Quantifying virtual reality pain modulation in healthy volunteers: A randomized, crossover study.

STUDY OBJECTIVE: Virtual reality (VR) is an emerging tool to reduce pain and anxiety during procedures. Although VR's clinical benefits are reported, biometric data quantifying VR's effect on pain tolerance is lacking. We used time-lapse, subjective, and biometric data to evaluate VR's effect on modulating pain. DESIGN: Randomized, controlled crossover within-subject clinical trial. SETTING: This study was conducted in the Chariot Lab at Lucile Packard Children's Hospital and outdoors at Stanford University School of Medicine. PATIENTS: 156 healthy volunteers were included. INTERVENTIONS: Participants underwent pain-inducing ice immersions while connected to biometric sensors. Participants were randomized to immerse their dominant or non-dominant hand with VR or control (no VR) for one immersion, and then crossed-over to the other hand for the second immersion. We instructed participants to submerge their hand until they reached their pain tolerance or until four minutes elapsed. MEASUREMENTS: Outcomes included ice immersion duration, perceived pain scores, and skin conductance response density (SCRD), a marker of sympathetic arousal. We used survival analysis and mixed effects models to compare measurements with and without VR. MAIN RESULTS: 153 participants were included in the analysis. Participants with VR were 64% less likely to remove their hands from the ice bath throughout the immersion's duration compared to control (P < 0.001). Participants with VR reported significantly lower pain scores after controlling for dominant hand treatment assignment, VR vs. no VR treatment order, and gender (P < 0.001). SCRD increased as time progressed for both VR and control groups (P = 0.047 combined), with no significant mean group differences. CONCLUSIONS: Participants with VR were more likely to survive the 4-min ice bath challenge longer and with lower levels of pain perception, supporting VR's effectiveness as a distraction tool during painful procedures. We observed no differences in sympathetic response when comparing VR to no VR.

ENDS Device Type and Initiation of Combustible Tobacco Products Among Adolescents.

INTRODUCTION: The aim of this study was to determine whether Electronic Nicotine Delivery Systems (ENDS) device type (disposable devices, replaceable cartridges, and refillables) at initial or first ENDS use predicts subsequent initiation of combustible tobacco products (cigarettes, hookah, cigars) among adolescents and/or differentiates between those who initiate use of both ENDS and combustible tobacco products at the same time. METHODS: The study examined data from the Texas Adolescent Tobacco and Marketing Surveillance System (TATAMS), a longitudinal population-based cohort of students in major metropolitan areas of Texas (n = 3907; N = 461 069). Data were collected every 6 months, from 2014 to 2018; 33.9% (n = 1324; N = 151 784) of the sample initiated ENDS use across this period. Unadjusted and adjusted logistic regression models were used to assess the odds of initiating combustible tobacco products at a subsequent or similar wave as ENDS initiation, given initial ENDS device type. RESULTS: After adjusting for sociodemographic factors, the odds of initiating combustible tobacco use subsequent to ENDS initiation were significantly lower among those who reported using Cartridges as their initial device type compared to those who reported Refillables as their initial device type (adjusted odds ratio = 0.42 [0.18-0.98], p = .05). In addition, after controlling for sociodemographic variables, the odds of initiating combustible tobacco use in the same wave as ENDS initiation were significantly higher among those who reported using Cartridges as their initial device type, compared with those who reported Refillables as their initial device type (adjusted odds ratio = 2.31 [1.05-5.10], p = .04). No significant differences were found in adjusted models when Disposables were compared to Refillables and Cartridges to Disposables. CONCLUSION: ENDS device type differentiates between adolescents who start using combustible tobacco products at the same time as initial ENDS use, or subsequently. IMPLICATIONS: Previous research has shown ENDS use predicts subsequent combustible use among adolescents, but there is lack of research on the role of specific ENDS device types and the timing of initiation. Findings from this longitudinal study show that initiation of combustible tobacco product use varies by initial ENDS device type among adolescents. These findings can become a focal point for developing interventions for adolescents and could have regulatory implications for ENDS products.

Whose Post Is It? Predicting E-cigarette Brand from Social Media Posts.

OBJECTIVES: E-cigarette advertisers know that 76% of youth use social media, yet little is known about the nature of e-cigarette advertising on social media most favored by youth. We utilized text-mining to characterize e-cigarette advertising and marketing messages from image-focused social media brand sites, and to construct and test an algorithm for predicting brand from brand-generated social media posts. METHODS: Data comprised 5022 unique posts accompanied by an image from Facebook, Instagram or Pinterest e-cigarette brand pages for Blu, Logic, Metro, and NJOY from February 2012 to April 2015. Text-tokenization was used to quantify text for use as predictors in analyses. RESULTS: Blu had the largest social media presence (65%), followed by Logic (16%), NJOY (12%) and Metro (7%). Blu's average post length was significantly shorter than all other brands. Words most commonly used in posts differed by brand. Regression analyses successfully differentiated Blu and NJOY brands from other brands. CONCLUSIONS: Analyses revealed e-cigarette brands used different types of messages to appeal to social media users. Whereas words used by Blu and NJOY sold a "lifestyle," words used by Logic and Metro relied on device and product identification.

Texas Adolescent Tobacco and Marketing Surveillance System's Design.

OBJECTIVES: To provide a full methodological description of the design of the wave I and II (6-month follow-up) surveys of the Texas Adolescent Tobacco and Marketing Surveillance System (TATAMS), a longitudinal surveillance study of 6th, 8th, and 10th grade students who attended schools in Bexar, Dallas, Tarrant, Harris, or Travis counties, where the 4 largest cities in Texas (San Antonio, Dallas, Fort Worth, Houston, and Austin, respectively) are located. METHODS: TATAMS used a complex probability design, yielding representative estimates of these students in these counties during the 2014-2015 academic year. Weighted prevalence of the use of tobacco products, drugs and alcohol in wave I, and the percent of: (i) bias, (ii) relative bias, and (iii) relative bias ratio, between waves I and II are estimated. RESULTS: The wave I sample included 79 schools and 3,907 students. The prevalence of current cigarette, e-cigarette and hookah use at wave I was 3.5%, 7.4%, and 2.5%, respectively. Small biases, mostly less than 3.5%, were observed for nonrespondents in wave II. CONCLUSIONS: Even with adaptions to the sampling methodology, the resulting sample adequately represents the target population. Results from TATAMS will have important implications for future tobacco policy in Texas and federal regulation.

Flavored Tobacco Product Use among Youth and Young Adults: What if Flavors Didn't Exist?

OBJECTIVE: We aimed to determine the potential for reductions in the prevalence of young people's e-cigarette and tobacco use if characterizing flavors were not present. METHODS: Two parallel cross-sectional surveys of 2483 youth (TATAMS: Texas Adolescent Tobacco and Marketing Surveillance System) and 4326 young adults (M-PACT: Marketing and Promotions across Colleges in Texas) in Texas (Houston, Dallas/Ft. Worth, San Antonio, Austin). Current use of e-cigarettes and other tobacco (cigarettes, cigar products, hookah, smokeless tobacco). Users were asked: "When you use [product], do you usually use any of the following flavors?" Flavored product users were asked: "Would you continue using [product] if it were not flavored?" RESULTS: Over 80% of youth and young adult tobacco users reported using flavored tobacco. Three-fourths of flavored product users said they would no longer use the product if it was not flavored. This was highest for e-cigarettes and hookah and lowest for cigarettes. Few demographic differences in findings were observed. CONCLUSIONS: Restricting flavors in tobacco products would not eradicate e-cigarette or other tobacco use among young people, but the potential for substantial reductions in the prevalence of young people's e-cigarette and other tobacco use seems high if flavors were removed.