Retrospective review of acute post-tracheostomy complications and contributing risk factors.

OBJECTIVE: Tracheostomy is performed for various indications ranging from prolonged ventilation to airway obstruction. Many factors may play a role in the incidence of complications in the immediate post-operative period including patient-related factors. Chronic obstructive pulmonary disease and asthma are some of the most common pulmonary pathologies in the United States. The relationship between obstructive pulmonary diseases and acute post-tracheostomy complications has been incompletely studied. DESIGN: A retrospective chart review was designed in order to answer these objectives. Medical records were reviewed for the technique used, complications, and contributing patient factors. Post-operative complications were defined as any tracheostomy-related adverse event occurring within 14 days. SETTING: The study took place at an academic comprehensive cancer. PARTICIPANTS: Inclusion criteria included patients from January 2017 through December 2018 who underwent a tracheostomy. Exclusion criteria included presence of stomaplasty, total laryngectomy, and tracheostomies performed at outside hospitals. MAIN OUTCOME MEASURES: Patient factors examined included demographics, comorbidities, and body mass index with the primary outcome measured being the rate of tracheostomy complications. RESULTS: The most common indication for tracheostomy among the 321 patients that met inclusion criteria was airway obstruction or a head and neck cancer surgical procedure. Obstructive sleep apnea was associated with acute complications in bivariate analysis (29.4% complications, p = .003). Chronic obstructive pulmonary disease and asthma were not associated with acute complications in bivariate analysis (11.6% complications, p = .302). Among the secondary outcomes measured, radiation was associated with early complications occurring in post-operative days 0-6 (1.1%, p = .029). CONCLUSION: Patients with obstructive sleep apnea may have a higher risk of acute post-tracheostomy complications that might be due to the patient population at risk for obstructive sleep apnea. Patients with obstructive pulmonary pathologies such as asthma or chronic obstructive pulmonary disorder did not have an elevated risk of complications which is clinically significant when considering the utility of ventilation and tracheostomy in the management of acute respiratory failure secondary to these conditions.

Sexual Minority Youth E-Cigarette Use.

BACKGROUND AND OBJECTIVES: There is consistent evidence that sexual minority youth (SMY) use more traditional cigarettes than their non-SMY counterparts. However, there is relatively less information on e-cigarettes and, importantly, differences between and within SMY populations by race and ethnicity and sex. This study examines e-cigarette use by sexual orientation status and the intersection of race and ethnicity and sex. METHODS: Data come from high school students in the 2020 and 2021 National Youth Tobacco Surveys (N = 16 633). Current e-cigarette use prevalence by sexual identity categories was calculated for racial and ethnic subgroups. Multivariable logistic regression analysis examined the association between sexual identity and e-cigarette use by race and ethnicity groups and sex. RESULTS: E-cigarette use prevalence was higher for most SMY racial and ethnic groups than their non-SMY counterparts. However, multivariable logistic analysis showed varied results by race and ethnic groups, with higher e-cigarette use odds for SMY populations, although not statistically significant for some race and ethnic groups. Black gay or lesbian (adjusted odds ratio: 3.86, 95% confidence interval, 1.61-9.24) and bisexual (adjusted odds ratio: 3.31, 95% confidence interval, 1.32-8.30) high school students had significantly higher e-cigarette use odds than Black heterosexuals. Non-Hispanic Black females e-cigarettes use odds are 0.45 times that of non-Hispanic white males, and non-Hispanic other gay or lesbian had 3.15 times higher e-cigarette use odds than non-Hispanic white heterosexuals. CONCLUSIONS: E-cigarette use is more prevalent among SMY populations. Disparities in e-cigarette use vary depending on race and ethnicity and sex.

Is socioeconomic status related to youth e-cigarette use? Examining family affluence and sexual identity.

There is limited evidence about the relationship between socioeconomic status (SES) and youth electronic cigarette use, particularly among sexual minorities. This study investigates whether family affluence is significantly associated with e-cigarette use among youth, including sexual minority youth. Data came from the 2021 National Youth Tobacco Survey (N = 10,515). The prevalence of e-cigarette use for all participants and sexual minority youth (N = 1376) by SES was calculated and ranked according to the Family Affluence Scale. A propensity score weighting method was used to address the imbalance in characteristics among SES groups. The associations of SES with current e-cigarette use and current flavored e-cigarette use were estimated using univariate survey logistic regression for all participants and self-identified sexual minority students. The prevalence of e-cigarette use was similar among socioeconomic groups for all participants and sexual minorities. The propensity score weighting analysis showed no significant association between SES and current e-cigarette use for all participants and sexual minority students. Equally, there was no significant association between SES and current flavored e-cigarette use. Findings suggest that other protective and risk factors might explain youth e-cigarette use more than SES (family affluence scale).

A double disparity: Rural sexual minorities and tobacco use among U.S. adults.

BACKGROUND: Marginalized groups continue to face an uneven distribution of the risks and consequences of smoking cigarettes, with rural/urban geography and sexual orientation status examined independently. However, little is known about the intersection of rural/urban geography and sexual orientation regarding tobacco use disparities. This study examined rural-urban sexual minority differences in tobacco use in the United States. METHODS: Data came from the 2018-2020 Behavioral Risk Factor Survey System (N = 675,221). We estimated cigarette smoking prevalence for each year of survey data by rural/urban status and sexual orientation. Multivariable logistic regressions were used to assess associations of rural/urban location and sexual orientation status with cigarette use. Additional Multivariable logistic regressions were conducted, including stratified analyses by sex on multiple sexual orientation categories. FINDINGS: Cigarette smoking was higher among participants who lived in rural areas and identified as lesbian or gay and bisexual. Furthermore, the disparities in smoking rates were significantly different, with 38 % higher odds of smoking among rural sexual minorities than urban sexual minorities (aOR = 1.38, 95 % CI = 1.19, 1.60). Stronger odds of cigarette smoking were found among rural gays or lesbians (aOR = 1.83, 95 % CI = 1.47, 2.28) and rural bisexuals (aOR = 2.40, 95 % CI = 2.03, 2.84) compared to urban straight counterparts. CONCLUSION: Findings highlight rural populations, particularly sexual minorities, might have an elevated risk of cigarette use. Prevention and cessation efforts that help these especially disadvantaged groups will be beneficial in addressing tobacco use disparities.

Does state repeal of alcohol exclusion laws increase problem drinking?

BACKGROUND: For decades, alcohol exclusion laws (AELs) have allowed insurance companies to reject claims for physical injuries caused by alcohol consumption, including injuries from impaired driving. A central premise of AELs is that they function as a deterrent to risk-taking behaviors, such as excessive drinking. If this assumption is correct, state repeal of these laws should result in increased drinking. This study examines whether the repeal of AELs by some states affects drinking behaviors. METHODS: Data were obtained from the 1993 to 2017 Behavioral Risk Factor Surveillance System nationwide survey. Exploiting the natural experiment presented by state repeal of AELs, we assessed the impact on current drinking and binge drinking. We used a rigorous quasi-experimental difference-in-differences analysis and conducted a battery of sensitivity analyses to assure robust findings. RESULTS: Overall, the study found no discernable impact of state repeal of AELs on alcohol consumption. While the repeal of AELs significantly decreased the odds of reporting drinking in the past 30 days compared to those living in states with AELs or that never had AELs, the effects were small (aOR = 0.98, 95% CI = 0.96, 0.99). Likewise, there were higher odds of binge drinking among individuals living in states that repealed AELs compared to those living in states without AELs, yet with small effects (aOR = 1.03, 95% CI = 1.01, 1.05). After additionally adjusting for state-varying characteristics and state-specific time trends, no significant effects were identified regarding current and binge drinking. Findings from the sensitivity analyses were largely consistent with the main analysis. CONCLUSION: This study found no evidence supporting the idea that repealing AELs increased alcohol consumption or binge drinking. Future studies should consider other state-specific dimensions within the Uniform Accident and Sickness Policy Provision Law.

Mental health condition indicators and e-cigarette use among sexual minority youth.

BACKGROUND: Sexual minorities face mental health disparities compared to heterosexual people. There is limited research on the possible connections between mental health and e-cigarette use among sexual minority youth. This study examines anxiety, depression, and e-cigarette use for sexual minority youth only and between sexual minorities versus straight youth. METHODS: Study data were drawn from the 2021 National Youth Tobacco Survey (n = 16,065). Prevalence of self-reported anxiety and depression by sexual minority status was calculated, and the univariate analysis was assessed using Rao-Scott Chi-Square tests. Multivariable logistic regression models were used to evaluate the association of current e-cigarette use with self-reported anxiety and depression among sexual minority youth. The study also examined current e-cigarette use between sexual minorities versus straight students for those with or without anxiety and depression, and stratified analyses were performed by sex. RESULTS: Analysis showed a substantially higher prevalence of all self-reported mental health problems among sexual minorities than straight students. Sexual minority males with anxiety (aOR 1.91, 95 % CI, 1.22-3.00), depression (aOR 2.08, 95 % CI, 1.27-3.40), moderate depression and anxiety (aOR 1.85, 95 % CI, 1.16-2.97), and severe depression and anxiety (aOR 2.03, 95 % CI, 1.16-3.56) were more likely to be current e-cigarette users than their straight peers with similar mental health conditions. LIMITATIONS: Self-reported measures and the analysis design precludes making causal inferences. CONCLUSIONS: Sexual minority males with mental health conditions may be particularly vulnerable to e-cigarette use and may require special efforts toward prevention and cessation.

Trends in the frequency of cigar use among US adults, 1998/99-2018/19.

There is limited information on the trend in the frequency of cigar use from the literature. This study aimed to examine the trends of cigar use frequency among U.S. adults. Data were obtained from 1998/99 to 2018/19 Tobacco Use Supplement to the Current Population Survey (n = 21,940). We generated estimates of the cigar use frequency among current cigar users for each survey year for the full sample, as well as by sociodemographic characteristics. Linear regression models were used to test the statistical significance of the linear trend. Additional analyses were conducted among someday users only. Over the study period, the cigar use frequency among current users was stable at approximately 10 days in the past 30 days. In 1998/1999, male current cigar users and someday cigar users reported using cigars for 9.6 and 5.2 days in the past 30 days, respectively, which decreased to 9.2 and 4.7 days in 2018/2019. In contrast, a significant increasing trend was found among female current cigar users and someday cigar users from 8.4 and 4.7 days to 13.6 and 6.2 days from 1998/1999 to 2018/2019. Likewise, we found that the cigar use frequency increased among current cigar and cigarette users over the study period. Overall, cigar use frequency is relatively stable. Over time, cigar use frequency decreased significantly among males, while it increased among females. Our findings further highlight that targeted efforts are needed to reduce the disproportionate use of cigars.

A low molecular weight multifunctional theranostic molecule for the treatment of prostate cancer.

Rationale: Although surgery and radiation therapy in patients with low risk prostate cancer appear appropriate and effective, those with high-risk localized disease almost always become hormone refractory and then rapidly progress. A new treatment strategy is urgently needed for patients with high-risk localized prostate cancer, particularly an approach that combines two drugs with different mechanisms. Combinations of photodynamic therapy (PDT) and chemotherapy have shown synergistic effects in clinical trials, but are limited by off-target toxicity. Prostate specific membrane antigen (PSMA) is a well-established biomarker for prostate cancer. Here we describe the use of a PSMA ligand to selectively and simultaneously deliver a potent microtubule inhibiting agent, monomethyl auristatin E (MMAE), and a PDT agent, IR700, to prostate cancers. Methods: Using a bifunctional PSMA ligand PSMA-1-Cys-C6-Lys, we created a novel theranostic molecule PSMA-1-MMAE-IR700. The molecule was tested in vitro and in vivo for selectivity and antitumor activity studies. Results: PSMA-1-MMAE-IR700 showed selective and specific uptake in PSMA-positive PC3pip cells, but not in PSMA-negative PC3flu cells both in vitro and in vivo. In in vitro cytotoxicity studies, when exposed to 690 nm light, PSMA-1-MMAE-IR700 demonstrated a synergistic effect leading to greater cytotoxicity for PC3pip cells when compared to PSMA-1-IR700 with light irradiation or PSMA-1-MMAE-IR700 without light irradiation. In vivo antitumor activity studies further showed that PSMA-1-MMAE-IR700 with light irradiation significantly inhibited PC3pip tumor growth and prolonged survival time as compared to mice receiving an equimolar amount of PSMA-1-IR700 with light irradiation or PSMA-1-IR700-MMAE without light irradiation. Conclusion: We have synthesized a new multifunctional theranostic molecule that combines imaging, chemotherapy, and PDT for therapy against PSMA-expressing cancer tissues. This work may provide a new treatment option for advanced prostate cancer.

Longitudinal associations of tobacco-related social media involvement with cigarette and e-cigarette initiation among US adolescents.

Tobacco is the leading cause of preventable morbidity and mortality in the USA. Evidence suggests adolescents are particularly vulnerable to online tobacco marketing. This study examined longitudinal associations of following or liking of tobacco brands with subsequent cigarette and e-cigarette initiation among US adolescents. We used Wave 1-Wave 4 Population Assessment of Tobacco and Health study data (n = 6997) and discrete-time survival regression models to examine associations of past-year tobacco-related social media interactions with the initiation of cigarettes and e-cigarettes among US adolescents. About 4.8% (n = 280) of adolescent never cigarette users and 4.9% (n = 288) of never e-cigarette users followed or liked tobacco brands on social media between Wave 1 and Wave 2. By Wave 4, 8.8% of all cigarettes never users had initiated cigarette use, and 18.7% of never e-cigarette users initiated e-cigarette use. The following or liking tobacco brands on social media was significantly associated with increased odds of cigarette initiation (adjusted odds ratio (aOR) 2.12, 95% CI 1.56-2.88) and e-cigarette initiation (aOR 2.11, 95% CI 1.66-2.69). Also, the initiation of cigarettes and e-cigarettes differed significantly among race/ethnicity, school performance, and other tobacco and substance use.Conclusion: Adolescents who followed or liked tobacco products on social media were more likely to initiate cigarette or e-cigarette use subsequently. Increasing anti-tobacco efforts on social media sites could be beneficial. What is Known: • Evidence suggests adolescents are particularly vulnerable to online tobacco marketing. What is New: • The following or liking tobacco brands on social media was significantly associated with the odds of cigarette and e-cigarette initiation.

Disparities in the receipt of medical doctors' advice to quit smoking in the U.S., 1992-2019.

There has been significant progress in reducing tobacco use in the last few decades. However, there is a considerable concern that the decrease in cigarette use has not been distributed equally across certain groups. The current study examines sociodemographic trends in the receipt of advice to quit from healthcare professionals. Data were drawn from the 1992-2019 Tobacco Use Supplement to the Current Population Survey (n = 192,398). Cochran-Armitage tests were used to assess changes in the prevalence over time in the population and by demographic characteristics. Multivariable logistic regression was used to examine factors associated with the receipt of advice to quit smoking. The prevalence of receiving advice to quit increased significantly from 50.1% in 1992/1993 to 63.9% in 2018/2019. Results showed differences in the receipt of quit advice from medical doctors by demographic characteristics, with a significant increase in smoking quit advice for all races (p < 0.0001). Current Hispanic smokers consistently had lower rates of receiving advice to quit than non-Hispanics throughout the study period. Multivariable analysis showed that in 2018/19, male (aOR 0.89; 95% CI 0.81-0.98) and Hispanic (aOR 0.73; 95% CI 0.61-0.88) current smokers were less likely to receive advice to quit. Those older and living in metropolitan areas had higher odds of receiving advice to quit. Findings that Hispanics appear to be significantly less likely to receive advice to quit from health care professionals indicate that these populations might need additional targeted efforts.

Exposure to tobacco and e-cigarette advertisements by sexual identity status among high school students.

INTRODUCTION: The literature on tobacco advertising among sexual minorities is relatively scarce. This study examined the association between exposure to tobacco products and e-cigarettes advertisements and sexual identity. METHODS: Data were from the 2020 National Youth Tobacco Survey (n = 7223). The prevalence of exposure to tobacco marketing through various channels was estimated among high school students and by sexual identity subgroups. Multivariable logistic regressions were used to examine the association between sexual identity status and exposure to tobacco and e-cigarette advertisements. RESULTS: The proportion of sexual minority adolescents who reported exposure to tobacco and e-cigarette advertisements was higher than heterosexuals. In multivariable analysis, gay or lesbian youth (aOR 1.45, 95% CI, 1.04-2.02) had higher odds of any exposure to tobacco and e-cigarette advertisement than heterosexuals. Regarding the channel of advertisement exposure, sexual minorities were more likely to be exposed via newspapers/magazines for cigarettes or other tobacco products. Likewise, gay or lesbian youth and those not sure about their sexual identity had higher odds of exposure via newspapers/magazines for e-cigarettes. Analysis stratified by sex showed significant differences, with gay or lesbian males more likely to be exposed to any tobacco and e-cigarette advertisements via the internet, newspapers/magazines, and TV/streaming services. Males not sure about their sexual identity are more likely to be exposed to tobacco and e-cigarette advertisements via newspapers/magazines. CONCLUSIONS: Overall, sexual minority adolescents had high exposure to tobacco products and e-cigarette advertisements, especially males. Prevention and intervention efforts targeting this population could help reduce the well-established tobacco use disparities.

Repeal of state laws permitting denial of health claims resulting from alcohol impairment: Impact on treatment utilization.

BACKGROUND: Many states in the U.S. still have Alcohol Exclusion Laws (AELs), which allow insurance companies to deny health claims resulting from alcohol impairment. There are concerns that this form of structural stigmatization affects alcohol treatment-seeking behaviors. We examined the effects of AEL repeal on treatment admissions for alcohol use disorder (AUD). METHODS: Data on alcohol treatment admissions from 1992 to 2017 were obtained from the Treatment Episode Data Set. The state-level aggregate number of treatment admissions was derived, including healthcare professional referrals only, self-referrals only, and both self-referral and healthcare professional referrals. The number of treatment admissions by health insurance status (private, public, and uninsured) was also calculated. The study used a difference-in-differences (DID) quasi-experimental design. RESULTS: The DID analysis showed that the number of admissions for alcohol treatment from healthcare professional referrals increased 16% in the AEL repeal states compared to states with AELs or that never had AELs (IRR=1.16, 95% CI=1.07, 1.25). These results were consistent for analysis by payment sources. In particular, treatment admissions from healthcare professional referrals for patients covered by private insurance increased about 38% in states with AEL repeal (IRR=1.38, 95% CI=1.17, 1.64) compared to states without AEL repeal. However, the findings were no longer significant when the state-specific time trends were taken into account. CONCLUSIONS: This study documented that AEL repeal may have had a significant impact on the number of treatment admissions for AUD. These findings suggest that AELs function as a barrier to treatment-seeking behavior.

Tobacco Craving, Nicotine Dependence, and Quit Intentions among LGB and Non-LGB High School Students: A Quasi-Experimental Analysis.

There is evidence of higher tobacco use among lesbian or gay and bisexual (LGB) populations. However, a limited number of studies have examined whether there are differences in potential indicators of future tobacco cessation behaviors between LGB and non-LGB populations. This study examined whether sexual identity is associated with craving, nicotine dependence, and quit intentions among high school students. Data were drawn from the 2020 National Youth Tobacco Survey (n = 1642). A propensity score matching (PSM) technique was used to address covariate imbalance among sexual identity groups. Additionally, subgroup analyses were performed for both males and females. The PSM results showed higher odds of craving among students who were gay or lesbian (aOR, 1.70; 95% CI = 1.13-2.55) and bisexual (aOR, 1.89; 95% CI = 1.23-2.92) compared to heterosexual (straight) students. In the sex-based subgroup analyses, we found that gay or lesbian (aOR, 1.92; 95% CI = 1.10-3.34) and bisexual (aOR, 3.12; 95% CI, 1.46-6.66) male students had significantly higher odds of craving when compared to heterosexual/straight male adolescents. However, the association was not significant in female students. Additionally, female bisexuals had significantly lower odds for quit intention (aOR, 0.48; 95% CI = 0.29-0.81) when compared to heterosexual/straight female adolescents. Results also showed no significant differences between LGB and non-LGB students for nicotine dependence. Sexual minority adolescents, especially male adolescents, were more likely to have tobacco cravings and bisexual females had lower odds of quit intention than heterosexual peers. Prevention efforts targeting this subpopulation may be beneficial.

Trends in sexual orientation disparities in cigarette smoking: Intersections between race/ethnicity and sex.

Cigarette smoking is disproportionately high among sexual minority populations, but it is unclear whether these disparities exist among race/ethnicity subgroups. This study examined trends in sexual orientation disparities in cigarette smoking by race/ethnicity. Data are from the 2014-2019 Behavioral Risk Factor Surveillance System (N = 1,194,768). Trend analyses compared cigarette smoking by race/ethnicity (non-Hispanic White, non-Hispanic Black, Hispanic, non-Hispanic other) and sexual orientation (straight, lesbian or gay, bisexual, something else/don't know/refused). Multivariable analyses examined associations between sexual orientation and cigarette use for each race/ethnicity, controlling for other sociodemographic characteristics. Between 2014 and 2019, lesbian or gay, and bisexual populations consistently had higher smoking rates than straight populations, which held across race/ethnicity. Among non-Hispanic White adults, lesbians (OR = 1.51, 95% CI = 1.29, 1.76), bisexual females (OR = 1.56, 95% CI = 1.39, 1.75), gay (OR = 1.38, 95% CI = 1.22, 1.55), and bisexual males (OR = 1.22, 95% CI = 1.04, 1.43) had higher odds of smoking compared those self-identifying as straight. Among non-Hispanic Black adults, lesbians (OR = 1.90, 95% CI =1.33, 2.73) and bisexual females (OR = 1.85, 95% CI =1.42, 2.41) were more likely to currently smoke. Among Hispanic adults, those self-identifying as lesbian or gay (OR = 1.58, 95% CI = 1.19, 2.09) or bisexual (OR = 2.40, 95% CI = 1.88, 3.07) were more likely to currently smoke, though the associations were not significant in Hispanic males. Disparities in cigarette smoking by race/ethnicity and sexual orientation suggest that aggregating these groups mask important differences and limit efforts to target those most at risk.

Disparities in the frequency of tobacco products use by sexual identity status.

BACKGROUND: Largely absent from the literature are studies examining differences in tobacco use frequency among sexual minority populations versus heterosexuals. The current study examined the frequency of tobacco product use (i.e., cigarette, e-cigarettes and cigars, smokeless tobacco, hookah, and heated tobacco products) among sexual minority students versus heterosexuals (straight). METHODS: Data from the 2020 National Youth Tobacco Survey (n = 14,531) were analyzed to examine the association between sexual identity (lesbian or gay, bisexual, not sure, and heterosexual or straight) and tobacco use frequency. Negative binomial regression and zero-inflated negative binomial models were used to assess the association between sexual identity and each tobacco use frequency among current and ever users. RESULTS: Current e-cigarettes users who identified as gay or lesbian used e-cigarette more frequently than heterosexual students. Multivariable count regression analysis showed that the e-cigarette use frequency in the past 30 days was significantly higher for gays or lesbians (IRR 1.45, 95% CI, 1.19-1.76) compared to heterosexuals. Similarly, gay or lesbian students who were current hookah users on average reported 81% more days of hookah use (IRR, 1.81, 95% CI, 1.08-3.03). The frequency of cigarette smoking was also significantly higher among bisexual cigarette smokers. No significant differences were found in other tobacco product use frequencies between sexual minority and heterosexual youths. CONCLUSION: Sexual identity was associated with tobacco use frequency, especially for e-cigarettes and hookah. Elevated tobacco use among sexual minority groups deserves special consideration among a population group that is highly vulnerable to marketing and advertisement targeting.

Examining the Role of Acculturation in E-Cigarette Use among U.S. Immigrant Adults.

Evidence suggests that as immigrants' length of residence in the host country increases, they may integrate their behavior and norms to align with the new community's cultural norms. The current study examined e-cigarette use among immigrants in the U.S., and whether the length of residence in the U.S. is associated with e-cigarette use among immigrants compared to the native-born population. Data were drawn from the 2014/15 and 2018/19 Tobacco Use Supplement to the Current Population Survey. Multivariable logistic regression was used to compare differences in e-cigarette use between native-born populations and immigrants, when immigrants' length of residence in the U.S. was considered. Among immigrants, the prevalence of ever and current e-cigarette use increased significantly from 2.5% and 0.5% in 2014/2015 to 3.2% and 0.8% in 2018/2019, respectively. Multivariable analysis showed that immigrants had significantly lower odds of ever e-cigarette use compared to the mainland-born citizen (0-5 years in the U.S., adjusted Odds Ratio (aOR) 0.57, 95% Confidence Interval (CI) 0.46-0.69; 6-10 years, aOR 0.51, 95% CI 0.41-0.63; 11-20 years, aOR 0.45, 95% CI 0.39-0.53; 20+years, aOR 0.68, 95% CI 0.62-0.76). Similar results were found for current e-cigarette use, with immigrants being less likely to be current users. Findings that e-cigarette use among all immigrants-regardless of years living in the U.S.-was consistently lower than among the native-born population run contrary to the notion that as length of stay increases, health behaviors between immigrants and native populations of the host country become similar.

Heated Tobacco Products: Awareness and Ever Use Among U.S. Adults.

INTRODUCTION: Heated tobacco products, also referred to as heat-not-burn tobacco, are among the latest products introduced to the market by the tobacco industry. However, data on heated tobacco product awareness and use from population-based probability surveys are limited. This study examines heated tobacco product awareness and ever use among U.S. adults. METHODS: This study used data (n=42,477) from the 2019 Tobacco Use Supplement to the Current Population Survey, analyzed in 2020. Descriptive statistics, including a weighted prevalence of heated tobacco product awareness and ever use, were estimated. The awareness and ever use of heated tobacco products were also estimated by age, sex, cigarette smoking status, E-cigarette use status, and other tobacco product use status. Multivariable logistic regression examined the individual characteristics associated with the awareness and ever use of heated tobacco products. RESULTS: Overall, approximately 8.6% of U.S. adults were aware of heated tobacco products. Awareness was higher among participants who were younger, male, cigarette smokers, E-cigarette users, and other tobacco product users. Ever use of heated tobacco products was uncommon among U.S. adults (0.51%) but more prevalent among E-cigarette users and cigarette smokers. In the general adult populations, the odds of ever use of heated tobacco products were significantly higher among cigarette smokers (AOR=2.19, 95% CI=1.63, 2.94), E-cigarette smokers (AOR=2.70, 95% CI=1.71, 4.25), and other tobacco product users (AOR=1.69, 95% CI=1.30, 2.20). CONCLUSIONS: Although the ever use of heated tobacco products is uncommon among U.S. adults, recent regulatory approval of the marketing of IQOS as modified risk tobacco products may increase use. Therefore, ongoing monitoring of heated tobacco products use and their long-term health consequences are important for informing future decision making.

Unemployment rate, opioids misuse and other substance abuse: quasi-experimental evidence from treatment admissions data.

BACKGROUND: The relationship between economic conditions and substance abuse is unclear, with few studies reporting drug-specific substance abuse. The present study examined the association between economic conditions and drug-specific substance abuse admissions. METHODS: State annual administrative data were drawn from the 1993-2016 Treatment Episode Data Set. The outcome variable was state-level aggregate number of treatment admissions for six categories of primary substance abuse (alcohol, marijuana/hashish, opiates, cocaine, stimulants, and other drugs). Additionally, we used a broader outcome for the number of treatment admissions, including primary, secondary, and tertiary diagnoses. We used a quasi-experimental approach -difference-in-difference model- to estimate the association between changes in economic conditions and substance abuse treatment admissions, adjusting for state characteristics. In addition, we performed two additional analyses to investigate (1) whether economic conditions have an asymmetric effect on the number of substance use admissions during economic downturns and upturns, and (2) the moderation effects of economic recessions (2001, 2008-09) on the relationship between economic conditions and substance use treatment. RESULTS: The baseline model showed that unemployment rate was significantly associated with substance abuse treatment admissions. A unit increase in state unemployment rate was associated with a 9% increase in treatment admissions for opiates (ß = 0.087, p < .001). Similar results were found for other substance abuse treatment admissions (cocaine (ß = 0.081, p < .001), alcohol (ß = 0.050, p < .001), marijuana (ß = 0.036, p < .01), and other drugs (ß = 0.095, p < .001). Unemployment rate was negatively associated with treatment admissions for stimulants (ß = - 0.081, p < .001). The relationship between unemployment rate and opioids treatment admissions was not statistically significant in models that adjusted for state fixed effects and allowed for a state- unique time trend. We found that the association between state unemployment rates and annual substance abuse admissions has the same direction during economic downturns and upturns. During the economic recession, the negative association between unemployment rate and treatment admissions for stimulants was weakened. CONCLUSION: These findings suggest that economic hardship may have increased substance abuse. Treatment for substance use of certain drugs and alcohol should remain a priority even during economic downturns.

Associations between sexual identity-attraction discordance, and prescription opioid misuse among adults.

Prior research has shown that sexual minorities are disproportionately affected by substance use disorders and prescription opioid misuse. While most studies explore how single dimensions of sexual orientation (i.e., identity, attraction, and behavior) are associated with substance use disorders, we aimed to explore how multiple dimensions of sexual orientation interact with substance use behaviors. Specifically, we examined sexual identity-attraction discordance, the situation when one's sexual identity does not match their socially-expected sexual attractions, with prescription opioid misuse. This study assessed the association between sexual identity-attraction discordance with prescription opioid misuse utilizing data from the National Survey on Drug Use and Health from 2015 to 2017 among adults while employing propensity score weighting with multivariable logistic regression. The study included 127,430 adult participants, of whom 1.3%, 4.4%, and 10.6% self-reported prescription opioid misuse in the past month, past year, and lifetime, respectively. Those with discordant sexual identity-attractions had higher odds of prescription opioid misuse in their lifetime (aOR= 1.22, 95% CI 1.07-1.40) when compared to those with concordant sexual identity-attractions. When stratified by sex, we found sexual identity-attraction discordant females had higher odds of prescription opioid misuse in their lifetime (aOR= 1.29, 95% CI 1.13-1.49); there was no association among males. These findings further emphasize the need to consider the dynamic nature of sexual orientation in substance use research.