Electronic nicotine delivery systems (ENDS) use, including e-cigarettes, has surpassed the use of conventional tobacco products. Emerging research suggests that susceptibility to e-cigarette use is associated with actual use among adolescents. However, few studies exist involving adolescents in high-risk, rural, socioeconomically distressed environments. This study examines susceptibility to and subsequent usage in school-going adolescents in a rural distressed county in Appalachian Tennessee using data from an online survey (N = 399). Relying on bivariate analyses and logistic regression, this study finds that while 30.6% of adolescents are ever e-cigarette users, 15.5% are current users. Approximately one in three adolescents are susceptible to e-cigarettes use, and susceptibility is associated with lower odds of being a current e-cigarette user (OR = 0.03; CI: 0.01–0.12; p < 0.00). The age of tobacco use initiation was significantly associated with decreased current use of e-cigarettes (OR = 0.89; CI: 0.83–0.0.97; p < 0.01). Overall, the results of this exploratory study suggest the need for larger studies to identify unique and generalizable factors that predispose adolescents in this high-risk rural, socioeconomically disadvantaged region to ENDS use. Nevertheless, this study offers insight into e-cigarette usage among U.S adolescents in rural, socioeconomically disadvantaged environments and provides a foundation for a closer examination of this vulnerable population.

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Introduction: The United States Centers for Disease Control and Prevention (CDC) issued behavioral recommendations to limit the spread of the novel coronavirus disease-2019 (COVID-19). No studies have examined the influence of various factors on adherence to COVID-19 preventive measures. Among individuals with co-morbidities, such as cardiovascular disease (CVD) and residing in rural communities, adherence is essential as they are at an increased risk of COVID-19 infection and increased disease severity. Objective: This study aims to explore factors influencing adherence to evidence-based recommendations for preventing COVID-19 among patients/family caregivers with CVD in rural Central Appalachia. Methods: During March-April 2020, 102 CVD Stakeholders - patients/family caregivers, community leaders, and providers from six states across Appalachia participated in a survey administered through REDCap. This study used a subsample (n=73) that excluded providers. Adherence score was defined as the rate of compliance with health authorities’ guidelines, including handwashing, physical distancing, staying home if sick, wearing a face mask, disinfecting and cleaning daily, and cough and sneezing etiquette. Simple and multiple linear regressions were performed to examine associations between adherence scores and variables of interest. Results: Over half (53.42%) of participants complied with all guidelines. Gender, employment status, hypertension, smoking, no insurance, getting information about COVID-19 from Government/CDC website, and getting information about COVID-19 from worship place/club were significantly associated with adherence to CDC recommendations (p<0.05). Compared to low personal perception of threat (PPT), having no and high PPT were associated with lower and higher adherence scores, respectively (β= -2.32, 1.42; p=0.001). Compared to low perception of COVID-19 threat towards family/friends, having moderate or high perception of COVID-19 threat toward family/friends was associated with improved adherence (β= 1.3, 1.57; p<0.05 for both), whereas having no perception was negatively associated with adherence (β= -2.08, p=0.003). Moderate and high perception of COVID-19 threat toward one's community (β= 2.14, 2.06; p<0.001) were likewise associated with higher adherence. R squared for the model= 0.459. Conclusion: Moderate and high perceptions of COVID-19 threats are associated with higher adherence, whereas no perception was associated with lower adherence with health authority recommendations for COVID-19 prevention. These factors should be considered in order to develop effective adherence interventions for CVD stakeholders in rural communities. Results should be confirmed in a larger study.

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We aimed to investigate the association between either or both of benzodiazepines (BZDs) and non-BZDs and the incidence of atrial fibrillation (AF) in the Taiwan National Health Insurance Database. The participants with at least two prescriptions of BZDs and/or non-BZDs were identified as hypnotics users, whereas those without any prescription of hypnotics were non-hypnotics users. The hypnotics and non-hypnotics cohorts were 1:1 matched on their propensity scores. A total of 109,704 AF-free individuals were included; 610 AF cases occurred in the 54,852 hypnotics users and 166 in the 54,852 non-hypnotics users during the 602,470 person-years of follow-up, with a higher risk of new-onset AF in the users than the non-users (hazard ratio (HR): 3.61, 95% confidence interval [CI]: 3.04–4.28). The users at the highest tertiles of the estimated defined daily doses per one year (DDD) had a greater risk for AF than the non-users, with the risk increasing by 7.13-fold (95% CI: 5.86–8.67) for >0.74-DDD BZDs, 10.68-fold (95% CI: 6.13–18.62) for >4.72-DDD non-BZDs, and 3.26-fold (95% CI: 2.38–4.47) for > 1.65-DDD combinations of BZDs with non-BZDs, respectively. In conclusion, hypnotics use was associated with elevated incidence of AF in the Taiwanese population, which highlighted that the high-dose usage of hypnotics needs more caution in clinical cardiological practice.