Effect of age at initiation of the human papillomavirus vaccine on the association between race/ethnicity and completion of the vaccine series.

BACKGROUND: Up-to-date (UTD) of the human papillomavirus (HPV) vaccine series has been low despite 2016 recommendations for 2 doses among initiators <15 years of age and 3 doses for 15+ year olds. This study examined how age at initiation affected the association between race/ethnicity and UTD among adolescent HPV vaccine initiators. We also examined how administration of other adolescent vaccines affected UTD. METHODS: A secondary analysis of The National Immunization Survey - Teen data between 2016 and 2020 was conducted. Characteristics associated with initiation of the vaccine series was examined and used to evaluate UTD among initiators. All data were weighted. Associations between characteristics and HPV vaccine initiation were examined using Rao Scott chi-square tests and univariable logistic regression. Multivariable binary logistic regression models stratified by race/ethnicity calculated the strength of association between independent variables and odds of initiation and UTD among initiators. RESULTS: The final sample size was 99,719 with 67,855 (68.1 %) initiating HPV vaccination. Among HPV vaccine initiators, Hispanic and black adolescents had lower odds of UTD. However, 9-10-year-old initiators had increased odds (aOR: 5.71; 95 %CI: 3.78-8.63) of UTD compared to 12-year-old initiators. Increased odds of UTD among initiators younger than 12 years were found across racial/ethnic groups. Flu vaccination was associated with decreased odds of UTD among white (aOR: 0.76; 95 %CI:0.65-0.88) and black adolescents (aOR: 0.67; 95 %CI: 0.46-0.96). CONCLUSION: Strong recommendations to ensure patients are UTD on the HPV vaccine series are essential to improving UTD among all adolescents and follow-up should occur when administering other vaccines to reduce missed opportunities.

Distracted and Impaired Driving Among U.S. Adolescents, 2019, USA.

Distracted driving, the act of focusing on something else while operating a vehicle, is a significant health problem among adolescents. Although some studies have reported on prevalence among adolescents in the United States, limited studies have examined differences by sexual identity status. The purpose of the present study was to examine past 30-day distracted driving by sexual identity status among a large, national sample of adolescents ages 14 to 18 years. A secondary analysis was conducted on the 2019 Youth Risk Behavioral Surveillance System (YRBSS) data, and associations between distracted driving and demographics (e.g., biological sex, age, race/ethnicity) were assessed with weighted logistic regression analyses. A total of 13,590 adolescents ages 14 to 18 years were part of the final analytic sample. Twenty-three percent of adolescents reported distracted driving in the past 30 days. Compared with heterosexual adolescents, gay/lesbian (14.3%), bisexual (18.1%), and questioning (12.9%) adolescents reported lower distracted driving in the past 30 days. Findings through a health equity approach may inform harm reduction efforts and behavioral interventions.

Past-Year Blunt Smoking among Youth: Differences by LGBT and Non-LGBT Identity.

Blunt use (co-use of tobacco and marijuana) is a growing phenomenon among youth and disproportionately affects minority populations. LGBT+ populations are significantly more likely to use marijuana and tobacco, but this relationship has yet to be examined among LGBT+ adolescents. This analysis aimed to investigate past-year blunt use among a national sample of youth and delineate the differences between non-LGBT and LGBT+ youth. We used Wave 2 of the Population and Tobacco Health (PATH) study. We analyzed data from 7518 youth, comparing past-year blunt use between LGBT+ and non-LGBT youth, controlling for biological sex, race, and age using weighted logistic regression models. Greater than 1 in 10 youth (10.6%) reported using blunts in the past year. More than one in five (21.6%) LGBT+ youth reported using blunts in the past year. There were no significant differences between boys and girls. Older youth (17 years old) were more likely to use blunts in the past year (aPR: 3.04, 95% CI 2.48, 3.79) than younger youth. Compared with non-LGBT youth, LGBT+ youth were 2.17 times (95% CI 1.86, 2.54) more likely to report using blunts in the past year. Blunt use and its respective impact on health outcomes among developing youth are of concern to public health. These findings demonstrate that certain subgroups of youth are more at risk for use and emphasize the need for tailored interventions to mitigate initiation and current use, given that one of the goals of the Healthy People 2030 initiative is to "Improve the health, safety, and well-being of lesbian, gay, bisexual, and transgender (LGBT) individuals".

Measuring vaping-related expectancies in young adults: Psychometric evaluation of the Electronic Nicotine Vaping Outcomes (ENVO) scale.

OBJECTIVE: Electronic cigarettes are the most commonly used tobacco products by young adults. Measures of beliefs about outcomes of use (i.e., expectancies) can be helpful in predicting use, as well as informing and evaluating interventions to impact use. METHODS: We surveyed young adult students (N = 2296, Mean age=20.0, SD=1.8, 64 % female, 34 % White) from a community college, a historically black university, and a state university. Students answered ENDS expectancy items derived from focus groups and expert panel refinement using Delphi methods. Factor Analysis and Item Response Theory (IRT) methods were used to understand relevant factors and identify useful items. RESULTS: A 5-factor solution [Positive Reinforcement (consists of Stimulation, Sensorimotor, and Taste subthemes, α = .92), Negative Consequences (Health Risks and Stigma, α = .94), Negative Affect Reduction (α = .95), Weight Control (α = .92), and Addiction (α = .87)] fit the data well (CFI=0.95; TLI=0.94; RMSEA=0.05) and was invariant across subgroups. Factors were significantly correlated with relevant vaping measures, including vaping susceptibility and lifetime vaping. Hierarchical linear regression demonstrated factors were significant predictors of lifetime vaping after controlling for demographics, vaping ad exposure, and peer/family vaping. IRT analyses indicated that individual items tended to be related to their underlying constructs (a parameters ranged from 1.26 to 3.18) and covered a relatively wide range of the expectancies continuum (b parameters ranged from -0.72 to 2.47). CONCLUSIONS: A novel ENDS expectancy measure appears to be a reliable measure for young adults with promising results in the domains of concurrent validity, incremental validity, and IRT characteristics. This tool may be helpful in predicting use and informing future interventions. IMPLICATIONS: Findings provide support for the future development of computerized adaptive testing of vaping beliefs. Expectancies appear to play a role in vaping similar to smoking and other substance use. Public health messaging should target expectancies to modify young adult vaping behavior.

Examining gender and the longitudinal effect of weight conscious drinking dimensions on body mass index among a college freshman cohort.

Objective: This study aims to: (1) examine gender differences for weight conscious drinking among college students accounting for the broader phenomenon (e.g. including the Alcohol Effects dimension); and (2) longitudinally examine the effect of weight conscious drinking behaviors on body mass index (BMI). Participants: United States freshmen students from eight participating universities (N= 1,149). Methods: Structural equation modeling was used to model the effect of gender on weight conscious drinking dimensions at 7-month follow-up. Results: Findings suggest a significant effect of gender on Alcohol Effects (ß = -.15, SE = .05, p = .005) at 7-month follow-up among college freshmen. Weight conscious drinking dimensions predicted no significant change in BMI at 7-month follow-up among college freshmen. Conclusion: Findings contribute to weight conscious drinking theory and provide campus weight conscious drinking prevention initiatives with evidence to tailor their programming to address female tendencies to engage in compensatory strategies to enhance the psychoactive effects of alcohol.

Tobacco-related health inequalities among Black Americans: A narrative review of structural and historical influences.

We conducted a narrative literature review to examine contributing factors of disparities in tobacco usage and outcomes affecting Black Americans. We propose potential solutions that can be used to effectively address these disparities. We identified historical factors; socioeconomic factors; targeted marketing/advertising; the influence of racism/discrimination; neighborhood socioeconomic disadvantage; and mass incarceration. We call for more thorough examinations of these factors as a key element of tobacco-focused research and interventions to eliminate the disproportionate burdens faced by Black Americans. We advocate for greater emphases on the impacts of personal and structural racism on tobacco usage and outcomes affecting Black Americans.

Aerosol, vapor, or chemicals? College student perceptions of harm from electronic cigarettes and support for a tobacco-free campus policy.

Objective: This study is the first to examine the influence of e-cigarette emission phrasing on perceived harm of secondhand exposure, and whether harm perception was associated with support for a tobacco-free campus policy. Participants: In the fall 2018 and spring 2019 semesters, 52 sections of a college English course (N = 791 students) were cluster randomized to one of three conditions ("vapor," "aerosol," or "chemicals") assessing harm of secondhand exposure to e-cigarette emissions. Methods: Regression models adjusted for demographic characteristics, tobacco use, and other potential confounders. Results: Compared to the "vapor" condition, "chemicals" and "aerosol" conditions were associated with increased odds of perceiving secondhand exposure to e-cigarettes to be harmful/very harmful (AOR = 2.0, p < 0.01). Greater perceived harm of secondhand e-cigarette exposure was associated with increased odds of supporting a tobacco-free campus policy (AOR = 2.22, p < 0.001). Conclusions: Health campaigns should use accurate terminology to describe e-cigarette emissions, rather than jargon that conveys lower risk.

The Role of Alcohol-Related Proactive Dietary Restriction to Feel the Psychoactive Effects of Alcohol Faster on Binge Drinking Frequency among Freshmen College Students.

BACKGROUND: There is a positive cross-sectional relationship between alcohol-related proactive dietary restriction to feel the effects of alcohol faster (APDR) and binge drinking, a health and safety issue impacting college students. Objective: To examine: 1) the longitudinal predictive ability of varying levels of APDR on binge drinking frequency; and 1a) the strength of the relationship between varying levels of APDR and binge drinking frequency during freshman year of college (n = 1,149). METHODS: Ordinal logistic regression was used to model the relationship between APDR and binge drinking frequency. RESULTS: Main findings suggest APDR of students who reported eating less than usual (low APDR) prior to drinking to feel the effects of alcohol faster was a significant predictor of binge drinking frequency (1.27 (95% CI, 0.06 to 0.42), Wald χ2 (1) = 8.46, p=.009) at baseline, but not at 7-month follow-up (1.02 (95% CI, -0.18 to 0.23), Wald χ2 (1) = .51, p=.83). APDR for students who reported skipping one or more meals (high APDR) to feel the effects of alcohol faster was not a significant predictor of binge drinking frequency at baseline nor at 7-month follow-up. CONCLUSION: Low APDR is a significant predictor of binge drinking frequency that is established early in the first semester of college with no significant change occurring in binge drinking frequency over the course of students' freshman year at 7-month follow-up. Campus health professionals are urged to emphasize the detrimental health effects of low APDR early in the first semester of college.

Discordance Between Perinatal Alcohol Use Among Women and Provider Counseling for Alcohol Use: An Assessment of the Pregnancy Risk Assessment Monitoring System.

OBJECTIVE: In the United States, guidelines indicate all pregnant women should be screened for and counseled on alcohol use to prevent adverse perinatal outcomes due to alcohol consumption. The objective of this study was to describe sociodemographic factors associated with receipt of prenatal alcohol counseling and perinatal alcohol use among US women. METHODS: State health departments collected data for the Pregnancy Risk Assessment Monitoring System Phase 7 during 2012-2015, and we restricted the sample to a complete case analysis (N = 135 111). The 3 dichotomous outcomes were preconception alcohol use (3 months before pregnancy), prenatal alcohol use (during last 3 months of pregnancy), and prenatal alcohol counseling. Predictor variables were age, race, Hispanic ethnicity, education, marital status, health insurance status, and previous live births. We estimated survey-weighted logistic regression models for each outcome. RESULTS: Half (56.0%) of pregnant women reported preconception alcohol use, 70.5% received prenatal alcohol counseling, and 7.7% reported prenatal alcohol use during the last 3 months of pregnancy. Black women were significantly less likely than White women (odds ratio [OR] = 0.49; 95% CI, 0.46-0.52) and Hispanic women were significantly less likely than non-Hispanic women (OR = 0.62; 95% CI, 0.58-0.66) to report preconception alcohol use. We found similar patterns for prenatal alcohol use among Black women. Black women were significantly more likely than White women (OR = 1.66; 95% CI, 1.55-1.77) and Hispanic women were significantly more likely than non-Hispanic women (OR = 1.51; 95% CI, 1.40-1.61) to receive prenatal alcohol counseling. We found similar patterns for age, education, and health insurance status. CONCLUSION: Disparities in alcohol counseling occurred despite the national recommendation for universal screening and counseling prenatally. Continued integration of universal screening for alcohol use during pregnancy is needed.

Electronic cigarette explosion/burn and poisoning related emergency department visits, 2018-2019.

BACKGROUND: Electronic cigarette (ECIG) use has increased dramatically in recent years. Negative ECIG-related acute health effects have included explosion/burn injuries from battery failure and child ingestion/poisoning of liquid nicotine. However, there is an urgent need for continued surveillance of ECIG health effects to determine whether these outcomes change as ECIG devices and liquids rapidly evolve. This study updates national estimates of ECIG-related emergency department (ED) visits and describes the context of these injuries. METHODS: A keyword search of case narrative text was used to identify ECIG-related ED visits in the National Electronic Injury Surveillance System (NEISS) data. These cross-sectional data are designed to be weighted to provide national estimates of consumer product-related injuries treated in EDs. ECIG-related injuries were described and categorized, and sampling weights applied to model national estimates. RESULTS: From 2015 to 2019 there were an estimated 3369 ED visits from ECIG explosion/burn injuries (95% CI = 2020, 4718), and an estimated 676 visits from 2019 alone (95% CI = 315, 1036). In 2018-2019, there were an estimated 1550 cases of children <5 years old ingesting ECIG liquids (95% CI = 778, 2322). CONCLUSIONS: Despite a notable shift in the US market towards ECIG devices that use lower electrical power and disposable "pods" (e.g., JUUL), liquid chemical ingestion among young children and ECIG explosion/burn injuries persist. Improved product regulations are urgently needed to prevent negative health effects caused by ECIGs, as well as prevent their ingestion and use by children.

Smoking cessation and survival among people diagnosed with non-metastatic cancer.

BACKGROUND: We aimed to estimate the effects of smoking cessation on survival among people diagnosed with cancer. METHODS: We used data from a Comprehensive Community Cancer Program that is part of a large urban safety-net hospital system. Eligible patients were diagnosed with primary invasive solid tumors between 2013 and 2015, and were current smokers at time of diagnosis. Our exposure of interest was initiation of smoking cessation within 6 months of cancer diagnosis. We estimated inverse probability weighted restricted mean survival time (RMST) differences and risk ratio (RR) for all cause 3-year mortality. RESULTS: Our study population comprised 369 patients, of whom 42% were aged < 55 years, 59% were male, 44% were racial/ethnic minorities, and 59% were uninsured. The 3-year RMST was 1.8 (95% CL: - 1.5, 5.1) months longer for individuals who initiated smoking cessation within 6 months of cancer diagnosis. The point estimate for risk of 3-year mortality was lower for initiation of smoking cessation within 6 months of diagnosis compared with no initiation within 6 months (RR = 0.72, 95% CL: 0.37, 1.4). CONCLUSIONS: Our point estimates suggest longer 3-year survival, but the results are compatible with 1.5 month shorter or 5.1 longer 3-year overall survival after smoking cessation within 6 months of cancer diagnosis. Future studies with larger sample sizes that test the comparative effectiveness of different smoking cessation strategies are needed for more detailed evidence to inform decision-making about the effect of smoking cessation on survival among cancer patients. IMPLICATIONS FOR CANCER SURVIVORS: The benefits of smoking cessation after cancer diagnosis may include longer survival, but the magnitude of benefit is unclear.

Cigarette Use Before and After the 2009 Flavored Cigarette Ban.

PURPOSE: On September 22, 2009, the U.S. Food and Drug Administration's national ban on flavored cigarette products went into effect, barring the sale of flavored cigarettes with the exception of menthol. Flavored cigarettes largely appeal to and were disproportionately used by youth (under age 18 years). However, little research has evaluated the effects of the ban. This study examined past 30-day cigarette use among youth (12-17 years), young adults (18-25 years), adults (26-49 years), and older adults (≥50 years) before and after the implementation of this ban. METHODS: Analyses were conducted using 2002-2017 National Survey on Drug Use and Health (NSDUH) data (n = 893,226). Regression models-weighted for national representation-were used to examine past 30-day cigarette use before and after the flavored cigarette ban in different age groups, using a quasi-experimental design incorporating elements of interrupted time series and difference-in-differences design. This design was used to examine differences in pre- versus post-ban smoking within age groups and heterogeneous policy effects between age groups, to help adjust for the generally stronger tobacco control environment over time. RESULTS: The flavor ban was associated with statistically significant immediate increases as well as reductions over time in youth and young adult use of any cigarettes and menthol cigarettes, compared to older adults. In 2017, the predicted probability of youth and young adult cigarette smoking were reduced by 43% and 27%, respectively, compared to the model predicted probability in absence of the ban. No such effect was observed for older adults. The predicted probability of menthol use was reduced by 60% and 55% for youth and young adults, respectively. CONCLUSIONS: Findings support the effectiveness of flavored cigarette bans at reducing cigarette use among young people and suggest a substitution effect between flavored tobacco products.

Examining the effect of weight conscious drinking on binge drinking frequency among college freshmen.

OBJECTIVE: To examine the effect of weight-conscious drinking and compensatory behavior temporality on binge drinking frequency of college freshmen. Participants: Freshmen (n = 1149) from eight US universities, Fall 2015. Methods: Participants completed the Compensatory Eating Behaviors in Response to Alcohol Consumption Scale and Alcohol Use Disorders Identification Test-Consumption. Structural equation modeling was used to model the effect of weight-conscious drinking constructs on binge drinking frequency. Results: Bulimia, Dietary Restraint and Exercise, Restriction, proactive Alcohol Effects, during Alcohol Effects, and proactive Dietary Restraint and Exercise factors significantly predicted binge drinking frequency. Conclusion: Weight-conscious drinking among this cohort of college students comprises temporal factors significantly associated with binge drinking frequency. Relationships between Bulimia, Dietary Restraint and Exercise, and Restriction compensatory behaviors and binge drinking should be considered in interventions to address binge drinking among college students.

Correlates of Nonmedical Prescription Opioid Use Among U.S. Adolescents.

INTRODUCTION: The purpose of this study is to assess risk factors, including other substance use, for nonmedical prescription opioid use among U.S. adolescents. METHODS: A secondary data analysis of the 2017 Youth Risk Behavior Survey was conducted (n=10,175) in 2018. The outcome was nonmedical prescription opioid use. Predictor variables included other substance use, mood, sleep, academic performance, and demographic characteristics. Survey-weighted procedures in SAS, version 9.4 were used, and an adjusted logistic regression model was conducted. RESULTS: Among the sampled adolescents, 13.8% (95% confidence limit=12.4%, 15.3%) reported nonmedical prescription opioid use. Nonmedical prescription opioid use was more likely among participants aged 15 years (versus 16 years), American Indian/Alaskan Natives, and those who reported being sad or hopeless. All other substance use was significantly associated with increased odds of nonmedical prescription opioid use. Nonmedical prescription opioid use was 1.5 times more likely among electronic vapor users (AOR=1.58, 95% CI=1.34, 1.86), 2 times more likely among cigarette (AOR=2.49, 95% CI=2.16, 2.88) and marijuana users (AOR=2.45, 95% CI=2.05, 2.93), and almost 3 times as likely among alcohol users (AOR=2.98, 95% CI=2.18, 4.07). CONCLUSIONS: Study findings suggest a need for more interventions for nonmedical prescription opioid use among adolescents in the U.S. Information on nonmedical prescription opioid use should be added to all substance use prevention programs for adolescents. Moreover, future research needs to identify longitudinal predictors of adolescent nonmedical prescription opioid use to inform prevention efforts.

Vaping Expectancies: A Qualitative Study among Young Adult Nonusers, Smokers, Vapers, and Dual Users.

BACKGROUND: "Expectancies," or beliefs about outcomes, robustly correlate with and predict several behaviors including electronic nicotine delivery system ("e-cigarette") use. However, there is limited qualitative research available regarding relevant e-cigarette vaping expectancies. OBJECTIVES: The present study used a qualitative approach to derive and refine e-cigarette expectancy themes among young adults. METHODS: We conducted 12 focus groups and two individual interviews with young adult nonusers, e-cigarette vapers, cigarette smokers, and dual users to assess beliefs about the effects of e-cigarettes. After a series of open-ended questions, follow-up questions assessed reactions to domains previously examined in expectancy measures for cigarette smoking and e-cigarette vaping. The constant comparative method was used to derive themes from transcripts. RESULTS: Four main themes (Positive Reinforcement, Social Benefits, Negative Affect Reduction, Negative Consequences) emerged from the results. Each theme contained three associated subthemes (Positive Reinforcement: Sensorimotor Experiences, Taste, Stimulation; Social Benefits: Social Facilitation, Influence on Others, Convenience; Negative Affect Reduction: Stress Reduction, Appetite Reduction, Boredom Reduction; and Negative Consequences: Health Risks, Addiction, Secondhand Effects). CONCLUSIONS/IMPORTANCE: Previously identified smoking expectancies appear relevant for young adult vaping, with some notable refinements. Positive reinforcement aspects encompassed aerosol clouds, vaping tricks, and unique flavors. Social benefits included influencing others via social media and competitive activity, as well as the convenience of use in a variety of places. Negative affect reduction was controversial among user groups, but vaping was seen as more interesting than smoking and thus more effective at boredom reduction. Young adults were uncertain regarding negative consequences, but appreciated a potential for secondhand effects. Measure refinement via qualitative research and future field testing can enhance our understanding of this relatively new behavior, supporting tobacco control surveillance, marketing/labeling regulations, and counter-advertising development/evaluation.

Racial and ethnic disparities in a state-wide registry of patients with pancreatic cancer and an exploratory investigation of cancer cachexia as a contributor to observed inequities.

Pancreatic cancer (PC) is characterized by racial/ethnic disparities and the debilitating muscle-wasting condition, cancer cachexia. Florida ranks second in the number of PC deaths and has a large and understudied minority population. We examined the primary hypothesis that PC incidence and mortality rates may be highest among Black Floridians and the secondary hypothesis that biological correlates of cancer cachexia may underlie disparities. PC incidence and mortality rates were estimated by race/ethnicity, gender, and county using publicly available state-wide cancer registry data that included approximately 2700 Black, 25 200 Non-Hispanic White (NHW), and 3300 Hispanic/Latino (H/L) Floridians diagnosed between 2004 and 2014. Blacks within Florida experienced a significantly (P < 0.05) higher incidence (12.5/100 000) and mortality (10.97/100 000) compared to NHW (incidence = 11.2/100 000; mortality = 10.3/100 000) and H/L (incidence = 9.6/100 000; mortality = 8.7/100 000), especially in rural counties. To investigate radiologic and blood-based correlates of cachexia, we leveraged data from a subset of patients evaluated at two geographically distinct Florida Cancer Centers. In Blacks compared to NHW matched on stage, markers of PC-induced cachexia were more frequent and included greater decreases in core musculature compared to corresponding healthy control patients (25.0% vs 10.1% lower), greater decreases in psoas musculature over time (10.5% vs 4.8% loss), lower baseline serum albumin levels (3.8 vs 4.0 gm/dL), and higher platelet counts (332.8 vs 268.7 k/UL). Together, these findings suggest for the first time that PC and cachexia may affect Blacks disproportionately. Given its nearly universal contribution to illness and PC-related deaths, the early diagnosis and treatment of cachexia may represent an avenue to improve health equity, quality of life, and survival.

Food Choice Priorities Change Over Time and Predict Dietary Intake at the End of the First Year of College Among Students in the U.S.

This study assessed food choice priorities (FCP) and associations with consumption of fruits and vegetables (FV), fiber, added sugars from non-beverage sources, and sugar-sweetened beverages (SSB) among college students. Freshmen from eight U.S. universities (N = 1149) completed the Food Choice Priorities Survey, designed for college students to provide a way to determine the factors of greatest importance regarding food choices, and the NCI Dietary Screener Questionnaire. Changes in FCP and dietary intake from fall 2015 to spring 2016 were assessed. Multiple regression models examined associations between FCP and log-transformed dietary intake, controlling for sex, age, race, and BMI. Participant characteristics and FCP associations were also assessed. FCP importance changed across the freshmen year and significantly predicted dietary intake. The most important FCP were price, busy daily life and preferences, and healthy aesthetic. Students who endorsed healthy aesthetic factors (health, effect on physical appearance, freshness/quality/in season) as important for food choice, consumed more FV and fiber and less added sugar and SSB. Busy daily life and preferences (taste, convenience, routine, ability to feel full) predicted lower FV, higher added sugar, and higher SSB consumption. Price predicted lower FV, higher SSB, and more added sugar while the advertising environment was positively associated with SSB intake. FCP and demographic factors explained between 2%⁻17% of the variance in dietary intake across models. The strongest relationship was between healthy aesthetic factors and SSB (B = -0.37, p < 0.01). Self-rated importance of factors influencing food choice are related to dietary intake among students. Interventions that shift identified FCP may positively impact students' diet quality especially considering that some FCP increase in importance across the first year of college.

Development and Preliminary Testing of the Food Choice Priorities Survey (FCPS): Assessing the Importance of Multiple Factors on College Students' Food Choices.

Understanding factors that influence food choice may help improve diet quality. Factors that commonly affect adults' food choices have been described, but measures that identify and assess food choice factors specific to college students are lacking. This study developed and tested the Food Choice Priorities Survey (FCPS) among college students. Thirty-seven undergraduates participated in two focus groups ( n = 19; 11 in the male-only group, 8 in the female-only group) and interviews ( n = 18) regarding typical influences on food choice. Qualitative data informed the development of survey items with a 5-point Likert-type scale (1 = not important, 5 = extremely important). An expert panel rated FCPS items for clarity, relevance, representativeness, and coverage using a content validity form. To establish test-retest reliability, 109 first-year college students completed the 14-item FCPS at two time points, 0-48 days apart ( M = 13.99, SD = 7.44). Using Cohen's weighted κ for responses within 20 days, 11 items demonstrated moderate agreement and 3 items had substantial agreement. Factor analysis revealed a three-factor structure (9 items). The FCPS is designed for college students and provides a way to determine the factors of greatest importance regarding food choices among this population. From a public health perspective, practical applications include using the FCPS to tailor health communications and behavior change interventions to factors most salient for food choices of college students.