The Association Between Electronic Cigarette Use and Cigarette Smoking Behavior Among Young Adults in the United States

The prevalence of electronic cigarette (e-cigarette) use is rapidly increasing in adults and youth; however, little is known about the public health impact of their use. A debate over e-cigarettes has emerged in the literature; one side recognizes the potential benefit of e-cigarettes as a harm reduction tool, while others argue e-cigarette use may delay or deter smoking cessation due to dual use or increase the risk of initiation of conventional cigarettes among previous nonsmokers. Drawing on the Theory of Planned Behavior, this dissertation focused on attitudes, beliefs, and perceived social norms of e-cigarettes, as well as openness to conventional cigarette smoking among young adult users of the product. Using a mixed methods approach, this dissertation analyzed secondary data from the 2012-2013 National Adult Tobacco Survey (NATS) as well as focus group data collected in five cities across the U.S. to better understand the relationship between e-cigarette use and cigarette smoking among young adults. In Study 1, quantitative analyses found non-cigarette smoking young adults who have tried e-cigarettes were more likely to report openness to cigarette smoking in the future compared to those who have not tried e-cigarettes (AOR= 2.4; 95% CI= 1.7-3.3). In Study 2, qualitative findings suggest that young adult exclusive e-cigarette users were less interested in conventional cigarette smoking, and overwhelmingly described negative aspects to cigarette smoking that appeared to become more salient as a result of their e-cigarette use. In Study 3, focus group participants expressed many positive attitudes towards e-cigarettes, and simultaneously reported a lack of information and knowledge about the products. The relationship between e-cigarette use and cigarette smoking is complex and multifaceted, and influenced by a myriad of individual and social factors. Although quantitative findings suggest young adults who have used e-cigarettes compared to those who have not used e-cigarettes were more likely to report openness to future cigarette smoking, qualitative findings did not support the notion that young adult e-cigarette users (who may have prior experience with cigarette smoking) are open to future cigarette smoking. These findings provide a basis for further exploration of the association between e-cigarette use and cigarette smoking

Can the Hunger Vital Sign™ act as a prescreen for other social needs?

Background: Addressing health-related social needs is essential for improving health and reducing longstanding disparities. However, barriers to screening – including clinician and patient time burden of screening for multiple social needs – limit identification. To address this concern and promote the uptake of screening by clinicians, it is important that screening tools effectively and efficiently identify social needs’ presence and absence among patients. Objective: This study evaluated whether a validated and widely implemented 2-question food insecurity screening tool, the Hunger Vital Sign™ (HVS™), has adequate negative predictive value to serve as a pre-screen for other social needs. Methods: In 2007-2015, Children\u27s HealthWatch interviewed 28,611 publicly insured caregivers from households with low incomes with children age 0-48 months at 5 pediatric clinic/emergency departments (AR, MA, MD, MN, PA). Caregivers self-reported information about their households. Descriptive data were used to describe the sample and negative predictive value was calculated between the Hunger Vital Sign™ and other household hardships. Results: A negative Hunger Vital Sign™ identified 18,259 households (63.8%) as food secure. The negative predictive value in these households was 77.4% (95% CI 76.7, 78.2) for housing instability, 82.4% (95% CI 81.9, 83.0) for energy insecurity, 87.2% (95% CI 86.7, 87.7) for foregone health care at the household level, and 97.5% (95% CI 97.3, 97.7) at the child level. Results demonstrate, at varying levels, high NPV of the HVS™ to correctly identify other hardships’ absence, indicating that families who do not endorse the HVS™ may not be the highest priority for screening for other hardships. However, clinicians should be aware that roughly 20% of families who do not endorse the HVS™ do, in fact, experience other hardships and would not be identified as warranting further hardship-specific screening by this method. Conclusions: This is the first paper to our knowledge that examines the NPV of a screening tool for other social needs. While acknowledging the limited amount of time during a clinical visit, we recommend clinicians choose a multi-domain screener to obtain a nuanced understanding of their patients’ unique challenges. To best inform screening tool selection, providers seeking to screen for and address health-related social needs should first and foremost achieve clarity of purpose - by identifying the social needs of concern, the institution\u27s ability to suitably identify those needs, and what targeted actions will be taken. Further research to replicate and expand these findings in diverse samples of children of varying ages and more economically diverse circumstances as well as in other geographic regions is needed to develop a maximally efficient approach for clinical screening for social determinants of health. Beyond adopting a SDOH framework, providers and the health care sector can advocate for strong evidence-based policies that enable them to better address health inequities and improve health outcomes

Place matters: but does local leadership?

The arrival of New Labour into Government witnessed the prominent re-emergence of place onto the policy agenda. This heralded a range of area-based-initiatives designed to both tackle neighbourhood forms of deprivation and to re-establish a sense of identity and connection between individuals and their local community. In terms of place-making, effective and inclusive participation, representation and leadership were all identified as prerequisites for the creation of sustainable communities . But how important is local leadership and strategic vision within local public service organisations in achieving the desired place-making outcomes? This paper examines the extent to which local leadership and strategic vision represents a significant factor in promoting higher levels of satisfaction, belonging, cohesion and participation across single tier councils in England. The ensuing empirical evidence raises significant questions not only about the importance of local leadership in place-making, but also the environmental and organizational factors that shape local places

Assessment of wastewater and recycled water quality: A comparison of lines of evidence from in vitro, in vivo and chemical analyses

We investigated water quality at an advanced water reclamation plant and three conventional wastewater treatment plants using an “ecotoxicity toolbox” consisting of three complementary analyses (chemical analysis, in vitro bioanalysis and in situ biological monitoring), with a focus on endocrine disruption. The in vitro bioassays were chosen to provide an appropriately wide coverage of biological effects relevant to managed aquifer recharge and environmental discharge of treated wastewater, and included bioassays for bacterial toxicity (Microtox), genotoxicity (umuC), photosynthesis inhibition (Max-I-PAM) and endocrine effects (E-SCREEN and AR-CALUX). Chemical analysis of hormones and pesticides using LCMSMS was performed in parallel to correlate standard analytical methods with the in vitro assessment. For two plants with surface water discharge into open drains, further field work was carried out to examine in situ effects using mosquitofish (Gambusia holbrooki) as a bioindicator species for possible endocrine effects.The results show considerable cytotoxicity, phytotoxicity, estrogenicity and androgenicity in raw sewage, all of which were significantly reduced by conventional wastewater treatment. No biological response was detected to RO water, suggesting that reverse osmosis is a significant barrier to biologically active compounds. Chemical analysis and in situ monitoring revealed trends consistent with the in vitro results: chemical analysis confirmed the removal trends observed by the bioanalytical tools, and in situ sampling did not reveal any evidence of endocrine disruption specifically due to discharge of treated wastewater (although other sources may be present). Biomarkers of exposure (in vitro) and effect (in vivo or in situ) are complementary and together provide information with a high level of ecological relevance. This study illustrates the utility of combining multiple lines of evidence in the assessment of water quality

Intentions to Smoke Cigarettes Among Never-Smoking US Middle and High School Electronic Cigarette Users: National Youth Tobacco Survey, 2011–2013

Introduction: Electronic cigarette (e-cigarette) use is increasing rapidly, and the impact on youth is unknown. We assessed associations between e-cigarette use and smoking intentions among US youth who had never smoked conventional cigarettes. Methods: We analyzed data from the nationally representative 2011, 2012, and 2013 National Youth Tobacco Surveys of students in grades 6–12. Youth reporting they would definitely not smoke in the next year or if offered a cigarette by a friend were defined as not having an intention to smoke; all others were classified as having positive intention to smoke conventional cigarettes. Demographics, pro-tobacco advertisement exposure, ever use of e-cigarettes, and ever use of other combustibles (cigars, hookah, bidis, kreteks, and pipes) and noncombustibles (chewing tobacco, snuff, dip, snus, and dissolvables) were included in multivariate analyses that assessed associations with smoking intentions among never-cigarette-smoking youth. Results: Between 2011 and 2013, the number of never-smoking youth who used e-cigarettes increased 3-fold, from 79,000 to more than 263,000. Intention to smoke conventional cigarettes was 43.9% among ever e-cigarette users and 21.5% among never users. Ever e-cigarette users had higher adjusted odds for having smoking intentions than never users (adjusted odds ratio = 1.70, 95% confidence interval = 1.24–2.32). Those who ever used other combustibles, ever used noncombustibles, or reported pro-tobacco advertisement exposure also had increased odds for smoking intentions. Conclusion: In 2013, more than a quarter million never-smoking youth used e-cigarettes. E-cigarette use is associated with increased intentions to smoke cigarettes, and enhanced prevention efforts for youth are important for all forms of tobacco, including e-cigarettes

Efficacy of exercise counselling as an aid for smoking cessation: a randomized controlled trial.

To examine whether exercise counselling increases smoking abstinence and reduces tobacco withdrawal and gains in weight and body fat

Pain and analgesic use associated with skeletal-related events in patients with advanced cancer and bone metastases

PURPOSE: Bone metastases secondary to solid tumors increase the risk of skeletal-related events (SREs), including the occurrence of pathological fracture (PF), radiation to bone (RB), surgery to bone (SB), and spinal cord compression (SCC). The aim of this study was to evaluate the impact of SREs on patients' pain, analgesic use, and pain interference with daily functioning. METHODS: Data were combined from patients with solid tumors and bone metastases who received denosumab or zoledronic acid across three identically designed phase 3 trials (N = 5543). Pain severity (worst pain) and pain interference were assessed using the Brief Pain Inventory at baseline and each monthly visit. Analgesic use was quantified using the Analgesic Quantification Algorithm. RESULTS: The proportion of patients with moderate/severe pain and strong opioid use generally increased in the 6 months preceding an SRE and remained elevated, while they remained relatively consistent over time in patients without an SRE. Regression analysis indicated that all SRE types were significantly associated with an increased risk of progression to moderate/severe pain and strong opioid use. PF, RB, and SCC were associated with significantly greater risk of pain interference overall. Results were similar for pain interference with emotional well-being. All SRE types were associated with significantly greater risk of pain interference with physical function. CONCLUSIONS: SREs are associated with increased pain and analgesic use in patients with bone metastases. Treatments that prevent SREs may decrease pain and the need for opioid analgesics and reduce the impact of pain on daily functioning