Do NO, N2O, N2 and CO2 fluxes differ in soils sourced from cropland and varying riparian buffer vegetation? An incubation study.

Riparian buffers are expedient interventions for water quality functions in agricultural landscapes. However, the choice of vegetation and management affects soil microbial communities, which in turn affect nutrient cycling and the production and emission of gases such as nitric oxide (NO), nitrous oxide (N2O), nitrogen gas (N2) and carbon dioxide (CO2). To investigate the potential fluxes of the above-mentioned gases, soil samples were collected from a cropland and downslope grass, willow and woodland riparian buffers from a replicated plot scale experimental facility. The soils were re-packed into cores and to investigate their potential to produce the aforementioned gases via potential denitrification, a potassium nitrate (KNO3 -) and glucose (labile carbon)-containing amendment, was added prior to incubation in a specialized laboratory DENItrification System (DENIS). The resulting NO, N2O, N2 and CO2 emissions were measured simultaneously, with the most NO (2.9 ± 0.31 mg NO m-2) and N2O (1413.4 ± 448.3 mg N2O m-2) generated by the grass riparian buffer and the most N2 (698.1 ± 270.3 mg N2 m-2) and CO2 (27,558.3 ± 128.9 mg CO2 m-2) produced by the willow riparian buffer. Thus, the results show that grass riparian buffer soils have a greater NO3 - removal capacity, evidenced by their large potential denitrification rates, while the willow riparian buffers may be an effective riparian buffer as its soils potentially promote complete denitrification to N2, especially in areas with similar conditions to the current study.

Testing Cross-Generational Effects of the Raising Healthy Children Intervention on Young Adult Offspring of Intervention Participants.

This study tested whether effects of a preventive intervention delivered in elementary school showed benefits for the young adult offspring of intervention recipients over 20 years later. The Raising Healthy Children (RHC) intervention, trialed in 18 public schools in Seattle, Washington, from 1980-1986 (grades 1-6), sought to build strong bonds to family and school to promote school success and avoidance of substance use and illegal behavior. Four intervention groups were constituted: full, late, parent training only, and control. Participants were followed through 2014 (age 39 years). Those who became parents were enrolled in an intergenerational study along with their oldest offspring (10 assessments between 2002 and 2018). This study includes young adult offspring (ages 18-25 years; n = 169; 52% female; 4% Asian, 25% Black, 40% multiracial, 4% Native American, 2% Native Hawaiian/Pacific Islander, 25% White, and 14% Hispanic/Latinx) of participants in the original RHC trial. Offspring outcome measures included high school noncompletion, financial functioning, alcohol misuse, cannabis misuse, cigarette use, criminal behavior, internalizing behavior, social skills, and social bonding. A global test across all young adult outcome measures showed that offspring of parents who received the full RHC intervention reported better overall functioning compared to offspring of control group parents. Analyses of individual outcomes showed that offspring of full intervention group parents reported better financial functioning than offspring of control group parents. Findings show the potential of universal preventive interventions to provide long-term benefits that reach into the next generation. ClinicalTrials.gov Identifier: NCT04075019; retrospectively registered in 2019.

Effect of the Communities That Care Prevention System on Adolescent Handgun Carrying: A Cluster-Randomized Clinical Trial.

Importance: There is little information on upstream community-based interventions that reduce the prevalence of handgun carrying among adolescents, especially those growing up in rural areas. Objective: To test whether Communities That Care (CTC), a community-based prevention system focusing on risk and protective factors for behavioral problems early in life, reduces handgun carrying prevalence among adolescents growing up in rural areas. Design, Setting, and Participants: Community-randomized trial of 24 small towns in 7 states assigned randomly to the CTC or control group with outcomes assessed from 2003 to 2011. Participants were youths attending public schools in grade 5 who received consent from their parents to participate (77% of the eligible population) and were repeatedly surveyed through grade 12 with 92% retention. Analyses were conducted from June to November 2022. Interventions: A coalition of community stakeholders received training and technical assistance to install CTC, used local epidemiologic data to identify elevated risk factors and low protective factors for adolescent behavioral problems, and implemented tested preventive interventions for youth, their families, and schools. Main Outcomes and Measures: Handgun carrying (never vs at least once) operationalized in 2 ways: (1) prevalence of past-year handgun carrying, and (2) cumulative prevalence of handgun carrying from grade 6 through grade 12. Results: Overall, the 4407 study participants' mean (SD) age was 12 (.4) years in both CTC (2405 participants) and control (2002 participants) communities in grade 6; about one-half of participants in each group were female (1220 [50.7 %] in the CTC group and 962 [48.1%] in the control group). From grade 6 through grade 12, 15.5% of participants in CTC communities and 20.7% of those in control communities reported carrying a handgun at least once. Youths in CTC communities were significantly less likely to report handgun carrying at a given grade than those in control communities (odds ratio [OR], 0.73; 95% CI, 0.65-0.82). The most pronounced effects were observed in grade 7 (OR, 0.70; 95% CI, 0.42-0.99), grade 8 (OR, 0.58; 95% CI, 0.41-0.74), and grade 9 (OR, 0.65; 95% CI, 0.39-0.91). Cumulatively from grade 6 through grade 12, youths in CTC communities were significantly less likely to report handgun carrying at least once than those in control communities (OR, 0.76; 95% CI, 0.70-0.84). Overall, CTC reduced the prevalence of past-year handgun carrying by 27% at a given grade and by 24% cumulatively through grade 12. Conclusions and Relevance: In this study, CTC reduced the prevalence of adolescent handgun carrying in participating communities. Trial Registration: ClinicalTrials.gov Identifier: NCT01088542.

Perceptions of friendship, peers and influence on adolescent smoking according to tobacco control context: a systematic review and meta-ethnography of qualitative research.

BACKGROUND: A relationship between smoking and interpersonal influences has been well established within the literature. There have been cultural shifts in denormalisation and a reduction in tobacco smoking in many countries. Hence there is a need to understand social influences on adolescents' smoking across smoking normalisation contexts. METHODS: The search was conducted in July 2019 and updated in March 2022 within 11 databases and secondary sources. Search terms included schools, adolescents, smoking, peers, social norms and qualitative research. Screening was conducted by two researchers independently and in duplicate. Study quality was assessed using the eight-item Evidence for Policy and Practice Information and Co-ordinating Centre (EPPI-centre) tool for the appraisal of qualitative studies. Results were synthesised using a meta-narrative lens for meta-ethnography and compared across smoking normalisation contexts. RESULTS: Forty one studies were included and five themes were developed, mapping onto the socio ecological model. The social processes by which adolescents take up smoking differed according to a mixture of school type, peer group structure and the smoking culture within the school, as well as the wider cultural context. Data available from smoking denormalised contexts, described changes in social interactions around smoking to cope with its stigmatisation. This was manifested through i) direct peer influence, whereby subtle techniques were employed, ii) group belonging whereby smoking was less likely to be seen as a key determinant of group membership and smoking was less commonly reported to be used as a social tool, and iii) popularity and identity construction, whereby smoking was perceived more negatively in a denormalised context, compared with a normalised context. CONCLUSIONS: This meta-ethnography is the first study to demonstrate, drawing on international data, that peer processes in adolescent smoking may undergo changes as smoking norms within society change. Future research should focus on understanding differences across socioeconomic contexts, to inform the adaptation of interventions.

Use of the Posterior Auricular Artery for Indirect Bypass in Moyamoya: A Pediatric Case Series.

INTRODUCTION: Encephaloduroarteriosynangiosis (EDAS) for moyamoya is predominantly performed using a branch of the superficial temporal artery (STA) as the donor artery. At times, other branches of the external carotid artery are better suited for EDAS than is the STA. There is little information in the literature concerning using the posterior auricular artery (PAA) for EDAS in the pediatric age-group. In this case series, we review our experience using the PAA for EDAS in children and adolescents. CASE PRESENTATIONS: We describe the presentations, imaging, and outcomes of 3 patients in whom the PAA was used for EDAS, as well our surgical technique. There were no complications. All 3 patients were confirmed to have radiologic revascularization from their surgeries. All patients also had improvement of their preoperative symptoms, and no patient has had a stroke postoperatively. CONCLUSION: The PAA is a viable option for use as a donor artery in EDAS for the treatment of moyamoya in children and adolescents.

Soil CO2 emissions in cropland with fodder maize (Zea mays L.) with and without riparian buffer strips of differing vegetation.

Vegetated land areas play a significant role in determining the fate of carbon (C) in the global C cycle. Riparian buffer vegetation is primarily implemented for water quality purposes as they attenuate pollutants from immediately adjacent croplands before reaching freashwater systems. However, their prevailing conditions may sometimes promote the production and subsequent emissions of soil carbon dioxide (CO2). Despite this, the understanding of soil CO2 emissions from riparian buffer vegetation and a direct comparison with adjacent croplands they serve remain elusive. In order to quantify the extent of CO2 emissions in such an agro system, we measured CO2 emissions simultaneously with soil and environmental variables for six months in a replicated plot-scale facility comprising of maize cropping served by three vegetated riparian buffers, namely: (i) a novel grass riparian buffer; (ii) a willow riparian buffer, and; (iii) a woodland riparian buffer. These buffered treatments were compared with a no-buffer control. The woodland (322.9 ± 3.1 kg ha- 1) and grass (285 ± 2.7 kg ha- 1) riparian buffer treatments (not significant to each other) generated significantly (p = < 0.0001) the largest CO2 compared to the remainder of the treatments. Our results suggest that during maize production in general, the woodland and grass riparian buffers serving a maize crop pose a CO2 threat. The results of the current study point to the need to consider the benefits for gaseous emissions of mitigation measures conventionally implemented for improving the sustainability of water resources.

Soil N2O and CH4 emissions from fodder maize production with and without riparian buffer strips of differing vegetation.

Purpose: Nitrous oxide (N2O) and methane (CH4) are some of the most important greenhouse gases in the atmosphere of the 21st century. Vegetated riparian buffers are primarily implemented for their water quality functions in agroecosystems. Their location in agricultural landscapes allows them to intercept and process pollutants from adjacent agricultural land. They recycle organic matter, which increases soil carbon (C), intercept nitrogen (N)-rich runoff from adjacent croplands, and are seasonally anoxic. Thus processes producing environmentally harmful gases including N2O and CH4 are promoted. Against this context, the study quantified atmospheric losses between a cropland and vegetated riparian buffers that serve it. Methods: Environmental variables and simultaneous N2O and CH4 emissions were measured for a 6-month period in a replicated plot-scale facility comprising maize (Zea mays L.). A static chamber was used to measure gas emissions. The cropping was served by three vegetated riparian buffers, namely: (i) grass riparian buffer; (ii) willow riparian buffer and; (iii) woodland riparian buffer, which were compared with a no-buffer control. Results: The no-buffer control generated the largest cumulative N2O emissions of 18.9 kg ha- 1 (95% confidence interval: 0.5-63.6) whilst the maize crop upslope generated the largest cumulative CH4 emissions (5.1 ± 0.88 kg ha- 1). Soil N2O and CH4-based global warming potential (GWP) were lower in the willow (1223.5 ± 362.0 and 134.7 ± 74.0 kg CO2-eq. ha- 1 year- 1, respectively) and woodland (1771.3 ± 800.5 and 3.4 ± 35.9 kg CO2-eq. ha- 1 year- 1, respectively) riparian buffers. Conclusions: Our results suggest that in maize production and where no riparian buffer vegetation is introduced for water quality purposes (no buffer control), atmospheric CH4 and N2O concerns may result.

Is e-cigarette use associated with better health and functioning among smokers approaching midlife?

INTRODUCTION: Many adult smokers have tried electronic cigarettes (e-cigarettes) as a less harmful alternative to combustible cigarettes. There is limited evidence, however, for the extent to which switching to e-cigarettes is associated with better health and functioning among nicotine users approaching their 40s-the beginning of midlife-when many health issues become more evident. This study examined the adoption of e-cigarette use ("vaping") among smokers in their 30s, and its association with diverse measures of healthy and successful aging at age 39. METHODS: Data were from the Seattle Social Development Project, a panel study of 808 diverse participants with high retention (88%-91%). A subsample of 156 who used combustible cigarettes (smoked) at age 30 and smoked or vaped at age 39 was selected for analysis. A measure of vaping frequency, relative to combustible cigarette use, was computed from self-reports of past-month vaping and smoking at age 39. Nine measures of health and functioning in the past year were computed at age 39, with nine corresponding measures at age 30. RESULTS: Among smokers at age 30, 36% adopted vaping some or all of the time by age 39. Higher relative vaping frequency was related to 4 of 9 outcomes examined, including significantly more exercise, more constructive engagement, better physical health, and higher SES at age 39, accounting for prior behaviors at age 30. CONCLUSIONS: Findings suggest that, among smokers in their 30s, replacing combustible cigarettes with vaping may be associated with key markers of healthy and successful aging to age 39.

Exploring the association between school-based peer networks and smoking according to socioeconomic status and tobacco control context: a systematic review.

BACKGROUND: Whilst prevalence of youth smoking in middle and high income countries has decreased, inequality has prevailed. The introduction of legislation regulating tobacco use in public spaces varies across countries, impacting the tobacco control context. Thus reviewing our knowledge of how social networks may influence smoking differently within different contexts is required to facilitate the development of context-specific interventions. METHODS: The search, conducted on 31st May 2019, included the following smoking-related terms; schools, adolescents, peers and social networks. Inclusion and exclusion criteria were applied throughout the title and abstract screening and full text screening. Quality assessment and synthesis followed. Studies were narratively synthesised to identify changes according to legislative context. This synthesis was conducted separately for findings relating to three categories: socioeconomic status; social selection and influence; and network position. RESULTS: Thirty studies were included. Differences in the relationship between network characteristics and smoking according to socioeconomic status were measured in five out of fifteen studies in Europe. Results varied across studies, with differences in network characteristics and their association with smoking varying both between schools of a differing and those of a similar socioeconomic composition. For studies conducted both before and after the introduction of comprehensive smoking legislation, the evidence for selection processes was more consistent than influence, which varied according to reciprocity. Findings showed that isolates were more likely to smoke and in-degree and out-degree centrality were related to smoking both before and after the introduction of legislation. The relationship between popularity and smoking was contingent on school level smoking prevalence in studies conducted before the introduction of legislation, but not after. CONCLUSIONS: Overall, effects according to socioeconomic status were underreported in the included studies and no consistent evidence of change after the introduction of a comprehensive smoking ban was observed. Further network analyses are required using more recent data to obtain a comprehensive understanding of how network processes may influence smoking differently according to socioeconomic status, and how adaptation could be used to enhance intervention effectiveness. SYSTEMATIC REVIEW REGISTRATION: International Prospective Register of Systematic Reviews (PROSPERO) registration number: CRD42019137358 .

Parent-focused prevention of adolescent health risk behavior: Study protocol for a multisite cluster-randomized trial implemented in pediatric primary care.

Evidence-based parenting interventions play a crucial role in the sustained reduction of adolescent behavioral health concerns. Guiding Good Choices (GGC) is a 5-session universal anticipatory guidance curriculum for parents of early adolescents that has been shown to reduce substance use, depression symptoms, and delinquent behavior. Although prior research has demonstrated the effectiveness of evidence-based parenting interventions at achieving sustained reductions in adolescent behavioral health concerns, public health impact has been limited by low rates of uptake in community and agency settings. Pediatric primary care is an ideal setting for implementing and scaling parent-focused prevention programs as these settings have a broad reach, and prevention programs implemented within them have the potential to achieve population-level impact. The current investigation, Guiding Good Choices for Health (GGC4H), tests the feasibility and effectiveness of implementing GGC in 3 geographically and socioeconomically diverse large integrated healthcare systems. This pragmatic, cluster randomized clinical trial will compare GGC parenting intervention to usual pediatric primary care practice, and will include approximately 3750 adolescents; n = 1875 GGC intervention and n = 1875 usual care. The study team hypothesizes that adolescents whose parents are randomized into the GGC intervention arm will show reductions in substance use initiation, the study's primary outcomes, and other secondary (e.g., depression symptoms, substance use prevalence) and exploratory outcomes (e.g., health services utilization, anxiety symptoms). The investigative team anticipates that the implementation of GGC within pediatric primary care clinics will successfully fill an unmet need for effective preventive parenting interventions. Trial registration: Clinicaltrials.govNCT04040153.

Early medical abortion by telemedicine in the United Kingdom: a costing analysis.

OBJECTIVE: To determine the potential cost savings resulting from the introduction of routine early medical abortion (EMA) at home by telemedicine in the UK. DESIGN: A costing study. SETTING: The UK. POPULATION: Women in 2020 undergoing EMA provided by three independent abortion providers and two National Health Service (NHS) abortion clinics. METHODS: Computation of the costs of each abortion procedure and of managing failed or incomplete abortion and haemorrhage requiring blood transfusion. MAIN OUTCOME MEASURES: Cost savings. RESULTS: Overall estimated cost savings are £15.80 per abortion undertaken by independent abortion providers, representing a saving to the NHS of over £3 million per year. Limited data from NHS services resulted in an estimated average saving of £188.84 per abortion. CONCLUSIONS: Were telemedicine EMA to become routine, an increase in the number of women eligible for medical rather than surgical abortion, and a reduction in adverse events resulting from earlier abortion, could result in significant cost savings. TWEETABLE ABSTRACT: Early medical abortion at home using telemedicine could save the NHS £3 million per year.

State of the Art in Substance Use Prevention and Early Intervention: Applications to Pediatric Primary Care Settings.

With changes to drug-related policies and increased availability of many drugs, we currently face a public health crisis related to substance use and associated health consequences. Substance use and substance use disorders (SU/SUDs) are complex developmental disorders with etiologies that emerge through the intergenerational transmission of biological, familial, and environmental factors. The family ecosystem both influences and is influenced by SU/SUDs, particularly in children and adolescents. Family dynamics and parent functioning and behaviors can represent either risk or protective factors for the development of SU/SUDs in children. Primary care providers who provide care for children, adolescents, and families are in an ideal position to deliver prevention messages and to intervene early in the development of substance misuse and SUD among their patients. Despite recommendations from the American Academy of Pediatrics, few pediatric primary care providers provide anticipatory guidance to prevent or screen for substance misuse. Many barriers to those practices can be overcome through the integration and application of findings from the field of prevention science and the many lessons learned from the implementation of evidence-based interventions. Consideration of the implications of prevention science findings would help clarify the relevant roles and responsibilities of the primary care clinician, and the benefit of referral to and consultation from addiction specialists. Additionally, the past decade has seen the development and validation of a continuum of evidence-based prevention and early SU/SUD intervention activities that can be adapted for use in primary care settings making wide-spread implementation of prevention feasible. We propose a paradigm shift away from a model based on diagnosis and pathology to one upstream, that of family-focused prevention and early intervention. Adapting and scaling out empirically based prevention and early SU/SUD interventions to primary care settings and removing barriers to collaborative care across primary care, addiction medicine, and mental health providers offer the potential to meaningfully impact intergenerational transmission of SU/SUD - addressing a leading health problem facing our nation.

The role of electronic cigarette use for quitting or reducing combustible cigarette use in the 30s: Longitudinal changes and moderated relationships.

BACKGROUND: Evidence for use of electronic cigarettes (e-cigs) as a potential aid in quitting or reducing combustible cigarette (c-cig) use is mixed. This study examined the extent to which e-cig initiation among smokers in their 30 s predicted quitting or reducing smoking or nicotine dependence symptoms by age 39, and whether the role of e-cigs in quitting differed by prospectively assessed moderators. METHODS: Data were from the Seattle Social Development Project (SSDP), a panel study of 808 diverse participants with high retention. A subsample of 221 smokers at age 33 was selected for analysis. Self-reports of c-cig use and dependence were assessed longitudinally at ages 33 and 39. Sixteen potential moderators were examined, including social demographics, smoking attitudes and desire to quit, other health behaviors and status, and adolescent and early adult assessments of smoking history. RESULTS: The use of e-cigs was consistently associated with a lower likelihood of quitting c-cigs by age 39, after accounting for frequency of prior c-cig use at age 33. This negative association persisted across all moderators examined, although it was nonsignificant among those with a definite desire to cut down. Among those who did not quit smoking, e-cig use had no association with decreases in either quantity of c-cigs used or dependence symptoms. CONCLUSIONS: Results indicate that e-cigarette use was not helpful for quitting or reducing combustible cigarette use in the 30 s. Rather, across extensive tests of moderation, e-cig initiation consistently predicted less quitting during this important age period for successful cessation.

Nifedipine for Acute Tocolysis of Preterm Labor: A Placebo-Controlled Randomized Trial.

OBJECTIVE: To evaluate the effectiveness of acute nifedipine tocolysis in preventing preterm birth in women in preterm labor. METHOD: This was a randomized, double-blind, placebo-controlled trial of nifedipine in women with a singleton pregnancy between 28 0/7 and 33 6/7 weeks of gestation who were admitted with uterine activity, intact membranes, and cervical dilatation from 2 to 4 cm. Women were randomized to receive nifedipine 20 mg or placebo orally, followed by a repeat dose after 90 minutes if contractions persisted. The study drug was continued every 4 hours to complete a 48-hour regimen. The primary outcome was birth before 37 weeks of gestation. A total of 150 women were necessary to detect a one-third reduction in this outcome. After treating 88 patients, a preplanned interim analysis of blinded outcomes by the Data Safety Monitoring Committee recommended discontinuation of the trial due to futility. RESULTS: A total of 90 women were enrolled between May 2014 and November 2017. After two women withdrew, 88 were analyzed: 46 in the nifedipine group and 42 in the placebo group. There was no significant difference in the primary outcome of delivery before 37 weeks of gestation in the nifedipine group compared with the placebo group (52% vs 48%, relative risk [RR] 1.1, 95% CI 0.7-1.7), nor in the secondary outcome of delivery at least 48 hours from randomization (78% vs 71%, respectively, RR 1.1, 95% CI 0.9-1.4). There were also no significant differences between groups in neonatal outcomes. CONCLUSION: Acute tocolysis of preterm labor with nifedipine did not affect preterm birth rates, delivery within 48 hours, or neonatal outcomes. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov, NCT02132533.

Where next for the design, delivery, and evaluation of community-based physical activity prescription? Emerging lessons from the United Kingdom.

Despite widespread use, community-based physical activity prescription is controversial. Data limitations have resulted in a lack of clarity about what works, under what circumstances, and for whom, reflected in conservative policy recommendations. In this commentary we challenge a predominantly negative discourse, using contemporary research to highlight promising findings and "lessons learnt" for design, delivery, and evaluation. In doing so, we argue for the importance of a more nuanced approach to future commissioning and evaluation. Novelty: Amalgamating learning from multiple research teams to create recommendations for advancing physical activity prescription.

A systematic review of patient-reported outcome measures used to assess sleep in postpartum women using Consensus Based Standards for the Selection of Health Measurement Instruments (COSMIN) guidelines.

STUDY OBJECTIVES: We performed a systematic review to identify the best patient-reported outcome measure (PROM) of postpartum sleep in women. METHODS: We searched four databases for validated PROMs used to assess postpartum sleep. Studies were considered if they evaluated at least one psychometric measurement property of a PROM. An overall performance rating was assigned for each psychometric measurement property of each PROM based upon COSMIN criteria. A modified GRADE approach was used to assess the level of evidence and recommendations were then made for each PROM. RESULTS: We identified 15 validation studies of eight PROMs, in 9,070 postpartum women. An adequate number of sleep domains was assessed by five PROMs: Bergen Insomnia Scale (BIS), Pittsburgh Sleep Quality Index (PSQI), General Sleep Disturbance Scale (GSDS), Athens Insomnia Scale (AIS), and the Sleep Symptom Checklist (SSC). BIS and GSDS were the only PROMs to demonstrate adequate content validity and at least a low level of evidence of sufficient internal consistency, resulting in Class A recommendations. The BIS was the only PROM, which is easily accessible and free to use for noncommercial research, that achieved a Class A recommendation. CONCLUSION: The BIS is the best currently available PROM of postpartum sleep. However, this PROM fails to assess several important domains such as sleep duration (and efficiency), chronotype, sleep-disordered breathing and medication usage. Future studies should focus on evaluating the psychometric measurement properties of BIS in the North American setting and in different cultural groups, or to develop a more specific PROM of postpartum sleep.

Long-term Impacts and Benefit-Cost Analysis of the Communities That Care Prevention System at Age 23, 12 Years After Baseline.

This study estimated sustained impacts and long-term benefits and costs of the Communities That Care (CTC) prevention system, implemented and evaluated in a longitudinal cluster-randomized trial involving 24 communities in seven states. Analyses utilized reports from a longitudinal panel of 4407 participants, followed since the study's baseline in grade 5, with most recent follow-up 12 years later at age 23. Impacts on lifetime abstinence from primary outcomes of substance use and antisocial behavior were estimated using generalized linear mixed Poisson regression analysis, adjusted for individual and community-level covariates. Possible cascading effects on 4-year college completion, major depressive disorder, and generalized anxiety disorder through age 23 were evaluated as secondary outcomes. CTC had a statistically significant global effect on primary outcomes and also on combined primary and secondary outcomes. Among primary outcomes, point estimates suggested absolute improvements in lifetime abstinence of 3.5 to 6.1% in the intervention arm and relative improvements of 13 to 55%; 95% confidence intervals revealed some uncertainty in estimates. Among secondary outcomes, 4-year college completion was 1.9% greater among young adults from intervention communities, a 20% relative improvement. Mental health outcomes were approximately the same across trial arms. Although CTC had small sustained effects through age 23, benefit-cost analyses indicated CTC was reliably cost beneficial, with a net present value of $7152 (95% credible interval: $1253 to $15,268) per participant from primary impacts and $17,919 ($306 to $39,186) when secondary impacts were also included. It remained cost beneficial even when impacts were adjusted downward due to the involvement of CTC's developer in the trial. Findings suggest that broader dissemination of CTC could improve public health and individual lives in the long term and generate positive net benefits to society.

Adult Social Environments and the Use of Combustible and Electronic Cigarettes: Opportunities for Reducing Smoking in the 30s.

INTRODUCTION: Reducing cigarette use is a major public health goal in the United States. Questions remain, however, about the potential for the social environment in the adult years-particularly in the 30s and beyond-to influence cigarette use. This study tested pathways hypothesized by the social development model to understand the extent to which social environmental factors at age 33 (eg, involvement with smokers or with physically active people) contribute to changes in cigarette use from age 30 to age 39. Both combustible and electronic cigarette use were investigated. METHODS: Data were from the Seattle Social Development Project, a longitudinal study of 808 diverse participants with high retention. Self-reports assessed social developmental constructs, combustible and electronic cigarette use, and demographic measures across survey waves. RESULTS: At age 30, 32% of the sample reported past-month cigarette use. Using structural equation modeling, results showed high stability in cigarette use from age 30 to 39. After accounting for this stability, cigarette-using social environments at age 33 predicted personal beliefs or norms about smoking (eg, acceptability and social costs), which in turn predicted combustible cigarette use at age 39. Cigarette-using environments, however, directly predicted electronic cigarette use at age 39, with no significant role for beliefs about smoking. CONCLUSIONS: Cigarette use was highly stable across the 30s, but social environmental factors provided significant partial mediation of this stability. Pathways were different for combustible and electronic cigarette use, however, with personal smoking norms playing an important role for the former but not the latter. IMPLICATIONS: This study addresses the need for longitudinal investigation of social mechanisms and cigarette use in the 30s. Findings reinforce efforts to prevent the uptake of cigarettes prior to the 30s because, once started, smoking is highly stable. But social environmental factors remain viable intervention targets in the 30s to disrupt this stability. Addressing personal norms about smoking's acceptability and social costs is likely a promising approach for combustible cigarette use. Electronic cigarettes, however, present a new challenge in that many perceived social costs of cigarette use do not readily translate to this relatively recent technology.