simple effects were detected, individually the interventions were more efficacious than the control in achieving repeated 7-day point prevalence all tobacco abstinence: Web (ITT, OR = 1.41, 95% CI = 1.03, 1.94, p = .033) and Quitline (ITT: OR = 1.54, 95% CI = 1.13, 2.11, p = .007). Participants were more likely to complete a Quitline call when offered only the Quitline intervention (OR = 0.71, 95% CI = .054, .093, p = .013), the number of website visits and duration did not differ when offered alone or in combination with Quitline. Rates of program helpfulness (p <.05) and satisfaction (p <.05) were higher for those offered both interventions versus offered only quitline. CONCLUSION: Combining Web and Quitline interventions did not result in additive or synergistic effects, as have been found for smoking. Both interventions were more effective than a self-help control condition in helping motivated smokeless tobacco users quit tobacco. Intervention usage and satisfaction were related to the amount intervention content offered. Usage of the Quitline intervention decreased when offered in combination, though rates of helpfulness and recommendations were higher when offered in combination. TRIAL REGISTRATION: Clinicaltrials.gov NCT00820495; http://clinicaltrials.gov/ct2/show/NCT00820495.

Long-term efficacy of click city(r): tobacco: a school-based tobacco prevention program.

INTRODUCTION: Click City (®) : Tobacco is an innovative, computer-based tobacco prevention program designed to be implemented in 5th-grade classrooms with a booster in 6th grade. The program targets etiological mechanisms predictive of future willingness and intentions to use tobacco and initiation of tobacco use. Each component was empirically evaluated to assure that it changed its targeted mechanism. This paper describes long-term outcomes for students who participated in a randomized controlled efficacy trial of the program. METHODS: A total of 26 middle schools were stratified and randomly assigned to the Click City (®) : Tobacco program or Usual Curriculum. The 47 elementary schools that fed into each middle school were assigned to the same condition as their respective middle school. In Click City (®) : Tobacco schools, 1,168 students from 24 elementary schools and 13 middle schools participated. In Usual Curriculum schools, 1,154 students from 23 elementary schools and 13 middle schools participated. All participating students completed baseline, post-6th grade program, and 7th grade assessments. RESULTS: As compared to students in schools that continued with their usual curriculum, intentions and willingness to smoke increased less from baseline to 6th grade and from baseline to 7th grade, among students in schools that used the Click City (®) : Tobacco curriculum. Changes in mechanisms were also in the expected direction. The program was particularly efficacious for at-risk students. CONCLUSIONS: Results provide evidence to support the long-term efficacy of Click City (®) : Tobacco. Program development, based on an empirical evaluation of each component, most likely played a role in the success of the program.

Randomized controlled trial of MyLastDip: a Web-based smokeless tobacco cessation program for chewers ages 14-25.

INTRODUCTION: Use of smokeless tobacco (ST) is a significant public health problem for young adults, many of whom want to quit. We describe the outcome of a Randomized Controlled Trial (RCT) examining the efficacy of two web-based ST cessation interventions targeting young chewers. METHODS: One thousand seven hundred and sixteen ST users wanting to quit were recruited online to the MyLastDip program and randomly assigned to one of two fully automated web-based ST cessation interventions: (a) an Enhanced Condition (N = 857) with tailored treatment recommendations and interactive features, or (b) a Basic Condition (N = 859) that provided an online ST cessation guide in static text. RESULTS: Assessment completion rates at 3 months, 6 months, and for both 3 and 6 months were 73%, 71%, and 65%, respectively. No significant differences were found between conditions. Using complete case analysis for repeated point prevalence (3- and 6-month assessments), all tobacco abstinence was 28.9% for participants in the Enhanced Condition and 25.6% in the Basic Condition. Using intent-to-treat analysis, abstinence rates were 35.2% versus 32.3%. Similar results were obtained for ST abstinence. Participants reported being satisfied with their programs and the Enhanced Condition participants were relatively more engaged. Differences in program engagement were not related to tobacco abstinence at 6 months. CONCLUSIONS: Both web-based ST cessation programs encouraged robust levels of absolute tobacco and ST abstinence at follow-up. The absence of between-group differences was discussed in terms of composition of the control condition and implications for next steps in treatment development and testing.

Smoking trajectories across high school: sensation seeking and Hookah use.

INTRODUCTION: This study investigated the associations of trajectories of cigarette smoking over the high school years with the prior development of childhood sensation seeking and the subsequent use of cigarettes and hookah at age 20/21. METHODS: Participants (N = 963) were members of a cohort-sequential longitudinal study, the Oregon Youth Substance Use Project. Sensation seeking was assessed across 4th-8th grades and cigarette smoking was assessed across 9th-12th grades. Cigarette and hookah use was assessed at age 20/21 for 684 of the 963 participants. RESULTS: Four trajectory classes were identified: Stable High Smokers (6%), Rapid Escalators (8%), Experimenters (15%), and Stable Nonsmokers or very occasional smokers (71%). Membership in any smoker class versus nonsmokers was predicted by initial level and growth of sensation seeking. At age 20/21, there was a positive association between smoking and hookah use for Nonsmokers and Experimenters in high school, whereas this association was not significant for Stable High Smokers or Rapid Escalators. CONCLUSIONS: Level and rate of growth of sensation seeking are risk factors for adolescent smoking during high school (Stable High Smokers, Rapid Escalators, and Experimenters), suggesting the need for interventions to reduce the rate of increase in childhood sensation seeking. For those who were not already established smokers by the end of high school, hookah use may have served as a gateway to smoking.

A randomized clinical trial of a web-based tobacco cessation education program.

OBJECTIVES: We report the results of a randomized clinical trial of a 3-hour, web-based, tobacco cessation education program, the Web-Based Respiratory Education About Tobacco and Health (WeBREATHe) program, for practicing pediatric respiratory therapists (RTs), registered nurses (RNs), and nurse practitioners (NPs). METHODS: Two hundred fifteen RTs (n = 40), RNs (n = 163), and NPs (n = 12) employed at the Children's Hospital of Philadelphia and the Children's Hospital, University of Colorado at Denver, participated in this study. All study activities were completed online. After consenting, participants were randomly assigned to either the training (intervention) or delayed training (control) condition. The training condition consisted of a 3-hour continuing education unit course plus ongoing online resources. Participants were assessed at baseline, 1 week, and 3 months after enrollment. RESULTS: Participants in the training condition were more likely to increase their tobacco cessation intervention behaviors than their delayed training counterparts (F[1, 213] = 32.03, P < .001). Training participants showed significantly greater levels of advise (F[1, 213] = 7.22, P < .001); assess (F[1, 213] = 19.56, P < .001); and particularly assist/arrange (F[1213] = 35.52, P < .001). In addition, training condition participants rated the program highly on measures of consumer satisfaction. CONCLUSIONS: The WeBREATHe program is the first evidence-based education program in tobacco cessation designed specifically for pediatric RTs, RNs, and NPs. Engagement in WeBREATHe increased participants' tobacco cessation-related behaviors.