Suicide Prevention Referrals in a Mobile Health Smoking Cessation Intervention

Automated mobile health (mHealth) programs deliver effective smoking cessation interventions through text message platforms. Smoking is an independent risk factor for suicide, so the Department of Veterans Affairs incorporated information about the Veterans Crisis Line into its SmokefreeVET smoking cessation text messaging program. Almost 7% of all SmokefreeVET enrollees have accessed this information. Because of the reach and automated nature of this and similar programs, we recommend including a referral to a suicide prevention hotline for all smoking cessation mHealth interventions.Mobile health (mHealth) interventions have altered the health care landscape with new opportunities available to both patients and health care providers. However, with the adoption of any technology, potential consequences also emerge. mHealth activities include a wide variety of health care tasks delivered via automated programs and live human interactions. We discuss a key clinical issue that is most relevant to automated interventions that are delivered without human involvement.Automated mHealth programs can enhance population-based approaches to health care through increased reach of interventions and patient engagement, with the added benefit of cost reduction. Examples of such programs include health promotion interventions delivered via mobile text messaging service and smartphone applications. Smoking and tobacco use cessation programs have been early adopters of mHealth, with established efficacy.1,2 Despite their considerable potential as platforms from which to deliver population-level health interventions, these interventions lack clearly defined guidelines and protocols with regard to patient safety.     

The role of flavors in vaping initiation and satisfaction among U.S. adults

BackgroundThe prevalence of electronic cigarette use has grown over the past decade, with some users reportedly initiating e-cigarette use primarily due to flavors. This study examined the role of flavors in initiation among adult e-cigarette users, as well as the association of flavors with satisfaction and perceived addiction to vaping.MethodsThe analysis sample consisted of 1492 current e-cigarette users aged 18 or older, drawn from an online quantitative survey conducted in 2016. Multivariable logistic regression and general linear models were used.ResultsMost current e-cigarette users (62.9%) typically used flavors other than tobacco (including fruit, mint/menthol, sweet, candy, coffee and other), 24.2% typically used tobacco flavors, and 12.9% typically used non-flavored e-cigarettes. Flavor was a common reason for vaping initiation, selected by 29.5% of the sample. Flavor, particularly fruit flavor, was more likely to motivate young adults 18–24 to initiate vaping compared adults 35–44. Those who used flavors, particularly mint/menthol and flavors other than tobacco flavor, had higher odds of reporting high satisfaction with vaping and had higher odds of perceived addiction to vaping than respondents who did not use flavored e-cigarettes.ConclusionsUsers of flavored e-cigarettes reported greater satisfaction and self-perceived addiction than users of non-flavored e-cigarettes. The appeal of flavors, particularly among young adults, has implications for regulatory policy regarding the marketing and promotion of flavored products. These findings may provide direction for the Food and Drug Administration's plans to restrict flavors other than menthol, mint, and tobacco.     

Smokers' physical activity and weight gain one year after a successful versus unsuccessful quit attempt

ObjectiveTo examine whether smokers' physical activity is related to weight change following a quit attempt.MethodData were analyzed for participants (n = 683) of a randomized controlled trial comparing the efficacy of different smoking cessation pharmacotherapies (Wisconsin, 2005–2008). Activity (assessed via pedometry) and body weight were measured in the days surrounding the quit day and again one year later, at which time 7-day point-prevalence abstinence from smoking was assessed. We examined the effects of quitting, physical activity, and their interaction, on a one-year weight change with relevant covariate adjustment.ResultsParticipants were predominantly female (57%), 46 ± 11 years of age (mean ± SD), and took 7544 ± 3606 steps/day at baseline. Of those who quit, 87% gained weight. A main effect was found for quitting (p < 0.001), but not physical activity (p = 0.06). When pattern of activity was examined across the 1-year study period, quitters who decreased their physical activity had significantly greater weight gain than quitters who increased their physical activity (p < 0.01) or maintained a high level of activity (p = 0.02).ConclusionPhysical activity is associated with an attenuation of the weight gain that often occurs after quitting smoking.     

American Cancer Society's report on the status of cancer disparities in the United States, 2021

In this report, the authors provide comprehensive and up-to-date US data on disparities in cancer occurrence, major risk factors, and access to and utilization of preventive measures and screening by sociodemographic characteristics. They also review programs and resources that have reduced cancer disparities and provide policy recommendations to further mitigate these inequalities. The overall cancer death rate is 19% higher among Black males than among White males. Black females also have a 12% higher overall cancer death rate than their White counterparts despite having an 8% lower incidence rate. There are also substantial variations in death rates for specific cancer types and in stage at diagnosis, survival, exposure to risk factors, and receipt of preventive measures and screening by race/ethnicity, socioeconomic status, and geographic location. For example, kidney cancer death rates by sex among American Indian/Alaska Native people are ≥64% higher than the corresponding rates in each of the other racial/ethnic groups, and the 5-year relative survival for all cancers combined is 14% lower among residents of poorer counties than among residents of more affluent counties. Broad and equitable implementation of evidence-based interventions, such as increasing health insurance coverage through Medicaid expansion or other initiatives, could substantially reduce cancer disparities. However, progress will require not only equitable local, state, and federal policies but also broad interdisciplinary engagement to elevate and address fundamental social inequities and longstanding systemic racism.     

Are accelerometer measures of temporal patterns of static standing associated with lower extremity pain among blue-collar workers?

BackgroundPain in the lower extremities is common among blue-collar workers, with prolonged static standing as a potential risk factor. However, little is known about the association between diurnal accelerometer measures of static standing and pain in the lower extremities, and the potential importance of temporal patterns of static standing for this association.Research questionWe aimed to investigate the cross-sectional association between accelerometer measures of total static standing time and temporal patterns (bout duration) of static standing (short: 0–5 min; moderate: >5-10 min; and long bouts: >10 min) during total day, work and leisure and pain intensity (on a 0–10 scale) in hips, knees and feet/ankles.MethodsAccelerometers were used to measure static standing during four consecutive days among 677 blue-collar workers. Linear regression analyses were used to investigate the association between static standing time and pain intensity in the lower extremities.ResultsTotal static standing time comprised, on average, 3.9 h per day. 72.6% of the workers were exposed to long bouts of static standing, averaging 0.1 h per day. Short bouts of static standing were positively associated with hip and knee pain during total day, and positively associated with knee pain during work. Also, total static standing time during leisure was positively associated with knee and hip pain. A negative, but not significant, association was found for static standing in moderate bouts at work and hip pain.SignificanceEven though the associations found were weak, these findings suggest that the temporal pattern of static standing is of importance for pain in the lower extremities. Future research should examine the possibility that moderate bouts of standing could play a role in preventing lower extremity pain.     

Youth perspectives on concurrent smoking and vaping: Implications for tobacco control

Most people who smoke cigarettes begin young. Consequently, public health efforts directed at youth are a priority. The increasing popularity of electronic nicotine delivery systems (ENDS) among youth in the United States has raised concerns in the public health community about the potential of ENDS to renormalize cigarette smoking and perpetuate nicotine addiction, creating dual users who both vape and smoke. Despite limited and inconclusive evidence about dual use for young people, restrictive approaches towards ENDS have shaped tobacco control agendas in the United States. Based on analysis of 26 interviews with young dual users in California, we explored the meanings young people ascribe to their dual using practices and how those meanings relate to the broader tobacco control environment which structures their lives. Results suggest that dual users of ENDS and cigarettes overwhelmingly perceive a utilitarian meaning of dual use and view vaping as a tool for reducing smoking-related harm in the near term and facilitating quitting smoking in the long term. Also, participants’ narratives related to Tobacco 21 laws, which prohibit sales of both ENDS and cigarettes to individuals under 21 years of age, revealed concerns about restrictive policies that limit access to less harmful tobacco products. Results of this study raise important questions about whether we are working towards further reductions in the prevalence of smoking and tobacco-related diseases.     

Vaping to lose weight: Predictors of adult e-cigarette use for weight loss or control

IntroductionSome traditional cigarette smokers are motivated to smoke to lose weight or control their weight. The current study evaluated whether a subset of adult e-cigarette users reported vaping to lose or control their weight and examined potential predictors of vaping for weight management.MethodsAdult e-cigarette users (n = 459) who reported wanting to lose weight or maintain their weight completed an anonymous online survey. Participants reported on demographics, vaping frequency, e-cigarette nicotine content, cigarette smoking status, preferred e-cigarette/e-liquid flavors, current weight status (i.e., overweight, underweight), use of dieting strategies associated with anorexia and bulimia, lifetime history of binge eating, self-discipline, and impulse control. Binary logistic regression was used to examine whether vaping for weight loss/control was associated with the aforementioned variables.ResultsParticipants who reported vaping for weight loss/control (13.5%) were more likely to vape frequently (adjOR = 1.15; 95% CI [1.00, 1.31]); be overweight (adjOR = 2.80; [1.33, 5.90]); restrict calories (adjOR = 2.23; [1.13, 4.42]); have poor impulse control (adjOR = 0.59; [0.41, 0.86]); and prefer coffee- (adjOR = 2.92; [1.47, 5.80]) or vanilla-flavored e-liquid (adjOR = 7.44; [1.56, 36.08]).ConclusionsA subset of adult e-cigarette users reported vaping for weight loss/control, raising concerns about expanded, scientifically unsubstantiated uses of e-cigarettes. Identifying where individuals obtain information about vaping for weight loss (e.g., e-cigarette ads, Internet) and whether weight-related motives promote e-cigarette initiation among e-cigarette naïve individuals is important to informing regulatory efforts. Further research also is needed to better understand the link between e-liquid flavors and weight loss motivations.