Smokers are highly reactive to smoking-related cues that are directly linked, or most proximal, to actual smoking behavior (e.g., lit cigarettes). However, over the course of smoking, proximal cues may not be the only stimuli to become strongly associated with smoking. Distal cues, such as the environments in which smoking occurs (e.g., bar) might also gain associative properties and come to evoke robust reactivity from smokers. To test this, a pilot study was first conducted to develop standard pictorial stimuli of smoking and nonsmoking environments, all of which were completely devoid of proximal smoking cues. A comparison set of smoking and nonsmoking proximal cues was then created. Using the 12 total pictorial cues developed, 62 adult smokers participated in a cuereactivity study during which they viewed and rated pictorial smoking and nonsmoking environment and proximal cues. Results demonstrate that, similar to proximal cues, environments associated with smoking can alone function as stimuli capable of evoking strong subjective reactivity from smokers. This work supports a broader conceptualization of drug-related cues in cue-based research and treatment development that includes proximal and distal cues as distinct categories. Keywordscraving; cue reactivity; proximal and distal stimuli; environments; smoking Cue-based research offers a wealth of information regarding how smokers respond to smokingrelated stimuli, or cues, associated with past cigarette use. Studies aimed at eliciting responses to such cues in smokers typically employ a paradigm in which smokers are exposed to smokingand nonsmoking-related stimuli through in vivo (e.g., watching someone smoke), imaginal (e.g., imagining smoking scenes), audio (e.g., hearing a description of smoking), and less commonly video (e.g., seeing a film of someone smoking), and/or pictorial (e.g., viewing pictures of smoking-related paraphernalia) stimulus modes. On balance this research has revealed that, regardless of presentation mode, smokers consistently show robust subjective

Pictorial representations of specific environments related to smoking can evoke robust craving to smoke, even in the absence of any proximal cues to smoke (e.g., cigarettes, lighters.) To evaluate the salience of smoking environment cues, we developed a novel procedure for bringing smokers’ real world smoking and nonsmoking environments into the laboratory to compare them with standard (i.e. not personalized) environments within a cue-reactivity paradigm. Seventy-two smokers used digital cameras to take pictures of the environments in which they do and do not smoke. They then completed a cue-reactivity session during which they viewed and rated pictures of smoking and nonsmoking environments, half personal and half standard, all devoid of proximal smoking cues. As hypothesized, personal environments led to a significantly larger smoking-nonsmoking difference in craving, compared with the standard environments. Personalization also enhanced stimuli vividness, relevance, positive affect, and excitement, as well as heart rate changes from baseline. Implications of these findings for exposure-based research and treatment for addiction, as well as other psychological disorders, are discussed.

introduction: Recent research has identified that the environments in which smoking has previously occurred can alone, in the absence of any explicit smoking stimuli (e.g., cigarettes, lighters), serve as cues that induce robust craving to smoke. The goal of the present study was to determine if people can similarly function as smoking and nonsmoking cues capable of directly affecting smokers' cue-induced craving.

Context: A changing public health landscape requires local governmental health departments (LHDs) to have a workforce prepared to meet complex challenges. While previous assessments looked at organizational data on the LHD workforce, the Public Health Workforce Interests and Needs Survey (PH WINS) is the first nationally representative survey to examine individual perceptions of training needs, workplace environment, job satisfaction, and awareness of emerging concepts in public health. Objectives: Characterize key interests and needs of the local governmental public health workforce. Design: Survey invitations were sent to individual LHD employees on the basis of a stratified sampling approach. The LHDs had to employ a minimum of 25 staff and serve a population of 25 000 or greater to be eligible for inclusion. Setting: 399 LHDs across the United States. Participants: A total of 26 533 LHD employees completed the survey (59% response rate). Results: The majority of local public health workers are female (81%, 95% confidence interval [CI]: 78%-84%) and white non-Hispanic (68%, 95% CI: 64%-72%). Of the nearly quarter of workers who declared an intent to leave within the next year excluding retirement (22%, 95% CI: 19%-25%), the most common reasons included pay (46%, 95% CI: 42%-50%), lack of opportunities for advancement (40%, 95% CI: 38%-50%), and workplace environment (30%, 95% CI: 27%-32%). Across jurisdiction size and supervisory level, skills gaps were noted in budget and financial management, systems and strategic thinking, developing a vision for a healthy community, and change management. Conclusions: As the first nationally representative sample of the local governmental public health workforce, these data create a national benchmark against which LHDs can measure their workforce. Given the similarities found across LHDs serving different jurisdiction sizes, a unified approach to workforce development should be employed across all LHDs. The LHD leadership should address retention, reward creativity and innovation, improve communication between leadership and employees, and provide opportunities for advancement.