Social influence and advocacy pathways during a web-based program for adolescent smoking prevention

Introduction

Exposure to smokers has been identified as a predictor of adolescent tobacco use. Conversely, adolescents who tend to be advocates against smoking may become less likely to initiate smoking themselves. Several digital tobacco prevention programs have been developed to include social strategies. This study aimed to identify (1) whether programs can motivate adolescents to become advocates against smoking, and (2) if being an advocate against smoking and exposure to friends who smoke can predict smoking while controlling for a program's effect.

Methods

We conducted a non-prespecified secondary analysis using data from a randomized controlled trial (RCT) with 18-month follow-up. High schools were randomized to either receive ASPIRE or a tobacco education booklet. We conducted a cross-lagged linear path model to allow for reciprocal associations, estimating a two-time-points, three-variable panel model with logistic regression.

Results

Receiving ASPIRE was associated with a lower likelihood of smoking, but it did not predict becoming an advocate against smoking or changing adolescents' proportion of friends who smoke. After controlling for the effect of ASPIRE, the study shows that adolescents who were advocates against smoking had a decreased risk of smoking by follow-up, and smoking at baseline significantly predicted having a higher proportion of friends who smoke at follow-up.

Discussion

Being an advocate against smoking can be a key predictor of lower odds of smoking, even when controlling for an individual-based intervention. Future research can study the mechanisms and long-term effects of advocacy and incorporate social strategies that can leverage social networks for tobacco prevention.

Racial and ethnic differences in initiation of menthol tobacco smoking and subsequent tobacco use in the Population Assessment of Tobacco and Health Study, Waves 1-4 (2013-2018)

INTRODUCTION

Certain subpopulations in the United States are highly vulnerable to tobacco initiation and addiction, and elimination of disparities among those groups is crucial to reducing the burden of tobacco use.

METHODS

This study evaluated the racial/ethnic differences in smoking initiation of menthol/mint flavored cigarettes and cigars among never-users, and in subsequent tobacco use among new users of menthol-flavored products, using longitudinal data from Waves 1¬4 of the Population Assessment of Tobacco and Health Study. The outcomes of interest were new use of menthol-flavored products, and subsequent past 30-day and past 12-month cigarette and cigar smoking, irrespective of flavors, after initiation.

RESULTS

The percentages of new users of menthol-flavored cigarettes and cigars at Waves 2¬4 were disproportionately higher in non-Hispanic Black and Hispanic than in non-Hispanic White people. Adjusting for age and sex, Black people who first used any menthol cigars had higher risk of past 30-day use of the same cigar category at the subsequent wave (adjusted risk ratio, aRR 1.48; 95% confidence interval, CI 1.11¬1.96) and past 12-month (aRR 1.74; 95% CI 1.55¬2.63) compared to non-Hispanic White smokers. Black people who first used menthol-flavored cigarettes had marginally higher risk of subsequent past 30-day cigarette use (aRR 1.44; 95% CI 0.99¬2.10) compared with their non-Hispanic White counterparts.

CONCLUSIONS

This study shows that racial/ethnic differences exist in both initiation of menthol-flavored tobacco products and product-specific subsequent use after first using menthol-flavored products; Black and Hispanic people have higher rates of initiation; Black people also have higher rates of subsequent use.

IMPLICATIONS

Use of menthol flavors in tobacco products is confirmed to be a contributor to large disparities in tobacco use; Black and Hispanic people are more likely to maintain smoking through use of mentholated products than non-Hispanic White people. The findings suggest educational and regulatory actions on menthol-flavored tobacco products including restricting the selective marketing to vulnerable communities and banning characterizing flavors in cigarettes and cigars may reduce tobacco-related disparities and inform the FDA's evidence-based rulemaking process.

A novel method for evaluating physician communication: A pilot study testing the feasibility of parent-assisted audio recordings via Zoom

OBJECTIVE

Quality of physician consultations are best assessed via direct observation, but require intensive in-clinic research staffing. To evaluate physician consultation quality remotely, we pilot tested the feasibility of parents using their personal mobile phones to facilitate audio recordings of pediatric visits.

METHODS

Across four academic pediatric primary care clinics, we invited all physicians with a patient panel (n=20). For participating physicians, we identified scheduled patients from medical records. We invited parents to participate via text message and phone calls. During their adolescent's appointment, parents used their mobile phone to connect to Zoom for remote research staff to audio record.

RESULTS

In Spring 2021, five of 20 (25%) physicians participated. During a nine-week period, we invited parents of all 54 patients seen by participating physicians of which 15 (28%) completed adult consent and adolescent assent and 10 (19%) participated. For 9 recordings, at least 45% of the conversation was audible.

CONCLUSIONS

It was feasible and acceptable to directly observe physician consultations virtually with Zoom, although participation rates and potentially audio quality were lower.

INNOVATION

Patients used their cellular phone calling features to connect to Zoom where research staff audio-recorded their physician consultation to evaluate communication quality.

Cancer disparities related to poverty and rurality for 22 top cancers in Florida

We aimed to examine poverty and rurality as potential predictors of cancer health disparities. This cross-sectional study used data from the Florida Cancer Data System on all cancer diagnoses in the years 2014–2018 to determine age-adjusted incidence and mortality (per 100,000 population) for the 22 most common cancer sites within rural and urban counties, and high poverty and low poverty communities. Rural/urban and high/low poverty related cancer disparities were tested for statistical significance using the Rate Ratio statistical test. Overall cancer incidence was significantly lower in rural areas than in urban, but significantly higher in high poverty communities. Rurality and poverty were both associated with disparity in cancer incidence risk for tobacco-related cancers. The overall mortality was 22% higher in high poverty areas compared to low poverty areas. Ten cancer sites had mortality disparity from 83% to 17% higher in high poverty areas. Only three cancer sites, all tobacco-related, had higher mortality in rural areas than urban areas, demonstrating the intersectional nature of inhaled and smokeless tobacco use in rural low-income communities. Cancer and mortality rates in rural and urban areas may be largely driven by poverty. The high disparities related to high poverty areas reflects poor access to preventative care and treatment. Low income communities, rural or urban, will require focused efforts to address challenges specific to each population.

Friendship influence moderating the effect of a web-based smoking prevention program on intention to smoke and knowledge among adolescents

PURPOSE

Web-based tobacco prevention programs for adolescents have stressed human-computer interaction, but they have not yet extensively applied social interactivity (i.e., computer-mediated or face-to-face interactions). This study examines if prior tendencies for positive social influence (PSI), negative social influence (NSI), and having friends who smoke (HFS) moderate the success of a web-based program for smoking prevention.

METHODS

Participants were 101 adolescents (aged 12-18 years) from the ASPIRE-Reactions study, a randomized controlled trial comparing a program called ASPIRE with its text-based version. Knowledge of tobacco consequences and intention to smoke were assessed at baseline and end-of-treatment. Tendency for PSI (i.e., avoid tobacco when advised by friends) and NSI (i.e., accept tobacco when offered by friends) were measured at baseline. Repeated-measures mixed-effect modeling was used for hypothesis-testing.

RESULTS

While controlling for ASPIRE effects, both NSI and PSI predicted lower intention to smoke. Adolescents with high NSI were more likely to show a group difference with respect to change in intention to smoke, but not knowledge. Although not significant, this moderation effect was observed in the expected direction with PSI, predicting intention to smoke and knowledge. HFS significantly moderated the effect of ASPIRE on knowledge. Associations with depression and internet use are also described.

CONCLUSION

The results suggest that adolescents with high tendencies for NSI may particularly benefit from web-based interventions such as ASPIRE. Also, web-based interventions may benefit from peer-to-peer interactions, boosting PSI. While current web-based programs include human-computer interaction as their main feature, this study suggests considering social interactivity.

Examining proximity exposure in a social network as a mechanism driving peer influence of adolescent smoking

BACKGROUND

Adolescent peers' influence on tobacco smoking is a dynamic process affected by close friends and other network peers. Although research has examined the influence of immediate friends on smoking behavior (i.e., by cohesion exposure), the influence of all peers according to closeness (i.e., proximity exposure) remains unknown. This study introduces proximity exposure as a potential driver of peer influence.

METHODS

Using the Teenage Friends and Lifestyle Study dataset, we examined 160 adolescents followed for 3 years and assessed their friendship ties and health behavior. Proximity exposure was calculated as the proportion of an individual's network peers who smoked, considering their distance from the individual. Path analysis was conducted with cross-lagged models testing the effect of proximity exposure on smoking frequency over time.

RESULTS

Among nonsmokers without cohesion exposure (n = 80), proximity exposure at year 1 was significantly associated with smoking initiation by year 3. Path analysis (n = 160) indicated that smoking at year 1 predicted cohesion exposure by year 3. When proximity exposure was included, the effect of smoking on cohesion exposure was lost. Early smoking predicted future proximity exposure. However, the predictive value of early proximity toward future smoking was stronger.

CONCLUSION

These results suggest that proximity exposure can predict smoking even among nonsmokers without direct ties to friends who smoke. In support of a peer selection hypothesis, early smoking predicted friendship formation with smokers through cohesion. Conversely, in support of a peer influence hypothesis, proximity exposure predicted smoking. Researchers may consider developing interventions that decrease proximity exposure among adolescents.

Pilot study to inform young adults about the risks of electronic cigarettes through text messaging

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Text messaging is a potentially powerful tool for informing the public about risks.

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After 16 texts, the perceived risk of using e-cigarettes was significantly increased.

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Tobacco risk communication via texts could help guide healthful choices.

Introduction

Young adults are rapidly adopting electronic cigarette (e-cigarette) use. The popularity of e-cigarettes among young people can be attributed to heavy industry advertising and misleading health claims. Data indicate that young e-cigarette users who have never used conventional cigarettes may transition toward smoking combustible cigarettes. Communicating e-cigarette risks via text messaging is limited. This pilot study assessed the impact of exposure to 16 text messages on e-cigarette knowledge and risk perception. The short text messages delivered to participants conveyed e-cigarette use may lead to addiction to nicotine and explained the latest health-related findings.

Methods

A two-group randomized pretest and posttest study was conducted among 95 racially, ethnically diverse young adults recruited from vocational training programs. Fifty percent of participants were randomized to receive either gain- or loss-framed messages. Knowledge and risk perceptions about e-cigarettes and tobacco use were assessed pre- and post-message exposure.

Results

Participants had a mean age of 20.8 years, SD = 1.7. Current use of e-cigarettes was reported by 10.5% (10/95) and 27.4% (26/95) used a variety of other tobacco products. Findings revealed significant increases in knowledge about e-cigarettes after exposure to the messages (range for ps: p < 04 to p < 0.0001). A statistically significant increase in perceived e-cigarette risk was found post-exposure (p = 0.002). Participants randomized to gain-framed messages reported a significantly higher perceived risk of using e-cigarettes post-exposure than did those who received loss-framed messages (p = 0.02).

Conclusions

This was a small-scale pilot requiring additional evidence to support the effectiveness of text messaging for increasing e-cigarette knowledge and risk perception. Future research may apply text messages to test new ways to educate young populations about tobacco use and consider addressing these messages to specific subgroups at high risk of use such as non-college bound young adults.

The presence and stability of nicotine dependence symptoms among adolescents after the implementation of a smoking prevention program

INTRODUCTION

Symptoms of nicotine dependence among adolescents occur at an early stage in smoking onset and can be present even with low exposure to cigarettes. We aim to examine the early occurrence of symptoms of nicotine dependence and how they predict later smoking behavior.

METHODS

Participants were ninety-four currently smoking 9th-graders attending high school in Targu Mures, Romania. They were followed for 6 months with two assessment points: baseline, and follow-up at 6 months. We assessed the following: 1) the number of smoked cigarettes in the last 30 days, 7 days, and 24 hours using the Minnesota Smoking Index; 2) vulnerability to addiction manifested in cessation difficulties, using the 9-item version of the Hooked On Nicotine Checklist (HONC), 3) loss of autonomy using the endorsement of at least one HONC item, and 4) dependence, using the modified Fagerström Tolerance Questionnaire (mFTQ). We performed statistical analysis with SPSS version 19, using paired-sample t-tests for comparing the differences between baseline and follow-up data. We also conducted linear regression analysis to demonstrate the predictive role of the assessed variables, such as the scores of the mFTQ and the HONC in maintaining smoking and reported smoking status.

RESULTS

Regression models indicated that baseline-measures for symptoms of dependence (β=0.64, p<0.001), vulnerability to addiction (β=0.47, p<0.001), and loss of autonomy (β=0.34, p<0.001) regarding smoking cessation were significant predictors of smoking, explaining 41.7% of the variability of the reported increase in cigarette consumption. At follow-up at 6-months, the three variables were responsible for 14.9% for the variance in cigarette consumption (R2=0.14, F(1,92)=16.05, p<0.01).

CONCLUSIONS

Nicotine dependence at baseline and at follow-up show significant differences in the control group while in the intervention group the scores remained stable. The findings suggest that participation in the Romanian version of ASPIRE was protective against progression towards nicotine addiction.

Development and initial testing of the brief adolescent smoking curiosity scale (ASCOS)

BACKGROUND

Although the reasons behind tobacco smoking at young age are complex, research has identified curiosity as a potent driver of smoking among adolescents.

OBJECTIVE

The objective of the current study is to develop and provide initial evidence of reliability and validity of a short scale assessing smoking curiosity among adolescents (first measure of its kind). In particular, we developed and tested the adolescent smoking curiosity scale (ASCOS).

METHODS

After scale development, 101 adolescents completed a survey on smoking-related measures, including ASCOS (June to August 2014). We conducted exploratory factor analysis and Cronbach's alpha calculation to inspect factor-structure and reliability. We conducted multiple linear regression models to examine the scale's capacity to predict antecedents of smoking initiation.

RESULTS

Factor analysis supported a single-factor structure of smoking curiosity. ASCOS was internally reliable (Cronbach's alpha=0.83). Controlling for demographics, the measure correlated significantly with temptation to try smoking (β=0.41, p<0.01), number of friends who smoke (β=0.27, p<0.01), agreeing with the pros of smoking (β=0.41, p<0.001), sensation seeking (β=0.21, p<0.05), and depression (β=0.23, p<0.01). When controlling for a single-item measure for smoking curiosity, ASCOS significantly predicted susceptibility to smoke cigarettes (OR=3.40, p<0.05) and cigars (OR=6.66, p<0.01).

CONCLUSIONS

ASCOS presented good psychometric properties and passed initial validity-testing through associations with antecedents of smoking. ASCOS was a better predictor of susceptibility to smoke than did a traditional single-item measure used by previous research. As an implication, ASCOS can be crucial to the development of tailored interventions for smoking prevention that can reduce smoking curiosity.

Validation of mobile phone text messages for nicotine and tobacco risk communication among college students: A content analysis

INTRODUCTION

In the United States, young adults have the highest prevalence of tobacco use. The dissemination of mobile phone text messages is a growing strategy for tobacco risk communication among young adults. However, little has been done concerning the design and validation of such text messages. The Texas Tobacco Center of Regulatory Science (Texas-TCORS) has developed a library of messages based on framing (gain- or loss-framed), depth (simple or complex) and appeal (emotional or rational). This study validated the library based on depth and appeal, identified text messages that may need improvement, and explored new themes.

METHODS

The library formed the study sample (N=976 messages). The Linguistic Inquiry and Word Count (LIWC) software of 2015 was used to code for word count, word length and frequency of emotional and cognitive words. Analyses of variance, logistic regression and scatter plots were conducted for validation.

RESULTS

In all, 874 messages agreed with LIWC-coding. Several messages did not agree with LIWC. Ten messages designed to be complex indicated simplicity, while 51 messages designed to be rational exhibited no cognitive words. New relevant themes were identified, such as health (e.g. ‘diagnosis’, ‘cancer’), death (e.g. ‘dead’, ‘lethal’) and social connotations (e.g. ‘parents’, ‘friends’).

CONCLUSIONS

Nicotine and tobacco researchers can safely use, for young adults, messages from the Texas-TCORS library to convey information in the intended style. Future work may expand upon the new themes. Findings will be utilized to develop new campaigns, so that risks of nicotine and tobacco products can be widely disseminated.

Testing the nicotine dependence measure mFTQ for adolescent smokers: A multinational investigation

BACKGROUND AND OBJECTIVES

As a measure of nicotine dependence among adolescent smokers, the modified Fagerström Tolerance Questionnaire (mFTQ; seven items), has been successfully used in the United States (USA). Nonetheless, the validity and reliability of mFTQ at the international level is still needed. The current study is the first to test the validity and reliability of mFTQ in four countries: Thailand, Spain, the USA, and Russia.

METHODS

In a cross-sectional survey, mFTQ, risk factors of nicotine dependence, and sociodemographic characteristics were assessed. Risk factors included age of first cigarette, frequency of alcohol use, frequency of marijuana use, and number of cigarettes smoked yesterday. Salivary cotinine was also obtained in Thailand and Spain.

RESULTS

For all four countries, mFTQ exhibited a single factor structure, as supported by previous work in the USA. For all studied countries except Thailand, mFTQ presented acceptable internal reliability. Overall, risk factors of nicotine dependence have predicted mFTQ scores across countries. Frequency of alcohol use in the USA and frequency of marijuana use in Thailand and Spain were not associated with mFTQ scores.

DISCUSSION AND CONCLUSIONS

mFTQ is a single-factor measure of nicotine dependence that shows acceptable internal consistency and validity across countries. Further work can advance the scale and tailor it to different cultures.

SCIENTIFIC SIGNIFICANCE

mFTQ can be a clinically practical international measure of nicotine dependence. This study provides initial support for the utility of the mFTQ among Thai, Spanish, American, and Russian adolescents. Further research is needed to test and advance mFTQ across cultures. (Am J Addict 2017;26:689-696).

A Pilot Study for Linking Adolescent Patients to an Interactive Tobacco Prevention Program

CONTEXT

The American Academy of Pediatrics and professional guidelines recommend intervening with adolescents about avoiding tobacco use in the health-care setting. Barriers in the clinical setting limit consistent provision of this critical service.

OBJECTIVES

This pilot study compared 2 approaches for referring adolescents to an evidence-based tobacco prevention and cessation program in the outpatient setting. Secondary aims assessed tobacco use, knowledge, and program evaluation.

DESIGN SETTING AND PARTICIPANTS

The study setting was a medical and dental clinic. Participants aged 13 to 18 received tobacco advice and instructions to work through "A Smoking Prevention Interactive Experience." The program addresses health concerns of adolescents about tobacco use and is founded on behavioral change theories. The link to access it is featured on the website of the National Cancer Institute's Research-Tested Interventions. Participants (N = 197) were randomized to 1 of 2 approaches (ie, a program link via e-mail or referral by a printed card).

RESULTS

The program was accessed by 57% (112 of 197) of participants. Both referral approaches were equally effective. Non-Hispanics were twice as likely to access the program as Hispanics (adjusted odds ratio = 2.1, 95% confidence interval = 1.2-3.8, P < .05). Over 95% of participants identified themselves as nonusers of tobacco and evaluated the program as beneficial in increasing knowledge and motivation to remain tobacco-free.

CONCLUSION

Linking adolescent patients to an evidence-based tobacco prevention/cessation program at a community health clinic was highly promising and feasible. We present conclusions for future research.

Developing mobile phone text messages for tobacco risk communication among college students: a mixed methods study

BACKGROUND

Engaging young adults for the purpose of communicating health risks associated with nicotine and tobacco use can be challenging since they comprise a population heavily targeted with appealing marketing by the evolving tobacco industry. The Food and Drug Administration seeks novel ways to effectively communicate risks to warn about using these products. This paper describes the first step in developing a text messaging program delivered by smartphones that manipulate three messaging characteristics (i.e., depth, framing, and appeal).

METHODS

Perceptions of community college students were described after previewing text messages designed to inform about risks of using conventional and new tobacco products. Thirty-one tobacco users and nonusers, aged 18-25 participated in five focus discussions held on two community college campuses. Attendees reviewed prototype messages and contributed feedback about text message structure and content. Qualitative data were coded and analyzed using NVivo Version 10.

RESULTS

Most participants were female and two-thirds were ethnic minorities. A variety of conventional and new tobacco products in the past month were used by a third of participants. Three identified domains were derived from the qualitative data. These included perceived risks of using tobacco products, receptivity to message content, and logistical feedback regarding the future message campaign.

CONCLUSION

Overall, participants found the messages to be interesting and appropriate. A gap in awareness of the risks of using new tobacco products was revealed. Feedback on the prototype messages was incorporated into message revisions. These findings provided preliminary confirmation that the forthcoming messaging program will be appealing to young adults.

Efficacy of two Staphylococcus aureus phage cocktails in cheese production

Staphylococcus aureus is one of the most prevalent pathogenic bacteria contaminating dairy products. In an effort to reduce food safety risks, virulent phages are investigated as antibacterial agents to control foodborne pathogens. The aim of this study was to compare sets of virulent phages, design phage cocktails, and use them in a cocktail to control pathogenic staphylococci in cheese. Six selected phages belonging to the three Caudovirales families (Myoviridae, Siphoviridae, Podoviridae) were strictly lytic, had a broad host range, and did not carry genes coding for virulence traits in their genomes. However, they were sensitive to pasteurization. At MOI levels of 15, 45, and 150, two anti-S. aureus phage cocktails, each containing three phages, one from each of the three phage families, eradicated a 10(6)CFU/g S. aureus population after 14 days of Cheddar cheese curd ripening at 4°C. The use of these phages did not trigger over-production of S. aureus enterotoxin C. The use of phage cocktails and their rotation may prevent the emergence of phage resistant bacterial strains.

Effects of readiness to change, quit history, and health perceptions on depressive symptoms among young adult smokers

BACKGROUND

The current study sought to evaluate the main and interactive effect of health perceptions, smoking quit attempt history, and readiness to change with respect to depressive symptoms among college student smokers.

METHOD

The present data came from baseline data from a randomized trial and included 495 undergraduate students (M_age = 23.84, SD = 4.92, 47.47% female) who reported smoking at least 1 cigarette per day.

RESULTS

A three-way interaction emerged between smoking quit attempt history, health perceptions, and readiness to change with respect to depressive symptoms. Quit attempt history was positively associated with depressive symptoms, particularly among individuals high in readiness to change if they perceived their health as poorer relative to peers; however, quit attempt history was negatively associated with depressive symptoms, particularly among individuals high in readiness to change if they perceived their health as comparable or better than that of their peers.

CONCLUSION

These findings support the assertion that readiness to change, quit history and perceived health interact in a dynamic way to confer greater risk for poor outcomes including smoking- (e.g., cessation failure) and psychological-related outcomes (e.g., increased depressive symptoms). As such, development of informed interventions and programs targeting readiness to change to improve quit history and perceptions of health may provide unique benefit.

A televised entertainment-education drama to promote positive discussion about organ donation

This article investigates pathways between the exposure to an entertainment-education (E-E) television drama called Three Rivers and positive discussion of organ donation among viewers of the drama in the United States. A cross-sectional survey was conducted using an online advertising for a period of one week. Survey participants included 1325 adults living in the United States, who had viewed the first episode of Three Rivers on television. Data were collected on recall of events in the storyline, perceived entertainment value, perceived accuracy of the presented health information, rejection of organ donation myths and positive discussion of organ donation and the storyline. Covariates were registration for organ donation, membership to the donation or transplant community and demographic variables. Results show that viewers with high recall of the storyline were more likely to reject myths about organ donation and engage in pro-donation discussions with others. Perceived entertainment value and perceived accuracy acted as mediators in such relationships. The insertion of accurate health information in television drama may be effective in promoting positive discussions about organ donation and myth rejection. Recall of events from the televised E-E drama Three Rivers, entertainment value and accuracy perception were associated with positive discussion.

Application of a novel fiber-optic biosensor in situ to investigate the metabolic effect of lactate infusion

Recently developed biosensor technology, which allows near real-time measurement in situ of gas tension (pCO2 and pO2) and of pH, was applied to arterial blood, cerebrospinal fluid (CSF), and brain parenchyma during intravenous lactate infusion in monkeys. Comparison of simultaneous biosensor measurements and discrete arterial blood sampling for traditional blood gas analyses indicated a high level of correlation for pCO2, pO2, and pH. Arterial pO2 and pH values were significantly higher and pCO2 significantly lower than corresponding CSF and brain parenchyma values at baseline, during and following lactate infusion. There was a divergence between arterial and brain parenchyma pH and pO2 measurements. Lactate infusion was associated with progressive arterial pH rises, consistent with the production of a metabolic alkalosis. Cerebrospinal fluid pCO2 remained unchanged during and following lactate infusion. Brain parenchyma exhibited a complex pattern of response characterized by a trend for pO2 and pH to decrease during lactate infusion, which reversed following completion of the infusion. These observations are suggestive of a transient hypoxia from decreased cerebral blood flow and/or reduced oxyhemoglobin dissociation during lactate infusion, but verification of these results is required.