Effects of Very Low Nicotine Content Cigarettes on Smoking Behavior and Biomarkers of Exposure in Menthol and Non-menthol Smokers.

IntroductionBecause 30% of cigarettes sold in the United States are characterized as menthol cigarettes, it is important to understand how menthol preference may affect the impact of a nicotine reduction policy.MethodsIn a recent trial, non-treatment-seeking smokers were randomly assigned to receive very low nicotine cigarettes (VLNC; 0.4 mg nicotine/g tobacco) or normal nicotine cigarettes (NNC; 15.5 mg/g) for 20 weeks. On the basis of preference, participants received menthol or non-menthol cigarettes. We conducted multivariable regression analyses to examine whether menthol preference moderated the effects of nicotine content on cigarettes per day (CPD), breath carbon monoxide (CO), urinary total nicotine equivalents (TNE), urinary 2-cyanoethylmercapturic acid (CEMA), and abstinence.ResultsAt baseline, menthol smokers (n = 346) reported smoking fewer CPD (14.9 vs. 19.2) and had lower TNE (52.8 vs. 71.6 nmol/mg) and CO (17.7 vs. 20.5 ppm) levels than non-menthol smokers (n = 406; ps < .05). At week 20, significant interactions indicated that menthol smokers had smaller treatment effects than non-menthol smokers for CPD (-6.4 vs. -9.3), TNE (ratio of geometric means, 0.22 vs. 0.10) and CEMA (ratio, 0.56 vs. 0.37; ps < .05), and trended toward a smaller treatment effect for CO (-4.5 vs. -7.3 ppm; p = .06). Odds ratios for abstinence at week 20 were 1.88 (95% confidence interval [CI] = 0.8 to 4.4) for menthol and 9.11 (95% CI = 3.3 to 25.2) for non-menthol VLNC smokers (p = .02) relative to the NNC condition.ConclusionsAlthough menthol smokers experienced reductions in smoking, toxicant exposure, and increases in quitting when using VLNC cigarettes, the magnitude of change was smaller than that observed for non-menthol smokers.ImplicationsResults of this analysis suggest that smokers of menthol cigarettes may respond to a nicotine reduction policy with smaller reductions in smoking rates and toxicant exposure than would smokers of non-menthol cigarettes

Impact of a Reduced Nicotine Standard on Young Adult Appeal for Menthol and Non-Menthol Cigarettes

Introduction The Food and Drug Administration (FDA) announced its intention to reduce the nicotine content in cigarettes as a strategy to promote cessation and reduce smoking-related harm. A low nicotine product standard will apply to all cigarettes on the market, including menthol cigarettes. In December 2021, the FDA approved a modified risk tobacco product application for menthol and non-menthol flavoured very low nicotine cigarettes (VLNC) from the 22nd Century Group. Notably, experimentation with menthol cigarettes is linked to smoking progression, as well as greater nicotine dependence relative to non-menthol cigarette use. If menthol VLNCs are perceived as more appealing than non-menthol VLNCs, this would indicate that some aspect of menthol may maintain smoking even in the absence of nicotine and FDA’s regulatory authority to ban or restrict the sale of menthol cigarettes should apply to reduced nicotine content of cigarettes. In April 2022, the FDA announced proposed rulemaking to prohibit menthol cigarettes, however it is unclear if a menthol prohibition would apply to VLNCs. Methods and analysis This study will recruit 172 young adult menthol smokers (with a specific subsample of n=40 sexual and gender minority young adults) and measure appeal for smoking experimental menthol and non-menthol VLNCs, and the impact of proposed product standards on tobacco product purchasing behaviour using an Experimental Tobacco Marketplace. Appeal across product standards will be assessed in a controlled laboratory and using ecological momentary assessment. Ethics and dissemination The protocol was approved by the University of Oklahoma Health Sciences Center Institutional Review Board (#11865). Findings will examine the effects of a reduced nicotine standard and a menthol ban on young adult smoking and will be disseminated through peer-reviewed journal articles and presentations at scientific conferences. Trial registration number NCT04340947

Understanding and Addressing Cancer Disparities Among American Indians in North Carolina: The Southeastern American Indian Cancer Health Equity Partnership (SAICEP)

Introduction American Indians and Alaska Natives (AIANs) experience significant cancer incidence and mortality disparities, with elevated cancer risk factor exposure, lower cancer screening rates, and poorer quality of cancer care relative to non-Hispanic Whites. To address these issues, the Southeastern American Indian Cancer health Equity Partnership (SAICEP) was formed to understand and address cancer disparities among southeastern American Indians (AIs). Methods SAICEP formed in 2021 through the Community Outreach and Engagement offices of the NCI-designated Comprehensive Cancer Centers in North Carolina (NC). The catchment areas for these cancer centers include the tribal homelands for eight state and federally recognized Tribes, representing the largest AI populations in the eastern US. SAICEP seeks to: (1) increase awareness of cancer health needs of AI populations; (2) expand access to cancer health education and build community capacity to address cancer health needs; (3) develop collaborative research relationships to better understand and address the AI cancer burden. Results For Aim 1, SAICEP created a virtual speakers’ series, featuring prominent AI cancer researchers and clinicians, hosted by the UNC Lineberger Cancer Network three times a year. To date, 10 webinars have been convened, with a total of 538 participants. For Aim 2, SAICEP participates in tribal events throughout the year, reaching over 3500 AIs and disseminating printed cancer educational materials and giveaways. For Aim 3, SAICEP secured funding to conduct analyses to assess cancer incidence, mortality, and care quality for NC AIs, to collect information to understand community cancer needs and culturally adapt and disseminate information on cancer screening and risk reduction. Conclusion Through its targeted research and engagement, SAICEP has successfully moved towards achieving its goal of understanding and addressing cancer disparities among AIs in NC. Future directions will involve the development of a community advisory board and collaborations with Tribes in other states.Plain Language Summary American Indians and Alaska Natives (AIANs) face significant challenges with cancer, including greater exposure to risk factors, lower screening rates, limited access to quality care compared to non-Hispanic Whites, and higher rates of cancer-related deaths. To address these issues, the Southeastern American Indian Cancer health Equity Partnership (SAICEP) was created. SAICEP’s mission is to understand and address the burden of cancer among American Indian (AI) people in our combined service area. SAICEP was formed in 2021 as a partnership between the three NCI designated cancer centers in North Carolina, which serve multiple tribal nations and Urban Indian organizations. SAICEP engages with Native people through initiatives like a virtual speakers’ series featuring AI cancer experts. So far, SAICEP has hosted 10 webinars, reaching 538 attendees. Additionally, SAICEP participates in tribal events, sharing educational materials and information to help communities understand and reduce cancer risks. Our team has also secured funding to study cancer trends, care quality, and community needs for AIs in North Carolina, which helps identify ways to improve care and support cancer prevention. SAICEP’s efforts have made meaningful progress toward understanding and addressing cancer disparities among AIs. Looking ahead, the group plans to create a community advisory board and expand its work to include partnerships with Tribes in other states. By combining research, education, and community outreach, SAICEP aims to ensure AI communities have the tools and resources they need to fight cancer

Spontaneous Coronary Artery Dissection (SCAD): Unveiling the Enigma of the Unexpected Coronary Event

PURPOSE OF REVIEW: Spontaneous coronary artery dissection (SCAD) is an underrecognized cause of acute coronary syndrome, primarily affecting younger women without traditional risk factors. This review synthesizes current knowledge, identifies research gaps, and explores how precision medicine can improve diagnosis, treatment, and patient outcomes. RECENT FINDINGS: SCAD is clinically and biologically heterogeneous, with variation in presentation, etiology, and recurrence risk. Contributing factors include sex-specific hormonal differences, vascular abnormalities, genetic predisposition, psychosocial stressors, and social determinants of health. Despite growing awareness, major gaps persist in risk stratification and tailored care. Emerging tools, including genomics, radiomics, and multiomics, offer opportunities to define SCAD subtypes and personalized management. SUMMARY: A precision medicine framework integrating molecular, imaging, and social data may transform SCAD care. Continued research is essential to improve early detection, optimize therapy, and reduce recurrence

Assessing the effect of insecticide-treated cattle on tsetse abundance and trypanosome transmission at the wildlife-livestock interface in Serengeti, Tanzania

In the absence of national control programmes against Rhodesian human African trypanosomiasis, farmer-led treatment of cattle with pyrethroid-based insecticides may be an effective strategy for foci at the edges of wildlife areas, but there is limited evidence to support this. We combined data on insecticide use by farmers, tsetse abundance and trypanosome prevalence, with mathematical models, to quantify the likely impact of insecticide-treated cattle. Sixteen percent of farmers reported treating cattle with a pyrethroid, and chemical analysis indicated 18% of individual cattle had been treated, in the previous week. Treatment of cattle was estimated to increase daily mortality of tsetse by 5–14%. Trypanosome prevalence in tsetse, predominantly from wildlife areas, was 1.25% for T. brucei s.l. and 0.03% for T. b. rhodesiense. For 750 cattle sampled from 48 herds, 2.3% were PCR positive for T. brucei s.l. and none for T. b. rhodesiense. Using mathematical models, we estimated there was 8–29% increase in mortality of tsetse in farming areas and this increase can explain the relatively low prevalence of T. brucei s.l. in cattle. Farmer-led treatment of cattle with pyrethroids is likely, in part, to be limiting the spill-over of human-infective trypanosomes from wildlife areas

The public health implications for regulating tobacco products

The FDA has the regulatory authority to implement tobacco product standards. Because nicotine is the primary reinforcing constituent in cigarettes, researchers have proposed implementing a very low nicotine product standard for cigarettes as a potential harm reduction strategy. Reducing the level of nicotine in cigarettes could enable more current smokers to quit by reducing nicotine dependence, decrease the number of adolescents who transition from cigarette experimentation to nicotine dependence, and allow those who want to continue smoking more of a choice to smoke. However, a low nicotine product standard in cigarettes may cause smokers to seek alternative nicotine sources to satisfy their nicotine addiction. Ideally, they would select nicotine replacement therapies but for those who are unwilling or unable to stop using tobacco they may choose other tobacco products to fill their nicotine void. Depending on which product(s) they select, switching to another tobacco product(s) could have a net positive public health impact. There is a continuum of harm for tobacco products. By selectively regulating other tobacco products, the FDA can shift consumers away from the most dangerous products and allow for the continued use of less harmful products. In a regulated cigarette environment, what are the potential public health risks and benefits of using other tobacco products? This essay will describe little cigars/cigarillos, snus, and electronic nicotine delivery systems (ENDS) as examples of tobacco products across the continuum of harm and provide recommendations on how the FDA can regulate these tobacco products in order to maximize the public health impact of a reduced nicotine product standard in cigarettes. Little cigars/cigarillos should be regulated in a manner similar to cigarettes in order to move smokers away from combustible products. Oral tobacco products and ENDS are likely less harmful products. If regulated effectively, they could be viable alternative nicotine sources. The FDA will need to carefully consider the potential benefits and negative health consequences for each of these products

The Influence of Alpaca Assisted Activities on Individuals with a Dual Diagnosis of Down Syndrome and Autism Spectrum Disorder

Occupational therapy addresses mental health, sensory needs, physical abilities, and socio-emotional skills for individuals across the lifespan. This can include animal assisted therapy, such as utilizing dogs for sensory benefits and improved well-being in a variety of settings. Based on previous research with animal-assisted activities (AAA), there is a lack of studies involving exotic animals, such as alpacas, in a natural setting, as well as a lack of research on the population consisting of a dual diagnosis of Down Syndrome and Autism Spectrum Disorder (DS-ASD) and their sensory and socio-emotional needs. Therefore, the aim of this study was to explore the influence of Alpaca Assisted Activities (AAA) on individuals with a dual diagnosis of DS-ASD and to determine whether AAA is a beneficial form of therapy for improving social and emotional behavior within this population. We believed that AAA with alpacas would improve quality of life, promote well-being, and enhance the socio-emotional skills of individuals with DS-ASD. In this pilot study, we observed the behaviors of two nonverbal teenage boys with a dual diagnosis of DS-ASD in their homes before and after the intervention. In addition, we strove to better understand the mothers’ perspectives of the value of the intervention. The intervention consisted of plans for Alpaca Assisted Activities held weekly across a four-weeks period at a local alpaca farm. The activities included petting, feeding, and walking the alpacas. While one researcher observed and recorded the frequency of behaviors during interactions with the alpaca, the other researcher assisted each boy one-on-one during the sessions. Researchers switched roles but either observed or interacted with the same boy throughout the study. Findings from parental interviews and systematic observations of participants revealed that alpaca-assisted activities were positively associated with social behaviors including initiating social interactions, increased gentle touches, and changes in mood reflected by smiles and laughter. Implications of the findings for continued research and clinical practice in animal-assisted activities and dual diagnosis DS-ASD are discussed