The Contracting World of Cutter’s Expansive Classification

Exposure and response to current text-only smokeless tobacco health warnings among smokeless tobacco users aged ≥ 18 years, United States, 2012–2013

Nicotine warning labels on e-cigarette products can inform potential consumers that using e-cigarettes can cause addiction. This study examined awareness of the omnipresence of nicotine in the JUUL e-cigarette through a cross-sectional online survey of 4860 adolescents (13–17 years), 3746 young adults (18–24 years) and 5000 older adults (25–99 years) in the United States. Analyses also examined variation in nicotine awareness as a function of age, ownership, and past 30-day frequency of JUUL use. Results indicated fewer than half of JUUL ever-users and fewer than half of past 30-day JUUL users were aware that JUUL e-cigarettes always contain nicotine. Among JUUL ever-users, awareness of the omnipresence of nicotine in JUUL e-cigarettes was significantly lower among adolescents and those who did not personally own a JUUL. Among past 30-day JUUL users, awareness of the omnipresence of nicotine was significantly lower among adolescents and infrequent users (i.e. used on 1–19 of the past 30 days). Results suggest many users of a JUUL, especially youth, non-owners and infrequent users, may be underestimating their risk of becoming addicted to JUUL products, or overestimating their ability to stop using JUUL products whenever they choose. Reasons for low awareness and methods for increasing public awareness of the omnipresence of nicotine in JUUL products are proposed.

The intrauterine device (IUD) is recognized as an effective, economical, and safe method of reversible contraception. It is the second most commonly used contraceptive method in the United States. Early 19th-century designs made of pewter and platinum have been replaced by plastic devices that may be medicated and may contain copper or hormones. Their effectiveness is apparently related to disturbance in endometrial function, implantation, or both. Although the physical forms vary, all such devices currently have a monofilamentous synthetic "tail" with which the IUD may communicate with the external environment. Additionally, the device may alter the intrauterine milieu, thus making it more conducive for the growth of certain microorganisms. <i>Actinomyces</i>belong to the family of higher bacteria and are susceptible to antibiotics. These anaerobes have been observed in the vaginal smears of current or immediate past users (within six to eight weeks) of IUDs (R. T. Burkman, MD, and colleagues,

Introduction: Proton Pump Inhibitors (PPI) are one of the most prescribed medications in the United States, but their use is associated with risk of infection due to disruption in gut flora. This has led many to question the relationship between COVID-19 and PPI use as the virus has been shown to be transmitted through both the respiratory and gastrointestinal tract. Our aim is to investigate the correlation between PPI use and COVID-19 severity. Methods: We conducted a retrospective chart review to identify patients within our network who tested positive for SARS-CoV-2 with RT-PCR testing from March to August 2020. Patients were subdivided into groups: active, past, or no PPI use. Active users included patients prescribed PPIs within the last 30 days prior to admission. Past users included those with a history of use within the last 31 to 365 days. No PPI use included all additional patients. The strength of PPI dosing, demographic and clinical variables, comorbid conditions, and critical care outcomes were also recorded. Direct multivariable logistic regression models were created to determine primary outcomes and chi square and Kruskal Wallis tests were used in analysis of secondary outcomes. Results: 2,594 patients met inclusion criteria (Active use, n=448 (17.3%); past use n=98 (3.8%); no use, n=2,048 (78.9%)). Majority were female (50.5%) and White (57.7%) and the mean age was 52.6 years with mean BMI of 30.7. mg/m2. Subgroup analysis showed that active and past PPI users had significantly higher rates of comorbid conditions. PPI use was not associated with increased hospital admission or 30-day mortality in the regression model; however, age, male gender, diabetes, COPD, cardiovascular disease, kidney disease, and obesity were independently and significantly associated. Active PPI users had higher median length of hospital stay (p=0.02) and a higher percentage of ICU admissions (P = 0.03). No secondary outcomes for active PPI users based on PPI dosage were statistically significant. Conclusion: Our results show that neither active nor past PPI use predict need for hospital admission or 30-day mortality. Admitted patients with active PPI use had higher median length of stay but higher frequency of comorbid conditions. Our data suggests descalation and discontinuation of PPI therapy when appropriate although no association was seen in our study. Ultimately in order to substantiate findings, more clinical data is necessary to determine the association between PPI use and COVID-19 susceptibility.Table 1.: Unadjusted Comparisons for Hospital Admission within Two Weeks of COVID Testing and for Overall 30-Day Mortality * Denominators differ for some variables due to missing data. ** PPI: proton pump inhibitor; SD: standard deviation; COPD: chronic obstructive pulmonary disease *** Cardiovascular disease is a composite of cardiomyopathy, congestive heart failure, and coronary artery disease. **** Defined as BMI > 30 kg/m2.***** Based on separate one-way analysis of variance or chi square tests, as appropriate.

Disparities in Tobacco use and cravings among sexual and gender minority adolescents in the United States.

Factors Associated With E-Cigarette Quitting Behavior Among Adolescents in the United States: A Prospective Observational Study

&lt;div&gt;AbstractBackground:&lt;p&gt;Sex and racial/ethnic identity-specific cut-points for validating tobacco use using Wave 1 (W1) of the Population Assessment of Tobacco and Health (PATH) Study were published in 2020. The current study establishes predictive validity of the W1 (2014) urinary cotinine and total nicotine equivalents-2 (TNE-2) cut-points on estimating Wave 4 (W4; 2017) tobacco use.&lt;/p&gt;Methods:&lt;p&gt;For exclusive and polytobacco cigarette use, weighted prevalence estimates based on W4 self-report alone and with exceeding the W1 cut-point were calculated to identify the percentage missed without biochemical verification. Sensitivity and specificity of W1 cut-points on W4 self-reported tobacco use status were examined. ROC curves were used to determine the optimal W4 cut-points to distinguish past 30-day users from non-users, and evaluate whether the cut-points significantly differed from W1.&lt;/p&gt;Results:&lt;p&gt;Agreement between W4 self-reported use and exceeding the W1 cut-points was high overall and when stratified by demographic subgroups (0.7%–4.4% of use was missed if relying on self-report alone). The predictive validity of using the W1 cut-points to classify exclusive cigarette and polytobacco cigarette use at W4 was high (&gt;90% sensitivity and specificity, except among polytobacco Hispanic smokers). Cut-points derived using W4 data did not significantly differ from the W1-derived cut-points [e.g., W1 exclusive = 40.5 ng/mL cotinine (95% confidence interval, CI: 26.1–62.8), W4 exclusive = 29.9 ng/mL cotinine (95% CI: 13.5–66.4)], among most demographic subgroups.&lt;/p&gt;Conclusions:&lt;p&gt;The W1 cut-points remain valid for biochemical verification of self-reported tobacco use in W4.&lt;/p&gt;Impact:&lt;p&gt;Findings from can be used in clinical and epidemiologic studies to reduce misclassification of cigarette smoking status.&lt;/p&gt;&lt;/div&gt;

Cannabis is the most widely used drug in the United States, and its use carries negative health consequences; however, universal screening for cannabis use is cumbersome. If data commonly collected in the primary care setting (eg, use of alcohol, smoking status, and depression symptoms) could predict cannabis use, then providers can implement targeted marijuana screening in high-risk groups. We reviewed Behavioral Health Laboratory data collected between 2003 and 2006 from 5512 patients referred by Veterans Affairs primary care clinics for potential mental health needs. Logistic regression was used to determine the predictors of past year marijuana use. A total of 11.5% of the sample reported using marijuana in the past year. Age, gender, other drug use, presence of alcohol use disorders, smoking status, depressive disorders, posttraumatic stress disorder, anxiety disorders, and psychotic symptoms, individually, were associated with the patients' use of marijuana during the past year. When controlling for age, race, and gender in a logistic regression analyses, only other drug use, alcohol use disorder, and smoking status were linked to past year marijuana use. Patients were 5.4 (95% confidence interval [CI] 4.3-6.7) times more likely to have used marijuana during the past year if they used another illicit drug during the past year. Those with alcohol use disorder diagnosis or current smokers were 2.3 (95% CI 1.9-2.8) and 1.5 times (95% CI 1.3-1.7), respectively, more likely to have used marijuana during the past year. Receiver operating characteristic curve (area under curve = 0.79) represents good sensitivity and specificity of the model, correctly classifying 88.4% of the past year marijuana users. Identifying patients at high risk for cannabis use may facilitate targeted screening and provision of interventions in primary care. Patients who screen positive for cigarette use, alcohol abuse or dependence, or have evidence of other illicit drug use could be considered for cannabis screening.

HIV disproportionately affects sexual minority men (SMM) in the United States. We sought to determine past HIV postexposure prophylaxis (PEP) use and current and prior pre-exposure prophylaxis (PrEP) use among a web-based sample of cisgender and transgender men who have sex with men. In 2019, HIV-negative and unknown status SMM (n=63,015) were recruited via geosocial networking apps, social media, and other web-based venues to participate in a brief eligibility screening survey. Individuals were asked about past PEP use and current and prior PrEP use. We examined associations of demographics, socioeconomic indicators, and recent club drug use with PEP and PrEP use, as well as the association between past PEP use and current and prior PrEP use using generalized linear models and multinomial logistic regression. Statistical significance was considered at P<.001, given the large sample size; 99.9% CIs are reported. Prior PEP use was reported by 11.28% (7108/63,015) of the participants, with current or prior PrEP use reported by 21.95% (13,832/63,015) and 8.12% (5118/63,015), respectively. Nearly half (3268/7108, 46%) of the past PEP users were current PrEP users, and another 39.9% (2836/7108) of the participants who reported past PEP use also reported prior PrEP use. In multivariable analysis, past PEP use was associated with current (relative risk ratio [RRR] 23.53, 99.9% CI 14.03-39.46) and prior PrEP use (RRR 52.14, 99.9% CI 29.39-92.50). Compared with White men, Black men had higher prevalence of past PEP use and current PrEP use, Latino men had higher prevalence of PEP use but no significant difference in PrEP use, and those identifying as another race or ethnicity reported higher prevalence of past PEP use and lower current PrEP use. Past PEP use and current PrEP use were highest in the Northeast, with participants in the Midwest and South reporting significantly lower PEP and PrEP use. A significant interaction of Black race by past PEP use with current PrEP use was found (RRR 0.57, 99.9% CI 0.37-0.87), indicating that Black men who previously used PEP were less likely to report current PrEP use. Participants who reported recent club drug use were significantly more likely to report past PEP use and current or prior PrEP use than those without recent club drug use. PrEP use continues to be the predominant HIV prevention strategy for SMM compared with PEP use. Higher rates of past PEP use and current PrEP use among Black SMM are noteworthy, given the disproportionate burden of HIV. Nonetheless, understanding why Black men who previously used PEP are less likely to report current PrEP use is an important avenue for future research.

This article examines illegal drug use among adults living in nonmetropolitan and rural areas of the United States using data from the National Household Survey on Drug Abuse. Subjects were classified into three categories by residence: nonmetropolitan-urban, metropolitan-rural, and nonmetropolitan-rural. Respondents indicate about 10% of adults were current users of marijuana or other illegal drugs. Discriminant analysis was used to examine differences among groups of individuals classified as current users, past users, and nonusers. For both marijuana and other illegal drugs, the variables that accounted most for group differences were age, marital, status, employment status, occupation, and income. Only minor differences in drug use were exhibited across the three residential categories. It is recommended that future research on the rural and nonmetropolitan adult population incorporate both structural level measures of socioeconomic and demographic characteristics of localities, and individual level measures of peer influence, work stress, family factors, and psychosocial characteristics.

The United States Medical Licensing Examination (USMLE) has been a subject of performance study for artificial intelligence (AI) models. However, their performance on questions involving USMLE soft skills remains unexplored. This study aimed to evaluate ChatGPT and GPT-4 on USMLE questions involving communication skills, ethics, empathy, and professionalism. We used 80 USMLE-style questions involving soft skills, taken from the USMLE website and the AMBOSS question bank. A follow-up query was used to assess the models’ consistency. The performance of the AI models was compared to that of previous AMBOSS users. GPT-4 outperformed ChatGPT, correctly answering 90% compared to ChatGPT’s 62.5%. GPT-4 showed more confidence, not revising any responses, while ChatGPT modified its original answers 82.5% of the time. The performance of GPT-4 was higher than that of AMBOSS's past users. Both AI models, notably GPT-4, showed capacity for empathy, indicating AI's potential to meet the complex interpersonal, ethical, and professional demands intrinsic to the practice of medicine.

Excessive sodium consumption contributes to high blood pressure, which is a risk factor for cardiovascular disease. To (1) identify state and urban local laws addressing adult or general population sodium consumption in foods and beverages and (2) align findings to a previously published evidence classification review, the Centers for Disease Control and Prevention Sodium Quality and Impact of Component (QuIC) evidence assessment. Systematic collection of sodium reduction laws from all 50 states, the 20 most populous counties in the United States, and the 20 most populous cities in the United States, including Washington, District of Columbia, effective on January 1, 2019. Relevant laws were assigned to 1 or more of 6 interventions: (1) provision of sodium information in restaurants or at point of purchase; (2) consumer incentives to purchase lower sodium foods; and provision of lower sodium offerings in (3) workplaces, (4) vending machines, (5) institutional meal services, and (6) grocery, corner, and convenience stores. The researchers used Westlaw, local policy databases or city Web sites, and general nutrition policy databases to identify relevant laws. Thirty-nine sodium reduction laws and 10 state laws preempting localities from enacting sodium reduction laws were identified. Sodium reduction laws were more common in local jurisdictions and in the Western United States. Sodium reduction laws addressing meal services (n = 17), workplaces (n = 12), labeling (n = 13), and vending machines (n = 11) were more common, while those addressing grocery stores (n = 2) or consumer incentives (n = 6) were less common. Laws with high QuIC evidence classifications were generally more common than laws with low QuIC evidence classifications. The distribution of sodium laws in the US differed by region, QuIC classification, and jurisdiction type, indicating influence from public health and nonpublic health factors. Ongoing research is warranted to determine how the strength of public health evidence evolves over time and how those changes correlate with uptake of sodium reduction law.

Objective To determine whether use of serotonin or non-serotonin reuptake inhibitors near to delivery is associated with postpartum hemorrhage. Design Cohort study. Setting 2000-07 nationwide Medicaid data (Medicaid Analytic eXtract)....

The spread of COVID-19 has been a major disruptive force in people's everyday lives and mobility behavior. The demand for on-demand ride services, such as taxis and ridehailing, has been specifically affected given both restrictions in service operations and users' concerns about virus transmission in shared vehicles. In the early months of the pandemic, demand for these modes decreased by as much as 80%. This study examines intentions to use on-demand ride services in the early lockdown stage of the pandemic in the United States, a period of unprecedented mobility reductions, changing household routines and transforming travel behaviors. Using data from a survey disseminated in June 2020 to 700 U.S. respondents, we use multigroup MIMIC (Multiple Indicator Multiple Cause) models to investigate the stated shift in intentions to use on-demand modes of travel. By using group-based segmentation we control for variation in ridership intentions according to personal, household, attitudinal factors, and pandemic experiences. The results point to a reduction across the board in the likelihood of using on-demand mobility associated with a significant COVID-19 effect. Beyond this general decrease, several groups are found to have more positive intentions, including younger adults, urban residents, graduate-degree holders, and people of Hispanic, Latino, Asian, and Pacific Islander ethnicities/races. The attitudinal effect of "tech-savviness" drives higher user intentions, revealing indirect effects of gender, education, and age. Multigroup analysis provides further evidence of potential COVID-triggered shifts in on-demand ridership intentions. The most significant drops in likelihood are observed for younger respondents (below 45), Black compared with all other racial/ethnic status, and for past users of on-demand mobility. This latter result is somewhat surprising, as riders who are younger and more experienced with on-demand travel are more likely to have been users in the past, but also more likely to reduce use during the pandemic. To conclude, we discuss the need to investigate pandemic experiences, risk attitudes, and circumstances to understand evolving mobility behavior and specific service model impacts.

One million individuals in the United States, predominantly males under 25 yr of age, are current or past users of anabolic-androgenic steroids. Fifty percent of these young adults administer their drugs intramuscularly, placing them at risk for infections related to injection. We present here a case report of an injection-related thigh abscess in a 26-yr-old anabolic steroid injector who did not use sterile injection technique and reported sharing multidosage vials with two other weightlifting colleagues. Reported infections associated with anabolic-androgenic steroid injection include abscesses attributable to Mycobacterium smegmatis, Staphylococcus, Streptococcus, and Pseudomonas organisms as well as HIV, hepatitis B, and hepatitis C. These infections are primarily related to nonsterile injection technique, shared injection equipment, and are avoidable with appropriate prevention techniques. Education is needed to prevent infectious complications such as abscesses and blood-borne pathogens among anabolic-androgenic steroid injectors.