A randomised controlled trial testing acceptance of practitioner-referral versus self-referral to stop smoking services within the Lung Screen Uptake Trial.

BACKGROUND AND AIMS: Optimising smoking cessation (SC) referral strategies within lung cancer screening (LCS) could significantly reduce lung cancer mortality. This study aimed to measure acceptance of referral to SC support by either practitioner-referral or self-referral among participants attending a hospital-based lung health check appointment for LCS as part of the Lung Screen Uptake Trial. DESIGN: Single-blinded two-arm randomised controlled trial. SETTING: England. PARTICIPANTS: Six hundred forty-two individuals ages 60 to 75 years, who self-reported currently smoking or had a carbon monoxide reading over 10 ppm during the lung health check appointment. INTERVENTION AND COMPARATOR: Participants were randomised (1:1) to receive either a contact information card for self-referral to a local stop smoking service (SSS) (self-referral, n = 360) or a SSS referral made on their behalf by the nurse or trial practitioner (practitioner-referral, n = 329). MEASUREMENTS: The primary outcome was acceptance of the practitioner-referral (defined as participants giving permission for their details to be shared with the local SSS) compared with acceptance of the self-referral (defined as participants taking the physical SSS contact information card to refer themselves to the local SSS). FINDINGS: Half (49.8%) accepted the practitioner-made referral to a local SSS, whereas most (88.5%) accepted the self-referral. The odds of accepting the practitioner-referral were statistically significantly lower (adjusted odds ratio = 0.10; 95% confidence interval = 0.06-0.17) than the self- referral. In analyses stratified by group, greater quit confidence, quit attempts and Black ethnicity were associated with increased acceptance within the practitioner-referral group. There were no statistically significant interactions between acceptance by referral group and any of the participants' demographic or smoking characteristics. CONCLUSIONS: Among participants in hospital-based lung cancer screening in England who self-reported smoking or met a carbon monoxide cut-off, both practitioner-referral and self-referral smoking cessation strategies were highly accepted. Although self-referral was more frequently accepted, prior evidence suggests practitioner-referrals increase quit attempts, suggesting practitioner-referrals should be the first-line strategy within lung cancer screening, with self-referral offered as an alternative.

Unconscious associations between stressor type and ability to cope: An experimental approach using ancient and modern sources of stress.

OBJECTIVES: Work has emerged that suggests it is salient and feasible to include a chronological approach to the taxonomy of stress. The ability to make an explicit distinction between ancient stressors (AS) and modern stressors (MS) has been reported in young and older adults; AS have been associated with greater ability to cope and MS with poorer health outcomes. Whether these explicit distinctions exist at an implicit, unconscious level, has yet to be determined. DESIGN: A quantitative design employed a computer-based Implicit Association Test (IAT) to examine implicit associations between AS/MS and coping appraisal. METHODS: One hundred adults (75 females) aged 18-58 years (M = 28.27 years, SD = 10.02) completed the AS/MS IAT, to compare reaction time (RT) and accuracy between consistent pairs (AS/ability to cope; MS/inability to cope) and inconsistent pair responses (AS/inability to cope; MS/ability to cope); followed by an explicit self-report questionnaire. RESULTS: Repeated measures ANCOVAs, controlling for sex and age, revealed significant main effects of faster RT and higher accuracy in responses for consistent than inconsistent pairs. Adult participants made implicit associations indicating an unconscious AS and MS distinction. Using the D algorithm, a univariate ANCOVA and independent t-tests found that males, compared to females, showed a stronger implicit preference for consistent than inconsistent pairs. CONCLUSIONS: Findings suggest an implicit association between ancient and modern stressors and perceived coping ability. Utilizing a chronological taxonomy for understanding evolutionary origins that drive individual's responses to stress has implications for developing effective coping strategies to improve health outcomes.

Can ancient and modern stressors be distinguished? A mixed-methods exploration of psychosocial characteristics and health symptoms in young and older adults.

A novel conceptualisation of stress includes a distinction between ancient (AS) and modern stressors (MS); the notion that established adaptive psychophysiological coping processes may enable individuals to better withstand AS than MS. Two consecutive mixed-methods studies assessed the feasibility of distinguishing between AS and MS in young and older adults, using questionnaires and interviews. MS were positively associated with cold symptoms in older adults; and five psychosocial characteristics were identified to profile AS and MS along a continuum. An evolutionary distinction between AS and MS provides an important psychological dimension in better understanding and assessing stress-health processes.

Harm and Addiction Perceptions of the JUUL E-Cigarette Among Adolescents.

INTRODUCTION: This study assessed adolescents' harm and addiction perceptions of the highest-selling brand-JUUL-of the most commonly used tobacco product-electronic cigarettes (e-cigarettes)-among adolescents in the United States. METHODS: A cross-sectional online survey assessed use and perceptions of the harmfulness and addictiveness of the JUUL e-cigarette and conventional tobacco cigarettes in a nationally representative sample of 9865 adolescents aged 13-17 years in the United States. Associations between adolescents' harm and addiction perceptions and their use of a JUUL e-cigarette were examined through multinomial logistic regression models. RESULTS: Overall, 6.1% and 9.3% of adolescents believed daily use and occasional use of a JUUL e-cigarette, respectively, would cause them no harm. Around 11.3% believed they would either never experience harm from using a JUUL e-cigarette or they could use a JUUL e-cigarette for at least 20 years before experiencing any harm, and 7.3% believed they would be "very unlikely" to become addicted to using a JUUL e-cigarette. Overall, 39.3% and 29.3% of adolescents perceived the JUUL e-cigarette as "less harmful" and "less addictive" than conventional cigarettes, respectively. Compared to never users of the JUUL e-cigarette, current and former users held significantly lower harm and addiction perceptions of the JUUL e-cigarette on all measures. CONCLUSIONS: The majority of adolescents believed using a JUUL e-cigarette would put them at, at least, some risk for experiencing health problems and addiction. A smaller but significant proportion believed they could use a JUUL e-cigarette without ever being harmed by or becoming addicted to the JUUL e-cigarette. IMPLICATIONS: The study reports adolescents' perceptions of the harmfulness and addictiveness of the highest-selling brand of the most commonly used tobacco product among youth in the United States. Though the majority of adolescents correctly believed that using a JUUL e-cigarette would put them at, at least, some risk for experiencing health problems and addiction, a small proportion believed that using a JUUL e-cigarette would be risk free. Correcting such risk-free perceptions may reduce adolescents' interest in trying and continuing to use JUUL e-cigarettes.

Sources of youth access to JUUL vaping products in the United States.

INTRODUCTION: This study assessed sources of youth access to JUUL vaping products, the highest selling brand of the most commonly used tobacco product among adolescents in the United States. METHODS: A cross-sectional online survey assessed use of JUUL vaping products in a non-probability, nationally representative sample of 9865 adolescents aged 13-17 years in the United States. Past 30-day JUUL users (n = 1537) were asked how they got the JUUL vaping products they had used in the past 30-days. Those who reported having bought JUUL products themselves were asked about the places and people from whom they had bought products. Population-weighted percentages and 95% confidence intervals are reported for each source of access. RESULTS: An estimated 79.6% (95% CI = 77.5-81.6%) of current JUUL users obtained JUUL products from at least one social source (e.g. 'someone bought for me, someone offered to me) in the past 30 days. By comparison, 20.0% [95% CI = 18.0-22.0%) of current users bought JUUL products themselves. Of 1322 youth who reported obtaining JUUL products from at least one source or by buying products themselves in the past 30 days, 77.5% (95% CI = 75.3-79.8%) had obtained JUUL products exclusively from social sources (i.e. they did not buy products directly), 17.2% (95% CI = 15.2-19.3%) obtained JUUL products exclusively by buying the products themselves (i.e. they did not obtain products from any social sources), and 5.2% (95% CI = 4.0-6.4%) had obtained JUUL products both from social sources and from buying the products themselves. Among youth who bought JUUL products themselves, the most common place of purchase was 'a gas station or convenience store' [53.1% (95% CI = 47.5- 58.6%)]. CONCLUSIONS: Youth who are currently using JUUL vaping products obtain these products predominantly through social sources, such as friends and peers. Youth sources of access to JUUL vaping products appear to mirror youth sources of access to other tobacco products. Reducing youth use of JUUL vaping products will require a greater focus on measures that deter or penalize legal-age purchasers who give or sell products to minors.