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ObjectiveA California, USA, law raised the minimum tobacco sales age to 21 (T21) on 9 June 2016. We investigated whether T21 was associated with reductions adolescents’ use of tobacco cigarettes, smokeless tobacco and electronic cigarettes and whether these associations differed across racial and ethnic groups.MethodsSecondary analyses of data from 2 956 054 7th, 9th and 11th grade students who participated in the California Healthy Kids Survey from 2010–11 to 2017–2018.ResultsMultilevel mixed effects logistic regression analyses showed that T21 was associated with reduced prevalence of lifetime smokeless tobacco and e-cigarette use and past month smokeless tobacco use in the overall student population. T21 was associated with increases in prevalence of past month e-cigarette use. Moderation analyses indicated differences by racial and ethnic groups. Notably, T21 was associated with reductions in lifetime and past 30-day use of all tobacco and nicotine products among Latinx youth. The findings were more mixed for other racial and ethnic groups. Slopes analyses indicated that T21 was associated with accelerated downward trends for 30-day cigarette and smokeless use; moderated trends for lifetime cigarette smoking such that downward slopes became less steep; and reversed downward trends for e-cigarette use. Changes in slopes varied across racial and ethnic groups.ConclusionsOur findings highlight the importance of understanding the complex associations that T21 and other tobacco control policies have with the use of different tobacco and nicotine products among racial and ethnic groups. Future research should investigate mechanisms underlying these differences to inform tobacco control efforts.

Substance use, sexual assault, and sexual risk behaviors are common among adolescents and are interrelated. Nearly 1 in 5 adolescents use substances before sexual encounters, placing these young people at risk for both sexual assault and sexual risk behaviors. Primary care visits present a unique opportunity to address multiple health risk behaviors. Teen Well Check is a web-based integrated prevention program for substance use, sexual assault, and sexual risk behaviors with demonstrated usability and acceptability among patients and providers. The aim of this study was to conduct a pilot randomized controlled trial to assess feasibility. Adolescents (n=123) aged 14 to 18 years from diverse backgrounds were recruited from primarily Medicaid-serving pediatric primary care clinics. Participants completed a baseline survey; were randomized to receive Teen Well Check or an assessment-only control; and completed 1-, 3-, and 6-month follow-up surveys. Feasibility was assessed in terms of recruitment and retention rates. Preliminary changes from baseline to follow-up periods were examined separately in the Teen Well Check and control conditions. We recruited 123 participants (Teen Well Check: n=61, 49.6%; control: n=62, 50.4%). Of the 61 participants assigned to the Teen Well Check condition, 55 (90%) completed the full program and viewed all intervention content. Of the 123 participants, 105 (85.4%) were retained across at least 1 follow-up period, and there was no difference in follow-up rates between the conditions (χ =0.6; P=.43). The completion of Teen Well Check took an average of 6.2 (SD 5.8) minutes. Preliminary analyses revealed that there were significant reductions in perceived peer norms (descriptive norms) for substance use before sex across follow-ups among participants in the Teen Well Check condition (P=.001 from baseline to 6 months), whereas there were significant increases among participants in the control condition (P=.003 from baseline to 6 months). In addition, there were nonsignificant reductions in substance misuse risk from baseline to the 6-month follow-up among participants in the Teen Well Check condition (P=.16). These findings support the feasibility of Teen Well Check delivery within pediatric primary care clinics. A randomized clinical trial is needed to assess efficacy. ClinicalTrials.gov NCT3489434; https://www.clinicaltrials.gov/study/NCT03489434.

Research on youth use of electronic nicotine delivery systems (ENDS) has explored the correlates of initiation and use; however, little is known about the factors that predict continued youth use of ENDS. We used an ecological momentary assessment (EMA) burst design to explore both daily variability within adolescents over a two-week observation period and variability over time two years later (2018 and 2020). The contribution of device characteristics, motivations for use, contextual factors, and community factors to daily use occasions were explored. Youth participants (n = 35) at the start of the study were past two-week nicotine vapers, 14 to 17 years old, who resided within 100 miles of Louisville, KY, and reported past two-week ENDS use. Close to a quarter of participants ceased all tobacco use two years later, suggesting that some youth, despite prior regular vaping habits, may have only been experimenting with ENDS. The regular continued use of ENDS was predicted by trying to quit using cigarettes, appealing flavors, and being in locations where cigarette use was prohibited. Except for flavors, these factors did not affect ENDS use in year one. These findings suggest that tobacco policy might target ENDS use by prohibiting all tobacco use, including ENDS, in locations where smoking is already banned.

Previous research suggests a high prevalence of suicidal ideation among military personnel. Suicidal ideation is associated with suicide attempts and death. This study focused on the association between belongingness—a component of the Interpersonal Psychological Theory of Suicide—and alcohol misuse on suicidal ideation among the different categories of military branch and military service status. Using the Military Suicide Research Consortium Common Data Elements database (N = 2516), we conducted linear regression analyses to examine the moderating effect of belongingness and alcohol misuse on the association between military branch and military service status (i.e., Active Duty) on suicidal ideation. Results showed a negative significant association between belongingness and suicidal ideation, and a positive significant association between alcohol and suicidal ideation. The results indicated that alcohol misuse moderated the association between military branch and suicidal ideation, but did not moderate the association between military service status and suicidal ideation. Additionally, the results indicated that belongingness moderated the association between military branch and suicidal ideation and the association between military service status and suicidal ideation. The results highlight the differences across military branches and military service statuses and suggest the importance of developing tailored suicide prevention programs to address the specific needs of each military subpopulation.

The aim of the current research is to understand how different perspectives in a violent event can affect empathy, violence sensitivity, and word usage. Participants (N=289 University of Rhode Island undergraduate students) were randomly assigned to the perspective (victim, bystander, and perpetrator) and media by which they learned about a violent event (watching a video or reading a news article), and were asked to answer a few open-ended questions about the event, followed by a short survey. Results showed that for the words in the categories of negative emotion, anger, first person pronoun, and affective process, participants assigned to the perpetrator and victim perspectives used the words at a similar rate, and participants in the bystander perspective used the words of these categories less. Participants who watched the video used more words in the personal pronoun (first, second, and third person pronoun), first person pronoun (e.g., I, me), and negative emotion categories. Results did not show differences between the groups for the subscales of empathy, and for the categories of violence sensitivity. Separate ANCOVAS suggested group differences based on perspective in violence severity for physical violent behaviors, and group differences based on media in violence severity for nonphysical violent behaviors. There were also main effects for perspective and media on violence sensitivity total. Participants assigned to the bystander perspective who watched the video clip were less violence sensitive. Finally, there was a significant correlation between empathy total and violence sensitivity total. Overall, results suggest that bystanders perceive events differently than perpetrators and victims, and participants who read are more violence sensitive and empathetic. The results of this study could be applied in the development of bystander intervention and violence prevention programs.