Biochemical verification of smoking abstinence remains an important validity check of cessation trial outcomes. Digital health trials rarely establish in-person contacts between participants and ...intervention providers, requiring novel strategies to biochemically verify outcomes. We describe remote verification of smoking abstinence via saliva cotinine and individual predictors of compliance in a digital intervention.
Data came from a feasibility trial and randomized controlled trial of a Facebook smoking cessation intervention for young adults. In both trials, participants completed baseline and follow-up surveys at 3, 6 and 12 months. Participants indicating past 7-day point prevalence smoking abstinence were mailed a saliva cotinine kit. Participants were instructed to electronically send two photos - one of them giving a saliva sample and the other with the test results. We investigated predictors of compliance with these procedures, independent of verification results, among participants that were mailed a kit at any follow-up point (N=130; mean age = 21.3; 59.2% female) using logistic and multinomial regression.
A total of 189 kits were sent out, of which 97 were completed (51.3% compliance). We did not identify significant predictors of completing any vs no kits using logistic regression. We also found no significant predictors of extent of kit completion (none vs some; none vs all) using multinomial regression and controlling for number of kits sent.
Findings demonstrate the feasibility of this biochemical verification method and suggest low risk for bias of results. Future studies should replicate findings in larger samples and improve compliance with verification procedures.
Digital smoking cessation interventions frequently use automated delivery of content. Integrating a counselor may improve participant engagement and facilitate health behavior change. We investigated ...engagement with live counseling compared to automated content in a Facebook intervention and the impact of engagement on smoking cessation outcomes. The Tobacco Status Project is a 90-day smoking cessation intervention for young adults utilizing automated posts and weekly sessions with a live counselor in Facebook groups tailored to readiness to quit (precontemplation, contemplation, preparation). Data came from the treatment group of a randomized trial. Post-level analyses investigated participant engagement (number of comments) by post type (e.g., counselor posts or automated posts based on transtheoretical model of behavior change, clinical practice guidelines, motivational interviewing), stratified by readiness to quit. Participant-level analyses examined whether extent of participant engagement with counselor posts predicted abstinence at 3 months. We analyzed data of N = 251 participants and N = 2,941 posts, 11% of which were live counselor initiated, and together generated 8,403 comments. Post-level analyses found that compared to the most engaging automated content (motivational content for precontemplation and contemplation, informational content for preparation), live counseling generated more engagement among participants in preparation, similar engagement in precontemplation, and less engagement in contemplation. Extent of live counseling participation predicted 3-month verified abstinence (adjusted OR = 1.10, 95% CI 1.02, 1.20). In digital interventions, counselor contact may be beneficial in addition to automated posts at yielding engagement and abstinence; however, participants engage differently with counseling according to readiness to quit.
Abstract The quantification of tyramine (Tyr) and spermidine (Spd) is essential to protect and ensure quality and safety for food and beverage consumers. In this work, an electrochemical study was ...carried out, and a new, rapid, sensitive, reliable, and selective square‐wave voltammetric method for simultaneously determining Tyr and Spd in wines was developed. A Chemically Modified Carbon Paste electrode with Zinc PhthaloCyanine (CMCPE‐ZnPC) was used as a sensor in the electrochemical study, and a standard addition procedure (SAP) was employed to solve the matrix effect in the quantification of Tyr and Spd in wines. These analytes were electroactive on the stable, sensitive, and selective CMCPE‐ZnPC sensor under study using SWV technique, displaying peak anodic potentials at around 400 mV for Tyr and 860 mV for Spd. Wine samples were analyzed using the proposed and reference methods. No statistically significant differences were observed among the results obtained for Tyr and Spd determinations, applying the paired t ‐test at a confidence level of 95 %. The proposed method yielded low limits of detection (6.8 nmol L −1 for Tyr and 10.8 nmol L −1 for Spd), good recovery rates (from 86.1 to 107.5 %), and reproducibility (overall RSD of 2.6 %). The proposed method contributes to green analytical chemistry since it uses no chemical pretreatment of the wine samples.
“Dabbing” involves vaporizing a “dab” of cannabis concentrate on a heated “nail,” passing the vapour through a water-pipe rig or portable pen device, and inhaling the vapour. While some cannabis ...industry media claims that this process is cleaner, safer, and more effective for getting high, medical and public health sources raise concerns about residual solvents and pesticides, unexpectedly intense effects, and rapid increases in tolerance. The aim of this study is to characterize the content of questions about dabbing posed in cannabis and dabbing-specific forums on the Reddit social media platform, as well as comment responses to these questions.
We conducted a content analysis of one year (2017) of information-seeking user-generated posts to three Reddit online cannabis community discussion forums (“subreddits”) that contained the terms “dab” and “question.” We also examined post engagement and the types and sentiment of information exchanged in the comment responses.
Across 193 dabbing question posts, the most frequently asked question content was about types and logistical use of devices and related equipment (38%) and comparisons of cannabis products (32%), followed by questions about the step-by-step process of getting high (18%), legal issues (17%), and health concerns (13%). Nearly every post had a response (98%), with a median 5 comments per post and few negative (i.e. hostile, condescending, or trolling) comments (4%). Source of advice or information was stated in about a quarter (26%) of comment responses, with the overwhelming majority of this information (89%) coming from disclosures of personal experience vs. web or commercial sources.
People seeking advice online about dabbing inquired most often about logistics of use, but less often about health, tolerance, and legal risks. These findings may be used to inform public health efforts and health practitioner education as cannabis becomes increasingly legal and accessible.
•A third of young adults who smoked and drank were at high risk for alcohol use disorder.•Readiness to quit smoking was associated with increased importance of reducing alcohol use.•Polysubstance use ...among young adults was not associated with readiness to quit smoking.•Older age was positively associated with readiness to quit smoking.
Young adults who smoke cigarettes often report heavy episodic drinking (HED) and co-use of other psychoactive substances which may complicate efforts to quit cigarette smoking. The current study examined factors associated with readiness to quit cigarette smoking among young adults who smoke and engage in HED.
One hundred seventy-nine young adults aged 18 to 25 who reported regular cigarette smoking and past month HED enrolled in the 90-day Facebook-based Smoking Tobacco and Drinking (STAND) intervention study. Analyses compared baseline differences in patterns of cigarette smoking and alcohol and cannabis use, thoughts about abstinence, use of nicotine replacement therapy (NRT), sociodemographic characteristics, and other health behaviors between participants who were ready to quit cigarette smoking in the next 30 days and those who were not.
Participants were 40.2% female, 49.7% male, 10.1% non-binary, and 80.4% Non-Hispanic White. They reported on average moderate nicotine dependence (FTCD), moderate risk for alcohol use disorder (AUDIT), and occasional or regular cannabis use. Readiness to quit cigarette smoking in the next 30 days (33.5%) was positively associated with age (p = .021), NRT use in the past 30 days (p = .037) and perceived importance to also reduce alcohol use (p = .033).
Findings indicate that readiness to quit cigarette smoking among young adults who drink is positively associated with importance to reduce alcohol use, but not with use patterns or levels of dependence. Interventions addressing polysubstance use may be better suited to help young adults reduce or quit cigarette smoking once they signal readiness for behavior change.
Youth with psychiatric disorders are at increased risk of tobacco use. Outpatient mental health settings have received little investigation for delivering tobacco treatment. This study obtained ...formative data to guide development of a tobacco cessation program for transitional age youth with co-occurring psychiatric disorders with a focus on outpatient mental health settings.
Applying qualitative methods, we analyzed transcripts from interviews with 14 mental health clients (aged 16-23) and 8 mental health providers.
The youth identified internal (nicotine addiction and mood), social, parental, and media influences to their use of tobacco. Providers' viewed youth tobacco use as a normative developmental process, closely tied to management of psychiatric symptoms, supported by parents, and of lower priority relative to youth alcohol and illicit drug use. Youth and providers believed that clinicians can do more to address tobacco use in practice and emphasized nonjudgmental support and nondirective approaches. Top recommended quitting strategies, however, differed notably for the youth (cold turkey, support from friends, physical activity, hobbies) and providers (cessation pharmacotherapy, cessation groups, treatment referrals).
Mental health providers' greater prioritization of other substances and view of youth smoking as developmentally normative and a coping strategy for psychopathology are likely contributing to the general lack of attention to tobacco use currently. Integrating care within mental health settings would serve to reach youth in an arena where clinical rapport is already established, and study findings suggest receptivity for system improvements. Of consideration, however, is the apparent disconnect between provider and youth recommended strategies for supporting cessation.
Flexible intramedullary nailing (IMN) is a valuable tool in the treatment of femoral fractures in school-age children, whereas spica cast immobilization has been the standard of care for younger ...children. We compared these treatment modalities in a group of preschool-age children (four to five years of age).
A retrospective cohort of consecutive patients, four to five years of age, with an isolated, complete femoral shaft or subtrochanteric fracture treated with intramedullary nailing or early spica cast immobilization and followed until fracture-healing were identified from two centers. Radiographic and clinical outcomes were compared between the groups. Statistical methods included chi-square and Fisher exact tests for categorical variables and the Mann-Whitney test for continuous variables.
Two hundred and sixty-two patients followed for a mean of thirty-two weeks were identified. One hundred and four patients underwent IMN and 158 patients were treated with immediate spica cast immobilization at the surgeon's discretion. The patients who underwent IMN were older than those who underwent spica cast immobilization (mean, 5.2 versus 4.7 years; p < 0.001), were heavier (mean, 21.5 versus 18.0 kg; p < 0.001), and were more likely to have a higher-energy mechanism of injury (p = 0.025). At the time of final follow-up, there was no difference between groups with regard to the percentages of patients who had acceptable coronal angulation (≤15°), sagittal angulation (≤20°), and early fracture shortening (≤20 mm) (96.2% in the spica group versus 99.0% in the IMN group; p = 0.09). While there was no significant difference in the percentages who had an unplanned return to the operating room (3.8% in the IMN group versus 4.4% in the spica group; p > 0.99), the patients in the IMN group had more clinic visits (mean, 5.8 versus 4.0; p < 0.001) and longer follow-up (mean, forty-four versus twenty-five weeks; p < 0.001) than the patients in the spica group and a higher percentage of them underwent repeat procedures (89.4% versus 5.1%; p < 0.001), primarily for elective implant removal.
Preschool-age children (four to five years old) with an isolated femoral fracture have similar clinical and radiographic outcomes regardless of whether they are treated with immediate spica cast immobilization or IMN.
Tobacco use and heavy episodic drinking (HED) commonly co-occur in young adults. We developed and tested usability of the Smoking Tobacco and Drinking (STAND) intervention for young adults delivered ...on Facebook.
To inform the intervention, focus groups were held with 25 young adults age 18 to 25 (12% female; Mean age = 20.4) who smoked cigarettes and reported at least one HED episode in the past month. Facebook intervention posts (N = 180) were tailored to readiness to quit smoking, and tested in two private Facebook behavioral change groups (Ready, Not Ready) with N = 29 young adults (10% female; Mean age = 20.8). Participants flagged posts in need of change, and we assessed engagement (comment frequency).
Focus groups revealed preference for changing one substance at a time and greater receptivity to quitting smoking than reducing drinking. Mean comments per post were 5.3 (SD = 1.1) in Ready groups and 11.7 (SD = 5.1) in Not Ready groups; 94/180 (52.2%) posts were flagged for change. The level of engagement and the flagging of posts for change did not differ by group or by whether the post targeted tobacco, alcohol, or both substances combined (all p > .10). Overall, STAND was rated as easy to understand, providing sound advice, worthy of recommendation, and helpful (all agreement 100% among Ready; 50-70% among Not Ready).
The current findings informed development of a social media-based intervention targeting tobacco and alcohol use in young adults. Although there was greater interest in making changes in smoking than drinking behavior, receptivity and acceptability of the Facebook post messages in the STAND intervention was high overall. The intervention is being further refined for evaluation in a larger trial. Trial registration Name of the registry Smoking Tobacco and Drinking Study (STAND); Trial registration number NCT03163303; Date of registration 5/23/17; URL of trial registry record https://clinicaltrials.gov/ct2/show/NCT03163303 .
Abstract The present study examined patterns of recent club drug use among 400 young adults (18–29) recruited using time–space sampling in NYC. Subjects had used at least one of six club drugs ...(methylenedioxymethamphetamine (MDMA), ketamine, gamma -hydroxybutyrate (GHB), cocaine, methamphetamine, and d -lysergic acid diethylamide (LSD)) within the prior 3 months. We used latent class analysis (LCA) to estimate latent groups based on patterns of recent club drug use and examined differences in demographic and psychological variables by class. A 3-class model fit the data best. Patterns were: Primary cocaine users (42% of sample), Mainstream users (44% of sample), and Wide-range users (14% of sample). Those most likely to be Primary cocaine users were significantly less likely to be heterosexual males and had higher educational attainment than the other two classes. Those most likely to be Wide-range users were less likely to be heterosexual females, more likely to be gay/bisexual males, dependent on club drugs, had significantly greater drug and sexual sensation seeking, and were more likely to use when experiencing physical discomfort or pleasant times with others compared to the other two groups. Findings highlight the utility of using person-centered approaches to understand patterns of substance use, as well as highlight several patterns of club drug use among young adults.
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