Erika S. Trapl

Complexity of Measuring “Cigar Use” in Adolescents: Results From a Split Sample Experiment

INTRODUCTION Inclusion of brand-specific examples (BE) in health surveys assessing lifetime and current cigar use has been shown to impact response rates. A split sample experimental design was used to investigate whether these rates are consistent by race, gender, and geographic locale. METHODS The 2009 Cuyahoga County Youth Risk Behavior Survey was conducted among 20 randomly selected high schools. Two versions of the survey were created; the first included items assessing lifetime and current cigar use with no brand-specific examples (NBE) while the second included BE in the items assessing cigar use. Both survey versions were distributed randomly within selected classrooms in participating schools. RESULTS Within the City, both White and Black BE respondents reported higher lifetime cigar product use prevalence and current cigar product use compared to the NBE group; however, the difference was only significant among Black respondents (odds ratio [OR] = 1.45, 95% CI 1.02-2.06). In the Outer Ring, White BE respondents were significantly less likely to report lifetime cigar use (OR = 0.73, 95% CI: 0.54 - 0.98) and current cigar use (OR = 0.66, 95% CI: 0.44-0.99) when compared with White NBE respondents. CONCLUSIONS Inclusion of BE in current measures of cigar product use may improve product use estimates in at-risk groups. However, better estimation of cigar product use may be accomplished by creating additional items to assess the use of subtypes of cigars.

Adult use of cigars, little cigars, and cigarillos in Cuyahoga County, Ohio: A cross-sectional study

INTRODUCTION Adult use of cigars, cigarillos, and little cigars has increased over the past two decades; however, little is known about the characteristics of the users. METHODS The data were derived from 5 years (2003-2007) of the Cuyahoga County Behavioral Risk Factor Surveillance Survey, a random digit-dialed telephone survey conducted by ICF Macro International, based on the survey and methods of the Ohio BRFSS. RESULTS Results indicate that the prevalence of current cigarette smoking across the 5 years was 23.1%. Cigar use and little cigar use were reported by 4.3% and 3.3% of respondents, respectively. Compared with cigarette users, cigar and little cigar users were far more likely to report multiple product use (12.8% vs. 63.9% and 80.5%, respectively). Cigar and little cigar users differed from cigarette smokers in demographic profile and patterns of multiple product use. DISCUSSION Black and lower income adults were significantly more likely to report use of little cigars and use of multiple products. These disparities potentially contribute to the disproportionate rates of tobacco-related illnesses and underrepresentation of low-income and minority populations in tobacco use prevalence rates.

“I just use it for weed”: The modification of little cigars and cigarillos by young adult African American male users

ABSTRACT Little cigar and cigarillo (LCC) use has received increased attention, but research on their modification is limited. Qualitative interviews with 17 young adult African American male LCC users investigated tobacco use behaviors and patterns, including LCC modification. The modification of LCCs for use as blunts emerged as a very prominent aspect of LCC users’ tobacco use. Four subthemes regarding marijuana and blunt use are explored in this article, including participants’ explanations of how blunts are made and used, concurrent use of marijuana and tobacco, perceptions and reasons for smoking marijuana and blunts, and perceptions of the risks of blunt use.

Effectiveness of Health Education Teachers and School Nurses Teaching Sexually Transmitted Infections/Human Immunodeficiency Virus Prevention Knowledge and Skills in High School.

BACKGROUND We examined the differential impact of a well-established human immunodeficiency virus (HIV)/sexually transmitted infections (STIs) curriculum, Be Proud! Be Responsible!, when taught by school nurses and health education classroom teachers within a high school curricula. METHODS Group-randomized intervention study of 1357 ninth and tenth grade students in 10 schools. Twenty-seven facilitators (6 nurses, 21 teachers) provided programming; nurse-led classrooms were randomly assigned. RESULTS Students taught by teachers were more likely to report their instructor to be prepared, comfortable with the material, and challenged them to think about their health than students taught by a school nurse. Both groups reported significant improvements in HIV/STI/condom knowledge immediately following the intervention, compared to controls. Yet, those taught by school nurses reported significant and sustained changes (up to 12 months after intervention) in attitudes, beliefs, and efficacy, whereas those taught by health education teachers reported far fewer changes, with sustained improvement in condom knowledge only. CONCLUSIONS Both classroom teachers and school nurses are effective in conveying reproductive health information to high school students; however, teaching the technical (eg, condom use) and interpersonal (eg, negotiation) skills needed to reduce high-risk sexual behavior may require a unique set of skills and experiences that health education teachers may not typically have.

Reporting of treatment fidelity in behavioural paediatric obesity intervention trials: a systematic review

Behavioural interventions for paediatric obesity are promising, but detailed information on treatment fidelity (i.e. design, training, delivery, receipt and enactment) is needed to optimize the implementation of more effective interventions. Little is known about current practices for reporting treatment fidelity in paediatric obesity studies. This systematic review, in accordance with Preferred Reporting Items for Systematic Reviews and Meta‐Analyses guidelines, describes the methods used to report treatment fidelity in randomized controlled trials. Treatment fidelity was double‐coded using the National Institutes of Health Fidelity Framework checklist. Three hundred articles (N = 193 studies) were included. Mean inter‐coder reliability across items was 0.83 (SD = 0.09). Reporting of treatment design elements within the field was high (e.g. 77% of studies reported designed length of treatment session), but reporting of other domains was low (e.g. only 7% of studies reported length of treatment sessions delivered). Few reported gold standard methods to evaluate treatment fidelity (e.g. coding treatment content delivered). General study quality was associated with reporting of treatment fidelity (p < 0.01) as was the number of articles published for a given study (p < 0.01). The frequency of reporting treatment fidelity components has not improved over time (p = 0.26). Specific recommendations are made to support paediatric obesity researchers in leading health behaviour disciplines towards more rigorous measurement and reporting of treatment fidelity.

The Cleveland-Cuyahoga County Food Policy Coalition: "we have evolved".

Several pieces of legislation passed in Cleveland, Ohio, from 2007 to 2011, focused on improving the city’s food environment through urban agriculture initiatives. We used qualitative, case study methods, including interviews with 7 key informants, to examine the policy development process and investigate the role of the Cleveland–Cuyahoga County Food Policy Coalition in developing and implementing 4 pieces of legislation. In this article, we focus on 2 pieces of legislation: zoning designation of an urban garden and allowance of small farm animals and bees on residential property. Five key themes emerged: impetus for policy came from community needs; education and raising awareness helped mitigate barriers; a cultural shift took place among policy makers; social connections and individual champions were needed; and concerns over food access and health influenced policy decisions. Legislative actions are important tools to influence the nutrition environment, as long as they are based on local needs and context.

Evaluation of the use of audio-enhanced personal digital assistants to survey latino migrant farmworkers

We describe the feasibility of audio-enhanced personal digital assistants (ADPAs) for data collection with 60 Latino migrant farmworkers. All participants chose to complete APDA surveys rather than using paper-and-pencil. No one left the study prematurely: two (3%) data cases were lost due to technical difficulties. Across all data .27% missing data were observed: nine missing responses on eight items. Participants took 19 minutes on average to complete the 58-question survey. The factor most influential for completion was education level. APDA methodology enabled both English- and Spanish-speaking Latino migrant farmworkers to become active research participants with minimal loss of data.

User and Content Characteristics of Public Tweets Referencing Little Cigars

OBJECTIVES Compared to cigarettes, little cigars and cigarillos (LCC) are minimally regulated, affordable, and widely available to young people. Because Twitter is a preferred mode of communication among younger people, product portrayals may be useful for informing both interventions and public health or tobacco policy. METHODS A mixed-methods study was implemented to analyze the content of public tweets (N = 288) and profile photos sampled from a search of 2 LCC brands (Black & Mild and Swisher Sweets). Metadata and manifest attributes of profile photo demographic features and tweet message features were coded and analyzed. Thematic analysis of the tweets was conducted using an iterative immersion/ crystallization method. RESULTS Tweeters were most often boys or men (63%) and appeared young (76%). Prevalent content themes included expressing affiliation for the LCC product and reporting smoking activity. Although men and women tweeted affiliation for LCC products and reported smoking activity in similar numbers, women were significantly less likely to tweet about blunting than men. CONCLUSIONS Twitter provides a potentially potent source of nuanced information about how young people are using little cigars. These observed characteristics may be useful to inform counter-messaging strategies and interventions.

Youth Acquisition and Situational Use of Cigars, Cigarillos, and Little Cigars:: A Cross-sectional Study.

INTRODUCTION Although adolescent use of cigars, cigarillos, and little cigars (CCLCs) has been increasing, little research has been conducted to understand how adolescents acquire CCLCs and the situations in which they smoke CCLCs. Thus, this study aims to understand how adolescent smokers acquire CCLCs and the situations in which they smoke them. METHODS Data were drawn from the 2011 Cuyahoga County Youth Risk Behavior Survey. Current CCLC smoking was assessed; analysis was limited to current smokers (n=1,337). Current users were asked to identify situations in which they use cigars and ways in which they get cigars. Bivariate analyses assessed differences by sex, race, and concurrent substance use. Data were analyzed in 2014. RESULTS Youth acquired CCLCs most commonly by buying (64.2%). CCLC smokers also reported high rates of social use (81.1%). There were no significant differences is situational use across sexes, but female adolescents were significantly more likely than male adolescents to share CCLCs and significantly less likely to buy or take CCLCs. Conversely, significant differences were seen for situational use by race/ethnicity, with whites significantly more likely to use in social situations and less likely to use in solitary situations versus blacks and Hispanics. Finally, significant differences were observed in both acquisition and use for youth who concurrently used CCLCs and cigarettes compared with CCLCs only; fewer differences were noted among those who concurrently used CCLCs and marijuana compared with CCLCs only. CONCLUSIONS These findings highlight how adolescents acquire and use CCLCs and can inform tobacco control strategies to prevent and reduce CCLC use.

Mixed Methods Evaluation of a Produce Prescription Program for Pregnant Women

ABSTRACT Fruit and vegetable consumption has been shown to be associated with positive birth outcomes. Farmers’ markets (FMs) are a growing opportunity to increase access in neighborhoods with limited access to fruits and vegetables. The objective of this mixed methods study was to determine the applicability of integrating a produce prescription intervention (PRx) with the existing health care and farmers’ market systems in Cuyahoga County, Ohio. The program served pregnant women within underserved areas with limited access to fruits and vegetables. The intervention included nutritional counseling and