A nutrient-specific gut hormone arbitrates between courtship and feeding.

Animals must set behavioural priority in a context-dependent manner and switch from one behaviour to another at the appropriate moment1-3. Here we probe the molecular and neuronal mechanisms that orchestrate the transition from feeding to courtship in Drosophila melanogaster. We find that feeding is prioritized over courtship in starved males, and the consumption of protein-rich food rapidly reverses this order within a few minutes. At the molecular level, a gut-derived, nutrient-specific neuropeptide hormone-Diuretic hormone 31 (Dh31)-propels a switch from feeding to courtship. We further address the underlying kinetics with calcium imaging experiments. Amino acids from food acutely activate Dh31+ enteroendocrine cells in the gut, increasing Dh31 levels in the circulation. In addition, three-photon functional imaging of intact flies shows that optogenetic stimulation of Dh31+ enteroendocrine cells rapidly excites a subset of brain neurons that express Dh31 receptor (Dh31R). Gut-derived Dh31 excites the brain neurons through the circulatory system within a few minutes, in line with the speed of the feeding-courtship behavioural switch. At the circuit level, there are two distinct populations of Dh31R+ neurons in the brain, with one population inhibiting feeding through allatostatin-C and the other promoting courtship through corazonin. Together, our findings illustrate a mechanism by which the consumption of protein-rich food triggers the release of a gut hormone, which in turn prioritizes courtship over feeding through two parallel pathways.

Ccr4-Not maintains genomic integrity by controlling the ubiquitylation and degradation of arrested RNAPII.

The Ccr4-Not complex regulates essentially every aspect of gene expression, from mRNA synthesis to protein destruction. The Not4 subunit of the complex contains an E3 RING domain and targets proteins for ubiquitin-dependent proteolysis. Ccr4-Not associates with elongating RNA polymerase II (RNAPII), which raises the possibility that it controls the degradation of elongation complex components. Here, we demonstrate that Ccr4-Not controls the ubiquitylation and turnover of Rpb1, the largest subunit of RNAPII, during transcription arrest. Deleting NOT4 or mutating its RING domain strongly reduced the DNA damage-dependent ubiquitylation and destruction of Rpb1. Surprisingly, in vitro ubiquitylation assays indicate that Ccr4-Not does not directly ubiquitylate Rpb1 but instead promotes Rpb1 ubiquitylation by the HECT domain-containing ligase Rsp5. Genetic analyses suggest that Ccr4-Not acts upstream of RSP5, where it acts to initiate the destruction process. Ccr4-Not binds Rsp5 and forms a ternary complex with it and the RNAPII elongation complex. Analysis of mutant Ccr4-Not lacking the RING domain of Not4 suggests that it both recruits Rsp5 and delivers the E2 Ubc4/5 to RNAPII. Our work reveals a previously unknown function of Ccr4-Not and identifies an essential new regulator of RNAPII turnover during genotoxic stress.

Cannabis use among cancer survivors in 22 states: Results from the Behavioral Risk Factor Surveillance System, 2020.

BACKGROUND: This study identified factors associated with recent cannabis use and cannabis use for medical purposes among cancer survivors relative to individuals without a history of cancer. METHODS: Data from the Behavioral Risk Factor Surveillance System were analyzed for the 22 states completing the optional cannabis module in 2020. Weighted multiple logistic regression was performed to explore variables associated with past 30-day cannabis use and cannabis use for medical purposes, stratified by history of cancer. Covariates included state-level cannabis policy, sociodemographic characteristics, health status indicators, and substance use. RESULTS: Cannabis use was lower among cancer survivors compared to individuals with no history of cancer (7.57% vs. 10.83%). However, a higher proportion of cancer survivors reported use for medical purposes (82.23% vs. 62.58%). After adjusting for state-level policy, biological sex, age, educational attainment, self-reported race/ethnicity, home ownership, mental health status and physical health status, current smoking (odds ratio [OR], 5.14 vs. 3.74) and binge drinking (OR, 2.71 vs. 2.69) were associated with cannabis use in both groups. Characteristics associated with medical cannabis use varied for the two groups; however, daily use (20-30 days; OR, 1.72 vs. 2.43) was associated with cannabis use for medical purposes in both groups after adjusting for other variables in the model. CONCLUSIONS: A high proportion of individuals report cannabis use for medical purposes with higher rates among cancer survivors. Findings support the urgent need for ongoing cannabis research to better understand and inform its use for medical purposes, as well as the development of high-quality standardized education materials and clinical practice guidelines.

Disparities in cannabis use outcomes, perceived risks and social norms across sexual orientation groups of US young adult women and men.

Little research has examined mechanisms driving cannabis use disparities among sexual minority (SM; versus heterosexual) young adults (YAs). Participants were US YA women (N = 1345; 24.8% bisexual, 6.1% lesbian) and men (N = 998: 8.9% bisexual, 13.8% gay). Bivariate analyses examined associations between sexual orientation (heterosexual, gay/lesbian, bisexual) and cannabis use outcomes (past 30-day [current] use, use frequency, cannabis-tobacco dual use, use intentions), perceived risks (harm, addictiveness) and social norms (social acceptability, peer use). Regressions examined sexual orientation, perceived risks and social norms as correlates of cannabis outcomes. Bisexual and lesbian (versus heterosexual) women reported lower cannabis-related perceived risks, greater social norms and higher odds of current use. Bisexual (versus heterosexual) women reported more days of use, higher odds of cannabis-tobacco dual use and greater use intentions. Gay (versus heterosexual) men reported lower perceived addictiveness, greater social norms and higher odds of current use. Lower perceived risks and greater social norms predicted greater use outcomes for women and men. Bisexual women displayed higher odds of several cannabis use outcomes, whereas lesbian women and gay men displayed higher odds of current cannabis use only. Cannabis-related perceptions and social norms may be important targets for public health messaging for SMYAs.

Oklahoma Tobacco Helpline Utilization and Outcomes by Diabetes Status.

CONTEXT: Diabetes and cigarette smoking are major causes of morbidity and mortality. Individuals with type 2 diabetes (T2D) who smoke are at an increased risk of smoking- and diabetes-related morbidity and mortality. OBJECTIVE: We examined utilization patterns, satisfaction, and tobacco cessation outcomes among persons with T2D to determine whether the Oklahoma Tobacco Helpline is an equally effective intervention for tobacco users with T2D compared with those without diabetes. DESIGN: This study was a retrospective cohort design using registration and follow-up data from a state tobacco quitline. SETTING: We examined Oklahoma Tobacco Helpline registration data from July 2015 to June 2021 to compare Helpline utilization among individuals who self-reported a previous diagnosis of T2D compared with those not reporting a diagnosis of diabetes. PARTICIPANTS: Oklahoma Tobacco Helpline registrants enrolled in a call program, either the single- or multiple-call program, who reported diabetes status at baseline. We compared tobacco use history, program enrollment, and services received for individuals self-reporting T2D with those without diabetes. MAIN OUTCOME MEASURES: We compared 30-day point-prevalence abstinence at 7 months and evaluated program satisfaction. RESULTS: Registrants with T2D were more likely to receive a higher intensity of services including the number of coaching calls and the amount of nicotine replacement therapy. At 7-month follow-up, 32.3% of registrants with T2D and 35.1% of those without diabetes reported 30-day point-prevalence abstinence, but the differences were not statistically significant. CONCLUSIONS: While findings demonstrate similar effectiveness, more research is needed to better understand why the prevalence of tobacco use remains high among individuals with T2D and how to improve cessation in this population.

Evaluating the Psychometric Properties of the Severson 7-Item Smokeless Tobacco Dependence Scale (SSTDS).

INTRODUCTION: The objective of the study was to assess the psychometric properties of the Severson 7-item Smokeless Tobacco Dependence Scale (SSTDS). METHODS: Data from 95 male exclusive smokeless tobacco (ST) users were obtained through a self-administered mail survey to evaluate the reliability and validity of the SSTDS. Reliability of the scale was assessed by measures of internal consistency including Cronbach's coefficient alpha and item-total correlation. Other ST dependence scales and salivary cotinine concentration were used to evaluate concurrent validity. Structure model of the scale was ascertained by exploratory factor analysis. Overall accuracy and optimal cutoff score were obtained to evaluate SSTDS as a screening tool for ST dependence. RESULTS: The SSTDS had high reliability as assessed by the internal consistency coefficient (ordinal α = 0.83). SSTDS total score was significantly correlated with Fagerström Test for Nicotine Dependence for ST users-FTND-ST (r = 0.42) and modified Tobacco Dependence Screener-TDS (r = 0.58). Exploratory factor analysis of the SSTDS identified two underlying factors measuring distinct dimensions of dependence. With reference to TDS based dependence diagnosis, SSTDS demonstrated good diagnostic accuracy (area under the curve: 0.82, 95% confidence interval: 0.74-0.90). Salivary cotinine concentration was not associated with the total score of the SSTDS; however, at an optimal cutoff score of SSTDS >9, everyday ST users classified as dependent had significantly higher cotinine concentration. CONCLUSIONS: SSTDS is a reliable measure of dependence that has higher concurrent validity and reliability as compared with other commonly used ST dependence scales. Further research is needed using a larger and more diverse sample of ST users to unequivocally establish the validity of the scale. IMPLICATIONS: ST dependence has multiple aspects that can be best studied by multidimensional dependence scales. The study findings validate that the SSTDS measures not only the physical dependence but also the behavioral and psychological dimensions of dependence. Good psychometric properties, diagnostic accuracy, and multidimensional structure of SSTDS indicate that it may serve as an effective tool in assessing ST dependence in clinical and research settings.

Knowledge and Perceptions of Tobacco-Related Harm Associated with Intention to Quit among Cigarette Smokers, e-Cigarette Users, and Dual Users: Findings from the US Population Assessment of Tobacco and Health (PATH) Wave 1.

OBJECTIVE: To study the association between knowledge of diseases caused by smoking, perceptions of harm of cigarettes and intention to quit among cigarettes and e-cigarettes users. Methods: Using US Population Assessment of Tobacco and Health (PATH) Wave 1 data (2013-2014), we investigated the mean knowledge of diseases due to smoking and perceptions of harm of cigarettes scores among cigarette smokers (n = 8,263), e-cigarette users (n = 829), and dual users (n = 745) and examined the association between knowledge, perceptions of harm and intention to quit. Results: E-cigarette users had the highest scores in both knowledge and perceptions of harm items. We found a stronger association between knowledge and intention to quit among females (aOR: 1.25; 95% CI: 1.18, 1.34) compared to males (aOR: 1.11; 95% CI: 1.05, 1.18). We observed a strong association between perceptions of harm and intention to quit among cigarette smokers (p < 0.0001) and dual users (p = 0.0001), but not e-cigarette users. Conclusions: Our study indicates it is urgent for federal and state governments to develop comprehensive guidelines for targeted health messaging regarding the harms of cigarettes, noncombustible tobacco products, and dual use, and the benefits of cessation. Further, findings suggest that effective health education should include tobacco product-specific risks and the comprehensive negative health impacts of tobacco given the strong positive association of perceptions of harm and intention to quit.Supplemental data for this article is available online at https://doi.org/10.1080/10826084.2021.1879145.

Replicating state Quitline innovations to increase reach: findings from three states.

BACKGROUND: Reaching tobacco users is a persistent challenge for quitlines. In 2014, ClearWay MinnesotaSM changed its quitline services and media campaign, and observed substantial increases in reach and strong quit outcomes. Oklahoma and Florida implemented the same changes in 2015 and 2016. We examined whether the strategies used in Minnesota could be replicated with similar results. METHODS: We conducted a cross-sectional observational study of Minnesota's QUITPLAN® Services, the Oklahoma Tobacco Helpline, and Florida's Quit Your Way program. Each program offers free quitline services to their state's residents. For each state, data were compared for 1 year prior to service changes to 1 year after services changed and promotions began. Registration and program utilization data from 21,918 (Minnesota); 64,584 (Oklahoma); and 141,209 (Florida) program enrollees were analyzed. Additionally, outcome study data from 1542 (Minnesota); 3377 (Oklahoma); and 3444 (Florida) program enrollees were analyzed. We examined treatment reach, satisfaction, 24-h quit attempts, 30-day point prevalence abstinence rates, select demographic characteristics, registration mode (post period only), and estimated number of quitters. Data were analyzed using χ2 analyses and t-tests. RESULTS: Treatment reach rates increased by 50.62% in Oklahoma, 66.88% in Florida, and 480.56% in Minnesota. Significant increases in the estimated number of quitters were seen, ranging from + 42.75% to + 435.90%. Statistically significant changes in other variables (satisfaction, 24-h quit attempts, 30-day point prevalence abstinence rates, gender, and race) varied by state. During the post period, participants' method of registration differed. Online enrollment percentages ranged from 19.44% (Oklahoma), to 54.34% (Florida), to 70.80% (Minnesota). In Oklahoma, 71.63% of participants enrolled by phone, while 40.71% of Florida participants and 26.98% of Minnesota participants enrolled by phone. Fax or electronic referrals comprised 8.92% (Oklahoma), 4.95% (Florida), and 2.22% (Minnesota) of program enrollees, respectively. CONCLUSIONS: Changing quitline services and implementing a new media campaign increased treatment reach and the estimated number of participants who quit smoking in three states. Quitline funders and tobacco control program managers may wish to consider approaches such as these to increase quitline utilization and population health impact.

Experiences of women with cervical dysplasia and associated diagnoses using electronic cigarettes for smoking substitution.

INTRODUCTION: The aim of this qualitative study was to describe the motivation and experiences of women with cervical dysplasia and associated diagnoses who used electronic cigarettes (ECs) to reduce the number of cigarettes they smoked. METHODS: Qualitative interviews were conducted with 26 women aged 18-65 years with cervical dysplasia and associated diagnoses who smoked at least three cigarettes daily for the past year or more and who enrolled in an intervention designed to substitute regular cigarettes with ECs. At the 12-week follow-up, patients were contacted by telephone. Semi-structured interviews were recorded, then transcribed, coded and analysed for themes. RESULTS: When confronted with a new diagnosis associated with smoking, women in this study were eager to try ECs to help them reduce their intake of cigarettes. Women reported that physical cues similar to smoking, delivery of nicotine sufficient to assist with smoking reduction and the security of having the device available to use in instances where temptations to smoke may occur were all positive experiences in trying the device. Other women in the study reported negative experiences, such as a lack of sufficient nicotine to eliminate cravings, heaviness of the device and the need to keep it charged. Depression, nicotine addiction and habit were factors that made it difficult to decrease cigarette consumption. CONCLUSIONS: Findings suggest that ECs may help with smoking substitution in patients who must reduce smoking due to medical conditions or diagnoses.

Community-Based Study Recruitment of American Indian Cigarette Smokers and Electronic Cigarette Users.

Data on the effectiveness of strategies for the recruitment of American Indians (AIs) into research is needed. This study describes and compares methods for identifying and recruiting AI tobacco users into a pilot study. Community-based strategies were used to recruit smokers (n = 35), e-cigarette users (n = 28), and dual users (n = 32) of AI descent. Recruitment was considered proactive if study staff contacted the individual at a pow wow, health fair, or vape shop and participation on-site or reactive if the individual contacted the study staff and participation occurred later. Screened, eligible, participated and costs and time spent were compared with Chi square tests. To understand AI descent, the relationship between number of AI grandparents and AI blood quantum was examined. Number of participants screened via the proactive strategy was similar to the reactive strategy (n = 84 vs. n = 82; p-value = 0.8766). A significantly greater proportion of individuals screened via the proactive than the reactive strategy were eligible (77 vs. 50%; p-value = 0.0002) and participated (75 vs. 39%; p-value = < 0.0001). Per participant cost and time estimated for the proactive strategy was $89 and 87 min compared to $79 and 56 min for the reactive strategy. Proportion at least half AI blood quantum was 32, 33, and 70% among those with 2, 3, and 4 AI grandparents, respectively (p = 0.0017). Proactive strategies resulted in two-thirds of the sample, but required more resources than reactive strategies. Overall, we found both strategies were feasible and resulted in the ability to reach sample goals. Lastly, number of AI biological grandparents may be a good, non-invasive indicator of AI blood quantum.

Psychometric Properties of Fagerström Test for Nicotine Dependence for Smokeless Tobacco Users (FTND-ST).

INTRODUCTION: Fagerström Test for Nicotine Dependence (FTND) is the most commonly used measure of dependence among tobacco users. Psychometric properties of FTND have been validated among cigarette smokers, but the reliability and validity of its variant for smokeless tobacco (ST) users (FTND-ST) is not well documented. The objective of the present study is to evaluate reliability, construct validity, and structure model of FTND-ST. METHODS: Data from 95 exclusive ST users living in Oklahoma were used for this study. Participants completed a self-administered mail survey including FTND-ST and other questionnaires. Measures of internal consistency, Cronbach's coefficient α and item-total correlation were estimated to evaluate reliability of the FTND-ST. To ascertain the factor structure of the scale, confirmatory factor analysis was performed. We examined concurrent and construct validity with correlation and regression analysis. Salivary cotinine concentration was used as a criterion variable. RESULTS: The FTND-ST demonstrated good reliability with acceptable Cronbach's coefficient (α = 0.72) and significant item-total correlations. Study findings showed that FTND-ST had positive significant association with salivary cotinine concentration (r = 0.61, p <.0001) and Tobacco Dependence Screener (r = 0.44, p < .0001). Results of factor analysis support a unidimensional factor structure of FTND-ST. CONCLUSIONS: The FTND-ST demonstrated good psychometric properties. The unidimensional structure of the scale indicates that it measures single clearly defined aspect of dependence, physical dependence. Given its good reliability and demonstrated construct validity, FTND-ST is a useful measure of dependence among ST users. IMPLICATIONS: Because of the paucity of ST dependence research, there are limited studies evaluating ST dependence measures. Although the FTND was exclusively developed for cigarette smoking, it has been adapted for ST users in the form of FTND-ST. This is the first study to examine reliability, concurrent and construct validity, and structure model of FTND-ST among regular ST users. Findings suggest that the FTND-ST measures physical aspect of dependence. Good psychometric properties of FTND-ST and its orientation as a continuous scale indicate that FTND-ST is a useful measure of dependence among ST users.

Assessment of the Tobacco Dependence Screener Among Smokeless Tobacco Users.

INTRODUCTION: Variants of the Fagerström Tolerance Questionnaire and Fagerström Test for Nicotine Dependence (FTND) are widely used to study dependence among smokeless tobacco (ST) users. However, there is a need for a dependence measure which is based on the clinical definition of dependence and is easy to administer. The Tobacco Dependence Screener (TDS), a self-administered 10-item scale, is based on the Diagnostic and Statistical Manual, fourth edition (DSM-IV) and ICD-10 definitions of dependence. It is commonly used as a tobacco dependence screening tool in cigarette smoking studies but it has not been evaluated for dependence in ST users. The purpose of this study is to evaluate the TDS as a measure of tobacco dependence among ST users. METHODS: Data collected from a community-based sample of exclusive ST users living in Oklahoma (n = 95) was used for this study. TDS was adapted to be used for ST dependence as the references for smoking were changed to ST use. Concurrent validity and reliability of TDS were evaluated. Salivary cotinine concentration was used as a criterion variable. Overall accuracy of the TDS was assessed by receiver's operating characteristic (ROC) curve and optimal cutoff scores for dependence diagnosis were evaluated. RESULTS: There was no floor or ceiling effect in TDS score (mean = 5.42, SD = 2.61). Concurrent validity of TDS as evaluated by comparing it with FTND-ST was affirmative. Study findings showed significant association between TDS and salivary cotinine concentration. The internal consistency assessed by Cronbach's alpha indicated that TDS had acceptable reliability (α = 0.765). TDS was negatively correlated with time to first chew/dip and positively correlated with frequency (number of chews per day) and years of ST use. Results of logistic regression analysis showed that at an optimal cutoff score of TDS 5+, ST users classified as dependent had significantly higher cotinine concentration and FTND-ST scores. CONCLUSIONS: TDS demonstrated acceptable reliability and concurrent validity among ST users. These findings are consistent with the results of previous cigarette smoking studies evaluating TDS. A self-administered tobacco dependence measure for ST users based on a clinical definition of dependence is an effective tool in research setting. IMPLICATIONS: ST dependence research is still evolving. This is the first study of the TDS among ST users providing preliminary evidence about some of the psychometric properties of the scale. Similar to cigarette smokers, TDS is an effective measure of ST dependence. Study showed moderate reliability and affirmative concurrent validity of the TDS among ST users.

Tobacco Control and Prevention in Oklahoma: Best Practices in a Preemptive State.

For more than a decade, the Oklahoma Tobacco Settlement Endowment Trust and Oklahoma State Department of Health have collaborated to implement best practices in tobacco control through state and community interventions, including legislated and voluntary policy approaches, health communication, cessation programs, and surveillance and evaluation activities. This partnership eliminates duplication and ensures efficient use of public health dollars for a comprehensive tobacco control program based on a systems and social norm change approach. The purpose of this paper is to briefly describe strategies to reduce tobacco use despite a rare policy environment imposed by the presence of near-complete state preemption of tobacco-related law. Key outcome indicators were used to track progress related to state tobacco control and prevention programs. Data sources included cigarette excise tax stamp sales, statewide surveillance systems, Oklahoma Tobacco Helpline registration data, and local policy tracking databases. Data were collected in 2001-2013 and analyzed in 2012 and 2013. Significant declines in cigarette consumption and adult smoking prevalence occurred in 2001-2012, and smoking among high school students fell 45%. Changes were also observed in attitudes and behaviors related to secondhand smoke. Community coalitions promoted adoption of local policies where allowable, with 92 ordinances mirroring state clean indoor air laws and 88 ordinances mirroring state youth access laws. Tobacco-free property policies were adopted by 292 school districts and 309 worksites. Moving forward, tobacco use will be prioritized as an avoidable health hazard in Oklahoma as it is integrated into a wellness approach that also targets obesity reduction.

State-Level Correlates of Unassisted Quit Attempts and Success.

BACKGROUND: Although the majority of smokers attempting to quit do so without assistance, research in the area of unassisted quit behaviors is limited. The aim of this study was to investigate whether population-level policies and programs, such as smoke-free air policies and tobacco control programs, contribute to unassisted quit attempts and cessation. METHODS: The current study used the 2003 Tobacco Use Supplement to the Current Population Survey (TUS-CPS) special Cessation Supplement (CS) to estimate unassisted quit attempt and success rates by state. Linear regression was used to examine whether state-level unassisted quit attempt and success rates were related to state-level policies and social norms. State-level factors investigated were tobacco control program funding, tobacco taxes, smoke-free air policies, state anti-smoking sentiment and recent change in smoking prevalence. RESULTS: Consistent with previous studies, this study found the majority of smokers who attempted to quit did so without assistance. This study also found unassisted quit attempt rates were higher than assisted attempt rates in every state and DC. Additionally, unassisted quit success rates were higher than assisted quit success rates in most states; however, some states had higher assisted quit success rates. State-level factors associated with unassisted quit attempt rates included anti-smoking sentiment and tobacco taxes; however, no significant relationships were uncovered between unassisted quit success rates and state-level factors. CONCLUSIONS: These results suggest that state-level factors may be more important in motivating smokers to attempt quitting, and other individual factors or unmeasured state factors may be related to quit success.

Race and Gender Disparities in Lung Cancer Incidence Rates, 2001-2010.

OBJECTIVE: Despite progress to reduce the burden of tobacco, disparities in tobacco-related morbidity and mortality remain. This research examines trends in lung cancer incidence rates by race and by gender within race during 2001-2010 in Oklahoma. METHODS: Incident cases of lung cancer were obtained from the Oklahoma State Department of Health public use database. Cases were linked to the Indian Health Service database to reduce misclassification of American Indian race. Annual percent change (APC) was estimated by race and by gender within race to describe rates over time. Rates were considered to increase or decrease if the p-value for trend was < 0.05. RESULTS: Average lung cancer incidence rates were highest among American Indians (105.52 per 100,000) and lowest among whites (78.64 per 100,000). Lung cancer incidence rates declined among the overall white (APC: -2.17%; p = 0.001) and African American (APC: -2.95%; p = 0.003) populations, as well as white (APC: -3.02%; p < .001) and African American males (APC: -3.39%; p = 0.007). Rates increased among American Indian females (APC: 2.20%; p = 0.03). CONCLUSION: Analysis of lung cancer incidence data reveals an inequality in tobacco-related morbidity among American Indians, especially American Indian females. This research suggests a need for more evidence-based tobacco control interventions within the American Indian population.

An Ecological Analysis of Tobacco Use and Oral Cavity and Pharynx Cancers in U.S. Males.

BACKGROUND: As the 8th most frequently diagnosed cancers among U.S. males, cancers of the oral cavity and pharynx are a significant component of the cancer burden among U.S. males. Avoidance of tobacco products is critical for the prevention of oral cavity and pharynx cancers. The objective of this brief report was to describe state-specific incidence rates of oral cavity and pharynx cancers and to examine the correlation between state-specific prevalences of tobacco use and oral cavity and pharynx cancer incidence rates among U.S. adult males. METHODS: Secondary surveillance data were used to conduct this ecological analysis. Incidence rates of oral cavity and pharynx cancers during 2009 through 2011 among males were obtained from the Centers for Disease Control and Prevention (CDC) WONDER system. Prevalences of cigarette smoking and smokeless tobacco use during 1995 and 1996 among males were obtained from the CDC STATE System. Relations were examined by calculating Pearson correlation coefficients and by performing linear regression analysis. Statistical significance was considered at alpha < 0.05. RESULTS: Current cigarette smoking prevalence was significantly correlated (r = 0.57; r2 = 0.33; p-value = < .0001) with the incidence rate of oral cavity and pharynx cancer; while there was a non-statistically significant correlation (r = 0.22; r2 = 0.05; p-value = 0.1147) between smokeless tobacco use and oral cavity and pharynx cancer. A 1% increase in the prevalence of current cigarette smoking was estimated to increase the incidence rate of oral cavity and pharynx cancer by 0.52 per 100,000 males. Although non-statistically significant, a 1% increase in the prevalence of smokeless tobacco use was estimated to increase the incidence rate of oral cavity and pharynx cancer by 0.18 per 100,000 males. CONCLUSION: Among U.S. males, a statistically significant positive correlation was observed between cigarette smoking and oral cancer, but not between smokeless tobacco use and oral cancer. Moreover, current cigarette smoking was estimated to predict one-third of the total variability in oral cancer. These findings contribute to the body of literature and provide further evidence that cigarette smoking is an important behavioral risk factor for oral cavity and pharynx cancer among U.S. males.

Oklahoma "Tobacco Stops with Me" Media Campaign Effects on Attitudes toward Secondhand Smoke.

IMPORTANCE: Public education campaigns in tobacco control play an important role in changing tobacco-related knowledge, attitudes and behaviors. The Oklahoma Tobacco Stops with Me campaign has been effective in changing attitudes overall and across subpopulations towards secondhand smoke risks. OBJECTIVE: Investigate campaign impact on secondhand smoke policy and risk attitudes. DESIGN: Serial cross-sectional data analyzed with univariate and multivariable models. SETTING: Random-digit dialing surveys conducted in 2007 and 2015 PARTICIPANTS: Oklahomans 18-65 years old Main Outcomes and Measures: (1) Support for smokefree bars; (2) risk assessment of secondhand smoke (very harmful, causes heart disease, causes sudden infant death); and 3) likelihood of protecting yourself from secondhand smoke. RESULTS: With Tobacco Stops with Me exposure, from 2007 to 2015, Oklahomans demonstrated significant increases in: (1) supporting smokefree bars (23.7% to 55%); (2) reporting beliefs that SHS causes heart disease (58.5% to 72.6%), is very harmful (63.8% to 70.6%) and causes sudden infant death (24% to 34%); and 3) reporting they are very likely to ask someone not to smoke nearby (45% to 52%). Controlling for demographics, smokers and males showed reduced attitude change. In uncontrolled comparisons, high-school graduates faired better than non-diploma individuals, who lacked significant attitude changes. CONCLUSIONS AND RELEVANCE: Tobacco Stops with Me achieved its mission to more closely align public perception of SHS with well-documented secondhand smoke risks. Efforts to target women were particularly successful. Smokers may be resistant to messaging; closing taglines that reinstate individual choice may help to reduce resistance/reactance (e.g., adding Oklahoma Helpline contact information).

Oklahoma "Tobacco Stops with Me"Media Campaign Effects on Attitudes toward Secondhand Smoke.

IMPORTANCE: Public education campaigns in tobacco control play an important role in changing tobacco-related knowledge, attitudes and behaviors. The Oklahoma Tobacco Stops with Me campaign has been effective in changing attitudes overall and across subpopulations towards secondhand smoke risks. OBJECTIVE: Investigate campaign impact on secondhand smoke policy and risk attitudes. DESIGN: Serial cross-sectional data analyzed with univariate and multivariable models. SETTING: Random-digit dialing surveys conducted in 2007 and 2015. PARTICIPANTS: Oklahomans 18-65 years old. MAIN OUTCOMES AND MEASURES: 1) Support for smokefree bars; 2) risk assessment of secondhand smoke (very harmful, causes heart disease, causes sudden infant death); and 3) likelihood of protecting yourself from secondhand smoke. RESULTS: With Tobacco Stops with Me exposure, from 2007 to 2015, Oklahomans demonstrated significant increases in: 1) supporting smokefree bars (23.7% to 55%); 2) reporting beliefs that SHS causes heart disease (58.5% to 72.6%), is very harmful (63.8% to 70.6%) and causes sudden infant death (24% to 34%); and 3) reporting they are very likely to ask someone not to smoke nearby (45% to 52%). Controlling for demographics, smokers and males showed reduced attitude change. In uncontrolled comparisons, high-school graduates faired better than non-diploma individuals, who lacked significant attitude changes. CONCLUSIONS AND RELEVANCE: Tobacco Stops with Me achieved its mission to more closely align public perception of SHS with well-documented secondhand smoke risks. Efforts to target women were particularly successful. Smokers may be resistant to messaging; closing taglines that reinstate individual choice may help to reduce resistance/reactance (e.g., adding Oklahoma Helpline contact information).

Increased Evidence-Based Tobacco Treatment Through Oklahoma Hospital System Changes.

BACKGROUND: Oklahoma hospitals admit approximately 120,000 tobacco users each year, many for diseases resulting from tobacco use. PURPOSE: To describe a unique partnership between the Oklahoma Hospital Association and Oklahoma Tobacco Settlement Endowment Trust to reach more tobacco users through the implementation of sustainable health system changes within hospitals and clinics to integrate an evidence-based tobacco treatment protocol for all tobacco-using patients. METHODS: The Oklahoma Hospital Association tobacco-cessation model included (1) identifying all tobacco-using patients; (2) assessing addiction level and readiness to quit; (3) prescribing medications to manage withdrawal while in hospital; and (4) proactively faxing a referral to the Oklahoma Tobacco Helpline for all patients ready to quit. Helpline registration patterns and characteristics of fax-referred hospitalized patients were tracked for the 4 years of the initiative (2009-2013); data were analyzed in 2013. RESULTS: Twenty-one hospitals and 12 clinics participated in the initiative. Fax referrals to the Helpline increased by > 150% in the first year, from about 600 during the year prior to the implementation of the program (July 2009 to June 2010) to 1,581 from Oklahoma Hospital Association facilities alone in the first year following the launch of the initiative. Nearly 5,600 Oklahoma Hospital Association fax referrals were made during the 4-year study period. About 41% of these referrals resulted in Helpline enrollment (n = 2,289). CONCLUSIONS: Sustainable, evidence-based tobacco treatment interventions embedded in hospital systems can successfully identify tobacco users and provide effective treatment, including increased proactive Helpline referrals for quit coaching.

Susceptibility to e-cigarette use and associated factors in high school youth, Oklahoma Youth Tobacco Survey, 2021-2022.

Introduction: Susceptibility predicts subsequent uptake of e-cigarettes (EC) by youth. This study identified factors associated with EC susceptibility among high school students who have never used a tobacco/nicotine product. Methods: The Oklahoma Youth Tobacco Survey was administered to a random sample of 36 Oklahoma High Schools during the 2021-2022 school year (n = 1,220 participating students). Associations between EC susceptibility and covariates were identified using stepwise logistic regression for weighted survey data. Results: More than one third of Oklahoma high school students who had never used tobacco or nicotine products (36.4%) were susceptible, and males had higher susceptibility than females (38.8 and 33.9%, respectively). In males, EC susceptibility was associated with race (Black, American Indian, and other were less susceptible), psychological distress (aOR = 2.4, 95% CI = 1.1, 4.8), disagreement that all tobacco products are dangerous (aOR = 3.1, 95% CI = 1.2, 7.9), and perception of little/no harm from secondhand vapor (aOR = 3.4, 95% CI = 2.1, 5.3). In females, identifying as gay, lesbian, or bisexual (aOR = 2.1, 95% CI = 1.1, 3.9), poor academic performance (aOR = 4.5, 95% CI = 1.6, 12.6), psychological distress (aOR = 2.6, 95% CI = 1.2, 5.5) and interacting with EC content on social media (aOR = 5.9, 95% CI = 1.9, 18.1) were associated with EC susceptibility. Conclusion: Males and females had different patterns of susceptibility to EC use. Understanding groups of adolescents most susceptible to using nicotine products can help target prevention efforts at home, in schools, and within communities.