Bonnie Halpern-Felsher

All Publications

• Gaps in Awareness of the United States Minimum Legal Age of E-Cigarette and Cigarette Sales: Implications for Public Health Messaging. The Journal of adolescent health : official publication of the Society for Adolescent Medicine McCauley, D. M., Halpern-Felsher, B. 2024

  Abstract

  In 2019, the United States raised the minimum legal age (MLA) of sales for all tobacco products from 18 to 21. Public awareness of the federal MLA of tobacco sales overall and by demographics is understudied.A national, cross-sectional 2023 survey in which 6,098 participants aged 13-40 years responded to the question, "at which age is it legal to purchase [e-cigarettes; cigarettes; alcohol] in the United States?" Participants also reported age, sex, race/ethnicity, and prior use of each substance.Sixty-one percent, 64.6%, and 88.7% correctly identified the MLA of sales for e-cigarettes, cigarettes, and alcohol, respectively. Differences in awareness of the MLA were found by age, sex, race/ethnicity, and prior use status.Gaps in awareness of the MLA of tobacco sales, particularly among adolescents and adults, suggest messaging regarding the federal Tobacco 21 law is needed.

  View details for DOI 10.1016/j.jadohealth.2024.08.017

  View details for PubMedID 39387725

• Supporting Adolescents' Desire to Quit E-Cigarettes. JAMA Halpern-Felsher, B. 2024

  View details for DOI 10.1001/jama.2024.13142

  View details for PubMedID 39110453

• Products and patterns through which adolescents, young adults, and adults initiate co-use of tobacco and cannabis. Addictive behaviors McCauley, D. M., Liu, J., Gaiha, S. M., Halpern-Felsher, B. 2024; 158: 108105

  Abstract

  BACKGROUND: Co-use of tobacco and cannabis is common. However, few studies have examined the temporal sequencing through which individuals initiate co-use, and how these patterns vary across age. This study addresses this gap by examining the specific products and temporal sequencing through which adolescents, young adults, and adults initiate co-use of tobacco and cannabis. Among adolescents, young adults, and adults who co-used tobacco and cannabis in the past 30days, we examined (a) whether tobacco or cannabis was used first in their lifetime and (b) which specific tobacco or cannabis product (e.g., nicotine e-cigarettes, cannabis edibles) was the first used.METHODS: Data were from a cross-sectional national survey (N=6,131, 13-40years old) in which participants reported ever use, past-30-day-use, and order of use for 17 different tobacco and cannabis products. Results were analyzed overall and by age group (13-20; 21-24; 25-40).RESULTS: 38.4% of participants reported use of both tobacco and cannabis in the past 30days. Among these participants, 70.9% used tobacco first in their lifetime (66.6%<21; 71.7% 21-24; 76.6%>24). Approximately 60% of participants who initiated co-use with tobacco reported nicotine e-cigarettes as their first tobacco product (63.3%<21; 66.7% 21-24; 49.6%>24).CONCLUSIONS: The majority of participants who used both tobacco and cannabis used tobacco first in their lifetime, and nicotine e-cigarettes were the most common form of tobacco initiation, particularly among adolescents and young adults. Findings emphasize the need for co-use prevention programs to target common products of initiation.

  View details for DOI 10.1016/j.addbeh.2024.108105

  View details for PubMedID 39047653

• Popularity of Zyn and other nicotine pouch brands among U.S. adolescents, young adults, and adults in 2021. Preventive medicine Liu, J., Halpern-Felsher, B. 2024: 108068

  Abstract

  OBJECTIVE: This study identifies brands of nicotine pouches used in 2021, just before the surge in popularity of Zyn use.METHODS: We conducted a national, cross-sectional online survey of a general U.S. population (November to December 2021; N = 6131; age 13-40) via Qualtrics panels. Descriptive analyses and chi-squared tests (alpha = 0.05) were performed to assess ever and past-30-day use of nicotine pouch brands across adolescents (13-20), young adults (21-24), and adults (25-40), and to assess frequency of popular brands used among peers.RESULTS: The top brands ever used were Zyn (overall: 30.9%; adolescents: 31.9%; young adults: 33.2%; adults: 28.3%) and Lyft (overall: 28.8%; adolescents: 28.4%; young adults: 32.9%; adults: 26.3%), with no differences in ever-use by age group (p's > 0.095). The top brands used in the past-30-days were Zyn (overall: 26.4%; adolescents: 24.5%; young adults: 24.3%; adults: 30.0%) and Rush (overall: 24.2%; adolescents: 21.0%; young adults: 22.7%; adults: 28.6%). Adults (vs. adolescents, young adults) were more likely to report past-30-day use of Lyft (p = 0.004). Participants indicated Zyn (18.5%) and Lyft (18.2%) to be the most popular brands among peers.CONCLUSIONS: Even in 2021, Zyn was the most popular brand of nicotine pouches. Findings will help regulate and reduce impact of marketing of Zyn.

  View details for DOI 10.1016/j.ypmed.2024.108068

  View details for PubMedID 39002807

• Appealing characteristics of E-cigarette marketing in the retail environment among adolescents. Preventive medicine reports Gaiha, S. M., Lempert, L. K., Lung, H., Vescia, F., Halpern-Felsher, B. 2024; 43: 102769

  Abstract

  Nearly 3 million U.S. adolescents use e-cigarettes. E-cigarette marketing is associated with adolescent e-cigarette use; however, studies have not asked adolescents their perceptions about whether and which e-cigarette marketing in retail stores influences purchase and use.Eleven 90-minute focus groups with 12-19-year-olds (mean age 15.7, 46.6 % female) from 11 U.S. states (n = 58) recruited through Instagram and schools (May 2021-Aug 2022). Photographs of e-cigarette marketing in and around retail stores were used to aid discussion. Thematic analysis identified themes related to appealing marketing characteristics.Adolescents indicated that e-cigarette marketing in and around retail stores arouses their curiosity, reminds them to buy, and normalizes using e-cigarettes. Adolescents identified specific e-cigarette marketing characteristics that they believed influence their decision to purchase and use e-cigarettes including the Tobacco Power Wall, free samples and flavor smelling samples, price incentives such as discounts and starter-kits, e-cigarette displays near checkout encouraging grab-and-go, displays near food, snacks or candy, and e-cigarette advertising through posters on store windows and stickers at checkout. Adolescents reported combining online and social media strategies to bypass age verification in retail stores (e.g., buying gift cards online and using them in stores). Adolescents suggested adding warning images on negative health effects of e-cigarettes, increasing prominence of minimum-age-of-tobacco-sale signs, and developing marketing education as counter-marketing strategies.Adolescents indicate that specific e-cigarette marketing characteristics in retail stores influence their purchase and use decisions. Addressing such e-cigarette marketing exposures in retail stores through counter-marketing messages may bolster adolescent e-cigarette prevention efforts.

  View details for DOI 10.1016/j.pmedr.2024.102769

  View details for PubMedID 38883928

  View details for PubMedCentralID PMC11177049

• Engagement, Mental Health, and Substance Use Under In-Person or Remote School Instruction During the COVID-19 Pandemic. The Journal of school health Chaffee, B. W., Cheng, J., Couch, E. T., Halpern-Felsher, B. 2023

  Abstract

  Adolescents' school engagement, mental health, and substance use have been major concerns during the COVID-19 pandemic, particularly given disruptions to school instruction. We examined how the instructional setting was associated with academic and health-related outcomes within an adolescent cohort followed during the pandemic.During 3 semi-annual follow-up surveys, adolescents (N = 1066 students; 2242 observations) from 8 California high schools responded to items measuring academic self-efficacy, school connectedness, internalizing and externalizing problems, and use of substances. Separate generalized estimating equation models predicted outcomes based on the instructional setting.Relative to in-person instruction, students in remote instruction reported lower academic self-efficacy (Beta: -0.11; 95% confidence interval [CI]: -0.22, -0.01) and school connectedness (Beta: -0.37; 95% CI: -0.48, -0.25), greater odds of past 30-day internalizing problems (AOR: 1.46; 95% CI: 1.09, 1.95), externalizing problems (AOR: 1.36; 95% CI: 1.02, 1.82), and cigarette, cigar, smokeless tobacco, or hookah use (AOR: 2.50; 95% CI: 1.06, 5.91), but lower odds of past 30-day e-cigarette use (AOR: 0.50; 95% CI: 0.30, 0.86).Multiple adverse outcomes related to school engagement, mental health, and substance use were associated with remote instruction. To reduce such impacts under future emergencies, schools should rely sparingly on remote instruction and provide appropriate supportive resources.

  View details for DOI 10.1111/josh.13418

  View details for PubMedID 38086782

• E-cigarette and combustible cigarette cessation patterns, reasons, and methods among adolescents, young adults, and adults. Addictive behaviors Lin, C., Mathur Gaiha, S., Halpern-Felsher, B. 2023; 150: 107918

  Abstract

  Research is limited regarding adolescents' and young adults' (AYA) patterns, methods of, and reasons for cigarette or e-cigarette cessation. Further, while adults may try to use e-cigarettes to quit combustible cigarettes, little is known about how adults then quit e-cigarettes. This study utilizes a national, cross-sectional online survey of 6131 diverse participants aged 13-40 years to examine reasons for quitting e-cigarettes or cigarettes, quit methods, and quit attempt outcomes among AYAs and adults. In our sample, 3137 (51.2%) had ever used an e-cigarette, of whom 2310 (37.7%) were aged 13-24 years and 827 (13.5%) were 25-40 years old; 2387 (38.9%) had ever used a combustible cigarette (1440 [23.5%] were 13-24 years old and 947 [15.4%] were 25-40 years old). Among e-cigarette ever-users, 39.4% of 13-24-year-olds intended to quit in the next 6 months, and 36.9% had a serious plan for quitting in the next 30 days; 25.2% wanted to decrease the amount they used while 34.8% wanted to quit completely. Similar rates were found among e-cigarette ever users aged 25-40 years, as well as past 30-day e-cigarette users, cigarette ever-users, and past 30-day cigarette users across all ages. "Cold turkey" (41.0%) followed by "tried to cut down slowly by vaping/smoking less often or fewer puffs" (25.5%) was the most common quit method among e-cigarette ever-users and cigarette ever-users of all ages. Further study of effective tobacco cessation methods to help both AYAs and adults successfully quit nicotine, whether from cigarettes or e-cigarettes, is urgently needed.

  View details for DOI 10.1016/j.addbeh.2023.107918

  View details for PubMedID 38070362

• Ocular Symptoms in Adolescents and Young Adults With Electronic Cigarette, Cigarette, and Dual Use. JAMA ophthalmology Nguyen, A. X., Gaiha, S. M., Chung, S., Halpern-Felsher, B., Wu, A. Y. 2023

  Abstract

  Despite increasing use of cigarettes and electronic cigarettes (e-cigarettes) and related health effects among youth, few studies have reported their effects on eyes.To examine the frequency and severity of ocular symptoms (ocular discomfort, pain, burning, itching, redness, dryness, glare, blurriness, strain, and headaches) in young e-cigarette and cigarette users.In an observational cross-sectional study, a survey conducted in May 6 to 14, 2020, asked participants about use (ever, past 30 days, and past 7 days) of e-cigarettes and cigarettes. The participants included US individuals aged 13 to 24 years.Associations between vision-related outcomes (general vision, severity/frequency of ocular symptoms) and tobacco use were analyzed using weighted multivariable logistic regressions, adjusting for sociodemographic factors, contact lens use, and other combustible use.There were 2168 never users, 2183 ever users, 1092 past 30-day users, and 919 past 7-day users of e-cigarettes; 55.9% of e-cigarette ever users also used cigarettes (dual users). Of the 4351 respondents, 63.8% identified as female, and mean (SD) age was 19.1 (2.9) years. Between 1.1% and 3.9% of ever dual users reported severe to very severe ocular symptoms; between 0.9% and 4.3% reported daily symptoms, which was higher than the proportion of symptoms in e-cigarette- or cigarette-only users. Past 7-day dual users had more severe itching (adjusted odds ratio [AOR], 2.37; 95% CI, 1.36-4.13; P = .002), redness (AOR, 2.58; 95% CI, 1.50-4.46; P = .001), dryness (AOR, 2.89; 95% CI, 1.64-5.08; P < .001), glare (AOR, 2.56; 95% CI, 1.50-4.35; P = .001), blurriness (AOR, 2.47; 95% CI, 1.36-4.50; P = .003), headaches (AOR, 2.31; 95% CI, 1.34-4.00; P = .003); and more frequent pain (AOR, 3.45; 95% CI, 2.09-5.68; P < .001), burning (AOR, 3.08; 95% CI, 1.86-5.09; P < .001), and redness (AOR, 2.72; 95% CI, 1.69-4.36; P < .001) than all other participants. Past 30-day dual users had more severe dryness (AOR, 2.65; 95% CI, 1.61-4.36; P < .001) and more frequent pain (AOR, 3.33; 95% CI, 2.12-5.21; P < .001) than all other participants. Ever dual users experienced more severe dryness (AOR, 1.60; 95% CI, 1.05-2.43; P = .03) and blurriness (AOR, 1.79; 95% CI, 1.21-2.64; P = .003) and more frequent pain (AOR, 1.69; 95% CI, 1.13-2.53; P = .01) and blurriness (AOR, 1.63; 95% CI, 1.13-2.36; P = .009) than never users.In this cross-sectional US study, adolescents and young adult users of both e-cigarettes and cigarettes had a higher likelihood of experiencing severe and frequent ocular symptoms, with past 7-day users reporting more symptoms than past 30-day users or ever users. These findings provide additional reasons for users of e-cigarettes and cigarettes to reduce their tobacco use to possibly prevent or minimize ocular symptoms.

  View details for DOI 10.1001/jamaophthalmol.2023.3852

  View details for PubMedID 37651129

• Effects of a Reduced Risk Claim on Adolescents' Smokeless Tobacco Perceptions and Willingness to Use. The Journal of adolescent health : official publication of the Society for Adolescent Medicine Chaffee, B. W., Couch, E. T., Popova, L., Halpern-Felsher, B. 2023

  Abstract

  United States Smokeless Tobacco Company LLC submitted a modified risk tobacco product application to the US Food and Drug Administration, proposing a claim that switching to Copenhagen snuff fine cut from cigarettes reduces lung cancer risk. This claim could affect adolescents' smokeless tobacco perceptions and its use.Students (N = 592; mean age: 15.3 years; 46% male; 32% nonHispanic White; 8% smokeless tobacco ever-users) at seven California high schools were randomized within a survey to view a Copenhagen snuff image, either with or without the proposed reduced risk claim. Participants were then asked about the harm of smokeless tobacco and their willingness to try Copenhagen snuff if a friend offered. Postimage harm rating and willingness were compared between image groups overall, stratified by past 30-day tobacco use (87% of tobacco users were e-cigarette users), and adjusted for participant characteristics using multivariable regression.Participants who viewed the claim were less likely to perceive smokeless tobacco to cause "a lot" of harm (56% vs. 64%; p = .03), including after statistical adjustment (risk ratio [RR]: 0.84; 95% confidence interval [CI]: 0.75, 0.94), and with a numerically stronger effect among tobacco users (RR: 0.65; 95% CI: 0.48, 0.86). The claim did not increase willingness overall (17% vs. 20%; p = .41) but did increase willingness among tobacco users (RR: 1.67; 95% CI: 1.05, 2.67).Brief exposure to a reduced-risk claim decreased adolescents' smokeless tobacco harm perceptions and increased willingness to try among tobacco users. The Food and Drug Administration order permitting this claim could increase some adolescents' susceptibility to smokeless tobacco, particularly those already using other tobacco products like e-cigarettes.

  View details for DOI 10.1016/j.jadohealth.2023.04.025

  View details for PubMedID 37294249

• Effects of a short school-based vaping prevention program for high school students. Preventive medicine reports McCauley, D. M., Baiocchi, M., Cruse, S., Halpern-Felsher, B. 2023; 33: 102184

  Abstract

  Educational programs that address adolescents' misperceptions of e-cigarette harms and benefits and increase refusal skills play an important role in preventing initiation and use. This study evaluates changes in adolescents' e-cigarette perceptions, knowledge, refusal skills, and intentions to use following a real-world implementation of a school-based vaping-prevention curriculum. Study participants were 357 9th-12th grade students from one high school in Kentucky, United States who participated in a 60-minute vaping prevention curriculum from the Stanford REACH Lab's Tobacco Prevention Toolkit. Participants completed pre- and post-program assessments regarding their e-cigarette knowledge, perceptions, refusal skills, and intentions to use e-cigarettes. Matched paired t-tests and McNemar tests of paired proportions were applied to assess changes in study outcomes. Following the curriculum, participants indicated statistically significant changes on all 15 survey items related to e-cigarette perceptions (p's < 0.05). Participants demonstrated improved knowledge that e-cigarettes deliver nicotine in the form of an aerosol (p <.001), reported that if a friend offered them a vape it would be easier to say no (p <.001), and indicated they would be less likely to take the vape (p <.001) after receiving the curriculum. Other survey items related to knowledge, refusal skills, and intentions did not demonstrate significant changes. Overall, participation in a single session vaping-prevention curriculum was associated with several positive changes in high school students' e-cigarettes knowledge, perceptions, refusal skills, and intentions. Future evaluations should examine how such changes affect long-term trajectories of e-cigarette use.

  View details for DOI 10.1016/j.pmedr.2023.102184

  View details for PubMedID 37223577

  View details for PubMedCentralID PMC10201847

• Use, marketing, and appeal of oral nicotine products among adolescents, young adults, and adults. Addictive behaviors Gaiha, S. M., Lin, C., Lempert, L. K., Halpern-Felsher, B. 2023; 140: 107632

  Abstract

  IMPORTANCE: Oral nicotine products such as pouches, lozenges, tablets, gums, and toothpicks are gaining popularity, especially among adolescents and young adults, with increased marketing.OBJECTIVE: To estimate use patterns of oral nicotine products and likelihood of buying and liking products based on marketing, using a large group of adolescents, young adults, and adults.DESIGN, SETTING, AND PARTICIPANTS: A cross-sectional, online survey among U.S. participants (n=6,131; ages 13-40years) was conducted in November-December 2021.MAIN OUTCOMES AND MEASURES: Ever, past-30-day, and past-7-day use, behaviors, and flavors of oral nicotine products. Liking marketing and likelihood of buying specific oral nicotine products (Zyn pouches and Lucy gum) from marketing.RESULTS: Our sample included 2,025 (33.0%) ever-users, 1,191 (19.4%) past-30-day users, and 998 (16.3%) past-7-day users of any oral nicotine product. Use patterns by age (in years): ever-users (<21: 816 (22.3%); 21-40: 1,209 (48.9%)); past-30-day users (<21: 458 (12.5%); 21-40: 733 (29.7%)); and past-7-day users (<21: 383 (10.5%); 21-40: 615 (24.9%)). Across products, 10-18% of participants reported using nicotine strength ranging from 6-10mg. Fruit, sweet/dessert, alcohol, coffee, and mint were the most used flavors. When shown marketing, ever-users liked and were likely to buy Zyn pouches compared to never users, and participants under 21years felt equally targeted by Lucy and Zyn marketing. Liking Zyn marketing even a little bit compared to not at all increased the likelihood of buying Zyn pouches across age groups. After observing marketing, participants<21years were more likely to buy Zyn if they perceived marketing to contain messages about good tasting flavors (AOR 1.43, 1.09-1.87; 0.009) and helping to feel comfortable in social situations (AOR 1.38, 1.02-1.87; 0.033), and were more likely to buy Lucy if they felt it could be used anywhere (AOR 1.57, 1.05-2.33; 0.026).CONCLUSIONS: This study provides a foundation for estimating use, behaviors, flavors, and marketing influence of oral nicotine products in the US and globally. Adolescent and young adult use of oral nicotine products and likelihood of buying products when exposed to marketing highlights the need for expanded tobacco use surveillance, marketing regulations, and counter marketing and educational efforts.

  View details for DOI 10.1016/j.addbeh.2023.107632

  View details for PubMedID 36731224

• Use of Emerging and Conventional Oral Tobacco Among Adolescent and Young Adult E-Cigarette Users. Substance use & misuse Couch, E. T., Halpern-Felsher, B., Werts, M., Chaffee, B. W. 2023: 1-6

  Abstract

  Background: National surveillance assessing use of novel oral tobacco products (OTPs; nicotine pouches, lozenges, and gums not approved for tobacco cessation) among adolescents and young adults is limited. Objectives: To assess OTP behaviors in a sample of adolescent and young adult e-cigarette users, including use prevalence, dual/poly use with other products, and associated demographics. Methods: A national (United States) cross-sectional survey was conducted from March to April 2021 among 2253 participants (ages 14-20; 65% female) who ever used e-cigarettes ≥3 times. Demographics, lifetime use, and past 30-day use of 10 tobacco and cannabis products, including novel and conventional (chew, moist snuff, or snus) OTPs was assessed. Analysis was descriptive, examining use prevalence (lifetime and past 30-day) of each product, including by demographics and other product use. Results: Nearly 44% reported ever using any OTP, with nicotine pouches being the most commonly ever used (29%) and used in the past month (11%). Novel OTP use was more common among older participants (18-20 years), male participants, and past 30-day users of e-cigarettes, combustible tobacco, and conventional oral tobacco. However, female participants and combustible tobacco non-users were over twice and 4-times as likely, respectively, to use novel OTPs than conventional OTPs. Nearly 73% of past 30-day conventional OTP users were past 30-day novel OTP users. Conclusion: Novel OTP use was prevalent among adolescent and young adult e-cigarette users. Compared to conventional OTPs, novel OTPs likely have greater appeal to females and combustible tobacco non-users. Action to restrict access and reduce interest in OTPs is needed to prevent use among this population.

  View details for DOI 10.1080/10826084.2022.2161314

  View details for PubMedID 36645845

• Adolescents, Young Adults, and Adults Continue to Use E-Cigarette Devices and Flavors Two Years after FDA Discretionary Enforcement. International journal of environmental research and public health McCauley, D. M., Gaiha, S. M., Lempert, L. K., Halpern-Felsher, B. 2022; 19 (14)

  Abstract

  This study assesses the use of e-cigarette devices and flavors using a large, cross-sectional survey of adolescents, young adults, and adults (N = 6131; ages 13-40 years old; Mage = 21.9) conducted from November to December 2021, 22 months after the FDA announced its prioritized enforcement policy against some flavored pod/cartridge-based e-cigarettes. We analyzed the patterns of use by age group: adolescents and young adults (AYAs) under 21 (minimum age of e-cigarette sales), young adults (21-24 years old), and adults (25-40 years old). The participants reported using e-cigarettes ever (44.2% < 21; 67.1% 21-24; 58.0% > 24), in the past 30 days (29.8% < 21; 52.6% 21-24; 43.3% > 24), and in the past 7 days (24.5% < 21; 43.9% 21-24; 36.5% > 24). Disposables were the most used e-cigarette device type across age groups (39.1% < 21; 36.9% 21-24; 34.5% > 24). Fruit, sweet, mint, and menthol flavors were popular across age groups; however, chi-squared tests for trends in proportions revealed age-related trends in past 30-day flavor use by device type. Findings suggest current AYA e-cigarette use may be higher than recorded by the NYTS 2021. The FDA, states, and localities should adopt more comprehensive restrictions on flavored e-cigarette products in order to reduce adolescent and young adult e-cigarette use.

  View details for DOI 10.3390/ijerph19148747

  View details for PubMedID 35886599

• Nicotine Dependence from Different E-Cigarette Devices and Combustible Cigarettes among US Adolescent and Young Adult Users. International journal of environmental research and public health Lin, C., Gaiha, S. M., Halpern-Felsher, B. 2022; 19 (10)

  Abstract

  E-cigarettes, the most popular tobacco product among adolescents, vary widely in design and nicotine composition; thus, different devices may have different addictive potential. However, few studies examine levels of nicotine dependence across devices among adolescent and young adult (AYA) e-cigarette users. To assess the extent of nicotine dependence among US AYA (ages 13-24) by e-cigarette device type, we conducted a large, national, cross-sectional survey (n = 4351) and used the Hooked on Nicotine Checklist (HONC) to assess levels of nicotine dependence among those who had used disposable, pod-based, and/or mods/other e-cigarette devices in the past 30 days. We also examined HONC scores among those who had used combustible cigarettes in the past 30 days, whether with or without using e-cigarettes. Patterns of nicotine dependence were comparable across those who had used a combustible cigarette and/or e-cigarette in the past 30 days, with 91.4% of combustible cigarette users, 80.7% of disposable e-cigarette users, 83.1% of pod-based e-cigarette users, and 82.5% of mods/other e-cigarette users showing signs of nicotine dependence, as measured by endorsing at least one HONC symptom. This pattern persisted when analyses were restricted to e-cigarette only users, with more than 70% of all e-cigarette only past-30-day users endorsing at least one HONC symptom, across all types of devices. A thorough understanding of the extent and presentation of nicotine dependence among AYA will help researchers, public health officials, and clinicians recognize and manage AYA nicotine dependence.

  View details for DOI 10.3390/ijerph19105846

  View details for PubMedID 35627381

• Use Patterns, Flavors, Brands, and Ingredients of Nonnicotine e-Cigarettes Among Adolescents, Young Adults, and Adults in the United States. JAMA network open Gaiha, S. M., Lin, C., Lempert, L. K., Halpern-Felsher, B. 2022; 5 (5): e2216194

  Abstract

  Importance: Nonnicotine e-cigarettes contain chemicals, flavorants, and solvents that have known health harms and/or have not been proven safe for inhalation.Objective: To evaluate nonnicotine e-cigarette use patterns, including common flavors, brands, and ingredients.Design, Setting, and Participants: This cross-sectional study included a convenience sample of US residents aged 13 to 40 years who completed an online survey in November and December 2021. Quota sampling was used for an equal proportion of participants aged 13 to 17 years, 18 to 20 years, and 21 to 40 years, balanced for sex, race, and ethnicity per the latest US Census.Main Outcomes and Measures: Nonnicotine e-cigarette use (ever, past 30- and past 7-day, number of times used, time taken to finish); co-use with nicotine e-cigarettes; age at first try; and flavors, brands, and ingredients used.Results: Overall, 6131 participants (mean [SD] age, 21.9 [6.8] years; range, 13-40 years; 3454 [56.3%] identifying as female) completed the survey (55.1% completion rate). Among all participants, 1590 (25.9%) had ever used a nonnicotine e-cigarette, 1021 (16.7%) used one in the past 30 days, and 760 (12.4%) used one in the past 7 days. By age group, 227 of 1630 participants aged 13 to 17 years (13.9%), 497 of 2033 participants aged 18 to 20 years (24.4%), 399 of 1041 participants aged 21 to 24 years (38.3%), and 467 of 1427 participants aged 25 to 40 years (32.7%) had ever used nonnicotine e-cigarettes. Among 1590 participants who had ever used a nonnicotine e-cigarette, 549 (34.5%) had used one more than 10 times; 1017 (63.9%) finished 1 nonnicotine e-cigarette in less than 1 week. Co-use of nonnicotine with nicotine e-cigarettes was reported by 1155 participants (18.8%), 1363 (22.2%) exclusively used nicotine e-cigarettes, and 431 (7.0%) exclusively used nonnicotine e-cigarettes. Most-used flavors were sweet, dessert, or candy (578 [36.3%]); fruit (532 [33.4%]); and mint or menthol (321 [20.2%]); similar flavor patterns were observed for the top 2 flavors among those who used nonnicotine e-cigarettes in the past 30 days, followed by combinations of coffee, alcohol, flower, plant, and mint or menthol flavors by age group. Participants most reported using tetrahydrocannabinol (587 [36.9%]), cannabidiol (537 [33.7%]), melatonin (438 [27.5%]), caffeine (428 [26.9%]), and essential oils (364 [22.9%]) in their nonnicotine e-cigarettes.Conclusions and Relevance: In this study of adolescents, young adults, and adults, a sizeable proportion reported having used nonnicotine e-cigarettes and co-using them with nicotine e-cigarettes. Surveillance studies should further assess nonnicotine e-cigarette use patterns and regulations, and prevention should be developed to address youth appeal, unsubstantiated health claims, and possible health harms.

  View details for DOI 10.1001/jamanetworkopen.2022.16194

  View details for PubMedID 35612852

• E-cigarette devices, brands, and flavors attract youth: Informing FDA's policies and priorities to close critical gaps. Addictive behaviors Gaiha, S. M., Lempert, L. K., McKelvey, K., Halpern-Felsher, B. 2021; 126: 107179

  Abstract

  PURPOSE: Identify e-cigarette devices, brands, and flavor types used by adolescents and young adults soon after the enactment of flavor restrictions, youth access laws, FDA's enforcement prioritization against some flavored pod/cartridge-based e-cigarettes, and during COVID-19 pandemic-related school closures.METHODS: National cross-sectional online survey (N=4,351) in May 2020 assessed popularity, ever- and past-30-day use of e-cigarette device types (pod/cartridge-based, disposables, others), brands, flavor types and flavor-enhancers, by age group (under age 21 and 21 and over).RESULTS: While pod/cartridge-based e-cigarettes had the highest ever-use (82.7% <21; 69.8% ≥21) and were most often-used (41.9% <21; 41.4% ≥21), most past 30-day-users (50.8% <21; 61.9% ≥21) and 7-day-users (36.0% <21; 56.7% ≥21) used disposables. Mint/menthol was the most-used flavor type (pod/cartridge-based: 48.2% <21, 48.1% ≥21; disposables: 51.6% <21, 56.4% ≥21), followed by fruit (pod/cartridge-based: 37.4% <21, 35.5%≥ 21; disposables: 51.6% >21, 46.2% ≥ 21), and sweet/dessert/candy flavor types (pod/cartridge-based: 24.4% <21, 24.7% ≥21; disposables: 29.7% <21, 33.8% ≥21). Participants reported using add-on e-cigarette flavor-enhancers (pod/cartridge-based: 24.6%; disposables: 31.3%).CONCLUSION: Soon after FDA's January 2020 announcement of prioritized enforcement against flavored pod/cartridge-based e-cigarettes and during the pandemic lockdown, adolescents' and young adults' past 30-day use included mostly flavored disposables rather than pod/cartridge-based e-cigarettes, mint/menthol flavors, and some used add-on flavor enhancers. To reduce youth use, comprehensive regulation of e-cigarette devices and flavors should be enacted and enforced at federal, state, and local levels.

  View details for DOI 10.1016/j.addbeh.2021.107179

  View details for PubMedID 34861522

• Impact of Local Flavored Tobacco Sales Restrictions on Policy-Related Attitudes and Tobacco Product Access. Health education & behavior : the official publication of the Society for Public Health Education Feld, A. L., Rogers, T., Gaber, J., Pikowski, J., Farrelly, M. C., Henriksen, L., Johnson, T. O., Halpern-Felsher, B., Andersen-Rodgers, E., Zhang, X. 2021: 10901981211027520

  Abstract

  BACKGROUND: As of September 2020, more than 300 state and local jurisdictions restrict the sales of flavored tobacco, with some including menthol.AIMS: o evaluate the impact of local ordinances restricting the sale of flavored tobacco, we surveyed Californians regarding policy support and perceived access to flavored tobacco.METHODS: In 2019, we conducted an online survey of 3,075 California youth and young adults recruited via social media, about half of whom lived in a policy jurisdiction. Logistic regressions assessed differences on propensity score-weighted outcomes, policy support, and perceived access.RESULTS: Most respondents indicated agreement with almost all policy support statements. Although policy respondents were less likely than rest-of-California respondents to report perceived difficulty in buying flavored cigars, flavored vape users in policy jurisdictions were more likely than those in the rest of California to report perceived difficulty in buying flavored e-liquid. Regardless of jurisdiction, certain priority subgroups were significantly more likely to report perceived difficulty in accessing flavored cigars, flavored vaping products, flavored e-liquid, and menthol cigarettes.DISCUSSION: With some exceptions, these findings demonstrate that among vape users in policy jurisdictions and priority subgroups, there is a higher likelihood of reporting perceived difficulty to access flavored tobacco products.CONCLUSIONS: Findings might be an early indication of shifts in social norms about flavored tobacco products in California, which could gain traction as local sales restriction ordinances proliferate throughout the state and a statewide flavored-tobacco sales restriction goes into effect.

  View details for DOI 10.1177/10901981211027520

  View details for PubMedID 34399591

• Adolescents' Substance Use and Physical Activity Before and During the COVID-19 Pandemic. JAMA pediatrics Chaffee, B. W., Cheng, J., Couch, E. T., Hoeft, K. S., Halpern-Felsher, B. 2021

  Abstract

  Importance: Stay-at-home policies related to the COVID-19 pandemic could disrupt adolescents' substance use and physical activity.Objective: To compare adolescents' substance use and physical activity behaviors before and after stay-at-home restrictions.Design, Setting, and Participants: Ongoing prospective cohort study of tobacco use behaviors among ninth- and tenth-grade students enrolled at 8 public high schools in Northern California from March 2019 to February 2020 and followed up from September 2019 to September 2020. Race/ethnicity was self-classified from investigator-provided categories and collected owing to racial/ethnic differences in tobacco and substance use.Exposures: In California, a COVID-19 statewide stay-at-home order was imposed March 19, 2020. In this study, 521 six-month follow-up responses were completed before the order and 485 were completed after the order.Main Outcomes and Measures: The prevalence of substance use (ie, past 30-day use of e-cigarettes, other tobacco, cannabis, and alcohol) and physical activity (active ≥5 days/week) was compared at baseline and follow-up. A difference-in-difference approach was used to assess whether changes from baseline to 6-month follow-up varied if follow-up occurred after the stay-at-home order, adjusting for baseline behaviors and characteristics. All models were weighted for losses to follow-up using the inverse probability method. Weights were derived from a logistic regression model for having a follow-up response (dependent variable), as predicted by baseline characteristics and behaviors.Results: Of 1423 adolescents enrolled at baseline, 1006 completed 6-month follow-up (623 [62%] were female, and 492 [49%] were non-Hispanic White). e-Cigarette use declined from baseline to 6-month follow-up completed before the stay-at-home order (17.3% [89 of 515] to 11.3% [58 of 515]; McNemar chi2=13.54; exact P<.001) and 6-month follow-up completed after the stay-at-home order (19.9% [96 of 482] to 10.8% [52 of 482]; McNemar chi2=26.16; exact P<.001), but the extent of decline did not differ statistically between groups responding before vs after the stay-at-home order (difference-in-difference adjusted odds ratio, 0.84; 95% CI, 0.47-1.52; P=.58). In contrast, being physically active was unchanged from baseline if follow-up was before the order (53.7% [279 of 520] to 52.9% [275 of 520]; McNemar chi2=0.09; exact P=.82) but declined sharply from baseline if follow-up was after the order (54.0% [261 of 483] to 38.1% [184 of 483]; McNemar chi2=30.72; exact P<.001), indicating a pronounced difference in change from baseline after the stay-at-home order (difference-in-difference adjusted odds ratio, 0.49; 95% CI, 0.35-0.69; P<.001). Overall in the cohort, reported use of other tobacco, cannabis, and alcohol did not differ meaningfully before and after the order.Conclusions and Relevance: In this cohort, a reduction in e-cigarette use occurred independently of COVID-19 stay-at-home restrictions, but persistent cannabis and alcohol use suggest continued need for youth substance use prevention and cessation support. Declining physical activity during the pandemic is a health concern.

  View details for DOI 10.1001/jamapediatrics.2021.0541

  View details for PubMedID 33938922

• Measures of both perceived general and specific risks and benefits differentially predict adolescent and young adult tobacco and marijuana use: findings from a Prospective Cohort Study. Humanities & social sciences communications McKelvey, K., Gaiha, S. M., Delucchi, K. L., Halpern-Felsher, B. 2021; 8 (1)

  Abstract

  Health behavior theorists and prevention researchers use a variety of measures of adolescent and young adult (AYA) risk and benefit perceptions to predict tobacco-use and marijuana-use behaviors. However, studies have not examined whether and how perception measures that ask about likelihood of more general outcomes such as "harm" versus ask about specific risk or benefit outcomes compare or whether they differentially predict AYA willingness to use if one of your best friends were to offer it and intentions to use in the next year; and if these measures have differential ability to predict actual use of tobacco and marijuana. We used data from a prospective cohort of California AYAs to create and test new scales to measure perceptions of specific health and social outcomes related to risks (e.g., smell bad) and benefits (e.g., look cool) related to tobacco and marijuana, and then addressed three questions: (1) Whether and how measures of perceptions of specific social and health risks and benefits (for our purposes "specific measures") and measures of perceived general harm are differentially associated with measures of willingness, social norms, and intentions to use? (2) Are specific versus general measures differentially associated with and predictive of tobacco and cannabis use behavior? (3) Are specific perceptions measures differentially predictive of behavior compared to measures of willingness, social norms, and behavioral intentions? Our results demonstrate that to better predict AYA tobacco and marijuana use, measures that address general outcomes, such as harmfulness, as well as willingness and behavioral intention should be used. We also found that measures of specific perceived risks (short-term, long-term, social) and benefits were unrelated and correlated differently with different products. For example, adolescents perceived both risks and benefits from using products like e-cigarettes, and perceived greater risk from smokeless tobacco compared to combustible cigarettes. These findings indicate that measures of specific perceived social and health outcomes can be useful to discern nuanced differences in motivation for using different substances. Study implications are important for survey dimension-reduction and assessing relationships among perceptions, motivations, and use of tobacco and marijuana products.

  View details for DOI 10.1057/s41599-021-00765-2

  View details for PubMedID 34435190

  View details for PubMedCentralID PMC8382238

• Inside the adolescent voice: A qualitative analysis of the appeal of different tobacco products. Tobacco induced diseases Liu, J. n., Ramamurthi, D. n., Halpern-Felsher, B. n. 2021; 19: 15

  Abstract

  While cigarette use has decreased, adolescents' overall use of tobacco (e.g. e-cigarettes, cigars, and hookah) has increased. The purpose of this qualitative study is to highlight the decision-making process of adolescents to use certain products over others and why certain tobacco products appeal to them.Twenty-five participants were recruited from a larger study surveying adolescents' perceptions and tobacco use (772 high school students). The participants were involved in one-on-one semi-structured phone interviews on the appeal of different tobacco products. Interviews were recorded, transcribed verbatim, and analyzed by identifying relevant codes and themes.Participants for this study had a mean age of 16.4 (SD=1.2) years; over half (14/25) were female. Three major themes emerged from the interviews: 1) social context and circumstances to use, including using and sharing with peers, and reducing boredom; 2) importance of flavors, smell, taste, smoke tricks, and accessibility of products; and 3) misperceptions and misinformation of product risks.The findings that emerged showed why participants favored certain tobacco products, especially e-cigarettes, over others. The results support areas for future research and practice, and inform how interventions can better address the appeal of different tobacco products to ultimately prevent adolescent use.

  View details for DOI 10.18332/tid/132856

  View details for PubMedID 33654482

  View details for PubMedCentralID PMC7908110

• A novel approach to training educators to conduct school-based adolescent e-cigarette education and prevention: Using the Tobacco Prevention Toolkit. Addictive behaviors Lazaro, A. n., Ceballos, R. n., Fischer, M. n., Smuin, S. n., Halpern-Felsher, B. n. 2021; 118: 106858

  Abstract

  Emerging tobacco products, especially e-cigarettes, present a challenge for educators tasked with providing adolescent tobacco prevention education, as they typically have insufficient time to stay uptodate with the latest information on all tobacco products. To equip educators to implement e-cigarette and other prevention materials, we developed a novel, experiential training of the Tobacco Prevention Toolkit, comprising three components: (1) information session, (2) website navigation demonstration, and (3) hands-on curriculum demonstration allowing educators to present and practice Toolkit lessons.We evaluated this experiential training using a post-training survey, conducted with 486 participants (75% female) from 21 separate trainings. Surveys included demographic questions, training evaluation questions, and 4 open-ended questions administered via Qualtrics. Quantitative data were analyzed for frequencies via R statistical software. Qualitative data were analyzed using grounded theory.Training participants overwhelmingly agreed or strongly agreed that their knowledge of e-cigarettes increased as a result of the training; they were satisfied with the overall training; and they indicated intention to use the Toolkit in the future. Participants favored the enthusiastic presenters, the information about e-cigarettes, the website navigation, and the curriculum demonstration features of the training. Participants requested more time for various components of the training, more in-depth information about e-cigarettes, and more direction for Toolkit implementation.This novel, experiential training increased educator-reported knowledge of tobacco products and was overwhelmingly well-received, suggesting that such training can be important for effective dissemination of other e-cigarette prevention and intervention curricula.

  View details for DOI 10.1016/j.addbeh.2021.106858

  View details for PubMedID 33640832

• Underage Youth and Young Adult e-Cigarette Use and Access Before and During the Coronavirus Disease 2019 Pandemic. JAMA network open Gaiha, S. M., Lempert, L. K., Halpern-Felsher, B. 2020; 3 (12): e2027572

  Abstract

  Importance: Understanding patterns of e-cigarette use and access during the coronavirus disease 2019 (COVID-19) pandemic is important because e-cigarettes may put users at risk for more severe respiratory effects and other health problems.Objective: To examine whether underage youth and young adults who ever used e-cigarettes self-reported changes in access and use of e-cigarettes since the COVID-19 pandemic began.Design, Setting, and Participants: A national, cross-sectional online survey study was conducted from May 6 to May 14, 2020. This sample of 4351 participants aged 13 to 24 years across the US included 2167 e-cigarette ever-users. Quota sampling was used to balance for age, sex, race/ethnicity, and 50% having ever used e-cigarettes.Main Outcomes and Measures: Change in e-cigarette use (increase, decrease, quit, no change, and switch to another product) and access to e-cigarettes (easier or harder, and change in point-of-purchase) before and after the COVID-19 pandemic began, reasons for change, number of times e-cigarettes were used, nicotine dependence, and sociodemographic data.Results: This study focused on 2167 e-cigarette ever-users among 4351 participants who completed the survey. Among 2167 e-cigarette users, a total of 1442 were younger than 21 years and 725 were aged 21 years or older; 1397 were female (64.5%) and 438 identified as lesbian, gay, bisexual, transgender, queer (20.2%). The survey completion rate was 40%. Since the COVID-19 pandemic began, 1198 of 2125 e-cigarette users (56.4%) changed their use: 388 individuals (32.4%) quit, 422 individuals (35.3%) reduced the amount of nicotine, 211 individuals (17.6%) increased nicotine use, 94 individuals (7.8%) increased cannabis use, and 82 individuals (6.9%) switched to other products. Participants reported that not being able to go to vape shops and product unavailability were the reasons accessing e-cigarettes was difficult after the pandemic began. Since the COVID-19 pandemic began, individuals reported purchasing from alternative retail stores (disposables, 150 of 632 [23.7%]; pod-based, 144 of 797 [18.1%]; and other e-cigarette, 125 of 560 [22.3%], ie, between 18.1% and 23.7%), purchasing online instead of retail (disposables, 115 of 632 [18.2%]; pod-based, 156 of 797 [19.6%]; and other e-cigarette, 111 of 560 [19.8%], ie, between 18.2% to 19.8%), and shifted to retail instead of online (disposables, 11 of 632 [1.7%]; pod-based, 17 of 797 [2.0%]; and other e-cigarette, 13 of 560 [2.3%], ie, between 1.7%-2.3%). Other individuals reported no change: from retail stores (disposables 262 of 632 [41.5%]; pod-based 344 of 797 [43.2%]; and other e-cigarette, 223 of 560 [39.8%], ie, between 39.8% and 43.2%) and online (disposables 94 of 632 [14.9%]; pod-based 136 of 797 [17.1%]; and other e-cigarette, 88 of 560 [15.8%], ie, between 14.9% and 17.1%). Underage youth reported e-cigarette deliveries from vape shops and/or dealers or friends who received such deliveries, and 63 of 229 (27.5%) self-reported accessing e-cigarettes without age verification. e-Cigarette users were 52% less likely to quit or reduce their use if they previously used e-cigarettes between 11 and 99 times (adjusted odds ratio, 0.48; 95% CI, 0.30-0.78), 68% less likely to quit if they previously used e-cigarettes more than 100 times (adjusted odds ratio, 0.32; 95% CI, 0.20-0.51), and 51% were less likely to quit if they were nicotine dependent (adjusted odds ratio, 0.49; 95% CI, 0.35-0.70).Conclusions and Relevance: During the COVID-19 pandemic, youth e-cigarette users reported changes in e-cigarette use, point-of-purchase, and ability to purchase e-cigarettes without age verification. The US Food and Drug Administration and local policy makers may find these data useful to inform policies to prevent e-cigarette sales to underage youth.

  View details for DOI 10.1001/jamanetworkopen.2020.27572

  View details for PubMedID 33270127

• What Does It Meme? A Qualitative Analysis of Adolescents' Perceptions of Tobacco and Marijuana Messaging. Public health reports (Washington, D.C. : 1974) Liu, J., McLaughlin, S., Lazaro, A., Halpern-Felsher, B. 2020: 33354920947399

  Abstract

  OBJECTIVES: With the increasing popularity of electronic cigarettes and legalization of recreational marijuana, messaging from websites and social media is shaping product perceptions and use. Quantitative research on the aesthetic appeal of these advertisements from the adolescent and young adult perspective is lacking. We evaluated (1) how adolescents and young adults perceived tobacco and marijuana messaging online and through social media platforms and (2) interactive behaviors related to these messages.METHODS: We interviewed 24 participants from the Tobacco Perceptions Study, a longitudinal study of adolescents' and young adults' (aged 17-21) tobacco-related perceptions and tobacco use. We collected qualitative data from October 2017 through February 2018, through individual semi-structured interviews, on participants' experiences and interactions with online tobacco and marijuana advertisements and the advertisements' appeal. Two analysts recorded, transcribed, and coded interviews.RESULTS: Themes that emerged from the interviews focused on the direct appeal of online messaging to adolescents and young adults; the value of trusting the source; the role of general attitudes and personal decision-making related to using tobacco and/or marijuana; the appeal of messaging that includes colors, interesting packaging, and appealing flavors; and the preference of messages communicated by young people and influencers rather than by industry.CONCLUSION: These findings suggest the need for increased regulation of social media messaging and marketing of tobacco and marijuana, with a particular focus on regulating social media, paid influencers, and marketing that appeals to adolescents and young adults. The findings also suggest the importance of prevention programs addressing the role of social media in influencing the use of tobacco and marijuana.

  View details for DOI 10.1177/0033354920947399

  View details for PubMedID 32791026

• Association Between Youth Smoking, Electronic Cigarette Use, and Coronavirus Disease 2019. The Journal of adolescent health : official publication of the Society for Adolescent Medicine Gaiha, S. M., Cheng, J., Halpern-Felsher, B. 2020

  Abstract

  PURPOSE: This study aimed to assess whether youth cigarette and electronic cigarette (e-cigarette) use are associated with coronavirus disease 2019 (COVID-19) symptoms, testing, and diagnosis.METHODS: An online national survey of adolescents and young adults (n= 4,351) aged 13-24 years was conducted in May 2020. Multivariable logistic regression assessed relationships among COVID-19-related symptoms, testing, and diagnosis and cigarettes only, e-cigarettes only and dual use, sociodemographic factors, obesity, and complying with shelter-in-place.RESULTS: COVID-19 diagnosis was five times more likely among ever-users of e-cigarettes only (95% confidence interval [CI]: 1.82-13.96), seven times more likely among ever-dual-users (95% CI: 1.98-24.55), and 6.8 times more likely among past 30-day dual-users (95% CI: 2.40-19.55). Testing was nine times more likely among past 30-day dual-users (95% CI: 5.43-15.47) and 2.6 times more likely among past 30-day e-cigarette only users (95% CI: 1.33-4.87). Symptoms were 4.7 times more likely among past 30-day dual-users (95% CI: 3.07-7.16).CONCLUSIONS: COVID-19 is associated with youth use of e-cigarettes only and dual use of e-cigarettes and cigarettes, suggesting the need for screening and education.

  View details for DOI 10.1016/j.jadohealth.2020.07.002

  View details for PubMedID 32798097

• The Importance of Including Youth Research in Premarket Tobacco Product and Modified Risk Tobacco Product Applications to the Food and Drug Administration. The Journal of adolescent health : official publication of the Society for Adolescent Medicine Halpern-Felsher, B., Henigan, D., Riordan, M., Boonn, A., Perks, S. N., Krishnan-Sarin, S., Vallone, D. 2020

  View details for DOI 10.1016/j.jadohealth.2020.06.020

  View details for PubMedID 32674965

• Public Health Considerations for Adolescent Initiation of Electronic Cigarettes. Pediatrics Gaiha, S. M., Halpern-Felsher, B. 2020; 145 (Suppl 2): S175–S180

  Abstract

  Adolescent use of electronic cigarettes (e-cigarettes) has increased dramatically, with younger and nicotine-naive adolescents starting to use these devices and use them more frequently than combustible cigarettes. In emerging evidence, it is shown that e-cigarettes are not effective in helping adult smokers quit and that youth using e-cigarettes are at risk for becoming nicotine dependent and continuing to use as adults. Important gaps in our knowledge remain regarding the long-term health impact of e-cigarettes, effective strategies to prevent and reduce adolescent e-cigarette use, and the impact of provider screening and counseling to address this new method of nicotine use.

  View details for DOI 10.1542/peds.2019-2056E

  View details for PubMedID 32358208

• Longitudinal trends in e-cigarette devices used by Californian youth, 2014-2018. Addictive behaviors Lin, C., Baiocchi, M., Halpern-Felsher, B. 2020; 108: 106459

  Abstract

  The rate of adolescent and young adult (AYA) e-cigarette usage has increased in recent years, possibly due to the introduction of sleek new e-cigarette devices such as JUUL. This study analyzed data from 400 California AYA to examine trends in e-cigarette usage by device type (disposables, large-size rechargeables, vape/hookah pens, JUUL/pod-based). Participants were asked about their ever, past 30-day, and past 7-day use of e-cigarettes; their usual e-cigarette device used; and co-use of devices in seven surveys administered approximately biannually from 2014 to 2018. During this time period, total e-cigarette ever-usage in our cohort increased linearly from 14.1% to 46.2% (ptrend<0.001). JUUL/pod-based e-cigarette ever-usage increased from 14.9% to 22.5% in just six months in 2018. Furthermore, a majority of new e-cigarette users at the time of the survey endorsed using JUUL/pod-based devices (58.3% in Wave 6, 73.0% in Wave 7). With newer device options, AYA were also increasingly less likely to endorse older models such as disposables (19.1% to 6.9% from 2014 to 2018, ptrend<0.01) and rechargeables (69.1% to 26.2% from 2014 to 2018, ptrend<0.001) as their usual e-cigarette device. Participants who used JUUL/pod-based only as their usual device were more likely to endorse using only JUUL/pod-based devices during follow-up survey (70%), and none switched to a new device completely. Overall, this study provides a snapshot of how AYA's e-cigarette preferences appear to respond to new devices entering the market.

  View details for DOI 10.1016/j.addbeh.2020.106459

  View details for PubMedID 32388394

• YOUTH USE OF DIFFERENT BRANDS OF POD-TYPE E-CIGARETTES POPULARIZED BY JUUL: HOW AND WHY THEY ARE USING McKelvey, K., Halpern-Felsher, B. ELSEVIER SCIENCE INC. 2020: S32

  View details for Web of Science ID 000506637300060

• Support for Aggressive Tobacco Control Interventions Among California Adolescents and Young Adults. The Journal of adolescent health : official publication of the Society for Adolescent Medicine Sonnenberg, J. n., Bostic, C. n., Halpern-Felsher, B. n. 2020

  Abstract

  The aim of the study was to assess adolescent and young adult support for banning the sale of various tobacco and marijuana products and describe whether support varies by tobacco or marijuana use status.We analyzed data from a California school-based survey (N = 450) on tobacco access, perceptions, social norms, marketing, and use.We found a majority of respondents favored gradually banning the sale of cigarettes (76%); e-cigarettes other than JUULs (55%); JUULs (59%); cigars, cigarillos, and little cigars (70%); and hookah (54%). A majority of ever and never users favored immediately banning the sale of cigarettes. Support for gradual, immediate, and drugstore bans was higher among never users for every policy except an immediate ban on cigarette sales, for which there was no difference between the 2 groups.There is broad support for aggressive tobacco control interventions, especially for combustible tobacco products, among a sample of California youth and young adults.

  View details for DOI 10.1016/j.jadohealth.2019.11.302

  View details for PubMedID 31974013

• How and Why California Young Adults Are Using Different Brands of Pod-Type Electronic Cigarettes in 2019: Implications for Researchers and Regulators. The Journal of adolescent health : official publication of the Society for Adolescent Medicine McKelvey, K. n., Halpern-Felsher, B. n. 2020

  Abstract

  The aim of the study was to describe young adult use and perceptions of different brands of pod-based electronic cigarettes (e-cigarettes) and compare with earlier types of non-pod-based e-cigarettes (e.g., mods and tanks).Data were collected from January to March 2019 and derive from the final wave of a cohort study recruited in 2013-2014 using a convenience sample from 10 large California high schools with racially/ethnically and socioeconomically diverse populations. A total of 445 participants completed an online survey (mean age = 20.1 years [SD = 1.66], 64.8% female [n = 278], 38.8% white [n = 161], 23.9% each for Asian and "more than one race" [n = 99], 13.5% other [n = 56], and 36.9% Hispanic [n = 160]). The main outcomes were description of and reasons to use pods, perceived nicotine content, and use patterns.Although <25% of participants reported smoking cigarettes and using non-pod-based e-cigarettes, >25% reported ever use of JUUL. Similarly, <33% of cigarette smokers and non-pod-based e-cigarette users reported use in the past 30 days, and >50% of JUUL ever users did. The most agreed upon reason (58%) for using pods was because they are "easy to hide." About half of pod users "do not know" if they mix brands of e-juice and pods, the nicotine concentration in their e-juice cartridges, nor time to finish a cartridge. Of the 50% of participants who shared their pod, 23 (15%) did "sometimes," 20 (13%) "always," and 16 (11% each) "about half the time" or "often." There was no consensus about how to refer to different brands of pods.Our findings indicate young adults harbor confusion about pod-based e-cigarettes, including nicotine content, usage patterns, and labeling, and that pod use is largely because of the ease with which they can "stealth" vape. The findings suggest needed regulation and education about these products.

  View details for DOI 10.1016/j.jadohealth.2020.01.017

  View details for PubMedID 32192827

• PMI's heated tobacco products marketing claims of reduced risk and reduced exposure may entice youth to try and continue using these products. Tobacco control McKelvey, K. n., Baiocchi, M. n., Halpern-Felsher, B. n. 2020

  Abstract

  Philip Morris International (PMI) is seeking Food and Drug Administration's (FDA) authorisation to market IQOS as a modified risk tobacco product and to make marketing claims of reduced risk and reduced exposure. Such claims may be misunderstood by youth, thereby increasing their risk for tobacco initiation.To assess youth (mean age 19.3, SD=1.7) understanding and perceptions of PMI's proposed consumer marketing claims of reduced risk and reduced exposure, we embedded a randomised controlled experiment into a survey of 450 California youth (April to August 2018). Participants were randomised to see 'reduced exposure', 'reduced risk' or neither claim. Perceptions of IQOS-related health risks and general harm and understanding of the term 'switching completely' as used in PMI's proposed claims were compared.Mean expectancies to experience specific health risks did not differ by claim exposure. The reduced exposure group's perceptions of general harm did not differ from those of controls nor from the reduced risk group. The reduced risk group had the largest proportion who perceived IQOS as moderately/less harmful (n=78, 52%); controls the largest proportion perceiving IQOS as quite/extremely harmful (n=91, 63%). While 71% of the sample understood the term 'switch completely' correctly as used in the reduced risk (n=194, 71%) and reduced exposure (n=206, 72%) claims, more than 1 in 4 did not.FDA and other regulators must use caution when considering allowing claims of reduced risk or reduced exposure to appear on retail tobacco packaging. Youth misunderstand such claims, and misperceptions of harm are known to lead to tobacco-use initiation.

  View details for DOI 10.1136/tobaccocontrol-2019-055318

  View details for PubMedID 32029537

• Popular Flavors Used in Alternative Tobacco Products Among Young Adults. The Journal of adolescent health : official publication of the Society for Adolescent Medicine Nguyen, N., McKelvey, K., Halpern-Felsher, B. 2019; 65 (2): 306–8

  Abstract

  PURPOSE: The aim of the article was to examine flavors of alternative tobacco products most commonly used by young adults (YAs).METHODS: California YA (N= 365; mean age= 20.0years) were surveyed in 2018 about the first and usual flavors of alternative tobacco products used. Flavor categories were fruit, candy, menthol, mint, coffee, spice, alcohol, wintergreen, and tobacco.RESULTS: Fruit and mint were the most common flavors used (pod-based e-cigarettes: 35.4% and 29.3%; other e-cigarettes: 52.7% and 23.1%; hookah: 45.4% and 18.5%; cigars/cigarillos: 22.4% and 6.9%, respectively). For other e-cigarettes and hookah, candy was also popular (20.5% and 14.8%, respectively). For pod-based and other e-cigarettes, menthol was widely used (13.4% and 17.0%, respectively). Approximately half of the ever-flavor users reported they "usually" used the same flavors across products (menthol users: 52.2%; fruit users: 51.7%; mint users: 44.0%; and candy users: 43.8%).CONCLUSIONS: YA are clearly using flavors, specifically fruit, mint, candy, and menthol, in their tobacco products.

  View details for DOI 10.1016/j.jadohealth.2019.05.004

  View details for PubMedID 31331543

• Past 30-day co-use of tobacco and marijuana products among adolescents and young adults in California. Addictive behaviors Nguyen, N., Barrington-Trimis, J. L., Urman, R., Cho, J., McConnell, R., Leventhal, A. M., Halpern-Felsher, B. 2019; 98: 106053

  Abstract

  BACKGROUND: Limited research among adolescents and young adults (AYA) has assessed tobacco and marijuana co-use in light of specific products. We examined the patterns of past 30-day co-use of tobacco and marijuana products, and the product-specific associations among past 30-day use of these substances.METHODS: Data from three school-based convenience samples of California AYA (aged 15-22) (Sample 1 = 3008; Sample 2 = 1419; Sample 3 = 466) were collected during 2016-2017. Proportions of past 30-day co-use of tobacco (e-cigarettes, cigarettes, hookah, cigars) and marijuana (combustible, vaporized, edible, blunt) were estimated. Multivariable logistic regression analyses examined associations between use of each tobacco and marijuana product for individual samples, then the pooled analysis calculated combined ORs.RESULTS: In the three samples, 7.3-11.3% of participants reported past 30-day co-use. Combinations of e-cigarettes or cigarettes and combustible marijuana were the most common co-use patterns. Past 30-day use of e-cigarettes or cigarettes (vs. non-use) increased the odds of past 30-day use of all marijuana products [e-cigarettes: ORs (95%CI) ranging from 2.5 (1.7, 3.2) for edible marijuana to 4.0 (2.8, 5.2) for combustible marijuana; cigarettes: from 3.2 (2.1, 4.2) for vaporized marijuana to 5.5 (3.8, 7.3) for combustible marijuana]. Past 30-day use of hookah or cigars was positively associated with past 30-day use of three of four marijuana products, except for hookah and vaporized marijuana, and for cigars and combustible marijuana.CONCLUSIONS: Given various co-use patterns and significant associations among tobacco and marijuana products, interventions targeting AYA should address co-use across the full spectrum of specific products for both substances.

  View details for DOI 10.1016/j.addbeh.2019.106053

  View details for PubMedID 31357072

• Association of Alternative Tobacco Product Initiation With Ownership of Tobacco Promotional Materials Among Adolescents and Young Adults. JAMA network open Abdel Magid, H. S., Bradshaw, P. T., Ling, P. M., Halpern-Felsher, B. 2019; 2 (5): e194006

  Abstract

  Importance: Use of alternative tobacco products (ATPs) such as electronic cigarettes, chewing tobacco, pipes, cigars, cigarillos, little cigars, and hookah is rapidly increasing. Although marketing restrictions exist for cigarettes, marketing of ATPs is not yet fully regulated, and studies have not assessed the association between ownership of ATP promotional materials and subsequent ATP or cigarette initiation among adolescents and young adults.Objective: To estimate the association between marketing receptivity measured at baseline and ATP and any tobacco initiation 1 year later, including cigarettes, among adolescents and young adults.Design, Setting, and Participants: Longitudinal cohort study of adolescents and young adults aged 13 to 19 years recruited at high schools in California from July 2014 to October 2015, with follow-up 1 year later. Data were analyzed from January to March 2018.Exposures: Ownership of ATP-specific promotional material and ownership of any tobacco promotional materials (eg, samples, coupons, branded caps, t-shirts, or posters) assessed in wave 1.Main Outcomes and Measures: Outcomes were (1) ATP initiation and (2) either ATP or cigarette initiation in wave 2.Results: Of 757 participants (mean [SD] age at wave 1, 16.1 [1.1] years; 481 [63.5%] female; 166 [21.9%] Asian or Pacific Islander, 202 [26.7%] white, and 276 [36.4%] Latino), 129 (17.0%) initiated ATP use and 141 (18.6%) initiated ATP or cigarette use 1 year later. In unadjusted models, wave 2 ATP initiation was found to be significantly associated with wave 1 ownership of ATP promotional materials (odds ratio, 2.23; 95% CI, 1.26-3.97). After adjustment for wave 1 demographic covariates, the association between ownership of ATP promotional material and ATP initiation 1 year later yielded similar results (odds ratio, 2.13; 95% CI, 1.16-3.91). Results of models assessing a combined outcome variable of either ATP or cigarette ever use were not statistically significant.Conclusions and Relevance: Ownership of ATP promotional materials was associated with subsequent initiation of ATPs. The results of this study are consistent with the suggestion that current marketing restrictions for cigarettes, including restrictions of the distribution of samples, coupons, and other promotional material, should extend to ATPs.

  View details for DOI 10.1001/jamanetworkopen.2019.4006

  View details for PubMedID 31099874

• Effects of e-Cigarette Advertisements on Adolescents' Perceptions of Cigarettes. Health communication Kim, M., Popova, L., Halpern-Felsher, B., Ling, P. M. 2019; 34 (3): 290-297

  Abstract

  This study examined the effect of exposure to "cigalike" (products resembling cigarettes) e-cigarette advertisements on adolescents' perceptions of cigarettes. A nationally representative sample of 802 adolescents (13-17 years old) was randomly assigned to watch three e-cigarette or three control advertisements. Never-smokers who saw the e-cigarette advertisements (n = 352) reported significantly lower perceived risks of smoking than those in the control condition (n = 320). Ever-smokers (n = 130) did not show significant differences across the conditions. In subgroup analyses, current smokers (reported smoking in the past 30 days, n = 31) in the e-cigarette condition reported significantly lower perceived benefits of smoking than those in the control condition. E-cigarette advertisements can affect adolescents' perceptions of cigarettes. Many advertisements, especially the ones promoting "cigalikes," depict e-cigarettes as being similar to cigarettes (e.g., look, flavor) but also as a solution for cigarettes' shortcomings (e.g., bad smell). While the advertisements include messages about problems posed by cigarettes, proposing e-cigarettes as a solution may decrease the perceived risks of smoking among never-smokers. It may also not be clear to adolescents whether advertisements are for cigarettes or e-cigarettes. Regulating e-cigarette advertisements to minimize adolescents' exposure may prevent potential harmful effects on never-smokers' perception of smoking.

  View details for DOI 10.1080/10410236.2017.1407230

  View details for PubMedID 29236550

  View details for PubMedCentralID PMC5999542

• Tobacco Retail Density and Initiation of Alternative Tobacco Product Use Among Teens. The Journal of adolescent health : official publication of the Society for Adolescent Medicine Abdel Magid, H. S., Halpern-Felsher, B. n., Ling, P. M., Bradshaw, P. T., Mujahid, M. S., Henriksen, L. n. 2019

  Abstract

  The rise of noncigarette, alternative tobacco product (ATP) use among adolescents may be due in part to an increase in retail availability of ATPs. We examined whether proximity and density of tobacco retailers near students' homes are associated with a higher likelihood of initiating ATP use over time.Using data from 728 adolescents (aged 13-19 years at baseline) residing in 191 different neighborhoods and attending 10 different California high schools, longitudinal multilevel and cross-classified random effect models evaluated individual-level, neighborhood-level, and school-level risk factors for ATP initiation after 1 year. Covariates were obtained from the American Community Survey and the California Department of Education.The sample was predominantly female (63.5%) and was racially and ethnically diverse. Approximately one third of participants (32.5%) reported ever ATP use at baseline, with 106 (14.5%) initiating ATP use within 1 year. The mean number of tobacco retailers per square mile within a tract was 5.66 (standard deviation = 6.3), and the average distance from each participant's residence to the nearest tobacco retailer was .61 miles (standard deviation = .4). Living in neighborhoods with greater tobacco retailer density at baseline was associated with higher odds of ATP initiation (odds ratio = 1.22, 95% confidence interval = 1.07-2.12), controlling for individual and school factors.Tobacco retailers clustered in students' home neighborhood may be an environmental influence on adolescents' ATP use. Policy efforts to reduce adolescent ATP use should aim to reduce the density of tobacco retailers and limit the proximity of tobacco retailers near adolescents' homes and schools.

  View details for DOI 10.1016/j.jadohealth.2019.09.004

  View details for PubMedID 31784411

• The Juul Curriculum Is Not the Jewel of Tobacco Prevention Education. The Journal of adolescent health : official publication of the Society for Adolescent Medicine Liu, J., Halpern-Felsher, B. 2018; 63 (5): 527–28

  View details for PubMedID 30348276

• Heated tobacco products likely appeal to adolescents and young adults. Tobacco control McKelvey, K., Popova, L., Kim, M., Chaffee, B. W., Vijayaraghavan, M., Ling, P., Halpern-Felsher, B. 2018; 27 (Suppl 1): s41–s47

  Abstract

  BACKGROUND: Beginning in the 1960s in the USA and globally since 1998, tobacco companies have beenaggressively promoting heated tobacco products (HTP). In 2016, Philip Morris International (PMI) applied to the US Food and Drug Administration (FDA) seeking authorisation to market their IQOS HTP system and flavoured 'HeatSticks' in the USA as a modified-risk tobacco product (MRTP).METHODS: We systematically evaluated the publicly available data PMI submitted to FDA in its MRTP application to determine whether PMI's IQOS product meets the US Tobacco Control Act's standard for MRTP claims. We examined whether PMI provided sufficient data showing tobacco users will not initiate with IQOS, that youth will not misperceive the MRTP-related claims being made concerning IQOS, and how youth perceive health risks associated with IQOS.RESULTS: PMI's own studies failed to provide evidence that youth, including non-users and former users, will not find IQOS appealing, will not initiate use of IQOS and will not perceive these products as risk-free. Further, PMI did not refer to independent studies conducted among adolescents which could influence their conclusions. Finally, their studies suffered from design and implementation flaws and cannot be relied on to support the proffered claims.CONCLUSION: PMI's own data and available evidence from scientific studies conducted independent of the tobacco industry regarding how novel tobacco products are currently being marketed suggest that introduction of IQOS will result in adolescent and young adult non-users initiating tobacco use with IQOS and could also increase poly-use of IQOS along with other tobacco products.

  View details for PubMedID 30352843

• Adolescents' and Young Adults' Use and Perceptions of Pod-Based Electronic Cigarettes. JAMA network open McKelvey, K., Baiocchi, M., Halpern-Felsher, B. 2018; 1 (6): e183535

  Abstract

  Electronic cigarettes (e-cigarettes) are the most commonly used tobacco product among adolescents and young adults, and the new pod-based e-cigarette devices may put adolescents and young adults at increased risk for polytobacco use and nicotine dependence.To build an evidence base for perceptions of risk from and use of pod-based e-cigarettes among adolescents and young adults.In a survey study, a cross-sectional analysis was performed of data collected from April 6 to June 20, 2018, from 445 California adolescents and young adults as part of an ongoing prospective cohort study designed to measure the use and perceptions of tobacco products.Use of pod-based e-cigarettes, e-cigarettes, and cigarettes.Ever use, past 7-day use, and past 30-day use and co-use of pod-based e-cigarettes, e-cigarettes, and cigarettes; use of flavors and nicotine in pod-based e-cigarettes and e-cigarettes; and associated perceptions of risks, benefits, and nicotine dependence.Among 445 adolescents and young adults (280 females, 140 males, 6 transgender individuals, and 19 missing data; mean [SD] age, 19.3 [1.7] years) who completed wave 6 of the ongoing prospective cohort study, ever use information was provided by 437 respondents, of which 68 (15.6%) reported use of pod-based e-cigarettes, 133 (30.4%) reported use of e-cigarettes, and 106 (24.3%) reported use of cigarettes. The mean (SD) number of days that pod-based e-cigarettes were used in the past 7 days was 1.5 (2.4) and in the past 30 days was 6.7 (10.0). The mean (SD) number of days that other e-cigarettes were used in the past 7 days was 0.8 (1.8) and in the past 30 days was 3.2 (7.4). The mean (SD) number of days that cigarettes were used in the past 7 days was 0.7 (1.8) and in the past 30 days was 3.0 (7.6). Among ever users of pod-based e-cigarettes, 18 (26.5%) reported their first e-liquid was flavored menthol or mint and 19 (27.9%) reported fruit (vs 13 [9.8%] and 50 [37.6%] for other e-cigarettes). The mean perceived chance of experiencing social risks and short-term and long-term health risks from the use of either pod-based e-cigarettes or other e-cigarettes was 40% and did not differ statistically by e-cigarette type. Among 34 adolescents and young adults reporting any loss of autonomy from nicotine, there was no difference in mean (SD) Hooked On Nicotine Checklist scores between those using pod-based e-cigarettes (2.59 [3.14]) and other e-cigarettes (2.32 [2.55]).Use by adolescents and young adults of newer types of e-cigarettes such as pod-based systems is increasing rapidly, and adolescents and young adults report corresponding misperceptions and lack of knowledge about these products. Rapid innovation by e-cigarette manufacturers suggests that public health and prevention efforts appear to be needed to include messages targeting components common to all current and emerging e-cigarette products to increase knowledge and decrease misperceptions, with the goal to try to ultimately reduce e-cigarette use among adolescents and young adults.

  View details for DOI 10.1001/jamanetworkopen.2018.3535

  View details for PubMedID 30646249

  View details for PubMedCentralID PMC6324423

• Youth say ads for flavored e-liquids are for them. Addictive behaviors McKelvey, K., Baiocchi, M., Ramamurthi, D., McLaughlin, S., Halpern-Felsher, B. 2018

  Abstract

  INTRODUCTION: E-cigarettes are the most popular tobacco product among adolescents and young adults ("AYA") and are available in many flavors. The e-cigarette industry argues that flavors are not meant to appeal to youth, yet no study has asked youth what age group they think ads for flavored e-liquids are targeting. We asked AYA which age group they thought ads for flavored e-liquids targeted.METHODS: In 2016 as part of a larger survey, a random sample of 255 youth from across California (62.4% female, mean age = 17.5, SD = 1.7) viewed eight ads, presented in randomized order, for fruit-, dessert-, alcohol-, and coffee-flavored e-liquids and indicated the age group they thought the ads targeted: younger, same age, a little older, or much older than them. Population means and 95% confidence intervals were estimated using bootstrapping (100,000 replicate samples).RESULTS: Most participants (93.7%) indicated the cupcake man flavor ad targeted an audience of people younger than they. Over half felt ads for smoothy (68.2%), cherry (63.9%), vanilla cupcake (58%), and caramel cappuccino (50.4%) targeted their age and for no flavor ad did most feel the primary target age group was much older.CONCLUSIONS: Youth believe ads for flavored e-liquids target individuals about their age, not older adults. Findings support the need to regulate flavored e-liquids and associated ads to reduce youth appeal, which ultimately could reduce youth use of e-cigarettes.

  View details for PubMedID 30314868

• Measuring perceptions related to e-cigarettes: Important principles and next steps to enhance study validity ADDICTIVE BEHAVIORS Gibson, L. A., Creamer, M. R., Breland, A. B., Giachello, A., Kaufman, A., Kong, G., Pechacek, T. F., Pepper, J. K., Soule, E. K., Halpern-Felsher, B. 2018; 79: 219–25

  Abstract

  Measuring perceptions associated with e-cigarette use can provide valuable information to help explain why youth and adults initiate and continue to use e-cigarettes. However, given the complexity of e-cigarette devices and their continuing evolution, measures of perceptions of this product have varied greatly. Our goal, as members of the working group on e-cigarette measurement within the Tobacco Centers of Regulatory Science (TCORS) network, is to provide guidance to researchers developing surveys concerning e-cigarette perceptions. We surveyed the 14 TCORS sites and received and reviewed 371 e-cigarette perception items from seven sites. We categorized the items based on types of perceptions asked, and identified measurement approaches that could enhance data validity and approaches that researchers may consider avoiding. The committee provides suggestions in four areas: (1) perceptions of benefits, (2) harm perceptions, (3) addiction perceptions, and (4) perceptions of social norms. Across these 4 areas, the most appropriate way to assess e-cigarette perceptions depends largely on study aims. The type and number of items used to examine e-cigarette perceptions will also vary depending on respondents' e-cigarette experience (i.e., user vs. non-user), level of experience (e.g., experimental vs. established), type of e-cigarette device (e.g., cig-a-like, mod), and age. Continuous formative work is critical to adequately capture perceptions in response to the rapidly changing e-cigarette landscape. Most important, it is imperative to consider the unique perceptual aspects of e-cigarettes, building on the conventional cigarette literature as appropriate, but not relying on existing conventional cigarette perception items without adjustment.

  View details for PubMedID 29175027

  View details for PubMedCentralID PMC5807230

• Marijuana, Secondhand Smoke, and Social Acceptability JAMA INTERNAL MEDICINE Glantz, S. A., Halpern-Felsher, B., Springer, M. L. 2018; 178 (1): 13–14

  View details for PubMedID 29159409

• Adolescents have unfavorable opinions of adolescents who use e-cigarettes. PloS one McKelvey, K., Popova, L., Pepper, J. K., Brewer, N. T., Halpern-Felsher, B. 2018; 13 (11): e0206352

  Abstract

  INTRODUCTION: While evidence suggests positive opinions of smokers are associated with tobacco use, research exploring adolescents' opinions of e-cigarette users is nascent. We hypothesized that adolescents harbor positive opinions of e-cigarette users, and that these opinions will be more positive among adolescents willing to try or who have used e-cigarettes.METHODS: Participants were 578 U.S. adolescents (ages 14 to 20) recruited from ten California schools. An online survey assessed their attitudes toward and opinions of adolescents who use e-cigarettes in 2015-2016. Analyses examined whether these variables were associated with willingness to try and use (ever vs. never) of e-cigarettes.RESULTS: The majority (61%) of participants had negative overall opinions toward adolescent e-cigarette users. Few participants ascribed positive traits (i.e., sexy, cool, clean, smart, and healthy) to e-cigarette users. Participants who were willing to try or had used e-cigarettes endorsed positive traits more than those unwilling to try and never-users (all p < .01). Participants sometimes endorsed negative traits (i.e., unattractive, trashy, immature, disgusting, and inconsiderate) to describe e-cigarette users. Unwilling and never-users viewed negative traits as more descriptive of e-cigarette users than willing or ever-users (all p < .01).CONCLUSIONS: Adolescents generally had somewhat negative opinions of other adolescents who use e-cigarettes. Building on adolescents' negativity toward adolescent e-cigarette users may be a productive direction for prevention efforts, and clinicians can play an important role by keeping apprised of the products their adolescent patients are using and providing information on health effects to support negative opinions or dissuade formation of more positive ones.

  View details for PubMedID 30403731

• Adolescents' attitudes towards e-cigarette ingredients, safety, addictive properties, social norms, and regulation. Preventive medicine Gorukanti, A., Delucchi, K., Ling, P., Fisher-Travis, R., Halpern-Felsher, B. 2016

  Abstract

  E-cigarette use has dramatically increased. While studies have examined adolescents' attitudes towards smoking, few have extended this research to adolescents' attitudes towards e-cigarettes. The goal of this study was to examine adolescents' attitudes regarding e-cigarette ingredients, safety, addictive properties, social norms, accessibility, price, and regulation; and determine whether attitudes differ by past cigarette/e-cigarette use. Participants were 786 9th and 12th graders from California (63.21% females; mean age=16.10years [SD=1.6]; 26.61% White, 21.98% Asian/Pacific Islander, 29.82% Hispanic, and 21.59% other). Results indicated that 19.05% of participants believed smoke from e-cigarettes is water; 23.03% believed e-cigarettes aren't a tobacco product; 40.36% considered e-cigarettes to be for cessation, and 43.13% felt they were safer than cigarettes. Participants felt it was more acceptable to use e-cigarettes indoors and outdoors compared to cigarettes (p<0.0001), 23.13% felt raising e-cigarette taxes is a bad idea, 63.95% thought e-cigarettes were easier to get than cigarettes, 54.42% felt e-cigarettes cost too much, 64.33% felt the age for buying e-cigarettes should be raised, and 64.37% favored e-cigarette regulation. Adolescents who used e-cigarettes and/or cigarettes had significantly more favorable e-cigarette attitudes than non-users. This study indicates that adolescents are aware of some of the risks of e-cigarettes, although many harbor misperceptions and hold more favorable attitudes towards e-cigarettes than cigarettes. Of concern is the relationship between favorable e-cigarette attitudes and use. Findings suggest the need to provide adolescents with correct information about e-cigarette ingredients, risks, and the insufficient evidence of their role in cigarette cessation.

  View details for DOI 10.1016/j.ypmed.2016.10.019

  View details for PubMedID 27773711

• Perceptions of social norms and exposure to pro-marijuana messages are associated with adolescent marijuana use. Preventive medicine Roditis, M. L., Delucchi, K., Chang, A., Halpern-Felsher, B. 2016; 93: 171-176

  Abstract

  Despite consistent declines in rates of cigarette use among adolescents in the last five years, rates of marijuana use have remained constant, with marijuana being the most widely used illegal drug among adolescents. More work is needed to understand how social norms, perceived risks and benefits, and social media messaging impact use of marijuana. This study compared perceptions and social norms related to marijuana, blunts and cigarettes. Additionally, we assessed how perceptions related to social norms, risks and benefits, and exposure to pro- versus anti-marijuana messaging is related to use. Participants were 786 adolescents from Southern and Northern California (36.7% male, 63.21% females; mean age=16.1years; SD=1.6). Participants came from diverse ethnic backgrounds, with 207 (26.61%) White, 171 (21.98%) Asian/Pacific Islander, 232 (29.82%) Hispanic, and 168 (21.59%) other. Results indicated that marijuana and blunts were consistently perceived as more socially acceptable and less risky than cigarettes (p<0.01). Participants who reported that their friends used marijuana had a 27% greater odds of using marijuana themselves. Further, seeing messages about the good things or benefits of marijuana use was associated with a 6% greater odds of use [OR 1.06 (CI 1.00, 1.12)]. This study's findings offer a number of important public health implications, particularly as states move towards legalization of marijuana for recreational use. As this occurs, states need to take adolescents' perceptions of risks, benefits, social norms, and peer influences into account as they implement strategies to reduce youth use of marijuana and blunts.

  View details for DOI 10.1016/j.ypmed.2016.10.013

  View details for PubMedID 27746339

• Adolescents' Perceptions of Health Risks, Social Risks, and Benefits Differ Across Tobacco Products JOURNAL OF ADOLESCENT HEALTH Roditis, M., Delucchi, K., Cash, D., Halpern-Felsher, B. 2016; 58 (5): 558-566

  Abstract

  This study assesses perceptions of overall harm, short-term health and social risks, long-term health risks, and benefits associated with various tobacco products including conventional cigarettes, e-cigarettes, cigars, chew, and hookah. This study also assesses whether and how perceptions differ by age, gender, race/ethnicity, and previous experience with tobacco.A total of 722 high school students completed an online survey, answering questions about their use and perceptions of a variety of tobacco products. Differences in perceptions across products were assessed using a generalized estimation equation with an exchangeable correlation structure.Adolescents rated the various tobacco products as conferring significantly different levels of risks and benefits. Generally, adolescents rated cigarettes as most risky, followed by cigars and chew, with hookah and e-cigarettes rated as least risky. Adolescents rated hookah followed by cigarettes and e-cigarettes as most likely to make them look cool or fit in and cigars and chew as least likely to confer these benefits. There were interaction effects by age and use, with older adolescents and those with tobacco experience holding lower perceptions of risk. There were no significant interaction effects by race/ethnicity or gender.Given the significant differences in adolescents' perceptions of risks and benefits of using different tobacco products and research showing the predictive relationship between perceptions and behavior, there is a need for comprehensive messaging that discusses risks of all tobacco products, particularly hookah and e-cigarettes. There is also a need to address perceived benefits of tobacco products, especially hookah and e-cigarettes.

  View details for DOI 10.1016/j.jadohealth.2016.01.012

  View details for Web of Science ID 000375158600010

  View details for PubMedID 27107909

• Adolescent (Mis)Perceptions About Nicotine Addiction: Results From a Mixed-Methods Study HEALTH EDUCATION & BEHAVIOR Roditis, M., Lee, J., Halpern-Felsher, B. L. 2016; 43 (2): 156-164

  Abstract

  Despite evidence that adolescents become addicted to nicotine even after limited use, adolescents believe they can experiment with or smoke cigarettes for a few years and easily quit. The goal of this study was to examine adolescents' understanding of the definition and process of nicotine addiction using a mixed-methods approach.Method A total of 367 adolescents with and without smoking experience rated the perceived risk for addiction, still being a smoker in 5 years, and ability to quit smoking. A subsample of adolescents (N= 41) were interviewed about their conceptualization and understanding of nicotine addiction. Within-participants analyses of variance were conducted to assess differences in perceptions of addiction across the three scenarios; thematic analyses of interviews were conducted to assess adolescents' understanding of addiction.Results Adolescents rated their perceived risk for addiction, still being a smoker in 5 years, and ability to quit as significantly different from one another for three different scenarios (F= 7.81, 47.78, and 70.27, respectively;p< .001). Seven themes describing how youth conceptualize and understand addiction emerged from the interview data, including skepticism and uncertainty about addiction, how smoking makes a person feel, and family and friends' experiences.While adolescents have received the message that cigarettes are addictive, they are uncertain regarding the definition of addiction and have not recognized that addiction means experiencing difficulty quitting and continuing to smoke longer than expected. Findings suggest the need for comprehensive messaging regarding nicotine addiction in educational, clinical, and intervention settings and for product warning messages aimed at reducing and preventing tobacco use.

  View details for DOI 10.1177/1090198115598985

  View details for Web of Science ID 000373699600006

  View details for PubMedID 26293459

• Adolescents' Perceptions of Risks and Benefits of Conventional Cigarettes, E-cigarettes, and Marijuana: A Qualitative Analysis JOURNAL OF ADOLESCENT HEALTH Roditis, M. L., Halpern-Felsher, B. 2015; 57 (2): 179-185

  Abstract

  Although rates of adolescent cigarette use have remained constant or decreased, rates of marijuana and e-cigarette use are rising. Knowledge and perceptions of risks and benefits of tobacco products impact adolescents' decisions to use these products. However, little is known regarding adolescents' knowledge and perceptions of risks of e-cigarettes and marijuana nor how these perceptions are formed. This study uses qualitative techniques to assess and compare adolescents' perceptions of the risks and benefits of cigarettes, e-cigarettes, and marijuana.Twenty-four adolescents (nine females and 15 males) from Northern California participated in six small-group discussions. Adolescents were asked what good or bad things might happen from using these products. To assess how perceptions and knowledge of risks and benefits were formed, participants were asked where and from whom they had learned about these products.Adolescents described negative consequences of cigarette use but were much less sure regarding risks of marijuana and e-cigarette use. Conversely, they described few benefits of cigarettes but described a number of benefits of e-cigarette and marijuana use. Adolescents described learning about these products from the media, from family and friends, and from the school environment.Adolescents have learned from multiple sources about risks of using cigarettes, but they receive much less and often incorrect information regarding marijuana and e-cigarettes, likely resulting in their positive and often ambivalent perceptions of marijuana and e-cigarettes.

  View details for DOI 10.1016/j.jadohealth.2015.04.002

  View details for Web of Science ID 000358262900011

  View details for PubMedCentralID PMC4515157

• Longitudinal Study of Adolescents' Attempts to Promote and Deter Friends' Smoking Behavior JOURNAL OF ADOLESCENT HEALTH Brady, S. S., Morrell, H. E., Song, A. V., Halpern-Felsher, B. L. 2013; 53 (6): 772-777

  Abstract

  Little research has examined the extent to which adolescents directly attempt to influence friends' smoking. This study examines adolescents' reported actions to promote or deter friends' smoking, and whether actions vary by adolescents' smoking experience.Data were collected between 2001 and 2004 at four time points across the 9th and 10th grades from an ethnically diverse school-based sample (N = 395; 53% female).Deterrence of smoking was reported by a greater percentage of adolescents than was promotion of smoking, both among those who had ever smoked and never smoked. By the end of the study, over 45% of ever smokers and less than 5% of never smokers had promoted smoking among friends. In contrast, over 70% of ever smokers and roughly 40% of never smokers had deterred smoking. Among adolescents who had ever smoked, positive consequences of smoking by fall of 10th grade predicted attempts to promote smoking by the end of 10th grade (OR = 4.37, p < .05). To a lesser extent, negative consequences of smoking predicted attempts to deter smoking (OR = 2.60, p < .08). These effects were independent of the opposite type of smoking consequences, level of personal smoking experience, having close friends who smoked, prior attempts to influence friends' behavior, and smoker's gender.Models of peer influence should account for both positive and negative influence of adolescents on friends' health behavior. Adolescents who have engaged in risk-taking and experienced negative consequences may be a resource in designing and delivering interventions; future research should evaluate their ability to change friends' behavior.

  View details for DOI 10.1016/j.jadohealth.2013.06.022

  View details for Web of Science ID 000327481300016

  View details for PubMedID 23945053

• "It was pretty scary": the theme of fear in young adult women's descriptions of a history of adolescent dating abuse. Issues in mental health nursing Burton, C. W., Halpern-Felsher, B., Rehm, R. S., Rankin, S., Humphreys, J. C. 2013; 34 (11): 803-813

  Abstract

  The mental health impact of abusive adolescent dating relationships has not been well described, but fear related to abuse has been reported. We elaborate the theme of fear in women's descriptions of a history of adolescent dating abuse. A sample of community-based women, ages 19-34, who experienced an abusive dating relationship during adolescence (ages 11-20) was used. Data were analyzed via thematic analysis. Fear was a consistent and resonant theme. Three types of fear were identified: fear for self, fear for other relationships, and fearful expectation. These results offer important insights into the impact of abusive adolescent relationships on women's mental health.

  View details for DOI 10.3109/01612840.2013.827286

  View details for PubMedID 24131412

• Identification and Characterization of Adolescents' Sexual Boundaries JOURNAL OF ADOLESCENT HEALTH Wolf, H. T., Morrell, H. E., Halpern-Felsher, B. L. 2013; 53 (1): 85-90

  Abstract

  Adolescents' decisions to have sex may be based on a priori boundaries placed on sex. This study addresses: (1) to what extent adolescents set vaginal sexual boundaries; (2) the types of sexual boundaries most and least likely to be endorsed; and (3) to what extent sexual boundaries vary by sex, race/ethnicity, and sexual experience.A cross-sectional study of 518 students attending 10th grade. Survey measures queried about demographics, ever having sex, and existence of sexual boundaries (e.g., being in love, having an attractive partner) that must be in place before having vaginal sex.The most frequently endorsed boundaries were maturity, commitment, trust, love, and marriage. These boundaries were more frequently endorsed than having a safer-sex method. Compared with females, males were more likely to choose boundaries based on partner attractiveness (p < .001) and avoiding trouble (p < .04). Compared with Asians and Pacific Islanders, whites were more likely to endorse wanting to be a certain age to have sex (p < .01 and p < .05, respectively); Asians and Pacific Islanders were more likely to choose sexual boundaries based on marriage (p's < .05). Adolescents who were sexually experienced were more likely than inexperienced adolescents to endorse boundaries related to relationship characteristics and partner attractiveness (OR = 2.5), and less likely to endorse boundaries related to feeling mature (OR = .34) and waiting until marriage (OR = .34).Identifying adolescents' sexual boundaries should help healthcare professionals better understand under what circumstances adolescents are more or less likely to have sex; and this information should ultimately inform the development of new interventions.

  View details for DOI 10.1016/j.jadohealth.2013.01.004

  View details for Web of Science ID 000320768200014

  View details for PubMedID 23481297

• What Does It Take to Be a Smoker? Adolescents' Characterization of Different Smoker Types NICOTINE & TOBACCO RESEARCH Lee, J., Halpern-Felsher, B. L. 2011; 13 (11): 1106-1113

  Abstract

  Studies have demonstrated that clinical- and research-based definitions of who a smoker is and what constitutes smoking often differ from adolescent-derived definitions, which can be problematic for effective intervention and prevention efforts. We investigated how adolescents define different smoker types (nonsmoker, smoker, regular smoker, addicted smoker, heavy smoker, experimental smoker, casual smoker, and social smoker) using multiple indicators of smoking behaviors, including frequency, amount, place, and length of time cigarette smoking, and whether differences exist by smoking experience.Quantitative and qualitative methods were used to analyze data from a cohort of adolescents (N = 372) in northern California.We found differences in how adolescents characterized smoker types based on their own smoking experience. Ever-smokers tended to have a greater flexibility in determining what constituted nonsmoking and heavy smoking, while never-smokers had much narrower definitions. Results also indicated that adolescents may mistakenly associate nicotine addiction with a high frequency and amount of cigarette use as 74.3% characterized an addicted smoker as having smoked for a few years or more. In addition, there was a considerable amount of overlap in definitions between different smoker types, particularly among the smoker-regular smoker, addicted smoker-heavy smoker, and casual smoker-social smoker pairs.Health communication strategies for youth smoking prevention need to address the wide variability and overlap in how adolescents define different smoker types. Greater attention should be directed to understanding the nuances of how adolescents define smoking in order to maximize the effectiveness of youth-centered smoking prevention and cessation messages.

  View details for DOI 10.1093/ntr/ntr169

  View details for Web of Science ID 000296352300013

  View details for PubMedID 21849408

• Earlier Age of Smoking Initiation May Not Predict Heavier Cigarette Consumption in Later Adolescence PREVENTION SCIENCE Morrell, H. E., Song, A. V., Halpern-Felsher, B. L. 2011; 12 (3): 247-254

  Abstract

  Previous studies suggest that earlier cigarette smoking initiation in adolescence predicts greater cigarette consumption later in adolescence or adulthood. Results from these studies have been used to inform interventions for adolescent smoking. However, previous studies suffer from several important methodological limitations. The objective of the present study was to address these limitations by longitudinally and prospectively examining whether and how age of initiation of smoking among adolescents predicts cigarette consumption by age 16 or 17. Participants completed an in-class survey every 6 months for 2-3 school years. Participants included 395 adolescents (Mean age=14 years at baseline; 53.2% female) from two public high schools in Northern California (Schools A and B) who completed self-report measures of smoking initiation, number of friends who smoke, and number of whole cigarettes smoked by the final survey time point. Adolescents who were older when they first smoked one whole cigarette were 5.3 to 14.6 times more likely in School A and 2.9 to 4.3 times more likely in School B to have smoked a greater number of cigarettes by age 16 or 17. Results suggested that earlier smoking initiation may not lead to heavier cigarette consumption later in time, as has been previously shown. There may be a period of heightened vulnerability in mid- or late adolescence where smoking experimentation is more likely to lead to greater cigarette consumption. Targeting prevention efforts to adolescents aged 14 to 17 years may further reduce smoking initiation among youth, thus limiting subsequent smoking-related morbidity and mortality in adulthood.

  View details for DOI 10.1007/s11121-011-0209-6

  View details for Web of Science ID 000293708700003

  View details for PubMedID 21384136

• Predictive Relationship Between Adolescent Oral and Vaginal Sex Results From a Prospective, Longitudinal Study ARCHIVES OF PEDIATRICS & ADOLESCENT MEDICINE Song, A. V., Halpern-Felsher, B. L. 2011; 165 (3): 243-249

  Abstract

  To (1) identify the temporal order between oral and vaginal sex onset; (2) test whether oral sex or vaginal sex is a risk or protective factor for the other; and (3) determine whether the relationship between oral and vaginal sex varies across time.Prospective, longitudinal study with 6-month assessments conducted between 2002 and 2005.Self-administered surveys completed during class time.At baseline, 627 ninth grade high school students from 2 northern California schools were included in the study.Oral and vaginal sex onset.Among sexually active adolescents, most initiated vaginal sex after or within the same 6-month period of oral sex initiation. Adolescents who initiated oral sex at the end of ninth grade had a 50% chance of initiating vaginal sex by the end of 11th grade. In comparison, adolescents who delayed until the end of 11th grade had a 16% chance of initiating vaginal sex by the end of 11th grade.The first 2 years of high school may be a critical age period for adolescents' vulnerability to vaginal sex initiation via oral sex behaviors. Comprehensive evidenced-based interventions and provision of preventive services aimed toward reducing sexual risk should be expanded to include the role oral sex plays in adolescent sex behavior.

  View details for DOI 10.1001/archpediatrics.2010.214

  View details for Web of Science ID 000288087900010

  View details for PubMedID 21041589

• Predicting Adolescent Perceptions of the Risks and Benefits of Cigarette Smoking: A Longitudinal Investigation HEALTH PSYCHOLOGY Morrell, H. E., Song, A. V., Halpern-Felsher, B. L. 2010; 29 (6): 610-617

  Abstract

  To evaluate developmental changes, personal smoking experiences, and vicarious smoking experiences as predictors of adolescents' perceptions of the risks and benefits of cigarette smoking over time, and to identify new and effective targets for youth smoking prevention programs.There were 395 adolescents surveyed every 6 months for two school years, from the beginning of 9th grade to the end of 10th grade.Time, participant smoking, friend smoking, parental smoking, and sex were evaluated as predictors of smoking-related short-term risk perceptions, long-term risk perceptions, and benefits perceptions using multilevel modeling techniques.Perceptions of benefits did not change over time. Perceptions of risk decreased with time, but not after sex and parental smoking were included in the model. Adolescents with personal smoking experience reported decreasing perceptions of risk and increasing perceptions of benefits over time. Adolescents with more than 6 friends who smoked also reported increasing perceptions of benefits over time.Changes in risk perceptions may not purely be the result of developmental processes, but may also be influenced by personal and vicarious experience with smoking. Findings highlight the importance of identifying and targeting modifiable factors that may influence perceptions.

  View details for DOI 10.1037/a0021237

  View details for Web of Science ID 000284794700007

  View details for PubMedID 20939640

• Perceptions of Second-hand Smoke Risks Predict Future Adolescent Smoking Initiation JOURNAL OF ADOLESCENT HEALTH Song, A. V., Glantz, S. A., Halpern-Felsher, B. L. 2009; 45 (6): 618-625

  Abstract

  To directly test whether perceptions of second-hand smoke risks deter adolescent smoking initiation.A longitudinal survey design was utilized in this study. Baseline surveys measuring perceptions of tobacco-related risks and smoking behaviors were administered to 395 high school students, with three follow-up assessments every 6 months.Perceptions of personal second-hand smoke risks and parental second-hand smoke risks significantly deterred adolescent smoking initiation. Perceptions of personal second-hand smoke risks reduced the odds of smoking by a factor of 0.63 (95% confidence interval [CI]=0.42-0.94) for each quartile increase in perceptions of personal second-hand smoke risks. Adolescents who provided the highest estimates of risks for personal second-hand smoke were 0.25 as likely to smoke as adolescents who provided the lowest estimates of risk. Perceptions of parental second-hand smoke risks reduced the odds of smoking by a factor of 0.64 (95% CI=0.43-0.93) for each quartile increase. Adolescents who perceived the highest estimates of risks associated with parental second-hand smoke were 0.26 as likely to smoke in the future compared to adolescents who provided the lowest estimates of risk. These effects are over three times as large as a smoking peer's influence on a nonsmoking adolescents' risk for smoking initiation, odds ratio [OR]=1.18 (95% CI=1.02-1.35).Adolescent perceptions of risks of second-hand smoke are strongly associated with smoking initiation. Encouraging adolescents to express their objections to second-hand smoke, as well as encouraging parents to create smoke-free homes, may be powerful tobacco control strategies against adolescent smoking.

  View details for DOI 10.1016/j.jadohealth.2009.04.022

  View details for Web of Science ID 000272460300013

  View details for PubMedID 19931835

• Perceptions of Smoking-Related Risks and Benefits as Predictors of Adolescent Smoking Initiation AMERICAN JOURNAL OF PUBLIC HEALTH Song, A. V., Morrell, H. E., Cornell, J. L., Ramos, M. E., Biehl, M., Kropp, R. Y., Halpern-Felsher, B. L. 2009; 99 (3): 487-492

  Abstract

  The predictive value of perceptions of smoking-related risks and benefits with regard to adolescent smoking initiation has not been adequately established. We used prospective, longitudinal data to directly test whether smoking-related perceptions predict smoking initiation among adolescents.We administered surveys assessing perceptions of smoking-related risks and benefits to 395 high school students, beginning at the start of their ninth-grade year. We conducted follow-up assessments every 6 months until the end of 10th grade, obtaining 4 waves of data.Adolescents who held the lowest perceptions of long-term smoking-related risks were 3.64 times more likely to start smoking than were adolescents who held the highest perceptions of risk. Adolescents who held the lowest perceptions of short-term smoking-related risks were 2.68 times more likely to initiate. Adolescents who held the highest perceptions of smoking-related benefits were 3.31 times more likely to initiate.Findings from this study provide one of the first sets of empirical evidence to show that smoking initiation is directly related to smoking-related perceptions of risks and benefits. Thus, efforts to reduce adolescent smoking should continue to communicate the health risks of smoking and counteract perceptions of benefits associated with smoking.

  View details for DOI 10.2105/AJPH.2008.137679

  View details for Web of Science ID 000263808400021

  View details for PubMedID 19106420

• Intertemporal Tradeoffs: Perceiving the Risk in the Benefits of Marijuana in a Prospective Study of Adolescents and Young Adults MEDICAL DECISION MAKING Goldberg, J. H., Millstein, S., Schwartz, A., Halpern-Felsher, B. 2009; 29 (2): 182-192

  Abstract

  Intertemporal tradeoffs characterize the decision to use drugs: pleasure now traded off against the possibility of pain later. Traditional approaches have examined whether individuals use drugs because they either seek immediate benefit or fail to appreciate long-term risk. We asked whether risk taking might also result from failing to appreciate benefits. We refer to this as risk in the benefits (RIBs), an understanding that one's first drug experience can be so good, that a person may not want (or be able) to stop, putting him/her on a path that leads directly to addiction.In total, 304 participants, 160 adolescents and 144 young adults, participated in a longitudinal study on marijuana use and other risky health behaviors.The failure to perceive the RIBs of marijuana use led to increased risk taking 1 year later within 3 different health behaviors: alcohol, tobacco, and sexual risk-taking. Greater appreciation of RIBs predicted significantly less future risk taking over-and-above all the traditional cognitive and behavioral predictors, and RIBs were the only significant cognitive predictor when all were included in 1 model. RIBs also partially mediated the relationship between past and future risk taking, over and above the strongest predictors of risk taking.Failing to appreciate the impact of short-term benefits within the context of long-term risk increased future risk taking. Interventions that enhance the salience of RIBs may represent a new approach to reducing the likelihood that individuals will take risks with their health.

  View details for DOI 10.1177/0272989X08323918

  View details for Web of Science ID 000265110000004

  View details for PubMedID 18836059

• Oral sexual behavior: Harm reduction or gateway behavior? JOURNAL OF ADOLESCENT HEALTH Halpern-Felsher, B. 2008; 43 (3): 207-208

  View details for DOI 10.1016/j.jadohealth.2008.07.001

  View details for Web of Science ID 000258762200002

  View details for PubMedID 18710673

• Adolescents report both positive and negative consequences of experimentation with cigarette use PREVENTIVE MEDICINE Brady, S. S., Song, A. V., Halpern-Felsher, B. L. 2008; 46 (6): 585-590

  Abstract

  To examine the physiological and social consequences that 9th and 10th grade adolescents experience as a result of experimenting with cigarette use, and whether consequences vary by level of experimentation and gender.Data were collected between 2001 and 2004 from 395 adolescents attending two northern California public high schools. Analyses are limited to 155 adolescents who reported puffing on cigarettes or smoking whole cigarettes at any of four time points during the study.The percentage of adolescents reporting consequences of smoking was as follows: any positive consequence (56%), felt relaxed (46%), looked cool (31%), looked grown-up (27%), became popular (17%), any negative consequence (56%), friends were upset (35%), trouble catching breath (29%), bad cough (26%), and got into trouble (23%). Ten percent of adolescents reported only experiencing negative consequences, 11% reported only positive consequences, 45% reported both negative and positive consequences, and 34% reported no consequences. Greater levels of experimentation were associated with greater likelihood of reporting positive or negative consequences. Few gender differences emerged.Adolescents experience both positive and negative consequences of experimentation with cigarette use. Prevention and intervention efforts should acknowledge that positive consequences of smoking may occur and address how these consequences can be achieved through other behaviors.

  View details for DOI 10.1016/j.ypmed.2008.01.019

  View details for Web of Science ID 000257627000017

  View details for PubMedID 18336892

• Social and emotional consequences of refraining from sexual activity among sexually experienced and inexperienced youths in California AMERICAN JOURNAL OF PUBLIC HEALTH Brady, S. S., Halpern-Felsher, B. L. 2008; 98 (1): 162-168

  Abstract

  We examined the social and emotional consequences among adolescents of refraining from sexual activity (oral or vaginal sex) and whether these consequences differed over time and by gender and sexual experience.Adolescents (N=612; 58% female) recruited from 2 schools were assessed at 4 time points separated by 6-month intervals, beginning in fall of ninth grade.The percentage of adolescents who reported only positive consequences (e.g., they felt responsible, friends were proud) dramatically decreased over time, whereas the percentage that reported negative consequences (e.g., they felt left out, partners became angry) steadily increased. Adolescent girls and sexually experienced adolescents were more likely to report both positive and negative consequences than were adolescent boys and sexually inexperienced adolescents. Adolescents who began the study with sexual experience were more likely to report positive consequences of refraining from sexual activity by the end of the study than those who initiated sexual activity later.Sexual education programs should address how adolescents can cope with or prevent negative consequences of refraining from sexual activity, so that decisions to abstain are rewarding and decisions to engage in sexual activity are motivated by maturity and readiness.

  View details for DOI 10.2105/AJPH.2006.097923

  View details for Web of Science ID 000252178200033

  View details for PubMedID 18048792

• Adolescents' reported consequences of having oral sex versus vaginal sex PEDIATRICS Brady, S. S., Halpern-Felsher, B. L. 2007; 119 (2): 229-236

  Abstract

  The present study examined whether adolescents' initial consequences of sexual activity differ according to type of sexual activity and gender.Surveys were administered to 618 adolescents recruited from 2 public high schools in the autumn of ninth grade (2002) and at 6-month intervals until the spring of tenth grade (2004). Analyses were limited to the 275 adolescents (44%) who reported engaging in oral sex and/or vaginal sex at any assessment. Participants were 14 years of age at study entry, 56% female, and of diverse socioeconomic and ethnic backgrounds.In comparison with adolescents who engaged in oral sex and/or vaginal sex, adolescents who engaged only in oral sex were less likely to report experiencing a pregnancy or sexually transmitted infection, feeling guilty or used, having their relationship become worse, and getting into trouble with their parents as a result of sex. Adolescents who engaged only in oral sex were also less likely to report experiencing pleasure, feeling good about themselves, and having their relationship become better as a result of sex. Boys were more likely than girls to report feeling good about themselves, experiencing popularity, and experiencing a pregnancy or sexually transmitted infection as a result of sex, whereas girls were more likely than boys to report feeling bad about themselves and feeling used.Adolescents experience a range of social and emotional consequences after having sex. Our findings have implications for clinical practice and public health campaigns targeted toward youth.

  View details for DOI 10.1542/peds.2006-1727

  View details for Web of Science ID 000243942000001

  View details for PubMedID 17272611

• Adolescents tell us why teens have oral sex JOURNAL OF ADOLESCENT HEALTH Cornell, J. L., Halpern-Felsher, B. L. 2006; 38 (3): 299-301

  Abstract

  Adolescents' perceived reasons why teens have oral sex ranged from physical pleasure, improving intimate relationships, reducing risks associated with vaginal sex, the influence of substances, and social factors such as reputation concerns and peer experiences.

  View details for DOI 10.1016/j.jadohealth.2005.04.015

  View details for Web of Science ID 000235817200020

  View details for PubMedID 16488832

• Oral versus vaginal sex among adolescents: Perceptions, attitudes, and behavior PEDIATRICS Halpern-Felsher, B. L., Cornell, J. L., Kropp, R. Y., Tschann, J. M. 2005; 115 (4): 845-851

  Abstract

  Despite studies indicating that a significant proportion of adolescents are having oral sex, the focus of most empirical studies and intervention efforts concerning adolescent sexuality have focused on vaginal intercourse. This narrow focus has created a void in our understanding of adolescents' perceptions of oral sex. This study is the first to investigate adolescents' perceptions of the health, social, and emotional consequences associated with having oral sex as compared with vaginal sex, as well as whether adolescents view oral sex as more acceptable and more prevalent than vaginal sex.Participants were 580 ethnically diverse ninth-grade adolescents (mean age: 14.54; 58% female) who participated in a longitudinal study on the relationship between risk and benefit perceptions and sexual activity. Participants completed a self-administered questionnaire that inquired about their sexual experiences and percent chance of experiencing outcomes from, attitudes toward, and perceived prevalence of oral versus vaginal sex among adolescents.More study participants reported having had oral sex (19.6%) than vaginal sex (13.5%), and more participants intended to have oral sex in the next 6 months (31.5%) than vaginal sex (26.3%). Adolescents evaluated oral sex as significantly less risky than vaginal sex on health, social, and emotional consequences. Adolescents also believed that oral sex is more acceptable than vaginal sex for adolescents their own age in both dating and nondating situations, oral sex is less of a threat to their values and beliefs, and more of their peers will have oral sex than vaginal sex in the near future.Given that adolescents perceive oral sex as less risky, more prevalent, and more acceptable than vaginal sex, it stands to reason that adolescents are more likely to engage in oral sex. It is important that health care providers and others who work with youths recognize adolescents' views about oral sex and broaden their clinical preventive services to include screening, counseling, and education about oral sex.

  View details for DOI 10.1542/peds.2004-2108

  View details for Web of Science ID 000228107900022

  View details for PubMedID 15805354

• Adolescents' beliefs about the risks involved in smoking "light" cigarettes PEDIATRICS Kropp, R. Y., Halpern-Felsher, B. L. 2004; 114 (4): E445-E451

  Abstract

  Light cigarettes have been marketed by the tobacco industry as being a healthier smoking choice, a safe alternative to cessation, and a first step toward quitting smoking altogether. Research, however, has failed to show a reduction in smoking-related health risks, an increase in rates of smoking cessation, a decrease in the amount of carbon monoxide or tar released, or a reduction in the rates of cardiovascular disease or lung cancer associated with light cigarette use, compared with regular cigarette use. Nevertheless, more than one-half of adolescent smokers in the United States smoke light cigarettes. This study is the first to investigate adolescents' perception of the risks associated with smoking light cigarettes, as well as adolescents' attitudes and knowledge about the delivery of tar and nicotine, health risks, social effects, addiction potential, and ease of cessation with light cigarettes, compared with regular cigarettes.Participants were 267 adolescents (mean age: 14.0 years) who completed a self-administered questionnaire during class time. After reading scenarios in which they imagined that they smoked regular or light cigarettes, participants estimated the chances that they would personally experience 7 smoking-related health risks and 3 addiction risks. Participants also responded to 14 items concerning their attitudes and knowledge about light cigarettes versus regular cigarettes.Participants thought that they would be significantly less likely to get lung cancer, have a heart attack, die from a smoking-related disease, get a bad cough, have trouble breathing, and get wrinkles when smoking light cigarettes, compared with regular cigarettes, for the rest of their lives. Furthermore, when participants were asked how long it would take to become addicted to the 2 cigarette types, they thought it would take significantly longer to become addicted to light versus regular cigarettes. Adolescents also thought that their chances of being able to quit smoking were higher with light versus regular cigarettes. Similarly, when participants were asked how easy it would be to quit smoking the 2 cigarette types, they thought it would be significantly easier for them to quit smoking light cigarettes than regular cigarettes. Adolescents agreed or strongly agreed that regular cigarettes deliver more tar than light cigarettes and that light cigarettes deliver less nicotine than regular cigarettes.Overall, the results of this study show that adolescents hold misperceptions in both their personal risk estimates and their general attitudes about the health risks, addictive properties, and ease of cessation associated with light cigarettes. With a variety of light and ultralight cigarettes on the market, adolescents are led to think that there is a progression of safety levels to choose from when deciding which cigarettes to smoke. This illusion of control over health outcomes contributes to an underestimation of risks associated with smoking light cigarettes and supports these misperceptions. These results are of concern, given evidence suggesting that, if adolescents think they are less vulnerable to smoking-related health risks (ie, lung cancer), then they are more likely to initiate smoking. Furthermore, there is evidence that adolescents are not fully aware of the addictive nature of cigarettes and therefore think that they can experiment with smoking during adolescence without becoming addicted or experiencing any health consequences. The data presented here support concerns regarding smoking addiction; adolescents might be even more inclined to smoke light cigarettes to delay addiction. Without correct information about light cigarettes, adolescents are unable to make informed decisions about their smoking behaviors. The findings presented here strongly suggest that health care practitioners need to talk to their adolescent clients not only about the overall risks of smoking but also about the specific risks associated with smoking light cigarettes and other tobacco varieties, including the potential for addiction and long-term health consequences. Information shared with adolescents about light cigarettes, both individually by health care practitioners and at the population level via counter-advertising campaigns, may be successful in changing current misperceptions, and ultimately light cigarette smoking patterns, among youth.

  View details for DOI 10.1542/peds.2004-0893

  View details for Web of Science ID 000224242200008

  View details for PubMedID 15466070

• Perceived risks and benefits of smoking: differences among adolescents with different smoking experiences and intentions PREVENTIVE MEDICINE Halpern-Felsher, B. L., Biehl, M., Kropp, R. Y., Rubinstein, M. L. 2004; 39 (3): 559-567

  Abstract

  Explanations of adolescent smoking often make reference to adolescents' beliefs that they are invulnerable to harm. However, empirical examination of whether adolescents do acknowledge risks. Further, few studies have considered perceived benefits in adolescents' behavioral decisions. This study examined perceived smoking-related physical and social risks and benefits between adolescents who have vs. have not smoked and do vs. do not intend to smoke.Three hundred and ninety-five students (mean age = 14.0) completed a survey concerning their smoking experiences, intentions, and perceived risks and benefits of smoking.Adolescent smokers and those who intend to smoke estimated their chance of experiencing a smoking-related negative outcome as less likely than did nonsmokers and non-intenders. Smokers and intenders also reported the chance of addiction as less likely than did others. In contrast, adolescent smokers and intenders perceived the chance of experiencing a smoking-related benefit as more likely than did nonsmokers and non-intenders.The data suggest that rather than solely focusing on health risks as a way to deter adolescent smoking, the role of perceived social risks and benefits in adolescents' smoking may be an additional critical focus for intervention. In addition, efforts should be made to increase adolescents' awareness of the addictive nature of cigarettes.

  View details for DOI 10.1016/j.ypmed.2004.02.017

  View details for Web of Science ID 000223760000016

  View details for PubMedID 15313096

• The role of behavioral experience in judging risks HEALTH PSYCHOLOGY Halpern-Felsher, B. L., MILLSTEIN, S. G., Ellen, J. M., Adler, N. E., Tschann, J. M., Biehl, M. 2001; 20 (2): 120-126

  Abstract

  This study used conditional risk assessments to examine the role of behavioral experiences in risk judgments. Adolescents and young adults (ages 10-30; N = 577) were surveyed on their risk judgments for natural hazards and behavior-linked risks, including their personal experiences with these events. Results indicated that participants who had experienced a natural disaster or engaged in a particular risk behavior estimated their chance of experiencing a negative outcome resulting from that event or behavior as less likely than individuals without such experience. These findings challenge the notion that risk judgments motivate behavior and instead suggest that risk judgments may be reflective of behavioral experiences. The results have implications for health education and risk communication.

  View details for Web of Science ID 000170976500004

  View details for PubMedID 11315729

• Costs and benefits of a decision - Decision-making competence in adolescents and adults JOURNAL OF APPLIED DEVELOPMENTAL PSYCHOLOGY Halpern-Felsher, B. L., Cauffman, E. 2001; 22 (3): 257-273

  View details for Web of Science ID 000169871600003

• Preventive services in a health maintenance organization - How well do pediatricians screen and educate adolescent patients? ARCHIVES OF PEDIATRICS & ADOLESCENT MEDICINE Halpern-Felsher, B. L., Ozer, E. M., MILLSTEIN, S. G., Wibbelsman, C. J., Fuster, C. D., Elster, A. B., IRWIN, C. E. 2000; 154 (2): 173-179

  Abstract

  To determine whether pediatricians in managed care settings adhere to national guidelines concerning the provision of clinical preventive services.Surveys were mailed between September 1996 and April 1997 to all pediatricians practicing in a California group-model health maintenance organization. The survey asked pediatricians about their screening and education practices on 34 recommended services and the actions taken with adolescent patients who have engaged in risk behavior.The response rate was 66.2% (N = 366). Pediatricians, on average, screened 92% of their adolescent patients for immunization status and blood pressure; 85% for school performance; 60% to 80% for obesity, sexual intercourse, cigarette use, alcohol use, drug use, and seat belt and helmet use; 30% to 47% for access to handguns, suicide, eating disorders, depression, and driving after drinking alcohol; fewer than 20% for use of smokeless tobacco, sexual orientation, sexual and physical abuse, and riding a bike or swimming after drinking alcohol; and 26% to 41% for close friends' engagement in risk behavior. Pediatricians' assessment and education with adolescent patients who screened positive for risk behavior was particularly low. Female physicians, physicians who saw a greater proportion of older adolescents, and recent medical school graduates were more likely to provide preventive services.Pediatricians in this health maintenance organization provide preventive services to adolescent patients at rates below recommendations but at rates greater than physicians in other practice settings. Improvement is especially needed in the areas that contribute most to adolescent mortality and for patients who screen positive for a risk behavior.

  View details for Web of Science ID 000085193100010

  View details for PubMedID 10665605

• Social Media Exposure and Other Correlates of Increased e-Cigarette Use Among Adolescents During Remote Schooling: Cross-Sectional Study. JMIR pediatrics and parenting Pravosud, V., Ling, P. M., Halpern-Felsher, B., Gribben, V. 2024; 7: e49779

  Abstract

  Little is known about the role of exposure to e-cigarette-related digital content, behavioral and mental health factors, and social environment on the change in adolescent e-cigarette use during COVID-19 shelter-in-place orders and remote schooling.The aim of the study was to examine changes in adolescent e-cigarette use during shelter-in-place and remote schooling in association with exposure to e-cigarette-related digital content and other correlates: stronger e-cigarette dependence, feeling lonely, inability to socialize, e-cigarette use to cope with shelter-in-place, and the number of family members aware of participants' e-cigarette use.A cross-sectional survey conducted between August 2020 and March 2021 included 85 California adolescents (mean age 16.7, SD 1.2 years; 39/85, 46% identified as female and 37/85, 44% as Hispanic) who reported e-cigarette use in the past 30 days. Multivariable penalized logistic regressions determined associations adjusted for age, race and ethnicity, and mother's education. The outcome of increased e-cigarette use was defined as more frequent use of e-cigarettes of the same or stronger nicotine or tetrahydrocannabinol concentration.Almost all respondents (83/85, 98%) reported using social media more since shelter-in-place, and 74% (63/85) reported seeing e-cigarette digital content. More than half (46/85, 54%) reported increased e-cigarette use during shelter-in-place. Most individuals who increased use were exposed to e-cigarette digital content (38/46, 83%) compared to those who did not increase e-cigarette use (25/39, 64%), but the association was nonsignificant after adjusting for demographics (adjusted odds ratio [AOR] 2.34, 95% CI 0.71-8.46). Respondents who felt lonely (AOR 3.33, 95% CI 1.27-9.42), used e-cigarettes to cope with shelter-in-place (AOR 4.06, 95% CI 1.39-13.41), or had ≥2 family members aware of participants' e-cigarette use (AOR 6.42, 95% CI 1.29-39.49) were more likely to report increased e-cigarette use.Almost all participants reported using social media more during shelter-in-place, with many respondents reporting increased e-cigarette use, and significant associations with loneliness and use to cope with shelter-in-place. Future interventions should consider leveraging digital platforms for e-cigarette use prevention and cessation and address the mental health consequences of the COVID-19 pandemic.

  View details for DOI 10.2196/49779

  View details for PubMedID 39432716

• Improving Hospital-to-Home for Medically Complex Children: Views From Spanish-Speaking Caregivers. Hospital pediatrics Squires, S. S., Hoang, K., Grajales, L., Halpern-Felsher, B., Sanders, L. 2024

  Abstract

  Children with medical complexity (CMC) experience increased risk of adverse events during and after hospitalization, and these risks are even greater for CMC whose caregiver has a preferred language other than English. Because many adverse events for CMC may be attributable to communication challenges, understanding caregiver and physician perspectives may help prevent adverse events.We conducted semistructured interviews with Spanish-speaking caregivers of hospitalized CMC and their inpatient attending physicians. Each interview was conducted 24 to 72 hours after hospital discharge. Interviews continued until thematic sufficiency was reached. Interviews were audio recorded, transcribed, and translated verbatim. Investigators independently coded and reconciled codes using constant comparison to develop themes via inductive thematic analysis.We conducted 28 interviews (14 caregivers, 14 physicians). Three themes were identified: (1) barriers exist in providing language-concordant care in planning for transitions from hospital-to-home; (2) both physicians and caregivers perceived logistical challenges in using interpreters at the point of care; and (3) many caregivers felt uncomfortable asking physicians questions related to their child's medical management because of their language barrier. Participants also offered strategies to improve the transition from hospital to home: (1) empower families to ask questions and take notes, (2) consider the use of medical educators, and (3) improve the ability of hospital-based physicians to follow up with patients after discharge.Physicians strive for language-concordant care at each stage of discharge planning. However, unresolved gaps such as the lack of interpreter availability during medical-device education, require attention to promote safe transitions from hospital to home.

  View details for DOI 10.1542/hpeds.2024-007925

  View details for PubMedID 39410907

• Perceptions of Harm and Addictiveness for Nicotine Products, THC e-Cigarettes, and e-Cigarettes with Other Ingredients Among Adolescents, Young Adults, and Adults. Substance use & misuse Liu, J., McCauley, D., Gaiha, S. M., Halpern-Felsher, B. 2024: 1-11

  Abstract

  Perceptions of health harms and addictiveness related to nicotine products, THC e-cigarettes, and e-cigarettes with other ingredients are an important predictor of use. This study examined differences in perceived harm and addiction across such products among adolescents, young adults, and adults.We conducted a cross-sectional survey (N = 6,131, ages 13-40 years old) in which participants reported perceived harm and addictiveness for 11 products (cigarettes, disposable nicotine e-cigarettes, pod-based nicotine e-cigarettes, other nicotine e-cigarettes, THC e-cigarettes, e-cigarettes with other ingredients, nicotine pouches, nicotine lozenges, nicotine gums, nicotine tablets, nicotine toothpicks). We applied adjusted regression models and conducted pairwise comparisons between age groups (13-17, 18-20, 21-25, and 26-40) and product use status (never, ever, and past-30-day use), adjusting for gender, race/ethnicity, sexual orientation, and financial comfort.Overall, participants in younger age groups perceived products to be more harmful and addictive than those in older age groups, with the exception of e-cigarettes with other ingredients. For all products, participants who never used perceived each product to be more harmful than those who ever used. For all products, participants who used the products in the past 30-days had lower perceived harm and addictiveness compared to never and ever use. Certain sociodemographic groups, such as people who identify as LGBTQ+, Non-Hispanic Black, or Hispanic, had lower perceived harm and addictiveness for most products.Efforts should be made to educate all age groups and minoritized groups on harms and addictiveness of all nicotine products, THC e-cigarettes, and e-cigarettes with other ingredients.

  View details for DOI 10.1080/10826084.2024.2403105

  View details for PubMedID 39289177

• Adolescents' Experiences and Perceptions of E-Cigarettes and NicotineAddiction. Substance use & misuse Guerra Castillo, C., Hoeft, K. S., Couch, E. T., Urata, J., Halpern-Felsher, B., Chaffee, B. W. 2024: 1-9

  Abstract

  BACKGROUND: E-cigarettes are the most-used tobacco product among US adolescents and are associated with nicotine addiction. This qualitative investigation aimed to understand adolescents' experiences and perceptions with nicotine addiction, and related influences of addiction, to inform product regulation, health communication, and cessation resource development.METHODS: Between May 2020 and December 2021, in-depth, semi-structured individual interviews were conducted with 47 California (United States) adolescents ages 13-17 who reported recent tobacco use (primarily e-cigarette use). The topic of addiction both arose organically and followed specific interviewer questions. Researchers used thematic analysis techniques to identify unifying themes related to addiction.RESULTS: Adolescents described e-cigarette addiction in ways that reflected a loss of control over their routines and activities and as physical symptoms, including reward and withdrawal. While some viewed addiction risk as a reason not to vape, others perceived it possible to use e-cigarettes and avoid or manage addiction. Specific characteristics of e-cigarette devices, particularly disposable nicotine-salt products, including flavors, "cool" designs, concealable size and odor, low price, and ease-of-use, were seen as enhancing addiction risk. Quit attempts were difficult and usually unsupported by adults or formal cessation aids.CONCLUSIONS: For many adolescents, addiction is a major component of their experience with e-cigarettes, often in ways that disrupt their routines and reduce their quality of life. Tobacco control or regulation could target e-cigarette product characteristics to decrease potential for addiction among adolescents. Needed are youth-targeted public communication about nicotine addiction and adolescent-tailored, evidence-based cessation support.

  View details for DOI 10.1080/10826084.2024.2392516

  View details for PubMedID 39287112

• Adolescent Perspectives on Their E-Cigarette Initiation Experiences. American journal of health promotion : AJHP Guerra Castillo, C., Hoeft, K. S., Couch, E. T., Halpern-Felsher, B., Chaffee, B. W. 2024: 8901171241277669

  Abstract

  To examine adolescents' perspectives regarding external and internal influences of the e-cigarette initiation process.Semi-structured, in-depth qualitative interviews.California, remote videoconference.Adolescents ages 13-17 who currently or previously used e-cigarettes (n = 47).Interviews occurred from May 2020-February 2021. Two researchers coded transcripts based on a codebook developed inductively. Coded excerpts were reviewed to identify encompassing themes related to adolescent e-cigarette initiation.Adolescents were often near e-cigarette use by peers, family members, and others, creating ample opportunities to try e-cigarettes in response to curiosity, peer pressure, and desires to cope with stress or belong to a group. Adverse first experiences were common (eg, throat irritation, nausea), but many adolescents vaped again or continued to use regularly in attempts to cement friendships or alleviate symptoms of stress and anxiety. Specific characteristics of e-cigarette devices, including low-cost, concealability, and variety in designs and flavors facilitated initiation, continued use, and nicotine dependence.Adolescents progress to e-cigarette use via a multistage process, starting where social expectations and opportunity converge. While individual circumstances vary, many continue to vape as a perceived coping tool for emotional issues, to gain social belonging, or influenced by e-cigarette characteristics that contribute to ongoing use and dependence. Efforts to deter use should address the devices themselves and the social forces driving youth interest in them.

  View details for DOI 10.1177/08901171241277669

  View details for PubMedID 39189439

• Depression screening outcomes among adolescents, young adults, and adults reporting past 30-day tobacco and cannabis use. Addictive behaviors Gaiha, S. M., Wang, M., Baiocchi, M., Halpern-Felsher, B. 2024; 156: 108076

  Abstract

  Few studies examine the relationship between depression and use of specific tobacco and/or cannabis products among adolescents, young adults, and adults. We determined whether the odds of depression are greater among those who used specific tobacco and/or cannabis products and among co-users of tobacco and cannabis.Cross-sectional online survey of a national convenience sample of 13-40-year-olds (N = 6,038). The survey included depression screening and past 30-day use of specific tobacco and cannabis products (cigarettes; e-cigarettes, vaped cannabis, little cigars, cigarillos, cigars, hookah, chewing tobacco, smoked cannabis, edible cannabis, blunts). Analyses correspond to the total sample, and 13-17-, 18-24-, and 25-40-year-olds.Among 5,281 individuals who responded to the depression screener and nine product use questions, 1,803 (34.1 %) reported co-use of at least one tobacco product and one cannabis product in the past 30 days. Past 30-day co-use was associated with higher likelihood of screening positive for depression compared to past 30-day use of tobacco-only (aOR = 1.32, 1.06-1.65; 0.006) or cannabis-only (aOR = 1.94, 1.28-2.94; <0.001). Screening positive for depression was more likely among those who reported past 30-day use of e-cigarettes (aOR = 1.56; 1.35-1.80; <0.001), cigarettes (aOR = 1.24, 1.04-1.48; 0.016), chewed tobacco (aOR = 1.91, 1.51-2.42; <0.001), and blunts (aOR = 1.22, 1.00-1.48; 0.053) compared to those who did not report past 30-day use of these products. Among the 2,223 individuals who screened positive for depression, the most used two-product combination was nicotine e-cigarettes and smoked cannabis (614 individuals, 27.6 %).Screening positive for depression was more likely among past 30-day co-users versus past 30-day users of tobacco-only or cannabis-only. Findings suggest that prevention programs for depression and substance use address tobacco and cannabis co-use.

  View details for DOI 10.1016/j.addbeh.2024.108076

  View details for PubMedID 38838604

• Suggestions to Avoid Perpetuating Tobacco Industry Reduced-Harm Marketing Tropes. Pediatrics Jackler, R. K., Halpern-Felsher, B. 2024

  View details for DOI 10.1542/peds.2023-064501

  View details for PubMedID 38463000

• ACCEPTABILITY OF "BACK TO SCHOOL": A NOVEL MINECRAFTBASED E-CIGARETTE PREVENTION AND CESSATION GAME Lung, H. H., Tan, X., Rosencovich, N., Goldenhersch, E., Waitman, C., Halpern-Felsher, B. ELSEVIER SCIENCE INC. 2024: S76-S77

  View details for Web of Science ID 001301045100143

• WHICH NICOTINE AND NON-NICOTINE PRODUCTS DO ADOLESCENTS AND YOUNG ADULTS WHO IDENTIFY AS LGBTQ plus PERCEIVE AS MOST HARMFUL AND ADDICTIVE? Liu, J., McCauley, D., Gaiha, S. M., Halpern-Felsher, B. ELSEVIER SCIENCE INC. 2024: S91

  View details for Web of Science ID 001301045100171

• HOW DOES AGE OF E-CIGARETTE INITIATION PREDICT PATTERNS OF PAST 30-DAY USE? McCauley, D., Gaiha, S., Liu, J., Halpern-Felsher, B. ELSEVIER SCIENCE INC. 2024: S9-S10

  View details for Web of Science ID 001301045100017

• WHAT E-CIGARETTE MARKETING IN RETAIL STORES APPEALS TO YOUTH? Gaiha, S., Lung, H., Vescia, F., Halpern-Felsher, B. ELSEVIER SCIENCE INC. 2024: S76

  View details for Web of Science ID 001301045100142

• Sociodemographic differences in use of nicotine, cannabis, and non-nicotine E-cigarette devices. Drug and alcohol dependence McCauley, D. M., Baiocchi, M., Gaiha, S. M., Halpern-Felsher, B. 2023; 255: 111061

  Abstract

  Sociodemographic differences in e-cigarette use have been documented; however, disparities in use of specific e-cigarette types with various ingredients have yet to be thoroughly investigated. This study examines ever- and past-30-day-use of nicotine, cannabis, and non-nicotine e-cigarette device types by sex, sexual orientation, race/ethnicity, and financial comfort.Data were drawn from a 2021 national cross-sectional survey of adolescents, young adults, and adults (N = 6131, ages 13-40 years old). Participants reported ever and past-30-day-use of (1) disposable nicotine e-cigarettes, (2) pod/cartridge-based nicotine e-cigarettes, (3) "other" nicotine e-cigarettes, (4) non-nicotine e-cigarettes, (5) e-cigarettes with THC, and (6) e-cigarettes with CBD. We constructed summary tables for each e-cigarette device type in which percentages of ever and past-30-day-use were calculated by birth year category and sociodemographic variables: (a) sex, (b) sexual orientation, (c) race/ethnicity, and (d) financial comfort.Females born between 1996 and 2008 reported higher rates of past-30-day disposable e-cigarette use relative to males (females 26.4%; males 22.4%). Compared to their heterosexual counterparts, LGBTQ+ participants reported higher overall rates of past-30-day-use for disposable (LGBTQ+ 27.9%; Heterosexual 23.8%), THC (LGBTQ+ 30.8%; Heterosexual 24.1%), and CBD e-cigarettes (LGBTQ+ 20.0%; Heterosexual 16.9%). Hispanic/Latino participants generally reported higher rates of past-30-day-use across device types relative to those identifying as Black or White non-Hispanic, particularly disposable nicotine e-cigarettes.Findings highlight sociodemographic disparities in e-cigarette use, though differences varied based on e-cigarette device type and participant birth year category. Tailored preventive efforts may be necessary to mitigate e-cigarette use among populations at highest risk.

  View details for DOI 10.1016/j.drugalcdep.2023.111061

  View details for PubMedID 38134543

• Evaluation of Early and Late High School Student Science Research and Mentorship Programs: Virtual Gateway to Science Curricula and Mentorship During the COVID-19 Pandemic. Journal of STEM outreach Wozniak, L., Guzman, A., McLaughlin, S., Halpern-Felsher, B. 2023; 6 (1)

  Abstract

  People from racial and ethnic minoritized groups, those with disabilities, and those from low-income backgrounds are underrepresented in biomedical careers. Increasing diversity in the biomedical workforce, particularly health care providers, is imperative to address the disparities faced by minoritized patients. The COVID-19 pandemic highlighted disparities experienced by minoritized populations and emphasized the need for a more diverse biomedical workforce. Science internship, mentorship, and research programs, which have historically been conducted in person, have been shown to increase interest in biomedical fields for minoritized students. During the pandemic, many science internship programs pivoted to virtual programming. This evaluation focuses on two such programs for both early and late high school students and evaluates change in scientific identity and scientific tasks pre- and post-program. Additionally, early high school students were interviewed to obtain more in-depth information on the program experiences and effects. Early and late high school students reported increased scientific identity and comfort with scientific tasks compared pre- to post-program in several domains. Desire to pursue biomedical careers was maintained pre- to post-program for both groups. These results highlight the importance and acceptance of developing curricula for online platforms to help boost interest in biomedical fields and desire for biomedical careers.

  View details for DOI 10.15695/jstem/v6i1.07

  View details for PubMedID 37425209

• EXAMINING DEPRESSION SCREENING OUTCOMES AND PAST 30-DAY TOBACCO AND CANNABIS USE PATTERNS Gaiha, S., Wang, M., Baiocchi, M., Halpern-Felsher, B. ELSEVIER SCIENCE INC. 2023: S84

  View details for Web of Science ID 000995238000148

• DEVELOPMENTAL AND RACIAL/ETHNIC DIFFERENCES IN USE OF NICOTINE, NON-NICOTINE, AND THC E-CIGARETTES McCauley, D., Gaiha, S. M., Halpern-Felsher, B. ELSEVIER SCIENCE INC. 2023: S95

  View details for Web of Science ID 000995238000169

• DIGITAL MEDIA MARKETING OF ALCOHOL, MARIJUANA, AND TOBACCO TO BLACK, INDIGENOUS, AND YOUTH OF COLOR Pineda, N., Chang, J., Gerola, A., Gonzalez, J., Halpern-Felsher, B. ELSEVIER SCIENCE INC. 2023: S1-S2

  View details for Web of Science ID 000995238000002

• Admission and Care Practices in United States Well Newborn Nurseries. Hospital pediatrics Joshi, N. S., Flaherman, V. J., Halpern-Felsher, B., Chung, E. K., Congdon, J. L., Lee, H. C. 2023

  Abstract

  OBJECTIVES: Late preterm and term infants comprise 97.3% of annual births in the United States. Admission criteria and the availability of medical interventions in well newborn nurseries are key determinants of these infants remaining within a mother-infant dyad or requiring a NICU admission and resultant separation of the dyad. The objective of this study was to identify national patterns for well newborn nursery care practices.METHODS: We surveyed a physician representative from each nursery in the Better Outcomes through Research for Newborns Network. We described the admission criteria and clinical management of common newborn morbidities and analyzed associations with nursery demographics.RESULTS: Of 96 eligible nursery representatives, 69 (72%) completed surveys. Among respondents, 59 (86%) used a minimal birth weight criterion for admission to their well newborn nursery. The most commonly used criteria were 2000 g (n = 29, 49%) and 1800 g (n = 19, 32%), with a range between 1750 and 2500 g. All nurseries used a minimal gestational age criterion for admission; the most commonly used criterion was 35 weeks (n = 55, 80%). Eleven percent of sites required transfer to the NICU for phototherapy. Common interventions in the mother's room included dextrose gel (n = 56, 81%), intravenous antibiotics (n = 35, 51%), opiates for neonatal abstinence syndrome (n = 15, 22%), and an incubator for thermoregulation (n = 14, 20%).CONCLUSIONS: Wide variation in admission criteria and medical interventions exists in well newborn nurseries. Further studies may help identify evidence-based optimal admission criteria to maximize care within the mother-infant dyad.

  View details for DOI 10.1542/hpeds.2022-006882

  View details for PubMedID 36843483

• Concern over tobacco and marijuana perceptions and use among adolescents and young adults with cystic fibrosis. Addictive behaviors Hamberger, E. S., Halpern-Felsher, B. 2023; 142: 107669

  Abstract

  This study assesses use and perceptions of short- and long-term harms associated with cigarettes, e-cigarettes, and smoked marijuana among adolescents and young adults (AYAs) with cystic fibrosis (CF).A total of 205 AYAs with CF completed an online survey querying about use, safety perceptions, and education related to traditional cigarettes, electronic cigarettes (e-cigarettes), and smoked marijuana. In addition, parents of AYAs with CF and CF healthcare providers were asked questions about experiences in avoidance education.AYA participants with CF reported using tobacco and marijuana at rates lower than that of the general AYA population, with heavy use considerably lower in this population. AYAs with CF perceived lower risk of negative outcomes associated with using e-cigarettes and smoked marijuana compared to combustible cigarettes. Ever-use was correlated with a lower perception of risk across all products. CF providers estimated lower rates of product use in their own patients compared to both the general AYA CF population and the general AYA population, and estimated lower use among the general CF AYA population compared to the general AYA population. Receipt of avoidance education varied greatly when comparing AYAs with CF, parents of individuals with CF, and CF healthcare providers. Reasons for undereducation include but are not limited to lack of familiarity with products, assumption of avoidance, assumption of education, and time constraints.Findings concerning safety perceptions and use of combustible tobacco, e-cigarettes, and marijuana in individuals with cystic fibrosis underscore the importance of providing avoidance education to vulnerable patient populations. Insight derived from this study may also inform pediatric to adult clinic transition education, when chronic disease populations are at greatest risk for engaging in risky behaviors.We report data on use, risk perception, and education of cigarettes, electronic cigarettes, and cannabis in individuals with cystic fibrosis, with a focus on adolescents and young adults. Such Findings will inform prevention education, especially during the critical transition period from pediatric to adult care when these behaviors are prevalent.

  View details for DOI 10.1016/j.addbeh.2023.107669

  View details for PubMedID 36921439

• Introduction to special issue of addictive behaviors: Tobacco regulatory science. Addictive behaviors Smith, T. T., McClure, E. A., Halpern-Felsher, B. 2023; 142: 107671

  View details for DOI 10.1016/j.addbeh.2023.107671

  View details for PubMedID 36905899

• Digital Antibiotic Allergy Decision Support Tool Improves Management of Beta Lactam Allergies. The journal of allergy and clinical immunology. In practice Dunham, T. B., Gardner, R. M., Lippner, E. A., Fasani, D. E., Moir, E., Halpern-Felsher, B., Sundaram, V., Liu, A. Y. 2023

  Abstract

  BACKGROUND: Frontline providers frequently make time-sensitive antibiotic choices, but many feel poorly equipped to handle antibiotic allergies.OBJECTIVE: We hypothesized that a digital decision support tool could improve antibiotic selection and confidence when managing beta lactam allergies.METHODS: A digital decision support tool was designed to guide non-allergist providers in management of patients with beta lactam allergy labels. Non-allergists were asked to make decisions in clinical test cases without, then with, the tool. These decisions were compared using paired t-tests. Users also completed surveys assessing their confidence in managing antibiotic allergies.RESULTS: The tool's algorithm was validated by confirming its recommendations aligned with that of five allergists. Non-allergist providers (n=102) made antibiotic management decisions in test cases, both with and without the tool. Use of the tool increased the proportion of correct decisions from 0.41 to 0.67, a difference of 0.26 (95% CI: 0.22-0.30, p<0.001). Users were more likely to give full-dose antibiotics in low-risk situations, give challenge doses in medium-risk situations, and avoid the antibiotic and/or consult Allergy in high-risk situations. Ninety-eight (96%) users said the tool would increase their confidence when choosing antibiotics for patients with allergies.CONCLUSION: A point-of-care clinical decision tool provides allergist-designed guidance to non-allergists and is a scalable system for addressing antibiotic allergies, irrespective of allergist availability. This tool encouraged appropriate antibiotic use in low- and medium-risk situations and increased caution in high-risk situations. A digital support tool should be considered in quality improvement and antibiotic stewardship efforts.

  View details for DOI 10.1016/j.jaip.2023.01.026

  View details for PubMedID 36736957

• Clinician confidence and practices for evaluating bone health in male and female adolescents and young adults with an eating disorder. Eating disorders Nelson, L. R., Carlson, J. L., Halpern-Felsher, B. L., Nagata, J. M. 2022: 1-9

  Abstract

  Extensive literature exists on bone health in females with an eating disorder, yet few have studied males. Our study assessed clinician confidence and current practices for assessing bone health in patients with an eating disorder. We also aimed to identify any differences in practice based on patient sex. Our 31-item survey, distributed to adolescent clinicians in the United States via the Society for Adolescent Health and Medicine (SAHM) listserv, assessed clinician confidence and practices for assessing bone mineral density in both male and female adolescents with an eating disorder. Findings showed that clinicians (n=104) were less confident in assessing bone mineral density in males compared to females (p<.001), yet there was no significant difference in rates of obtaining a DXA (p=.390). Although clinicians are less confident assessing bone health in males with an eating disorder than females, this does not appear to result in screening differences.

  View details for DOI 10.1080/10640266.2022.2141714

  View details for PubMedID 36404478

• Does virtual versus in-person e-cigarette education have a differential impact? HEALTH EDUCATION JOURNAL Gaiha, S., Warnock, A., Kile, S., Brake, K., do Rosario, C., Oates, G. R., Halpern-Felsher, B., Walley, S. 2022

  View details for DOI 10.1177/00178969221119287

  View details for Web of Science ID 000847836600001

• Tobacco product use and the risks of SARS-CoV-2 infection and COVID-19: current understanding and recommendations for future research. The Lancet. Respiratory medicine Benowitz, N. L., Goniewicz, M. L., Halpern-Felsher, B., Krishnan-Sarin, S., Ling, P. M., O'Connor, R. J., Pentz, M. A., Robertson, R. M., Bhatnagar, A. 2022

  Abstract

  Heterogeneity in the clinical presentation of SARS-CoV-2 infection and COVID-19 progression underscores the urgent need to identify individual-level susceptibility factors that affect infection vulnerability and disease severity. Tobacco product use is a potential susceptibility factor. In this Personal View, we provide an overview of the findings of peer-reviewed, published studies relating tobacco product use to SARS-CoV-2 infection and COVID-19 outcomes, with most studies focusing on cigarette smoking in adults. Findings pertaining to the effects of tobacco product use on the incidence of SARS-CoV-2 infection are inconsistent. However, evidence supports a role for cigarette smoking in increasing the risk of poor COVID-19 outcomes, including hospital admission, progression in disease severity, and COVID-19-related mortality. We discuss the potential effects of tobacco use behaviour on SARS-CoV-2 transmission and infection, and highlight the pathophysiological changes associated with cigarette smoking that could promote SARS-CoV-2 infection and increased disease severity. We consider the biological mechanisms by which nicotine and other tobacco product constituents might affect immune and inflammatory responses to SARS-CoV-2 infection. Finally, we identify current knowledge gaps and suggest priorities for research to address acute and post-acute health outcomes of COVID-19 during and after the pandemic.

  View details for DOI 10.1016/S2213-2600(22)00182-5

  View details for PubMedID 35985357

• Preferences, use, and perceived access to flavored e-cigarettes among United States adolescents and young adults. Drug and alcohol dependence reports Chaffee, B. W., Halpern-Felsher, B., Croker, J. A., Werts, M., Couch, E. T., Cheng, J. 2022; 3

  Abstract

  Citing concern over youth use, the Food and Drug Administration announced a prioritized enforcement policy against cartridge-based (reusable pod) e-cigarettes in non-menthol, non-tobacco flavors, effective February 2020. Data are needed regarding youth e-cigarette access and use behaviors following this policy.This cross-sectional national (USA) online panel survey, conducted March/April 2021, included 2253 participants ages 14-20 who ever used e-cigarettes ≥3 times (73% past 30-day users). Participants reported their flavor preferences, use reasons, and perceived ease of access. Latent class analysis categorized participants according to their preferred e-cigarette flavors, and multinominal logistic regression identified sociodemographic and behavioral correlates of class membership.Most past 30-day e-cigarette users used reusable pod (77%) or modern disposable (68%) devices, ≥1 non-tobacco (92%), sweet (76%), and/or menthol flavors including fruit-ice (70%) (flavor and device categories not mutually exclusive). Most past 30-day users (70%) and non-users (63%) perceived it would be somewhat or very easy to acquire e-cigarettes in flavors they like. Latent class analysis identified four e-cigarette flavor preference classes: mint (34% of sample), no preference (29%), fruit/sweet (28%), and dislikes ≥1 flavor (10%). Relative to no preference, membership in fruit/sweet (RRR: 1.87; 95% CI: 1.37, 2.57) and mint (RRR: 3.85; 95% CI: 2.77, 5.36) classes was associated with using e-cigarettes ≥50 times. Fruit/sweet membership was inversely associated with combustible tobacco use (RRR: 0.50; 95% CI: 0.38, 0.66).Young e-cigarette users maintained ample access to flavored and cartridge-based products. Stronger access restrictions and enforcement are required to reduce youth e-cigarette use.

  View details for DOI 10.1016/j.dadr.2022.100068

  View details for PubMedID 35757567

  View details for PubMedCentralID PMC9224229

• School-based programs to prevent adolescent e-cigarette use: A report card. Current problems in pediatric and adolescent health care Liu, J., Gaiha, S. M., Halpern-Felsher, B. 2022: 101204

  Abstract

  Given high rates and known health consequences of adolescent e-cigarette use as well as adolescents' susceptibility to nicotine addiction, school-based efforts to prevent and reduce adolescent e-cigarette use should continue to be developed, implemented, disseminated, and evaluated. This paper elaborates on best practices for developing and implementing prevention programs, including the importance of grounding programs in theories and frameworks that empower adolescents, including normative and interactive education, and having programs that are easily accessible and free of cost. Programs should also address key factors driving adolescent e-cigarette use, including discussing misperceptions, flavors, nicotine content, addiction, and the role that marketing plays in appealing to adolescents. The paper also discusses the gap areas of currently available prevention programs and highlights the need for evidence-based approaches and the importance of rigorous evaluation of programs.

  View details for DOI 10.1016/j.cppeds.2022.101204

  View details for PubMedID 35534403

• Adolescents' and young adults' perceptions of risks and benefits differ by type of cannabis products. Addictive behaviors Nguyen, N., Wong, M., Delucchi, K., Halpern-Felsher, B. 2022; 131: 107336

  Abstract

  INTRODUCTION: Cannabis use patterns among adolescents and young adults (AYAs) have changed recently, with increasing use of non-combustible cannabis products. Little is known about perceived risks or benefits related to non-combustible products (e.g., vaporized and edible cannabis). We examined whether AYAs' perceived risks and benefits differ across four cannabis products, and by use status.METHODS: We conducted a survey of 433 California AYAs (Mage=18.9years old, 66.5% females) during 2017-2018. We compared a variety of perceived risks and benefits corresponding to short-term and long-term use of each product (combustible, blunt, vaporized, and edible cannabis), and between ever and never users.RESULTS: Participants perceived combustible cannabis and blunts conferred the greatest risk for short-term (bad cough, trouble catching breath) and long-term (lung disease, oral and lung cancer, and heart attack) health outcomes and short-term social risks (friends upset, getting into trouble). These products were also perceived to have greater short-term and long-term benefits (i.e., reducing mental health problems) than vaporized and edible cannabis. The most common perceived risks were "get into trouble" and "become addicted." The most common benefits were "feel high or buzzed" and "feel less anxious." Ever cannabis users perceived less risks and greater benefits related to cannabis use than never users.CONCLUSIONS: AYAs differentially perceived risks and benefits related to use of four cannabis products. Public health and education efforts should address both perceived and real risks and benefits of specific cannabis products to prevent cannabis use among AYAs.

  View details for DOI 10.1016/j.addbeh.2022.107336

  View details for PubMedID 35436697

• ADOLESCENT PERCEPTIONS OF DIFFERENT E-CIGARETTE MARKETING CHARACTERISTICS IN RETAIL, ONLINE AND SOCIAL MEDIA Gaiha, S., Halpern-Felsher, B. ELSEVIER SCIENCE INC. 2022: S67

  View details for Web of Science ID 000768696700124

• ASSOCIATION BETWEEN ADOLESCENTS' PAST-30 DAY USE OF DIFFERENT SUBSTANCES AND DEPRESSION Gaiha, S., Halpern-Felsher, B. ELSEVIER SCIENCE INC. 2022: S67

  View details for Web of Science ID 000768696700125

• EVALUATION OF AN EARLY HIGH SCHOOL STUDENT SCIENCE KICKSTARTER PROGRAM: VIRTUAL GATEWAY TO SCIENCE CURRICULA AND MENTORSHIP DURING THE COVID-19 PANDEMIC Wozniak, L., Guzman, A., McLaughlin, S., Halpern-Felsher, B. ELSEVIER SCIENCE INC. 2022: S64

  View details for Web of Science ID 000768696700119

• THE STANFORD VAPING INFORMATION, SOLUTIONS, AND INTERVENTIONS TOOLKIT (VISIT) FOR HEALTHCARE PROVIDERS Halpern-Felsher, B., Lazaro, A., Ceballos, R., Zorrilla, M., Zicherman, B., Anoshiravani, A. ELSEVIER SCIENCE INC. 2022: S94

  View details for Web of Science ID 000768696700177

• ASSESSING CLINICIAN COMFORT AND SCREENING PRACTICES FOR EVALUATING BONE MINERAL DENSITY IN ADOLESCENTS AND YOUNG ADULTS WITH AN EATING DISORDER BASED ON PATIENT SEX Nelson, L., Carlson, J., Halpern-Felsher, B., Nagata, J. ELSEVIER SCIENCE INC. 2022: S84-S85

  View details for Web of Science ID 000768696700159

• Youth Perceptions of E-Cigarette-Related Risk of Lung Issues and Association With E-Cigarette Use HEALTH PSYCHOLOGY Gaiha, S. M., Epperson, A. E., Halpern-Felsher, B. 2022

  Abstract

  E-cigarette use is associated with increased risk of negative health outcomes, including respiratory problems such as Coronavirus Disease 2019 (COVID-19). Nevertheless, adolescents and young adults (AYAs) continue to use e-cigarettes at alarming rates. We examined AYA's perceptions of the health harms of e-cigarettes in relation to respiratory problems and the associations between these perceptions and e-cigarette use.In May 2020, we conducted an online, national cross-sectional survey of AYAs aged 13 to 24 years old (N = 4,315; 65% female; 50% ever-users, 50% never-users) to assess e-cigarette use and perceptions of the risk of respiratory problems, COVID-19, and severe lung disease for AYAs with different levels of e-cigarette use.In comparisons between AYAs with different levels of e-cigarette use, e-cigarette-related health risk perceptions were lower among ever-users compared to never-users and among ever-users who used e-cigarettes in the past 30 days compared to ever-users who did not use in the past 30 days. After controlling for demographics, AYAs were less likely to have used in the past 30 days if they agreed that young people are at risk of respiratory problems due to e-cigarette use (adjusted Odds Ratio [aOR] = .68, 95% confidence interval [CI; .59, .78]) and e-cigarettes are harmful for their health (aOR = .52, 95% CI [.30, .90]). AYAs were more likely to have used in the past 30 days if they believed that there is no hard evidence that e-cigarette use with nicotine increases risk of severe lung disease (aOR = 1.61, 95% CI [1.42, 1.82]) and that e-cigarette use is safer than smoking cigarettes (aOR = 1.26, 95% CI [1.11, 1.42]).Among AYAs who had ever used e-cigarettes, those who did not believe that e-cigarette use increases the risks of respiratory problems were more likely to have used e-cigarettes in the past month. To bridge the gap between youth perceptions and emerging scientific evidence on e-cigarette-related health risks, prevention messaging should seek to explain how e-cigarette use is linked to respiratory problems and could affect COVID-19 outcomes. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

  View details for DOI 10.1037/hea0001146

  View details for Web of Science ID 000754044600001

  View details for PubMedID 35157478

• Sociodemographic Factors Associated with Adolescents' and Young Adults' Susceptibility, Use, and Intended Future Use of Different E-Cigarette Devices. International journal of environmental research and public health Gaiha, S. M., Rao, P., Halpern-Felsher, B. 2022; 19 (4)

  Abstract

  Numerous studies have identified sociodemographic factors associated with susceptibility, ever-use and past-30-day use of e-cigarettes, including JUUL. However, it remains unknown which sociodemographic factors are associated with adolescents' and young adults' (AYA) use of the entire spectrum of different types of e-cigarette devices (e.g., disposables, pod/cartridge-based, and other e-cigarettes, like mods or tanks). The aim of this study was to examine the relationship between sociodemographic factors and use, future use intent and susceptibility to use different e-cigarette device types. We conducted a national online survey using a convenience sample of 13-24-year-olds, 50:50 e-cigarette ever- to never-users and sex and race/ethnicity balanced per the U.S. Census (n = 4351). Sociodemographic factors were not associated with ever use of disposables among AYAs or generally with intent to use e-cigarette devices in the future. However, sociodemographic factors were related to the use of pod/cartridge-based and other e-cigarette devices. LGBTQ+ AYAs were more likely to use pod/cartridge-based devices and to be susceptible to using all device types compared to other AYAs. Young adults, males, and other/multiracial non-Hispanic AYAs were more likely to report past-30-day-use of all devices and AA/Black non-Hispanic AYAs were more likely to report past-30-day use of pod/cartridge-based and other devices compared to former users. AA/Black non-Hispanic AYAs were more likely to be susceptible to using all devices and other/multiracial non-Hispanic AYAs were susceptible to using other devices (compared to White non-Hispanic AYAs). AYAs under 21 who were former users were more likely to intend using other devices in the future compared to AYAs 21 years or above. These findings may inform targeted prevention efforts to curb the growing popularity of different devices among AYAs.

  View details for DOI 10.3390/ijerph19041941

  View details for PubMedID 35206132

• Day-to-Day Decision Making by Adolescents and Young Adults with Cancer. Journal of pediatric hematology/oncology nursing Pyke-Grimm, K. A., Franck, L. S., Halpern-Felsher, B., Goldsby, R. E., Rehm, R. S. 2022: 27527530211068718

  Abstract

  Background: Adolescents and young adults (AYAs) with cancer must negotiate the transition between childhood and adulthood while dealing with a life-threatening illness. AYA involvement in decision making varies depending on the type of decision and when decisions occur during treatment, and evidence suggests that AYAs want to be involved in decision making. Objective: To explore involvement of AYAs with cancer in day-to-day decisions affected by their cancer and treatment. Methods: This qualitative study used interpretive focused ethnography within the sociologic tradition, informed by symbolic interactionism. Semi-structured interviews and informal participant observation took place at two quaternary pediatric oncology programs. Results: Thirty-one interviews were conducted with 16 AYAs ages 15 to 20 years. Major day to day decision-making categories identified included: (1) mental mindset, (2) self-care practices, (3) self-advocacy, and (4) negotiating relationships. Participants described how they came to grips with their illness early on and decided to fight their cancer. They described decisions they made to protect their health, how they advocated for themselves and decisions they made about relationships with family and friends. Conclusions: Through day-to-day decisions, participants managed the impact of cancer and its treatment on their daily lives. Research should focus on developing and implementing interventions to empower AYAs to participate in day-to-day decisions that will affect how they manage their cancer, its treatment and ultimately their outcomes. Implications for Practice: Healthcare providers can facilitate AYA's participation in day-to-day decision making through encouraging autonomy and self-efficacy by providing support and through effective communication.

  View details for DOI 10.1177/27527530211068718

  View details for PubMedID 35538622

• Biomarkers of nicotine exposure correlate with the Hooked on Nicotine Checklist among adolescents in California, United States. Addictive behaviors Chaffee, B. W., Halpern-Felsher, B., Jacob, P. 3., St Helen, G. 1800; 128: 107235

  Abstract

  BACKGROUND: The Hooked on Nicotine Checklist (HONC) has been used to assess nicotine dependence (loss of autonomy over tobacco) among adolescents. Existing HONC validation studies for non-cigarette products, such as electronic cigarettes (e-cigarettes), have generally not considered biomarkers of nicotine exposure.METHODS: Within a cross-sectional sample of California (USA) high school students (total N = 1396; mean age 15.2 years; 56% female; 54% Hispanic/Latinx), self-reported past 30-day users of any tobacco (including e-cigarettes) completed a modified 10-item HONC questionnaire and provided saliva samples (N = 318 samples, including N = 234 exclusive past 30-day e-cigarette users). Samples were analyzed for cotinine using liquid chromatography-tandem mass spectrometry (lower limit of quantification: 1.0 ng/mL).RESULTS: Across four categories of HONC score corresponding to an increasing number of reported dependence symptoms (scores: 0, 1, 2-4, 5-10), the prevalence of quantifiable salivary cotinine increased among past 30-day tobacco users (20%, 21%, 38%, 55%, respectively, P-for-trend < 0.001) and among past 30-day exclusive e-cigarette users (15%, 22%, 31%, 42%, respectively, P-for-trend = 0.001). Among participants with quantifiable cotinine levels, HONC total score and cotinine were positively correlated among past 30-day tobacco users (n = 89; Spearman rho = 0.449; P < 0.001) and past 30-day exclusive e-cigarette users (n = 49; Spearman rho = 0.520; P < 0.001). HONC score was also associated with past 30-day frequency of tobacco product use and reported use of tobacco within 30 min of waking.CONCLUSIONS: These results support the validity of HONC to assess nicotine dependence among adolescents. Dependence symptoms may be experienced at low levels of nicotine exposure.

  View details for DOI 10.1016/j.addbeh.2022.107235

  View details for PubMedID 35033980

• Advance Care Planning Preferences for Adolescents With Cardiac Disease. Pediatrics Hansen, K., Edwards, L. A., Yohannes, K., Luong, R., Lin, A., Long, J., Halpern-Felsher, B., Cohen, H., Kaufman, B. D. 1800

  Abstract

  BACKGROUND AND OBJECTIVES: Adolescents with cardiac disease are at risk for life-changing complications and premature death. The importance of advance care planning (ACP) in adults with congenital heart disease and in pediatric patients with HIV and cancer has been demonstrated. ACP preferences of adolescents with heart disease have not been evaluated. We describe ACP preferences of adolescents with heart disease and compare with those of their caregivers.METHODS: Outpatient adolescents aged 12 to 18 years with heart failure, cardiomyopathy, heart transplantation, or who were at risk for cardiomyopathy, as well as their caregivers, completed self-administered questionnaires which evaluated participants' opinions regarding content and timing of ACP discussions, preferences for end-of-life communication, and emotional responses to ACP.RESULTS: Seventy-eight adolescents and 69 caregivers participated, forming 62 adolescent-caregiver dyads. Adolescents and caregivers reported that adolescent ACP discussions should occur early in the disease course (75% and 61%, respectively). Adolescents (92%) wanted to be told about terminal prognosis, whereas only 43% of caregivers wanted the doctor to tell their child this information. Most adolescents (72%) and caregivers (67%) anticipated that discussing ACP would make the adolescent feel relieved the medical team knew their wishes. Most caregivers (61%) believed that adolescents would feel stress associated with ACP discussions, whereas only 31% of adolescents anticipated this.CONCLUSIONS: Adolescents and their caregivers agree that ACP should occur early in disease course. There are discrepancies regarding communication of prognosis and perceived adolescent stress related to ACP discussions. Facilitated conversations between patient, caregiver, and providers may align goals of care and communication preferences.

  View details for DOI 10.1542/peds.2020-049902

  View details for PubMedID 34984466

• Cross-sectional online survey of clinicians' knowledge, attitudes and challenges to screening and counselling adolescents and young adults for substance use. BMJ open Gorukanti, A. L., Kimminau, K. S., Tindle, H. A., Klein, J. D., Gorzkowski, J., Kaseeska, K., Ali, R., Singh, L., David, S. P., Halpern-Felsher, B. 2022; 12 (11): e059019

  Abstract

  OBJECTIVE: To examine adolescent healthcare clinicians' self-reported screening practices as well as their knowledge, attitudes, comfort level and challenges with screening and counselling adolescents and young adults (AYA) for cigarette, e-cigarette, alcohol, marijuana, hookah and blunt use.DESIGN: A 2016 cross-sectional survey.SETTING: Academic departments and community-based internal medicine, family medicine and paediatrics practices.PARTICIPANTS: Adolescent healthcare clinicians (N=771) from 12 US medical schools and respondents to national surveys. Of the participants, 36% indicated male, 64% female, mean age was 44 years (SD=12.3); 12.3% of participants identified as Asian, 73.7% as white, 4.8% as black, 4.2% as Hispanic and 3.8% as other.PRIMARY AND SECONDARY OUTCOME MEASURES: Survey items queried clinicians about knowledge, attitudes, comfort level, self-efficacy and challenges with screening and counselling AYA patients about marijuana, blunts, cigarettes, e-cigarettes, hookah and alcohol.RESULTS: Participants were asked what percentage of their 10-17years old patients they screened for substance use. The median number of physicians reported screening 100% of their patients for cigarette (1st, 3rd quartiles; 80, 100) and alcohol use (75, 100) and 99.5% for marijuana use (50,100); for e-cigarettes, participants reported screening half of their patients and 0.0% (0, 50), (0, 75)) reported screening for hookah and blunts, respectively. On average (median), clinicians estimated that 15.0% of all 10-17years old patients smoked cigarettes, 10.0% used e-cigarettes, 20.0% used marijuana, 25.0% drank alcohol and 5.0% used hookah or blunts, respectively; yet they estimated lower than national rates of use of each product for their own patients. Clinicians reported greater comfort discussing cigarettes and alcohol with patients and less comfort discussing e-cigarettes, hookah, marijuana and blunts.CONCLUSIONS: This study identified low rates of screening and counselling AYA patients for use of e-cigarettes, hookahs and blunts by adolescent healthcare clinicians and points to potential missed opportunities to improve prevention efforts.

  View details for DOI 10.1136/bmjopen-2021-059019

  View details for PubMedID 36414284

• E-cigarette, cannabis and combustible tobacco use: associations with xerostomia among California adolescents. Community dentistry and oral epidemiology Chaffee, B. W., Halpern-Felsher, B., Cheng, J. 1800

  Abstract

  OBJECTIVE: Xerostomia (subjective experience of dry mouth), while less common in younger populations, can contribute to caries and oral discomfort. Use of e-cigarettes and cannabis among adolescents is increasing and may be a xerostomia risk factor. This study evaluates xerostomia prevalence in an adolescent population, overall and by e-cigarette, cannabis and combustible tobacco use.METHODS: Cross-sectional analyses of 12-month follow-up data (N=976; collected 2020-2021) from a cohort of adolescents recruited from public high schools in Northern California (USA) compared self-reported past 30-day e-cigarette, cannabis and other tobacco use and dry mouth (overall dry mouth experience; shortened xerostomia inventory, SXI). Dry mouth experience (never, occasionally, frequently/always) was modelled using ordered logistic regression with school-level clustering and adjustment for gender, race/ethnicity, alcohol use, asthma, physical activity and mutually for e-cigarette, cannabis and tobacco use.RESULTS: Past 30-day use prevalence was 12% for e-cigarettes, 16% for cannabis and 3% for combustible tobacco. Occasional dry mouth experience (54%) was more common than frequent/always experience (5%). Frequent/always dry mouth was more prevalent among frequent (>5days/month) e-cigarette (14%) and cannabis (19%) users and combustible tobacco users (19%) than non-users of those respective products (all comparisons p<0.001). In covariable-adjusted models, frequent e-cigarette use was no longer significantly associated with dry mouth experience (OR: 1.40; 95% CI: 0.69, 2.84), while frequent cannabis use (OR: 3.17; 95% CI: 1.47, 6.82) and combustible tobacco use (OR: 1.92; 95% CI: 1.38, 2.68) were associated with greater odds of reporting more frequent dry mouth. Findings were qualitatively similar using the SXI.CONCLUSIONS: In this study, xerostomia was not independently associated with e-cigarette use but was one potential health concern of adolescent cannabis and combustible tobacco use.

  View details for DOI 10.1111/cdoe.12721

  View details for PubMedID 34927762

• Self-reported changes in cannabis vaping among US adolescents and young adults early in the COVID-19 pandemic. Preventive medicine reports Nguyen, N., Mathur Gaiha, S., Halpern-Felsher, B. 1800; 24: 101654

  Abstract

  Cannabis vaping may increase susceptibility toCOVID-19 infection and related outcomes; however, little is known about the impact of the pandemic on cannabis vaping among US young populations. This study examined self-reported changes in cannabis vaping since the pandemic and factors associated with changes. A national, cross-sectional survey was conducted among 4,351 US adolescents and young adults (13-24years old) in May 2020. Of those, 1,553 participants who reported ever vaping cannabis were included in the analytic sample. Binary outcome was self-reported increase in cannabis vaping (more hours/times of vaping in a day) vs. no change/quitting/reducing/switching. Weighted logistic regression examined associations between independent variables (i.e., risk perceptions of vaping, cannabis dependence, and stress/anxiety) and the outcome, controlling for sociodemographic factors. Overall, 6.8% reported increasing cannabis vaping since the pandemic, 37.0% quitting or reducing vaping in general, and 42.3% no change. Participants were more likely to report increased cannabis vaping if they perceived "Vaping is safer than smoking cigarettes" (Adjusted Odds Ratio [AOR]=3.66; 95%CI=1.43-9.38), reported more dependence on cannabis vaping (AOR=1.59; 95%CI=1.11-2.27), and were female (AOR=2.80; 95%CI=1.23-6.36). Those perceiving "Vaping cannabis can cause lung injuries" were less likely to increase cannabis vaping (AOR=0.37; 95%CI=0.18-0.76). Findings indicate that adolescent and young adult ever-cannabis vapers were more likely to report decreasing vaping generally than increasing cannabis vaping and most did not change use during the early pandemic. Educational campaigns should address potential health risks of cannabis vaping and focus on lung health to reduce use among young people during and following the pandemic.

  View details for DOI 10.1016/j.pmedr.2021.101654

  View details for PubMedID 34976701

• Clinician practices assessing hypothalamic-pituitary-gonadal axis suppression in adolescents with an eating disorder. The International journal of eating disorders Nelson, L. R., Halpern-Felsher, B. L., Nagata, J. M., Carlson, J. L. 2021

  Abstract

  OBJECTIVE: Although extensive literature exists on hypothalamic-pituitary-gonadal (HPG) axis suppression in females with an eating disorder, there are few studies in males. Our study aimed to determine clinician practices for the assessment of HPG axis suppression and to identify differences in practice based on the sex of the patient.METHOD: Our 31-item survey queried clinicians about confidence level and practices for assessing HPG suppression in male compared to female patients.RESULTS: Findings showed that clinicians (n=104) were less likely to evaluate HPG suppression in males compared to females, including assessment of sexual maturity rating (p<.050), screening of decreased libido compared to amenorrhea (p<.001) and lab assessment (luteinizing hormone and follicular-stimulating hormone: p<.001; estradiol/testosterone: p<.010; TSH: p<.050). Participants also felt less confident evaluating male patients (p<.001) and requested better screening tools for males (p<.001).DISCUSSION: Our data suggest that clinician practices differ based on patient sex and that clinicians request tools for HPG suppression assessment in males. This is the first study examining specific practices and comfort levels of clinicians when assessing HPG axis suppression. Findings suggest that more guidance on the management of male patients may be needed to standardize care and to prevent short and long-term sequela of malnutrition.

  View details for DOI 10.1002/eat.23625

  View details for PubMedID 34611918

• JUUL and other e-cigarettes: Socio-demographic factors associated with use and susceptibility in California. Preventive medicine reports Mathur Gaiha, S., Halpern-Felsher, B., Feld, A. L., Gaber, J., Rogers, T., Henriksen, L. 2021; 23: 101457

  Abstract

  This study examined which socio-demographic factors are associated with susceptibility (lack of commitment to avoid future use), past-12-month and past-30-day use of JUUL and other e-cigarettes, and reasons for and against using JUUL. An online survey of 3,075 Californians ages 15-29, including 24.3% who identified as LGBTQ, were recruited via social media in January-March 2019. Multi-level weighted logistic regression models suggest that LGBTQ participants were more likely to be susceptible to JUUL [AOR=2.11 (1.60, 2.79) (parentheses include 95% Confidence Intervals)] and other e-cigarettes [AOR=2.31 (1.75, 3.05)], and more likely to use JUUL [AOR=1.27 (1.02, 1.58)] and other e-cigarettes [AOR=1.66 (1.35, 2.05)] in the past 12months. Susceptibility to using JUUL was more likely among adolescents (ages 15-17) [AOR=1.72 (1.30, 2.28)] and young adults (ages 18-20) [AOR=1.26 (1.00,1.58)] than adults (ages 21-29). At the community level, living in jurisdictions with higher median household income was associated with a higher likelihood of being susceptible to using JUUL and other e-cigarettes. Compared to non-Hispanic Whites, Asian/Pacific Islanders were less likely to use JUUL [AOR=0.68 (0.54, 0.86)] and other e-cigarettes [AOR=0.60 (0.48, 0.76)] in the past 12months. Past-30-day JUUL use was more likely among males than females [AOR=1.44 (1.11, 1.88)]. Common reasons for using JUUL were: friends' use, flavors, "safer" than cigarettes, no one will notice, and nicotine rush is greater than other devices. Common reasons against using JUUL were: harmful to self/others, contains nicotine and is addictive. E-cigarette prevention and cessation efforts should include tailored messaging for people who identify as LGBTQ and reinforce reasons for not vaping nicotine.

  View details for DOI 10.1016/j.pmedr.2021.101457

  View details for PubMedID 34194963

• Development and Reach of the Stanford Tobacco Prevention Toolkit: Implementation of a Community-Based Participatory Approach. The Journal of school health Gaiha, S. M., Zorrilla, M., Sachnoff, I., Smuin, S., Lazaro, A., Ceballos, R. D., Razo, A., Halpern-Felsher, B. 2021

  Abstract

  BACKGROUND: We developed the Tobacco Prevention Toolkit (Toolkit) to enhance the impact of school-based tobacco education. This study describes the process of developing the Toolkit, its contents, and reach.METHODS: Qualitative community-based participatory research (CBPR), including focus group discussions (N=152) and working groups with parents, educators, researchers, and youth (N=87) were used to develop the Toolkit and design its implementation. Toolkit reach was assessed through number of trained educators using the Toolkit, estimated number of youth recipients of the Toolkit resources, and using Google Analytics for online engagement.RESULTS: The Toolkit is a free, online resource aimed at preventing tobacco use by middle and high school students. Toolkit content addresses varied forms of tobacco including electronic cigarettes, hookah, smokeless tobacco, and cigarettes; addiction; and positive youth development; and is available in multiple interactive formats such as real-time quizzes, factsheets, activities, and presentations. The Toolkit is mainly delivered by trained educators, who adapt its content and duration to tailor their drug prevention teaching to student needs. As of April 2020, when data for this paper were collected, 4,750 educators have reached an estimated 1.3 million youth. The Toolkit website has 186,116 users and 802,602 page views, growing steadily since 2016. As of August 2021, additional students have been reached, for now a total of 1.85 million students reached.CONCLUSION: The Toolkit resources are evidence-based, comprehensive, responsive, interactive, easily accessible, and flexible. Applying CBPR was instrumental in developing the Toolkit and expanding its reach.

  View details for DOI 10.1111/josh.13074

  View details for PubMedID 34426975

• Using Speed Mentoring to Expand Scholarship Perspectives and Opportunities for Fellows. Journal of graduate medical education Guerin, A., Okamura, E., Rotandi, C. L., Halpern-Felsher, B., Blankenburg, R., Gans, H. A. 2021; 13 (3): 423-424

  View details for DOI 10.4300/JGME-D-20-01284.1

  View details for PubMedID 34178272

• Improving Pediatric Subspecialty Recruitment Using an Interdivisional Department Session. Journal of graduate medical education Okamura, E., Rotandi, C. L., Guerin, A., Halpern-Felsher, B., Blankenburg, R., Gans, H. A. 2021; 13 (3): 424-426

  View details for DOI 10.4300/JGME-D-20-01302.1

  View details for PubMedID 34178273

• Stemming the tide of youth E-cigarette use: Promising progress in the development and evaluation of E-cigarette prevention and cessation programs. Addictive behaviors Gaiha, S. M., Halpern-Felsher, B. 2021; 120: 106960

  View details for DOI 10.1016/j.addbeh.2021.106960

  View details for PubMedID 33940340

• Sources of flavoured e-cigarettes among California youth and young adults: associations with local flavoured tobacco sales restrictions. Tobacco control Gaiha, S. M., Henriksen, L., Halpern-Felsher, B., Rogers, T., Feld, A. L., Gaber, J., Andersen-Rodgers, E. 2021

  Abstract

  PURPOSE: This study compares access to flavoured JUUL and other e-cigarettes from retail, online and social sources among underage and young adult e-cigarette users who live in California jurisdictions that restrict sales of flavoured tobacco with the rest of the state.METHODS: An online survey used social media advertisements to recruit participants (n=3075, ages 15-29) who lived in one of nine jurisdictions that restrict sales (n=1539) or in the rest of state, and oversampled flavoured tobacco users. Focusing on past-month e-cigarette users (n=908), multilevel models tested whether access to flavoured JUUL and other e-cigarettes from retail, online and social sources differed by local law (yes/no) and age group (15-20 or older), controlling for other individual characteristics.RESULTS: The percent of underage users who obtained flavoured JUUL and other e-cigarettes in the past month was 33.6% and 31.2% from retail, 11.6% and 12.7% online, and 76.0% and 70.9% from social sources, respectively. Compared with underage and young adult users in the rest of California, those in localities that restrict the sales of flavoured tobacco were less likely to obtain flavoured JUUL from retail sources (Adjusted OR=0.54, 95% CI 0.36 to 0.80), but more likely to obtain it from social sources (Adjusted OR=1.55, 95% CI 1.02 to 2.35). The same pattern was observed for other brands of flavoured e-cigarettes.CONCLUSION: Although local laws may reduce access to flavoured e-cigarettes from retail sources, more comprehensive state or federal restrictions are recommended to close the loopholes for online sources. Dedicated efforts to curtail access from social sources are needed.

  View details for DOI 10.1136/tobaccocontrol-2020-056455

  View details for PubMedID 33850007

• Corroborating Adolescent Tobacco Use and Sociodemographic Patterns From Multiple National Surveys. The Journal of adolescent health : official publication of the Society for Adolescent Medicine Gaiha, S. M., Halpern-Felsher, B. 2021; 68 (4): 642–43

  View details for DOI 10.1016/j.jadohealth.2021.01.015

  View details for PubMedID 33781469

• Measures of both perceived general and specific risks and benefits differentially predict adolescent and young adult tobacco and marijuana use: findings from a Prospective Cohort Study HUMANITIES & SOCIAL SCIENCES COMMUNICATIONS McKelvey, K., Gaiha, S., Delucchi, K. L., Halpern-Felsher, B. 2021; 8 (1)

  View details for DOI 10.1057/s41599-021-00765-2

  View details for Web of Science ID 000636350600001

• Smokers Are More Likely to Smoke More after the COVID-19 California Lockdown Order. International journal of environmental research and public health Gonzalez, M., Epperson, A. E., Halpern-Felsher, B., Halliday, D. M., Song, A. V. 2021; 18 (5)

  Abstract

  To determine if cigarette smoking, electronic cigarette use, and rate of consumption of these products differed before and after a pandemic lockdown order, two convenience samples of adults in Central California were recruited and surveyed before (March 2020) and after (May 2020) COVID-19 lockdown orders were implemented in California (n = 2571). Multivariable logistic and negative binomial regression models tested the association between adults recruited pre- or post-California lockdown and past month cigarette use, past month electronic cigarette use, past month cigarette consumption, and past month e-cigarette consumption among current users, controlling for demographic differences. Adults pre- and post-lockdown had equal odds of using cigarettes during the past month. Cigarette users who responded post-lockdown had higher cigarette consumption rates compared to cigarette users who responded pre-lockdown (IRR = 1.13, 95% CI = 1.15, 1.23). Adults who responded post-lockdown had lower odds of using electronic cigarettes during the past month compared to participants surveyed before the order (OR = 0.66, 95% CI: 0.55, 0.78). Cigarette users may be using more cigarettes during the state mandated lockdown. Possible causes for this increase in cigarette use may include increased stress, the change in workplace smokefree protections coverage, and increased opportunities for smoking or vaping.

  View details for DOI 10.3390/ijerph18052582

  View details for PubMedID 33807503

  View details for PubMedCentralID PMC7967350

• Addressing Goals of Parents of Hospitalized Children: A Qualitative Analysis of Parents' and Physicians' Perspectives ACADEMIC PEDIATRICS Hoang, K., Halpern-Felsher, B., Brooks, M., Blankenburg, R. 2021; 21 (2): 244–51

  View details for Web of Science ID 000625570700008

• Smokers Are More Likely to Smoke More after the COVID-19 California Lockdown Order INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH Gonzalez, M., Epperson, A. E., Halpern-Felsher, B., Halliday, D. M., Song, A. V. 2021; 18 (5)

  View details for DOI 10.3390/ijerph18052582

  View details for Web of Science ID 000628104600001

• Does Tobacco Screening in Youth Primary Care Identify Youth Vaping? The Journal of adolescent health : official publication of the Society for Adolescent Medicine Liu, J., Halpern-Felsher, B., Harris, S. K. 2021

  Abstract

  PURPOSE: The purpose of this study was to evaluate the sensitivity of a tobacco use screening question, modified to include the word "e-cigarette," in detecting past 12-month nicotine vaping and past 12-month tobacco product use inclusive of nicotine vaping, among adolescent primary care patients.METHODS: We conducted secondary analysis of data from a pilot trial of adolescent substance usescreening and brief intervention in pediatric primary care. Participants were patients aged 12-18years (N= 278) presenting for annual well-visits at five practices in Massachusetts in 2015-2017. Study measures consisted of a clinical brief screener item and tobacco/electronic cigarette items on a confidential, self-administered research questionnaire (criterion measure).RESULTS: The clinical brief screener item identified 24 of 30 adolescents with past 12-month tobacco use (sensitivity 80%); 15 of 30 with past 12-month electronic cigarette use (sensitivity 50.0%), and 25 of 42 with tobacco and/or electronic cigarette use (sensitivity 59.5%).CONCLUSIONS: These findings support the need to develop and test a screening measure that is sensitive for capturing electronic cigarette use.

  View details for DOI 10.1016/j.jadohealth.2021.01.017

  View details for PubMedID 33610402

• DOES TOBACCO SCREENING IN YOUTH PRIMARY CARE IDENTIFY YOUTH VAPING? Liu, J., Halpern-Felsher, B., Harris, S. ELSEVIER SCIENCE INC. 2021: S7–S8

  View details for Web of Science ID 000616262000014

• Online Antibiotic Allergy Decision Support Tool Improves Management of Beta Lactam Allergies Dunham, T., Fasani, D., Lippner, E., Moir, E., Halpern-Felsher, B., Gardner, R., Sundaram, V., Liu, A. MOSBY-ELSEVIER. 2021: AB7

  View details for Web of Science ID 000629158000021

• ADOLESCENT E-CIGARETTE USE AND ACCESS BEFORE AND DURING THE COVID-19 PANDEMIC Gaiha, S., Lempert, L., McKelvey, K., Halpern-Felsher, B. ELSEVIER SCIENCE INC. 2021: S57

  View details for Web of Science ID 000616262000110

• YOUTH PERCEPTIONS ABOUT THE RELATIONSHIP BETWEEN E-CIGARETTE USE AND COVID-19 Gaiha, S., Epperson, A., Halpern-Felsher, B. ELSEVIER SCIENCE INC. 2021: S57

  View details for Web of Science ID 000616262000109

• Gaiha et al. Disregarded Conventional Publishing Standards Respond JOURNAL OF ADOLESCENT HEALTH Halpern-Felsher, B., Vallone, D., Hair, E., Ling, P., Song, A. V., Bondy, M. L., Boykan, R. 2021; 68 (1): 216–21

  View details for Web of Science ID 000612549900038

• The Authors Respond. The Journal of adolescent health : official publication of the Society for Adolescent Medicine Halpern-Felsher, B., Vallone, D., Hair, E., Ling, P., Song, A. V., Bondy, M. L., Boykan, R. 2021; 68 (1): 216–21

  View details for DOI 10.1016/j.jadohealth.2020.10.017

  View details for PubMedID 33349356

• Perceptions About the Impact of Cigarette Filters on the Environment and Smoking-Related Behaviors. The Journal of adolescent health : official publication of the Society for Adolescent Medicine Epperson, A. E., Novotny, T. E., Halpern-Felsher, B. 2020

  Abstract

  PURPOSE: Examine adolescents' and young adults' (AYAs) knowledge and perceptions about the composition and environmental harms of cigarette filters and determine how perceptions are associated with support for policy interventions.METHODS: Cross-sectional, convenience sample from 10 California schools. AYAs (N= 429; 70% < 21years) were surveyed about tobacco use, perceptions of cigarette filters, their impact on the environment, and cigarette sales bans.RESULTS: Most agreed that filters are harmful to the environment and not biodegradable (89%, n= 383 respectively); fewer knew filters are made of plastic (43%, n= 185). AYAs who agreed that filters are harmful to the environment were more supportive of cigarette sales bans (OR= 2.78 [95% CI: 1.18, 6.58]).CONCLUSIONS: Knowledge of the environmental harms of cigarettes among AYAs may strengthen support for tobacco control. More research is needed to further understand the knowledge and attitudes about the environmental impact of tobacco and to clarify how this might add support for tobacco-related policies.

  View details for DOI 10.1016/j.jadohealth.2020.10.022

  View details for PubMedID 33288455

• A Breath of Knowledge: Overview of Current Adolescent E-cigarette Prevention and Cessation Programs. Current addiction reports Liu, J., Gaiha, S. M., Halpern-Felsher, B. 2020: 1–13

  Abstract

  Purpose: Adolescent use of electronic cigarettes (e-cigarettes) has risen rapidly, which is concerning given the health effects of e-cigarettes and youth susceptibility to nicotine addiction. It is critical that efforts to educate, prevent, and reduce adolescent use of e-cigarettes are developed and evaluated. The purpose of this paper is to review available current prevention and cessation programs.Findings: A web-based search of currently available e-cigarette prevention and cessation/treatment programs was conducted using Google in May of 2020. Programs were then reviewed on whether they included theory- and evidence-based practices of effective adolescent prevention and cessation programs. Eight prevention programs, seven cessation programs, and one program that addressed both prevention and cessation were identified and included in this review. Most prevention programs included the importance of understanding flavored e-cigarette products, addressed industry-targeted marketing, included social learning activities to develop refusal skills, delivered free-of-cost, available online, and explicitly stated their incorporation of theory. Five prevention programs and two cessation programs had empirically evaluated their e-cigarette-related components.Conclusions: Although the programs reviewed largely incorporated theory and included key components known to be effective, there are some gaps in the programs' overall ability to prevent and stop adolescents from using e-cigarettes, such as lack of dedicated e-cigarette materials. More evidence-based tools, resources, and evaluations are needed to best inform adolescent e-cigarette cessation. Addressing the gaps that existing prevention and cessation programs present requires intervening at multiple systematic levels, conducting more rigorous program evaluations, and bolstering the availability of cessation programs.

  View details for DOI 10.1007/s40429-020-00345-5

  View details for PubMedID 33204602

• 3 Dimensions of Treatment Decision Making in Adolescents and Young Adults With Cancer. Cancer nursing Pyke-Grimm, K. A., Franck, L. S., Halpern-Felsher, B., Goldsby, R. E., Rehm, R. S. 2020; 43 (6): 436–45

  Abstract

  BACKGROUND: Adolescents and young adults (AYAs) experience treatment nonadherence rates as high as 60%, which can increase the risk of cancer relapse. Involvement of AYAs in treatment decisions might support adherence to medical treatment.OBJECTIVE: The aim of this study was to explore the involvement of AYAs, aged 15 to 20 years, in cancer treatment decision making (TDM).METHODS: Using interpretive focused ethnography, we conducted interviews with 16 AYAs (total of 31 interviews) receiving cancer treatment within 1 year of diagnosis. Participants reflected on a major recent TDM experience (eg, clinical trial, surgery) and other treatment decisions.RESULTS: Participants distinguished important major cancer treatment decisions from minor supportive care decisions. We identified 3 common dimensions related to AYAs' involvement in cancer TDM: (1) becoming experienced with cancer, (2) import of the decision, and (3) decision-making roles. The preferences of AYAs for participation in TDM varied over time and by type of decision. We have proposed a 3-dimensional model to illustrate how these dimensions might interact to portray TDM during the first year of cancer treatment for AYAs.CONCLUSIONS: As AYAs accumulate experience in making decisions, their TDM preferences might evolve at different rates depending on whether the decisions are perceived to be minor or major. Parents played a particularly important supportive role in TDM for AYA participants.IMPLICATIONS FOR PRACTICE: Clinicians should consider the AYAs' preferences and the role they want to assume in making different decisions in order to support and encourage involvement in their TDM and care.

  View details for DOI 10.1097/NCC.0000000000000820

  View details for PubMedID 33084293

• Parent Perspectives in Shared Decision-Making for Children With Medical Complexity ACADEMIC PEDIATRICS Lin, J. L., Clark, C. L., Halpern-Felsher, B., Bennett, P. N., Assis-Hassid, S., Amir, O., Nunez, Y., Cleary, N., Gehrmann, S., Grosz, B. J., Sanders, L. M. 2020; 20 (8): 1101–8

  View details for Web of Science ID 000587738600013

• Shared Decision-making With Parents of Hospitalized Children: A Qualitative Analysis of Parents' and Providers' Perspectives. Hospital pediatrics Hoang, K., Halpern-Felsher, B., Brooks, M., Blankenburg, R. 2020

  Abstract

  OBJECTIVES: Shared decision-making (SDM) is the pinnacle of patient-centered care and has been shown to improve health outcomes, especially for children with chronic medical conditions. However, parents perceive suboptimal involvement during hospitalization. The objective was to explore the perspectives of parents of hospitalized children and their hospital providers on facilitators and barriers to SDM in the hospital and identify strategies to increase SDM.METHODS: A qualitative study was conducted by using semistructured interviews with parents of hospitalized children with and without complex chronic conditions and their pediatric hospital medicine faculty. Parents and faculty were matched and individually interviewed on the same day. Two investigators iteratively coded transcripts and identified themes using modified grounded theory, with an additional author reviewing themes.RESULTS: Twenty-seven parents and 16 faculty participated in the interviews. Four themes emerged: (1) parents and providers value different components of SDM; (2) providers assume SDM is easier with parents of children with medical complexity; (3) factors related to providers, parents, patients, and family-centered rounds were identified as barriers to SDM; and (4) parents and providers identified strategies to facilitate SDM in the hospital.CONCLUSIONS: There is a discrepancy between parents' and providers' understanding of SDM, with parents most valuing their providers' ability to actively listen and explain the medical issue and options with them. There are many barriers that exist that make it difficult for both parties to participate. Several strategies related to family-centered rounds have been identified that can be implemented into clinical practice to mitigate these barriers.

  View details for DOI 10.1542/hpeds.2020-0075

  View details for PubMedID 33037030

• Tracking Adolescent Health Behaviors and Outcomes: Strengths and Weaknesses of the Youth Risk Behavior Surveillance System. NAM perspectives Underwood, J. M., Brener, N., Halpern-Felsher, B. 2020; 2020

  View details for DOI 10.31478/202010a

  View details for PubMedID 35291743

  View details for PubMedCentralID PMC8916798

• School-based e-cigarette education in Alabama: Impact on knowledge of e-cigarettes, perceptions and intent to try. Addictive behaviors Gaiha, S. M., Duemler, A., Silverwood, L., Razo, A., Halpern-Felsher, B., Walley, S. C. 2020; 112: 106519

  Abstract

  BACKGROUND AND OBJECTIVES: Educational programs are needed to combat the sharp rise in adolescent e-cigarette use. We assessed adolescent knowledge about e-cigarettes, perceptions of harmfulness and addictiveness and intent to try e-cigarettes before and after an e-cigarette educational session.METHODS: We conducted a one-group pre- and post-test study among middle and high school students in Alabama in 2019. The intervention included a 30-minute educational session based on the Stanford Tobacco Prevention Toolkit on e-cigarette types, contents, marketing and advertising, health effects and nicotine addiction. McNemar tests of paired proportions and multi-level, mixed-effects logistic regression models were used to analyze intervention effects.RESULTS: Surveys were completed by 2,889 middle and high school students. The intervention was associated with significantly increased knowledge about e-cigarettes and perceptions that e-cigarettes are harmful and addictive, and with significantly lower intent to try e-cigarettes. At pre-test, middle school students had lower knowledge, believed that e-cigarettes were not as addictive and showed higher intent to try both e-cigarettes and cigarettes compared to high school students. Groups that were associated with lower perceived harmfulness and addictiveness were: ever-users of e-cigarettes, ever-users of both e-cigarettes and cigarettes and prior users of mint/menthol flavored e-cigarettes.CONCLUSIONS: A school-based educational session was significantly associated with improved adolescent knowledge about e-cigarettes, increased the perceived harmfulness and addictiveness of e-cigarettes, and reduced intent to try e-cigarettes. E-cigarette education should be prioritized for middle school students due to lower levels of knowledge and higher intent to try tobacco compared to high school students.

  View details for DOI 10.1016/j.addbeh.2020.106519

  View details for PubMedID 32890911

• Parent perspectives in shared decision-making for children with medical complexity. Academic pediatrics Lin, J. L., Clark, C. L., Halpern-Felsher, B., Bennett, P. N., Assis-Hassid, S., Amir, O., Nunez, Y. C., Cleary, N. M., Gehrmann, S., Grosz, B. J., Sanders, L. M. 2020

  Abstract

  OBJECTIVE: Shared decision-making (SDM) may improve outcomes for children with medical complexity (CMC). CMC have lower rates of SDM than other children, but little is known about how to improve SDM for CMC. The objective of this study is to describe parent perspectives of SDM for CMC and identify opportunities to improve elements of SDM specific to this vulnerable population.METHODS: Interviews with parents of CMC explored SDM preferences and experiences. Eligible parents were ≥18 years old, English- or Spanish-speaking, with a CMC < 12 years old. Interviews were recorded, transcribed, and analyzed by independent coders for shared themes using modified grounded theory. Codes were developed using an iterative process, beginning with open-coding of a subset of transcripts followed by discussion with all team members, and distillation into preliminary codes. Subsequent coding reviews were conducted until no new themes emerged and existing themes were fully explored.RESULTS: We conducted interviews with 32 parents (27 in English, mean parent age 34 years, SD=7; mean child age 4 years, SD=4; 50% with household income <$50,000, 47% with low health literacy) in inpatient and outpatient settings. Three categories of themes emerged: participant, knowledge, and context. Key opportunities to improve SDM included: providing a shared decision timeline, purposefully integrating patient preferences and values, and addressing uncertainty in decisions.CONCLUSION: Our results provide insight into parent experiences with SDM for CMC. We identified unique opportunities to improve SDM for CMC that will inform future research and interventions to improve SDM for CMC.

  View details for DOI 10.1016/j.acap.2020.06.008

  View details for PubMedID 32540424

• Addressing Goals of Parents of Hospitalized Children: A Qualitative Analysis of Parents' and Physicians' Perspectives. Academic pediatrics Hoang, K., Halpern-Felsher, B., Brooks, M., Blankenburg, R. 2020

  Abstract

  OBJECTIVE: Goals of care discussions are crucial in helping parents navigate complex medical decisions and shown to improve quality of care. Little is known about whether physicians elicit or address parents' goals during a child's hospitalization. The purpose of this study was to understand the current practice of goal setting at the beginning of hospitalization by exploring the perspectives of parents of hospitalized children and their hospital physicians.METHODS: A qualitative study with semi-structured interviews was conducted from 2018 to 2019 at a 361-bed quaternary suburban freestanding children's hospital. Twenty-seven parents of hospitalized children and sixteen pediatric hospital medicine faculty were matched to participate. Data was analyzed using modified grounded theory, with themes identified through constant comparative approach.RESULTS: Five themes were identified: 1) Majority of hospitalized children's parents want to share their goals with physicians. 2) Parents and physicians share the same underlying goal of getting the child better to go home. 3) Parents of children with chronic diseases identified non-hospital goals that were not addressed. 4) Physicians do not explicitly elicit but rather assume what parents' goals of care are. 5) Factors related to patient, parent, and physician were identified as barriers to goal setting.CONCLUSIONS: Physicians may not consistently elicit parents' goals of care for their hospitalized children at the start of hospitalization. Parents desire their physicians to explicitly ask about their goals and involve them in goal setting during hospitalization. Strategies were identified by parents and physicians to improve goal setting with parents of hospitalized children.

  View details for DOI 10.1016/j.acap.2020.05.016

  View details for PubMedID 32492580

• Vaping in adolescents: epidemiology and respiratory harm. Current opinion in pediatrics Hamberger, E. S., Halpern-Felsher, B. 2020

  Abstract

  PURPOSE OF REVIEW: This review highlights epidemiologic changes in e-cigarette use in adolescents, discusses recent advances in aerosolized nicotine delivery, and provides and updated profile of research related to the lung-specific harm of e-cigarettes.RECENT FINDINGS: In the past decade, nicotine-containing e-cigarettes have emerged as the most popular tobacco and nicotine delivery modality among adolescents in the United States. The surge in popularity of these devices has coincided with an outbreak of vaping-related lung injury, bringing e-cigarette use to national attention, and creating a great deal of confusion regarding their potential for respiratory harm. Newer pod-based devices and formulations of e-liquids have resulted in products appeal to youth and deliver nicotine with increasing efficiency. E-liquid aerosols are associated with direct harm to respiratory epithelium and have been shown to alter pulmonary function, inflammation, mucociliary clearance, and lung histology.SUMMARY: Although the long-term harms of regular e-cigarette use are unknown, numerous studies including early longitudinal data suggest e-cigarette use is associated with incidence of respiratory disease, independent of concurrent traditional cigarette use. Improved understanding and recognition of harm will contribute to the basis of further studies examining the role of e-cigarettes on chronic respiratory disease and will inform future prevention education.

  View details for DOI 10.1097/MOP.0000000000000896

  View details for PubMedID 32332328

• ADOLESCENTS AND YOUNG ADULTS HARBOR MISPERCEPTIONS ABOUT DIFFERENT TYPES OF MARIJUANA PRODUCTS Wong, M., Halpern-Felsher, B. ELSEVIER SCIENCE INC. 2020: S138

  View details for Web of Science ID 000506637300272

• APPLYING LESSONS OF OPTIMAL ADOLESCENT HEALTH TO IMPROVE BEHAVIORAL OUTCOMES FOR YOUTH Coyne-Beasley, T., Adrien, R., Bryan, A., Chang, T., Corona, R., Halpern-Felsher, B., Hutchinson, J., Kahn, N., Murry, V., Wilson, S. ELSEVIER SCIENCE INC. 2020: S98

  View details for Web of Science ID 000506637300193

• Escalating Safety Concerns Are Not Changing Adolescent E-Cigarette Use Patterns: The Possible Role of Adolescent Mental Health. The Journal of adolescent health : official publication of the Society for Adolescent Medicine Gaiha, S. M., Halpern-Felsher, B. 2020; 66 (1): 3–5

  View details for DOI 10.1016/j.jadohealth.2019.10.008

  View details for PubMedID 31866056

• Electronic cigarette and moist snuff product characteristics independently associated with youth tobacco product perceptions. Tobacco induced diseases Chaffee, B. W., Couch, E. T., Urata, J. n., Cash, D. n., Werts, M. n., Halpern-Felsher, B. n. 2020; 18: 71

  Abstract

  Tobacco product characteristics convey product attributes to potential users. This study aimed to assess independent contributions of specific e-cigarette and smokeless tobacco product characteristics to adolescents' perceptions about these products.In 2019-2020, students (N=1003) attending a convenience sample of 7 high schools in California (USA) were individually randomized to one of two discrete choice experiments, featuring either electronic cigarettes (e-cigarettes) or moist snuff. Participants were presented like-product pairs of randomlygenerated hypothetical tobacco products differing in device type, flavor, vapor cloud, and nicotine amount (for e-cigarettes) or differing in brand, flavor, cut, and price (for moist snuff). Within pairs, participants were asked about which product they were more curious, was more dangerous, would give a greater 'buzz,' and would be easier to use. Conditional logistic regression was used to quantify independent associations of product characteristics to participants' choices.Each e-cigarette and moist snuff characteristic was independently associated with multiple product perceptions. All non-tobacco flavors were associated with more curiosity and perceived ease-of-use but lower perceived danger. Tank and pod-type e-cigarettes were viewed as easier to use and garnered more curiosity than 'cigalike' or 'drip-mod' devices. Smaller vapor cloud e-cigarettes and lower-price moist snuff were viewed as less dangerous, less buzz-inducing, and easier to use. Product ever users held stronger perceptions than never users about device type (e-cigarettes) and brands (moist snuff), while product naïve participants more strongly associated flavor with danger and buzz.Tobacco product characteristics convey product attributes to adolescents that may increase appeal. Restricting specific characteristics, including flavors, could reduce positive perceptions of these products among youth.

  View details for DOI 10.18332/tid/125513

  View details for PubMedID 32934617

  View details for PubMedCentralID PMC7485438

• "So Why Should I Call Them?": Survivor Support Service Characteristics as Drivers of Help-Seeking in India. Journal of interpersonal violence Newberry, J. A., Kaur, J. n., Gurrapu, S. n., Behl, R. n., Darmstadt, G. L., Halpern-Felsher, B. n., Rao, G. V., Mahadevan, S. V., Strehlow, M. C. 2020: 886260520970306

  Abstract

  Women in South Asia face the highest lifetime prevalence of intimate partner violence in the world, which is just one form of violence against women (VAW). In India, few women seek help after experiencing violence, particularly from formal resources, such as physicians or the police. While many studies have investigated the impact of survivor characteristics and patterns of violence on help-seeking behaviors, there is scant research on support service characteristics and their impact on help-seeking. The introduction of a novel crisis helpline in Gujarat, India provided an opportunity to better understand how successful help-seeking can be driven by the perceived and experienced characteristics of the helpline. We conducted in-depth interviews with helpline users to identify factors and pathways that promoted or discouraged help-seeking in general, help-seeking from a formal source, and help-seeking from this particular helpline. We analyzed 32 interviews of women who used the helpline. Participants were from eight districts across the state, representing a diverse range of sociodemographic backgrounds. After conducting a thematic analysis, we found that action-oriented service, timeliness, and women-focused staff influenced (positively and negatively) participants' feelings of safety, empowerment, and trust in the helpline, which ultimately impacted their decision to seek help from the helpline or even to seek help at all. This study illuminates how service characteristics, in and of themselves, can influence the likelihood that survivors will seek help, emphasizing the need for survivors to have a voice in the growth and refinement of VAW support services. Consequently, these areas must be a focus of future research and initiatives to improve help-seeking by VAW survivors.

  View details for DOI 10.1177/0886260520970306

  View details for PubMedID 33150827

• Alternative flavored and unflavored tobacco product use and cigarette quit attempts among current smokers experiencing homelessness. Addictive behaviors reports Alizaga, N. M., Hartman-Filson, M. n., Elser, H. n., Halpern-Felsher, B. n., Vijayaraghavan, M. n. 2020; 12: 100280

  Abstract

  Alternative tobacco product (ATP) use is common in the general population; however, few studies have explored ATP among individuals experiencing homelessness. We recruited individuals experiencing homelessness who were current cigarette smokers to explore flavored and unflavored ATP use and its association with past-year cigarette quit attempts.Using time-location sampling, we recruited participants from eight service sites in San Francisco, CA between December 2017 and July 2018. We explored type of ATP use and perceptions of product addiction, harm and risk between cigarette-only smokers and those who used cigarettes and ATPs ('ATP users'). We used logistic regression to examine the association between ATP and past-year quit attempts, adjusting for demographics, substance use disorders, depressive symptoms, and cigarette use characteristics.Among the 470 participants, 34.5% were cigarette-only users and 65.5% were ATP users. Among ATP users, 74.0% used cigars and 29.8% used e-cigarettes in the past month, with fruit-flavored products being the most common. ATP users were more likely to perceive cigars, blunts, and smokeless tobacco to be quite to extremely harmful or addictive compared to cigarette-only users. ATP use was not associated with past-year quit attempts, whereas hazardous alcohol use (OR = 2.07; CI 1.07-4.02) was associated with higher odds and and amphetamine use (OR = 0.50; CI 0.26-0.98) was associated with lower odds of past-year attempts.High rates of ATP use highlight a need for studies that explore motivations for use, beyond use as a smoking cessation aid, among people experiencing homelessness.

  View details for DOI 10.1016/j.abrep.2020.100280

  View details for PubMedID 32637560

  View details for PubMedCentralID PMC7330871

• PhenX: Host: Biobehavioral measures for tobacco regulatory research. Tobacco control Giovino, G. A., Swan, G. E., Blount, B., O'Malley, S., Brown, D. C., Hendershot, T. P., PhenX TRR Host: Biobehavioral Working Group, Joseph, A. M., O'Malley, S. S., Blount, B. C., Colby, S. M., Giovino, G. A., Hecht, S., Shields, P., Halpern-Felsher, B., Swan, G. E., Conway, K. P., Mermelstein, R. J., Postow, L., Wanke, K. L., Hendershot, T., Brown, D. C., Kilpatrick, L., Shiffman, S. 2020; 29 (Suppl 1): s13–s19

  Abstract

  A working group (WG) of experts from diverse fields related to nicotine and tobacco addiction was constituted to identify constructs and measures for the PhenX (Phenotypes and eXposures) Tobacco Regulatory Research (TRR) Host: Biobehavioral Collection with potential relevance to users of both conventional and newer tobacco products. This paper describes the methods and results the WG used to identify, select, approve and place measures in the PhenX TRR Collection. The WG recognised 13 constructs of importance to guide their categorisation of measures already in the PhenX Toolkit ('complementary measures') and to identify novel or improved measures of special relevance to tobacco regulatory science. In addition to the 22 complementary measures of relevance to tobacco use already in the PhenX Toolkit, the WG identified and recommended nine additional Host: Biobehavioral measures characterising the use, exposure and health outcomes of tobacco products for application to TRR. Of these, five were self-administered or interviewer-administered measures: amount, type and frequency of recent tobacco use; flavor preference in e-cigarette users (adult and youth); pregnancy status and tobacco use; pregnancy status-mother and baby health and withdrawal from tobacco use. The remaining four measures were laboratory-based: cotinine in serum, expired carbon monoxide, 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol in urine and cue reactivity. Although a number of validated tools are now available in the Host: Biobehavioral Collection, several gaps were identified, including a need to develop and test the identified measures in adolescent samples and to develop or identify measures of nicotine dependence, tolerance and withdrawal associated with newer non-combusted tobacco products.

  View details for DOI 10.1136/tobaccocontrol-2019-054975

  View details for PubMedID 31992659

• PhenX: Host: Social/Cognitive measures for tobacco regulatory research. Tobacco control Piper, M. E., Brown, D. C., Hendershot, T. P., Swan, G. E., PhenX TRR Host: Social/Cognitive Working Group, Brandon, T. H., Tiffany, S. T., Fagan, P., Piper, M., Halpern-Felsher, B., Prochaska, J. J., Wanke, K. L., Kaufman, A., Hendershot, T., Brown, D. C., Kilpatrick, L. 2020; 29 (Suppl 1): s5–s12

  Abstract

  A working group (WG) of experts from diverse fields related to nicotine and tobacco addiction was convened to identify elements and measures from the Host: Social/Cognitive domain to include in the Tobacco Regulatory Research Collection in the PhenX Toolkit, a catalogue of measures for biomedical research. This paper describes the methods used to identify, select, approve and include measures in the toolkit with potential relevance to users of both conventional and newer tobacco products, such as electronic cigarettes (e-cigarettes). In addition to 25 complementary measures primarily focused on cigarette use already present in the PhenX Toolkit, the WG recommended 11 additional social/cognitive measures focused on children and adult users or potential users of tobacco products. Of these, 10 were self-administered measures: frequency of communication with parents about smoking, quality of communication with parents about smoking, susceptibility to tobacco use, behaviour economics/purchase behaviour, motivation to quit (both single and multi-item measures), hedonic tone or response to pleasurable situations, multigroup ethnic identity, peer and family influence on smoking, attentional control and house rules about tobacco use. The remaining selected measure was computer based (distress tolerance). Although validated tools for use in the Host: Social/Cognitive realm are available, much remains to be done to develop, standardise and validate the tools for application to users of e-cigarettes and other non-combusted tobacco products, non-English language speakers and adolescents.

  View details for DOI 10.1136/tobaccocontrol-2018-054467

  View details for PubMedID 31992658

• Promoting Positive Adolescent Health and Well-Being, Thriving in the 21st Century: Implications for Research, Programs, and Policies. The Journal of adolescent health : official publication of the Society for Adolescent Medicine Coyne-Beasley, T. n., Halpern-Felsher, B. n. 2020; 66 (6): 656–57

  View details for DOI 10.1016/j.jadohealth.2020.03.022

  View details for PubMedID 32473721

• The NIDDK High School Short-Term Research Experience for Underrepresented Persons. Ethnicity & disease Rivers, R., Norris, K. C., Hui, G., Halpern-Felsher, B., Dodge-Francis, C., Guerrero, L. R., Golshan, A., Brinkley, K., Tran, K., McLaughlin, S., Antolin, N., Yoshida, T., Caffey-Fleming, D. E., Agodoa, L. 2020; 30 (1): 5–14

  Abstract

  Background: Increasing the pipeline of aspiring minority biomedical/health professionals is a crucial component to diversifying the health science workforce. The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) created the High School Short-Term Research Experience for Underrepresented Persons (HS-STEP-UP) to provide introductory biomedical/biobehavioral research experiences to promising high school students, who are traditionally underrepresented in the biomedical/biobehavioral sciences. The program reaches out to African American and Lationo/Hispanic students, as well as Native American students and students from the United States Territories.Methods: HS-STEP-UP provides a stimulating, rigorous 8- to 10-week summer research experience for a national cohort of ~100 high school students each year; the experience is organized through four National Institutes of Health (NIH)-funded coordinating centers. Typically, the program receives about 300 applications a year and about 100 students are accepted. Applicants are reviewed and selected based upon their online application that includes: a high school transcript, list of classes and extracurricular activities, two recommendation letters and a personal statement. The program culminates with a symposium at the NIH where students present their research and attend workshops and seminars.Results: For the 2017 and 2018 HS-STEP-UP programs, the classes included 193 students; 67% were females and 82% were underrepresented minorities. Forty eight percent of students reported a family income <$37,000/year, and 23% were from first generation college families. Ninety percent were very satisfied or satisfied with their research topic and 94% rated the end of the year symposium at NIH as excellent or very good. Only 65% were very satisfied or satisfied with their mentor matching, and 21% stated they were dissatisfied or very dissatisfied with their mentor. All the students successfully completed their summer research projects and presented their research abstracts at the symposium. All participating seniors reported attending college.Conclusion: HS-STEP-UP has been highly successful in recruiting traditionally underrepresented students and supporting underrepresented HS students with a rewarding introductory experience to research. Students are overall satisfied with the program, but mentor matching needs more attention. Longer-term follow-up is needed to determine how participating in STEP UP impacts their decisions to participate in the biomedical workforce in the future.

  View details for DOI 10.18865/ed.30.1.5

  View details for PubMedID 31969778

• Attitudes of Members of Genetics Professional Societies Toward Human Gene Editing. The CRISPR journal Armsby, A. J., Bombard, Y., Garrison, N. A., Halpern-Felsher, B. L., Ormond, K. E. 2019; 2 (5): 331–39

  Abstract

  Gene-editing technologies have improved in ease, efficiency, and precision. Although discussions are occurring around acceptable uses of human gene editing, limited data exist on the views of genetics-trained individuals. In 2017, we distributed an anonymous online survey to assess the attitudes of members of genetics professional societies toward gene editing (N=500). Virtually all respondents were supportive of somatic editing in basic-science (99.2%) and clinical (87.4%) research on nonreproductive human cells. Only 57.2% were supportive of germline-editing basic-science research; 31.9% supported the transfer of viable embryos to humans for clinical research. While most favored future therapeutic uses of somatic (96.6%) and germline (77.8%) editing, there was little support for enhancement in somatic (13.0%) or germline (8.6%) cells. This study describes attitudes toward gene editing from genetics professionals worldwide and contributes to ongoing discourse and policy guidance in this domain.

  View details for DOI 10.1089/crispr.2019.0020

  View details for PubMedID 31599688

• Health Care Experiences of Youth Living With HIV Who Were Lost to Follow-up in Western Kenya JANAC-JOURNAL OF THE ASSOCIATION OF NURSES IN AIDS CARE Wolf, H. T., Davidoff, K., Auerswald, C. L., Halpern-Felsher, B. L., Bukusi, E. A., Lyon, M., Cohen, C. R. 2019; 30 (5): 539–47

  Abstract

  HIV is the leading cause of mortality for youth in sub-Saharan Africa. Youth are more likely than any other age group to be lost to follow-up (LTFU) from care. We investigated the health care-related experiences of youth living with HIV (YLWH) who were LTFU (i.e., had not returned to care for at least 4 months), as well as the perceptions of the community health workers who supported them. Data were collected from two focus group discussions with community health workers (n = 18) who worked with YLWH and 27 semistructured interviews with YLWH (ages 15-21 years) who were LTFU. Attitudes toward health care were presented in the context of a social-ecological model. Respondents highlighted the need for improved youth-oriented services, including youth-friendly clinics and training for care providers about specific needs of YLWH. Researchers should develop and test the impact of these interventions to improve retention of YLWH in care.

  View details for DOI 10.1097/JNC.0000000000000044

  View details for Web of Science ID 000509695700015

  View details for PubMedID 31461737

• A cigarette pack by any other color: Youth perceptions mostly align with tobacco industry-ascribed meanings. Preventive medicine reports McKelvey, K., Baiocchi, M., Lazaro, A., Ramamurthi, D., Halpern-Felsher, B. 2019; 14: 100830

  Abstract

  Youth interpret cigarette pack-colors in line with industry-intended associations.Product-packaging restrictions may be circumvented by use of colors that misrepresent product harms.43.2% of participants attributed extra strong to the black cigarette pack.35.6% of participants ascribed rich to gold.31.1% of participants ascribed menthol to green.

  View details for PubMedID 30815339

• Point-of-sale marketing of heated tobacco products in Israel: cause for concern. Israel journal of health policy research Halpern-Felsher, B. 2019; 8 (1): 47

  Abstract

  Understanding how PMI markets IQOS at the point-of-sale in Israel is critical to determining whether marketing practices adhere to regulations and appeal to groups most at risk at initiating new tobacco products, such as adolescents. An article by Bar-Zev, Levine, Rubinstein, Khateb, and Berg (2019) examined the marketing of IQOS in retail stores in Israel. They found that while no free samples or promotions were provided at the point-of-sale, IQOS and their related HEETS (HeatSticks) were placed near youth-oriented merchandise and in prominent locations easily seen by youth. Further, package colors were used to indicate tobacco flavorings and strength, and retailers described the IQOS products as being less harmful, a cessation device, and not producing smoke. These findings are concerning given numerous studies linking marketing of novel tobacco products, product misperceptions, and subsequent tobacco use. Studies are needed to ensure that the marketing of IQOS, including the use of package colors, product placement at point-of-sales, and other product characteristics are significantly reducing harm and risk of tobacco-related disease to IQOS users, and that the health of the population as a whole, including those not using IQOS or other tobacco products, will not be harmed. Until such evidence is available, caution is warranted and regulations needed in the marketing of these novel products.

  View details for DOI 10.1186/s13584-019-0316-6

  View details for PubMedID 31133053

• Development and psychometric validation of a novel measure of sensory expectancies associated with E-cigarette use ADDICTIVE BEHAVIORS Morean, M. E., Krishnan-Sarin, S., Sussman, S., Foulds, J., Fishbein, H., Grana, R., Halpern-Felsher, B., Kim, H., Weaver, S. R., O'Malley, S. S. 2019; 91: 208–15

  Abstract

  E-cigarette dependence measures largely focus on e-cigarette use ("vaping") that is linked to nicotine use, and measures assessing sensory aspects of vaping that may influence use (e.g., taste) are limited in scope. Thus, we developed the novel Sensory E-cigarette Expectancies Scale (SEES).In Summer 2017, 610 adult e-cigarette users (48.7% male, 84.9% White, 37.41[±12.15] years old) completed an online survey that included 23 SEES items. Psychometric analyses included evaluating latent structure, internal consistency, measurement invariance, mean differences, and test-criterion relationships.Factor analyses supported a 9-item, 3-subscale structure (taste/smell, pleasure/satisfaction, vapor cloud production). Subscales evidenced internal consistency and scalar invariance by sex, race, smoking status (current/not), vaping status (daily/not), e-liquid nicotine content (yes/no), and device type (cig-a-likes/vape-pens/Advanced Personal Vaporizers [APVs]/Mods). Women and daily e-cigarette users reported stronger SEEs for taste/smell and pleasure than their counterparts. Non-white participants reported stronger SEEs for cloud production than White participants. Cig-a-like users reported the weakest SEEs for taste/smell and weaker SEEs linked to cloud production than APV/mod users. SEES scores evidenced convergence with nicotine dependence (mean r = .36). Finally, SEES scores predicted vaping frequency and habitual vaping concurrently and incrementally beyond nicotine dependence.The SEES evidenced good psychometric properties, suggesting that the measure can be used to assess sensory vaping expectancies in adults. Importantly, SEES scores indicated that sensory expectancies are related, yet distinct, from nicotine dependence. Future research should evaluate how SEEs relate to product characteristic preferences and patterns of vaping including the development and maintenance of addiction.

  View details for DOI 10.1016/j.addbeh.2018.08.031

  View details for Web of Science ID 000458711400031

  View details for PubMedID 30197032

  View details for PubMedCentralID PMC6358482

• Youth's Perceptions of E-cigarette Advertisements with Cessation Claims TOBACCO REGULATORY SCIENCE Kim, M., Ling, P. M., Ramamurthi, D., Halpern-Felsher, B. 2019; 5 (2): 94–104

  View details for DOI 10.18001/TRS.5.2.1

  View details for Web of Science ID 000458864900001

• Youth's Perceptions of E-cigarette Advertisements with Cessation Claims. Tobacco regulatory science Kim, M., Ling, P. M., Ramamurthi, D., Halpern-Felsher, B. 2019; 5 (2): 94-104

  Abstract

  E-cigarettes are not FDA-approved smoking cessation aids. Nevertheless, content analyses have shown that e-cigarette companies make claims about cessation efficacy. Some advertisements are explicit (directly mentioning their product can help smokers quit or stop smoking), while others are implicit (not containing cessation-related language, but implying cessation efficacy through subtle wording and imagery). This is the first study to examine directly how adolescents and young adults (AYAs) perceived these ads, and specifically whether they identify the cessation claims in e-cigarette advertisements.248 AYAs in California viewed 4 e-cigarette advertisements with cessation claims, then selected claims made by each advertisement. Descriptive statistics and multi-level logistic regression models were used to examine the relationship between the type of claims and perception.The claim "helps me quit smoking" was most frequently selected after viewing advertisements with explicit cessation claims, but not after viewing implicit claims. No significant effect of tobacco use and age on claim selection was observed.E-cigarette manufacturers make claims about cessation efficacy, and AYAs can identify such claims in advertisements, especially the explicit ones. FDA should regulate these advertisements as making therapeutic claims.

  View details for DOI 10.18001/TRS.5.2.1

  View details for PubMedID 31840040

  View details for PubMedCentralID PMC6910223

• Effects of e-Cigarette Advertisements on Adolescents' Perceptions of Cigarettes HEALTH COMMUNICATION Kim, M., Popova, L., Halpern-Felsher, B., Ling, P. M. 2019; 34 (3): 290–97

  View details for DOI 10.1080/10410236.2017.1407230

  View details for Web of Science ID 000458383300003

• WHAT ABOUT THE GOOD STUFF?: VALIDATION OF MEASUREMENT SCALES FOR ADOLESCENT TOBACCO AND MARIJUANA-RELATED PERCEPTIONS OF SPECIFIC RISKS AND BENEFITS McKelvey, K., Halpern-Felsher, B. ELSEVIER SCIENCE INC. 2019: S80

  View details for DOI 10.1016/j.jadohealth.2018.10.171

  View details for Web of Science ID 000455853700156

• TOBACCO RETAIL ENVIRONMENT AND ALTERNATIVE TOBACCO PRODUCT USE AMONG TEENS Magid, H., Halpern-Felsher, B., Bradshaw, P., Ling, P., Henriksen, L. ELSEVIER SCIENCE INC. 2019: S17–S18

  View details for DOI 10.1016/j.jadohealth.2018.10.047

  View details for Web of Science ID 000455853700034

• Treatment Decision-Making Involvement in Adolescents and Young Adults With Cancer. Oncology nursing forum Pyke-Grimm, K. A., Franck, L. S., Patterson Kelly, K., Halpern-Felsher, B., Goldsby, R. E., Kleiman, A., Rehm, R. S. 2019; 46 (1): E22–E37

  Abstract

  PROBLEM IDENTIFICATION: Involvement in treatment decision making (TDM) is considered a key element of patient- and family-centered care and positively affects outcomes. However, for adolescents and young adults (AYAs) with cancer, little is known about the current state of knowledge about their perspective on and involvement in TDM or the factors influencing AYAs' TDM involvement.LITERATURE SEARCH: Integrative review focused on AYAs aged 15-21 years, their involvement in TDM, and factors influencing their involvement using the MEDLINE, PsycINFO, CINAHL, and Web of Science databases.DATA EVALUATION: 4,047 articles were identified; 21 met inclusion criteria.SYNTHESIS: Five factors were identified.IMPLICATIONS FOR RESEARCH: Research is needed to understand AYAs' preferences for TDM, the type and degree of their involvement, and the interactions between factors that contribute to or impede TDM.

  View details for PubMedID 30547960

• From tobacco-endgame strategizing to Red Queen's race: The case of non-combustible tobacco products. Addictive behaviors McKelvey, K., Halpern-Felsher, B. 2019

  View details for PubMedID 30642577

• Electronic health record (EHR) training program identifies a new tool to quantify the EHR time burden and improves providers' perceived control over their workload in the EHR. JAMIA open DiAngi, Y. T., Stevens, L. A., Halpern-Felsher, B. n., Pageler, N. M., Lee, T. C. 2019; 2 (2): 222–30

  Abstract

  To understand if providers who had additional electronic health record (EHR) training improved their satisfaction, decreased personal EHR-use time, and decreased turnaround time on tasks.This pre-post study with no controls evaluated the impact of a supplemental EHR training program on a group of academic and community practice clinicians that previously had go-live group EHR training and 20 months experience using this EHR on self-reported data, calculated EHR time, and vendor-reported metrics.Providers self-reported significant improvements in their knowledge of efficiency tools in the EHR after training and doubled (significant) their preference list entries (mean pre = 38.1 [65.88], post = 63.5 [90.47], P < .01). Of the 7 EHR satisfaction variables, only 1 self-reported variable significantly improved after training: Control over my workload in the EHR (mean pre = 2.7 [0.96], post = 3.0 [1.04], P < .01). There was no significant decrease in their calculated EHR usage outside of clinic (mean pre = 0.39 [0.77] to post = 0.37 [0.48], P = .73). No significant difference was seen in turnaround time for patient calls (mean pre = 2.3 [2.06] days, post = 1.9 [1.76] days, P = .08) and results (mean before = 4.0 [2.79] days, after = 3.2 [2.33] days, P = .03).Multiple sources of data provide a holistic view of the provider experience in the EHR. This study suggests that individualized EHR training can improve the knowledge of EHR tools and satisfaction with their perceived control of EHR workload, however this did not translate into less Clinician Logged-In Outside Clinic (CLOC) time, a calculated metric, nor quicker turnaround on in box tasks. CLOC time emerged as a potential less-costly surrogate metric for provider satisfaction in EHR work than surveying clinicians. Further study is required to understand the cost-benefit of various interventions to decrease CLOC time.This supplemental EHR training session, 20 months post go-live, where most participants elected to receive 2 or fewer sessions did significantly improve provider satisfaction with perceived control over their workload in the EHR, but it was not effective in decreasing EHR-use time outside of clinic. CLOC time, a calculated metric, could be a practical trackable surrogate for provider satisfaction (inverse correlation) with after-hours time spent in the EHR. Further study into interventions that decrease CLOC time and improve turnaround time to respond to inbox tasks are suggested next steps.

  View details for DOI 10.1093/jamiaopen/ooz003

  View details for PubMedID 31984357

  View details for PubMedCentralID PMC6952029

• Measuring Cigarette Smoking Risk Perceptions. Nicotine & tobacco research : official journal of the Society for Research on Nicotine and Tobacco Kaufman, A. R., Twesten, J. E., Suls, J. n., McCaul, K. D., Ostroff, J. S., Ferrer, R. A., Brewer, N. T., Cameron, L. D., Halpern-Felsher, B. n., Hay, J. L., Park, E. R., Peters, E. n., Strong, D. R., Waters, E. A., Weinstein, N. D., Windschitl, P. D., Klein, W. M. 2019

  Abstract

  Risk perception is an important construct in many health behavior theories. Smoking risk perceptions are thoughts and feelings about the harms associated with cigarette smoking. Wide variation in the terminology, definition, and assessment of this construct makes it difficult to draw conclusions about the associations of risk perceptions with smoking behaviors. To understand optimal methods of assessing adults' cigarette smoking risk perceptions (among both smokers and nonsmokers), we reviewed best practices from the tobacco control literature, and where gaps were identified, we looked more broadly to the research on risk perceptions in other health domains. Based on this review, we suggest assessments of risk perceptions (1) about multiple smoking-related health harms, (2) about harms over a specific timeframe, and (3) for the person affected by the harm. For the measurement of perceived likelihood in particular (ie, the perceived chance of harm from smoking based largely on deliberative thought), we suggest including (4) unconditional and conditional items (stipulating smoking behavior) and (5) absolute and comparative items and including (6) comparisons to specific populations through (7) direct and indirect assessments. We also suggest including (8) experiential (ostensibly automatic, somatic perceptions of vulnerability to a harm) and affective (emotional reactions to a potential harm) risk perception items. We also offer suggestions for (9) response options and (10) the assessment of risk perception at multiple time points. Researchers can use this resource to inform the selection, use, and future development of smoking risk perception measures.Incorporating the measurement suggestions for cigarette smoking risk perceptions that are presented will help researchers select items most appropriate for their research questions and will contribute to greater consistency in the assessment of smoking risk perceptions among adults.

  View details for DOI 10.1093/ntr/ntz213

  View details for PubMedID 31883013

• Disease burden and social impact of pediatric chronic nonbacterial osteomyelitis from the patient and family perspective. Pediatric rheumatology online journal Oliver, M., Lee, T. C., Halpern-Felsher, B., Murray, E., Schwartz, R., Zhao, Y., CARRA SVARD CRMO/CNO workgroup, Oliver, M., Lee, T. C., Murray, E., Schwartz, R., Zhao, Y. 2018; 16 (1): 78

  Abstract

  BACKGROUND: Chronic nonbacterial osteomyelitis (CNO) is an autoinflammatory bone disorder that if left untreated can result in bone destruction and severe continuing pain due to persistent inflammation. The impact this chronic disease has on the daily lives of affected children and their families is not well known. The purpose of this study is to understand the disease burden and socioeconomic and psychological impact of CNO from the patients' and families' perspectives and identify areas of improvement for patient care and reduced disease burden based on patients' and families' responses.METHODS: Participants were invited through a social media platform group and at clinic visits at Stanford Children's Health. An online survey was administered to patients with a diagnosis of CNO made at <22years of age and/or the parent/guardian of a patient with CNO diagnosis made at <22years of age.RESULTS: There was a total of 284 survey participants. The median age at CNO diagnosis was 10years (range 2-22+). Median time from first CNO symptom to diagnosis was 2years. Antibiotics were used in 35% of patients prior to CNO diagnosis; of these, 24% received antibiotics for greater than 6months. Between 25 and 61% reported a negative effect of CNO on relationships, school/work performance, or finances; and 19-50% reported effects on psychosocial well-being. The majority agreed patients' performance with daily tasks and hobbies was challenged bypain, fatigue and physical limitation related to CNO.CONCLUSIONS: Patients with CNO experienced on average a 2-year delay in diagnosis and receiving effective treatments. At least 25% reported problems with relationships, school, work, finances and well-being due to CNO. Recognition of these challenges emphasizes the need to increase awareness of this disease and address the socioeconomic stressors and mental health issues in order to provide optimal care of children with CNO.

  View details for PubMedID 30547806

• Adolescents' and Young Adults' Use and Perceptions of Pod-Based Electronic Cigarettes JAMA NETWORK OPEN McKelvey, K., Baiocchi, M., Halpern-Felsher, B. 2018; 1 (6)

  View details for DOI 10.1001/jamanetworkopen.2018.3535

  View details for Web of Science ID 000452647700030

• LUNG HEALTH RISK BEHAVIORS AND PERCEPTIONS IN ADOLESCENTS AND YOUNG ADULTS WITH CYSTIC FIBROSIS Hamberger, E., Halpern-Felsher, B., Milla, C. WILEY. 2018: 64–65

  View details for Web of Science ID 000443947300023

• IQOS labelling will mislead consumers. Tobacco control McKelvey, K., Popova, L., Kim, M., Lempert, L. K., Chaffee, B. W., Vijayaraghavan, M., Ling, P., Halpern-Felsher, B. 2018

  Abstract

  BACKGROUND: Philip Morris International (PMI) continually expands and diversifies their nicotine product portfolio, which includes IQOS, a heated tobacco product. In December 2016, PMI filed a modified risk tobacco product (MRTP) application with the US Food and Drug Administration (FDA), seeking authorisation to market IQOS in USA with three claims of reduced harm: 'switching completely from conventional cigarettes to the IQOS system' (1) 'can reduce the risks of tobacco-related diseases;' (2) 'significantly reduce[s] your body's exposure to harmful or potentially harmful chemicals;' and (3) 'presents less risk of harm than continuing to smoke cigarettes.' Consumers may misunderstand what is meant by 'switching completely'.METHODS: We critically reviewed study reports submitted to FDA by PMI in support of proposed marketing claims in its MRTP application for IQOS and focused on the statement that switching completely to IQOS reduces risk.RESULTS: We found deficiencies with evidence provided by PMI supporting their assertions that: current smokers will understand what is meant by the phrase 'switching completely'; the proposed claims will not decrease smokers' intentions to quit; and IQOS users will in fact 'switch completely' from smoking cigarettes to using IQOS. The studies and measurement instruments employed by PMI suffer from design flaws and their reporting of associated findings is misleading.CONCLUSION: Consumers will not understand the condition of the claims-that they must quit using cigarettes completely to achieve the inferred health benefits of IQOS. Rather, they are likely to misunderstand the unsupported claims of reduced risks to mean IQOS are harm-free.

  View details for PubMedID 30158208

• Adult Connection in Assault Injury Prevention among Male Youth in Low-Resource Urban Environments JOURNAL OF URBAN HEALTH-BULLETIN OF THE NEW YORK ACADEMY OF MEDICINE Culyba, A. J., Miller, E., Ginsburg, K. R., Branas, C. C., Guo, W., Fein, J. A., Richmond, T. S., Halpern-Felsher, B. L., Wiebe, D. J. 2018; 95 (3): 361–71

  Abstract

  Strengths-based strategies to reduce youth violence in low-resource urban communities are urgently needed. Supportive adolescent-adult relationships may confer protection, but studies have been limited by self-reported composite outcomes. We conducted a population-based case-control study among 10- to 24-year-old males in low-resource neighborhoods to examine associations between supportive adult connection and severe assault injury. Cases were victims of gunshot assault injury (n = 143) and non-gun assault injury (n = 206) from two level I trauma centers. Age- and race-matched controls (n = 283) were recruited using random digit dial from the same catchment. Adolescent-adult connections were defined by: (1) brief survey questions and (2) detailed family genograms. Analysis used conditional logistic regression. There were no significant associations between positive adult connection, as defined by brief survey questions, and either gunshot or non-gun assault injury among adolescents with high prior violence involvement (GSW OR = 2.46, 95% CI 0.81-7.49; non-gun OR = 1.59, 95% CI 0.54-4.67) or low prior violence involvement (GSW OR = 0.92, 95% CI 0.34-2.44; non-gun OR = 1.96, 95% CI 0.73-5.28). In contrast, among adolescents with high levels of prior violence involvement, reporting at least one supportive adult family member in the family genogram was associated with higher odds of gunshot assault injury (OR = 4.01, 95% CI 1.36-11.80) and non-gun assault injury (OR = 4.22, 95% CI 1.48-12.04). We were thus unable to demonstrate that positive adult connections protected adolescent males from severe assault injury in this highly under-resourced environment. However, at the time of injury, assault-injured adolescents, particularly those with high prior violence involvement, reported high levels of family support. The post-injury period may provide opportunities to intervene to enhance and leverage family connections to explore how to better safeguard adolescents.

  View details for PubMedID 29700679

• Measuring E-cigarette use, dependence, and perceptions: Important principles and considerations to advance tobacco regulatory science ADDICTIVE BEHAVIORS Halpern-Felsher, B., Kim, H. 2018; 79: 201–2

  View details for PubMedID 29175026

  View details for PubMedCentralID PMC5831549

• Type of E-Cigarette Device Used Among Adolescents and Young Adults: Findings From a Pooled Analysis of Eight Studies of 2166 Vapers NICOTINE & TOBACCO RESEARCH Barrington-Trimis, J. L., Gibson, L. A., Halpern-Felsher, B., Harrell, M. B., Kong, G., Krishnan-Sarin, S., Leventhal, A. M., Loukas, A., McConnell, R., Weaver, S. R. 2018; 20 (2): 271–74

  Abstract

  A recent study of adult smokers who vape found that disposable/cigalike electronic (e-) cigarette devices were more commonly used than later generation devices. However, whether these trends reflect patterns among adolescents and young adults, many of whom have limited or no history of combustible cigarette use, has not been studied.Participants were drawn from eight locally, regionally, and US nationally representative studies. Surveys took place between Fall 2014 and Spring 2016; participants were residents of California (3 studies), Texas (2 studies), Connecticut (1 study), or randomly selected from the US population (2 studies). Data were collected from middle and high school students (4 studies), young adults under 30 (3 studies), or a mixture (1 study) to assess type of e-cigarette device used among past-30 day e-cigarette users: disposable/cigalike, or later generation e-cigarette device.Fewer than 15% of participants in each study reported primarily using a disposable/cigalike device in the past month (across all studies: 7.5%; 95%CI: 4.9%, 10.5%). The proportion using later generation devices ranged from 58% to 86% across studies; overall, 77.0% (95%CI: 70.5%, 82.9%) reported primary use of a later generation device. Combined, 13.2% (95%CI: 5.9%, 22.8%) reported "don't know" or were missing data.Among adolescent and young adult e-cigarette users, primary use of disposable/cigalike devices was rare. Future research should continue to evaluate the type of device used by adolescents and young adults, as these data may be relevant to regulatory oversight of e-cigarettes recently acquired by the Food and Drug Administration Center for Tobacco Products.In this pooled analysis of adolescent and young adult vapers, primary use of later generation e-cigarette devices was substantially more common than use of disposable/cigalike devices. The type of device predominantly used by adolescents and young adults has regulatory implications for policy to reduce adolescent use of e-cigarettes.

  View details for PubMedID 28371890

  View details for PubMedCentralID PMC5896438

• YOUTH-ASCRIBED CIGARETTE PACK COLOR MEANING: CORRECT PERCEPTIONS OF GREEN MENTHOL FLAVOR COLOR, YET CONFUSION OVER OTHER COLORS McKelvey, K., Halpern-Felsher, B., Lazaro, A. ELSEVIER SCIENCE INC. 2018: S137

  View details for Web of Science ID 000422677600274

• YOUTH SAY FLAVORED E-CIGARETTE ADS ARE FOR THEM McKelvey, K., Halpern-Felsher, B. ELSEVIER SCIENCE INC. 2018: S136–S137

  View details for Web of Science ID 000422677600273

• Contraception for Adolescents and Young Adults in the Inpatient Setting: The Providers' Perspective. Hospital pediatrics Goldstein, R. L., Carlson, J. L., Halpern-Felsher, B. n. 2018

  Abstract

  To assess pediatric providers' attitudes and barriers to initiating a contraceptive method in the inpatient setting.Pediatric attending physicians and trainees from 5 academic institutions were surveyed about contraceptive prescribing practices, attitudes, and potential barriers to initiating contraception in the inpatient setting.In 2016, 271 pediatric providers (34.0% were attending physicians, 18.1% fellows, and 47.9% residents) completed the survey; the response rate was 19.2%. Most participants practiced in both inpatient and outpatient settings (95.7% and 85.0%, respectively). More providers felt confident screening for sexual activity among young adults as compared with adolescents (71.9% vs 65.6%). The same was true for discussing contraceptive options (44.0% vs 38.8%, respectively). Inpatient providers reported seeing adolescents and young adults privately, discussing confidentiality, and asking about sex less than half of the time. More than 80% of providers agreed that it would be appropriate to initiate a contraceptive method for inpatients; 35.8% had done so, and 85.2% indicated that having additional consultation would increase initiation of a contraceptive method in the hospital (88.1% felt similarly for long-active reversible contraception methods). General barriers to initiating contraception included insufficient training, insufficient exposure to adolescents and young adults to maintain skills, and lack of time. Barriers specific to the inpatient setting included concerns about follow-up, confidentiality, and interference with the treatment plan.Initiation of a contraceptive method in the inpatient setting is acceptable to providers. In our findings, it is suggested that strategies are needed to enhance provision of these services by addressing confidentiality concerns and educating providers.

  View details for PubMedID 29496729

• Adolescent Oral Sex and Condom Use: How Much Should We Worry and What Can We Do? The Journal of adolescent health : official publication of the Society for Adolescent Medicine Goldstein, R. n., Halpern-Felsher, B. n. 2018; 62 (4): 363–64

  View details for PubMedID 29571434

• Access to Tobacco Among California High School Students: The Role of Family Members, Peers, and Retail Venues JOURNAL OF ADOLESCENT HEALTH Meyers, M. J., Delucchi, K., Halpern-Felsher, B. 2017; 61 (3): 385–88

  Abstract

  The purpose of the study was to determine from whom and where adolescents obtained tobacco, including cigarettes, e-cigarettes, and hookah.California adolescents (N = 772; 63.19% female; mean age = 16.13 years, SD = 1.61; 26.44% white, 22.12% Asian/Pacific Islander, 36.65% Hispanic, and 14.79% other) were surveyed about their access to different tobacco products.Adolescents were significantly more likely to obtain tobacco from friends (54.9%) than family members or direct purchasing (p < .001). Smoke shops were the most common purchase location across products (44.3%), with adolescents significantly more likely to purchase hookah and e-cigarettes from smoke shops than gas stations, liquor stores, or drug stores (p < .02).The effective characterization of tobacco access patterns is critical to the development of comprehensive tobacco control. By demonstrating peers and smoke shops as the primary social and retail outlets, this study identifies targets for the optimization of regulation and messaging aimed at reducing adolescents' access to tobacco.

  View details for PubMedID 28712593

  View details for PubMedCentralID PMC5610576

• Effect of a Prior History of Overweight on Return of Menses in Adolescents With Eating Disorders JOURNAL OF ADOLESCENT HEALTH Seetharaman, S., Golden, N. H., Halpern-Felsher, B., Peebles, R., Payne, A., Carlson, J. L. 2017; 60 (4): 469-471

  Abstract

  The purpose of this study was to determine whether a history of overweight, weight suppression, and weight gain during treatment have an effect on return of menses (ROM) in adolescents with eating disorders (EDs).Retrospective chart review of female adolescents presenting to an ED program from January 2007 to June 2009.One hundred sixty-three participants (mean age, 16.6 ± 2.1 years) met eligibility criteria. The mean median body mass index percent at ROM for those previously overweight was 106.1 ± 11.7 versus 94.2 ± 8.9 for those not previously overweight (p < .001). Both groups needed to gain weight for ROM. Greater weight suppression (odds ratio, 0.90; 95% confidence interval, 0.84-0.98; p = .013) was associated with lower likelihood of ROM, and greater weight gain during treatment (odds ratio, 1.20; 95% confidence interval, 1.07-1.36; p = .002) was associated with higher likelihood of ROM in those not previously overweight.Previously overweight amenorrheic patients with EDs needed to be at a higher median body mass index percent for ROM compared to those who were not previously overweight.

  View details for DOI 10.1016/j.jadohealth.2016.10.019

  View details for Web of Science ID 000401108300017

• The effectiveness of an adolescent reproductive health education intervention in Uganda. International journal of adolescent medicine and health Wolf, H. T., Teich, H. G., Halpern-Felsher, B. L., Murphy, R. J., Anandaraja, N., Stone, J., Kalumuna, C. 2017; 29 (2)

  Abstract

  Ugandan adolescents lack sufficient reproductive health knowledge, which accounts in part for the staggering rates of teen pregnancies and sexually transmitted (STI) infections in this population. This study aimed to (1) examine Ugandan adolescents' baseline STI and contraceptive knowledge; (2) determine whether this knowledge varies by demographic factors, prior sexual experience or school grade; and (3) evaluate the effectiveness of an educational program to increase and retain STI and contraceptive knowledge among Ugandan adolescents. This study surveyed 129 adolescents (ages 15-19) regarding knowledge of STIs and contraceptive methods at schools and community non-governmental organizations at three time points. Findings demonstrated that at baseline the mean test scores for contraceptive knowledge and STI knowledge were 44% and 72%, respectively. Participants in higher secondary school grade-levels had greater odds of having prior STI knowledge (OR=19.6, 95% CI 2.0-187.6); participants who had previously engaged in sex had greater odds of having prior contraceptive knowledge (OR=4.62, 95% CI 1.45-14.72). A higher grade level was not associated with better knowledge of contraception; and being sexually active was not associated with better knowledge of STI information. Participants' knowledge of STIs and contraceptives improved after the education session (p<0.001), and knowledge was retained 3-weeks later (p<0.001). Findings suggest that Ugandan adolescents do not have adequate education regarding contraceptive methods and that implementation of reproductive health modules by an outside party can be effective in improving knowledge.

  View details for DOI 10.1515/ijamh-2015-0032

  View details for PubMedID 26360489

• Effect of a Prior History of Overweight on Return of Menses in Adolescents With Eating Disorders. journal of adolescent health Seetharaman, S., Golden, N. H., Halpern-Felsher, B., Peebles, R., Payne, A., Carlson, J. L. 2017; 60 (4): 469-471

  Abstract

  The purpose of this study was to determine whether a history of overweight, weight suppression, and weight gain during treatment have an effect on return of menses (ROM) in adolescents with eating disorders (EDs).Retrospective chart review of female adolescents presenting to an ED program from January 2007 to June 2009.One hundred sixty-three participants (mean age, 16.6 ± 2.1 years) met eligibility criteria. The mean median body mass index percent at ROM for those previously overweight was 106.1 ± 11.7 versus 94.2 ± 8.9 for those not previously overweight (p < .001). Both groups needed to gain weight for ROM. Greater weight suppression (odds ratio, 0.90; 95% confidence interval, 0.84-0.98; p = .013) was associated with lower likelihood of ROM, and greater weight gain during treatment (odds ratio, 1.20; 95% confidence interval, 1.07-1.36; p = .002) was associated with higher likelihood of ROM in those not previously overweight.Previously overweight amenorrheic patients with EDs needed to be at a higher median body mass index percent for ROM compared to those who were not previously overweight.

  View details for DOI 10.1016/j.jadohealth.2016.10.019

  View details for PubMedID 27998699

• Evidence That Classroom-Based Behavioral Interventions Reduce Pregnancy-Related School Dropout Among Nairobi Adolescents HEALTH EDUCATION & BEHAVIOR Sarnquist, C., Sinclair, J., Mboya, B. O., Langat, N., Paiva, L., Halpern-Felsher, B., Golden, N. H., Maldonado, Y. A., Baiocchi, M. T. 2017; 44 (2): 297-303

  Abstract

  Purpose To evaluate the effect of behavioral, empowerment-focused interventions on the incidence of pregnancy-related school dropout among girls in Nairobi's informal settlements. Method Retrospective data on pregnancy-related school dropout from two cohorts were analyzed using a matched-pairs quasi-experimental design. The primary outcome was the change in the number of school dropouts due to pregnancy from 1 year before to 1 year after the interventions. Results Annual incidence of school dropout due to pregnancy decreased by 46% in the intervention schools (from 3.9% at baseline to 2.1% at follow-up), whereas the comparison schools remained essentially unchanged (p < .029). Sensitivity analysis shows that the findings are robust to small levels of unobserved bias. Conclusions Results suggest that these behavioral interventions significantly reduced the number of school dropouts due to pregnancy. As there are limited promising studies on behavioral interventions that decrease adolescent pregnancy in low-income settings, this intervention may be an important addition to this toolkit.

  View details for DOI 10.1177/1090198116657777

  View details for Web of Science ID 000398072000012

• Adolescent Cigarette Smoking Perceptions and Behavior: Tobacco Control Gains and Gaps Amidst the Rapidly Expanding Tobacco Products Market From 2001 to 2015. journal of adolescent health McKelvey, K., Halpern-Felsher, B. 2017; 60 (2): 226-228

  Abstract

  The aim of the study was to determine whether adolescents' intentions to smoke, cigarette smoking behavior, and specific perceptions of cigarette smoking are different in 2015 versus 2001.Data from two California school-based studies (Xage = 14) were compared: one conducted in 2001-2002 ("2001"), N = 395; the second in 2014-2015 ("2015"); N = 282.In 2015, more participants reported it was very unlikely they would smoke (94% vs. 65%) and that they never smoked (95% vs. 74%); they reported perceiving less likelihood of looking more mature (17% vs. 28%) and greater likelihood of getting into trouble (86% vs. 77%), having a heart attack (76% vs. 69%), and contracting lung cancer (85% vs. 78%) from smoking (p < .001). Perceptions of short-term health problems and addiction were similar in 2001 and 2015.Findings suggest that adolescents in 2015 perceived greater risks compared to those in 2001 even amidst the rapidly changing tobacco product landscape. In addition to continuing messages of long-term health risks, prevention efforts should include messages about addiction and short-term health and social risks.

  View details for DOI 10.1016/j.jadohealth.2016.09.025

  View details for PubMedID 27939880

  View details for PubMedCentralID PMC5270372

• Factors influencing and modifying the decision to pursue genetic testing for skin cancer risk. Journal of the American Academy of Dermatology Fogel, A. L., Jaju, P. D., Li, S., Halpern-Felsher, B., Tang, J. Y., Sarin, K. Y. 2017

  Abstract

  Across cancers, the decision to pursue genetic testing is influenced more by subjective than objective factors. However, skin cancer, which is more prevalent, visual, and multifactorial than many other malignancies, may offer different motivations for pursuing such testing.The primary objective was to determine factors influencing the decision to receive genetic testing for skin cancer risk. A secondary objective was to assess the impact of priming with health questions on the decision to receive testing.We distributed anonymous online surveys through ResearchMatch.org to assess participant health, demographics, motivations, and interest in pursuing genetic testing for skin cancer risk. Two surveys with identical questions but different question ordering were used to assess the secondary objective.We received 3783 responses (64% response rate), and 85.8% desired testing. Subjective factors, including curiosity, perceptions of skin cancer, and anxiety, were the most statistically significant determinants of the decision to pursue testing (P < .001), followed by history of sun exposure (odds ratio 1.85, P < .01) and history of skin cancer (odds ratio 0.5, P = .01). Age and family history of skin cancer did not influence this decision. Participants increasingly chose testing if first queried about health behaviors (P < .0001).The decision to pursue hypothetical testing may differ from in-clinic decision-making. Self-selected, online participants may differ from the general population. Surveys may be subject to response bias.The decision to pursue genetic testing for skin cancer is primarily determined by subjective factors, such as anxiety and curiosity. Health factors, including skin cancer history, also influenced decision-making. Priming with consideration of objective health factors can increase the desire to pursue testing.

  View details for DOI 10.1016/j.jaad.2016.11.050

  View details for PubMedID 28087134

• Adolescents' attitudes towards e-cigarette ingredients, safety, addictive properties, social norms, and regulation PREVENTIVE MEDICINE Gorukanti, A., Delucchi, K., Ling, P., Fisher-Travis, R., Halpern-Felsher, B. 2017; 94: 65-71

  Abstract

  E-cigarette use has dramatically increased. While studies have examined adolescents' attitudes towards smoking, few have extended this research to adolescents' attitudes towards e-cigarettes. The goal of this study was to examine adolescents' attitudes regarding e-cigarette ingredients, safety, addictive properties, social norms, accessibility, price, and regulation; and determine whether attitudes differ by past cigarette/e-cigarette use. Participants were 786 9th and 12th graders from California (63.21% females; mean age=16.10years [SD=1.6]; 26.61% White, 21.98% Asian/Pacific Islander, 29.82% Hispanic, and 21.59% other). Results indicated that 19.05% of participants believed smoke from e-cigarettes is water; 23.03% believed e-cigarettes aren't a tobacco product; 40.36% considered e-cigarettes to be for cessation, and 43.13% felt they were safer than cigarettes. Participants felt it was more acceptable to use e-cigarettes indoors and outdoors compared to cigarettes (p<0.0001), 23.13% felt raising e-cigarette taxes is a bad idea, 63.95% thought e-cigarettes were easier to get than cigarettes, 54.42% felt e-cigarettes cost too much, 64.33% felt the age for buying e-cigarettes should be raised, and 64.37% favored e-cigarette regulation. Adolescents who used e-cigarettes and/or cigarettes had significantly more favorable e-cigarette attitudes than non-users. This study indicates that adolescents are aware of some of the risks of e-cigarettes, although many harbor misperceptions and hold more favorable attitudes towards e-cigarettes than cigarettes. Of concern is the relationship between favorable e-cigarette attitudes and use. Findings suggest the need to provide adolescents with correct information about e-cigarette ingredients, risks, and the insufficient evidence of their role in cigarette cessation.

  View details for DOI 10.1016/j.ypmed.2016.10.019

  View details for Web of Science ID 000396371600011

• Evidence That Classroom-Based Behavioral Interventions Reduce Pregnancy-Related School Dropout Among Nairobi Adolescents. Health education & behavior Sarnquist, C., Sinclair, J., Omondi Mboya, B., Langat, N., Paiva, L., Halpern-Felsher, B., Golden, N. H., Maldonado, Y. A., Baiocchi, M. T. 2016

  Abstract

  Purpose To evaluate the effect of behavioral, empowerment-focused interventions on the incidence of pregnancy-related school dropout among girls in Nairobi's informal settlements. Method Retrospective data on pregnancy-related school dropout from two cohorts were analyzed using a matched-pairs quasi-experimental design. The primary outcome was the change in the number of school dropouts due to pregnancy from 1 year before to 1 year after the interventions. Results Annual incidence of school dropout due to pregnancy decreased by 46% in the intervention schools (from 3.9% at baseline to 2.1% at follow-up), whereas the comparison schools remained essentially unchanged (p < .029). Sensitivity analysis shows that the findings are robust to small levels of unobserved bias. Conclusions Results suggest that these behavioral interventions significantly reduced the number of school dropouts due to pregnancy. As there are limited promising studies on behavioral interventions that decrease adolescent pregnancy in low-income settings, this intervention may be an important addition to this toolkit.

  View details for PubMedID 27486178

• The Importance of Scientific Mentoring Programs for Underrepresented Youth. Journal of health disparities research and practice Halpern-Felsher, B., McLaughlin, S. 2016; 9 (5): 87-89

  View details for PubMedID 29082110

  View details for PubMedCentralID PMC5656280

• Subjective Invulnerability and Perceptions of Tobacco-Related Benefits Predict Adolescent Smoking Behavior JOURNAL OF EARLY ADOLESCENCE Morrell, H. E., Lapsley, D. K., Halpern-Felsher, B. L. 2016; 36 (5): 679-703

  View details for DOI 10.1177/0272431615578274

  View details for Web of Science ID 000375707900004

• A Longitudinal Study of Adolescents' Optimistic Bias about Risks and Benefits of Cigarette Smoking AMERICAN JOURNAL OF HEALTH BEHAVIOR Popova, L., Halpern-Felsher, B. L. 2016; 40 (3): 341-351

  Abstract

  Optimistic bias, a perception that one's own risks are lower than others', can help explain why adolescents smoke cigarettes despite knowing their risks. We examined the extent and changes over time of adolescents' optimistic bias for various smoking-related perceptions of risks and benefits on the aggregate and individual level.Longitudinal study (6 measurements over 3 years) of 395 adolescents (mean age 14 years, SD=0.4, at baseline) who rated the chance of occurrence of 19 short- and long-term heath risks, social risks, addiction, and benefits related to cigarette smoking for self and comparable others.Optimistic bias was consistently found only for addiction (83% of comparisons; 37%- 60% of adolescents). Addiction-related optimistic bias decreased significantly with time for "still be smoking in 5 years" (β = -2.44, p < .001) and for "become addicted" (β = -1.71, p < .001). This reduction resulted from a greater decrease in perceived risks for others rather than an increase in the adolescent's own perceived risk. For other risks and benefits, adolescents were either realistic or pessimistically biased.Smoking-related optimistic bias in adolescents was not as prevalent as past studies showed. Anti-smoking interventions targeting adolescents should emphasize the risk of addiction and personal relevance of addiction.

  View details for DOI 10.5993/AJHB.40.3.6

  View details for Web of Science ID 000401109300006

  View details for PubMedID 27103413

• Depression and Self-Rated Health Among Rural Women Who Experienced Adolescent Dating Abuse: A Mixed Methods Study. Journal of interpersonal violence Burton, C. W., Halpern-Felsher, B., Rehm, R. S., Rankin, S. H., Humphreys, J. C. 2016; 31 (5): 920-941

  Abstract

  This study used mixed methods to examine the experiences and health of rural, young adult women (N = 100) who self-reported past experience of physical, emotional and verbal, sexual, and relational abuse in adolescent dating relationships. Few studies have examined the lasting health ramifications of adolescent dating abuse adolescent dating abuse in rural populations, and almost no mixed methods studies have explored adolescent dating abuse. Participants completed questionnaires on demographics, relationship behaviors, and mental health symptoms. A subsample (n = 10) of participants also completed semi-structured, in-depth interviews with the primary investigator. Results suggest that depressive symptoms and self-rating of health in these women are associated with particular kinds and severity of abusive experiences, and that adolescent dating abuse has ramifications for health and development beyond the duration of the original relationship. Self-rated health (SRH) was inversely associated with abusive behaviors in the relationship, whereas depressive symptoms were positively correlated with such behaviors. Self-rated health was also negatively correlated with depressive symptoms. The results of this study represent an important step toward establishing lifetime health risks posed by adolescent dating abuse.

  View details for DOI 10.1177/0886260514556766

  View details for PubMedID 25392389

• Neighborhood Characteristics and ADHD: Results of a National Study JOURNAL OF ATTENTION DISORDERS Razani, N., Hilton, J. F., Halpern-Felsher, B. L., Okumura, M. J., Morrell, H. E., Yen, I. H. 2015; 19 (9): 731-740

  Abstract

  We examined the association of neighborhood social and physical characteristics with ADHD, accounting for individual and family factors.The 2007 National Survey of Child Health, a nationally representative data set, was used (N = 64,076). Three neighborhood scales were generated: social support, amenities, and disorder. Logistic and ordinal logistic regressions were conducted to examine the association of these scales with ADHD diagnosis and severity while adjusting for individual and family characteristics.Eight percent had a child with ADHD: 47% described as mild, 40% moderate, and 13% severe. In adjusted models, lower neighborhood support was associated with increased ADHD diagnosis (odds ratio [OR] = 1.66 [1.05, 2.63]) and severity (OR = 3.74 [1.71, 8.15]); neighborhood amenities or disorder were not significantly associated. Poor parental mental health was associated with ADHD prevalence and severity.Neighborhood social support is a potential area of intervention for children with ADHD and their caregivers. Research challenges and opportunities are discussed.

  View details for DOI 10.1177/1087054714542002

  View details for Web of Science ID 000359153500001

  View details for PubMedID 25028386

• Adolescents' Perceptions of Risks and Benefits of Conventional Cigarettes, E-cigarettes, and Marijuana: A Qualitative Analysis. The Journal of adolescent health : official publication of the Society for Adolescent Medicine Roditis, M. L., Halpern-Felsher, B. 2015; 57 (2): 179-85

  Abstract

  Although rates of adolescent cigarette use have remained constant or decreased, rates of marijuana and e-cigarette use are rising. Knowledge and perceptions of risks and benefits of tobacco products impact adolescents' decisions to use these products. However, little is known regarding adolescents' knowledge and perceptions of risks of e-cigarettes and marijuana nor how these perceptions are formed. This study uses qualitative techniques to assess and compare adolescents' perceptions of the risks and benefits of cigarettes, e-cigarettes, and marijuana.Twenty-four adolescents (nine females and 15 males) from Northern California participated in six small-group discussions. Adolescents were asked what good or bad things might happen from using these products. To assess how perceptions and knowledge of risks and benefits were formed, participants were asked where and from whom they had learned about these products.Adolescents described negative consequences of cigarette use but were much less sure regarding risks of marijuana and e-cigarette use. Conversely, they described few benefits of cigarettes but described a number of benefits of e-cigarette and marijuana use. Adolescents described learning about these products from the media, from family and friends, and from the school environment.Adolescents have learned from multiple sources about risks of using cigarettes, but they receive much less and often incorrect information regarding marijuana and e-cigarettes, likely resulting in their positive and often ambivalent perceptions of marijuana and e-cigarettes.

  View details for DOI 10.1016/j.jadohealth.2015.04.002

  View details for PubMedID 26115908

  View details for PubMedCentralID PMC4515157

• Latino Parents' Beliefs about Television Viewing by Infants and Toddlers JOURNAL OF HEALTH CARE FOR THE POOR AND UNDERSERVED Beck, A. L., Takayama, J., Badiner, N., Halpern-Felsher, B. 2015; 26 (2): 463-474

  Abstract

  To determine Latino parents' beliefs regarding the effects of television viewing on infants and toddlers.We conducted interviews with 26 Latino parents of infants and toddlers. We evaluated parents' beliefs about the health effects of television viewing, sources of information on this topic and facilitators and barriers to following the American Academy of Pediatrics (AAP) screen-time guidelines.Parents believed that television viewing was educational for children but were concerned that watching television could worsen children's vision. Parents would be motivated to limit television viewing by children if it were recommended by a health care provider. Most parents were confident that they could limit their children's television viewing, although some perceived logistical challenges to following guidelines.Parents in our study had limited knowledge of the effects of television. Counseling on television by health care providers for Latino parents may decrease Latino infants and toddlers' television exposure.

  View details for Web of Science ID 000354587300015

  View details for PubMedID 25913344

• Conditional Risk Assessment of Adolescents' Electronic Cigarette Perceptions AMERICAN JOURNAL OF HEALTH BEHAVIOR Chaffee, B. W., Gansky, S. A., Halpern-Felsher, B., Couch, E. T., Essex, G., Walsh, M. M. 2015; 39 (3): 421-432

  Abstract

  To adapt an established instrument for measuring adolescents' cigarette-related perceptions for new application with electronic cigarettes (e-cigarettes).In this exploratory study, 104 male high school students (40% tobacco ever-users) estimated the probability of potential e-cigarette risks (eg, lung cancer) or benefits (eg, look cool). We calculated associations between risk/benefit composite scores, ever-use, and use intention for e-cigarettes, and analogously, for combustible cigarettes.E-cigarette ever-use was associated with lower perceived risks, with adjusted differences versus never-users greater for e-cigarettes than for cigarettes. Risk composite score was inversely associated, and benefit score positively associated, with e-cigarette ever-use and use intention.Conditional risk assessment characterized adolescents' perceived e-cigarette risk/benefit profile, with potential utility for risk-perception measurement in future studies.

  View details for DOI 10.5993/AJHB.39.3.14

  View details for Web of Science ID 000352621700014

  View details for PubMedID 25741686

  View details for PubMedCentralID PMC4351787

• Health Care Providers' Comfort With and Barriers to Care of Transgender Youth JOURNAL OF ADOLESCENT HEALTH Vance, S. R., Halpern-Felsher, B. L., Rosenthal, S. M. 2015; 56 (2): 251-253

  Abstract

  To explore providers' clinical experiences, comfort, and confidence with and barriers to providing care to transgender youth.An online survey was administered to members of the Society for Adolescent Health and Medicine and the Pediatric Endocrine Society with items querying about clinical exposure to transgender youth, familiarity with and adherence to existing clinical practice guidelines, perceived barriers to providing transgender-related care, and comfort and confidence with providing transgender-related care. The response rate was 21.9% (n = 475).Of the respondents, 66.5% had provided care to transgender youth, 62.4% felt comfortable with providing transgender medical therapy, and 47.1% felt confident in doing so. Principal barriers to provision of transgender-related care were lack of the following: training, exposure to transgender patients, available qualified mental health providers, and insurance reimbursement.This study suggests that more training in transgender-related care, available qualified mental health providers, and insurance reimbursement for transgender-related care are needed.

  View details for DOI 10.1016/j.jadohealth.2014.11.002

  View details for Web of Science ID 000348498100019

  View details for PubMedID 25620310

• "It is all about the fear of being discriminated [against] ... the person suffering from HIV will not be accepted": a qualitative study exploring the reasons for loss to follow-up among HIV-positive youth in Kisumu, Kenya BMC PUBLIC HEALTH Wolf, H. T., Halpern-Felsher, B. L., Bukusi, E. A., Agot, K. E., Cohen, C. R., Auerswald, C. L. 2014; 14

  Abstract

  Youth represent 40% of all new HIV infections in the world, 80% of which live in sub-Saharan Africa. Youth living with HIV (YLWH) are more likely to become lost to follow-up (LTFU) from care compared to all other age groups. This study explored the reasons for LTFU among YLWH in Kenya.Data was collected from: (1) Focus group Discussions (n = 18) with community health workers who work with LTFU youth. (2) Semi-structured interviews (n = 27) with HIV + youth (15-21 years old) that had not received HIV care for at least four months. (3) Semi-structured interviews (n = 10) with educators selected from schools attended by LTFU interview participants. Transcripts were coded and analyzed employing grounded theory.HIV-related stigma was the overarching factor that led to LTFU among HIV + youth. Stigma operated on multiple levels to influence LTFU, including in the home/family, at school, and at the clinic. In all three settings, participants' fear of stigma due to disclosure of their HIV status contributed to LTFU. Likewise, in the three settings, the dependent relationships between youth and the key adult figures in their lives were also adversely impacted by stigma and resultant lack of disclosure. Thus, at all three settings stigma influenced fear of disclosure, which in turn impacted negatively on dependent relationships with adults on whom they rely (i.e. parents, teachers and clinicians) leading to LTFU.Interventions focusing on reduction of stigma, increasing safe disclosure of HIV status, and improved dependent relationships may improve retention in care of YLWH.

  View details for DOI 10.1186/1471-2458-14-1154

  View details for Web of Science ID 000345145000001

  View details for PubMedID 25377362

• Understanding How Latino Parents Choose Beverages to Serve to Infants and Toddlers MATERNAL AND CHILD HEALTH JOURNAL Beck, A. L., Takayama, J. I., Halpern-Felsher, B., Badiner, N., Barker, J. C. 2014; 18 (6): 1308-1315

  Abstract

  To determine Latino parents' beliefs on the health effects of beverages on infants and toddlers, their sources of information on beverages and perceived barriers to following guidelines for healthy beverage consumption by children. We conducted 29 interviews with parents of Latino children ages 6-36 months. Parents were recruited in three community health centers in Northern California. The interviews were recorded, transcribed and analyzed using standard qualitative methods. The following dominant themes emerged. Parents believed that water and milk were healthy beverages for children and that sugar-sweetened beverages (SSBs) were unhealthy. Views on 100 % fruit juice were mixed. Parents distinguished between homemade beverages such as "agua fresca" which they considered healthy, despite containing added sugar, and beverages from stores which were viewed as unhealthy. Participants' main source of information on beverages was the federal nutrition program for Women, Infants, and Children (WIC). Parents were confused, however, as to why WIC provides juice yet counseled parents to avoid giving their children juice. Parents preferred to receive information on beverages from experts. Differing practices among family members regarding which beverages they provide to children was the most important barrier to following beverage guidelines. Our study suggests that Latino parents are receptive to counseling on beverages from expert sources. Such counseling should address both store-bought and homemade beverages. The WIC program is a key source of information on beverages for Latino parents; thus counseling offered by WIC should be evidence-based and avoid mixed messages.

  View details for DOI 10.1007/s10995-013-1364-0

  View details for Web of Science ID 000339884400003

  View details for PubMedID 24077961

• Experiences of community and parental violence among HIV-positive young racial/ethnic minority men who have sex with men AIDS CARE-PSYCHOLOGICAL AND SOCIO-MEDICAL ASPECTS OF AIDS/HIV Phillips, G., Hightow-Weidman, L. B., Fields, S. D., Giordano, T. P., Outlaw, A. Y., Halpern-Felsher, B., Wohl, A. R. 2014; 26 (7): 827-834

  Abstract

  Adolescents and young adults (ages 13-24) in the USA are frequently exposed to violence in their community and home. While studies have examined the prevalence and impact of violence exposure among adolescents, there is a lack of data focusing specifically on adolescent men of color who have sex with men. Eight demonstration sites funded through a Special Projects of National Significance (SPNS) Initiative recruited 363 HIV-positive racial/ethnic minority young men who have sex with men (YMSM) for a longitudinal study between 2006 and 2009. Over two-thirds of participants (83.8%) had witnessed community violence, 55.1% in the prior three months. Witnessing violence committed with a deadly weapon was significantly associated with being African-American, having ever used drugs, and drinking alcohol in the prior two weeks. Fear of violence in the community was significantly associated with depressive symptomatology, having less than a high school degree, not possessing health insurance, and site of enrollment. Having been emotionally or physically abused by a parent or caretaker was significantly associated with depressive symptomatology, attempting suicide, site of enrollment, and increased age. Witnessing violence with a deadly weapon was significantly associated with alcohol and drug use but not with high-risk sexual behaviors. As this was one of the first studies on the prevalence and correlates of violence exposure among racial/ethnic minority YMSM living with HIV, the findings can be used to inform the development of culturally appropriate resilience-focused interventions to address the aftereffects of violence exposures and help develop social support systems outside of the family.

  View details for DOI 10.1080/09540121.2013.861571

  View details for Web of Science ID 000335118600006

  View details for PubMedID 24274141

• Rejoinder-response to: Human linear growth trajectory defined. American journal of human biology Mon, A., Meyerhoff, D., Cabana, M., Halpern-Felsher, B. 2014; 26 (1): 109-110

  View details for DOI 10.1002/ajhb.22484

  View details for PubMedID 24254459

• "It was Pretty Scary": The Theme of Fear in Young Adult Women's Descriptions of a History of Adolescent Dating Abuse ISSUES IN MENTAL HEALTH NURSING Burton, C. W., Halpern-Felsher, B., Rehm, R. S., Rankin, S., Humphreys, J. C. 2013; 34 (11): 803-813

  View details for DOI 10.3109/01612840.2013.827286

  View details for Web of Science ID 000209366900004

• Human linear growth trajectory defined AMERICAN JOURNAL OF HUMAN BIOLOGY Mon, A., Cabana, M., Halpern-Felsher, B., Meyerhoff, D. J. 2013; 25 (5): 666-672

  Abstract

  The purpose of this study was to assess the applicability of a simple mathematical formula for prediction of individual child linear growth. The formula describes a square root dependence of height on age with only two constants, k and C.Retrospective serial height measurements of 137 healthy children (61 female), who attended clinic in the Pediatrics Department at the University of California, San Francisco were used. For each child, two of the initial measurements and their corresponding measurement times were used to determine the values of k and C. By substituting the determined values of k and C into the formula, the formula was then used to predict the trajectory of the child's growth.The 137 children were comprised of 20% Hispanic, 23% African-American, 27% Caucasian and 30% Asian. The formula predicted growth trajectories of 136 out of the 137 children with minimal discrepancies between the measured data and the corresponding predicted data. The mean of the discrepancies was 0.8 cm.Our proposed formula is very easy to use and predicts individual child growth with high precision irrespective of gender or ethnicity. The formula will be a valuable tool for studying human growth and possibly growths of other animals.

  View details for DOI 10.1002/ajhb.22428

  View details for Web of Science ID 000323479700013

  View details for PubMedID 23934960

• HIV Testing Behaviors of a Cohort of HIV-Positive Racial/Ethnic Minority YMSM AIDS AND BEHAVIOR Phillips, G., Hightow-Weidman, L. B., Arya, M., Fields, S. D., Halpern-Felsher, B., Outlaw, A. Y., Wohl, A. R., Hidalgo, J. 2012; 16 (7): 1917-1925

  Abstract

  The HIV epidemic in the United States has disproportionately affected young racial/ethnic minority men who have sex with men (YMSM). However, HIV testing rates among young men of color remain low. Within this sample of racial/ethnic minority YMSM (n = 363), the first HIV test was a median of 2 years after men who have sex with men sexual debut. Individuals with less than 1 year between their first negative and first positive HIV test were significantly more likely to identify the reason for their first negative test as being sick (OR = 2.99; 95 % CI 1.23-7.27). This may suggest that these YMSM may have experienced symptoms of acute HIV infection. Of major concern is that many YMSM in our study tested positive for HIV on their first HIV test. Given recommendations for at least annual HIV testing, our findings reveal that medical providers YMSM need to know the importance of regular testing.

  View details for DOI 10.1007/s10461-012-0193-2

  View details for Web of Science ID 000309223000024

  View details for PubMedID 22555382

• Age of MSM Sexual Debut and Risk Factors: Results from a Multisite Study of Racial/Ethnic Minority YMSM Living with HIV AIDS PATIENT CARE AND STDS Outlaw, A. Y., Phillips, G., Hightow-Weidman, L. B., Fields, S. D., Hidalgo, J., Halpern-Felsher, B., Green-Jones, M. 2011; 25: S23-S29

  Abstract

  The average reported age of sexual debut for youth in the United States is 14.4 years, with approximately 7% reporting their sexual debut prior to age 13. While the research literature on sexual debut for youth addresses gender and ethnic differences (with males and African-American youth experiencing earlier sexual debut), there is limited data regarding factors associated with sexual debut for young men who have sex with men (YMSM). Early sexual debut poses potential health risks, such as contracting HIV with an increased risk of unprotected intercourse. Given current high HIV infection rates for racial/ethnic minority YMSM, learning more about their sexual debuts and associated risk factors of this population is of great importance. This study investigated risk behaviors and emotional distress, and their association with MSM sexual debut for a multisite cohort of racial/ethnic minority YMSM living with HIV. We hypothesized that a MSM sexual debut younger than age 16 would be associated with engagement in more high-risk sexual behaviors (unprotected sex and exchange sex), substance use, and emotional distress than a MSM sexual debut at age 16 or older. Results indicated that participants having a MSM sexual debut before the age of 16 reported more exchange sex; drug use (specifically marijuana); emotional/psychological problems related to substance use; and a history of suicide attempts, compared to participants with later MSM sexual debuts. Comprehensive interventions that are racially/ethnically sensitive, inquire about initial sexual experiences, and focus on sexual health and healthy relationships are needed to improve health outcomes for this population.

  View details for DOI 10.1089/apc.2011.9879

  View details for Web of Science ID 000293886700005

  View details for PubMedID 21711140

• Relationships and betrayal among young women: theoretical perspectives on adolescent dating abuse JOURNAL OF ADVANCED NURSING Burton, C. W., Halpern-Felsher, B., Rankin, S. H., Rehm, R. S., Humphreys, J. C. 2011; 67 (6): 1393-1405

  Abstract

  Adolescent dating abuse is not specifically described by any current nursing theory, and this article presents discussion of some existing theories that could inform a nursing theory of adolescent dating abuse. To account for the effects of gender, this discussion is limited to young women.Adolescent dating abuse is an important and understudied international issue for nursing. Theoretical frameworks can support development of nursing scholarship for such issues. No single theory yet exists in nursing to explain the experiences and health ramifications of dating abuse among young women.A summary table of theories is provided. Literature was gathered via database search and bibliographic snowballing from reference lists of relevant articles. Included literature dates from 1982 through 2010.Theories of relationship formation and function are discussed, including attachment, investment, feminist and gender role conflict theories. Betrayal trauma theory is considered as a mechanism of injury following an abusive dating experience.Gender, relationship and adolescence combine in a complex developmental moment for young women. To improve nursing care for those at risk for or in the throes of abusive relationships, it is critical to develop specific nursing approaches to understanding these relationships.Existing theories related to relationship and traumatic experiences can be combined in the development of a nursing theory of adolescent dating abuse among young women.

  View details for DOI 10.1111/j.1365-2648.2010.05565.x

  View details for Web of Science ID 000290398300022

  View details for PubMedID 21261691

• Transmitted HIV-1 Drug Resistance Among Young Men of Color Who Have Sex With Men: A Multicenter Cohort Analysis JOURNAL OF ADOLESCENT HEALTH Hightow-Weidman, L. B., Hurt, C. B., Phillips, G., Jones, K., Magnus, M., Giordano, T. P., Outlaw, A., Ramos, D., Enriquez-Bruce, E., Cobbs, W., Wohl, A., Tinsle, M. 2011; 48 (1): 94-99

  Abstract

  Given the elevated potential for primary or transmitted drug resistance (TDR) among newly HIV-infected individuals, there is a need for a deeper understanding of the baseline resistance patterns present in young men of color who have sex with men.Genotypic data were collected for participants aged 13-24 who were enrolled from seven sites. Univariate and bivariate methods were used to describe the prevalence of TDR and characteristics associated with TDR.Of the 296 individuals participating in the substudy, 145 (49%) had baseline genotypes. The majority of the individuals were African American (65%) and gay-identified (70%). There was significant variation in genotype availability by site (p < .001). Major surveillance drug resistance mutations were present in 28 subjects (19.3%); the majority were non-nucleoside reverse transcriptase inhibitor mutations (12.4%). Subjects with TDR were less likely to have used alcohol on 1 or more days in the prior 2 weeks. Location was not associated with acquisition of TDR.There was a high rate of TDR in a geographically and racially diverse sample of HIV-infected young men of color who have sex with men. This represents a serious public health concern given the young age of this sample and the potential need for long-term antiretroviral therapy. These findings underscore the critical roles of both early case identification and secondary prevention.

  View details for DOI 10.1016/j.jadohealth.2010.05.011

  View details for Web of Science ID 000285629200016

  View details for PubMedID 21185530

• Unpredicted Trajectories: The Relationship Between Race/Ethnicity, Pregnancy During Adolescence, and Young Women's Outcomes JOURNAL OF ADOLESCENT HEALTH Casares, W. N., Lahiff, M., Eskenazi, B., Halpern-Felsher, B. L. 2010; 47 (2): 143-150

  Abstract

  Adolescents who become pregnant in the United States are at higher risk for a myriad of health concerns. One would predict even more adverse health outcomes among pregnant adolescents who are from disadvantaged racial/ethnic groups; however, previous studies indirectly suggest the opposite. This study examines whether adolescents from racial/ethnic minority groups are less affected by adolescent pregnancy compared to white adolescents.We used data from 1,867 adolescents participating in the National Longitudinal Study of Adolescent Health (1995-2001). Our predictor variable was self-reported race/ethnicity. Self-perception of health, educational attainment, and public assistance use in young adulthood were outcome measures. We conducted weighted multivariate logistic regressions and analyzed how adolescent pregnancy modified the relationship between our predictor and outcome variables.Black and American Indian young women had significantly higher odds than white young women of receiving public assistance (OR, 2.6 and 2.7, respectively; p <.01) and even higher odds if ever pregnant in adolescence (OR, 4.2 and 19.0, respectively; p = .03). White young women had significantly lower odds of high educational attainment if they had a live birth in adolescence as compared to those who had not (OR, 0.1; CI = 0.1-0.4).These findings support studies that found adolescent pregnancy increases the risk of public assistance use and low educational attainment. The study shows that, for educational attainment, black young women who become pregnant may not be as disadvantaged as their peers, whereas white young women who become pregnant are more disadvantaged.

  View details for DOI 10.1016/j.jadohealth.2010.01.013

  View details for Web of Science ID 000280063400005

  View details for PubMedID 20638006

• Adolescents and Driving: A Position Paper of the Society for Adolescent Health and Medicine JOURNAL OF ADOLESCENT HEALTH D'Angelo, L. J., Halpern-Felsher, B. L., Abraham, A. 2010; 47 (2): 212-214

  Abstract

  Motor vehicle crashes continue to be the leading cause of mortality and severe morbidity among adolescents and young adults. All states have changed their drivers' licensure laws to make the process of obtaining a license more protracted and focused on the development of safe driving skills. Health care providers who counsel children and adolescents should actively address safe driving with them, and also involve their parents in this discussion. Additionally, they should also advocate for strict and uniform graduated licensure laws.

  View details for DOI 10.1016/j.jadohealth.2010.05.016

  View details for Web of Science ID 000280063400016

  View details for PubMedID 20638018

• Is adolescence-onset antisocial behavior developmentally normative? DEVELOPMENT AND PSYCHOPATHOLOGY Roisman, G. I., Monahan, K. C., Campbell, S. B., Steinberg, L., Cauffman, E. 2010; 22 (2): 295-311

  Abstract

  Largely because of the influence of Moffitt's useful distinction between adolescence-limited and life-course persistent antisocial behavior, it has become increasingly common to view problem behavior that makes its first appearance in adolescence as developmentally normative. This study prospectively examined the lives of individuals in the NICHD Study of Early Child Care and Youth Development whose patterns of antisocial behavior varied with respect to age of onset and stability from kindergarten through age 15. Consistent with past research, early-onset, persistently deviant youth experienced more contextual adversity and evinced higher levels of intraindividual disadvantages than their peers from infancy through midadolescence. However, relative to youth who never showed significantly elevated antisocial behavior through age 15, children who showed antisocial behavior primarily in adolescence also were more disadvantaged from infancy forward, as were youth who only demonstrated significant externalizing problems in childhood. Findings generally replicated across sex and did not vary as a function of whether antisocial behavior groups were defined using T-scores normed within sex or identified using an empirically driven grouping method applied to raw data.

  View details for DOI 10.1017/S0954579410000076

  View details for Web of Science ID 000277598000007

  View details for PubMedID 20423543

• Adolescents' perceived risk of dying. journal of adolescent health Fischhoff, B., Bruine de Bruin, W., Parker, A. M., Millstein, S. G., Halpern-Felsher, B. L. 2010; 46 (3): 265-269

  Abstract

  Although adolescents' expectations are accurate or moderately optimistic for many significant life events, they greatly overestimate their chances of dying soon. We examine here whether adolescents' mortality judgments are correlated with their perceptions of direct threats to their survival. Such sensitivity would indicate the importance of ensuring that adolescents have accurate information about those threats, as well as the psychological support needed to deal with them.Data from two separate studies were used: a national sample of 3,436 14-18-year-old adolescents and a regional sample of 124 seventh graders and 132 ninth graders, 12-16 years old. Participants were asked about their chance of dying in the next year and before age 20, and about the extent of various threats to their physical well-being.Adolescents in both samples greatly overestimated their chance of dying. Those mortality estimates were higher for adolescents who reported direct threats (e.g., an unsafe neighborhood). Thus, adolescents were sensitive to the relative size of threats to their survival, but not to the implications for absolute risk levels.Contrary to the folk wisdom that adolescents have a unique sense of invulnerability, the individuals studied here reported an exaggerated sense of mortality, which was highest among those reporting greater threats in their lives. Such fears could affect adolescents' short-term well-being and future planning.

  View details for DOI 10.1016/j.jadohealth.2009.06.026

  View details for PubMedID 20159504

• Adolescents' Perceived Risk of Dying JOURNAL OF ADOLESCENT HEALTH Fischhoff, B., de Bruin, W. B., Parker, A. M., Millstein, S. G., Halpern-Felsher, B. L. 2010; 46 (3): 265-269

  View details for DOI 10.1016/j.jadohealth.2009.06.026

  View details for Web of Science ID 000274572400011

• Predictors and sequelae of trajectories of physical aggression in school-age boys and girls DEVELOPMENT AND PSYCHOPATHOLOGY Campbell, S. B., Spieker, S., Vandergrift, N., Belsky, J., Burchinal, M. 2010; 22 (1): 133-150

  Abstract

  Teacher-rated trajectories of physical aggression in boys and girls from first through sixth grade were examined using data from the NICHD Study of Early Child Care and Youth Development. In separate analyses, four trajectories were identified in boys and three in girls. Higher levels of aggression in both boys and girls were related to greater sociodemographic risk and higher maternal harshness in the preschool years; lower levels of observed maternal sensitivity during early childhood also predicted higher trajectories of aggression among girls. Trajectory groups also differed on a range of social and academic adjustment outcomes in sixth grade, with the most aggressive children and even moderately aggressive children evidencing some difficulties in adjustment. Patterns and levels of aggression in boys and girls are discussed as are their predictors and consequences.

  View details for DOI 10.1017/S0954579409990319

  View details for Web of Science ID 000274470800010

  View details for PubMedID 20102652

• Longitudinal Development of Secondary Sexual Characteristics in Girls and Boys Between Ages 9 1/2 and 15 1/2 Years ARCHIVES OF PEDIATRICS & ADOLESCENT MEDICINE Susman, E. J., Houts, R. M., Steinberg, L., Belsky, J., Cauffman, E., DeHart, G., Friedman, S. L., Roisman, G. I., Halpern-Felsher, B. L. 2010; 164 (2): 166-173

  Abstract

  To identify ages when adolescents were in sexual maturity stages 2 through 5; to explain the relations between breast (girls), genital (boys), and pubic hair (girls and boys) development between ages 9(1/2) and 15(1/2) years; and to evaluate synchrony of pubertal development across characteristics.Annual pubertal assessments.Ten locations in the United States.A total of 859 adolescents (427 boys [49.7%] and 432 girls [50.3%]; 737 white [85.8%] and 122 black [14.2%]).Changes in the 5 stages of breast, genital, and pubic hair development.Girls were in breast maturity stages 2 and 3 earlier than comparable pubic hair stages. Although breast development in girls started earlier than pubic hair development, girls completed breast and pubic hair development at approximately the same age. Black girls were in all stages of breast and pubic hair development earlier than white girls. Boys were in stages 2, 3, 4, and 5 of genital development before the comparable pubic hair stage. In boys, genital development started earlier than pubic hair development, but pubic hair development was completed in less time. Black boys were in genital and pubic hair development about 7 months earlier than white boys. Black and white boys completed genital development in approximately 4(1/2) years, but black boys took approximately 6 months longer than white boys to complete pubic hair development. At stage 2, for 66.2% of girls, breast development preceded their pubic hair development; for 91.1% of boys, genital development preceded their pubic hair development.The results of this study are useful in understanding normative variation in the timing and change in the development of secondary sexual characteristics at puberty. They will help identify adolescents with atypical changes in sexual maturation and unusual progression of sexual maturation and growth disorders.

  View details for Web of Science ID 000274139500008

  View details for PubMedID 20124146

• The Development of Reproductive Strategy in Females: Early Maternal Harshness -> Earlier Menarche -> Increased Sexual Risk Taking DEVELOPMENTAL PSYCHOLOGY Belsky, J., Steinberg, L., Houts, R. M., Halpern-Felsher, B. L. 2010; 46 (1): 120-128

  Abstract

  To test a proposition central to J. Belsky, L. Steinberg, and P. Draper's (1991) evolutionary theory of socialization-that pubertal maturation plays a role in linking early rearing experience with adolescent sexual risk taking (i.e., frequency of sexual behavior) and, perhaps, other risk taking (e.g., alcohol, drugs, delinquency)-the authors subjected longitudinal data on 433 White, 62 Black, and 31 Hispanic females to path analysis. Results showed (a) that greater maternal harshness at 54 months predicted earlier age of menarche; (b) that earlier age of menarche predicted greater sexual (but not other) risk taking; and (c) that maternal harshness exerted a significant indirect effect, via earlier menarche, on sexual risk taking (i.e., greater harshness --> earlier menarche --> greater sexual risk taking) but only a direct effect on other risk taking. Results are discussed in terms of evolutionary perspectives on human development and reproductive strategy, and future directions for research are outlined.

  View details for DOI 10.1037/a0015549

  View details for Web of Science ID 000273503400010

  View details for PubMedID 20053011

• The Developmental Significance of Adolescent Romantic Relationships: Parent and Peer Predictors of Engagement and Quality at Age 15 JOURNAL OF YOUTH AND ADOLESCENCE Roisman, G. I., Booth-LaForce, C., Cauffman, E., Spieker, S. 2009; 38 (10): 1294-1303

  Abstract

  From a longitudinal sample (n = 957; 49.9% male; 77.3% White/non-Hispanic) of participants studied from infancy through age 15, adolescents' depth of engagement in, and quality of romantic relationships were predicted from early and contemporaneous parent-child interactive quality and peer social competence. High quality maternal parenting and peer experiences prior to and during adolescence tended to be negatively associated with the depth of engagement in this domain for the full sample, yet positively associated with the quality of adolescents' romantic relationships for the sub-set of individuals currently dating at age 15. Results reconcile contrasting views of the origins of romantic relationship engagement and quality and the positive versus negative developmental salience of romantic relationships in adolescence.

  View details for DOI 10.1007/s10964-008-9378-4

  View details for Web of Science ID 000270180200003

  View details for PubMedID 19779806

• Early Family and Child-Care Antecedents of Awakening Cortisol Levels in Adolescence CHILD DEVELOPMENT Roisman, G. I., Susman, E., Barnett-Walker, K., Booth-LaForce, C., Owen, M. T., Belsky, J., Bradley, R. H., Houts, R., Steinberg, L. 2009; 80 (3): 907-920

  Abstract

  This study examined early observed parenting and child-care experiences in relation to functioning of the hypothalamic-pituitary-adrenocortical axis over the long term. Consistent with the attenuation hypothesis, individuals (n = 863) who experienced: (a) higher levels of maternal insensitivity and (b) more time in child-care centers in the first 3 years of life had lower awakening cortisol levels at age 15. Associations were small in magnitude. Nonetheless, results were (a) additive in that both higher levels of maternal insensitivity and more experience with center-based care uniquely (but not interactively) predicted lower awakening cortisol, (b) not accounted for by later caregiving experiences measured concurrently with awakening cortisol at age 15 or by early demographic variables, and (c) not moderated by sex or by difficult temperament.

  View details for DOI 10.1111/j.1467-8624.2009.01305.x

  View details for Web of Science ID 000266110400020

  View details for PubMedID 19489911

• Adolescent drivers - A developmental perspective on risk, proficiency, and safety Workshop on Preventing Teen Motor Crashes - Contributions form the Behavioral and Social Science Keating, D. P., Halpern-Felsher, B. L. ELSEVIER SCIENCE INC. 2008: S272–S277

  Abstract

  Despite considerable improvement in the rates of crashes, injuries, and fatalities among adolescent drivers, attributable in part to effective interventions such as graduated driver licensing, these rates and their associated health risks remain unacceptably high. To understand the sources of risky driving among teens, as well as to identify potential avenues for further advances in prevention, this article presents a review of the relevant features of contemporary research on adolescent development. Current research offers significant advances in the understanding of the sources of safe driving, proficient driving, and risky driving among adolescents. This multifaceted perspective--as opposed to simple categorization of good versus bad driving--provides new opportunities for using insights on adolescent development to enhance prevention. Drawing on recent work on adolescent physical, neural, and cognitive development, we argue for approaches to prevention that recognize both the strengths and the limitations of adolescent drivers, with particular attention to the acquisition of expertise, regulatory competence, and self-regulation in the context of perceived risk. This understanding of adolescent development spotlights the provision of appropriate and effective scaffolding, utilizing the contexts of importance to adolescents--parents, peers, and the broader culture of driving--to support safe driving and to manage the inherent risks in learning to do so.

  View details for DOI 10.1016/j.amepre.2008.06.026

  View details for Web of Science ID 000258740000004

  View details for PubMedID 18702981

• From the exam room to behind the wheel - Can healthcare providers affect automobile morbidity and mortality in teens? Workshop on Preventing Teen Motor Crashes - Contributions form the Behavioral and Social Science D'Angelo, L. J., Halpern-Felsher, B. L. ELSEVIER SCIENCE INC. 2008: S304–S309

  Abstract

  Despite clear evidence that motor-vehicle crashes are the leading cause of mortality and severe morbidity among adolescents and young adults, healthcare providers have not been fully engaged in efforts to reduce these rates. A new national awareness and effort to reduce motor-vehicle crashes provides an opportunity to engage healthcare providers and encourage them to play an active role in curbing crash rates. Indeed, research supports the notion that, when provided with adequate knowledge, training, and charting tools or electronic prompts, healthcare providers can increase their rates of screening, educating, and counseling youth and their parents about safe driving and that these efforts can be effective at increasing safety and reducing risk. Healthcare providers' efforts to advocate for safer driving laws and regulations are also important efforts in reducing youth driving risk.

  View details for DOI 10.1016/j.amepre.2008.06.014

  View details for Web of Science ID 000258740000009

  View details for PubMedID 18702986

• Family rearing antecedents of pubertal timing CHILD DEVELOPMENT Belsky, J., Steinberg, L. D., Houts, R. M., Friedman, S. L., DeHart, G., Cauffman, E., Roisman, G. I., Halpern-Felsher, B. L., Susman, E. 2007; 78 (4): 1302-1321

  Abstract

  Two general evolutionary hypotheses were tested on 756 White children (397 girls) studied longitudinally: (1) rearing experiences would predict pubertal timing; and (2) children would prove differentially susceptible to rearing. Analysis of pubertal measurements, including some based on repeated physical assessments, showed that mothering and fathering, earlier and later in childhood, predicted pubertal development, but only for girls, with negative parenting appearing most influential; maternal harsh control predicted earlier menarche. Rearing effects varied by infant negative emotionality, proving stronger (and opposite) for girls who in infancy were lower rather than higher in negativity. Maternal menarche, controlled in all analyses, was a stronger predictor than rearing. Findings are discussed in terms of theory development, genetic and nutritional influences, and sample restrictions.

  View details for Web of Science ID 000248524600017

  View details for PubMedID 17650140

• Adolescents' beliefs about preferred resources for help vary depending on the health issue JOURNAL OF ADOLESCENT HEALTH Marcell, A. V., Halpern-Felsher, B. L. 2007; 41 (1): 61-68

  Abstract

  Adolescents' health care use is less than ideal, especially for more sensitive services. We know little about adolescents' preferred resources for help for health-related issues, and whether these resources vary by problem type. This study examined whether adolescents' preferred resources for help differed depending on the health issue studied.Two hundred ten high school students (54% females; 76.6% participation rate) completed a self-administered survey of four separate age- and gender-specific health case scenarios: an adolescent who has symptoms of pneumonia; smokes five cigarettes daily; plans to initiate sex; and has symptoms of depression. For each health scenario, participants rated the importance of getting help in general, how important it was to get help from specific resources (friends/siblings; significant adults; health care professionals; and mental health professionals), and highest rankings of specific resources.Most adolescents believed it somewhat or very important to get help in general for all scenarios (94% pneumonia; 81% cigarette; 88% depression) except the sex scenario (27%). Repeated measures analysis of variance revealed significant differences in participants' beliefs in the importance of getting help from each specific resource across the four scenarios (all p < .001). Participants' top ranked resources included a doctor (55%) and parents (40%) for the pneumonia scenario; a friend (31%), parents (20%), and doctor (20%) for the cigarette scenario; a partner (38%) and friend (35%) for the sex scenario; and a partner (33%), psychologist (23%), and friend (20%) for the depression scenario. Beliefs in the importance of getting help from specific resources also varied by age, gender, and beliefs in importance of getting help in general.Adolescents' preferred resources for help differ depending on the health issue in question, with adolescents preferring informal resources (friends and partners) and significant adults (parents) to go to for help for nonphysical health-related issues and physicians for physical health-related issues. Future preventive service efforts and research should also consider the importance of age and gender when examining adolescents' preferred resources for help.

  View details for DOI 10.1016/j.jadohealth.2007.02.006

  View details for Web of Science ID 000247616200009

  View details for PubMedID 17577535

• Clinician practices for the management of amenorrhea in the adolescent and young adult athlete JOURNAL OF ADOLESCENT HEALTH Carlson, J. L., Curtis, M., Halpern-Felsher, B. 2007; 40 (4): 362-365

  Abstract

  This study sought to describe clinician practices for the management of amenorrhea in the adolescent and young adult athlete. Clinicians adhered to certain guidelines but did not have a uniform "standard of care" for amenorrheic athletes. Almost 80% of clinicians reported insufficient guidelines for the management of this population.

  View details for DOI 10.1016/j.jadohealth.2006.10.017

  View details for Web of Science ID 000245567900011

  View details for PubMedID 17367734

• Having sex and condom use: Potential risks and benefits reported by young, sexually inexperienced adolescents JOURNAL OF ADOLESCENT HEALTH Widdice, L. E., Cornell, J. L., Liang, W., Halpern-Felsher, B. L. 2006; 39 (4): 588-595

  Abstract

  This study determines what young adolescents themselves identify as the potential positive and negative outcomes of having sex, using a condom and not using a condom.Using written surveys, 418 ethnically diverse ninth graders, 86% of whom had never had sex, responded to a scenario describing two adolescents who had sex. One randomly selected group read a scenario in which a condom was used; the other group read a scenario in which no condom was used. All participants were asked to list the risks and benefits of having sex. Depending on the scenario read, participants were asked to list the risks and benefits of either using or not using a condom. Responses were coded thematically. Percentages of responses were compared with chi-square analysis in total and by gender.Participants spontaneously identified a broad range of health and psychosocial risks and benefits of having sex, using a condom and not using a condom. A strong aversion to pregnancy was evident, and the risks of sexually transmitted disease/human immunodeficiency virus (STD/HIV) and condom malfunction were commonly mentioned. Benefits of using a condom included pregnancy and STD prevention. Benefits of both having sex and of not using a condom included improving the relationship, fun, and pleasure. Gender differences emerged across questions.Communication with adolescents regarding safe sexual activity could benefit from widening the communication from a focus on health risks to include discussion of the psychosocial risks and benefits that adolescents themselves think about with respect to sex and condom use.

  View details for DOI 10.1016/j.jadohealth.2006.03.016

  View details for Web of Science ID 000240966400019

  View details for PubMedID 16982395

• Greater expectations: Adolescents' positive motivations for sex PERSPECTIVES ON SEXUAL AND REPRODUCTIVE HEALTH Ott, M. A., Millstein, S. G., Ofner, S., Halpern-Felsher, B. L. 2006; 38 (2): 84-89

  Abstract

  Effective STD and pregnancy prevention efforts should benefit from knowledge of what motivates adolescents to have sex. Positive motivations, and how they differ by gender and sexual experience, are poorly understood.A sample of 637 ninth graders were asked about their relationship goals, expectations of the degree to which sex would satisfy these goals and sexual experience. Three scales measured adolescents' goals for intimacy, sexual pleasure and social status within a romantic relationship. Another three scales measured expectations that sex would lead to these goals. Data were examined in analyses of variance and mixed models.Participants valued intimacy the most, then social status and, finally, sexual pleasure. These relationship goals differed significantly by gender and sexual experience. Females valued intimacy significantly more and sexual pleasure less than males. Sexually experienced adolescents valued both intimacy and pleasure more than sexually inexperienced adolescents. Among females, but not males, sexually experienced adolescents valued the goal of social status less than those with no sexual experience did. Adolescents expected that sex would most likely lead to sexual pleasure, then intimacy and, finally, social status. Females and sexually inexperienced adolescents reported lower expectations that sex would meet goals than did males and sexually experienced participants.Adolescents view intimacy, sexual pleasure and social status as important goals in a relationship. Many have strong positive expectations that sex would satisfy these goals. Prevention programs and providers should address the risks of sex in the context of expected benefits.

  View details for Web of Science ID 000238005900004

  View details for PubMedID 16772189

• Preventing underage alcohol use: Where do we go from here? JOURNAL OF ADOLESCENT HEALTH Halpern-Felsher, B. L., Cornell, J. L. 2005; 37 (1): 1-3

  View details for DOI 10.1016/j.jadohealth.2005.04.010

  View details for Web of Science ID 000230047100001

  View details for PubMedID 15963895

• Clear the air: adolescents' perceptions of the risks associated with secondhand smoke PREVENTIVE MEDICINE Halpern-Felsher, B. L., Rubinstein, M. L. 2005; 41 (1): 16-22

  Abstract

  Despite numerous studies on adolescents' recognition of the medical risks of primary smoke, there have been surprisingly few investigations of how adolescents perceive the risks associated with exposure to secondhand smoke. This study examined whether adolescents' risk estimates when exposed to secondhand smoke differed by: (1) actual smoking experience and (2) adolescents' intentions to smoke in the near future. We also explored whether adolescents perceive different risk depending on who is producing the secondhand smoke.Three hundred and ninety-five 9th graders (mean age = 14.0) completed a survey concerning their perceptions of secondhand smoke, smoking experiences, and intentions.On average, adolescents were aware of the serious risks posed by exposure to secondhand smoke. However, adolescents who smoke or intend to smoke were more likely to perceive the risks from exposure to secondhand smoke as lower than did adolescents who had never smoked or had no intentions to smoke.The findings from this study suggest that education regarding the risks of secondhand smoke might serve as an additional deterrent against smoking and smoking intentions. Further study using longitudinal data is still needed to fully understand the relationship between such perceptions and smoking behavior.

  View details for DOI 10.1016/j.ypmed.2004.11.002

  View details for Web of Science ID 000229651800003

  View details for PubMedID 15916988

• Adolescents' health beliefs are critical in their intentions to seek physician care PREVENTIVE MEDICINE Marcell, A. V., Halpern-Felsher, B. L. 2005; 41 (1): 118-125

  Abstract

  The examination of predictors of adolescents' intentions to use health care for different types of health issues has received little attention. This study examined adolescents' health beliefs and how they relate to intentions to seek physician care across different types of health problems.Two hundred ten high school students (54% females; 76.6% participation rate) completed a self-administered survey of four separate age- and gender-specific health case scenarios: an adolescent who has symptoms of pneumonia; smokes five cigarettes daily; plans to initiate sex; and has symptoms of depression. For each health scenario, participants rated the seriousness of the health problem, physician effectiveness, and intentions to seek physician care.Most adolescents believed all health problems were serious except for planning to initiate sex (P < 0.001). Adolescents believed that physicians were most effective in diagnosis and treatment for pneumonia, followed by cigarette use, depression, and sex, respectively (P's < 0.001). Adolescents' intentions to seek physician care were greatest for physical as compared to risk behavior or mental health problems (P < 0.001). Multiple regression analyses revealed that adolescents had greater intentions to seek physician care for cigarette, sex, and depression when they believed physicians were effective and they perceived these as health problems after controlling for age and gender (all P's < 0.001). Health beliefs explained 12% to 49% of the variance in intentions to seek care (all P's < 0.001).Adolescents' health beliefs are important when understanding intentions to seek physician care. Health care use may be improved by increasing adolescents' beliefs that physicians are effective in areas other than physical health, including risk behaviors and mental health.

  View details for DOI 10.1016/j.ypmed.2004.10.016

  View details for Web of Science ID 000229651800017

  View details for PubMedID 15917002

• Initiating sexual experiences: How do young adolescents make decisions regarding early sexual activity? JOURNAL OF RESEARCH ON ADOLESCENCE Michels, T. M., Kropp, R. Y., Eyre, S. L., Halpern-Felsher, B. L. 2005; 15 (4): 583-607

  View details for Web of Science ID 000233518500013

• Adolescents' self-efficacy to communicate about sex: Its role in condom attitudes, commitment, and use ADOLESCENCE Halpern-Felsher, B. L., Kropp, R. Y., Boyer, C. B., Tschann, J. M., Ellen, J. M. 2004; 39 (155): 443-456

  Abstract

  This study examined whether and how self-efficacy to communicate with parents and peers about sex relate to sexually experienced adolescent males' and females' (N= 144, 112) condom attitudes, intentions, and use. Results showed that males who reported greater self-efficacy to communicate with parents used condoms more frequently; and both males and females who can communicate with peers used condoms more frequently. Self-efficacy to communicate with peers was related to more positive condom attitudes, which in turn were associated with greater condom commitment and use. Greater ability to communicate with parents was also related to greater condom commitment and use among males. These results suggest the importance of designing interventions that give adolescents the skills they need to feel efficacious in their ability to communicate about sex and contraception.

  View details for Web of Science ID 000225951000003

  View details for PubMedID 15673222

• An evaluation of the use of the transdermal contraceptive patch in adolescents JOURNAL OF ADOLESCENT HEALTH Rubinstein, M. L., Halpern-Felsher, B. L., IRWIN, C. E. 2004; 34 (5): 395-401

  Abstract

  To evaluate the acceptability and feasibility of using the new transdermal contraceptive patch in adolescents.A 3-month longitudinal trial using the Ortho Evra transdermal contraceptive patch in 50 adolescent girls. All healthy girls aged 15-18 years were invited to participate from two San Francisco Bay Area teen clinics. Participants were followed after 1 month and 3 months of treatment. Data were collected on patch detachments, perceived advantages and disadvantages, side effects, and compliance. Data were analyzed using Student's t-test (SPSS).Forty participants (80%) completed 1 month of treatment and 31 (62%) completed all 3 months of the study. There were no pregnancies during treatment. At the 3-month follow-up, 87.1% of participants reported perfect compliance. Ease of use, the fact that it does not require daily attention, and the ease of concealment were among the main reported advantages. Roughly 77% of participants who completed the study were planning to continue using the patch. The 35.5% rate of complete or partial detachment of at least one patch was considerably higher than reported in previous studies of adults. As in adults, the most commonly reported complaints were application site reactions and breast discomfort.This evaluation found an overall positive impression of the new transdermal contraceptive patch, with good rates of short-term compliance and few side effects among adolescents. However, the high degree of detachment unique to this sample of adolescents is concerning and requires further evaluation.

  View details for DOI 10.1016/j.jadohealth.2003.08.017

  View details for Web of Science ID 000227099100007

  View details for PubMedID 15093794

• Adolescents discriminate between types of smokers and related risks: Evidence from nonsmokers JOURNAL OF ADOLESCENT RESEARCH Rubinstein, M. L., Halpern-Felsher, B. L., Thompson, P. J., MILLSTEIN, S. G. 2003; 18 (6): 651-663

  View details for DOI 10.1177/0743558403254782

  View details for Web of Science ID 000185777100004

• Differences in altruistic roles and HIV risk perception among staff, peer educators, and students in an adolescent peer education program Annual Meeting of the Pediatric-Academic-Societies Ott, M. A., Evans, N. L., Halpern-Felsher, B. L., Eyre, S. L. GUILFORD PUBLICATIONS INC. 2003: 159–71

  Abstract

  This qualitative study examines how adolescent peer educators understand and communicate HIV prevention messages. Semistructured ethnographic interviews were conducted with 21 program participants, including staff, peer educators, and students. Interviews were transcribed and analyzed using concept analysis, a method for identifying shared concepts among interview subjects. We found (a) similar beliefs about HIV transmission and risk reduction across groups; (b) different, but strong, altruistic roles among staff and peer educators; and (c) differences in HIV risk perception across the three groups. Altruistic roles took two forms. Staff acted as life skills mentors, whereas peer educators acted as HIV educators. Students were more passive, receiving counseling but not passing it on to others. Staff contextualized HIV risk, whereas peer educators and students emphasized risk. Although similar HIV knowledge across groups suggests program efficacy, stronger altruistic roles or contextualization of HIV risk may affect how prevention messages are delivered.

  View details for Web of Science ID 000182524000005

  View details for PubMedID 12739792

• Work group II: Healthy adolescent psychosocial development 2nd Conference on Health Futures of Youth Halpern-Felsher, B. L., MILLSTEIN, S. G., IRWIN, C. E. ELSEVIER SCIENCE INC. 2002: 201–7

  View details for Web of Science ID 000179724900010

  View details for PubMedID 12470916

• Beyond invulnerability: The importance of benefits in adolescents' decision to drink alcohol HEALTH PSYCHOLOGY Goldberg, J. H., Halpern-Felsher, B. L., MILLSTEIN, S. G. 2002; 21 (5): 477-484

  Abstract

  Some investigators propose that adolescents engage in risky behaviors mainly because they perceive themselves to be invulnerable to risk. However, studies have typically not included perceived benefits. In the current study, 5th, 7th, and 9th graders were surveyed about their perceptions of and experience with alcohol and tobacco. Results indicated that perceptions of the benefits were significantly related to drinking and smoking 6 months later, over and above perceptions of the risks, age of the respondent, and experience level. Further, the importance of benefits was replicated across 3 separate analyses. Experience with alcohol alone, especially positive experience, was also related to perception and behavior. These findings are discussed in terms of how to improve messages and influence adolescents' decisions regarding risk-taking behaviors.

  View details for DOI 10.1037//0278-6133.21.5.477

  View details for Web of Science ID 000177618900009

  View details for PubMedID 12211515

• Developmental sources of crash risk in young drivers - Discussion paper INJURY PREVENTION IRWIN, C. E., Halpern-Felsher, B. L. 2002; 8: 21-23

  View details for Web of Science ID 000181596800007

• Perceptions of risk and vulnerability Workshop on Adolescent Risk and Vulnerability MILLSTEIN, S. G., Halpern-Felsher, B. L. ELSEVIER SCIENCE INC. 2002: 10–27

  View details for Web of Science ID 000176699500003

  View details for PubMedID 12093608

• The effects of terrorism on teens' perceptions of dying: The new world is riskier than ever JOURNAL OF ADOLESCENT HEALTH Halpern-Felsher, B. L., MILLSTEIN, S. G. 2002; 30 (5): 308-311

  Abstract

  Adolescents assessed after the September 11, 2001 terrorist attacks perceived the risk of dying from general causes, a tornado, and an earthquake as dramatically higher than did adolescents assessed years before the attacks. Adolescents' heightened perceptions of vulnerability to death extended beyond the terrorist acts, and generalized to unrelated risks.

  View details for Web of Science ID 000175406700004

  View details for PubMedID 11996779

• Physicians' attitudes and beliefs concerning alcohol abuse prevention in adolescents AMERICAN JOURNAL OF PREVENTIVE MEDICINE Marcell, A. V., Halpern-Felsher, B., Coriell, M., MILLSTEIN, S. G. 2002; 22 (1): 49-55

  Abstract

  Primary alcohol abuse-prevention services delivered to adolescents are inadequate, despite the fact that alcohol abuse is a major health problem. Physicians' attitudes and beliefs regarding primary prevention of adolescent alcohol abuse and appropriate onset ages of alcohol use may be useful in understanding why delivery of prevention services is inadequate, but as yet has not been investigated.To examine (1) physicians' attitudes and beliefs regarding alcohol abuse prevention and practice, and (2) correlates of these attitudes and beliefs, including the delivery of primary alcohol abuse-prevention services to adolescents.A national, stratified random sample of pediatricians and family practitioners was drawn from the American Medical Association's Masterfile Registry. Inclusion criteria included active medical practice and seeing at least one adolescent per week. The response rate was 63%, resulting in a final sample of 1842 physicians. Participants were queried about their practice, alcohol use, attitudes and beliefs, and delivery of alcohol-related screening and education to adolescents.On average, physicians reported providing alcohol-related screening to 40.3% (standard error [SE]=0.6) and education to 52.0% (SE=0.8) of their adolescent patients. Participants had positive attitudes toward adolescents, believed that prevention was important, and approved of alcohol screening early in adolescence, but did not feel very comfortable about their adolescent alcohol-management skills. Except for ceremonial use, most physicians did not believe in underage drinking. Attitudes and beliefs were significantly related to the delivery of alcohol screening (R(2)=0.34, p < 0.001) and education (R(2)=0.18, p < 0.001). Participants who delivered more screening and education had more positive beliefs in the importance of prevention (beta=0.14 and beta=0.13, respectively; p < 0.001); approved of early alcohol screening (beta=0.29 and beta=0.09, respectively; p < 0.001); and were more comfortable with their alcohol management skills (beta=0.31 and beta=0.28, respectively; p < 0.001). A profile of physicians with positive attitudes and beliefs is presented.Physician attitudes and beliefs are associated with variations in alcohol screening and education services delivered to adolescents. A better understanding of physicians' attitudes and beliefs can be useful in providing physician education and training aimed at improving primary alcohol-abuse prevention.

  View details for Web of Science ID 000174222500008

  View details for PubMedID 11777679

• Judgments about risk and perceived invulnerability in adolescents and young adults JOURNAL OF RESEARCH ON ADOLESCENCE Millstein, S. G., Halpern-Felsher, B. L. 2002; 12 (4): 399-422

  View details for Web of Science ID 000179772000001

• Adolescents' and adults' understanding of probability expressions JOURNAL OF ADOLESCENT HEALTH Biehl, M., Halpern-Felsher, B. L. 2001; 28 (1): 30-35

  Abstract

  To examine whether there are differences between adolescents and adults in their interpretation of probability terms.Participants were 20 fifth graders, 54 seventh graders, 45 ninth graders, and 34 young adults (mean adult age = 26.24 years, standard deviation = 2.09) from the San Francisco Bay area. They completed a self-administered survey asking them to assign percentage estimates (0% to 100%) to 30 randomly ordered probability terms.Significant age differences in the mean percentage estimates for 8 of the 30 terms were shown. Moreover, we found large variation in the interpretation of most probability terms studied, with larger variation among the adolescents than adults. Finally, all age groups had some difficulty correctly differentiating between "possibly" and "probably".Owing to wide variation in the interpretation of probability terms, both within and across age groups, we suggest health practitioners use percentages rather than probability terms to convey risk to both adolescents and adults.

  View details for Web of Science ID 000166152200006

  View details for PubMedID 11137903

• Verbal and numerical expressions of probability: "It's a fifty-fifty chance" ORGANIZATIONAL BEHAVIOR AND HUMAN DECISION PROCESSES de Bruin, W. B., Fischhoff, B., MILLSTEIN, S. G., Halpern-Felsher, B. L. 2000; 81 (1): 115-131

  Abstract

  When estimating risks, people may use "50" as an expression of the verbal phrase "fifty-fifty chance," without intending the associated number of 50%. The result is an excess of 50s in the response distribution. The present study examined factors determining the magnitude of such a "50 blip," using a large sample of adolescents and adults. We found that phrasing probability questions in a distributional format (asking about risks as a percentage in a population) rather than in a singular format (asking about risks to an individual) reduced the use of "50." Less numerate respondents, children, and less educated adults were more likely to say "50." Finally, events that evoked feelings of less perceived control led to more 50s. The results are discussed in terms of what they reveal about how people express epistemic uncertainty. Copyright 2000 Academic Press.

  View details for Web of Science ID 000084791400006

• Influence of physician confidentiality assurances on adolescents' willingness to disclose information and seek future health care - A randomized controlled trial JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION Ford, C. A., MILLSTEIN, S. G., HALPERNFELSHER, B. L., IRWIN, C. E. 1997; 278 (12): 1029-1034

  Abstract

  Adolescents' concerns about privacy in clinical settings decrease their willingness to seek health care for sensitive problems and may inhibit their communication with physicians.To investigate the influence of physicians' assurances of confidentiality on adolescents' willingness to disclose information and seek future health care.Randomized controlled trial.Three suburban public high schools in California.The 562 participating adolescents represented 92% of students in mandatory classes.After random assignment to 1 of 3 groups, the adolescents listened to a standardized audiotape depiction of an office visit during which they heard a physician who assured unconditional confidentiality, a physician who assured conditional confidentiality, or a physician who did not mention confidentiality.Adolescents' willingness to disclose general information, willingness to disclose information about sensitive topics, intended honesty, and likelihood of return visits to the physician depicted in the scenario were assessed by anonymous written questionnaire.Assurances of confidentiality increased the number of adolescents willing to disclose sensitive information about sexuality, substance use, and mental health from 39% (68/175) to 46.5% (178/383) (beta=.10, P=.02) and increased the number willing to seek future health care from 53% (93/175) to 67% (259/386) (beta=.17, P<.001). When comparing the unconditional with the conditional groups, assurances of unconditional confidentiality increased the number of adolescents willing to return for a future visit by 10 percentage points, from 62% (122/196) to 72% (137/190) (beta=.14, P=.001).Adolescents are more willing to communicate with and seek health care from physicians who assure confidentiality. Further investigation is needed to identify a confidentiality assurance statement that explains the legal and ethical limitations of confidentiality without decreasing adolescents' likelihood of seeking future health care for routine and nonreportable sensitive health concerns.

  View details for Web of Science ID A1997XX01200040

  View details for PubMedID 9307357

• Relationship of alcohol use and risky sexual behavior: A review and analysis of findings JOURNAL OF ADOLESCENT HEALTH HALPERNFELSHER, B. L., MILLSTEIN, S. G., Ellen, J. M. 1996; 19 (5): 331-336

  Abstract

  In this review article, three methodologic approaches that have been used to examine the association between adolescents' alcohol use and their involvement in risky sex are discussed: global correlation studies, situational covariation studies, and event analyses. The strengths and limitations of each of these research methods are discussed. An extensive review of the most rigorous studies, which used event analysis to examine the alcohol-risky sex link, reveals positive results for first-time sexual events but equivocal findings for other types of sexual relationships. It is argued that differences in the types of sexual relationships studied have been confounded, limiting our ability to evaluate the extent to which alcohol has a causal influence on adolescents' condom use. It is suggested that future investigations consider the nature of the sexual relationship, and go beyond studying the length or status of the relationship to explore how variation in relationship dimensions such as trust and intimacy affect adolescents' sexual behavior.

  View details for Web of Science ID A1996VU57800004

  View details for PubMedID 8934293

• LANGUAGE PREFERENCE AND COMMUNICATION DEVELOPMENT OF A HEARING AND DEAF TWIN PAIR AMERICAN ANNALS OF THE DEAF Gaines, R., HALPERNFELSHER, B. L. 1995; 140 (1): 47-55

  Abstract

  This observational study examined the development and use of communication in a pair of deaf and hearing monozygotic twins from 13 months of age until 36 months of age. One twin contracted meningitis at 7 months, leaving her profoundly deaf but without other measurable sequelae. The other twin is normal in all respects. The prelingual twins were enrolled in a total communication preschool program where, with their parents, they participated in activities designed to enhance the language skills of deaf children. The twins were videotaped monthly, first at their preschool program and later at home. All forms of communication were recorded, including signs, vocalizations, and hand and body gestures. Additionally, eye gaze direction and body positions during communication were noted. Comparisons between the deaf and hearing twins showed that although both children were able to learn language and communicate successfully, the hearing twin preferred a vocal form of language, whereas the deaf twin used mostly sign language. Moreover, the hearing twin's communication was usually responsive, while the deaf twin's communication was comprised mostly of imitative signs and gestures. Methods of teaching a profoundly deaf child to communicate are discussed.

  View details for Web of Science ID A1995QV27800012

  View details for PubMedID 7778519

• HANGING IN THERE - BEHAVIORAL, PSYCHOLOGICAL, AND CONTEXTUAL FACTORS AFFECTING WHETHER AFRICAN-AMERICAN ADOLESCENTS STAY IN HIGH-SCHOOL JOURNAL OF ADOLESCENT RESEARCH CONNELL, J. P., HALPERNFELSHER, B. L., Clifford, E., CRICHLOW, W., USINGER, P. 1995; 10 (1): 41-63

  View details for Web of Science ID A1995QY47600003