Advancing youth tobacco surveillance with novel methods.

Tobacco surveillance in the United States is robust but cannot be quickly modified to capture newly identified tobacco products or behaviors. We present an example of a rapidly deployed nonprobability survey using social media recruitment that collected data on rapidly changing tobacco use behaviors. We recruited 15- to 17-year old current vapers from NY, USA, using targeted social media advertisements to complete the New York Adolescent Vaping Survey (NY AVS), which asked about vaping behaviors not addressed in existing probability surveillance surveys. We used the New York Youth Risk Behavior Survey (NY YRBS) to apply calibration weights to ensure that the distribution of the demographic characteristics accurately reflected the population distribution. We found systematic differences in demographic variable distributions between the probability-based NY YRBS and the convenience sample of the NY AVS that were reconciled in the weighting calibration. We found no statistically significant differences between the NY YRBS and NY AVS estimates after calibration for two outcome variables of interest. Recruiting a sample of adolescents using social media advertising to conduct a rapid survey on vaping provided valuable data that complemented traditional surveillance surveys; this approach could be used to fill future knowledge gaps in youth tobacco surveillance.

Perceived Safety, Not Perceived Legality, Mediates the Relationship Between Cannabis Legalization and Drugged Driving.

Cannabis legalization has rapidly spread throughout the United States and is associated with multiple public health outcomes, including driving under the influence of cannabis (DUIC). To improve understanding of the relationship between legalization and DUIC, we tested two potential mediators of this relationship: perceived safety and perceived legality of driving high. We analyzed data from 1,236 current (past 30-day) cannabis users who were recruited from states with recreational, medical only, or no legal cannabis between 2016 and 2017 using address-based and social media samples. Using a generalized linear model and adjusting for cannabis legalization, demographics, living in a state with a cannabis-specific drugged driving law, frequency of cannabis use, and weights, we found that perceived safety (risk ratio [RR] = 2.60, 95% CI [1.88, 3.58]), but not perceived legality (RR = 0.96, 95% CI [0.67, 1.37]), was significantly associated with DUIC. Perceived safety mediated the relationship between legalization and DUIC (Coeff: -0.12, 95% CI [-0.23, -0.01]). Models stratified by frequency of cannabis use yielded results consistent with those of pooled models except that, for frequent users, cannabis-specific driving laws were associated with a significantly lower risk of DUIC (RR = 0.64, 95% CI [0.44, 0.92]). Agencies developing cannabis-focused drugged driving educational campaigns should consider the potential role of perceived safety of driving high in DUIC campaigns.

Evaluation of fixed and variable hospital costs due to Clostridium difficile infection: institutional incentives and directions for future research.

BACKGROUND: Economic analysis of Clostridium difficile infection (CDI) should consider the incentives facing institutional decision-makers. To avoid overstating the financial benefits of infection prevention, fixed and variable costs should be distinguished. AIM: To quantify CDI fixed and variable costs in a tertiary referral hospital during August 2015. METHODS: A micro-costing analysis estimated CDI costs per patient, including the additional costs of a CDI outbreak. Resource use was quantified after review of patient charts, pharmacy data, administrative resource input, and records of salary and cleaning/decontamination expenditure. FINDINGS: The incremental cost of CDI was €75,680 (mean: €5,820 per patient) with key cost drivers being cleaning, pharmaceuticals, and length of stay (LOS). Additional LOS ranged from 1.75 to 22.55 days. For seven patients involved in a CDI outbreak, excluding the value of the 58 lost bed-days (€34,585); costs were 30% higher (€7,589 per patient). Therefore, total spending on CDI was €88,062 (mean: €6,773 across all patients). Potential savings from variable costs were €1,026 (17%) or €1,768 (26%) if outbreak costs were included. Investment in an antimicrobial pharmacist would require 47 CDI cases to be prevented annually. Prevention of 5%, 10% and 20% CDI would reduce attributable costs by €4,403, €8,806 and €17,612. Increasing the incremental LOS attributable to CDI to seven days per patient would have increased costs to €7,478 or €8,431 (if outbreak costs were included). CONCLUSION: As much CDI costs are fixed, potential savings from infection prevention are limited. Future analysis must consider more effectively this distinction and its impact on institutional decision-making.

INPP4B is an oncogenic regulator in human colon cancer.

Inositol polyphosphate 4-phosphatase type II (INPP4B) negatively regulates phosphatidylinositol 3-kinase signaling and is a tumor suppressor in some types of cancers. However, we have found that it is frequently upregulated in human colon cancer cells. Here we show that silencing of INPP4B blocks activation of Akt and serum- and glucocorticoid-regulated kinase 3 (SGK3), inhibits colon cancer cell proliferation and retards colon cancer xenograft growth. Conversely, overexpression of INPP4B increases proliferation and triggers anchorage-independent growth of normal colon epithelial cells. Moreover, we demonstrate that the effect of INPP4B on Akt and SGK3 is associated with inactivation of phosphate and tensin homolog through its protein phosphatase activity and that the increase in INPP4B is due to Ets-1-mediated transcriptional upregulation in colon cancer cells. Collectively, these results suggest that INPP4B may function as an oncogenic driver in colon cancer, with potential implications for targeting INPP4B as a novel approach to treat this disease.

Exploring the potential for a mass media campaign to influence support for a ban on tobacco promotion at the point of sale.

This study explores whether exposure to advertisements that focus on the negative effects of tobacco industry advertising and promotion at the point of sale (anti-POS advertising) influence: (i) attitude toward POS advertising; (ii) perceived impact of POS advertising on youth smoking; and (iii) support for a ban on tobacco promotion at the POS among adult non-smokers in New York. Data are from a split-sample, experimental study, using an online media tracking survey with embedded TV, radio and print advertising. Exposure to anti-POS advertising was associated with higher odds of holding a negative attitude toward POS advertising (OR 2.43, P < 0.001) and support for a ban on tobacco promotion at the POS (OR 1.77, P < 0.05), but not with perceived impact of POS tobacco advertisements on youth smoking. Findings suggest the possibility that a mass media campaign could be used to influence public attitude toward POS advertising and support for a ban on tobacco promotion at the POS.

Cotargeting histone deacetylases and oncogenic BRAF synergistically kills human melanoma cells by necrosis independently of RIPK1 and RIPK3.

Past studies have shown that histone deacetylase (HDAC) and mutant BRAF (v-Raf murine sarcoma viral oncogene homolog B1) inhibitors synergistically kill melanoma cells with activating mutations in BRAF. However, the mechanism(s) involved remains less understood. Here, we report that combinations of HDAC and BRAF inhibitors kill BRAF(V600E) melanoma cells by induction of necrosis. Cotreatment with the HDAC inhibitor suberoylanilide hydroxamic acid (SAHA) or panobinostat (LBH589) and the BRAF inhibitor PLX4720 activated the caspase cascade, but caspases appeared dispensable for killing, in that inhibition of caspases did not invariably block induction of cell death. The majority of dying cells acquired propidium iodide positivity instantly when they became positive for Annexin V, suggesting induction of necrosis. This was supported by caspase-independent release of high-mobility group protein B1, and further consolidated by rupture of the plasma membrane and loss of nuclear and cytoplasmic contents, as manifested by transmission electron microscopic analysis. Of note, neither the necrosis inhibitor necrostatin-1 nor the small interference RNA (siRNA) knockdown of receptor-interacting protein kinase 3 (RIPK3) inhibited cell death, suggesting that RIPK1 and RIPK3 do not contribute to induction of necrosis by combinations of HDAC and BRAF inhibitors in BRAF(V600E) melanoma cells. Significantly, SAHA and the clinically available BRAF inhibitor vemurafenib cooperatively inhibited BRAF(V600E) melanoma xenograft growth in a mouse model even when caspase-3 was inhibited. Taken together, these results indicate that cotreatment with HDAC and BRAF inhibitors can bypass canonical cell death pathways to kill melanoma cells, which may be of therapeutic advantage in the treatment of melanoma.

Enabling sustainable urban water management through governance experimentation.

A shift towards sustainable urban water management is widely advocated but poorly understood. There is a growing body of literature claiming that social learning is of high importance in restructuring conventional systems. In particular, governance experimentation, which explicitly aims for social learning, has been suggested as an approach for enabling the translation of sustainability ideas into practice. This type of experimentation requires a very different dynamic within societal relations and necessitates a changed role for professionals engaged in such a process. This empirically focused paper investigates a contemporary governance experiment, the Cooks River Sustainability Initiative, and determines its outcome in terms of enabling social learning for attaining sustainable water practice in an urban catchment. Drawing on the qualitative insights of the actors directly involved in this novel process, this paper provides evidence of changes in individual and collective understanding generated through diverse forms of social interaction. Furthermore, the research reveals perceived key-factors that foster and/or hamper the execution of this new form of experimentation, including project complexity, resource intensity and leadership. Overall, this paper highlights that, while implementation of governance experimentation in a conventional setting can be highly challenging, it can also be highly rewarding in terms of learning.

Capacity attributes of future urban water management regimes: projections from Australian sustainability practitioners.

Transitioning to more sustainable urban water management is widely accepted as an essential societal objective. While there has been significant progress in developing technical solutions to the challenges faced, numerous barriers remain at the regime level, indicating that further investigation into the regime is required. This paper reports on a social research project aimed at identifying capacity attributes of a more sustainable urban water management regime. Attributes were identified for the administrative and regulatory framework, inter- and intra-organisational and individual regime spheres. Over 125 urban water practitioners specialising in sustainability in Sydney and Melbourne were interviewed to identify the attributes of a more sustainable regime. The attributes reveal that a sustainable urban water management regime emphasises learning, diverse policy tools and institutional arrangements, together with interaction among stakeholders and professional disciplines. The interaction is characterised by respect, trust and mutual understanding. The sustainable regime attributes are compared to the traditional regime and reveal that while progress has been made towards a sustainable regime, additional improvement is required. Attributes identified across multiple regime spheres indicate potential focus areas for capacity building programs or reform efforts to more effectively enable regime change towards sustainable urban water management.

Exploring sustainable urban water governance: a case study of institutional capacity.

The sustainable urban water management system is likely to be characterised by complex and flexible governance arrangements, increased inter-organisational interaction and wide stakeholder participation, which contrasts significantly with the traditional approach. Recently there has been significant financial investment in urban water reform, however the reforms have not been as successful as anticipated and numerous institutional barriers remain. Understanding and assessing institutional capacity is central to addressing institutional impediments. Institutional capacity comprises individual, intra- and inter-organisational and external rules and incentives capacities. This paper reports on the first case study of a social research project that aims to develop an institutional capacity assessment framework. Empirical data from semi-structured interviews with 59 water industry experts in Sydney, Australia, and a broad literature survey were used. The key capacity attributes identified could form the basis of an institutional capacity assessment tool and reveal common and differing attributes across stakeholder groups which provide insight into stakeholder relations. Synthesis of the results revealed that intra- and inter-organisational capacities were facing particular challenges and should be explicitly addressed in reform, policy and capacity development initiatives.

Delivering sustainable urban water management: a review of the hurdles we face.

Sustainable urban water management (SUWM) requires an integrated, adaptive, coordinated and participatory approach. Current urban water policies are beginning to reflect this understanding yet the rhetoric is often not translated to implementation. Despite the 'new' philosophy, urban water management remains a complex and fragmented area relying on traditional, technical, linear management approaches. Despite widespread acknowledgement of the barriers to change, there has been little systematic review of what constitutes the scope of such barriers and how these should be addressed to advance SUWM. To better understand why implementation fails to occur beyond ad hoc project interventions, an extensive literature review of observed and studied barriers was conducted. Drawing on local, national and international literature from the field of integrated urban water management and other similar fields, 53 studies were assessed, resulting in a typology of 12 barrier types. The analysis revealed the barriers are largely socio-institutional rather than technical, reflecting issues related to community, resources, responsibility, knowledge, vision, commitment and coordination. Furthermore, the meta-analysis demonstrated a paucity of targeted strategies for overcoming the stated institutional barriers. Evaluation of the typology in relation to capacity building suggests that these systemic issues require a sophisticated programme of change that focuses on fostering social capital, inter-sectoral professional development, and inter-organisational coordination.

Challenges ahead: social and institutional factors influencing sustainable urban stormwater management in Australia.

In a time of climate uncertainty and drought in Australia, improved urban stormwater quality management practices are required not only for protecting waterway health, but also as a fit-for-purpose supply source. To conceive of urban stormwater as an environmental threat as well as a water supply source requires a substantial shift in our traditional linear supply and wastewater structures towards more hybrid and complex infrastructure systems. To understand what drives and limits treatment technology adoption for stormwater management, over 800 urban water professionals in three Australian capital cities completed an online questionnaire survey in November 2006. Using the conceptual framework of receptivity assessment, the results revealed the professional community to be highly associated with the importance of improving stormwater quality for receiving waterway health, yet they do not consider that politicians share this perspective by placing a substantially lower level of importance on stormwater quality management. Significant acquisition barriers within each city, including institutional arrangements, costs, responsibilities, and regulations and approvals processes were all identified as constraining more sustainable practices. Capacity building programs, fostering greater socio-political capital and developing key demonstration projects with training events are recommended as useful policy interventions for addressing current institutional impediments.

Consequences of dramatic reductions in state tobacco control funds: Florida, 1998-2000.

OBJECTIVE: This study assessed whether dramatic funding reductions to the Florida Tobacco Control Program (FTCP) influenced trends in recall of the Florida "truth" anti-smoking media campaign, anti-industry attitudes and non-smoking intentions among Florida teens. METHODS: We used an interrupted time series technique to test for differences in the rates of change in Florida "truth" recall, anti-industry beliefs and non-smoking intentions before and after the FTCP budget cuts using the Florida Anti-tobacco Media Evaluation (FAME) survey, a repeated cross-sectional telephone survey of Florida teens. RESULTS: Recall of the Florida "truth" anti-smoking campaign, anti-industry attitudes, and non-smoking intentions increased dramatically between April 1998 and May 1999. Florida "truth" recall declined after FTCP budget cuts in June 1999. Anti-industry beliefs and non-smoking intentions plateaued or began to decline after the budget cuts. The launch of the national "truth" campaign in February 2000 may have offset otherwise deleterious effects of the budget cuts on anti-industry beliefs, but not smoking intentions. CONCLUSION: Reductions in tobacco control funding have immediate effects on programme exposure and cognitive precursors to smoking initiation. There is a critical need to maintain and enhance funding for state tobacco control programmes to continue nationwide progress in preventing youth from initiating cigarette smoking.

Phase I/II study of treatment with matured dendritic cells with or without low dose IL-2 in patients with disseminated melanoma.

BACKGROUND: In the present study, we have examined whether treatment of patients with metastatic melanoma with matured dendritic cell (DC) vaccines with or without low dose IL-2 may improve treatment outcomes. METHODS: Sixteen patients received DC vaccines (DCs) sensitized with autologous melanoma lysates and 18 patients received DCs sensitized with peptides from gp100, MART-1, tyrosinase, MAGE-3.A2, MAGE-A10 and NA17. IL-2 was given subcutaneously (sc) at 1 MU/m2 on the second day after each injection for 5-14 days in half of each group. DCs were given by intranodal injection. RESULTS: There were 2 partial responses (PR) and 3 with stable disease (SD) in the nine patients receiving DCs + peptides + IL-2, and 1 PR and 1 SD in nine patients treated with DCs + peptides without IL-2. There were only two patients with SD in the group receiving DCs + autologous lysates and no IL-2. Median overall survival for all patients was very good at 18.5 months but this was most probably due to selection of a favourable group of patients for the study. There was no significant difference in survival between the groups by log rank analysis. Treatment was not associated with significant side effects. The quality and yield of the DCs in the preparations were generally good. CONCLUSIONS: We conclude that mature DC preparations may be superior to immature DC preparations for presentation of melanoma peptides and that IL-2 may increase clinical responses to the DCs plus peptides. However, in our view the low response rates do not justify the cost and complexity of this treatment approach.

Peer-reviewed publication output of psychiatric nurses in the Republic of Ireland.

Pre-registration psychiatric nursing education, in the Republic of Ireland, has recently moved to a 4-year degree programme, with the first cohort of psychiatric nursing graduants graduating in 2006. In addition, a number of other policy initiatives have taken place that will have a significant impact on psychiatric nursing practice, education and research activity. To provide a baseline for future benchmarking and evaluation, the year 2005 seemed an appropriate time to reflect on and record publications by psychiatric nurses in the Republic of Ireland. This article reports the findings of a study undertaken to identify psychiatric nursing publications in peer-reviewed journals, with a view to establishing trends in publication, such as the type of publication, subject area and journal type. Emerging trends are identified and discussed in light of concurrent changes in psychiatric nursing and mental health care, and suggestions are made for future development of publication capacity.

Youth smoking prevention and tobacco industry revenue.

OBJECTIVES: Epidemiological surveys make it clear that youth smoking contributes to both current and future tobacco industry revenue: over 80% of adult smokers reportedly began smoking before age 18. This paper estimates annual and lifetime revenue from youth smoking, and highlights the association between declines in youth smoking and declines in tobacco industry revenue. MAIN OUTCOME MEASURES: This paper reports the amount of tobacco industry revenue generated by youth smoking at two points in time (1997 and 2002), and describes the distribution of youth generated tobacco income among the major tobacco companies. The authors project the amount of tobacco industry revenue that will be generated by members of two cohorts (the high school senior classes of 1997 and 2002) over the course of their lifetimes. RESULTS: In 1997, youth consumed 890 million cigarette packs, generating $737 million in annual industry revenue. By 2002, consumption dropped to 541 million packs and revenue increased to nearly $1.2 billion. Fifty eight per cent of youth generated revenue goes to Philip Morris USA, 18% to Lorillard, and 12% to RJ Reynolds. The authors project that, over the course of their lives, the 1997 high school senior class will smoke 12.4 billion packs of cigarettes, generating $27.3 billion in revenue. The 2002 high school senior class is projected to smoke 10.4 billion packs, generating $22.9 billion in revenue over the course of their lives. CONCLUSIONS: Cigarette price increases from 1997 to 2002 have resulted in greater revenue for the tobacco industry, despite declines in youth smoking prevalence. However, in the absence of further cigarette price increases, declines in youth smoking are projected to lead ultimately to a loss of approximately $4 billion in future tobacco industry revenue from a single high school cohort.

Point of purchase cigarette promotions before and after the Master Settlement Agreement: exploring retail scanner data.

BACKGROUND: Evidence indicates that point of purchase (POP) advertising and promotions for cigarettes have increased since the Master Settlement Agreement (MSA). Retail promotions have the potential to offset the effects of cigarette tax and price increases and tobacco control programmes. OBJECTIVE: To describe the trend in the proportion of cigarette sales that occur as part of a POP promotion before and after the MSA. DESIGN: Scanner data were analysed on cigarette sales from a national sample of grocery stores, reported quarterly from 1994 through 2003. The proportion of total cigarette sales that occurred under any of three different types of POP promotions is presented. RESULTS: The proportion of cigarettes sold under a POP promotion increased notably over the sample period. Large increases in promoted sales are observed following implementation of the MSA and during periods of sustained cigarette excise tax increases. CONCLUSIONS: The observed pattern of promoted cigarette sales is suggestive of a positive relationship between retail cigarette promotions, the MSA, and state cigarette tax increases. More research is needed to describe fully the relationship between cigarette promotions and tobacco control policy.

How state counter-industry campaigns help prime perceptions of tobacco industry practices to promote reductions in youth smoking.

OBJECTIVE: This study assessed the impact of state media campaigns that prominently feature counter-industry messages on youth cigarette smoking, beyond the effects of price, secular trends, tobacco control efforts, and the national truth campaign. METHODS: Rates of youth smoking were compared in three groups of states: (1) those with long funded counter-industry campaigns (California, Florida, and Massachusetts); (2) states with more recently funded counter-industry media campaigns (Indiana, Minnesota, Mississippi, and New Jersey); and (3) other states. An analysis was performed for a series of national telephone surveys of 12-17 year olds between 1999 and 2002, controlling for differences in demographic background, the price of cigarettes, and exposure to the national truth campaign. RESULTS: Between 1999 and 2002, rates of current smoking and established smoking decreased significantly faster in states with established or more newly funded counter-industry campaigns than in other states. State counter-industry campaigns appear to prime, or make more salient, negative perceptions about tobacco industry practices. CONCLUSION: Results highlight the value of continued state counter-industry campaigns.

Changes in hospitality workers' exposure to secondhand smoke following the implementation of New York's smoke-free law.

OBJECTIVE: To assess the impact on hospitality workers' exposure to secondhand smoke of New York's smoke-free law that prohibits smoking in all places of employment, including restaurants, bars, and bowling facilities. DESIGN: Pre-post longitudinal follow up design. SETTINGS: Restaurants, bars, and bowling facilities in New York State. SUBJECTS: At baseline, 104 non-smoking workers in restaurants, bars, and bowling facilities were recruited with newspaper ads, flyers, and radio announcements. Of these, 68 completed a telephone survey and provided at least one saliva cotinine specimen at baseline. At three, six, and 12 month follow up studies, 47, 38, and 32 workers from the baseline sample of 68 completed a telephone survey and provided at least one saliva cotinine specimen. INTERVENTION: The smoke-free law went into effect 24 July 2003. MAIN OUTCOME MEASURES: Self reported sensory and respiratory symptoms and exposure to secondhand smoke; self administered saliva cotinine specimens. Analyses were limited to subjects in all four study periods who completed a telephone survey and provided at least one saliva cotinine specimen. RESULTS: All analyses were limited to participants who completed both an interview and a saliva specimen for all waves of data collection (n = 30) and who had cotinine concentrations < or = 15 ng/ml (n = 24). Hours of exposure to secondhand smoke in hospitality jobs decreased from 12.1 hours (95% confidence interval (CI) 8.0 to 16.3 hours) to 0.2 hours (95% CI -0.1 to 0.5 hours) (p < 0.01) and saliva cotinine concentration decreased from 3.6 ng/ml (95% CI 2.6 to 4.7 ng/ml) to 0.8 ng/ml (95% CI 0.4 to 1.2 ng/ml) (p < 0.01) from baseline to the 12 month follow up. The prevalence of workers reporting sensory symptoms declined from 88% (95% CI 66% to 96%) to 38% (95% CI 20% to 59%) (p < 0.01); there was no change in the overall prevalence of upper respiratory symptoms (p < 0.16). CONCLUSION: New York's smoke-free law had its intended effect of protecting hospitality workers from exposure to secondhand smoke within three months of implementation. One year after implementation, the results suggest continued compliance with the law.

The impact of anti-tobacco industry prevention messages in tobacco producing regions: evidence from the US truth campaign.

BACKGROUND: Adolescents who live in tobacco producing regions may not respond favourably to anti-industry ads. OBJECTIVE: To examine whether state level involvement in tobacco production appears to limit the effectiveness of anti-industry ads to prevent tobacco use among adolescents in the USA. DESIGN: Time trend analyses were done using repeated cross sectional data from six waves of the Legacy Media Tracking Survey, which were collected between 1999 and 2003. SETTING AND PARTICIPANTS: 28,307 adolescents, ages 12-17 years, were classified as living in: tobacco producing states (TPS) (n = 1929); non-tobacco producing states (non-TPS) with low tobacco control funding comparable to TPS (n = 5323); non-TPS with relatively high funding (n = 15,076); and non-TPS with established anti-industry ad campaigns (n = 5979). MAIN OUTCOME MEASURES: Reactions to anti-industry ads; strength of anti-industry attitudes/beliefs; changes in anti-industry attitudes/beliefs over time. RESULTS: Ad reactions did not differ by state type. Multivariate adjusted time trend analyses indicated significant, comparable increases in anti-industry attitudes/beliefs since the onset of the truth campaign, in both TPS and non-TPS. Mediation analyses indicated that these increases were due, in part, to campaign exposure. CONCLUSIONS: Adolescents who live in tobacco producing regions appear to be as responsive to anti-industry ads as their counterparts in non-tobacco producing regions. This study provides further evidence for the effectiveness of such ads.

The effects of higher cigarette prices on tar and nicotine consumption in a cohort of adult smokers.

The objective of this paper is to estimate the demand for tar and nicotine in cigarettes as a function of cigarette prices in a cohort of cigarette 11,966 smokers followed for 5 years. Data for the analysis come from a longitudinal telephone survey of 11,966 smokers who were interviewed in 1988 and 1993 as part of the Community Intervention Trial for Smoking Cessation (COMMIT). Separate models are estimated for three age groups to account for differences in levels of addiction and brand loyalty across age. We found that smokers respond to higher cigarette prices by reducing the number of cigarettes smoked per day but also by switching to cigarettes that are higher in tar and nicotine per cigarette.