The Effects of Traditional Cigarette and E-Cigarette Taxes on Adult Tobacco Product Use

We study the effects of traditional cigarette tax rate changes and e-cigarette tax adoption on use of these products among US adults. Data are drawn from the Behavioral Risk Factor Surveillance System and National Health Interview Survey data over the period 2011to 2017. Using a difference-in-differences model, we find that higher traditional cigarette taxes reduce adult traditional cigarette use and increase adult e-cigarette use, suggesting that the products are economic substitutes. E-cigarette tax adoption reduces e-cigarette use, with some heterogeneity across groups, and dilutes the own-tax responsiveness of traditional cigarettes

Patient Perspectives on Medication Assisted Therapy in Vermont

Introduction. Medication-Assisted Therapy (MAT) for opioid addiction has dramatically increased in Vermont, supported by a novel statewide system that integrates specialty treatment centers ( Hubs ) with primary care office-based opioid therapy ( Spokes ). In 2010, Vermont had the highest per capita buprenorphine use in the US. Previous studies of patient perspectives of MAT have identified social barriers, rigid program rules, and concerns about withdrawal and relapse as common causes of treatment failure. Our goal was to elicit patient perspectives on barriers and enablers of successful MAT to further inform system refinement. Methods. An interview guide was developed based on previous literature as well as discussions with program leadership, staff and clinicians, and community stakeholders. Responses were organized using thematic content analysis with consensus across seven interviewers and two analysts. The interviews were conducted with 44 patients enrolled in MAT at two Hub sites in Burlington, VT in October 2016. Results. The median age of subjects was 34 years, 34% were employed at least part-time, and 72% were female. Half reported a mental health condition and 20% reported chronic pain. Barriers included transportation (25%), lack of stable housing, and stigma (41%). Enablers included feeling supported (82% felt well-supported; 52% felt supported by healthcare professionals). Subjects expressed high confidence in the treatment system and high self-efficacy for sobriety. Conclusions. Patients in MAT have complex medical, mental health, social, personal, and work lives. A comprehensive system that addresses this wide range of domains is critical to achieving optimal outcomes.https://scholarworks.uvm.edu/comphp_gallery/1245/thumbnail.jp

The Effects of E-Cigarette Taxes on E-Cigarette Prices and Tobacco Product Sales: Evidence from Retail Panel Data

We explore the effect of e-cigarette taxes enacted through 2017 in eight states and two large counties on e-cigarette prices, e-cigarette sales, and sales of other tobacco products. We use the Nielsen Retail Scanner data for the years 2011 to 2017, comprising approximately 35,000 retailers nationally. We calculate a Herfindahl–Hirschman Index of 0.251 for retail-based purchases of e-cigarettes, indicating high market concentration. We estimate a tax-to-price pass-through of 1.55 (p \u3c 0.01) and an e-cigarette own-price elasticity of -2.6 (p \u3c 0.01) for the average e-cigarette tax. We also estimate a positive cross-price elasticity of demand for e-cigarettes and traditional cigarettes of roughly 1.1 for the average tax, suggesting that e-cigarettes and traditional cigarettes are economic substitutes. Our results suggest that higher e-cigarette taxes would increase e-cigarette prices and reduce e-cigarette sales, with an unintended effect of increasing traditional cigarette sales. We simulate that for every one standard e-cigarette pod (a device that contains liquid nicotine in e-cigarettes) of 0.7 ml no longer purchased as a result of an e-cigarette tax, the same tax increases traditional cigarettes purchased by 6.2 extra packs

The Impact of Formal Strength and Conditioning on the Fitness of Law Enforcement Recruits: A Retrospective Cohort Study

International Journal of Exercise Science 13(4): 1615-1629, 2020. Research involving law enforcement populations has suggested better fitness could enhance job task performance and reduce injuries. Academy training should lead to improvements in recruit fitness. The aim of this study was to investigate the impact of a strength and conditioning program on fitness among law enforcement recruits. Twenty-six recruits (23 males, three females) completed a 27-week academy, which incorporated 3-4 physical training sessions per week. Fitness assessment occurred during pre- (week 0), mid- (week 14), and post-testing (week 27) time points. The fitness assessments included: vertical jump, one-minute push-ups, one-minute sit-ups, posterior chain strength measured by a leg/back dynamometer, grip strength, and aerobic fitness measured by the 20-m multistage shuttle run (MSR). A repeated measures ANOVA with Bonferroni post hoc tests determined any significant changes in fitness between time points, with alpha set at p \u3c .05. Due to the small sample size of females, statistical analysis was only conducted on male recruits. Overall, significant main effects (p \u3c .001) were observed in all fitness assessments except for grip strength. The results detailed general improvements in fitness. However, push-up and MSR scores decreased from mid- to post-test, while sit-ups did not change. Posterior chain strength and the vertical jump improved from mid- to post-test. The data indicated that the strength and conditioning program positively influenced the fitness of recruits. An increased focus on skill-specific work in the second-half of academy may have contributed to the plateaus in muscular endurance and aerobic fitness, and improvement of lower-body strength and power

Intended and Unintended Effects of E-cigarette Taxes on Youth Tobacco Use

Over the past decade, rising youth use of e-cigarettes and other electronic nicotine delivery systems (ENDS) has prompted aggressive regulation by state and local governments. Between 2010 and 2019, ten states and two large counties adopted ENDS taxes. Applying a continuous treatment difference-in-differences approach to data from two large national datasets (Monitoring the Future and the Youth Risk Behavior Surveillance System), this study explores the impact of ENDS taxes on youth tobacco use. We find that ENDS taxes reduce youth e-cigarette consumption, with estimated e-cigarette tax elasticities of -0.06 to -0.21. However, we estimate sizable positive cigarette cross-tax elasticities, suggesting economic substitution between cigarettes and e-cigarettes for youth. These substitution effects are particularly large for frequent cigarette smoking. We conclude that the unintended effects of ENDS taxation may more than fully offset any public health gains

Association of angiotensin-converting enzyme inhibitor therapy and comorbidity in diabetes: results from the Vermont diabetes information system

<p>Abstract</p> <p>Background</p> <p>Angiotensin converting enzyme inhibitors (ACE inhibitors) reduce peripheral vascular resistance via blockage of angiotensin converting enzyme (ACE). ACE inhibitors are commonly used to treat congestive heart failure and high blood pressure, but other effects have been reported. In this study, we explored the association between ACE inhibitor therapy and the prevalence of comorbid conditions in adults with diabetes</p> <p>Methods</p> <p>We surveyed 1003 adults with diabetes randomly selected from community practices. Patients were interviewed at home and self-reported their personal and clinical characteristics including comorbidity. Current medications were obtained by direct observation of medication containers. We built logistic regression models with the history of comorbidities as the outcome variable and the current use of ACE inhibitors as the primary predictor variable. We adjusted for possible confounding by social (age, sex, alcohol drinking, cigarette smoking) and clinical factors (systolic blood pressure, body mass index (BMI), glycosolated hemoglobin (A1C), number of comorbid conditions, and number of prescription medications).</p> <p>Results</p> <p>ACE users reported a history of any cancer (except the non-life-threatening skin cancers) less frequently than non-users (10% <it>vs</it>. 15%; odd ratio = 0.59; 95% confidence interval [0.39, 0.89]; <it>P </it>= 0.01); and a history of stomach ulcers or peptic ulcer disease less frequently than non-users (12% <it>vs</it>. 16%, odd ratio = 0.70, [0.49, 1.01], <it>P </it>= 0.06). After correcting for potential confounders, ACE inhibitors remained significantly inversely associated with a personal history of cancer (odds ratio = 0.59, [0.39, 0.89]; <it>P </it>= 0.01) and peptic ulcer disease (odd ratio = 0.68, [0.46, 1.00], <it>P </it>= 0.05).</p> <p>Conclusion</p> <p>ACE inhibitor use is associated with a lower likelihood of a history of cancer and peptic ulcers in patients with diabetes. These findings are limited by the cross sectional study design, self-report of comorbid diagnoses, and lack of information on the timing and duration of ACE inhibitor use. Further research is needed to confirm these associations and understand their mechanisms.</p

Association between cancer prevalence and use of thiazolidinediones: results from the Vermont Diabetes Information System

<p>Abstract</p> <p>Background</p> <p>Peroxisome proliferator-activated receptors (PPARs) have emerged as important drug targets for diabetes. Drugs that activate PPARγ, such as the thiazolidinediones (TZDs), are widely used for treatment of Type 2 diabetes mellitus. PPARγ signaling could also play an anti-neoplastic role in several <it>in vitro </it>models, although conflicting results are reported from <it>in vivo </it>models. The effects of TZDs on cancer risk in humans needs to be resolved as these drugs are prescribed for long periods of time in patients with diabetes.</p> <p>Methods</p> <p>A total of 1003 subjects in community practice settings were interviewed at home at the time of enrolment into the Vermont Diabetes Information System, a clinical decision support program. Patients self-reported their personal and clinical characteristics, including any history of malignancy. Laboratory data were obtained directly from the clinical laboratory and current medications were obtained by direct observation of medication containers. We performed a cross-sectional analysis of the interviewed subjects to assess a possible association between cancer diagnosis and the use of TZDs.</p> <p>Results</p> <p>In a multivariate logistic regression model, a diagnosis of cancer was significantly associated with TZD use, even after correcting for potential confounders including other oral anti-diabetic agents (sulfonylureas and biguanides), age, glycosylated hemoglobin A1C, body mass index, cigarette smoking, high comorbidity, and number of prescription medications (odds ratio = 1.59, <it>P </it>= 0.04). This association was particularly strong among patients using rosiglitazone (OR = 1.89, <it>P </it>= 0.02), and among women (OR = 2.07, <it>P </it>= 0.01).</p> <p>Conclusion</p> <p>These data suggest an association between TZD use and cancer in patients with diabetes. Further studies are required to determine if this association is causal.</p

Feasibility of automated pre-screening for lifestyle and behavioral health risk factors in primary care

Background: Screening of primary care patients for unhealthy behaviors and mental health issues is recommended by numerous governing bodies internationally, yet evidence suggests that provider-initiated screening is not routine practice. The objective of this study was to implement systematic pre-screening of primary care patients for common preventive health issues on a large scale. Methods: Patients registered for non-acute visits to one of 40 primary care providers from eight clinics in an Academic Medical Center health care network in the United States from May, 2012 to May, 2014 were contacted one- to three-days prior to their visit. Patients were invited to complete a questionnaire using an Interactive Voice Response (IVR) system. Six items assessed pain, smoking, alcohol use, physical activity, concern about weight, and mood. Results: The acceptance rate among eligible patients reached by phone was 65.6 %, of which 95.5 % completed the IVR-Screen (N = 8,490; mean age 57; 57 % female). Sample demographics were representative of the overall primary care population from which participants were drawn on gender, race, and insurance status, but participants were slightly older and more likely to be married. Eighty-seven percent of patients screened positive on at least one item, and 59 % endorsed multiple problems. The majority of respondents (64.2 %) reported being never or only somewhat physically active. Weight concern was reported by 43.9 % of respondents, 36.4 % met criteria for unhealthy alcohol use, 23.4 % reported current pain, 19.6 % reported low mood, and 9.4 % reported smoking. Conclusions: The percent endorsement for each behavioral health concern was generally consistent with studies of screening using other methods, and contrasts starkly with the reported low rates of screening and intervention for such concerns in typical PC practice. Results support the feasibility of IVR-based, large-scale pre-appointment behavioral health/ lifestyle risk factor screening of primary care patients. Pre-screening in this population facilitated participation in a controlled trial of brief treatment for unhealthy drinking, and also could be valuable clinically because it allows for case identification and management during routine care