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Understanding why young people try and stop electronic cigarette (e-cigarette) use is critical to inform e-cigarette regulatory efforts. We conducted 18 focus groups (N = 127) in 1 middle school (MS), 2 high schools (HSs), and 2 colleges in Connecticut to assess themes related to e-cigarette experimentation and discontinuation. We then conducted surveys to evaluate these identified themes in 2 MSs, 4 HSs, and 1 college (N = 1,175) to explore whether reasons for e-cigarette experimentation and/or discontinuation differed by school level or cigarette smoking status. From the focus groups, we identified experimentation themes (i.e., curiosity, flavors, family/peer influence, easy access, and perceptions of e-cigarettes as \"cool\" and as a healthier/better alternative to cigarettes) and discontinuation themes (i.e., health concerns, loss of interest, high cost, bad taste, and view of e-cigarettes as less satisfying than cigarettes). The survey data showed that the top reasons for experimentation were curiosity (54.4%), appealing flavors (43.8%), and peer influences (31.6%), and the top reasons for discontinuation were responses related to losing interest (23.6%), perceiving e-cigarettes as \"uncool\" (16.3%), and health concerns (12.1%). Cigarette smokers tried e-cigarettes because of the perceptions that they can be used anywhere and to quit smoking and discontinued because they were not as satisfying as cigarettes. School level differences were detected. E-cigarette prevention efforts toward youth should include limiting e-cigarette flavors, communicating messages emphasizing the health risks of use, and changing social norms surrounding the use of e-cigarettes. The results should be interpreted in light of the limitations of this study.

Climate extremes pose significant risks to human health, agriculture, and water resources. These extremes are defined as long-term, unusual events that fall into the 10th or 90th percentile of a probability density function derived from observations at a certain location (e.g., drought and wildfire). The quantification of future climate risks is based on climate model predictions. Here, we present a review of literature focusing on extreme climate projections in the latest generation of climate models, namely, Coupled Model Intercomparison Project Phase 6 (CMIP6) from 2020 to the present. We highlight the extreme events that could cause potential societal risks, including precipitation (the 90th percentile of the cumulative frequency distribution of daily precipitation), temperature (the 10th or 90th percentile of daily temperature within a reference period), droughts (meteorological, hydrological, and agricultural), floods, heat waves, and compound/concurrent extremes. Regionally, the precipitation extremes are projected to increase in North Africa (Ethiopia, Uganda, and Kenya), followed by drying in South Africa. Heatwaves will increase in a warming scenario (SSP3-7.0) in Asia (Indo-Gangetic Plain) and Afghanistan. The rise in heat stress intensity in Asia will augment the climate risks to agriculture under the SSP2-4.5 and SSP5-8.5 scenarios. On a global scale, land areas are projected to face severe drought specifically in higher biomass regions, under the SSP5-8.5 scenario. Future droughts bring hazards to Europe and the Amazon River basin with severe aridification over Australia, the Middle East, South and North Africa, and Central Asia. The CMIP6 model projections on a regional and global scale over the US Southwest predict intense drought and hot dry summers. The study supplements the discussion section by providing insights on sources of uncertainty in extreme event projections, the role of emergent constraints in uncertainty reduction, and the impact of extremes on water resources, agriculture, and human health.

Oral nicotine pouches (NPs) that contain nicotine but no tobacco leaves are rapidly gaining popularity. However, there is limited research on NPs, including within priority populations. In the current study, we examined awareness of, susceptibility to, and use of NPs in young adults as well as comparative risk perceptions with smokeless tobacco. In 2021, 609 young adults (18-25 years) completed an online survey. Participants reported on NP awareness, susceptibility, and use as well as on comparative product perceptions for NPs versus smokeless tobacco. We ran unadjusted between-groups comparisons and an adjusted multinomial logistic regression to identify relationships between product perceptions and NP susceptibility and use. 41.5% of participants had heard of NPs before. Participants were non-susceptible (66.2%), susceptible (23.5%), or had used NPs (10.3%). Comparative product perceptions between NPs and smokeless tobacco suggested that young adults, as a whole, expressed uncertainty about the relative risk/benefit of using NPs versus smokeless tobacco. However, as expected, unadjusted and adjusted findings indicated that favorable perceptions of NPs versus smokeless tobacco were disproportionately observed among susceptible participants and NP users compared to non-susceptible individuals. Demographic differences were also observed (e.g., NP users were more likely than non-susceptible and susceptible individuals to have used smokeless tobacco). Young adults reported awareness of, susceptibility to, and use of NPs, with findings indicating that favorable perceptions of NPs versus smokeless tobacco may contribute to NP susceptibility and use beyond known correlates like smokeless tobacco use. However, further research is needed to understand the full range of factors that are associated with NP susceptibility and use. It will be important to disentangle factors that are associated with potential positive public health impacts (e.g., switching from smokeless tobacco to exclusive NP use) from those associated with negative public health impacts (e.g., initiation among nicotine naïve individuals).

Purpose This study aims to expand the emerging body of literature on employer branding from the current employee perspective. It proposes that effective integrated communication helps an organization fulfill its employer value proposition or employment value proposition (EVP). A firm that fulfills its brand promise in terms of EVP will derive employee-based brand equity (EBBE) benefits. Integrated communication is effective when employees experience coordination and consistency in brand communication. This influences their perception of psychological contract fulfillment (in terms of EVP attributes), which results in positive employee behavior in the form of EBBE benefits. Design/methodology/approach The study draws insights from the signaling theory and psychological contract literature which is based on the social exchange theory. The literature on integrated communication, employer branding and internal branding was reviewed to propose the relationships between the variables of interest. Data was collected using a questionnaire survey on 520 employees from the information technology (IT)-business process management industry in India, which is a customer-oriented industry known for its exemplary employer practices. Findings The findings suggest that integrated communication effectiveness impacts the perceived fulfillment of EVP attributes and EBBE. Again, the fulfillment of the relational value dimension of EVP attributes partially mediates the relationship between integrated communication effectiveness and EBBE. Originality/value This study is one of the first to explore employees’ perception of integrated communication effectiveness and fulfillment in terms of EVP attributes as antecedents to EBBE.

The increasing adoption of Internet of Medical Things (IoMT) devices generates vast amounts of sensor data in healthcare, posing challenges in data security, privacy and processing efficiency. This work addresses these issues by proposing a secure and efficient storage and classification system for skin disease detection. We present a blockchain-based healthcare storage solution where skin images are collected by IoMT devices, encrypted using the Chaotic-based Advanced Encryption Standard (CAES), and stored on a blockchain for secure, decentralized access. The encrypted images are then retrieved and classified using an Adaptive Multi-Scale Dilation-assisted Residual Attention Network (AMSD-RAN), optimized with a Hybrid Heuristic Algorithm, Renovated Position-based Galactic Swarm with Yellow Saddle Goatfish Optimization (RPGS-YSGO). It provides a scalable and secure solution for real-time healthcare applications. The proposed method shows 95% accuracy which is improved by 6.7% for Harvard Dataverse dataset and by 12% for PH2 dataset and significant reduction in processing time compared to previous approaches. This solution ensures secure storage, accurate skin disease detection and overcomes the limitations of traditional IoT and centralized management systems through blockchain’s decentralized architecture.

This study aimed to determine the prevalence and predictors of oral, ocular, or dermal e-liquid exposure and subsequent outcomes (becoming sick, going to the hospital) in the US. We examined survey data from the Population Assessment of Tobacco and Health Study Wave 5 (2018–2019). The analytic sample included US youth (aged 12–17 years), young adults (aged 18–24 years), and older adults (aged ≥ 25 years) who reported e-cigarette use in the past 12 months. We first determined the prevalence of self-reported e-liquid exposure (in the mouth, skin, or eyes), subsequently “becoming sick” from the exposure, and “going to the hospital” after the exposure. We also examined associations between these outcomes and the device type used (refillable tank /mod system, replaceable prefilled cartridges, disposable/ other device type). E-liquid exposure was reported by 25% of youth (aged 12–17 years), 25% of young adults (aged 18–24 years), and 19% of older adults (aged≥ 25 years). Among individuals reporting e-liquid exposure, subsequent sickness was reported by 10% of youth11% of young adults, and 14% of older adults, and “going to the hospital” was reported by 3.5% of youth, 2.7% of young adults, and 6.8% of older adults. Among young adults, the use of a refillable tank /mod system was associated with higher odds of e-liquid exposure (aOR = 2.2, 95% CI = 1.2, 4.1) than the use of other device types, including disposables. The findings suggest that, at a minimum, e-cigarettes/e-liquids may need warning labels that state the risks of e-liquid exposure and packaging regulations that promote device and bottle designs that minimize e-liquid spills.

Epilepsy becomes one of the most frequently arising brain disorder, and it is marked by the unexpected occurrence of frequent seizures. In this study, the University of the Boon Database with ictal seizure disorder diagnosis of the epilepsy is classified by making use of the expectation maximization features as dimensionality reduction technique followed by the nonlinear model, namely, Gaussian mixture model, logistic regression, firefly algorithm, and hybrid model such as cuckoo search with Gaussian mixture model and firefly algorithm with the Gaussian mixture model which are the classifiers used for the diagnosis of epilepsy from the electroencephalogram signals. The performance of the classifiers is analyzed based on performance index, sensitivity, specificity, accuracy, mean square error, good detection rate, and error rate. The most promising outcome in this work indicates expectation maximization features are applied as the dimensionality reduction technique and the hybrid model Cuckoo search with the Gaussian mixture model outperforms with classification accuracy of 92.19%, performance index of 81.43%, good detection rate of 83.48%, and with low error rate of 15.62%, among other classifiers.

Many e-cigarette users find the variety of e-cigarette flavors appealing. We examined whether preferences for e-liquid flavors and the total number of flavors preferred differed between samples of adolescent and adult e-cigarette users. We also examined whether these preferences were associated with e-cigarette use frequency for adolescents or adults, respectively. The analytic samples comprised 1) 396 adolescent, past-month e-cigarette users from 5 Connecticut high schools who completed an anonymous, school-based survey in Fall 2014 (56.1% male; 16.18 [1.18] years; 42.2% past-month smokers), and 2) 590 adult, past-month e-cigarette users who completed an anonymous, MTurk survey in Fall 2014 (53.7% male; 34.25 [9.89] years; 51.2% past-month smokers). Compared to adults, a larger proportion of adolescents preferred fruit, alcohol, and \"other\"-flavored e-liquids, whereas adults disproportionately preferred tobacco, menthol, mint, coffee, and spice-flavored e-liquids (p-values < .05). Adults also preferred a greater total number of flavors compared to adolescents and used e-cigarettes more frequently (p-values < .001). Flavor preferences uniquely were associated with frequency of e-cigarette use within the adolescent sample; the total number of flavors preferred was associated with more days of e-cigarette use (ηp2 = 0.04), as were preferences for fruit (ηp2 = 0.02), dessert (ηp2 = 0.02), and alcohol-flavored (ηp2 = 0.02) e-liquids. Flavor preferences differed between adolescent and adult samples. While youth reported less frequent e-cigarette use overall, their preferences for specific flavors and the total number of flavors preferred were associated with more days of e-cigarette use, indicating that flavor preferences may play an important role in adolescent e-cigarette use.

PurposeThe purpose of the study was to make sense of the role of human resource (HR) leaders in crisis management and in creating a resilient workplace amid conflicting institutional logics. The study also unearths the outcomes of crisis management from the different crisis response strategies implemented by HR leaders to build organizational resilience by managing conflicting institutional logics.Design/methodology/approachWe conducted a qualitative study among HR leaders from the service and manufacturing industries in India (n = 26). Data collected through semi-structured interviews were analysed using Gioia’s methodology, which focuses on providing a structured approach to developing a grounded model and presenting the findings in a convincing narrative.FindingsThe findings based on data analysis yielded three aggregate dimensions that helped provide reasons for HR leaders to have acted in particular ways in bringing about institutional change through effective crisis management. The aggregate dimensions include managing conflicting institutional logics during the crisis, synergizing institutional logics for adaptive resilience and balancing institutional logics for transformative resilience.Originality/valueThis study makes two key contributions to the existing literature. First, we contribute to the institutional theory by examining various crisis response strategies that HR leaders adopt in bringing about institutional change amidst conflicting logics emanating from different stakeholders. Second, the study findings highlight the principles of adaptive resilience that manage opposing tensions between exploiting existing knowledge and exploring new changes and transformative resilience that reconfigures the core values and underlying beliefs that fundamentally challenge the existing system.

\"Tobacco-free\" nicotine (TFN) e-cigarettes and nicotine pouches containing synthetic nicotine are increasingly available. The term TFN may lead to reduced risk perceptions and increased use intentions relative to tobacco-derived nicotine products. Effectively communicating messages about TFN may depend on the public's ability to differentiate TFN from tobacco-derived nicotine. Our goals were to examine knowledge about the source(s) of nicotine in commonly used products and beliefs about what TFN means. In 2021 we surveyed 2464 young adults (18-25 years) online. Participants reported whether cigarettes, smokeless tobacco, e-cigarettes, and nicotine pouches contain nicotine that comes from tobacco (always, sometimes, never). Correct responses were \"always\" for cigarettes/smokeless and \"sometimes\" for e-cigarettes/pouches. Participants also reported \"what [they] think TFN e-cigarettes/vapes contain\" (nicotine only; tobacco only; both nicotine and tobacco; neither nicotine nor tobacco). We ran unadjusted and adjusted models examining correct responses for nicotine source and TFN contents by past-month product use status (cigarettes, smokeless, e-cigarettes, pouches). Rates of correctly identifying nicotine source were modest (23.6% pouches-61.9% cigarettes). Except smokeless tobacco, using a given product was associated with identifying its nicotine source correctly in unadjusted models. Participants reported \"TFN\" means a product contains nicotine only (57.8%), tobacco only (10.8%), both (14.1%), or neither (17.1%). There is confusion about the source of nicotine in products, and many young adults incorrectly interpreted TFN to mean something other than containing nicotine but no tobacco. Regulatory efforts may be needed to restrict using the term \"tobacco-free nicotine\" on product labeling and advertising.