SARS-CoV-2 outbreak among staff and evacuees at Operation Allies Welcome Safe Havens.

We report on five SARS-CoV-2 congregate setting outbreaks at U.S. Operation Allies Welcome Safe Havens/military facilities. Outbreak data were collected, and attack rates were calculated for various populations. Even in vaccinated populations, there was rapid spread, illustrating the importance of institutional prevention and mitigation policies in congregate settings.

Osteopathic Manipulative Treatment for Allostatic Load Lowering.

CONTEXT: Limited research has been done to examine osteopathic manipulative treatment (OMT) effects on modulating a compilation of allostatic load (AL) biomarkers that work to measure the body's multisystem response to homeostatic deviation. OBJECTIVE: To examine the efficacy of OMT on graduate students' overall health through an objective index of representative AL biomarkers. METHODS: A within-subject pre- and postintervention study was conducted at Touro University College of Osteopathic Medicine in California during the fall 2017 semester. Graduate students enrolled in the Masters of Science in Medical Health Sciences program volunteered to participate in the study and received treatment by an osteopathic physician. The participants were evaluated using the following measures: Trier Inventory for the Assessment of Chronic Stress; diurnal urine cortisol and catecholamines; dried blood glycated hemoglobin, dehydroepiandrosterone, high-density lipoprotein, and high-sensitivity C-reactive protein; blood pressure, body mass index, and waist-to-hip ratio before (preintervention) and after (postintervention) OMT. RESULTS: The study consisted of 1 man (participant 1) and 1 woman (participant 2) aged 23 and 22 years, respectively. Participants were enrolled in the same academic program and received 3 OMT sessions in 7 weeks. Analysis of AL biomarkers revealed a decrease in overall AL scores from preintervention to postintervention in participant 1 (from 7 to 4) and participant 2 (from 9 to 7). Analysis of Trier Inventory for the Assessment of Chronic Stress scores revealed a decrease in self-perceived stress from preintervention to postintervention in participant 1 (from 18 to 15) and in participant 2 (from 40 to 13). CONCLUSION: The OMT protocol used in the current study decreased measures of overall AL and self-perceived stress in both participants. This finding suggests that OMT may represent a reasonable modality to reduce AL and self-perceived stress in graduate students. Since the current study is limited by its small sample size, further research is warranted.

The 'state' of tobacco: Perceptions of tobacco among Appalachian youth in Kentucky.

INTRODUCTION: In Appalachia, youth tobacco-use rates remain higher than the U.S. national average. Past research has indicated that several factors are related to high rates of tobacco use among Appalachian youth (e.g. low socioeconomic status, rural lifestyles). Of the Appalachian states, Kentucky has one of the highest rates of youth tobacco use. The aim of this study was to explore views of tobacco among Kentucky youth living in Appalachian counties. METHODS: In Fall 2014 - Spring 2015, focus group interviews were conducted with middle and high school students (N=109) in Appalachian counties in Kentucky. Each focus group session included open-ended questions and was conducted by trained facilitators. Focus group transcriptions and field notes were analyzed for themes. RESULTS: Study participants described an entrenched culture of tobacco. Three themes exemplified this culture. First, adult behavior served to enable youth tobacco use (e.g. teachers ignoring dip use in class, adults smoking with youth). Second, tobacco is easily accessible to youth (e.g. restrictions on youth sales are often ignored, family members provide). Third, symbols of tobacco are prevalent (e.g. festivals celebrating tobacco heritage, tobacco barns, and tobacco marketing logos). CONCLUSIONS: Youth participants described a deeply rooted tobacco culture, which they believed was unlikely to change. Additional studies and health education efforts are needed in these rural communities. Further, stricter enforcement of tobacco sales and marketing restrictions may be helpful in protecting this vulnerable population.

A picture is worth a thousand words: Electronic cigarette content on Instagram and Pinterest.

INTRODUCTION: This study examined electronic cigarette (e-cig) content in visual materials posted on the social-media platforms Instagram and Pinterest. Both platforms allow users to upload pictures to the internet and share them globally. Users can search for pictures tagged with specific keywords and phrases. METHODS: Using content analysis, this study identified themes in image postings of e-cigs on social media. During five weeks of data collection, keywords were used to identify pictures related to e-cigs. These pictures were then coded into one or more categories. RESULTS: The three most popular categories for Instagram posts were marketing, customization and juices/flavors. The three most popular categories for Pinterest posts were customization, marketing and memes. CONCLUSIONS: Because of the persuasive power of visuals, it is important to examine communication on Instagram and Pinterest as well as the specific visual messages communicated. Stores and manufacturers use these and similar platforms to communicate with users and potential users; thus it seems that marketers are capitalizing on opportunities for persuasive appeal. The results highlight the popularity of e-cig content on these two social media platforms and reveal an emphasis on marketing and customization.

Clean, cheap, convenient: promotion of Electronic cigarettes on YouTube.

INTRODUCTION: Videos promoting electronic cigarettes (e-cigarettes) can be easily accessed on YouTube. Marketing claims present in YouTube videos may help shape the public's opinion of e-cigarettes. Thus, it is important to understand the most frequent marketing claims and video sources. METHODS: The objectives of this study were to 1) identify marketing claims in YouTube videos that are commonly made on e-cigarette retail websites and 2) compare the frequency of marketing claims in user-generated and professional YouTube videos. Through content analysis, this study evaluated six marketing claims and descriptive information about YouTube videos (n = 50) related to "electronic cigarettes" and "vape". RESULTS: Overall, the most frequent marketing claim promoted e-cigarette use as better than traditional tobacco use (52%). Approximately 65% of videos appeared to be user-generated and 35% were professionally-produced. Compared to user-generated videos, significantly more professional videos made claims that e-cigarettes are cleaner (p < 0.001) and cheaper (p = 0.04) than traditional cigarettes. Additionally, more professional videos had claims promoting e-cigarettes as better than traditional cigarettes because of their convenience-the user can smoke anywhere (p < 0.0001) and the products do not produce secondhand smoke (p < 0.001). The most frequent claim in user-generated videos was related to recreation (53%). CONCLUSIONS: Videos on YouTube promote e-cigarettes as safer than other tobacco products. Videos appearing to be user-generated contained different marketing claims compared to professional videos. Further research is necessary to assess how the perceived source of the video impacts the ways these marketing claims shape public perception and influence use.

Vape Shop Employees: Public Health Advocates?

INTRODUCTION: E-cigarettes have increased in popularity and given rise to a new type of sales outlet-the vape shop. Expanding on work examining vape shop employee e-cigarette and tobacco attitudes and behaviors1, this study examined key messages that vape shop employees communicate to customers. METHODS: Using informal interviews, observations, and a cross-sectional survey, we examined vape shop employees' (n=16) perceptions and e-cigarette use. Data were collected in nine vape shops in Louisville, Kentucky. We used open coding to analyze the qualitative interviews, observation notes, and open-ended survey responses. Descriptive statistics were used to analyze survey data. RESULTS: The findings revealed that nearly all employees were former smokers (93.8%), who now only use e-cigarettes. Over one-third of the employees (37.5%) began using e-cigarettes as a replacement for traditional cigarettes, and 93.8% reported better health (e.g., easier breathing, less coughing) since starting to use e-cigarettes. Although most employees believed e-cigarettes should be regulated, 56.3% thought regulations should be different from those governing traditional cigarettes. Analysis of qualitative data revealed that employees see themselves as health advocates who: 1) provide instructions on vaping and promote a vape community, 2) encourage cessation of traditional cigarettes, and 3) support some regulations. CONCLUSIONS: The findings reveal that vape shop employees regard e-cigarettes as viable smoking cessation tools and relish their role in assisting others in taking what employees view as positive health actions. Future research addressing communication between vape shop employees and customers, especially related to smoking cessation and health, is needed.