Segmentation analysis of the unvaccinated US adult population 2 years into the COVID-19 pandemic,1 December 2021 to 7 February 2022

Objective We performed a segmentation analysis of the unvaccinated adult US population to identify sociodemographic and psychographic characteristics of those who were vaccine accepting,vaccine unsure and vaccine averse.Design Cross-sectional.Setting Nationally representative,web-based survey.Participants 211303 participants aged≥18 years were asked in the Household Pulse Survey conducted during 1 December 2021 to 7 February 2022,whether they had ever received a COVID-19 vaccine.Those answering‘No’were asked their receptivity to the vaccine and their responses were categorised as vaccine averse,unsure and accepting.Adjusted prevalence ratios(APR)were calculated in separate multivariable Poisson regression models to evaluate the correlation of the three vaccine dispositions.Results Overall,15.2%of US adults were unvaccinated during 1 December 2021 to 7 February 2022,ranging from 5.8%in District of Columbia to 29.0%in Wyoming.Of the entire unvaccinated population nationwide,51.0%were vaccine averse,35.0%vaccine unsure and 14.0%vaccine accepting.The likelihood of vaccine aversion was higher among those self-employed(APR=1.11,95%CI 1.02 to 1.22)or working in a private company(APR=1.09,95%CI 1.01 to 1.17)than those unemployed;living in a detached,single-family house than in a multiunit apartment(APR=1.15,95%CI 1.04 to 1.26);and insured by Veterans Affairs/Tricare than uninsured(APR=1.22,95%CI 1.01 to 1.47).Reasons for having not yet received a vaccine differed among those vaccine accepting,unsure and averse.The percentage reporting logistical or access-related barriers to getting a vaccine(eg,difficulty getting a vaccine,or perceived cost of the vaccine)was relatively higher than those vaccine accepting.Those vaccine unsure reported the highest prevalence of barriers related to perceived safety/effectiveness,including wanting to‘wait and see’if the vaccines were safe(45.2%)and uncertainty whether the vaccines would be effective in protecting them from COVID-19(29.6%).Those vaccine averse reported the highest prevalence for barriers pertaining to lack of trust in the government or in the vaccines(50.1%and 57.5%respectively),the perception that COVID-19 was not that big of a threat(32.2%)and the perception that they did not need a vaccine(42.3%).

Utilisation of smoking cessation aids among South African adult smokers:findings from a national survey of 18208 South African adults

Objective To examine the use of different cessation aids among current South African smokers who have ever tried to quit smoking.Design Cross-sectional design.Setting South Africa has progressively passed several policies over the past few decades to encourage smoking cessation.Data on cessation behaviours are needed to inform policymaking.We investigated utilisation of evidence-based cessation aids and e-cigarettes among current combustible smokers.Current tobacco use,past quit attempts and use of evidence-based cessation aids(counselling,nicotine replacement therapy or prescription medication)were self-reported.Data were weighted and analysed using descriptive and multivariable approaches(p<0.05).Participants Online participants were recruited from the national consumer database for News24-South Africa’s largest digital publisher.Of the 18208 participants aged 18 years or older,there were 5657 current smokers of any combustible tobacco product(cigarettes,cigars,pipes or roll-your-own cigarettes),including 4309 who had ever attempted to quit during their lifetime.Results Current combustible tobacco smoking prevalence was 22.4%(95%CI:21.2%to 23.5%),and 98.7%of all current smokers of any combustible tobacco were current cigarette smokers.Awareness of cessation aids was as follows among current combustible tobacco smokers:smoking cessation counselling programmes,50.8%(95%CI:48.1%to 53.6%);nicotine replacement therapy,92.1%(95%CI:90.5%to 93.6%);prescription cessation medication,68.2%(95%CI:65.2%to 70.6%).Awareness of cessation aids was lowest among Black Africans,men,and persons with little or no income.Of all current combustible tobacco smokers,74.6%(95%CI:72.2%to 76.7%)had ever attempted to quit and 42.8%(95%CI:40.0%to 45.4%)of these quit attempters had ever used any cessation aid.Among current combustible smokers who attempted to quit in the past,ever e-cigarette users were more likely than never e-cigarette users to have ever used any cessation aid(50.6%vs 35.9%,p<0.05).Of current combustible smokers intending to quit,66.7%(95%CI:64.2%to 68.9%)indicated interest in using a cessation aid for future quitting.By specific aids,24.7%(95%CI:21.3%to 28.1%)of those planning to use any cessation aid were interested in getting help from a pharmacist,44.6%(95%CI:40.9%to 48.4%)from a doctor,49.8%(95%CI:46.0%to 53.6%)from someone who had successfully quit,30.0%(95%CI:26.7%to 33.4%)from a family member and 26.5%(95%CI:23.0%to 30.0%)from web resources.Conclusion Only two in five past quit attempters had ever used counselling/pharmacotherapy.Any putative benefits of e-cigarettes on cessation may be partly attributable to pharmacotherapy/counselling given concurrent use patterns among past quit attempters using e-cigarettes.Comprehensive tobacco control and prevention strategies can help reduce aggregate tobacco consumption.

Medical use and misuse of psychoactive prescription medications among US youth and young adults

Objective To investigate prevalence and correlates of medical use and misuse of psychoactive prescription medications among US youth and young adults.Design Cross-sectional,self-reported surveys from the 2015-2018 National Survey of Drug Use and Health.Sampling was probabilistic and nationally representative.Setting The target population included individuals from households,non-institutional group quarters(eg,college dormitories)and civilians living on military bases.Questionnaires were completed using computer-assisted self-interview methods.Participants Our analytical sample included youth and young adults aged 12-25 years(n=110556).Psychoactive prescription medication misuse was a report by the respondent that they had used psychoactive prescription medications in the past year in any way not directed or prescribed for them.Medical use was defined as past-year use without a report of misuse.Because certain variables were assessed only among adults,our multivariable analysis to identify correlates of misuse was restricted to young adults aged 18-25 years(n=55690).Results Among US youth aged 12-17 years,25.0%reported use of any psychoactive prescription medication assessed,and 5.7%reported past-year use of at least two psychoactive prescription medications.Among youth who used any psychoactive prescription medications,20.9%(1.3 million)reported misuse;3.4%were classified as having substance use disorder.Past-year use of each psychoactive prescription medication was:opioids(19.0%),stimulants(7.2%),tranquillisers(4.3%)and sedatives(2.2%).Among users of each psychoactive prescription medication,the estimated percentage reporting misuse was as follows:opioids(17.6%,0.8 million),stimulants(24.2%,0.4 million),tranquillisers(40.1%,0.4 million)and sedatives(14.2%,80000).Among users of each psychoactive prescription medication,the estimated percentage having substance use disorder was as follows:opioids 2.6%,stimulants 3.0%,tranquillisers 7.0%and sedatives 3.6%.Analyses among young adults aged 18-25 years revealed that,compared with never users of non-prescription substances(including alcohol,tobacco,marijuana,cocaine,heroin),opioid misuse increased with:more recent use of non-prescription substances(adjusted prevalence ratios(APRs)=8.26,2.75 and 2.41 for past≤30-day,≤12-month and>12-month use,respectively);and a higher number of substances used(APRs=1.69,3.44,6.82,10.60 and 20.60 for 1,2,3,4 and 5+substances,respectively)(all p<0.05).Similar patterns were seen for stimulants,tranquillisers and sedatives.Conclusions It is important to monitor the diversity of medication misuse behaviours among youth and young adults,given their potential for abuse liability.Modifiable risk factors for prescription substance misuse,such as tobacco and other non-prescription substance use,underscore the need for comprehensive approaches towards health promotion among youth and young adults.

Depression,periodontitis,caries and missing teeth in the USA,NHANES 2009-2014

Purpose This study aimed to investigate the association between self-reported depressive symptoms and oral diseases in US adults,including periodontitis,caries,missing teeth and untreated dental caries.Design This study was designed as a secondary data analysis of a cross-sectional survey.We conducted descriptive,multivariable logistic and Poisson regression analyses on weighted data.Setting US National Health and Nutrition Examination Survey 2009-2014 data.Participants Individuals aged≥30 years who completed a periodontal examination and depression screening(n=9799).Results 21.6%(28.9 million)of adults aged≥30 years reported depressive symptoms,with a higher prevalence among females,current smokers and participants with lower income and education status.More than half of the adults with moderate depressive symptoms had periodontal diseases,and more than one-third had teeth with untreated dental caries.After adjusting for sociodemographics,behavioural factors,having diabetes and psychotherapeutic medication use,depressive symptoms were associated with poorer oral health.Severe depressive symptoms were associated with higher odds of mild periodontitis(2.20;99%CI 1.03 to 4.66).For those with mild depressive symptoms,the mean number of missing teeth was 1.20(99%CI 1.06 to 1.37)times the average of non-symptomatic individuals;and 1.38 times(99%CI 1.15 to 1.66)among individuals with moderate depressive symptoms.Conclusions Depressive symptoms were associated with mild periodontitis and a greater number of missing teeth,while having teeth with untreated dental caries was attributed to sociodemographic factors.Awareness of oral health status among patients with depressive symptoms can inform both dental and mental health providers to develop tailored treatment and help patients achieve overall wellness.