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Buettner-Schmidt K, Fraase KS, Barnacle M, Peltier A, Saarinen H, Maack B, Turrubiates N. A review of vaping's health effects, treatment, and policy implications: Nursing's call to action. Nurse Pract 2024; 49:36-47. [PMID: 39186124 PMCID: PMC11343445 DOI: 10.1097/01.npr.0000000000000221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/27/2024]
Abstract
ABSTRACT The emergence and subsequent surge in popularity of electronic nicotine delivery systems (ENDS), especially among adolescents and young adults, have reshaped the landscape of tobacco consumption, including use patterns and beliefs as well as therapeutic approaches to the condition. The health implications of ENDS are a cause for concern among NPs, as they include severe nicotine dependence, mental health consequences, and adverse effects on respiratory and cardiac systems, among other issues. This article focuses on the health implications of vaping across the lifespan and emphasizes the need for NPs to evaluate ENDS use consistently across age groups and offer age-appropriate treatment within the clinical setting. Importantly, although vaping is prevalent among various age groups, most tobacco use, including vaping, begins and becomes established during adolescence. This back-to-school season therefore marks an ideal time for NPs to educate their pediatric patients, along with their parents or caregivers, about the widespread effects of vaping on health, and it also serves as a reminder to screen for the condition in adults, regardless of smoking history. To combat this trend on a larger scale, NPs can further advocate for community health by promoting youth prevention programs and supporting policy initiatives aimed at curbing ENDS use.
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Lao J, Tan H, Wu Y, Ding T, Liu X, Sun L, Chen X, Zhu C, Kang Y, Chen YH, Tang C, Wang F, Liu Y. Cerebrospinal Fluid Nitric Oxide Synthase is a Potential Mediator Between Cigarette Smoke Exposure and Sleep Disorders. Nat Sci Sleep 2024; 16:897-906. [PMID: 38974692 PMCID: PMC11225998 DOI: 10.2147/nss.s458294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Accepted: 06/05/2024] [Indexed: 07/09/2024] Open
Abstract
Objective Cigarette smoking and low peripheral nitric oxide synthase (NOS) levels are strongly associated with sleep disorders. However, whether cerebrospinal fluid (CSF) NOS relates to sleep disorders and whether CSF NOS mediates the relationship between cigarette smoking and sleep disorders is unclear. Methods We measured CSF levels of total NOS (tNOS) and its isoforms (inducible NOS [iNOS] and constitutive NOS [cNOS]) in 191 Chinese male subjects. We applied the Pittsburgh Sleep Quality Index (PSQI). Results The PSQI scores of active smokers were significantly higher than those of non-smokers, while CSF tNOS, iNOS, and cNOS were significantly lower (all p < 0.001). CSF tNOS, iNOS, and cNOS were negatively associated with PSQI scores in the general population (all p < 0.001). Mediation analysis suggested that CSF tNOS, iNOS, and cNOS mediate the relationship between smoking and PSQI scores, and the indirect effect accounted for 78.93%, 66.29%, and 81.65% of the total effect, respectively. Conclusion Cigarette smoking is associated with sleep disorders. Active smokers had significantly lower CSF levels of tNOS, iNOS, and cNOS. Furthermore, tNOS, iNOS, and cNOS mediate the relationship between cigarette smoking and sleep quality. This study provides insights into how cigarette smoke affects sleep disorders.
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Affiliation(s)
- Jiaying Lao
- Department of Neurosurgery, Affiliated Cixi Hospital, Wenzhou Medical University, Ningbo, People’s Republic of China
- School of Mental Health, Wenzhou Medical University, Wenzhou, People’s Republic of China
| | - Hang Tan
- Department of neurosurgery, Hangzhou Mingzhou Brain Rehabilitation Hospital, Hangzhou, People’s Republic of China
| | - Yuyu Wu
- School of Mental Health, Wenzhou Medical University, Wenzhou, People’s Republic of China
| | - Ting Ding
- Department of Infectious Diseases, The Affiliated Xiangshan Hospital of Wenzhou Medical University, Ningbo, People’s Republic of China
| | - Xinqian Liu
- Department of Neurosurgery, Affiliated Cixi Hospital, Wenzhou Medical University, Ningbo, People’s Republic of China
| | - Lanrong Sun
- School of Mental Health, Wenzhou Medical University, Wenzhou, People’s Republic of China
| | - Xiyi Chen
- School of Mental Health, Wenzhou Medical University, Wenzhou, People’s Republic of China
| | - Chongrong Zhu
- School of Mental Health, Wenzhou Medical University, Wenzhou, People’s Republic of China
| | - Yiming Kang
- Psychosomatic Medicine Research Division, Inner Mongolia Medical University, Huhhot, People’s Republic of China
| | - Yu-Hsin Chen
- School of Mental Health, Wenzhou Medical University, Wenzhou, People’s Republic of China
- Zhejiang Provincial Clinical Research Center for Mental Disorders, The Affiliated Wenzhou Kangning Hospital, Wenzhou Medical University, Wenzhou, People’s Republic of China
| | - Chonghui Tang
- Department of Neurosurgery, Affiliated Cixi Hospital, Wenzhou Medical University, Ningbo, People’s Republic of China
| | - Fan Wang
- Beijing Hui−Long−Guan Hospital, Peking University, Beijing, People’s Republic of China
| | - Yanlong Liu
- School of Mental Health, Wenzhou Medical University, Wenzhou, People’s Republic of China
- Zhejiang Provincial Clinical Research Center for Mental Disorders, The Affiliated Wenzhou Kangning Hospital, Wenzhou Medical University, Wenzhou, People’s Republic of China
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Wang S, Nandy RR, Rossheim ME. Associations between e-cigarette use and sleep health among adults in the United States, NHANES 2015-2018. Sleep Med 2024; 114:220-228. [PMID: 38232605 DOI: 10.1016/j.sleep.2024.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 08/01/2023] [Accepted: 01/05/2024] [Indexed: 01/19/2024]
Abstract
OBJECTIVE To examine the associations between e-cigarette use or dual (e-cigarette and combustible cigarette) use and short sleep duration and trouble sleeping among U.S. adults. METHODS We used 2015-2018 data from the National Health and Nutrition Examination Survey (NHANES) (n = 11,659). E-cigarette use and dual use were categorized as current, former, and never use. Short sleep duration was defined as sleep duration ≤6 h. Trouble sleeping was self-reported. Weighted logistic regression analyses were performed. RESULTS Among those with current e-cigarette use, 53.9 % were with current dual use and 23.8 % were with former dual use. Compared to never e-cigarette use, current e-cigarette use was associated with significantly higher odds of trouble sleeping (OR = 2.16, 95 % CI: 1.49-3.13), adjusting for potential confounders. Significant associations were also observed for former e-cigarette use versus never use with trouble sleeping (OR = 1.54, 95 % CI: 1.15-2.07) after full adjustment. Current cigarette use was associated with both short sleep duration (OR = 1.65, 95 % CI: 1.28-2.14) and trouble sleeping (OR = 1.36, 95 % CI: 1.03-1.79) after full adjustment. Additionally, the fully adjusted ORs for short sleep duration and trouble sleeping were 1.64 (95 % CI: 1.06-2.54) and 2.14 (95 % CI: 1.34-3.42) among those with current dual use, and 1.46 (95 % CI: 1.17-1.81) and 2.11 (95 % CI: 1.66-2.67) among those with former dual use, compared to those without dual use. CONCLUSIONS Current cigarette use or dual use is associated with significantly higher odds of short sleep duration and trouble sleeping. Moreover, former e-cigarette use or dual use is associated with increased odds of trouble sleeping.
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Affiliation(s)
- Shanshan Wang
- Department of Population & Community Health, School of Public Health, University of North Texas Health Science Center, Fort Worth, TX, USA.
| | - Rajesh R Nandy
- Department of Population & Community Health, School of Public Health, University of North Texas Health Science Center, Fort Worth, TX, USA
| | - Matthew E Rossheim
- Department of Health Administration & Health Policy, School of Public Health, University of North Texas Health Science Center, Fort Worth, TX, USA
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Phiri D, Amelia VL, Muslih M, Dlamini LP, Chung MH, Chang PC. Prevalence of sleep disturbance among adolescents with substance use: a systematic review and meta-analysis. Child Adolesc Psychiatry Ment Health 2023; 17:100. [PMID: 37633926 PMCID: PMC10464186 DOI: 10.1186/s13034-023-00644-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 07/24/2023] [Indexed: 08/28/2023] Open
Abstract
PURPOSE Sleep disturbance has become a major challenge among adolescents worldwide. Substance use is among the most common factors contributing to sleep disturbance. This systematic review and meta-analysis examined the prevalence and categories of sleep disturbance among adolescents with substance use. METHODS We comprehensively searched for relevant studies published in the following databases from inception to August 2022: CINHAL (via EBSCOhost), PubMed, Scopus, Ovid Medline, Embase, ProQuest, and Web of Science. Data analysis was performed using Comprehensive Meta-Analysis version 3 software. We used a random-effects model to pool prevalence rates with 95% confidence intervals (CIs). Forest plots and p values for the Cochran Q statistic were used to evaluate heterogeneity among studies. Subgroup and meta-regression analyses were performed to compare the groups and identify the sources of heterogeneity. RESULTS We examined 18 studies that reported insomnia, hypersomnolence, sleep-related breathing disorders as sleep disturbances among adolescents with the use of alcohol, smoking, marijuana, and coffee. The total sample was 124,554. The overall prevalence rate of sleep disturbance was 29% (95% CI: 0.201-0.403). Subgroup analysis revealed that the prevalence rates of insomnia and hypersomnolence were higher among alcohol users (31%; 95% CI: 0.100-0.654) and smokers (46%; 95% CI: 0.232-0.700). The study design and method of assessment groups were the significant moderators that showed the source of variation in the included studies. CONCLUSION Sleep disturbance is highly prevalent among adolescents with substance use. Insomnia and hypersomnolence are more prevalent among alcohol users and smokers, respectively. On the basis of our findings, health-care providers can develop effective targeted interventions to reduce substance use, prevent sleep disturbance, and promote healthy sleep habits among adolescents.
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Affiliation(s)
- Doreen Phiri
- School of Nursing, College of Nursing, Taipei Medical University, Taipei City, Taiwan
| | - Vivi Leona Amelia
- School of Nursing, College of Nursing, Taipei Medical University, Taipei City, Taiwan
- Universitas Muhammadiyah Purwokerto, Purwokerto, Central Java, Indonesia
| | - Muhammad Muslih
- School of Nursing, College of Nursing, Taipei Medical University, Taipei City, Taiwan
- School of Nursing, Faculty of Health Science, University of Muhammadiyah Malang, Malang, Indonesia
| | | | - Min-Huey Chung
- School of Nursing, College of Nursing, Taipei Medical University, Taipei City, Taiwan.
- Department of Nursing, Taipei Medical University-Shuang Ho Hospital, New Taipei City, Taiwan.
| | - Pi-Chen Chang
- School of Nursing, College of Nursing, Taipei Medical University, Taipei City, Taiwan.
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Ali N, Xavier J, Engur M, Pv M, Bernardino de la Serna J. The impact of e-cigarette exposure on different organ systems: A review of recent evidence and future perspectives. JOURNAL OF HAZARDOUS MATERIALS 2023; 457:131828. [PMID: 37320902 DOI: 10.1016/j.jhazmat.2023.131828] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 05/22/2023] [Accepted: 06/08/2023] [Indexed: 06/17/2023]
Abstract
The use of electronic cigarettes (e-cigs) is rapidly increasing worldwide and is promoted as a smoking cessation tool. The impact of traditional cigs on human health has been well-defined in both animal and human studies. In contrast, little is known about the adverse effects of e-cigs exposure on human health. This review summarizes the impact of e-cigs exposure on different organ systems based on the rapidly expanding recent evidence from experimental and human studies. A number of growing studies have shown the adverse effects of e-cigs exposure on various organ systems. The summarized data in this review indicate that while e-cigs use causes less adverse effects on different organs compared to traditional cigs, its long-term exposure may lead to serious health effects. Data on short-term organ effects are limited and there is no sufficient evidence on long-term organ effects. Moreover, the adverse effects of secondhand and third hand e-cigs vapour exposure have not been thoroughly investigated in previous studies. Although some studies demonstrated e-cigs used as a smoking cessation tool, there is a lack of strong evidence to support it. While some researchers suggested e-cigs as a safer alternative to tobacco smoking, their long-term exposure health effects remain largely unknown. Therefore, more epidemiological and prospective studies including mechanistic studies are needed to address the potential adverse health effects of e-cigs to draw a firm conclusion about their safe use. A wide variation in e-cigs products and the lack of standardized testing methods are the major barriers to evaluating the existing data. Specific regulatory guidelines for both e-cigs components and the manufacturing process may be effective to protect consumer health.
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Affiliation(s)
- Nurshad Ali
- National Heart and Lung Institute, Imperial College London, Sir Alexander Fleming Building, London SW7 2AZ, UK; Department of Biochemistry and Molecular Biology, Shahjalal University of Science and Technology, Sylhet 3114, Bangladesh.
| | - Joseph Xavier
- National Heart and Lung Institute, Imperial College London, Sir Alexander Fleming Building, London SW7 2AZ, UK; Toxicology Division, Biomedical Technology Wing, Sree Chitra Tirunal Institute for Medical Sciences and Technology (Govt. of India), Poojapura, Trivandrum 695012, Kerala, India.
| | - Melih Engur
- National Heart and Lung Institute, Imperial College London, Sir Alexander Fleming Building, London SW7 2AZ, UK
| | - Mohanan Pv
- Toxicology Division, Biomedical Technology Wing, Sree Chitra Tirunal Institute for Medical Sciences and Technology (Govt. of India), Poojapura, Trivandrum 695012, Kerala, India.
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Kreski NT, Ankrum H, Cerdá M, Chen Q, Hasin D, Martins SS, Olfson M, Keyes KM. Nicotine Vaping and Co-occurring Substance Use Among Adolescents in the United States from 2017-2019. Subst Use Misuse 2023; 58:1075-1079. [PMID: 37198725 PMCID: PMC10277150 DOI: 10.1080/10826084.2023.2188462] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/19/2023]
Abstract
Background: The use of electronic cigarettes (or "vaping") among adolescents remains a public health concern given exposure to harmful substances, plus potential association with cannabis and alcohol. Understanding vaping as it intersects with combustible cigarette use and other substance use can inform nicotine prevention efforts. Methods: Data were drawn from 51,872 US adolescents (grades 8, 10, 12, years: 2017-2019) from Monitoring the Future. Multinomial logistic regression analyses assessed links of past 30-day nicotine use (none, smoking-only, vaping-only, and any smoking plus vaping) with both past 30-day cannabis use and past two-week binge drinking. Results: Nicotine use patterns were strongly associated with greater likelihood of cannabis use and binge drinking, particularly for the highest levels of each. For instance, those who smoked and vaped nicotine had 36.53 [95% CI:16.16, 82.60] times higher odds of having 10+ past 2-week binge drinking instances compared to non-users of nicotine. Discussion: Given the strong associations between nicotine use and both cannabis use and binge drinking, there is a need for sustained interventions, advertising and promotion restrictions, and national public education efforts to reduce adolescent nicotine vaping, efforts that acknowledge co-occurring use.
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Affiliation(s)
- Noah T Kreski
- Department of Epidemiology, Columbia University, Mailman School of Public Health, New York, New York, USA
| | - Hadley Ankrum
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, Connecticut, USA
| | - Magdalena Cerdá
- Department of Population Health, New York University School of Medicine, New York, New York, USA
| | - Qixuan Chen
- Department of Biostatistics, Columbia University, Mailman School of Public Health, New York, New York, USA
| | - Deborah Hasin
- Department of Epidemiology, Columbia University, Mailman School of Public Health, New York, New York, USA
- Department of Psychiatry, New York State Psychiatric Institute, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, New York, New York, USA
| | - Silvia S Martins
- Department of Epidemiology, Columbia University, Mailman School of Public Health, New York, New York, USA
| | - Mark Olfson
- Department of Epidemiology, Columbia University, Mailman School of Public Health, New York, New York, USA
- Department of Psychiatry, New York State Psychiatric Institute, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, New York, New York, USA
| | - Katherine M Keyes
- Department of Epidemiology, Columbia University, Mailman School of Public Health, New York, New York, USA
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Pan Z, Wang Q, Guo Y, Xu S, Pan S, Xu S, Zhou Q, Li L. Association of dual electronic cigarettes and marijuana use with sleep duration among adults from the United States, NHANES 2015–2018. Prev Med Rep 2023; 33:102190. [DOI: 10.1016/j.pmedr.2023.102190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 03/21/2023] [Accepted: 03/24/2023] [Indexed: 03/29/2023] Open
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Sutherland BD, Viera Perez PM, Crooks KE, Flannery JS, Hill-Bowen LD, Riedel MC, Laird AR, Trucco EM, Sutherland MT. The association of amygdala-insula functional connectivity and adolescent e-cigarette use via sleep problems and depressive symptoms. Addict Behav 2022; 135:107458. [PMID: 35998541 PMCID: PMC9730909 DOI: 10.1016/j.addbeh.2022.107458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 06/16/2022] [Accepted: 08/02/2022] [Indexed: 11/20/2022]
Abstract
BACKGROUND Adolescent electronic cigarette (e-cigarette) use remains high. Elucidating contributing factors may enhance prevention strategies. Neurobiologically, amygdala-insula resting-state functional connectivity (rsFC) has been linked with aspects of sleep, affect, and substance use (SU). As such, we hypothesized that amygdala's rsFC with the insula would be associated with e-cigarette use via sleep problems and/or depression levels. METHODS An adolescent sample (N = 146) completed a rs-fMRI scan at time 1 and self-reports at time 2 (∼15 months later). Given consistent associations between mental health outcomes and the rsFC of the laterobasal amygdala (lbAMY) with the anterior insula, we utilized a seed region (lbAMY) to region of interest (ROI) analysis approach to characterize brain-behavior relationships. Two serial mediation models tested the interrelations between amygdala's rsFC with distinct anterior insula subregions (i.e., ventral insula [vI], dorsal insula [dI]), sleep problems, depression levels, and days of e-cigarette use. RESULTS An indirect effect was observed when considering the lbAMY's rsFC with the vI. Greater rsFC predicted more sleep problems, more sleep problems were linked with greater depressive symptoms, and greater depressive symptoms were associated with more e-cigarette use (indirect effect = 0.08, CI [0.01,0.21]). Indicative of a neurobiological dissociation, a similar indirect effect linking these variables was not observed when considering the lbAMY's rsFC with the dI (indirect effect = 0.03, CI [-0.001,0.10]). CONCLUSIONS These outcomes highlight functional interactions between the amygdala and insula as a neurobiological contributor to sleep problems, depressive symptoms, and ultimately SU thereby suggesting potential intervention points to reduce teen e-cigarette use.
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Affiliation(s)
| | | | - Katharine E Crooks
- Department of Psychology, Florida International University, Miami, FL, United States
| | - Jessica S Flannery
- Department of Psychology and Neuroscience, University of North Carolina, Chapel Hill, NC, United States
| | - Lauren D Hill-Bowen
- Department of Psychology, Florida International University, Miami, FL, United States
| | - Michael C Riedel
- Department of Physics, Florida International University, Miami, FL, United States
| | - Angela R Laird
- Department of Physics, Florida International University, Miami, FL, United States
| | - Elisa M Trucco
- Department of Psychology, Florida International University, Miami, FL, United States; Addiction Center, University of Michigan, Ann Arbor, MI, United States; Department of Psychiatry, University of Michigan, Ann Arbor, MI, United States
| | - Matthew T Sutherland
- Department of Psychology, Florida International University, Miami, FL, United States
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Pisinger C, Rasmussen SKB. The Health Effects of Real-World Dual Use of Electronic and Conventional Cigarettes versus the Health Effects of Exclusive Smoking of Conventional Cigarettes: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph192013687. [PMID: 36294263 PMCID: PMC9603628 DOI: 10.3390/ijerph192013687] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 10/13/2022] [Accepted: 10/14/2022] [Indexed: 05/31/2023]
Abstract
BACKGROUND A high prevalence of dual use of e-cigarettes and conventional cigarettes has been reported across the world. METHODS A systematic search was carried out. We included original articles on any topic relevant to health, excluding mental health, in all languages. The PRISMA guidelines were followed. Both reviewers independently screened and read all publications. We compared dual use with exclusive smoking of conventional cigarettes (ESCC). RESULTS Fifty-two publications (49 studies) were included. Thirteen papers/10 studies were prospective. There was great heterogeneity across studies. Many methodological weaknesses, such as inaccurate exposure measurement, lack of adjustment for former tobacco consumption, and lack of significance testing were identified. Most prospective studies found dual use to be at least as harmful as ESCC. The longest follow-up was six years. Most of the best available cross-sectional studies found dual use associated with the same and, in several studies, significantly higher risk of self-reported symptoms/disease than in ESCC. The intensity of cigarette smoking seems associated with worse health. CONCLUSION Existing studies indicate that dual use is at least as, or probably even more, harmful than ESCC. Due to the predominance of cross-sectional studies and the methodological weaknesses we judged the overall certainty of the evidence as "low certainty".
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Affiliation(s)
- Charlotta Pisinger
- Center for Clinical Research and Prevention, Bispebjerg-Frederiksberg University Hospital, Capital Region of Denmark, 2400 Copenhagen, Denmark
- Danish Heart Foundation, 1120 Copenhagen, Denmark
- Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, 1165 Copenhagen, Denmark
| | - Sofie K. Bergman Rasmussen
- Center for Clinical Research and Prevention, Bispebjerg-Frederiksberg University Hospital, Capital Region of Denmark, 2400 Copenhagen, Denmark
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Holtz KD, Simkus AA, Twombly EC, Fleming ML, Wanty NI. Sleep deprivation and adolescent susceptibility to vaping in the United States. Prev Med Rep 2022; 26:101756. [PMID: 35359801 PMCID: PMC8961460 DOI: 10.1016/j.pmedr.2022.101756] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Revised: 03/03/2022] [Accepted: 03/06/2022] [Indexed: 11/19/2022] Open
Abstract
Adolescent sleep deprivation is associated with susceptibility to ENDS use. Less than 6 h sleep relates to higher perceived likelihoods of trying ENDS. ENDS prevention efforts may benefit by incorporating sleep hygiene measures.
Sleep deprivation may be a contributing factor to adolescents’ willingness to experiment with substance use, including electronic nicotine devices (ENDS). While it is generally accepted that nicotine has a negative overall effect on sleep, no studies have yet explored whether sleep deprivation may contribute to adolescents’ initiation of ENDS use. The purpose of this study is to explore whether sleep deprivation is associated with adolescents’ self-reported susceptibility to initiating ENDS use in the next month. Respondents were 1,100 adolescents aged 13–17 across the United States who participated in the Vaping Attitudes Youth Perspectives Survey (VAYPS). We used logistic regression to examine cross-sectional associations between self-reported average sleep duration and self-reported likelihood of trying ENDS in the future. Results of the three logistic regression models show that adolescents who reported getting less than six hours of sleep per night were associated with greater odds of reporting any likelihood to try a vape in the next 30 days even when controlling for demographics and potential confounders (<6hrs sleep: OR = 2.63, 95% CI 1.30–5.31). Future research on the association between sleep deprivation and ENDS use among adolescents will benefit from using longitudinal approaches to better understand causality.
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Affiliation(s)
| | - Andrew A. Simkus
- Corresponding author at: KDH Research & Communication, 145 15th Street, NE, Suite 831, Atlanta, GA 30309, USA.
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Baiden P, Szlyk HS, Cavazos-Rehg P, Onyeaka HK, Peoples J, Kasson E. Use of electronic vaping products and mental health among adolescent high school students in the United States: The moderating effect of sex. J Psychiatr Res 2022; 147:24-33. [PMID: 35007808 PMCID: PMC8905685 DOI: 10.1016/j.jpsychires.2021.12.050] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 10/29/2021] [Accepted: 12/20/2021] [Indexed: 12/30/2022]
Abstract
Although studies have investigated the association between conventional tobacco smoking and mental health outcomes among adolescents in the United States, few studies have examined the association between electronic vaping products (EVPs) and mental health among adolescents. This study aimed to investigate the cross-sectional association between EVPs use, symptoms of depression, and suicidal behaviors among adolescents. Data were pooled from the 2017 and 2019 Youth Risk Behavior Survey. An analytic sample of 14,285 adolescents (50.3% female) was analyzed using binary logistic regression. The outcome variables investigated were symptoms of depression, suicidal ideation, suicide plan, and suicide attempts, and the main explanatory variable was EVPs use. Of the 14,285 adolescents, 22.2%, 19.2%, and 58.8% were current, former and never users of EVPs, respectively. Controlling for other factors, current users of EVPs were significantly more likely to report having symptoms of depression (AOR = 1.82, 95% CI = 1.58-2.09), having suicidal ideation (AOR = 1.55, 95% CI = 1.30-1.86), making a suicide plan (AOR = 1.62, 95% CI = 1.34-1.97), or attempting suicide (AOR = 1.75, 95% CI = 1.41-2.18) when compared to never users of EVPs. Gender moderated the association between EVPs use, symptoms of depression, suicidal ideation, and suicide plan. Racial minority identity, sexual minority identity, sexual violence victimization, victim of school and cyberbullying, alcohol use, and cigarette smoking were all significantly associated with depression and suicidal behaviors. Study findings support the association between EVPs use and adolescent mental health. Future studies that employ longitudinal designs may offer more insight into the mechanisms underlying this association.
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Affiliation(s)
- Philip Baiden
- The University of Texas at Arlington, School of Social Work, 211 S. Cooper St., Box 19129, Arlington, TX, 76019, USA.
| | - Hannah S. Szlyk
- Rutgers, The State University of New Jersey, School of Social Work, 120 Albany St, New Brunswick, NJ 08901
| | - Patricia Cavazos-Rehg
- Department of Psychiatry, Washington University School of Medicine, 660 South Euclid Avenue, Box 8134, St. Louis, MO 63110
| | - Henry K. Onyeaka
- Harvard Medical School, Department of Psychiatry, Massachusetts General Hospital/McLean Hospital, Boston, MA, USA, 02115
| | - JaNiene Peoples
- The Brown School at Washington University in St. Louis, One Brookings Drive, St. Louis, MO 63130
| | - Erin Kasson
- Department of Psychiatry, Washington University School of Medicine, 660 South Euclid Avenue, Box 8134, St. Louis, MO 63110
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Gunge D, Marganski J, Advani I, Boddu S, Chen YJE, Mehta S, Merz W, Fuentes AL, Malhotra A, Banks SJ, Alexander LEC. Deleterious Association of Inhalant Use on Sleep Quality during the COVID-19 Pandemic. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182413203. [PMID: 34948812 PMCID: PMC8703610 DOI: 10.3390/ijerph182413203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 12/09/2021] [Accepted: 12/10/2021] [Indexed: 11/29/2022]
Abstract
The COVID-19 pandemic generated large amounts of stress across the globe. While acute stress negatively impacts health, defining exact consequences and behavioral interventions can be difficult. We hypothesized that a generalized increase in stress and anxiety caused by continuation of the global pandemic would negatively impact sleep quality and that ever users of e-cigarettes and conventional tobacco would have more profound alterations over time. Participants were recruited via social media to complete an online survey in April 2020 (n = 554). Inhalant use was assessed through the UCSD Inhalant Questionnaire and sleep quality was gauged through the Pittsburgh Sleep Quality Index (PSQI). A set of participants (n = 217) retook the survey in June 2020. Inhalant users—historical or current e-cigarette vapers, conventional tobacco smokers, and dual users—had higher PSQI scores than never smoker/never vapers, demonstrating worse sleep quality in inhalant users. Non-smoking/non-vaping subjects who retook the survey in June 2020 had improvement in their PSQI scores by paired t test, indicating better sleep quality as the pandemic continued, while inhalant users of all types had persistently high PSQI scores (poor sleep quality). These data suggest that ever users of tobacco products may be susceptible to overall diminished sleep quality in the setting of stressful life circumstances. These data also suggest that pandemic-initiated lifestyle changes may have led to improvements in sleep quality. Finally, these findings raise concerns for correlations between either past or active e-cigarette use on sleep, and thus overall health.
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Affiliation(s)
- Deepti Gunge
- Department of Medicine, Pulmonary Critical Care Section, Veterans Affairs (VA) San Diego Healthcare System, La Jolla, CA 92161, USA; (D.G.); (I.A.); (Y.J.E.C.); (S.M.); (W.M.); (A.L.F.); (A.M.); (S.J.B.)
- Department of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, University of California San Diego (UCSD), La Jolla, CA 92093, USA; (J.M.); (S.B.)
| | - Jordan Marganski
- Department of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, University of California San Diego (UCSD), La Jolla, CA 92093, USA; (J.M.); (S.B.)
| | - Ira Advani
- Department of Medicine, Pulmonary Critical Care Section, Veterans Affairs (VA) San Diego Healthcare System, La Jolla, CA 92161, USA; (D.G.); (I.A.); (Y.J.E.C.); (S.M.); (W.M.); (A.L.F.); (A.M.); (S.J.B.)
- Department of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, University of California San Diego (UCSD), La Jolla, CA 92093, USA; (J.M.); (S.B.)
| | - Shreyes Boddu
- Department of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, University of California San Diego (UCSD), La Jolla, CA 92093, USA; (J.M.); (S.B.)
| | - Yi Jan Ella Chen
- Department of Medicine, Pulmonary Critical Care Section, Veterans Affairs (VA) San Diego Healthcare System, La Jolla, CA 92161, USA; (D.G.); (I.A.); (Y.J.E.C.); (S.M.); (W.M.); (A.L.F.); (A.M.); (S.J.B.)
- Department of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, University of California San Diego (UCSD), La Jolla, CA 92093, USA; (J.M.); (S.B.)
| | - Sagar Mehta
- Department of Medicine, Pulmonary Critical Care Section, Veterans Affairs (VA) San Diego Healthcare System, La Jolla, CA 92161, USA; (D.G.); (I.A.); (Y.J.E.C.); (S.M.); (W.M.); (A.L.F.); (A.M.); (S.J.B.)
- Department of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, University of California San Diego (UCSD), La Jolla, CA 92093, USA; (J.M.); (S.B.)
| | - William Merz
- Department of Medicine, Pulmonary Critical Care Section, Veterans Affairs (VA) San Diego Healthcare System, La Jolla, CA 92161, USA; (D.G.); (I.A.); (Y.J.E.C.); (S.M.); (W.M.); (A.L.F.); (A.M.); (S.J.B.)
- Department of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, University of California San Diego (UCSD), La Jolla, CA 92093, USA; (J.M.); (S.B.)
| | - Ana Lucia Fuentes
- Department of Medicine, Pulmonary Critical Care Section, Veterans Affairs (VA) San Diego Healthcare System, La Jolla, CA 92161, USA; (D.G.); (I.A.); (Y.J.E.C.); (S.M.); (W.M.); (A.L.F.); (A.M.); (S.J.B.)
- Department of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, University of California San Diego (UCSD), La Jolla, CA 92093, USA; (J.M.); (S.B.)
| | - Atul Malhotra
- Department of Medicine, Pulmonary Critical Care Section, Veterans Affairs (VA) San Diego Healthcare System, La Jolla, CA 92161, USA; (D.G.); (I.A.); (Y.J.E.C.); (S.M.); (W.M.); (A.L.F.); (A.M.); (S.J.B.)
- Department of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, University of California San Diego (UCSD), La Jolla, CA 92093, USA; (J.M.); (S.B.)
| | - Sarah J. Banks
- Department of Medicine, Pulmonary Critical Care Section, Veterans Affairs (VA) San Diego Healthcare System, La Jolla, CA 92161, USA; (D.G.); (I.A.); (Y.J.E.C.); (S.M.); (W.M.); (A.L.F.); (A.M.); (S.J.B.)
- Department of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, University of California San Diego (UCSD), La Jolla, CA 92093, USA; (J.M.); (S.B.)
- Department of Neurosciences, Division of Pulmonary, University of California San Diego (UCSD), La Jolla, CA 92093, USA
| | - Laura E. Crotty Alexander
- Department of Medicine, Pulmonary Critical Care Section, Veterans Affairs (VA) San Diego Healthcare System, La Jolla, CA 92161, USA; (D.G.); (I.A.); (Y.J.E.C.); (S.M.); (W.M.); (A.L.F.); (A.M.); (S.J.B.)
- Department of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, University of California San Diego (UCSD), La Jolla, CA 92093, USA; (J.M.); (S.B.)
- Correspondence: ; Tel.: +1-619-438-4207
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Youth use of e-cigarettes: Does dependence vary by device type? Addict Behav 2021; 119:106918. [PMID: 33798918 DOI: 10.1016/j.addbeh.2021.106918] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 03/10/2021] [Accepted: 03/18/2021] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Youth nicotine dependence may vary by e-cigarette device used. METHODS E-cigarette device type ("JUUL," "similar pod/JUUL like device (i.e., pod mod)," or "other type of e-cigarette" (i.e., tank, mod)), nicotine dependence (Hooked on Nicotine Checklist; HONC), frequency of e-cigarette use (i.e., weekly, daily, monthly), and covariates were examined via a convenience sample of youth who use e-cigarettes in the United States via an online Qualtrics panel survey from April 2019 to May 2019. RESULTS Youth aged 13-17 (Mean age = 15.9 years, SD = 1.0 year; n = 185) were mostly 72.4% female. Primary device used by category was endorsed as follows: JUUL n = 87, pod mod n = 42, and other type of e-cigarette n = 56. Participants endorsed an average of 4.5 / 10 HONC symptoms (SD = 3.6). Compared to other e-cigarettes, youth who used JUUL and pod mod devices endorsed more dependence symptoms, even when adjusting for current smoking status (JUUL IRR = 1.96, 95% CI 1.30-2.97; pod mod device IRR = 1.76, 95% CI 1.08-2.87). In total, HONC symptoms significantly differed by device for 8/10 symptoms, with JUUL and pod mod users reporting higher frequency of items compared to other e-cigarette devices. CONCLUSIONS Features of nicotine dependence experienced by youth (i.e., feeling a stronger urge to vape) differed by primary device used, with those using JUUL and pod-mods reporting a greater level of dependence. Regulation of features of e-cigarette devices that may increase nicotine delivery and subsequent development of dependence among youth warrant urgent consideration.
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Combustible and electronic cigarette use and insufficient sleep among U.S. high school students. Prev Med 2021; 147:106505. [PMID: 33667467 PMCID: PMC8096720 DOI: 10.1016/j.ypmed.2021.106505] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 12/27/2020] [Accepted: 02/27/2021] [Indexed: 12/28/2022]
Abstract
The study aimed to investigate the relationships between current exclusive e-cigarette use, exclusive combustible cigarette smoking, and dual use of e-cigarettes and combustible cigarettes, and insufficient sleep among U.S. adolescents. We conducted a secondary data analysis of the 2017 Youth Risk Behavior Survey including 11,296 U.S. high school students. Current (past 30-day) tobacco use groups included exclusive e-cigarette users, exclusive combustible cigarette smokers, and dual-product users. We performed weighted unadjusted and adjusted logistic regression analyses. Insufficient sleep was defined as <8 h/night and < 7 h/night. Overall, 73.4% of adolescents reported insufficient sleep <8 h/night. Compared with non-tobacco users, exclusive e-cigarette users were more likely to report insufficient sleep <8 h/night (odds ratio [OR] = 1.55, 95%CI = 1.12-2.14; adjusted OR [aOR] = 1.57, 95%CI = 1.01-2.43) and < 7 h/night (OR = 1.55, 95%CI = 1.19-2.01; aOR = 1.61, 95%CI = 1.16-2.24). Dual-product users were at increased odds to report insufficient sleep <8 h/night (OR = 3.15, 95%CI = 1.87-5.32) and < 7 h/night (OR = 2.64, 95%CI = 1.87-3.72; aOR = 1.73, 95%CI = 1.14-2.62) than non-tobacco users. Exclusive combustible cigarette smokers were less likely to report insufficient sleep <8 h/night (aOR = 0.49, 95%CI = 0.29-0.84) than non-tobacco users, but no differences were found based on insufficient sleep <7 h/night. When comparing current use groups, exclusive e-cigarette users were at 3.20 increased odds (95%CI = 1.65-6.22) and dual-product users were at 3.26 increased odds (95%CI = 1.51-7.03) to report insufficient sleep <8 h/night when compared with exclusive combustible cigarette smokers after covariate adjustment. Dual-product users were 1.89 times more likely (95%CI = 1.01-3.51) to report insufficient sleep <7 h/night when compared with exclusive combustible cigarette smokers. School-based prevention efforts for tobacco use may promote sufficient sleep in youth.
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Abstract
Background: Recently, the use of cigarettes and e-cigarettes rises among Korean adults. This study examined between-groups differences in depression and sleep quality based on smoking/vaping status. Methods: The groups were classified into non-users, cigarette users, and dual-users according to the present use of cigarettes and e-cigarettes. Data from the 2018 Korean Community Health Survey (KCHS) were used in this study. The participants were 153,646 adults aged > 19cyears. Results: One-way analysis of covariance models showed that dual-users reported significantly higher depression scores (PHQ-9) and significantly lower sleep quality (PSQI-K), respectively, than did cigarette users and non-users. Conclusions: These results imply that dual-use can have a negative impact on mental health. This study supports previous studies on the harmfulness of dual-use and suggests that more studies related to the dual-use of cigarettes should be conducted in the future.
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Affiliation(s)
- Seon-Gyeong Kang
- Department of Psychology, Graduate School, Dankook University, Cheonan, Republic of Korea
| | - Sung-Man Bae
- Department of Psychology, Graduate School, Dankook University, Cheonan, Republic of Korea.,Department of Psychology and Psychotherapy, College of Health Science, Dankook University, Cheonan, Republic of Korea
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16
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Lee BG, Lee H. [Associations between Cigarette and Electronic Cigarette Use and Sleep Health in Korean Adolescents: An Analysis of the 14th (2018) Korea Youth Risk Behavior Surveys]. J Korean Acad Nurs 2021; 51:380-389. [PMID: 34215714 DOI: 10.4040/jkan.21034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 04/19/2021] [Accepted: 04/28/2021] [Indexed: 11/09/2022]
Abstract
PURPOSE This study aimed to understand the relationship between cigarette and electronic cigarette (e-cigarette) use and sleep health among Korean adolescents. METHODS Using the 14th Korea Youth Risk Behavior Survey, we included 52,928 adolescents who responded to sleep satisfaction and sleep duration. Participants were classified into four groups: non-users, cigarette-only users, e-cigarette-only users, and dual users of both products. To examine the associations between cigarette and e-cigarette use and sleep health, data were analyzed using complex samples cross tabulation and complex samples logistic regression. RESULTS Of the four groups, dual users reported the lowest level of sleep satisfaction and sleep duration; 57.0% and 86.9% of dual users were not satisfied with their sleep and have insufficient sleep duration, respectively. The proportion of students who were not satisfied with their sleep was higher among cigarette-only users compared to e-cigarette-only users (52.7% vs. 45.8%), but the two groups reported similar rates of insufficient sleep duration (84.2% vs. 84.3%). Compared to non-users, cigarette-only users, e-cigarette-only users, and dual users were more likely to not be satisfied with sleep (odds ratios [ORs] were 1.49, 1.36, and 1.75, respectively) and had significantly higher odds of experiencing insufficient sleep duration (ORs were 1.85, 2.06, and 2.34, respectively). CONCLUSION E-cigarette-only use and dual use as well as cigarette-only use were associated with poor sleep health. Therefore, to improve adolescent sleep health, health professionals should provide sleep intervention strategies considering the association between smoking and sleep health.
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Affiliation(s)
- Bo Gyeong Lee
- College of Nursing · Research Institute of Nursing Science, Daegu Catholic University, Daegu, Korea
| | - Haein Lee
- College of Nursing · Research Institute of Nursing Science, Daegu Catholic University, Daegu, Korea.
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Kianersi S, Zhang Y, Rosenberg M, Macy JT. Association between e-cigarette use and sleep deprivation in U.S. Young adults: Results from the 2017 and 2018 Behavioral Risk Factor Surveillance System. Addict Behav 2021; 112:106646. [PMID: 32977271 DOI: 10.1016/j.addbeh.2020.106646] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 08/18/2020] [Accepted: 09/02/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Few studies have assessed the association between e-cigarette use and sleep deprivation. This is an important question given the rapid increase in e-cigarette use among young adults in recent years. PURPOSE To determine whether e-cigarette use is associated with sleep deprivation in a sample of young (18-24 years-old) American adults. METHODS We used pooled cross-sectional data from the 2017 and 2018 Behavioral Risk Factor Surveillance System (BRFSS), selecting respondents aged 18 to 24 from forty-one states and U.S. territories that included the e-cigarette and sleep modules in the interview (N = 19,701). Poisson regression models tested the relationship between e-cigarette use and sleep deprivation. We adjusted for sociodemographic variables, physical activity, mental health, BMI, smokeless tobacco products use, alcohol drinking, and smoking. RESULTS In the pooled dataset, the weighted prevalence of current or former e-cigarette use was 47% and 35% of participants self-reported sleep deprivation. After adjusting for confounders, former e-cigarette users were 1.17 times more likely to report sleep deprivation, compared to never users (95%CI: 1.06, 1.29). The prevalence ratio for self-reported sleep deprivation increased to 1.42 (95%CI: 1.23, 1.65) for everyday users, compared to never e-cigarette users. CONCLUSIONS These findings suggest that e-cigarette use might be related to sleep deprivation in young adults. Future longitudinal studies should assess the causal and dose-response nature of this relationship.
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So CJ, Meers JM, Alfano CA, Garey L, Zvolensky MJ. Main and Interactive Effects of Nicotine Product Type on Sleep Health Among Dual Combustible and E-Cigarette Users. Am J Addict 2020; 30:147-155. [PMID: 33231910 DOI: 10.1111/ajad.13130] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 09/24/2020] [Accepted: 10/25/2020] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND AND OBJECTIVES E-cigarette use is associated with concurrent use of combustible cigarettes among adults and may increase the risk of future combustible cigarette use in adolescents and young adults. Detrimental effects of combustible cigarette use on sleep health are well documented, but little is known about the additive effects of concurrent e-cigarette use. The current study examined the main and interactive effects of daily nicotine product frequency on various components of sleep health. METHODS Two hundred and twenty-seven dual-product users (54.2% female, Mage = 36.89, SD = 10.17) completed questionnaires regarding demographic information, average number of cigarettes smoked per day, average number of times e-cigarettes used per day, and sleep health. RESULTS Combustible cigarette frequency uniquely predicted shorter sleep duration, whereas e-cigarette frequency uniquely predicted increased daytime dysfunction due to sleepiness. Further, there was an interactive effect of combustible and electronic cigarettes on the use of sleeping medications. DISCUSSION AND CONCLUSIONS Findings may suggest differential adverse effects on sleep, depending on the type of nicotine product used, and highlight potential intervention targets for users. Future work should examine these associations prospectively and/or use objective measurements of sleep and nicotine use to further elucidate the nature of these relationships. SCIENTIFIC SIGNIFICANCE This is the first study to explore the main and interactive effects of dual-product use on various dimensions of subjective sleep quality. This is important to investigate, given that dual nicotine users are at greater risk for physical health problems as well as the adverse effects of nicotine on sleep health. (Am J Addict 2020;00:00-00).
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Affiliation(s)
- Christine J So
- Department of Psychology, University of Houston, Houston, Texas
| | - Jessica M Meers
- Department of Psychology, University of Houston, Houston, Texas
| | - Candice A Alfano
- Department of Psychology, University of Houston, Houston, Texas.,HEALTH Research Institute, University of Houston, Houston, Texas
| | - Lorra Garey
- Department of Psychology, University of Houston, Houston, Texas
| | - Michael J Zvolensky
- Department of Psychology, University of Houston, Houston, Texas.,HEALTH Research Institute, University of Houston, Houston, Texas.,Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, Texas
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