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BACKGROUND: Co-use of tobacco and cannabis is common. However, few studies have examined the temporal sequencing through which individuals initiate co-use, and how these patterns vary across age. This study addresses this gap by examining the specific products and temporal sequencing through which adolescents, young adults, and adults initiate co-use of tobacco and cannabis. Among adolescents, young adults, and adults who co-used tobacco and cannabis in the past 30 days, we examined (a) whether tobacco or cannabis was used first in their lifetime and (b) which specific tobacco or cannabis product (e.g., nicotine e-cigarettes, cannabis edibles) was the first used. METHODS: Data were from a cross-sectional national survey (N = 6,131, 13-40 years old) in which participants reported ever use, past-30-day-use, and order of use for 17 different tobacco and cannabis products. Results were analyzed overall and by age group (13-20; 21-24; 25-40). RESULTS: 38.4% of participants reported use of both tobacco and cannabis in the past 30 days. Among these participants, 70.9% used tobacco first in their lifetime (66.6% < 21; 71.7% 21-24; 76.6% > 24). Approximately 60% of participants who initiated co-use with tobacco reported nicotine e-cigarettes as their first tobacco product (63.3% < 21; 66.7% 21-24; 49.6% > 24). CONCLUSIONS: The majority of participants who used both tobacco and cannabis used tobacco first in their lifetime, and nicotine e-cigarettes were the most common form of tobacco initiation, particularly among adolescents and young adults. Findings emphasize the need for co-use prevention programs to target common products of initiation.
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OBJECTIVE: This study identifies brands of nicotine pouches used in 2021, just before the surge in popularity of Zyn use. METHODS: We conducted a national, cross-sectional online survey of a general U.S. population (November to December 2021; N = 6131; age 13-40) via Qualtrics panels. Descriptive analyses and chi-squared tests (alpha = 0.05) were performed to assess ever and past-30-day use of nicotine pouch brands across adolescents (13-20), young adults (21-24), and adults (25-40), and to assess frequency of popular brands used among peers. RESULTS: The top brands ever used were Zyn (overall: 30.9%; adolescents: 31.9%; young adults: 33.2%; adults: 28.3%) and Lyft (overall: 28.8%; adolescents: 28.4%; young adults: 32.9%; adults: 26.3%), with no differences in ever-use by age group (p's > 0.095). The top brands used in the past-30-days were Zyn (overall: 26.4%; adolescents: 24.5%; young adults: 24.3%; adults: 30.0%) and Rush (overall: 24.2%; adolescents: 21.0%; young adults: 22.7%; adults: 28.6%). Adults (vs. adolescents, young adults) were more likely to report past-30-day use of Lyft (p = 0.004). Participants indicated Zyn (18.5%) and Lyft (18.2%) to be the most popular brands among peers. CONCLUSIONS: Even in 2021, Zyn was the most popular brand of nicotine pouches. Findings will help regulate and reduce impact of marketing of Zyn.
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Sistemas Electrónicos de Liberación de Nicotina , Humanos , Adolescente , Estudios Transversales , Masculino , Femenino , Adulto , Estados Unidos , Encuestas y Cuestionarios , Adulto Joven , Sistemas Electrónicos de Liberación de Nicotina/estadística & datos numéricos , NicotinaRESUMEN
Background: Nearly 3 million U.S. adolescents use e-cigarettes. E-cigarette marketing is associated with adolescent e-cigarette use; however, studies have not asked adolescents their perceptions about whether and which e-cigarette marketing in retail stores influences purchase and use. Methods: Eleven 90-minute focus groups with 12-19-year-olds (mean age 15.7, 46.6 % female) from 11 U.S. states (n = 58) recruited through Instagram and schools (May 2021-Aug 2022). Photographs of e-cigarette marketing in and around retail stores were used to aid discussion. Thematic analysis identified themes related to appealing marketing characteristics. Results: Adolescents indicated that e-cigarette marketing in and around retail stores arouses their curiosity, reminds them to buy, and normalizes using e-cigarettes. Adolescents identified specific e-cigarette marketing characteristics that they believed influence their decision to purchase and use e-cigarettes including the Tobacco Power Wall, free samples and flavor smelling samples, price incentives such as discounts and starter-kits, e-cigarette displays near checkout encouraging grab-and-go, displays near food, snacks or candy, and e-cigarette advertising through posters on store windows and stickers at checkout. Adolescents reported combining online and social media strategies to bypass age verification in retail stores (e.g., buying gift cards online and using them in stores). Adolescents suggested adding warning images on negative health effects of e-cigarettes, increasing prominence of minimum-age-of-tobacco-sale signs, and developing marketing education as counter-marketing strategies. Conclusions: Adolescents indicate that specific e-cigarette marketing characteristics in retail stores influence their purchase and use decisions. Addressing such e-cigarette marketing exposures in retail stores through counter-marketing messages may bolster adolescent e-cigarette prevention efforts.
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BACKGROUND: Few studies examine the relationship between depression and use of specific tobacco and/or cannabis products among adolescents, young adults, and adults. We determined whether the odds of depression are greater among those who used specific tobacco and/or cannabis products and among co-users of tobacco and cannabis. METHOD: Cross-sectional online survey of a national convenience sample of 13-40-year-olds (N = 6,038). The survey included depression screening and past 30-day use of specific tobacco and cannabis products (cigarettes; e-cigarettes, vaped cannabis, little cigars, cigarillos, cigars, hookah, chewing tobacco, smoked cannabis, edible cannabis, blunts). Analyses correspond to the total sample, and 13-17-, 18-24-, and 25-40-year-olds. RESULTS: Among 5,281 individuals who responded to the depression screener and nine product use questions, 1,803 (34.1 %) reported co-use of at least one tobacco product and one cannabis product in the past 30 days. Past 30-day co-use was associated with higher likelihood of screening positive for depression compared to past 30-day use of tobacco-only (aOR = 1.32, 1.06-1.65; 0.006) or cannabis-only (aOR = 1.94, 1.28-2.94; <0.001). Screening positive for depression was more likely among those who reported past 30-day use of e-cigarettes (aOR = 1.56; 1.35-1.80; <0.001), cigarettes (aOR = 1.24, 1.04-1.48; 0.016), chewed tobacco (aOR = 1.91, 1.51-2.42; <0.001), and blunts (aOR = 1.22, 1.00-1.48; 0.053) compared to those who did not report past 30-day use of these products. Among the 2,223 individuals who screened positive for depression, the most used two-product combination was nicotine e-cigarettes and smoked cannabis (614 individuals, 27.6 %). CONCLUSIONS: Screening positive for depression was more likely among past 30-day co-users versus past 30-day users of tobacco-only or cannabis-only. Findings suggest that prevention programs for depression and substance use address tobacco and cannabis co-use.
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Uso de la Marihuana , Humanos , Adolescente , Masculino , Femenino , Adulto Joven , Adulto , Estudios Transversales , Uso de la Marihuana/epidemiología , Vapeo/epidemiología , Vapeo/psicología , Fumar Marihuana/epidemiología , Fumar Marihuana/psicología , Tamizaje Masivo/métodos , Depresión/epidemiología , Depresión/psicología , Sistemas Electrónicos de Liberación de Nicotina/estadística & datos numéricos , Uso de Tabaco/epidemiologíaRESUMEN
Research is limited regarding adolescents' and young adults' (AYA) patterns, methods of, and reasons for cigarette or e-cigarette cessation. Further, while adults may try to use e-cigarettes to quit combustible cigarettes, little is known about how adults then quit e-cigarettes. This study utilizes a national, cross-sectional online survey of 6131 diverse participants aged 13-40 years to examine reasons for quitting e-cigarettes or cigarettes, quit methods, and quit attempt outcomes among AYAs and adults. In our sample, 3137 (51.2%) had ever used an e-cigarette, of whom 2310 (37.7%) were aged 13-24 years and 827 (13.5%) were 25-40 years old; 2387 (38.9%) had ever used a combustible cigarette (1440 [23.5%] were 13-24 years old and 947 [15.4%] were 25-40 years old). Among e-cigarette ever-users, 39.4% of 13-24-year-olds intended to quit in the next 6 months, and 36.9% had a serious plan for quitting in the next 30 days; 25.2% wanted to decrease the amount they used while 34.8% wanted to quit completely. Similar rates were found among e-cigarette ever users aged 25-40 years, as well as past 30-day e-cigarette users, cigarette ever-users, and past 30-day cigarette users across all ages. "Cold turkey" (41.0%) followed by "tried to cut down slowly by vaping/smoking less often or fewer puffs" (25.5%) was the most common quit method among e-cigarette ever-users and cigarette ever-users of all ages. Further study of effective tobacco cessation methods to help both AYAs and adults successfully quit nicotine, whether from cigarettes or e-cigarettes, is urgently needed.
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Sistemas Electrónicos de Liberación de Nicotina , Cese del Hábito de Fumar , Productos de Tabaco , Humanos , Adolescente , Adulto Joven , Adulto , Cese del Hábito de Fumar/métodos , Estudios Transversales , FumarRESUMEN
BACKGROUND: Sociodemographic differences in e-cigarette use have been documented; however, disparities in use of specific e-cigarette types with various ingredients have yet to be thoroughly investigated. This study examines ever- and past-30-day-use of nicotine, cannabis, and non-nicotine e-cigarette device types by sex, sexual orientation, race/ethnicity, and financial comfort. METHODS: Data were drawn from a 2021 national cross-sectional survey of adolescents, young adults, and adults (N = 6131, ages 13-40 years old). Participants reported ever and past-30-day-use of (1) disposable nicotine e-cigarettes, (2) pod/cartridge-based nicotine e-cigarettes, (3) "other" nicotine e-cigarettes, (4) non-nicotine e-cigarettes, (5) e-cigarettes with THC, and (6) e-cigarettes with CBD. We constructed summary tables for each e-cigarette device type in which percentages of ever and past-30-day-use were calculated by birth year category and sociodemographic variables: (a) sex, (b) sexual orientation, (c) race/ethnicity, and (d) financial comfort. RESULTS: Females born between 1996 and 2008 reported higher rates of past-30-day disposable e-cigarette use relative to males (females 26.4%; males 22.4%). Compared to their heterosexual counterparts, LGBTQ+ participants reported higher overall rates of past-30-day-use for disposable (LGBTQ+ 27.9%; Heterosexual 23.8%), THC (LGBTQ+ 30.8%; Heterosexual 24.1%), and CBD e-cigarettes (LGBTQ+ 20.0%; Heterosexual 16.9%). Hispanic/Latino participants generally reported higher rates of past-30-day-use across device types relative to those identifying as Black or White non-Hispanic, particularly disposable nicotine e-cigarettes. CONCLUSIONS: Findings highlight sociodemographic disparities in e-cigarette use, though differences varied based on e-cigarette device type and participant birth year category. Tailored preventive efforts may be necessary to mitigate e-cigarette use among populations at highest risk.
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Cannabis , Sistemas Electrónicos de Liberación de Nicotina , Alucinógenos , Productos de Tabaco , Vapeo , Adolescente , Adulto Joven , Humanos , Masculino , Femenino , Adulto , Nicotina , Estudios TransversalesRESUMEN
BACKGROUND: Adolescents' school engagement, mental health, and substance use have been major concerns during the COVID-19 pandemic, particularly given disruptions to school instruction. We examined how the instructional setting was associated with academic and health-related outcomes within an adolescent cohort followed during the pandemic. METHODS: During 3 semi-annual follow-up surveys, adolescents (N = 1066 students; 2242 observations) from 8 California high schools responded to items measuring academic self-efficacy, school connectedness, internalizing and externalizing problems, and use of substances. Separate generalized estimating equation models predicted outcomes based on the instructional setting. RESULTS: Relative to in-person instruction, students in remote instruction reported lower academic self-efficacy (Beta: -0.11; 95% confidence interval [CI]: -0.22, -0.01) and school connectedness (Beta: -0.37; 95% CI: -0.48, -0.25), greater odds of past 30-day internalizing problems (AOR: 1.46; 95% CI: 1.09, 1.95), externalizing problems (AOR: 1.36; 95% CI: 1.02, 1.82), and cigarette, cigar, smokeless tobacco, or hookah use (AOR: 2.50; 95% CI: 1.06, 5.91), but lower odds of past 30-day e-cigarette use (AOR: 0.50; 95% CI: 0.30, 0.86). CONCLUSIONS: Multiple adverse outcomes related to school engagement, mental health, and substance use were associated with remote instruction. To reduce such impacts under future emergencies, schools should rely sparingly on remote instruction and provide appropriate supportive resources.
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Importance: Despite increasing use of cigarettes and electronic cigarettes (e-cigarettes) and related health effects among youth, few studies have reported their effects on eyes. Objective: To examine the frequency and severity of ocular symptoms (ocular discomfort, pain, burning, itching, redness, dryness, glare, blurriness, strain, and headaches) in young e-cigarette and cigarette users. Design, Setting, and Participants: In an observational cross-sectional study, a survey conducted in May 6 to 14, 2020, asked participants about use (ever, past 30 days, and past 7 days) of e-cigarettes and cigarettes. The participants included US individuals aged 13 to 24 years. Main Outcomes and Measures: Associations between vision-related outcomes (general vision, severity/frequency of ocular symptoms) and tobacco use were analyzed using weighted multivariable logistic regressions, adjusting for sociodemographic factors, contact lens use, and other combustible use. Results: There were 2168 never users, 2183 ever users, 1092 past 30-day users, and 919 past 7-day users of e-cigarettes; 55.9% of e-cigarette ever users also used cigarettes (dual users). Of the 4351 respondents, 63.8% identified as female, and mean (SD) age was 19.1 (2.9) years. Between 1.1% and 3.9% of ever dual users reported severe to very severe ocular symptoms; between 0.9% and 4.3% reported daily symptoms, which was higher than the proportion of symptoms in e-cigarette- or cigarette-only users. Past 7-day dual users had more severe itching (adjusted odds ratio [AOR], 2.37; 95% CI, 1.36-4.13; P = .002), redness (AOR, 2.58; 95% CI, 1.50-4.46; P = .001), dryness (AOR, 2.89; 95% CI, 1.64-5.08; P < .001), glare (AOR, 2.56; 95% CI, 1.50-4.35; P = .001), blurriness (AOR, 2.47; 95% CI, 1.36-4.50; P = .003), headaches (AOR, 2.31; 95% CI, 1.34-4.00; P = .003); and more frequent pain (AOR, 3.45; 95% CI, 2.09-5.68; P < .001), burning (AOR, 3.08; 95% CI, 1.86-5.09; P < .001), and redness (AOR, 2.72; 95% CI, 1.69-4.36; P < .001) than all other participants. Past 30-day dual users had more severe dryness (AOR, 2.65; 95% CI, 1.61-4.36; P < .001) and more frequent pain (AOR, 3.33; 95% CI, 2.12-5.21; P < .001) than all other participants. Ever dual users experienced more severe dryness (AOR, 1.60; 95% CI, 1.05-2.43; P = .03) and blurriness (AOR, 1.79; 95% CI, 1.21-2.64; P = .003) and more frequent pain (AOR, 1.69; 95% CI, 1.13-2.53; P = .01) and blurriness (AOR, 1.63; 95% CI, 1.13-2.36; P = .009) than never users. Conclusions and Relevance: In this cross-sectional US study, adolescents and young adult users of both e-cigarettes and cigarettes had a higher likelihood of experiencing severe and frequent ocular symptoms, with past 7-day users reporting more symptoms than past 30-day users or ever users. These findings provide additional reasons for users of e-cigarettes and cigarettes to reduce their tobacco use to possibly prevent or minimize ocular symptoms.
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Sistemas Electrónicos de Liberación de Nicotina , Productos de Tabaco , Humanos , Adolescente , Femenino , Adulto Joven , Estudios Transversales , Productos de Tabaco/estadística & datos numéricos , Dolor , Cefalea/diagnóstico , Cefalea/epidemiología , Cefalea/etiología , Prurito , Fumar/efectos adversos , Fumar/epidemiologíaRESUMEN
People from racial and ethnic minoritized groups, those with disabilities, and those from low-income backgrounds are underrepresented in biomedical careers. Increasing diversity in the biomedical workforce, particularly health care providers, is imperative to address the disparities faced by minoritized patients. The COVID-19 pandemic highlighted disparities experienced by minoritized populations and emphasized the need for a more diverse biomedical workforce. Science internship, mentorship, and research programs, which have historically been conducted in person, have been shown to increase interest in biomedical fields for minoritized students. During the pandemic, many science internship programs pivoted to virtual programming. This evaluation focuses on two such programs for both early and late high school students and evaluates change in scientific identity and scientific tasks pre- and post-program. Additionally, early high school students were interviewed to obtain more in-depth information on the program experiences and effects. Early and late high school students reported increased scientific identity and comfort with scientific tasks compared pre- to post-program in several domains. Desire to pursue biomedical careers was maintained pre- to post-program for both groups. These results highlight the importance and acceptance of developing curricula for online platforms to help boost interest in biomedical fields and desire for biomedical careers.
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PURPOSE: United States Smokeless Tobacco Company LLC submitted a modified risk tobacco product application to the US Food and Drug Administration, proposing a claim that switching to Copenhagen snuff fine cut from cigarettes reduces lung cancer risk. This claim could affect adolescents' smokeless tobacco perceptions and its use. METHODS: Students (N = 592; mean age: 15.3 years; 46% male; 32% nonHispanic White; 8% smokeless tobacco ever-users) at seven California high schools were randomized within a survey to view a Copenhagen snuff image, either with or without the proposed reduced risk claim. Participants were then asked about the harm of smokeless tobacco and their willingness to try Copenhagen snuff if a friend offered. Postimage harm rating and willingness were compared between image groups overall, stratified by past 30-day tobacco use (87% of tobacco users were e-cigarette users), and adjusted for participant characteristics using multivariable regression. RESULTS: Participants who viewed the claim were less likely to perceive smokeless tobacco to cause "a lot" of harm (56% vs. 64%; p = .03), including after statistical adjustment (risk ratio [RR]: 0.84; 95% confidence interval [CI]: 0.75, 0.94), and with a numerically stronger effect among tobacco users (RR: 0.65; 95% CI: 0.48, 0.86). The claim did not increase willingness overall (17% vs. 20%; p = .41) but did increase willingness among tobacco users (RR: 1.67; 95% CI: 1.05, 2.67). DISCUSSION: Brief exposure to a reduced-risk claim decreased adolescents' smokeless tobacco harm perceptions and increased willingness to try among tobacco users. The Food and Drug Administration order permitting this claim could increase some adolescents' susceptibility to smokeless tobacco, particularly those already using other tobacco products like e-cigarettes.
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Sistemas Electrónicos de Liberación de Nicotina , Productos de Tabaco , Tabaco sin Humo , Adolescente , Femenino , Humanos , Masculino , Encuestas y Cuestionarios , Productos de Tabaco/efectos adversos , Uso de Tabaco , Estados UnidosRESUMEN
Educational programs that address adolescents' misperceptions of e-cigarette harms and benefits and increase refusal skills play an important role in preventing initiation and use. This study evaluates changes in adolescents' e-cigarette perceptions, knowledge, refusal skills, and intentions to use following a real-world implementation of a school-based vaping-prevention curriculum. Study participants were 357 9th-12th grade students from one high school in Kentucky, United States who participated in a 60-minute vaping prevention curriculum from the Stanford REACH Lab's Tobacco Prevention Toolkit. Participants completed pre- and post-program assessments regarding their e-cigarette knowledge, perceptions, refusal skills, and intentions to use e-cigarettes. Matched paired t-tests and McNemar tests of paired proportions were applied to assess changes in study outcomes. Following the curriculum, participants indicated statistically significant changes on all 15 survey items related to e-cigarette perceptions (p's < 0.05). Participants demonstrated improved knowledge that e-cigarettes deliver nicotine in the form of an aerosol (p <.001), reported that if a friend offered them a vape it would be easier to say no (p <.001), and indicated they would be less likely to take the vape (p <.001) after receiving the curriculum. Other survey items related to knowledge, refusal skills, and intentions did not demonstrate significant changes. Overall, participation in a single session vaping-prevention curriculum was associated with several positive changes in high school students' e-cigarettes knowledge, perceptions, refusal skills, and intentions. Future evaluations should examine how such changes affect long-term trajectories of e-cigarette use.
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BACKGROUND: This study assesses use and perceptions of short- and long-term harms associated with cigarettes, e-cigarettes, and smoked marijuana among adolescents and young adults (AYAs) with cystic fibrosis (CF). METHODS: A total of 205 AYAs with CF completed an online survey querying about use, safety perceptions, and education related to traditional cigarettes, electronic cigarettes (e-cigarettes), and smoked marijuana. In addition, parents of AYAs with CF and CF healthcare providers were asked questions about experiences in avoidance education. RESULTS: AYA participants with CF reported using tobacco and marijuana at rates lower than that of the general AYA population, with heavy use considerably lower in this population. AYAs with CF perceived lower risk of negative outcomes associated with using e-cigarettes and smoked marijuana compared to combustible cigarettes. Ever-use was correlated with a lower perception of risk across all products. CF providers estimated lower rates of product use in their own patients compared to both the general AYA CF population and the general AYA population, and estimated lower use among the general CF AYA population compared to the general AYA population. Receipt of avoidance education varied greatly when comparing AYAs with CF, parents of individuals with CF, and CF healthcare providers. Reasons for undereducation include but are not limited to lack of familiarity with products, assumption of avoidance, assumption of education, and time constraints. CONCLUSIONS: Findings concerning safety perceptions and use of combustible tobacco, e-cigarettes, and marijuana in individuals with cystic fibrosis underscore the importance of providing avoidance education to vulnerable patient populations. Insight derived from this study may also inform pediatric to adult clinic transition education, when chronic disease populations are at greatest risk for engaging in risky behaviors. IMPLICATIONS AND CONTRIBUTION: We report data on use, risk perception, and education of cigarettes, electronic cigarettes, and cannabis in individuals with cystic fibrosis, with a focus on adolescents and young adults. Such Findings will inform prevention education, especially during the critical transition period from pediatric to adult care when these behaviors are prevalent.
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Cannabis , Fibrosis Quística , Sistemas Electrónicos de Liberación de Nicotina , Productos de Tabaco , Transición a la Atención de Adultos , Humanos , Adolescente , Adulto Joven , Niño , Fibrosis Quística/epidemiología , Productos de Tabaco/efectos adversos , Uso de TabacoRESUMEN
BACKGROUND: Frontline providers frequently make time-sensitive antibiotic choices, but many feel poorly equipped to handle antibiotic allergies. OBJECTIVE: We hypothesized that a digital decision support tool could improve antibiotic selection and confidence when managing ß-lactam allergies. METHODS: A digital decision support tool was designed to guide non-allergist providers in managing patients with ß-lactam allergy labels. Non-allergists were asked to make decisions in clinical test cases without the tool, and then with it. These decisions were compared using paired t tests. Users also completed surveys assessing their confidence in managing antibiotic allergies. RESULTS: The tool's algorithm was validated by confirming its recommendations aligned with that of five allergists. Non-allergist providers (n = 102) made antibiotic management decisions in test cases, both with and without the tool. Use of the tool increased the proportion of correct decisions from 0.41 to 0.67, a difference of 0.26 (95% CI, 0.22-0.30; P < .001). Users were more likely to give full-dose antibiotics in low-risk situations, give challenge doses in medium-risk situations, and avoid the antibiotic and/or consult allergy departments in high-risk situations. A total of 98 users (96%) said the tool would increase their confidence when choosing antibiotics for patients with allergies. CONCLUSIONS: A point-of-care clinical decision tool provides allergist-designed guidance for non-allergists and is a scalable system for addressing antibiotic allergies, irrespective of allergist availability. This tool encouraged appropriate antibiotic use in low- and medium-risk situations and increased caution in high-risk situations. A digital support tool should be considered in quality improvement and antibiotic stewardship efforts.
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Hipersensibilidad a las Drogas , Hipersensibilidad , Humanos , beta-Lactamas/efectos adversos , Antibacterianos/efectos adversos , Hipersensibilidad a las Drogas/diagnóstico , Hipersensibilidad a las Drogas/terapia , Encuestas y Cuestionarios , PenicilinasRESUMEN
IMPORTANCE: Oral nicotine products such as pouches, lozenges, tablets, gums, and toothpicks are gaining popularity, especially among adolescents and young adults, with increased marketing. OBJECTIVE: To estimate use patterns of oral nicotine products and likelihood of buying and liking products based on marketing, using a large group of adolescents, young adults, and adults. DESIGN, SETTING, AND PARTICIPANTS: A cross-sectional, online survey among U.S. participants (n = 6,131; ages 13-40 years) was conducted in November-December 2021. MAIN OUTCOMES AND MEASURES: Ever, past-30-day, and past-7-day use, behaviors, and flavors of oral nicotine products. Liking marketing and likelihood of buying specific oral nicotine products (Zyn pouches and Lucy gum) from marketing. RESULTS: Our sample included 2,025 (33.0%) ever-users, 1,191 (19.4%) past-30-day users, and 998 (16.3%) past-7-day users of any oral nicotine product. Use patterns by age (in years): ever-users (<21: 816 (22.3%); 21-40: 1,209 (48.9%)); past-30-day users (<21: 458 (12.5%); 21-40: 733 (29.7%)); and past-7-day users (<21: 383 (10.5%); 21-40: 615 (24.9%)). Across products, 10-18% of participants reported using nicotine strength ranging from 6-10 mg. Fruit, sweet/dessert, alcohol, coffee, and mint were the most used flavors. When shown marketing, ever-users liked and were likely to buy Zyn pouches compared to never users, and participants under 21 years felt equally targeted by Lucy and Zyn marketing. Liking Zyn marketing even a little bit compared to not at all increased the likelihood of buying Zyn pouches across age groups. After observing marketing, participants < 21 years were more likely to buy Zyn if they perceived marketing to contain messages about good tasting flavors (AOR 1.43, 1.09-1.87; 0.009) and helping to feel comfortable in social situations (AOR 1.38, 1.02-1.87; 0.033), and were more likely to buy Lucy if they felt it could be used anywhere (AOR 1.57, 1.05-2.33; 0.026). CONCLUSIONS: This study provides a foundation for estimating use, behaviors, flavors, and marketing influence of oral nicotine products in the US and globally. Adolescent and young adult use of oral nicotine products and likelihood of buying products when exposed to marketing highlights the need for expanded tobacco use surveillance, marketing regulations, and counter marketing and educational efforts.
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Sistemas Electrónicos de Liberación de Nicotina , Productos de Tabaco , Humanos , Adulto Joven , Adolescente , Adulto , Nicotina , Estudios Transversales , Uso de Tabaco , Comportamiento del Consumidor , MercadotecníaRESUMEN
OBJECTIVES: Late preterm and term infants comprise 97.3% of annual births in the United States. Admission criteria and the availability of medical interventions in well newborn nurseries are key determinants of these infants remaining within a mother-infant dyad or requiring a NICU admission and resultant separation of the dyad. The objective of this study was to identify national patterns for well newborn nursery care practices. METHODS: We surveyed a physician representative from each nursery in the Better Outcomes through Research for Newborns Network. We described the admission criteria and clinical management of common newborn morbidities and analyzed associations with nursery demographics. RESULTS: Of 96 eligible nursery representatives, 69 (72%) completed surveys. Among respondents, 59 (86%) used a minimal birth weight criterion for admission to their well newborn nursery. The most commonly used criteria were 2000 g (n = 29, 49%) and 1800 g (n = 19, 32%), with a range between 1750 and 2500 g. All nurseries used a minimal gestational age criterion for admission; the most commonly used criterion was 35 weeks (n = 55, 80%). Eleven percent of sites required transfer to the NICU for phototherapy. Common interventions in the mother's room included dextrose gel (n = 56, 81%), intravenous antibiotics (n = 35, 51%), opiates for neonatal abstinence syndrome (n = 15, 22%), and an incubator for thermoregulation (n = 14, 20%). CONCLUSIONS: Wide variation in admission criteria and medical interventions exists in well newborn nurseries. Further studies may help identify evidence-based optimal admission criteria to maximize care within the mother-infant dyad.
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Casas Cuna , Lactante , Recién Nacido , Humanos , Estados Unidos/epidemiología , Peso al Nacer , Hospitalización , Edad Gestacional , Encuestas y Cuestionarios , Unidades de Cuidado Intensivo NeonatalRESUMEN
Background: National surveillance assessing use of novel oral tobacco products (OTPs; nicotine pouches, lozenges, and gums not approved for tobacco cessation) among adolescents and young adults is limited. Objectives: To assess OTP behaviors in a sample of adolescent and young adult e-cigarette users, including use prevalence, dual/poly use with other products, and associated demographics. Methods: A national (United States) cross-sectional survey was conducted from March to April 2021 among 2253 participants (ages 14-20; 65% female) who ever used e-cigarettes ≥3 times. Demographics, lifetime use, and past 30-day use of 10 tobacco and cannabis products, including novel and conventional (chew, moist snuff, or snus) OTPs was assessed. Analysis was descriptive, examining use prevalence (lifetime and past 30-day) of each product, including by demographics and other product use. Results: Nearly 44% reported ever using any OTP, with nicotine pouches being the most commonly ever used (29%) and used in the past month (11%). Novel OTP use was more common among older participants (18-20 years), male participants, and past 30-day users of e-cigarettes, combustible tobacco, and conventional oral tobacco. However, female participants and combustible tobacco non-users were over twice and 4-times as likely, respectively, to use novel OTPs than conventional OTPs. Nearly 73% of past 30-day conventional OTP users were past 30-day novel OTP users. Conclusion: Novel OTP use was prevalent among adolescent and young adult e-cigarette users. Compared to conventional OTPs, novel OTPs likely have greater appeal to females and combustible tobacco non-users. Action to restrict access and reduce interest in OTPs is needed to prevent use among this population.
Asunto(s)
Sistemas Electrónicos de Liberación de Nicotina , Productos de Tabaco , Tabaco sin Humo , Adolescente , Adulto Joven , Masculino , Humanos , Femenino , Estados Unidos/epidemiología , Adulto , Nicotina , Estudios Transversales , Nicotiana , Uso de Tabaco/epidemiologíaRESUMEN
Extensive literature exists on bone health in females with an eating disorder, yet few have studied males. Our study assessed clinician confidence and current practices for assessing bone health in patients with an eating disorder. We also aimed to identify any differences in practice based on patient sex. Our 31-item survey, distributed to adolescent clinicians in the United States via the Society for Adolescent Health and Medicine (SAHM) listserv, assessed clinician confidence and practices for assessing bone mineral density in both male and female adolescents with an eating disorder. Findings showed that clinicians (n = 104) were less confident in assessing bone mineral density in males compared to females (p < .001), yet there was no significant difference in rates of obtaining a DXA (p = .390). Although clinicians are less confident assessing bone health in males with an eating disorder than females, this does not appear to result in screening differences.