Flavored e-cigarette use: Characterizing youth, young adult, and adult users.

The purpose of this study is to investigate how the use of flavored e-cigarettes varies between youth (12-17 years old), young adults (18-29 years old), and older adults (30 + years old). Cross-sectional surveys of school-going youth (n = 3907) and young adult college students (n = 5482) in Texas, and young adults and older adults (n = 6051) nationwide were administered in 2014-2015. Proportions and 95% confidence intervals were used to describe the percentage of e-cigarette use at initiation and in the past 30 days that was flavored, among current e-cigarette users. Chi-square tests were applied to examine differences by combustible tobacco product use and demographic factors. Most e-cigarette users said their first and "usual" e-cigarettes were flavored. At initiation, the majority of Texas school-going youth (98%), Texas young adult college students (95%), and young adults (71.2%) nationwide said their first e-cigarettes were flavored to taste like something other than tobacco, compared to 44.1% of older adults nationwide. Fruit and candy flavors predominated for all groups; and, for youth, flavors were an especially salient reason to use e-cigarettes. Among adults, the use of tobacco flavor at initiation was common among dual users (e-cigarettes + combustible tobacco), while other flavors were more common among former cigarette smokers (P = 0.03). Restricting the range of e-cigarette flavors (e.g., eliminating sweet flavors, like fruit and candy) may benefit youth and young adult prevention efforts. However, it is unclear what impact this change would have on adult smoking cessation.

Why are urban Indian 6th graders using more tobacco than 8th graders? Findings from Project MYTRI.

OBJECTIVE: To investigate why urban Indian 6th graders may be using more tobacco than urban Indian 8th graders. DESIGN: Cross-sectional survey of students conducted in the summer of 2004, as the baseline evaluation tool for a group-randomised tobacco prevention intervention trial (Project MYTRI). Mixed-effects regression models were used to (1) examine the relationship between 15 psychosocial risk factors and current use of any tobacco, by grade; and (2) examine differences in psychosocial risk factors, by grade. SETTING: Thirty-two private (high socioeconomic status (SES)) and government (low-mid SES) schools in two large cities in India (Delhi and Chennai). SUBJECTS: Students in the 6th and 8th grade in these schools (n = 11642). Among these, 50.6% resided in Delhi (v Chennai), 61.4% attended a government school (v a private school), 52.9% were enrolled in 6th grade (v 8th), and 54.9% were male (v female). MAIN OUTCOME MEASURE: Current (past 30 day) use of any tobacco, including chewing tobacco (for example, gutkha), bidis, or cigarettes. RESULT: Almost all psychosocial factors were significantly related to tobacco use, for students in both grades. Some of the strongest correlates included social susceptibility to and social norms about use. Exposure to tobacco advertising was a strong correlate of tobacco use for 6th graders, but not for 8th graders. Sixth graders scored lower than 8th graders on almost all factors, indicating higher risk. CONCLUSIONS: The "risk profile" of 6th graders suggests they would be vulnerable to use and to begin using tobacco, as well as to outside influences that may encourage use.

Carbapenemase-producing Enterobacteriaceae in hospital wastewater: a reservoir that may be unrelated to clinical isolates.

BACKGROUND: Carbapenemase-producing Enterobacteriaceae (CPE) are an emerging infection control problem in hospitals worldwide. Identifying carriers may help reduce potential spread and infections. AIM: To assess whether testing hospital wastewater for CPE can supplement patient-based screening for infection prevention purposes in a hospital without a recognized endemic CPE problem. METHODS: Wastewater collected from hospital pipework on 16 occasions during February to March 2014 was screened for CPE using chromID(®) CARBA agar and chromID(®) CPS agar with a 10µg ertapenem disc and combination disc testing. Minimum inhibitory concentrations were determined using British Society for Antimicrobial Chemotherapy methodology and carbapenemase genes detected by polymerase chain reaction or whole-genome sequencing. Selected isolates were typed by pulsed-field gel electrophoresis. FINDINGS: Suspected CPE were recovered from all 16 wastewater samples. Of 17 isolates sent to the Antimicrobial Resistance and Healthcare Associated Infections Reference Unit, six (four Citrobacter freundii and two Enterobacter cloacae complex) were New Delhi metallo-ß-lactamase (NDM) producers and the remaining 11 (six Klebsiella oxytoca and five Enterobacter cloacae complex) were Guiana-Extended-Spectrum-5 (GES-5) producers, the first to be described among Enterobacteriaceae in the UK. The four NDM-producing C. freundii, two NDM-producing E. cloacae complex, and four out of five GES-5-producing E. cloacae complex were each indistinguishable isolates of the same three strains, whereas the six GES-5-producing K. oxytoca overall shared 79% similarity. CONCLUSION: CPE are readily isolated from hospital wastewater using simple culture methods. There are either undetected carriers of CPE excreting into the wastewater, or these CPE represent colonization of the pipework from other sources. Surveillance of hospital wastewater for CPE does not appear helpful for infection control purposes within acute hospitals.

Genetic variation among 82 pharmacogenes: The PGRNseq data from the eMERGE network.

Genetic variation can affect drug response in multiple ways, although it remains unclear how rare genetic variants affect drug response. The electronic Medical Records and Genomics (eMERGE) Network, collaborating with the Pharmacogenomics Research Network, began eMERGE-PGx, a targeted sequencing study to assess genetic variation in 82 pharmacogenes critical for implementation of "precision medicine." The February 2015 eMERGE-PGx data release includes sequence-derived data from ∼5,000 clinical subjects. We present the variant frequency spectrum categorized by variant type, ancestry, and predicted function. We found 95.12% of genes have variants with a scaled Combined Annotation-Dependent Depletion score above 20, and 96.19% of all samples had one or more Clinical Pharmacogenetics Implementation Consortium Level A actionable variants. These data highlight the distribution and scope of genetic variation in relevant pharmacogenes, identifying challenges associated with implementing clinical sequencing for drug treatment at a broader level, underscoring the importance for multifaceted research in the execution of precision medicine.

Predictors of overweight and overfatness in a multiethnic pediatric population. Child and Adolescent Trial for Cardiovascular Health Collaborative Research Group.

The goal of the study was to determine whether overweight or overfatness were predicted from sex, race or ethnicity, school site, and intervention or control status for children who were 9 y old at the outset of the Child and Adolescent Trial for Cardiovascular Health (CATCH). In this ethnically and geographically diverse group of 5106 students, height, weight, and triceps skinfold thickness were measured at 9 (baseline) and 11 y (follow-up) of age. The strongest predictors of status at follow-up were baseline overweight (odds ratio: 69.0; 95% CI: 54.9, 96.3) and overfatness (odds ratio: 27.4; 95% CI: 22.4, 33.4); site, African American race or ethnicity, and male sex were also significant independent associations. Children in the overweight (> 85th percentile for body mass index) group had significantly higher adjusted means for total blood cholesterol, higher apolipoprotein B concentrations, lower mean HDL-cholesterol concentrations, and lower performance on the 9-min run than those in other groups (< 15th, 15-49th, or 50-85th body mass index percentiles). Similar results were found for these factors for those subjects with greater triceps skinfold-thickness measurements. Groups of children who were overweight and overfat at baseline were more likely to be overweight and overfat at follow-up and to have more cardiovascular risk factors than their peers.

Pathways family intervention for third-grade American Indian children.

The goal of the feasibility phase of the Pathways family intervention was to work with families of third-grade American Indian children to reinforce health behaviors being promoted by the curriculum, food service, and physical activity components of this school-based obesity prevention intervention. Family behaviors regarding food choices and physical activity were identified and ranked according to priority by using formative assessment and a literature review of school-based programs that included a family component. The family intervention involved 3 primary strategies designed to create an informed home environment supportive of behavioral change: 1) giving the children "family packs" containing worksheets, interactive assignments, healthful snacks, and low-fat tips and recipes to take home to share with their families; 2) implementing family events at the school to provide a fun atmosphere in which health education concepts could be introduced and reinforced; and 3) forming school-based family advisory councils composed of family members and community volunteers who provided feedback on Pathways strategies, helped negotiate barriers, and explored ideas for continued family participation. For strategy 2, a kick-off Family Fun Night provided a series of learning booths that presented the healthful behaviors taught by Pathways. At an end-of-year Family Celebration, a healthy meal was served, students demonstrated newly learned Pathways activities, and certificates were presented in recognition of completion of the Pathways curriculum. Based on evaluation forms and attendance rosters, strategies 1 and 2 were more easily implemented and better received than strategy 3. Implications for developing family involvement strategies for intervention programs are discussed.

Tactile pattern recognition with the Optacon: superior performance with active touch and the left hand.

Independent groups of subjects (n = 12) attempted to identify individual digits 0-9 using active or passive touch with a vibrotactile display (Optacon II). Repeated measures were taken on the hand factor. Number recognition was superior with active touch and with the left hand.

Smoking prevention: behavioral prescriptions for the pediatrician.

Pediatricians are important instigators of behavior change for the promotion of nonsmoking. Smoking is harmful to infants, children, and adolescents, and evidence is reviewed that passive smoking can have potent deleterious effects. Interventions with young adolescents based on social-psychologic theory have shown promise in changing smoking behavior and reducing smoking onset rates. Interventions are described, based on epidemiologic and etiologic data, that are appropriate for infants, children, adolescents, and parents. Interventions for parents should encourage cessation and the creation of a smoke-free environment for children. Interventions for children should emphasize the negative health effects of smoking and help them build an armamentarium against factors that promote experimentation with smoking. Interventions for adolescents should encourage them to remain nonsmokers in an environment of social pressure to smoke. The rationale for these strategies and methods of implementation in the pediatrician's office are described.

The Minnesota Heart Health Program. Education for youth and parents.

Within the Minnesota Heart Health Program, all schools have participated in these programs and most have been incorporated as part of the regular school curriculum. The involvement of parents in youth programs has been challenging, but we view it as essential to making significant changes. Further, a program with appropriate underlying behavioral theory and community involvement can be successful. Such efforts seem critical to primary prevention of cardiovascular disease risk and subsequent disease in a culture where these diseases are common.

The tobacco industry and underage youth smoking: tobacco industry documents from the Minnesota litigation.

OBJECTIVE: To learn how underage youth have been regarded by the major tobacco companies, as revealed in industry documents during the Minnesota litigation. DATA SOURCES: Documents from Brown & Williamson Tobacco Corp, Lorillard Tobacco Co, Philip Morris Inc, and R. J. Reynolds Tobacco Co. STUDY SELECTION: Documents available from the State of Minnesota and Blue Cross and Blue Shield of Minnesota v Philip Morris Inc et al during the discovery process of the trial. Hundreds of industry documents related to youth, teenagers, and young adults were examined. A sample of documents are referenced as illustrations of key points. CONCLUSIONS: Underage youths are viewed by the tobacco industry as critical to its future. Underage youth smoking patterns were examined for decades. Reductions in youth smoking rates were seen by tobacco companies as a negative trend for the companies. Specific marketing campaigns were directed at underage youth and were successful with this age group. Tobacco industry practices should continue to be carefully scrutinized.

Three-year maintenance of improved diet and physical activity: the CATCH cohort. Child and Adolescent Trial for Cardiovascular Health.

OBJECTIVE: To assess differences through grade 8 in diet, physical activity, and related health indicators of students who participated in the Child and Adolescent Trial for Cardiovascular Health (CATCH) school and family intervention from grades 3 through 5. DESIGN: Follow-up of the 4-center, randomized, controlled field trial with 56 intervention and 40 control elementary schools. PARTICIPANTS: We studied 3714 (73%) of the initial CATCH cohort of 5106 students from ethnically diverse backgrounds in California, Louisiana, Minnesota, and Texas at grades 6, 7, and 8. RESULTS: Self-reported daily energy intake from fat at baseline was virtually identical in the control (32.7%) and intervention (32.6%) groups. At grade 5, the intake for controls remained at 32.2%, while the intake for the intervention group declined to 30.3% (P<.001). At grade 8, the between-group differential was maintained (31.6% vs 30.6%, P = .01). Intervention students maintained significantly higher self-reported daily vigorous activity than control students (P = .001), although the difference declined from 13.6 minutes in grade 5 to 11.2, 10.8, and 8.8 minutes in grades 6, 7, and 8, respectively. Significant differences in favor of the intervention students also persisted at grade 8 for dietary knowledge and dietary intentions, but not for social support for physical activity. No impact on smoking behavior or stages of contemplating smoking was detected at grade 8. No significant differences were noted among physiologic indicators of body mass index, blood pressure, or serum lipid and cholesterol levels. CONCLUSION: The original CATCH results demonstrated that school-level interventions could modify school lunch and school physical education programs as well as influence student behaviors. This 3-year follow-up without further intervention suggests that the behavioral changes initiated during the elementary school years persisted to early adolescence for self-reported dietary and physical activity behaviors.

Hypertension prevention through nutrition education in youth: a school-based program involving parents.

One approach to the prevention of high blood pressure may be the reduction of sodium intake early in life. To test the effect of nutrition education for salt use in third-grade students (ages 7 to 9), three teaching programs involving a classroom curriculum, a home-based curriculum, or the combination were compared to a control group. Thirty-one schools with 1,839 students were included. Measurements were made at the beginning and end of the school year. Participation rates exceeded 90% for school-based programs and 80% for those at home. Knowledge about salt increased significantly, with the classroom program showing the largest gains. However, reported salting behavior and sodium measured by 24-hr recall and overnight urines failed to show consistent and significant differences between treatments. Further analysis suggested that most ingested salt was hidden in processed foods with only a small fraction added in cooking or at meals (less than 7%). If sodium intake is to be reduced significantly in healthy children, more attention must be paid to hidden sources, particularly processed foods.

Dieting behaviors and weight change history in female adolescents.

The prevalence of dieting, weight change history, and specific weight loss behaviors was examined in a population-based sample of 1,015 female 9th-12th graders. Healthy weight loss behaviors were reported much more frequently than unhealthy weight loss behaviors (e.g., healthy behaviors: exercise = 32.4%, decrease fat intake = 26.0%, reduce snacks = 25.0%, reduce kilocalorie intake = 22.4%; unhealthy behaviors: fasting = 8.1%, diet pills = 5.4%, vomiting = 4.4%). Obesity status and restrained eating scores were positively related to greater history of weight loss episodes, pounds lost, and weight fluctuations and to greater use of healthy weight loss methods and weight loss programs. Implications for public health recommendations regarding dieting and its associated behaviors in female adolescents are discussed.

Effects of a saliva test pipeline procedure on adolescent self-reported alcohol use.

Self-reports on alcohol use collected via school-based questionnaires, telephone surveys, and household interviews are central measures in many studies in the alcohol field. The validity of such self-reports remains an issue. Use of biological pipeline procedures is one way in which the quality of self-reports might be improved. The current study tested the effectiveness of a saliva test pipeline procedure in increasing drinking disclosure rates among adolescents in the sixth and eighth grades. Two sixth-grade classes from each of 14 elementary schools (n = 828) and four eighth-grade classes from each of 8 middle schools (n = 754) were selected. Half of the classes in each school were assigned to the pipeline condition and half to the control condition. Each student in the pipeline condition was asked to provide a saliva sample via dental roll before completing a questionnaire that all students (pipeline and control) received. Pipeline students were told that "some of the saliva we collect today will be tested in a laboratory and will provide a biological measure of alcohol use." Sixth- and eighth-grade students exposed to the alcohol procedure reported 5 to 7% higher alcohol use prevalences than students in the control group. While the pattern of improved reporting under the pipeline condition held across four alcohol-use measures and two grade levels, the effect was statistically significant for only one measure. The pipeline procedures used here had small effects on adolescent self-reported alcohol use.

The ability of young people to purchase alcohol without age identification in northeastern Minnesota, USA.

The purpose of this study was to determine the rate at which young people can purchase alcohol without age identification in off-premises businesses, and the factors which influence the rate of purchase. All retail outlets licensed to sell distilled spirits and/or full strength beer and wine in 28 northern Minnesota communities were visited on different occasions by three 21-year-old female buyers who appeared to be aged 19 or younger. These youthful buyers were able to purchase beer without age identification in 47% of the 336 purchase attempts. Almost four-fifths of the businesses sold beer to these buyers at least once in three attempts. These results provide clear evidence that many commercial off-sale businesses in the US supply alcohol to youthful buyers, and that practices vary significantly by community and by business. These results support the need for greater attention to availability as a factor in teenage drinking patterns.

Personality and behavioral vulnerabilities associated with risk status for eating disorders in adolescent girls.

This article presents first-year cross-sectional findings from a study of the development of eating disorders. Adolescent female (N = 937) 7th through 10th graders completed measures that included information on personality, self-concept, eating patterns, and attitudes. A risk status score was calculated on the basis of comprehensive information regarding DSM-III-R eating disorders criteria and other weight and attitudinal data. All personality measures showed significant differences according to risk, based on subject classification into high, moderate, and mild risk status and comparison groups. Early puberty was not associated with increased risk. The strongest predictor variables for risk were body dissatisfaction, negative emotionality, and lack of interoceptive awareness. The possible diathesis of personality including temperamental factors in the later development of an eating disorder is discussed.

Prospective analysis of personality and behavioral vulnerabilities and gender influences in the later development of disordered eating.

This article presents the 2-year findings of a prospective investigation of the precursors to the later development of an eating disorder in adolescents. The sample consisted of 852 girls and 815 boys who began to study in Grades 7-10 and participated for 3 consecutive years. For both genders, the strongest predictors of Year 3 risk status were Years 1 and 2 risk scores. When the effects of Year 1 and Year 2 risk were controlled, race (Caucasian) and poor interoceptive awareness at Year 2 were significant predictors of disordered eating at Year 3 for girls. Previous risk status was the only significant predictor of Year 3 risk for boys. Gender difference evaluations in the risk score components indicated that a significantly greater proportion of girls than boys endorsed behaviors that were similar to eating disorder diagnostic criteria. Poor interoceptive awareness may provide a vulnerability for eating disorders; possible pathways were discussed.

Results of prevention programs with adolescents.

Programs for preventing smoking and alcohol and drug abuse have radically changed in the past decade. Instead of being regarded as a health or discipline problem that involves only a few deviant adolescents, drug use has begun to be viewed as social behavior that is functional for adolescents, not capricious, and is normative for that population. The most successful prevention programs have sought to delay the onset of tobacco use. Based on theoretical and etiological research, these programs target factors that have repeatedly been predictive of adolescent smoking, alcohol and drug use. The programs teach adolescents (1) why people their age smoke tobacco or use alcohol and drugs; (2) how these meanings get established by peers, older role models and advertising; (3) how to resist these influences to smoke or to use alcohol and drugs; and (4) life skills and competencies to counterbalance the functions that drug use serves. Because of the association with the onset of smoking and the onset of using other drugs, these strategies are being studied for alcohol use and other drugs. In addition, elected peer leaders are trained to conduct these activities with their classmates and act as new role models for non-use. Evaluations of these approaches are optimistic. Studies in northern California and Minnesota reveal 50-70% reductions in the onset of smoking. Botvin's 'Life Skills Training' program demonstrates success in delaying heavy alcohol and marijuana use.

Lessons from Project Northland: preventing alcohol problems during adolescence.

Project Northland, an ongoing community trial aimed at reducing alcohol use and alcohol-related problems among adolescents, is nearing completion. The project combines individual-based strategies to encourage adolescents not to use alcohol with community-based strategies to both reduce alcohol availability and modify community attitudes concerning youth drinking. Project Northland has developed prevention programs and followed the same group of adolescents from sixth grade to high school graduation. This article discusses the rationale for this type of program, elements of the adolescents' social environment targeted for change, the unique challenges of working with high school students compared with younger adolescents, and areas for future research.

Prevalence of marked overweight and obesity in a multiethnic pediatric population: findings from the Child and Adolescent Trial for Cardiovascular Health (CATCH) study.

OBJECTIVE: Determine the prevalence of marked overweight and obesity among children in the Child and Adolescent Trial for Cardiovascular Health (CATCH), identify high risk groups, and compare findings to other recent studies. DESIGN: Cohort study. SUBJECTS/SETTING: Five thousand one hundred-six school children who were participants in CATCH at baseline (age approximately 9 years) during 1991 and 4,019 of those children who had follow-up data from 1994 (age approximately 1 years) available. METHODS: Body mass index (BMI), triceps and subscapular skinfolds, subscapular to triceps skinfold (S/T) ratio, and an estimate of body fat distribution from skinfolds was calculated. Findings were compared to population-based reference data from the First National Health and Nutrition Examination Survey, 1971 to 1973 (NHANES I), to data from the Bogalusa Heart Study, and to data from the Third National Health and Nutrition Examination Survey, 1988 to 1994 (NHANES III). RESULTS: Children in CATCH were markedly heavier and fatter than the NHANES I population and more comparable to the NHANES III population, especially those in the upper percentiles. The prevalence of obesity based on BMI and triceps skinfolds >95th percentile among CATCH children was higher in boys than in girls at both baseline (boys 9.1%, girls 8.6%) and follow-up (boys 11.7%, girls 7.2%). It was higher among African-Americans and Hispanics than whites for both sexes. S/T ratios did not differ appreciably from those observed in the NHANES I reference population, suggesting that body fat distribution was more stable over time than BMI and skinfolds. APPLICATIONS: Our findings support other recent reports that American children, especially African-American and Hispanic children, are becoming heavier and fatter. Preventive measures are warranted, especially for high-risk youth.