Thyroid Cancer Prevalence, Risk Exposure, and Clinical Features Among Transgender Female Veterans.

Purpose: Transgender women experience higher-than-average rates of multiple medical conditions. Thyroid cancer occurs more frequently in those assigned female at birth than in those assigned male at birth. We sought to characterize thyroid cancer among transgender female veterans. Methods: We reviewed charts of veterans who were (1) seen in Veterans Affairs clinics across the United States from July 2017 to December 2022, (2) had an International Classification of Diseases, revision 10, diagnosis code for thyroid cancer, and (3) had an International Classification of Diseases, revision 10, diagnosis code for gender dysphoria or were assigned male at birth and ever had a prescription for estrogens. Charts of cisgender veterans were also reviewed for comparison. Results: Compared with calculated estimates of 0.641% (95% CI, 0.572-0.724) among cisgender females and 0.187% (95% CI, 0.156-0.219) among cisgender males, the measured prevalence among transgender female veterans was 0.341% (34/9988). Average age at thyroid cancer diagnosis in this population was 53.8 (± SEM 2.61) years. A total of 32.3% (11/34) of these patients had extrathyroidal disease at diagnosis. Discussion: To our knowledge, this study represents the first report of thyroid cancer prevalence among transgender women in the United States. Risk exposure among all transgender veterans including further assessment of the possible contributions of obesity, smoking, and gender-affirming hormone therapy are important future analyses.

Advancements in tooth autotransplantation.

BACKGROUND: Tooth autotransplantation (AT) involves the surgical relocation of a tooth from 1 site in the mouth to another site within the same patient. This approach is a good option in a growing patient when dental implant placements or fixed bridges are not suitable and when preserving natural teeth is a priority. Tooth AT is a complex procedure that requires specialized skills from a multidisciplinary team with careful patient and tooth selection and treatment planning. TYPES OF STUDIES REVIEWED: The authors provided a review of the state of knowledge and research on tooth AT and presented a case scenario and barriers to adoption, with a focus on the United States. RESULTS: Success rates for tooth AT can vary depending on several factors, including the patient's overall health, specific tooth involved, skill of the dental surgeon, and postoperative care provided. Long-term outcomes of autotransplanted teeth have been cited in the literature with impressive longitudinal follow-up spanning up to 26 years. Results of several systematic reviews showed survival rates from 75% through 98%. CONCLUSIONS AND PRACTICAL IMPLICATIONS: Adoption of tooth AT has grown over the years, owing to advancements in dental techniques, improved patient outcomes, and increased awareness among both dentists and patients. Increasing awareness and availability of tooth AT to replace missing teeth can provide a natural and functional alternative to traditional prosthetic options. Tooth AT helps preserve the alveolar bone in growing patients and can offer excellent esthetic and functional outcomes.

Optimizing donor tooth selection for autotransplantation in the anterior maxilla via CBCT-based root width and crown-root angle measurements.

BACKGROUND/AIM: The clinical management of growing patients with missing teeth in the anterior maxilla can be challenging due to limited treatment options and high esthetic demands. Tooth autotransplantation (AT) is a viable option for these cases. The selection of donor teeth has been reported to be driven by root development, existing malocclusion, and esthetics. The aim of this study was to add to the evidence base of tooth selection criteria for AT by examining candidate donor teeth root width and crown-root angles, two factors arguably important for surgical planning and esthetics. MATERIAL AND METHODS: Cementoenamel junction (CEJ) tooth width and crown-root angle measurements were made using cone-beam computed tomography (CBCT) images of 30 children and adolescents of European descent (mean age = 13 years, range = 10-17 years; 63% male) from a private orthodontic practice. Measurements of maxillary central and lateral incisors (index teeth) were compared with measurements of maxillary second premolars, mandibular central incisors, and mandibular first and second premolars (candidate donor teeth). Analyses relied on descriptive statistics of mean within-subject differences between index and donor teeth and the proportion of individuals without clinically important differences (i.e., >1.5 mm width deficit and > 15 degrees crown-root angle difference). RESULTS: Mandibular first premolars were the most compatible teeth for the replacement of maxillary central incisors based on both width (≥97% of individuals) and angle measurements (≥87% of individuals), followed closely by mandibular second premolars. Mandibular central incisors were the most compatible for the replacement of maxillary laterals, among all individuals based on width and ≥ 90% based on angle, whereas mandibular first premolars were somewhat less compatible. CONCLUSIONS: The study offers evidence of within-person, CBCT-based root width dimension and crown-root angle compatibilities. This information can be considered in addition to existing tooth selection criteria for AT including Angle's classification, midline deviation, crowding severity, root development, and esthetics.

A Study of Surgical Residents' Self-Assessment of Open Surgery Skills Using Gap Analysis.

BACKGROUND: Surgical residents need structured and objective feedback to develop their skills and become capable of performing surgical procedures autonomously. A shortage of experienced surgical staff has prompted residents to seek feedback from self-assessment and peer assessments. OBJECTIVES: We investigated whether surgical residents can reliably rate their own and their peers' basic surgical skills using the Global Rating Scale (GRS) from the Objective Structured Assessment of Technical Skills. METHODS: The study was a prospective and descriptive study conducted using gap analysis at the Copenhagen Academy for Medical Education and Simulation (Copenhagen, Denmark) from 2016 to 2017. Surgical residents were recruited during a course in basic open surgical skills. Among 102 course participants, 53 met the inclusion criteria and 22 participated in the study. RESULTS: We recruited surgical residents based in the Capital Region and Zealand Region of Demark, and 42% of eligible residents participated in the study. Surgical residents underestimated their own surgical performance (median, 17 [range, 15-18] vs. 20 [range, 19.75-22]; P < 0.001). They also rated their peers lower than an experienced rater did (median 10 [range, 8.75-14] vs. 15 and median 20.5 [range, 19-22] vs. 23; both P < 0.001). Gap analysis revealed residents had unrecognized strengths (ie, self-underappraisal) in most GRS domains. CONCLUSIONS: Ratings are unreliable when surgical residents assess their own and their peers' performances using GRS. A gap analysis revealed unrecognized strengths in time and motion, instrument handling, knowledge of instruments and sutures, and knowledge of specific procedure as well as unrecognized weaknesses in flow of operation and forward planning.

Brief Report: Implementation of a Universal Prescreening Protocol to Increase Recruitment to Lung Cancer Studies at a Veterans Affairs Cancer Center.

Introduction: The oncology clinical trial recruitment process is time, labor, and resource intensive, and poor accrual rates are common. We describe the VA Connecticut Cancer Center experience of implementing a standardized, universal prescreening protocol and its impact on thoracic oncology research recruitment. Methods: Research coordinators prescreened potentially eligible patients with confirmed or suspected cancer from multiple clinical sources and entered relevant patient and research study information into a centralized electronic database. The database provided real-time lists of potential studies for each patient. This enabled the research team to alert the patient's oncologist in advance of clinic visits and to prepare documents needed for enrollment. Clinicians could ensure sufficient time and attention in clinic to the informed consent process, therefore maximizing enrollment opportunities. Patients were also monitored on waitlists for future studies. Results: From March 2017 to December 2020, a total of 1518 patients with lung nodules and suspected or confirmed lung cancers were prescreened. Of these, 379 patients were enrolled to a study, 103 patients declined participation, and 639 were monitored for future studies. Our prescreening protocol identified all new patients with lung cancer who were ultimately added to the cancer registry. We found a substantial increase in study enrollment after prescreening implementation. Conclusions: Universal prescreening was associated with improved patient enrollment to thoracic oncology studies. The protocol was integral in our VA becoming the top accruing VA site for National Cancer Institute's National Clinical Trials Network studies for 2019 to 2021.

Plasma pharmacokinetics, pulmonary disposition, and safety of subcutaneous gamithromycin in alpacas.

The study objective was to determine the disposition of gamithromycin in plasma, peripheral blood polymorphonuclear cells (PMNs), pulmonary epithelial lining fluid (PELF), and bronchoalveolar lavage (BAL) cells in alpacas. A single subcutaneous injection of gamithromycin (6.6 mg/kg) was administered to six healthy adult alpacas. At various time points after administration, gamithromycin concentrations were analyzed via LC-MS/MS in plasma, PMNs, PELF, and BAL cells until Day 14 post-injection. Plasma gamithromycin concentrations were measured in all six alpacas; the remaining three body compartments were analyzed in four alpacas. Gamithromycin rapidly concentrated in blood PMNs, BAL cells, and PELF. Shorter Tmax , and lower Cmax, and AUC were observed in plasma than in the other three compartments. Cmax was highest in BAL cells (26001.80 ± 12400.00 ng/ml) and PMNs (2573.00 ± 963.30 ng/ml) compared to PELF (660.80 ± 413.70 ng/ml) and plasma (452.30 ± 196.20 ng/ml). Mean terminal half-lives were 72.60 ± 14.10 h in plasma, 56.60 ± 10.60 h in PELF, 62.80 ± 85.30 h in PMNs, and 93.60 ± 124.80 h in BAL cells. No injection site reactions occurred. One alpaca developed colic but no other adverse reactions were noted. Overall, gamithromycin was highly concentrated in white blood cells and pulmonary fluids/cells. Clinical utilization of gamithromycin in alpacas should be done with caution until further investigation of potential for colic.

Overcoming Gender Bias in Assessment of Surgical Skills.

OBJECTIVE: Female and male surgical residents are treated differently based on their gender. The use of assessment tools can help obtain objectivity in surgical skills assessment, avoid gender bias, and promote equal learning opportunities. The objective of the study was to explore whether knowledge of gender causes bias in the rating of surgical skills, and whether the raters' gender, surgical specialty, or experience affect ratings. DESIGN: The study is designed as a cross-sectional study, where an anonymous video showing surgical performance was rated by surgeons from different surgical specialties and different levels of surgical experience. The same video was presented to two randomized groups as either a male or female surgical trainee performing the procedure. SETTING: The participants used Objective Structured Assessment of Technical Skills (OSATS) to rate a video-recorded exam from a surgical skills course at Copenhagen Academy for Medical Education and Simulation (CAMES). The video rating was done through an internet-based platform and could thus be performed at home or at another location of choice. PARTICIPANTS: Novice and experienced surgeons from departments of gastrointestinal surgery, gynaecology, and urology in Denmark. RESULTS: There was no difference in OSATS rating score of the perceived female and male trainee (female trainee (n = 50):12.26 (SD = 3.08), male trainee (n = 57): 12.00 (SD = 3.28), p-value = 0.67). Rater characteristics: gender, age, surgical experience, and surgical specialty did not affect ratings. CONCLUSIONS: When OSATS a systematic assessment tool was used in rating surgical trainees we did not find any significant implicit gender bias. The rating was unaffected by the raters' gender, age, surgical specialty, or experience.

Condom use self-efficacy centered on sexual experience, cannabis, and CBD use among college students.

OBJECTIVES: The goal of this study was to understand how condom use self-efficacy varies based on sexual experience, cannabis and CBD use. METHODS: A cross-sectional survey was implemented through Qualtrics. A total of 455 undergraduate students were surveyed at a large U.S. northeastern university. RESULTS: Findings suggested that sexual experience itself and sexual experience with cannabis and CBD are associated with a person's condom use self-efficacy. Precisely, non-sexually active and cannabis or CBD nonusers perceived themselves as less efficacious in their future use of condoms compared with sexually active adolescents. CONCLUSIONS: Implications for health interventions are discussed, such as the importance of giving attention to non-sexually active adolescents and strengthening their condom use self- efficacy. It is critical to promote healthy sexual behaviors among future sexually active college students and reinforce healthy sexual behaviors among sexually active adolescents.

The Challenges of Dyad Practice in Simulation Training of Basic Open Surgical Skills-A Mixed-Method Study.

INTRODUCTION: Simulation training at home improves access to training, but motivation can be difficult to maintain. Dyad training could keep trainees motivated. This study aimed to examine the effect of self-regulated training of basic surgical skills in pairs versus individually. METHODS: One hundred one medical doctors were included in this prospective, mixed-method, simulation-based study. Participants were randomized to train individually or in pairs during a 6-week course in open surgical skills, consisting of didactic instructions and self-directed training at home. Trainees kept a training log and filled in a questionnaire. Skills were tested before and after the course. Tests were rated by an expert using the Objective Structured Assessment of Technical Skills Global Rating Scale. RESULTS: Ninety-seven doctors completed the study. We found no differences in test score between dyad and individual trainees. Dyad trainees compared with individual trainees improved by 7.23 points (intercept estimate) versus 6.94 points, respectively (P = 0.881). Dyad trainees trained less frequently [7.3 times (intercept estimate) vs. 12.1 times, P < 0.001, but for longer intervals compared with individual trainees (68 minutes vs. 38 minutes)]. Dyad trainees reported benefits such as having a sparring partner, receiving feedback, corrections, increased motivation, having fun, and more structured training sessions. However, the coordination of training sessions was difficult. CONCLUSIONS: No differences were found between dyad trainees and individual trainees in improvement of surgical skills. Off-site dyad training led to fewer, but longer training sessions, which may have negatively impacted the effectiveness of training. Dyad trainees perceived dyad training beneficial.

High particle counts in neonatal parenteral nutrition solutions with added cysteine: Relationship to crystal formation and effect of filtration on cysteine content.

BACKGROUND: Parenteral nutrition(PN) solutions containing calcium gluconate and cysteine have elevated particle counts when analyzed using laser light obscuration (LO) as recommended by the United States Pharmacopeia. It is unclear whether increased particle formation in these solutions results in decreased availability of cysteine to neonatal patients due to filtration. OBJECTIVE: The purpose of this study was to measure cysteine concentrations in neonatal PN solutions before and after filtration as well as analyze precipitates on filters. METHODS: Solutions of PN containing amino acids with and without cysteine that were compounded with calcium chloride or calcium gluconate plus potassium phosphate were analyzed using LO. Concentrations of cysteine were measured before and after filtration. The effect on particle formation of magnesium sulfate (MgSO4 ) and D70 was also evaluated. RESULTS: Multiple additives including the specific calcium or D70 additive, cysteine, and MgSO4 influenced particle formation of particles detected using LO. There was no significant decrease in cysteine concentration because of filtering and there was no difference in the amount of calcium on filters of various solutions after filtration regardless of LO particle counts. Scanning electron micrographic (SEM) analysis found no significant differences in crystal composition. Light microscopic and SEM examination did not show evidence of high particle counts on filters. CONCLUSION: The increased particle counts detected in neonatal PN solutions containing cysteine added at the time of compounding does not appear to result in increased precipitate or crystal formation. It is not associated witha decrease in cysteine delivery to patients.

Pharmacokinetics of diphenhydramine following single-dose intravenous and oral administration in non-fasted adult horses.

Diphenhydramine is an H1 receptor antagonist used to control urticaria and other allergic signs caused by type I hypersensitivity reactions in horses (Equus caballus). Limited studies have been conducted on pharmacokinetics of this drug in horses, with no studies involving oral formulations. Our study investigated pharmacokinetics of an oral diphenhydramine formulation compared to intravenous administration in non-fasted adult horses. Six healthy horses underwent a single administration of three different doses of diphenhydramine (1 mg/kg intravenously, 1 mg/kg intragastrically, and 5 mg/kg intragastrically) with a two-week washout period between doses. Bioavailability of intragastric diphenhydramine was less than one percent and six percent for 1 mg/kg and 5 mg/kg intragastric doses, respectively. This poor bioavailability is similar to what is reported in dogs. Two of six horses experienced transient side effects after intravenous diphenhydramine administration, emphasizing the need for determining therapeutic plasma levels in efforts to determine the lowest effective dose minimizing risk of adverse effects. The main conclusion of our study was that oral diphenhydramine at doses up to 5 mg/kg are unlikely to achieve therapeutic plasma levels in adult horses.

User-Agent Bond in Generalizable Environments: Long-Term Risk-Reduction via Nudged Virtual Choices.

Avatars or agents are digitized self-representations of a player in mediated environments. While using agents to navigate through mediated environments, players form bonds with their self-agents or characters, a process referred to as identification. Identification can involve automatic, but temporary, self-concept "shifts in implicit self-perceptions" (Klimmt et al., 2010, p. 323) of the media user by adopting or emphasizing the action choices on behalf of the social expectation of the avatar in the mediated environment. In the current study, we test the possibility that users' identification with video game avatars-a bond built between avatars and players- would account for subsequent behavior changes. We did so by using 3-month longitudinal data involving a narratively-based serious game: Socially Optimized Learning in Virtual Environments (SOLVE), a 3D-interactive game designed to reduce risky sexual behaviors among young men who have sex with men (n = 444). Results show that video game identification predicts both the reduction of risky sexual behaviors over time, and reduction in the number of non-primary partners with whom risky sex occurs. And when players identify with the game character, they tend to make healthier choices, which significantly mediates the link between video game identification and reduction of risky behaviors.

Leptin Decreases Energy Expenditure Despite Increased Thyroid Hormone in Patients With Lipodystrophy.

CONTEXT: Leptin is an adipokine that signals energy sufficiency. In rodents, leptin deficiency decreases energy expenditure (EE), which is corrected following leptin replacement. In humans, data are mixed regarding leptin-mediated effects on EE. OBJECTIVE: To determine the effects of metreleptin on EE in patients with lipodystrophy. DESIGN, SETTING, AND PATIENTS: Nonrandomized crossover study of 25 patients with lipodystrophy (National Institutes of Health, 2013-2018). INTERVENTION: The initiation cohort consisted of 17 patients without prior exposure to metreleptin, studied before and after 14 days of metreleptin. The withdrawal cohort consisted of 8 previously metreleptin-treated patients, studied before and after 14 days of metreleptin withdrawal. MAIN OUTCOMES: 24-h total energy expenditure (TEE), resting energy expenditure (REE), autonomic nervous system activity [heart rate variability (HrV)], plasma-free triiodothyronine (T3), free thyroxine (T4), epinephrine, norepinephrine, and dopamine. RESULTS: In the initiation cohort, TEE and REE decreased by 5.0% (121 ±â€…152 kcal/day; P = 0.006) and 5.9% (120 ±â€…175 kcal/day; P = 0.02). Free T3 increased by 19.4% (40 ±â€…49 pg/dL; P = 0.01). No changes in catecholamines or HrV were observed. In the withdrawal cohort, free T3 decreased by 8.0% (P = 0.04), free T4 decreased by 11.9% (P = 0.002), and norepinephrine decreased by 34.2% (P = 0.03), but no changes in EE, epinephrine, dopamine, or HrV were observed. CONCLUSIONS: Metreleptin initiation decreased EE in patients with lipodystrophy, but no changes were observed after metreleptin withdrawal. Thyroid hormone was higher on metreleptin in both initiation and withdrawal cohorts. Decreased EE after metreleptin in lipodystrophy may result from reductions in energy-requiring metabolic processes that counteract increases in EE via adipose tissue-specific neuroendocrine and adrenergic signaling.

Mummified baboons reveal the far reach of early Egyptian mariners.

The Red Sea was witness to important events during human history, including the first long steps in a trade network (the spice route) that would drive maritime technology and shape geopolitical fortunes for thousands of years. Punt was a pivotal early node in the rise of this enterprise, serving as an important emporium for luxury goods, including sacred baboons (Papio hamadryas), but its location is disputed. Here, we use geospatial variation in the oxygen and strontium isotope ratios of 155 baboons from 77 locations to estimate the geoprovenance of mummified baboons recovered from ancient Egyptian temples and tombs. Five Ptolemaic specimens of P. anubis (404-40 BC) showed evidence of long-term residency in Egypt prior to mummification, consistent with a captive breeding program. Two New Kingdom specimens of P. hamadryas were sourced to a region that encompasses much of present-day Ethiopia, Eritrea, and Djibouti, and portions of Somalia and Yemen. This result is a testament to the tremendous reach of Egyptian seafaring during the 2nd millennium BC. It also corroborates the balance of scholarly conjecture on the location of Punt.

Strontium is a chemical element that can act as a geographic fingerprint: its composition differs between locations, and as it enters the food chain, it can help to retrace the life history of extant or past animals. In particular, strontium in teeth ­ which stop to develop early ­ can reveal where an individual was born; strontium in bone and hair, on the other hand, can show where it lived just before death. Together, these analyses may hold the key to archaeological mysteries, such as the location of a long-lost kingdom revered by ancient Egyptians. For hundreds of years, the Land of Punt was one of Egypt's strongest trading partners, and a place from which to import premium incense and prized monkeys. Travellers could reach Punt by venturing south and east of Egypt, suggesting that the kingdom occupied the southern Red Sea region. Yet its exact location is still highly debated. To investigate, Dominy et al. examined the mummies of baboons present in ancient Egyptian tombs, and compared the strontium compositions of the bones, hair and teeth of these remains with the ones found in baboons living in various regions across Africa. This shed a light on the origins of the ancient baboons: while some were probably raised in captivity in Egypt, others were born in modern Ethiopia, Eritrea, Djibouti, Somalia and Yemen ­ areas already highlighted as potential locations for the Land of Punt. The work by Dominy et al. helps to better understand the ancient trade routes that shaped geopolitical fortunes for millennia. It also highlights the need for further archaeological research in Eritrea and Somalia, two areas which are currently understudied.

The Benefits of Tying Yourself in Knots: Unraveling the Learning Mechanisms of Guided Discovery Learning in an Open Surgical Skills Course.

PURPOSE: Teaching technical skills through the use of guided discovery learning (GDL) is an ongoing topic of research. In this approach, learners practice and struggle before receiving formal instruction. This has shown promise in other domains of learning, yet in the realm of procedural skills, clarity is still needed. This study seeks to address these gaps by investigating efficacy and mechanisms relating to application for a GDL approach in teaching basic surgical skills. METHOD: In 2018, young surgical trainees (N = 16) undertook a 6-week open surgical course applying the principles of GDL, each lesson beginning with a discovery phase before subsequent instruction and practice. A concurrent triangulation mixed-methods approach was used with direct observation and collection of semistructured interviews using a framework designed from productive failure literature. At the end of the course, all participants took a conceptual knowledge test and a performance-based skills test. Performance on the skills test was rated using global ratings and checklists. RESULTS: The GDL cohort outperformed the historical cohort on the written exam (F [1,65] = 4.96, P = .029, d = .62), as well as on the summative suturing test (F [1,65] = 6.23, P = .015, d = .68). Furthermore, 3 main themes that highlight the mechanisms and mediators of efficient GDL were: (1) building conceptual knowledge, (2) motivating self-regulated learning, and (3) the type of skill and psychological safety. CONCLUSIONS: GDL can be an efficient approach to teaching procedural skills. Implications for future research and curricular design are discussed.

Phosphorus Speciation in Atmospherically Deposited Particulate Matter and Implications for Terrestrial Ecosystem Productivity.

Chemical forms of phosphorus (P) in airborne particulate matter (PM) are poorly known and do not correlate with solubility or extraction measurements commonly used to infer speciation. We used P X-ray absorption near-edge structure (XANES) and 31P nuclear magnetic resonance (NMR) spectroscopies to determine P species in PM collected at four mountain sites (Colorado and California). Organic P species dominated samples from high elevations, with organic P estimated at 65-100% of total P in bulk samples by XANES and 79-88% in extracted fractions (62-84% of total P) by NMR regardless of particle size (≥10 or 1-10 µm). Phosphorus monoester and diester organic species were dominant and present in about equal proportions, with low fractions of inorganic P species. By comparison, PM from low elevation contained mixtures of organic and inorganic P, with organic P estimated at 30-60% of total P. Intercontinental PM transport determined from radiogenic lead (Pb) isotopes varied from 0 to 59% (mean 37%) Asian-sourced Pb at high elevation, whereas stronger regional PM inputs were found at low elevation. Airborne flux of bioavailable P to high-elevation ecosystems may be twice as high as estimated by global models, which will disproportionately affect net primary productivity.

Isotopic Fractionation of Potassium by Diffusion in Methanol.

We present the results of experiments involving the isotopic fractionation by diffusion of K+ cations in methanol at 298 K along with supporting molecular dynamic simulations. The experiments, using glass Rayleigh fractionators filled with a methanol solution of KCl, constrain the ratio of the individual diffusivities of 41K and 39K (D 41K/D 39K) in methanol, and so the isotopic fractionation of K+ due to diffusion in methanol, to 0.9995 ± 0.0001. This isotopic fractionation is 25% of the fractionation resulting from K+ diffusion in water. This is consistent with published molecular dynamics simulations indicating greater hydrodynamic coupling between K+ ions and solvating methanol molecules compared to K+ ions and solvating water molecules.

The relationship between social norms and sexual risk-reduction intentions and behavior among men who have sex with men: Findings from an eHealth intervention.

Normative-based research has found that norms are significant predictors of safe sex behavioral intentions and behavior. Research shows that group identity moderates the relationship between norms and intentions/behavior. The present study used the theory of normative social behavior to evaluate whether identification with characters in an HIV-prevention interactive video moderated the relationship between sexual risk-taking norms and risk reduction intentions/behavior. Participants included 540 men between the ages 18 and 30 enrolled in a randomized controlled trial with a 3-month follow-up. We found support for the hypothesized interaction. At low levels of character identification, the negative relationship between sexual risk-taking norms and risk reduction intentions was strong. However, as character identification increased, the link between norms and intentions became weaker. The mean intentions score of high-risk norm participants was elevated to the level reported by low risk norm participants, demonstrating the favorable effect of character identification on narrative persuasion in entertainment-education. The utility of a social norms approach to health behavior change is discussed in the context of eHealth interventions. (PsycINFO Database Record (c) 2019 APA, all rights reserved).