Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 58
Filtrar
Mais filtros










Base de dados
Intervalo de ano de publicação
1.
Addiction ; 2020 Apr 14.
Artigo em Inglês | MEDLINE | ID: mdl-32285978

RESUMO

AIMS: To examine the effect on adolescents of exposure to different e-cigarette advertisement themes on reported likelihood of purchasing e-cigarettes in a hypothetical scenario. DESIGN: Between-subjects design of four randomly assigned thematic conditions derived from a content analysis of 350 e-cigarette advertisements: general, flavor- and taste-themed, people- and product use-themed or control advertisements for bottled water. SETTING: Virginia, USA. PARTICIPANTS: Of 1360 adolescents (13-18 years old) participating, 1063 had complete data (519 current cigarette smokers, 544 tobacco-susceptible non-smokers). MEASUREMENTS: Participants completed an e-cigarette purchase task, reporting the likelihood of buying an e-cigarette at various prices. Indices of abuse liability included price responsiveness (whether likelihood of purchase decreased with increasing prices) and, among price-responsive adolescents, breakpoint (highest price before definitely would not buy), maximum probability-weighted expenditure (Omax ) and price elasticity (how quickly willingness to purchase decreases as prices increase). Regressions controlled for demographics, prior tobacco ad exposure, tobacco/substance use and sensation-seeking. FINDINGS: Prior advertisement exposure was positively associated with being price-responsive [odds ratio (OR) = 1.12, 95% confidence interval (CI) = 1.03, 1.22; P < 0.05]. Among price-responsive adolescents (n = 579), breakpoints were 58% higher in the flavor- and taste-themed condition (ß = 0.46, 95% CI = <0.01, 0.92) and 75% higher in the people- and product use-themed condition (ß = 0.56, 95% CI = 0.10, 1.03) compared with control (Ps < 0.05). Exposure to people- and product use-themed advertisements was associated with a 60% higher Omax (ß = 0.47, 95% CI = 0.01, 0.93; P < 0.05). The general and people- and product use-themed conditions were associated with 19% (ß = -0.21, 95% CI = -0.38, -0.04) and 21% (ß = -0.24, 95% CI = -0.42, -0.06) lower elasticity, respectively (Ps < 0.05). CONCLUSIONS: E-cigarette advertising exposure may increase reported likelihood of purchasing e-cigarettes, with effects differing by advertisement content. People- and product use-themed e-cigarette advertisements increased reported likelihood of purchasing in price-responsive adolescents.

2.
Pediatrics ; 145(4)2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32152134

RESUMO

BACKGROUND AND OBJECTIVES: Runaway youth and homeless youth are at risk for adverse mental health outcomes. These 2 populations are frequently pooled together in both research and interventions yet may have unique health needs. We sought to assess differences in mental health outcomes among these populations. METHODS: We conducted a secondary data analysis of ninth- and 11th-graders in the 2016 minnesota Student Survey (n = 68 785). We categorized youth into 4 subgroups based on housing status in the previous year: (1) unaccompanied homeless youth (0.5%), (2) runaway youth (4%), (3) youth who had both run away and been homeless (0.6%), and (4) stably housed youth (95%). We performed multivariable logistic regression to compare 4 mental health outcomes (self-injury, suicidal ideation, suicide attempts, and depressive symptoms) across groups, controlling for demographics and abuse history. RESULTS: Unstably housed youth had poorer mental health outcomes when compared with their stably housed peers (P < .05). For example, 11% of homeless youth, 20% of runaways, and 33% of youth who had experienced both had attempted suicide in the previous year compared with 2% of stably housed youth (adjusted odds ratios 2.4, 4.9, and 7.1, respectively). Other outcomes showed a similar pattern. CONCLUSIONS: Our findings suggest that runaway and homeless youth represent unique populations with high levels of mental health needs who would benefit from targeted clinical and community interventions. Pediatric clinicians represent one potential point of screening and intervention.

3.
Health Aff (Millwood) ; 39(2): 238-246, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32011949

RESUMO

Medicaid programs responded to the opioid crisis by expanding treatment coverage and reforming delivery systems. We assessed whether Virginia's Addiction and Recovery Treatment Services (ARTS) program, implemented in April 2017, influenced emergency department and inpatient use. Using claims for January 2016-June 2018 and difference-in-differences models, we compared beneficiaries with opioid use disorder before and after ARTS implementation to beneficiaries with no substance use disorder. After program implementation, the likelihood of having an emergency department visit in a quarter declined by 9.4 percentage points (a 21.1 percent relative decrease) among beneficiaries with opioid use disorder, compared to 0.9 percentage points among beneficiaries with no substance use disorder. Similarly, the likelihood of having an inpatient hospitalization declined among beneficiaries with opioid use disorder. In contrast to other states, Virginia has a new Medicaid expansion population whose beneficiaries enter a delivery system in which reforms of the addiction treatment system are well under way.

4.
J Am Coll Health ; : 1-8, 2020 Jan 29.
Artigo em Inglês | MEDLINE | ID: mdl-31995455

RESUMO

Objective: Cannabis policies are rapidly evolving in the US. This study's purpose was to examine relationships between cannabis harm perceptions, substance use, and demographic characteristics on attitudes toward cannabis policies.Participants: Participants were 619 undergraduate students in a Mid-Atlantic state where cannabis use was illegal.Methods: In 2016, participants completed a cross-sectional survey. Multinomial logistic regressions tested associations between attitudes toward cannabis policies (recreational cannabis use, use in private, or public) while controlling for harm perceptions, substance use, and demographics.Results: The majority (64%) of participants supported recreational cannabis legalization, while 78% supported private and 29% supported public use. Perceiving cannabis as less harmful and current cannabis use were positively associated with supporting all three cannabis policies.Conclusions: Results highlight diversity of young adults' opinions regarding specific cannabis policies and underscore relationships between cannabis use behaviors, harm perceptions, and support for legalization that may inform policy making and prevention efforts.

5.
Pediatr Res ; 87(2): 362-370, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31622974

RESUMO

Despite evidence that over 40% of youth in the United States have one or more adverse childhood experiences (ACEs), and that ACEs have cumulative, pernicious effects on lifelong health, few primary care clinicians routinely ask about ACEs. Lack of standardized and accurate clinical assessments for ACEs, combined with no point-of-care biomarkers of the "toxic stress" caused by ACEs, hampers prevention of the health consequences of ACEs. Thus, there is no consensus regarding how to identify, screen, and track ACEs, and whether early identification of toxic stress can prevent disease. In this review, we aim to clarify why, for whom, when, and how to identify ACEs in pediatric clinical care. To do so, we examine the evidence for such identification; describe the efficacy and accuracy of potential screening instruments; discuss current trends in, and potential barriers to, the identification of ACEs and the prevention of downstream effects; and recommend next steps for research, practice, and policy.

6.
Drug Alcohol Depend ; 206: 107730, 2020 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-31759233

RESUMO

BACKGROUND: E-cigarettes are the most popular tobacco product among youth. As more states adopt cannabis legalization policies, youth cannabis use in e-cigarettes is a mounting concern. METHODS: Data were from the 2016 and 2017 National Youth Tobacco Survey, a nationally-representative repeated cross-sectional survey administered to US middle and high school students. Ever use groups were categorized into e-cigarette ever users, cannabis in e-cigarette ever users, other tobacco ever users, and never users. Weighted multinomial logistic regression compared ever use groups, while controlling for state-level cannabis legalization and tobacco prevention polices, tobacco perceptions and exposures, and sociodemographic variables. Weighted prevalence of ever and current, or past 30 day, tobacco product use was determined by ever use groups. RESULTS: Compared to e-cigarette ever users, cannabis in e-cigarette ever users increased (Adjusted Relative Risk Ratio (ARRR) = 1.65; p < 0.01) from 2016 to 2017. Medical-only and medical and recreational cannabis laws, and no e-cigarette minimum legal sales age (MLSA) and increased e-cigarette MLSA at 19 or 21 were positively associated with cannabis in e-cigarette ever users (ARRR = 1.34-1.85; p < 0.01, each). Ever and current use of all individual tobacco products was highest among cannabis in e-cigarette ever users compared to e-cigarette and other tobacco ever users. CONCLUSIONS: Cannabis use in e-cigarettes has increased among youth, and these trends will likely continue as e-cigarettes continue to gain popularity and cannabis legalization policies proliferate. Targeted tobacco and cannabis prevention strategies are needed for youth, especially in states that have implemented cannabis 'medical and recreational laws.

7.
J Dev Behav Pediatr ; 40(9): 762-764, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31693647

RESUMO

CASE: Leo is a 26-month-old boy who you are seeing for an urgent care visit due to "sleep difficulty," particularly sleep onset. Since age 1, he screams, hits, and kicks his mother every day, starting after she gets home from work at 5 PM (or before the family's dinnertime on her days off) and escalating over the course of the evening until he "wears himself out" and falls asleep in a crib in his own room around 9 to 10 PM Once asleep, he sleeps well through the night and wakes easily around 7 AM in a pleasant mood; his mother leaves for work soon after he awakens. He naps after lunch for 2 to 3 hours on weekdays at an in-home child care with 1 to 2 adult caregivers and 5 other children aged 0 to 5 years. He refuses to nap at home.Leo goes to bed easily when his father puts him to bed if his mother is not at home, but his mother feels that evenings are the only time she can spend with Leo, and so, she tries to put him to bed most nights. However, because of Leo's behaviors at bedtime with her, she feels inadequate, depressed, and guilty; when she tries to disengage or allow her husband to help, Leo screams, "Mommy, mommy!" and tries to gain access to her and resists his father putting him to bed until his mother returns. Both parents worry that "he would not grow out of this," and his mother now avoids coming home from work for fear of Leo's behavior. Both parents feel that this situation is causing marital strain.Leo was born healthy at full-term and is an only child; pregnancy was complicated by hyperemesis gravidarum. Leo has been healthy and meeting developmental milestones. His parents describe his temperament as "like his father at that age," "easy, but never able to self-soothe," "intense" in his emotional reactions, persistent, "strong-willed and serious," and "shy and observant, withdrawn at first and then getting more pleasant after a while" in novel situations. Behaviorally, he engaged in noninjurious head-banging at home when upset between 12 and 15 months; bit children a few times at child care between 20 and 24 months; and lately refuses to share or will push other children at child care every few weeks. His parents recently read a book about parenting "spirited" children but did not find it helpful. What would you do next?

8.
Prev Med Rep ; 16: 100986, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31660286

RESUMO

This paper examines the prevalence of homelessness among transgender/gender diverse (TGD) youth in a population-based sample of adolescents. We used data from a statewide sample of 9th and 11th grade adolescents in Minnesota who responded to a school-based survey during 2016 (N = 80,929). Survey questions assessed adolescents' gender identity and experiences of homelessness (either with adult family members or unaccompanied) in the past 12 months. We used chi-square analyses to compare the prevalence of homelessness between gender identity groups. Overall, 2.7% of the sample reported identifying as TGD. Significantly more TGD (vs. cisgender) youth reported experiencing homelessness either with adult family members (6.7% vs. 3.5%) or unaccompanied (3.6% vs. 1.1%; p < .0001). Findings from this population-based survey suggest that TGD youth are more likely to experience homelessness, either with a family member or unaccompanied, than cisgender peers. Ensuring housing stability among this population is critical, given health risks associated with homelessness during adolescence. Data on homelessness experiences of TGD youth are needed to inform practice and policies for this distinct population.

9.
J Pediatr Psychol ; 44(10): 1224-1233, 2019 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-31386155

RESUMO

OBJECTIVE: Medical factors that put adolescents and young adults (AYA) with epilepsy at risk for poor health-related quality of life (HRQOL) are well-established. Less known is whether medical risk is associated with decreases in global psychological well-being and how self-management self-efficacy might contribute to resilience. The current study seeks to (a) examine the relationship between medical risk and both HRQOL and psychological well-being in AYA with epilepsy and (b) investigate the potential moderating role of self-management self-efficacy. METHODS: A sample of 180 AYA with epilepsy, aged 13-24 years, was recruited from clinic and community settings and completed questionnaires. A medical risk gradient composed of seizure frequency, antiepileptic drugs, and other health problems was created. HRQOL, psychological well-being, and self-management self-efficacy were assessed. RESULTS: Medical risk was negatively associated with HRQOL, such that youth with greater risk scores reported lower HRQOL (r = -0.35, p < .01). However, there was no significant relationship between medical risk and psychological well-being (r = -0.08, p = .31). Self-efficacy was positively correlated with HRQOL and well-being (r = 0.50, p < .01; r = 0.48, p < .01). A moderation effect was detected, such that the positive effect of self-efficacy on HRQOL differed across medical risk levels. IMPLICATIONS: Cultivating psychological strengths, as opposed to solely addressing medical problems, may be a promising intervention target when treating AYA with epilepsy, including those navigating healthcare transitions. Self-efficacy predicted HRQOL at most levels of risk, suggesting an important modifiable intrinsic factor that may promote resilience.

10.
Artigo em Inglês | MEDLINE | ID: mdl-31126016

RESUMO

This study assessed how electronic cigarette (ECIG) characteristics amenable to regulation-namely nicotine content, flavor, and modified risk messages-impact ECIG use susceptibility, harm/addiction perceptions, and abuse liability indices among combustible tobacco cigarette (CTC) smokers and non-smokers. CTC smokers and non-smokers varying in ECIG use recruited via Amazon Mechanical Turk (MTurk) completed an online survey in 2016 (analytic n = 706). Participants were randomly assigned to one of eight conditions differing in ECIG characteristics: nicotine content (no, low, high), flavor (menthol, tobacco, fruit), or modified risk message (reduced harm, reduced carcinogen exposure). Regressions assessed ECIG susceptibility, harm/addiction perceptions, and abuse liability indices (purchase task measures of breakpoint/intensity) within each regulatory domain (nicotine content, flavor, message) and their interactions with CTC/ECIG status. Differential effects on ECIG susceptibility, harm/addiction perceptions, and abuse liability indices were observed by regulatory domain with many effects moderated by CTC/ECIG status. ECIG nicotine content and flavor conditions were the most influential across outcomes. Greater nicotine content, tobacco-flavored and reduced carcinogen exposure ECIGs were more highly preferred by CTC smokers with some differing preferences for non-users. Findings reinforce consideration of discrete ECIG preferences across tobacco use status to improve regulatory efficacy.


Assuntos
Comportamento Aditivo/psicologia , Sistemas Eletrônicos de Liberação de Nicotina/estatística & dados numéricos , Sistemas Eletrônicos de Liberação de Nicotina/normas , não Fumantes/psicologia , não Fumantes/estatística & dados numéricos , Fumantes/psicologia , Fumantes/estatística & dados numéricos , Vaping/psicologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Comportamento do Consumidor , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Inquéritos e Questionários , Estados Unidos , Adulto Jovem
11.
Subst Use Misuse ; 54(8): 1355-1364, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30860933

RESUMO

BACKGROUND: E-cigarette (EC) use is increasing rapidly across the United States, especially among youth. EC advertisements are one likely contributor to this increase, as they currently have few marketing restrictions. Radio advertising reaches most of the U.S. population and may be particularly influential in this regard. OBJECTIVES: The purpose of the current study was to examine content themes and spending data from EC radio advertisements. METHODS: Competitrack, a marketing tracking firm, gathered 19 advertisements from four different EC brands across the United States from 2015 to 2016, which were coded by two individuals and analyzed for main content themes. Additionally, spending data were analyzed by identified EC brand. RESULTS: Logic was the most common EC brand advertised on the radio and included themes potentially appealing to youth, such as humor and sound effects. Of the 28 analyzed content themes, references to "taste" were the most popular, followed by highlighting benefits of using ECs, presence of music, and comparison to other EC brands. Only Logic advertisements (n = 7) included health disclaimers and age restriction messages, yet frequently included themes that were attractive to youth. Conclusions/Importance: As these radio advertisements are exposing youth and other vulnerable populations to ECs, regulations, similar to those made for conventional cigarette advertising, are necessary for prevention efforts.

12.
Prev Med ; 121: 109-114, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30776386

RESUMO

E-cigarettes are the most commonly used tobacco product among youth. In addition to harm potential, e-cigarette use is associated with initiating cigarette smoking. Limited research exists whether susceptibility to e-cigarette use is a risk factor for future tobacco and other substance use initiation. This study examined associations between baseline e-cigarette susceptibility and initiation and past 30-day use of e-cigarettes and cigarettes as well as initiation of marijuana and alcohol one year later, after adjusting for other risk factors and sociodemographic confounders. The study sample consisted of 5156 nationally representative youth (12-17 years) who completed both waves 1 (2013-2014) and 2 (2014-2015) of the Population Assessment of Tobacco and Health (PATH) study and were never users of tobacco, marijuana, and alcohol in Wave 1. Youth who were susceptible to e-cigarettes had increased odds of initiating e-cigarettes (adjusted OR: 2.22, 95% CI: 1.55-3.18), marijuana (aOR: 1.66, 95% CI: 1.12-2.46), and alcohol (aOR: 1.61, 95% CI: 1.26-2.06) between waves, as well as past reporting 30-day e-cigarette use (aOR: 3.64, 95% CI: 1.93-6.89) in Wave 2. Additionally, cigarette susceptibility, but not e-cigarette susceptibility, was associated with cigarette initiation (aOR: 3.36, 95% CI: 1.95-5.82) and past 30-day use (aOR: 2.83, 95% CI: 1.34-5.97). Prevention policies, as well as future research, could target youth susceptible to e-cigarettes to reduce the current trends on the use of these alternative tobacco products. Such efforts may also reduce the use of cigarettes and other substances.

13.
Addict Behav ; 93: 93-99, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-30703668

RESUMO

BACKGROUND: While e-cigarette use is increasing, reasons to use e-cigarettes are poorly summarized in the literature. The objective of this study was to organize reasons to use e-cigarette items into factors and determine associations between these factors and e-cigarette user characteristics. METHODS: Data were drawn from youth (12-17) and adults (18+) in Wave 1 (2013-2014) of the Population Assessment of Tobacco and Health (PATH) study. Exploratory factor analysis was conducted on 13 reasons to use survey items from experimental and established adult e-cigarette users and past 30 day youth e-cigarette users to determine two factors - "alternative to cigarettes" and "larger social environment". Weighted linear regression models tested the associations between e-cigarette user group and sociodemographics and reasons to use factors among youth and adults. RESULTS: Adult current established e-cigarette users were associated with both alternative to cigarettes (ß = 0.128, p < .001) and larger social environment (ß = 0.063, p < .001) factors, while former established e-cigarette users were associated with alternative to cigarettes (ß = 0.064, p < .001). Several adult sociodemographic characteristics were associated with one but not the other factor, or both but in opposite directions. Youth that used e-cigarettes earlier today were also associated with both reasons to use factors (ß = 0.127-0.130, p < .01, each); however, youth using any other day in the past 30 days was not associated with either factor. CONCLUSIONS: Reasons to use are associated with patterns of e-cigarette use among youth and adults. These factors could support a comprehensive approach to addressing rising e-cigarette use among youth and adults and target certain user populations.

14.
LGBT Health ; 6(2): 77-86, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30720385

RESUMO

PURPOSE: Sexual minority women (SMW) are vulnerable to cervical cancer, yet there is a dearth of research on potential mediators of cervical cancer disparities. Medical heterosexism, which involves sexual orientation-based discrimination in medical contexts, and provider-patient communication quality and trust in providers may be important factors influencing the cancer prevention decisions of SMW. The purpose of this study was to examine how provider-patient communication quality, trust in providers, and perceived medical heterosexism are associated with cervical cancer screening among SMW. METHODS: A dual-mode, one-time cross-sectional survey was administered to a community sample of SMW (N = 150), ages 21-53, in Richmond, Virginia, from December 2017 to February 2018. RESULTS: It was hypothesized that provider-patient communication quality and trust in providers would mediate the relationship between perceived medical heterosexism and cervical cancer screening outcomes. The hypothesis was supported; trust in providers (b = 0.05, p = 0.001, 95% confidence interval [CI] 0.02-0.08) and provider-patient communication quality (b = 0.06, p = 0.003, 95% CI 0.02-0.10) were positively associated with future screening intention, and their total indirect effect mediated the relationship between perceived medical heterosexism and intention (b = -0.03, 95% CI -0.05 to -0.02, ß = -0.25, 95% CI -0.39 to -0.15). Similarly, the total indirect effect of provider-patient communication quality mediated the relationship between perceived medical heterosexism and odds of routine screening (b = -0.03, 95% CI -0.06 to -0.01). CONCLUSION: These findings point to the need for cancer prevention and control strategies for SMW to target provider education and policy interventions that improve SMW's relationships with their providers and improve cervical cancer screening rates.

15.
J Pediatr ; 204: 71-76.e1, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30287067

RESUMO

OBJECTIVE: To investigate the relationship between adverse childhood experiences (ACEs) and weight status among adolescents. STUDY DESIGN: Data were drawn from the Minnesota Student Survey, a large (n = 105 759), statewide, anonymous survey of public school students in eighth, ninth, and eleventh grades. Self-reported height and weight were used to calculate body mass index. Multinomial logistic regression was used to examine associations between self-reported ACEs and weight status, controlling for key sociodemographic characteristics. RESULTS: ACEs were positively associated with weight status; adolescents with more ACEs were more likely to have overweight, obesity, and severe obesity than adolescents with no ACEs. Adolescents who reported an ACE were 1.2, 1.4, and 1.5 times as likely to have overweight, obesity, and severe obesity, respectively, compared with their peers with no ACEs. There was no relationship between ACEs and underweight. CONCLUSIONS: The results of this large sample of adolescents with anonymous data support the hypothesis that ACEs and obesity are strongly associated. The directionality of this relationship needs to be understood. Moreover, these findings suggest that child health professionals may need to screen for ACEs as an important aspect of clinical weight management.


Assuntos
Experiências Adversas da Infância/estatística & dados numéricos , Peso Corporal , Obesidade Pediátrica/etiologia , Adolescente , Índice de Massa Corporal , Criança , Estudos Transversais , Feminino , Humanos , Masculino , Minnesota , Obesidade Pediátrica/epidemiologia , Fatores de Risco , Estudantes
16.
Health Educ Behav ; 46(2): 197-203, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30360645

RESUMO

Understanding how two characteristics-flavors and modified risk messages-affect perceptions and subjective effects of electronic cigarettes (e-cigarettes) can inform tobacco control efforts. In two within-subjects studies ( N = 17 and N = 19), the effects of e-cigarette flavors (tobacco vs. menthol and unflavored vs. cherry) and hypothetical modified risk messages ("reduced harm relative to cigarettes" vs. no message and "reduced carcinogen exposure relative to cigarettes" vs. no message) on cigarette smokers' perceptions of e-cigarettes were measured after participants self-administered condition-specific products (own-brand cigarettes; e-cigarettes). Perceptions/subjective effects were tested using linear mixed-effects regressions. Cigarettes were perceived as most harmful but rated more positively than e-cigarettes ( ps < .05). Cherry and menthol e-cigarettes increased perceived pleasantness, taste, and physical sensations compared with unflavored and tobacco-flavored e-cigarettes, respectively ( ps < .05). Modified risk messages were associated with reduced ratings of aversive effects ( ps < .05) but not harm perceptions. Overall, few perceptions/subjective effects differed by e-cigarette flavor or message. Flavors and messages may have some influence on how smokers experience e-cigarettes.

17.
BMJ Open ; 8(10): e023850, 2018 10 10.
Artigo em Inglês | MEDLINE | ID: mdl-30309993

RESUMO

INTRODUCTION: In the USA, Food and Drug Administration regulations prohibit the sale of flavoured cigarettes, with menthol being the exception. However, the manufacture, advertisement and sale of flavoured cigar products are permitted. Such flavourings influence positive perceptions of tobacco products and are linked to increased use. Flavourings may mask the taste of tobacco and enhance smoke inhalation, influencing toxicant exposure and abuse liability among novice tobacco users. Using clinical laboratory methods, this study investigates how flavour availability affects measures of abuse liability in young adult cigarette smokers. The specific aims are to evaluate the effect of cigar flavours on nicotine exposure, and behavioural and subjective measures of abuse liability. METHODS AND ANALYSES: Participants (projected n=25) are healthy smokers of five or more cigarettes per day over the past 3 months, 18-25 years old, naive to cigar use (lifetime use of 50 or fewer cigar products and no more than 10 cigars smoked in the past 30 days) and without a desire to quit cigarette smoking in the next 30 days. Participants complete five laboratory sessions in a Latin square design with either their own brand cigarette or a session-specific Black & Mild cigar differing in flavour (apple, cream, original and wine). Participants are single-blinded to cigar flavours. Each session consists of two 10-puff smoking bouts (30 s interpuff interval) separated by 1 hour. Primary outcomes include saliva nicotine concentration, behavioural economic task performance and response to various questionnaire items assessing subjective effects predictive of abuse liability. Differences in outcomes across own brand cigarette and flavoured cigar conditions will be tested using linear mixed models. ETHICS AND DISSEMINATION: The Virginia Commonwealth University Institutional Review Board approved the study (VCU IRB: HM20007848). Dissemination channels for study findings include scientific journals, scientific meetings, and policy briefs. TRIAL REGISTRATION NUMBER: NCT02937051.


Assuntos
Fumar Charutos , Aromatizantes , Adolescente , Adulto , Ensaios Clínicos como Assunto , Estimulantes Ganglionares/análise , Humanos , Nicotina/análise , Saliva/química , Inquéritos e Questionários , Adulto Jovem
18.
Children (Basel) ; 5(8)2018 Aug 07.
Artigo em Inglês | MEDLINE | ID: mdl-30087271

RESUMO

While pediatric integrative medicine (PIM) emphasizes an "evidence-based practice using multiple therapeutic modalities"; paradoxically, literature reviews examining the prevalence and/or efficacy of such mind⁻body approaches often address PIM modalities separately. Such contributions are relevant, yet documentation of how to deliver combined complementary approaches in children and youth are scarce. Nevertheless, integrative practitioners in clinical practice routinely mix approaches to meet the individual needs of each patient. Best practices are flexible, and include blending and augmenting services within the same session, and/or connecting modalities sequentially for an incremental effect, and/or referring to outside resources for additional interventions. Resonating with integrative medicine's definition, this article's goal is to demonstrate paradigms that "bring together complementary approaches in a coordinated way within clinical practice" by linking clinical hypnosis, the trail-blazer modality in PIM's history, with mindfulness, biofeedback, acupuncture, and yoga. Following the consideration of the overlap of guided imagery with hypnosis and an abridged literature report, this clinical perspective considers the selection of modalities within a collaborative relationship with the child/teen and parents, emphasizing goodness-of-fit with patients' contexts, e.g., symptoms, resources, interests, goals, and developmental stage. Case vignettes illustrate practical strategies for mixing approaches.

19.
Children (Basel) ; 5(7)2018 Jul 16.
Artigo em Inglês | MEDLINE | ID: mdl-30012958

RESUMO

Youth who experience homelessness have worse health and well-being than housed youth. Internal assets, including social competency and positive self-identity, are factors that promote healthy development. This study compared internal assets between homeless and housed youth, and examined whether connectedness with parents moderates the association between homelessness and internal assets. Using data from a large population-based survey of middle- and high-school aged youth, we found that homelessness was associated with lower levels of internal assets. However, having high connectedness with a parent significantly predicted the strength of these assets, suggesting opportunities to promote health equity among homeless youth.

20.
Children (Basel) ; 5(7)2018 Jul 17.
Artigo em Inglês | MEDLINE | ID: mdl-30018217

RESUMO

Advances in developmental resilience science are highlighted with commentary on implications for pediatric systems that aspire to promote healthy development over the life course. Resilience science is surging along with growing concerns about the consequences of adverse childhood experiences on lifelong development. Resilience is defined as the capacity of a system to adapt successfully to challenges that threaten the function, survival, or future development of the system. This definition is scalable across system levels and across disciplines, applicable to resilience in a person, a family, a health care system, a community, an economy, or other systems. Robust findings on resilience in childhood underscore the importance of exposure dose; fundamental adaptive systems embedded in the lives of individuals and their interactions with other systems; developmental timing; and the crucial role of healthcare practitioners and educators as well as family caregivers in nurturing resilience on the "front lines" of lived childhood experience. Resilience science suggests that human resilience is common, dynamic, generated through myriad interactions of multiple systems from the biological to the sociocultural, and mutable given strategic targeting and timing. Implications for pediatric practice and training are discussed.

SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA