Research on adult tobacco use consistently shows a higher prevalence among lesbian/gay/bisexual/transgender (LGBT) populations than among the general population-reasons why are largely unknown, and counterstrategies are critical. Tobacco industry marketing, uncovered when the Master Settlement Agreement (MSA) forced companies to share its internal documents, provided insight. The American Legacy Foundation uncovered the industry campaign Project SCUM (Sub-Culture Urban Marketing) aimed at gays and the homeless. The formerly secret documents revealed specific marketing toward LGBT, whose rates increased when the MSA banned youth (but not other population) advertising. The industry reaches out to LGBT persons through direct and indirect advertising, community outreach, and sponsorships. Messages to LGBT have been relatively absent from advertising until recently, creating receptivity to such overtures. Reducing LGBT smoking rates is a public health challenge that will require exceeding the sense of validation tobacco advertising has created in LGBT communities.

Fragile X syndrome (FXS) is primarily due to a repeat expansion mutation found in the FMR1 X-linked gene. We have conducted a qualitative analysis of responses from women concerning their attitudes toward testing for carrier status of the fragile X mutation among reproductive-age women. We obtained responses from focus groups including women with and without FXS in their families. We found the following themes: (1) mothers of children with FXS have difficulty formulating their opinions on population screening because of their unique experiences surrounding their own carrier diagnosis and their relationship with their children with FXS, (2) the motivation for carrier testing and need for information differ by family history of FXS and parental status, and (3) the timing of carrier testing with respect to a woman's life stage dictates whether carrier information will be viewed as beneficial or detrimental. There was evidence that non-carrier women from the general population would be wholly unprepared for positive carrier results. These findings have significant implications for genetic counseling as well as for population screening.

Summary The growing success of solid organ transplantation poses unique challenges for the implementation of effective immunization strategies. Although live attenuated vaccines have proven benefits for the general population, immunosuppressed patients are at risk for unique complications such as infection from the vaccine because of lack of both clearance and containment of a live attenuated virus. Moreover, while vaccination strategies using killed organisms or purified peptides are believed to be safe for immunosuppressed patients, they may have reduced efficacy in this population. The current lack of knowledge of the basic safety and efficacy of vaccination strategies in the immunosuppressed has limited the development of guidelines regarding vaccination in this population. Recent fears of influenza pandemics and potential attacks by weaponized pathogens such as smallpox heighten the need for increased knowledge. Herein, we review the current understanding of the effects of immunosuppressants on the immune system and the ability of the suppressed immune system to respond to vaccination. This review highlights the need for systematic, longitudinal studies in both humans and nonhuman primates to understand better the defects in innate and adaptive immunity in transplant recipients, thereby aiding the development of strategies to vaccinate these individuals.

Fragile X syndrome is primarily due to a CGG repeat expansion found in the FMR1 X-linked gene. In a previous study, we conducted focus groups with women to assess their attitudes towards fragile X carrier screening. In this follow-up study, we conducted in-depth interviews of general population reproductive-age women who were identified as carriers. We explored their attitudes toward testing for carrier status of the fragile X mutation. These women underwent screening primarily to participate in a research project rather than in search of a diagnosis for specific symptoms. As such, these women were wholly unprepared for positive carrier results. Their responses about their results and carrier screening, in many cases, were being worked out over the course of the interview itself. The most salient finding of this work is the apparent lack of relevance of carrier status to these women. Many expressed that although the information could be relevant in the future, it is not relevant at this stage of their lives in terms of family planning (either with respect to having unaffected offspring or to premature ovarian failure) and personal relationships. Although issues of abortion seemed prominent in the focus groups, we found that carrier status did not have an apparent effect on women's attitudes about termination. We hypothesize this may be related to the fact that women had not processed their new carrier status and had not related it to previously-formed personal opinions. The findings of this work have significant implications for genetic counseling and population screening. Genetic counselors should be mindful that general population women may not recognize the immediate importance of their carrier status even when literature is provided and discussed prior to providing a sample. As part of comprehensive genetic counseling, counselors should identify the reproductive life stage of the woman receiving the new information and help her identify when this information would be more meaningful in her life. Counselors can assist in setting up a personalized road map with specific types of services that will be more applicable to the woman as her carrier status becomes more relevant.

Prior to the coronavirus disease 2019 pandemic, marriage and divorce had been in decline across the United States. As more data are released, evidence mounts that this pattern has persisted, and in some states been magnified, during the pandemic. The authors compared the change in yearly marriage and divorce counts prior to the beginning of the pandemic (change from 2018 to 2019) to estimate an expected number of marriages and divorces for 2020. By computing a P score on the basis of expected and observed marriages and divorces in 2020, the authors determined whether individual states experienced shortfalls or surpluses of marital events. Of the 20 states with available data on marriages, 18 experienced shortfalls (exceptions included Missouri and North Dakota), for an overall sample shortfall of nearly 11 percent. Regarding divorces, 31 of the 35 states with available data also experienced shortfalls (exceptions included Hawaii, Wyoming, Arizona, and Washington), for an overall sample shortfall of 12 percent.