U.S. adolescent and adult women\u27s experiences accessing and using toilets in schools, workplaces, and public spaces: A multi-site focus group study to inform future research in bladder health

The World Health Organization recognizes access to clean and safe toilets as crucial for public health. This study explored U.S. adolescent and adult cisgender women\u27s lived experiences accessing toilets in schools, workplaces, and public spaces. As part of the Prevention of Lower Urinary Tract Symptoms (PLUS) Research Consortium, we conducted 44 focus groups with female participants (n = 360; ages 11-93). Focus groups were stratified by age (11-14, 15-17, 18-25, 26-44, 45-64, 65+) and conducted across 7 geographically diverse U.S. sites from July 2017-April 2018. Using a transdisciplinary approach, we conducted conventional qualitative coding informed by our PLUS conceptual framework and used content analysis processes to identify salient themes. Across settings, toilet access was restricted by gatekeepers (i.e., individuals who control access to toilets). In contrast, self-restricting toilet use (deciding not to use the toilet despite biologic need to urinate) was based on internalized norms to prioritize school and job responsibilities over urination. In public spaces, self-restricting use was largely in response to lack of cleanliness. Across the life course, participants perceived gender disparities in the ability to easily access public toilets. Further research is needed to determine if and how these factors impact bladder health across the life course

Prevention of Lower Urinary Tract Symptoms Research Consortium focus group Study of Habits, Attitudes, Realities, and Experiences of Bladder health

AimThe study purpose is to explore adolescent and adult women’s experiences, perceptions, beliefs, knowledge and behaviours related to bladder health across the life course using a socioecological perspective. Lower urinary tract symptoms affect between 20-40% of young adult to middle-aged women, with symptoms increasing in incidence and severity with aging. There is limited evidence to address bladder health promotion and prevention of dysfunction. This first study of the Prevention of Lower Urinary Tract Symptoms (PLUS) Research Consortium is designed to address gaps in existing qualitative research in this area.DesignThis focus group study will be implemented across seven geographically diverse United States research centres using a semi-structured focus group guide informed by a conceptual framework based on the socioecological model.MethodsThe study was approved in July 2017. A total of 44 focus groups composed of 6-8 participants representing six different age categories (ranging from 11 to over 65 years) will be completed. We aim to recruit participants with diverse demographic and personal characteristics including race, ethnicity, education, socioeconomic status, urban/rural residence, physical/health conditions, and urinary symptom experience. Six of the focus groups will be conducted in Spanish and translated into English. Focus group transcripts will undergo content analysis and data interpretation to identify and classify themes and articulate emerging themes.DiscussionThis foundational qualitative study seeks to develop an evidence base to inform future research on bladder health promotion in adolescent and adult women.ImpactThis study has the potential to provide new insights and understanding into adolescent and adult women’s lived experience of bladder health, the experience of lower urinary symptoms and knowledge and beliefs across the life course.ç ®ç æ ¬ç  ç©¶ç ç ®ç æ ¯ä» ç¤¾ä¼ ç æ å­¦ç è§ åº¦,æ ¢è®¨é å° å¹´å æ å¹´å¥³æ §å ¨äººç è¿ ç¨ ä¸­ä¸ è è ±å ¥åº·ç ¸å ³ç ç» éª ã è§ å¿µã 信念ã ç ¥è¯ å è¡ ä¸ºã ä¸ å°¿è·¯ç ç ¶å½±å 20-40%ç 中é å¹´å¥³æ §,é ç å¹´é¾ ç å¢ é ¿,ç ç ¶ç å ç ç å 严é ç¨ åº¦é ½å ¨å¢ é ¿ã å ³äº ä¿ è¿ è è ±å ¥åº·å é¢ é ²å è ½é ç¢ ç è¯ æ ®æ é ã æ ¬æ¬¡é¢ é ²ä¸ å°¿è·¯ç ç ¶(PLUS)ç  ç©¶è ç ç ç  ç©¶æ ¯é¦ ä¸ªå ³äº æ­¤æ ¹é ¢ç ç  ç©¶,æ ¨å ¨è§£å ³ç °æ ç å® æ §ç  ç©¶å ¨è¿ æ ¹é ¢ç å·®è· ã è®¾è®¡è¯¥é¡¹ç ¦ç ¹å° ç» ç  ç©¶å° å ¨ä¸ ä¸ªä¸ å ä½ ç½®ç ç¾ å ½ç  ç©¶ä¸­å¿ è¿ è¡ ,ä»¥å ºäº ç¤¾ä¼ ç æ 模å æ¦ å¿µæ¡ æ ¶ç å ç» æ å ç ç ¦ç ¹å° ç» æ å 为æ 导ã æ ¹æ³ è¯¥ç  ç©¶äº 2017å¹´7æ è ·å¾ æ ¹å ã ç ±6-8å 代表6ä¸ªä¸ å å¹´é¾ ç±»å «(ä» 11å² å °65å² ä»¥ä¸ )ç å ä¸ è ç» æ å ±44ä¸ªç ¦ç ¹å° ç» ã æ 们计å æ å ä¸ å äººå £å ä¸ªäººç ¹å¾ ç å ä¸ è ,ä¾ å¦ ç§ æ ã ç§ æ æ¸ æº ã æ è ²ç» å ã ç¤¾ä¼ ç» æµ å °ä½ ã å ä¹¡å± æ° ã èº«ä½ /å ¥åº·ç ¶å µå æ³ å°¿ç³»ç» ç ç ¶ç» å ã å ­ä¸ªç ¦ç ¹å° ç» ç ç  ç©¶å° ä»¥è¥¿ç ­ç è¯­è¿ è¡ ,å¹¶ç¿»è¯ æ è ±è¯­ã ç ¦ç ¹å° ç» ç èª æ ¬å° è¢«ç ¨äº å 容å æ å æ °æ ®è§£é ,ä»¥ç¡®å® å å ç±»ä¸»é¢ ,并é æ æ °å ºç °ç ä¸»é¢ ã è®¨è®ºè¿ é¡¹å ºç¡ æ §ç å® æ §ç  ç©¶æ ¨å ¨ä¸ºæ é« æ ªæ ¥é å° å¹´å æ å¹´å¦ å¥³ç è è ±å ¥åº·ç ç  ç©¶æ ä¾ è¯ æ ®å ºç¡ ã å½±å è¿ é¡¹ç  ç©¶æ å ¯è ½æ ä¾ å ³äº é å° å¹´å æ å¹´å¦ å¥³ç è è ±å ¥åº·ç ç æ´»ç» éª ,ç» éª ç ä¸ å°¿è·¯ç ç ¶å ç ¥è¯ å ç æ³ ç 人ç è¿ ç¨ ä¸­æ °ç è§ è§£å ç 解ãPeer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/151981/1/jan14148_am.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/151981/2/jan14148.pd

Pilot Ecological Momentary Assessment Study of Subjective and Contextual Factors Surrounding E-Cigarette and Combustible Tobacco Product Use among Young Adults

Background: Dual use of e-cigarettes and combustible tobacco products is common in young adults. We aimed to explore how ratings of subjective and contextual factors differed between discrete episodes of e-cigarette use vs. combustible tobacco product smoking among a sample of young adults. Methods: Young adults (N = 29, ages 18–30) who used e-cigarettes and ≥1 combustible tobacco product at least once weekly completed a 1-week smartphone-based ecological momentary assessment (EMA). Twice daily random prompts assessed past-15-min use of tobacco products, ratings of subjective factors (e.g., negative affect, craving), and contextual factors related to activity, location, and companionship. A multivariable GEE model assessed whether subjective or contextual factors were associated with e-cigarette vs. combustible tobacco product episodes. Results: 184 tobacco use episodes were reported (39.7% e-cigarette, 60.3% combustible tobacco product). High baseline cigarette dependence, as measured by the Fagerström Test for Cigarette Dependence, was associated with lower odds of e-cigarette vs. combustible tobacco product episodes (aOR 0.01, 95% CI (0.002–0.08); p < 0.001). Neither between- or within-subjects negative affect or craving scores were associated with e-cigarette use. Activities of eating/drinking (aOR 0.20, 95% CI (0.08–0.49); p = 0.001) and being in the companionship of a person who smoked cigarettes (aOR 0.13, 95% CI (0.04–0.43); p = 0.001) were associated with lower odds of e-cigarette vs. combustible tobacco product use episodes. However, traveling (aOR 12.02, 95% CI (3.77–38.26); p ≤ 0.001) and being in a public space (aOR 2.76, 95% CI (1.10–6.96); p = 0.03) were associated with higher odds of e-cigarette than combustible tobacco product use episodes. Conclusions: This pilot data suggests that unique contextual factors may be associated with e-cigarette use, compared to combustible tobacco smoking in a sample of young adults who use both e-cigarettes and combustible tobacco products. Future research with larger samples is needed to better characterize varying contexts and cues for tobacco use among young adults who are dual users

Protecting Children and Adolescents From Tobacco and Nicotine

Significant strides have been made in reducing rates of cigarette smoking among adolescents in the United States. However, rates of e-cigarette and similar device use among youth are high, and rates of other tobacco product use, such as cigars and hookahs, have not declined. In addition, almost 40% of children 3 to 11 years of age are regularly exposed to secondhand tobacco smoke, and rates of secondhand exposure to e-cigarette aerosol have increased over the last decade. Pediatricians are uniquely positioned to help children, adolescents, and their families live tobacco-free lives. Actions by pediatricians can help reduce children\u27s risk of developing tobacco and nicotine use disorder and reduce children\u27s tobacco smoke and/or aerosol exposure

Protecting Children and Adolescents From Tobacco and Nicotine

Tobacco use remains the leading preventable cause of disease and death for adults in the United States. Significant strides have been made in reducing rates of cigarette smoking among adolescents in the United States. However, rates of e-cigarette and similar device use among youth are high, and rates of other tobacco product use, such as cigars and hookahs, have not declined. Public policy actions to protect children and adolescents from tobacco and nicotine use, as well as tobacco smoke and aerosol exposure, have proven effective in reducing harm. Effective public health approaches need to be both extended to include e-cigarettes, similar devices, and other and emerging tobacco products and expanded to reduce the toll that the tobacco epidemic takes on children and adolescents

Informing the regulation of e-cigarettes to restrict youth access

Aims: The FDA proposes to regulate e-cigarettes, with a focus on protecting youth. To better inform the FDA, we evaluated how adolescents obtain e-cigarettes, where they use e-cigarettes, and how they view e-cigarettes. Methods: We conducted surveys in 5 high schools and 2 middle schools in CT (N = 5152) in Spring 2014 to assess these important issues. The sample was 51% female and 15.3 (SD = 1.9) years old. Results: Among lifetime-e-cigarette users (23%), 37% reported obtaining e-cigarettes from friends, 13% from tobacco shops, 9% from gas stations, and 7% from online stores. Among adolescents (n = 429) or an online store (n = 367), 77% and 89%, respectively, reported that they were not denied purchase. Lifetime e-cigarette users reported using e-cigarettes in their home (51%), school (25%) and public places where smoking is not allowed (24%). Among the total sample, the availability of different flavors (17%), ability to do smoke tricks (14%), and the ability to customize flavors (9%) were the top appealing components of e-cigarettes. Logistic regression analyses showed that lifetime e-cigarette users were more likely than never-users to view the availability of different flavors (OR = 94.07), the ability to do smoke tricks (OR = 218.74), and the availability of odorless vapors (OR = 4.25) as appealing; whereas, non-users were more likely than lifetime users to view external features of e-cigarettes, such as its shape (OR = 5.11) and the ability to “light up” (OR = 4.38) as appealing. Conclusions: The findings underscore the need to regulate ecigarette sales to minors, including online purchases, and prohibit e-cigarette use indoors where cigarette smoking is prohibited. Furthermore, restricting various flavors, eliminating visible vapors, and reducing the appeal of the e-cigarette design may lessen youth interest

Protecting Children and Adolescents From Tobacco and Nicotine

This technical report provides the evidence base for the accompanying tobacco clinical report and policy statement. It builds on, strengthens, and expands AAP recommendations from the previous version in 2015. Tobacco use remains the leading preventable cause of disease and death for adults in the United States. The tobacco epidemic takes a substantial toll on children\u27s and adolescent\u27s health, including harms because of prenatal exposure during pregnancy, secondhand and thirdhand exposure during infancy and childhood, and/or direct use during adolescence. Tobacco and nicotine use almost always starts in childhood or adolescence. Almost 40% of children aged 3 to 11 years are regularly exposed to secondhand tobacco smoke, and rates of secondhand exposure to e-cigarette aerosol have increased over the last decade

Youth generated prevention messages about electronic cigarettes

Rates of e-cigarette use are high among youth, and there is little known about the long-term health effects of e-cigarettes. Since peer influence is a powerful determinant of tobacco use, we aimed to identify message themes about e-cigarettes that youth would use to encourage or discourage peers from using e-cigarettes. We conducted 10 focus groups (N = 69) with non-smokers and smokers from one middle school, high school and college in Connecticut. Participants engaged in a discussion about e-cigarettes, and each participant created one written message to encourage e-cigarette use and one to discourage use among peers. We content-analyzed the messages and identified three main themes and 12 encouraging and discouraging sub-themes. Encouraging themes included health benefits of e-cigarettes relative to cigarettes, attractive product characteristics (e.g. flavors) and social advantages (e.g. positive social image) of using e-cigarettes. Discouraging messages included health risks of e-cigarettes relative to cigarettes, unattractive product characteristics (e.g. cost) and social disadvantages (e.g. negative social image of using an e-cigarette). Overall, there were no differences by sex, age group or smoking status in generation of encouraging and discouraging message themes. This study identified youth-generated themes that may aid in e-cigarette prevention among youth

Nicotine concentration of e-cigarettes used by adolescents

Objective: E-cigarettes are popular among youth, but little is known about the nicotine concentrations of e-liquids used by adolescents. Materials and Method: In Spring, 2014, we conducted cross-sectional surveys in four Connecticut high schools and two middle schools. Among past-30-day e-cigarette users (n = 513, 45% female, mean age 15.9 [SD = 1.4]), we examined what nicotine concentration adolescents typically used in their e-cigarettes (range 0-30 mg/mL and I don\u27t know ). We first examined whether age, sex, smoking status, e-cigarette use frequency, and/or e-cigarette acquisition source were associated with using nicotine-free e-liquid, nicotine e-liquid, or not knowing the e-liquid nicotine concentration. Among nicotine users (n = 185), we then examined whether the aforementioned variables were associated with using higher nicotine concentrations. Results: Adolescents reported using nicotine-free e-liquid (28.5%), nicotine e-liquid (37.4%), or not knowing their e-liquid nicotine concentration (34.1%). Nicotine users comprised more smokers and heavier e-cigarette users compared to nicotine-free e-liquid users and those who did not know their nicotine concentration. Nicotine users also comprised more males and were more likely to purchase e-cigarettes online or from tobacco shops compared to those who did not know their nicotine concentration. Among nicotine users, cigarette smoking, male sex, and purchasing e-cigarettes from tobacco shops predicted using higher nicotine concentrations. Conclusions: Adolescents reported using e-liquids with variable nicotine concentrations. Smokers, males, and those who purchased their own e-cigarettes reported using the highest nicotine levels. Of concern, many adolescents were unaware of the nicotine concentration in their e-liquid, raising concerns about inadvertent nicotine exposure among youth