Introduction Changing social norms on cigarette smoking are proposed as a primary strategy to reduce smoking behaviour. Methods Using core questions in 30 years of tobacco use supplements (TUS) to the Current Population Survey (CPS), we develop a state-specific, injunctive social norm scale of Willingness to Restrict Smoking (WTRS) and test its association with smoking behaviours. Respondents (n=1 462 050) to US national and state representative TUS-CPS conducted at nine regular intervals from 1992 to 2022. Results Respondents were queried on their WTRS in 10 different settings, which varied somewhat over time. Psychometric analyses of 10 items supported a single primary dimension that accounted for 74% (SD: 7.3%) of estimated common variance. Using item response theory methods, we calibrated scores across different years and demonstrated consistency of measurement over time (differential test functioning (DTF) across adjacent years = <1% difference in scores). The resulting WTRS scale had good reliability (omega-h mean = 0.75, SD=0.04 and alpha mean =0.81, SD=0.03). Construct and concurrent validity of the scale were shown with regression analyses with outcomes of current cigarette smoking (p<0.001) and presence of home smoking restrictions (p<0.001). An 87% correlation between state-averaged smoking prevalence and WTRS score was observed over the 30-year period. The adjusted OR (AOR) of being a person who smokes for people in states with the lowest versus highest quartiles of states for the WTRS score was 0.74 (95% CI 0.69 to 0.76) which can be compared with the same OR between the lowest and highest quartiles of cigarette prices. (AOR=0.84, 95% CI 0.84 to 0.92). Conclusions This WTRS social norm scale was likely influenced by state tobacco control programmes targeting social norms and appears to be a strong indicator of declining smoking prevalence across 30 years of US data.

OBJECTIVE:To investigate the association of state-level cigarette price and tobacco control expenditure with the large 2000-2019 decline in cigarette smoking among US 18-24 year-olds. METHODS:Smoking behaviour was assessed in the 24 most populous US states using the 1992-2019 Tobacco Use Supplements to the Current Population Survey; association with price and expenditure was tested using adjusted logistic regression. States were ranked by inflation-adjusted average price and tobacco control expenditure and grouped into tertiles. State-specific time trends were estimated, with slope changes in 2001/2002 and 2010/2011. RESULTS:Between 2000 and 2010, the odds of smoking among US young adults decreased by a third (adjusted OR, AOR 0.68, 95% CI 0.56 to 0.84). By 2019, these odds were one-quarter of their 2000 level (AOR 0.24, 95% CI 0.19 to 0.31). Among states in the lowest tertile of price/expenditure tobacco control activity, initially higher young adult smoking decreased by 13 percentage points from 2010 to 2018-2019, to a prevalence of 5.6% (95% CI 4.5% to 6.8%), equal to that in the highest tobacco-control tertile of states (6.5%, 95% CI 5.2% to 7.8%). Neither state tobacco control spending (AOR 1.0, 95% CI 0.999 to 1.002) nor cigarette price (AOR 0.96, 95% CI: 0.92 to 1.01) were associated with young adult smoking in statistical models. In 2019, seven states had prevalence over 3 SDs higher than the 24-state mean. CONCLUSION:National programmes may have filled a gap in state-level interventions, helping drive down the social acceptability of cigarette smoking among young adults across all states. Additional interventions are needed to assist high-prevalence states to further reduce smoking.

Objective To compare trends in cigarette smoking and nicotine vaping among US population aged 17–18 years and 18–24 years. Methods Regression analyses identified trends in ever and current use of cigarettes and e-cigarettes, using three US representative surveys from 1992 to 2022. Results From 1997 to 2020, cigarette smoking prevalence among those aged 18–24 years decreased from 29.1% (95% CI 27.4% to 30.7%) to 5.4% (95% CI 3.9% to 6.9%). The decline was highly correlated with a decline in past 30-day smoking among those aged 17–18 years (1997: 36.8% (95% CI 35.6% to 37.9%; 2022: 3.0% (95% CI 1.8% to 4.1%). From 2017 to 2019, both ever-vaping and past 30-day nicotine vaping (11.0% to 25.5%) surged among those 17–18 years, however there was no increase among those aged 18–24 years. Regression models demonstrated that the surge in vaping was independent of the decline in cigarette smoking. In the 24 most populous US states, exclusive vaping did increase among those aged 18–24 years, from 1.7% to 4.0% to equivalent to 40% of the decline in cigarette smoking between 2014–15 and 2018–19. Across these US states, the correlation between the changes in vaping and smoking prevalence was low (r=0.11). In the two US states with >US$1/fluid mL tax on e-cigarettes in 2017, cigarette smoking declined faster than the US average. Conclusions Since 1997, a large decline in cigarette smoking occurred in the US population under age 24 years, that was independent of the 2017–19 adolescent surge in past 30-day e-cigarette vaping. Further research is needed to assess whether the 2014–15 to 2018–19 increase in exclusive vaping in those aged 18–24 years is a cohort effect from earlier dependence on e-cigarette vaping as adolescents.

Importance:There are still significant population-level health consequences of cigarette smoking in US states. Objective:To estimate whether differential sociodemographic trends in smoking prevalence since 1992 will close the prevalence gap between states by 2035. Design, Setting, and Participants:This cross-sectional study included data from 18 repeated, state-representative US Tobacco Use Supplement to the Current Population Surveys (TUS-CPS) from 1992 to 2022. Data were analyzed between June and October 2024. Main Outcomes and Measures:Nonlinear time series trends in smoking prevalence in US states from 1992 to 2022 were projected through 2035 and compared with recommended targets. States were grouped into tertiles using their 1990s prevalence. Differential change in sociodemographic groups were compared across tertiles. Results:The 18 surveys comprised 1 770 442 respondents (997 569 female [56.3%]; 146 865 Hispanic [8.3%], 160 751 non-Hispanic Black [9.1%], and 1 373 454 non-Hispanic White [78.0%]). From 1992 to 2022, all state tertiles experienced significant declines in smoking prevalence, each decreasing by approximately 13 percentage points from 2001 to 2022. In 2022, prevalence was 7.4% (95% CI, 6.9% to 7.9%) in tertile 1 (lowest 1990s prevalence), 10.0% (95% CI, 9.2% to 10.8%) in tertile 2, and 12.7% (95% CI, 11.9% to 13.4%) in tertile 3. Projections to 2035 indicated the prevalence gap closing between tertiles, to 3.8% (95% CI, 2.6% to 5.1%) in tertile 1, to 5.1% (95% CI, 3.2% to 7.2%) in tertile 2, and to 6.6% (95% CI, 4.8% to 9.1%) in tertile 3. The only sociodemographic trend that reduced the gap occurred among individuals aged 18 to 24 year (tertile 3 change, -21.3% [95% CI, -24.5% to -18.2%] vs tertile 1 change, -16.4% [95% CI, -18.5% to -14.4%]; P = .005). Yet age was not a significant factor in projected changes, as the decline in the group aged 50 years and older was greater in tertile 1 than 3 (-4.7% [95% CI, -5.7% to -3.8%] vs -2.3% [95% CI, -3.5% to -1.2%]; P < .001). By 2035, only 4 states (California, Utah, Hawaii, and Colorado) were projected to be significantly under the recommended target of 5% prevalence. Conclusions and Relevance:The findings of these repeated cross-sectional surveys suggest that the difference in cigarette smoking prevalence between historically high vs low prevalence states will shrink by 2035, primarily from much faster declines among young adults in the traditionally highest prevalence states. Slower prevalence declines among older adults are likely to slow the decline in health consequences in these states.

BACKGROUND:Tobacco use among United States (US) youth and young adults has declined from historic levels, but cannabis use has not. The importance of cannabis use as a risk factor for tobacco initiation is not known. METHODS:The association between past 12-month cannabis use in 2017 (study exposure; wave 4) and new-onset regular tobacco use in 2021 (study outcome; wave 6) was examined in a prospective representative US cohort aged 12-24 years who had never regularly used tobacco. Exposed respondents were propensity score matched to unexposed controls on demographics, tobacco use history, perceived harmfulness of cigarettes, mental health symptoms and other measures. RESULTS:Among these US youths aged 12-17 years who used cannabis, 32.7% (95% CI: 28.9% to 36.7%) progressed to regular tobacco use in 2021, an increase of 15.6 percentage points (pp) (95% CI: 11.1 pp to 20.2 pp) compared with their matched controls. Among the young adults aged 18-24 years, 14.0% (95% CI: 11.9% to 16.5%) of cannabis users reported regular tobacco use at follow-up, an increase of 5.4 pp (95% CI: 2.6 pp to 8.2 pp) over their matched controls. The matching analysis attributed 13.0% of total new regular tobacco use in the US to cannabis (the population attributable fraction), and estimated that in the absence of cannabis, 509 800 fewer US youth and young adults would have progressed to regular tobacco use in 2021. CONCLUSION:Among US youth and young adults who had never regularly used tobacco, cannabis use in 2017 was associated with a large increase in current regular tobacco use in 2021.

PURPOSE:Clinical guidelines recommend offering individualized physical activity prescriptions to cancer survivors. However, there are limited tools to support individualized physical activity discussions and prescriptions. We developed and validated a simulation model-based tool to estimate individualized survival outcomes for postdiagnosis physical activity among postmenopausal breast cancer survivors. METHODS:We adapted an established simulation modeling approach developed within the Cancer Intervention and Surveillance Modeling Network to estimate breast cancer-specific and all-cause survival associated with postdiagnosis physical activity for 50- to 75-year-old (postmenopausal) women with stage I to III invasive breast cancer. Model estimates were generated for 60,480 subgroups based on age, weight status (BMI), stage, tumor subtype, treatment, aerobic (<30 min/wk [no/minimal], ≥30 to <150 min/wk [insufficient], ≥150 to <300 min/wk [active], ≥300 min/wk [highly active]), and muscle-strengthening (<2 or ≥2 d/wk) activity. The outcomes were 10-year survival and absolute survival benefits for different levels of physical activity by individual characteristics and treatment. Model inputs were derived from trials, cohort studies, registry, and surveillance data. External validation used independent data. RESULTS:Survival rates and absolute benefits for physical activity varied by age, weight status, stage, tumor subtype, and amount and type of activity. For example, the 10-year breast cancer-specific and all-cause survival for no/minimal activity in a 65- to 69-year-old-woman with stage II, hormone receptor-positive, human epidermal growth factor receptor 2-negative breast cancer with obesity was 79.2% and 72.2%, respectively. Increasing aerobic activity from no/minimal to insufficient activity with <2 d/wk of muscle-strengthening was associated with absolute increases in 10-year breast cancer-specific and all-cause survival by 2.8 and 3.4 percentage points, respectively. The model closely replicated survival rates in independent data. CONCLUSION:Simulation model-based estimates could support clinical tools for guideline-recommended individualized discussions and physical activity prescriptions for breast cancer survivors.

Objective:Proposition 56, a $2 tobacco tax enacted in California in 2016, led to increased funding to Local Lead Agencies which work to reduce tobacco use. We examined whether Proposition 56 was associated with increases in the population covered by local policies addressing four areas: 1) tobacco retail sales (TRS), 2) flavored tobacco products sales (FTP), 3) outdoor secondhand smoke (SHS) restrictions, and 4) smoking restrictions in multi-unit housing (MUH). Methods:2007-2023 data from the Policy Evaluation Tracking System in California were analyzed. The unit of analysis was the California jurisdiction, with outcome the time (in months) to policy enactment in a jurisdiction. Kaplan-Meier estimates and population coverage percentages were calculated by weighing each jurisdiction by its population size. Discrete-time survival models were fitted to test the effect of Proposition 56 on the rate of population coverage for each policy of interest. Results:By January 2023, 79 % of the California population was covered by a local SHS policy but only 55 %, 47 % and 18 % was covered by a local TRS, FTP and MUH policy, respectively. The rate of increase in TRS and FTP policy coverage was greater post-Proposition 56 than pre-Proposition 56 (p < 0.001), while the rate of increase did not change significantly for MUH and SHS policies. Conclusions:Proposition 56 was associated with marked increases in the enactment of TRS and FTP, but not SHS or MUH policies. Despite increases post-Proposition 56, additional efforts are needed to increase local adoption of TRS, FTP and MUH policies because coverage remains low.

Importance:An important public health goal is to increase tobacco cessation, but there is limited research on associations of vaping with tobacco cessation. Objective:To estimate the association of vaping with long-term tobacco cessation among US cigarette smokers who used electronic nicotine delivery systems (ENDS; ie, e-cigarettes) in 2017. Design, Setting, and Participants:This cohort study used a nationally representative sample of US cigarette smokers from the Population Assessment of Tobacco and Health cohort at wave 4 (2017) with follow-up at wave 6 (2021). Data were analyzed from June 2023 to June 2024. Exposure:Wave 4 ENDS use: daily, nondaily, or no use. Main Outcomes and Measures:The primary outcomes were 12 or more months' abstinence from cigarette smoking and 12 or more months' abstinence from both cigarette and ENDS use, ascertained at wave 6. Propensity score matching was used to control confounding on 14 potential confounders, including interest in quitting, income, age, education, nondaily smoking, and presence of a smoke-free home. Results:A total of 6013 smokers were included in the sample (3634 aged ≥35 years [weighted percentage, 65.2%]; 3182 female [weighted percentage, 46.5%]). Among smokers who vaped daily (228 individuals), an estimated 20.9% (95% CI, 15.0% to 26.8%) were abstinent from cigarette smoking at follow-up, compared with 14.3% abstinence (95% CI, 13.0% to 15.5%) among smokers who did not vape (5070 individuals) and 12.6% abstinence (95% CI, 9.8% to 15.4%) among smokers who vaped nondaily (715 individuals). Compared with similar propensity score-matched smokers who did not vape, smoking cessation was 4.1 percentage points lower among those who vaped daily (95% CI, -11.9 to 3.6 percentage points; P = .30), a nonsignificant difference. Smoking cessation was 5.3 percentage points lower among those who vaped nondaily (95% CI, -9.1 to -1.5 percentage points; P = .01) compared with similar propensity score-matched controls. Considering abstinence from both smoking and vaping, compared with matched controls, smokers who vaped daily had lower abstinence at follow-up by 14.7 percentage points (95% CI, -20.2 to -9.2 percentage points; P < .001), and those who vaped nondaily had lower abstinence by 7.2 percentage points (95% CI, -10.7 to -3.8 percentage points; P < .001). Conclusions and Relevance:In this representative cohort study of US smokers who used ENDS, neither daily nor nondaily vaping was associated with increased smoking cessation, and each was associated with reduced tobacco abstinence, suggesting that careful adjustment of confounding is critical in studies of ENDS and smoking cessation.

ABSTRACTBackgroundCurrently, there are no agreed quality standards for post‐stroke aphasia services. Therefore, it is unknown if care reflects best practices or meets the expectations of people living with aphasia. We aimed to (1) shortlist, (2) operationalise and (3) prioritise best practice recommendations for post‐stroke aphasia care.MethodsThree phases of research were conducted. In Phase 1, recommendations with strong evidence and/or known to be important to people with lived experience of aphasia were identified. People with lived experience and health professionals rated the importance of each recommendation through a two‐round e‐Delphi exercise. Recommendations were then ranked for importance and feasibility and analysed using a graph theory–based voting system. In Phase 2, shortlisted recommendations from Phase 1 were converted into quality indicators for appraisal and voting in consensus meetings. In Phase 3, priorities for implementation were established by people with lived experience and health professionals following discussion and anonymous voting.FindingsIn Phase 1, 23 best practice recommendations were identified and rated by people with lived experience (n = 26) and health professionals (n = 81). Ten recommendations were shortlisted. In Phase 2, people with lived experience (n = 4) and health professionals (n = 17) reached a consensus on 11 quality indicators, relating to assessment (n = 2), information provision (n = 3), communication partner training (n = 3), goal setting (n = 1), person and family‐centred care (n = 1) and provision of treatment (n = 1). In Phase 3, people with lived experience (n = 5) and health professionals (n = 7) identified three implementation priorities: assessment of aphasia, provision of aphasia‐friendly information and provision of therapy.InterpretationOur 11 quality indicators and 3 implementation priorities are the first step to enabling systematic, efficient and person‐centred measurement and quality improvement in post‐stroke aphasia services. Quality indicators will be embedded in routine data collection systems, and strategies will be developed to address implementation priorities.Patient and Public ContributionProtocol development was informed by our previous research, which explored the perspectives of 23 people living with aphasia about best practice aphasia services. Individuals with lived experience of aphasia participated as expert panel members in our three consensus meetings. We received support from consumer advisory networks associated with the Centre for Research Excellence in Aphasia Rehabilitation and Recovery and the Queensland Aphasia Research Centre.

BackgroundSeveral programs addressing the long-term impacts of aphasia after stroke show promise. However, barriers restrict their implementation at scale. Hub-and-spoke models of care operate in several health contexts to reduce the health care costs associated with health professionals providing all direct services, and to improve the reach of services to communities at distance from the main service. We developed the Peer-led Hub-and-Spoke Community Aphasia Group (Peer-led HS CAG) program to address staff and service availability barriers. The Peer-led HS CAG organises service through a "Hub" of allied and mental health professionals, led by a speech pathologist, who provide consultative and occasional direct services to the aphasia group. The "spokes" are volunteers with and without aphasia, trained and supported by the "Hub" staff to facilitate groups in the community. AimsWe aimed to investigate the feasibility, acceptability, and preliminary efficacy of the Peer-led HS CAG program to address long-term impacts of aphasia. Methods & ProceduresIn a Phase I, proof of concept, mixed methods design we utilised: (1) a pre-post observational quantitative design; (2) an embedded qualitative study using semi-structured in-depth interviews of group facilitators and participants. Four health professionals from speech pathology, psychology, art therapy, and music therapy formed the Hub. Four volunteers were trained as group facilitators over two, half-day sessions prior to the group programs commencing. The 12-week group programme was delivered twice in a community setting, consisting of weekly 2-hour sessions. Seven people with aphasia attended: four in programme one, three in program two. The group program consisted of four compulsory topic sessions and eight "members choice" sessions. Seven close others attended four of the twelve program sessions: two with their family members with aphasia; two with specific "hub" staff input. During the remaining eight weeks of the program close others chose whether to meet independently. Outcome measures were taken at four time points: 6 weeks pre-program; immediately pre-program; immediately after-program; 6-week follow up. Outcomes & ResultsFour participants showed clinically meaningful gains in communication-related quality of life and three in functional communication immediately post-program or at 6-week follow up. Qualitative interviews confirmed the feasibility and overall acceptability of the program. Close others requested additional sessions specific to their needs. ConclusionsThe Peer-led HS CAG program is a feasible and acceptable way to address the current lack of community aphasia groups. Future phase II and III research should explore the efficacy and costs of this model.

PURPOSE:Carers of people with aphasia face unique challenges. Research has demonstrated that these carers have a higher burden of care and more negative stroke-related outcomes in comparison to carers of stroke survivors without aphasia. The aim of this scoping review was to map the range of interventions for carers other than communication partner training and to examine their outcomes. MATERIALS AND METHODS:We conducted a scoping review on this topic. RESULTS:Twenty studies were included. Most studies were case series with four randomised control trials. Both quantitative and qualitative approaches were used. Most studies occurred during the long-term phase of care. Two interventions had only carers as participants. Interventions were comprised of different combinations of intervention components including psychoeducation, skill-building, and support. There was high variability on who led the interventions, the format, and the dose/schedule. Twenty-eight different outcome measures for carers and dyads were used across various domains with overall positive outcomes post-intervention. CONCLUSIONS:This review uncovered a wide range of formats, dosages, and outcome measures in interventions for carers. Encouragingly, the majority of these interventions included psychoeducation, skill-building, and support components. While most studies were case series, there are promising interventions that have the potential to enhance carer wellbeing.

In today’s fast-paced and interconnected world, where human–computer interaction is an integral component of daily life, the ability to recognize and understand human emotions has emerged as a crucial facet of technological advancement. However, human emotion, a complex interplay of physiological, psychological, and social factors, poses a formidable challenge even for other humans to comprehend accurately. With the emergence of voice assistants and other speech-based applications, it has become essential to improve audio-based emotion expression. However, there is a lack of specificity and agreement in current emotion annotation practice, as evidenced by conflicting labels in many human-annotated emotional datasets for the same speech segments. Previous studies have had to filter out these conflicts and, therefore, a large portion of the collected data has been considered unusable. In this study, we aimed to improve the accuracy of computational prediction of uncertain emotion labels by utilizing high-confidence emotion labelled speech segments from the IEMOCAP emotion dataset. We implemented an audio-based emotion recognition model using bag of audio word encoding (BoAW) to obtain a representation of audio aspects of emotion in speech with state-of-the-art recurrent neural network models. Our approach improved the state-of-the-art audio-based emotion recognition with a 61.09% accuracy rate, an improvement of 1.02% over the BiDialogueRNN model and 1.72% over the EmoCaps multi-modal emotion recognition models. In comparison to human annotation, our approach achieved similar results in identifying positive and negative emotions. Furthermore, it has proven effective in accurately recognizing the sentiment of uncertain emotion segments that were previously considered unusable in other studies. Improvements in audio emotion recognition could have implications in voice-based assistants, healthcare, and other industrial applications that benefit from automated communication.

BACKGROUND:Primary progressive aphasia (PPA) is a neurodegenerative condition characterised by a prominent and progressive deterioration in language abilities, which significantly impacts quality of life and interpersonal relationships. Speech and language therapy plays a crucial role in offering interventions. Group intervention is one mode of delivery that could benefit communication functioning and overall wellbeing of people with PPA (pwPPA) and their care partners. Group interventions are also more efficient than one-to-one intervention and may facilitate peer support. AIMS:The aim of this review was to systematically evaluate the current evidence for the effectiveness of speech and language therapy groups for pwPPA and their care partners. Specifically, this paper considered three questions: 1.What evidence-based speech and language therapy groups for pwPPA and their care partners have been reported to date? 2.Are group communication interventions effective in improving quality of life and communication function for pwPPA and their care partners? 3.Are group communication interventions that are designed for people with communication difficulties of other aetiologies (such as stroke) effective for pwPPA? In addition, this review aimed to describe the structure and content of groups, including aims, disciplines involved, size and frequency of group meetings, and outcome measures. METHODS:MEDLINE, CINAHL and PsycINFO were used to retrieve articles of interest. A total of 10 studies published between 2009 and 2022 met the eligibility criteria and therefore were included in this study. Data were extracted from the articles regarding the structure and content of groups. MAIN CONTRIBUTION:Although evidence is currently limited, results suggest that speech and language therapy group intervention can improve specific linguistic processes, the use of communication strategies and psychosocial well-being. The importance of multidisciplinary input and care partners' involvement in groups was highlighted, along with the benefits of creative non-verbal activities as tools for self-expression. There is also initial evidence that telehealth group provision and one-off group sessions may be feasible and can benefit psychosocial well-being. Lastly, intentional recruitment and explicit education on different aphasia types are described as important when pwPPA participate in groups with mixed diagnoses. CONCLUSIONS:The literature on speech and language therapy group interventions for PPA shows promise of positive effects on communication function and psychosocial well-being of both pwPPA and their care partners. Speech and language therapists can consider these published interventions when designing and implementing similar groups, but more robust evidence is required to confirm the relative effectiveness of this approach. WHAT THIS PAPER ADDS:What is already known on this subject Speech pathology led group intervention shows some promise in benefitting communication functioning and overall well-being of pwPPA and their carers, but there has been no systematic evaluation of all the evidence regarding the efficacy of speech and language therapy led groups. Establishing feasibility, acceptability and efficacy of speech and language therapy group interventions for pwPPA and their carers may present a valuable addition for managing this progressive language disability. What this paper adds to existing knowledge Although evidence is currently limited, results from this systematic review suggest that speech and language therapy led group intervention can improve specific linguistic processes, the use of communication strategies and psychosocial well-being for pwPPA and their carers. The importance of multidisciplinary input and carers' involvement in groups was highlighted, along with the benefits of creative non-verbal activities as tools for self-expression. There is also initial evidence that telehealth group provision for carers may be feasible and can benefit psychosocial wellbeing. Lastly, intentional recruitment and explicit education on different aphasia types are described as important when pwPPA participate in groups with mixed diagnoses. What are the potential or actual clinical implications of this work? A synthesis of the evidence base for speech and language therapy led PPA groups, as well as a description of the group components and formats, will be valuable for clinical service planning, and will guide future examination of group options for pwPPA and their carers. Speech and language therapists can also consider the research findings from this systematic review when designing and implementing similar groups in their local context.

PURPOSE:Aphasia is an acquired communication disability resulting from impairments in language processing following brain injury, most commonly stroke. People with aphasia experience difficulties in all modalities of language that impact their quality of life. Therefore, researchers have investigated the use of Artificial Intelligence (AI) to deliver innovative solutions in Aphasia management and rehabilitation. MATERIALS AND METHODS:We conducted a scoping review of the use of AI in aphasia research and rehabilitation to explore the evolution of AI applications to aphasia, the progression of technologies and applications. Furthermore, we aimed to identify gaps in the use of AI in Aphasia to highlight the potential areas where AI might add value. We analysed 77 studies to determine the research objectives, the history of AI techniques in Aphasia and their progression over time. RESULTS:Most of the studies focus on automated assessment using AI, with recent studies focusing on AI for therapy and personalised assistive systems. Starting from prototypes and simulations, the use of AI has progressed to include supervised machine learning, unsupervised machine learning, natural language processing, fuzzy rules, and genetic programming. CONCLUSION:Considerable scope remains to align AI technology with aphasia rehabilitation to empower patient-centred, customised rehabilitation and enhanced self-management.

Prior to the introduction of JUUL, a high nicotine e-cigarette product that gained market predominance in 2017, adolescents who experimented with e-cigarettes mainly progressed to daily cigarette use. It is unknown how patterns of tobacco product use have changed since high nicotine e-cigarette products have gained market predominance. This longitudinal study examines temporal patterns of daily tobacco product use among ever users from the Truth Longitudinal Cohort (TLC). The analytic sample (N=5274) includes individuals aged 15-36 years, residing in the United States, who had ever used any tobacco product at Wave 7 (collected between February – May 2018) and provided information on tobacco use at Wave 9 (collected between November – December 2019). Respondents were asked to report on their use of e-cigarettes, cigarettes, and other combustible tobacco products (e.g., little cigars, cigarillos, cigars, hookah, smokeless tobacco, pipe tobacco) in the past 30 days. Use of any tobacco product on at least 25 days of the past 30 days was categorized as daily use. To determine temporal patterns of daily tobacco product use, variance estimates and 95% confidence intervals were calculated using STATA (Version 15.1). Survey weights were applied to obtain statistically valid estimates from longitudinal analyses. During the 23-month observation period, there was an 1.9% increase in the prevalence of daily tobacco use, from 11.4% to 13.3%. Overall, daily cigarette use decreased from 6.7% (95% CI: 6.0 – 7.4) to 6.3% (95% CI: 5.7 – 7.0), while daily e-cigarette use increased from 3.3% (95% CI: 2.8 – 3.8) to 5.3% (95% CI: 4.8 – 6.0). A large proportion of daily tobacco product users used a single product exclusively. Among daily tobacco users, there was considerable stability of tobacco product use over time. Specifically, 63.9% (95% CI: 58.7 – 68.9) of daily cigarette smokers, 58.7% (95% CI: 51.0 – 66.2) of daily e-cigarette vapers, and 26.3% (95% CI: 9.2 – 51.2) of daily dual users stayed with their primary tobacco product. There was also some evidence of switching, as 7.4% (95% CI: 4.9 – 10.6) of daily cigarette smokers became daily e-cigarette vapers and 3.5% (95% CI: 1.3 – 7.4) of daily e-cigarette vapers became daily cigarette smokers. Results demonstrate that although most daily tobacco users are likely to continue using their primary product over time, some daily users of combustible tobacco products will transition to daily e-cigarette use. Thus, policies and public education focused on reducing nicotine use are essential for implementing change in the trajectory of the nicotine addiction epidemic among youth and young adults.

Purpose: Tobacco use during early adolescence can harm brain development and cause adverse health outcomes. Identifying susceptibility in early adolescence before initiation presents an opportunity for tobacco use prevention.Methods: Data were drawn from the Adolescent Brain and Cognitive Development study that enrolled 9-10-year-old children in 21 US cities between 2016 and 2018 at baseline. Separate nested hierarchical models were performed to incrementally examine the associations of sociodemographic factors, psychosocial influences, parental substance use, immediate social contacts, and perceived neighborhood safety with tobacco use susceptibility among never tobacco users (n = 10,449), overall and stratified by gender.Results: A total of 16.6% of youths who have never used tobacco reported susceptibility to tobacco. Females (vs. males, adjusted odds ratio [AOR] [95% confidence interval {CI}] = 0.80 [0.70-0.91]), positive parental monitoring (AOR [95% CI] = 0.76 [0.66-0.87]) and positive school environment (AOR [95% CI] = 0.95 [0.93-0.98]) were associated with reduced susceptibility to tobacco use. Parental education level (high school, AOR [95% CI] = 1.52 [1.02-2.28]; bachelor's degree, AOR [95% CI] = 1.53 [1.03-2.28]; or postgraduate degree, AOR [95% CI] = 1.54 [1.03-2.3] vs. less than high school), youth substance ever use (AOR [95% CI] = 2.24 [1.95-2.58]), internalizing problems (AOR [95% CI] = 1.03 [1-1.06]), and high scores on negative urgency, lack of premeditation, lack of perseverance, sensation seeking, and positive urgency-impulsive behavior scale were associated with increased susceptibility to tobacco use. Stratified analysis showed that parent-perceived neighborhood safety was associated with reduced susceptibility to tobacco use among males but not among females (AOR [95% CI] = 0.89 [0.81-0.99]) vs. (AOR [95% CI] = 1.01 [0.9-1.13]). A positive school environment was associated with lower susceptibility to tobacco use among females but not among males. Discussion: Parental, environmental, and psychosocial factors influence early childhood tobacco susceptibility. Family and school-based tobacco prevention programs should consider integrating these factors into primary school curricula to reduce youth tobacco susceptibility and later initiation.(c) 2022 Society for Adolescent Health and Medicine. All rights reserved.

IntroductionRemoval of tobacco industry branding from cigarette packs may reduce their appeal. Adding graphic warning labels (GWLs) should enhance this effect. We investigate whether willingness to pay for various packaging designs changes after 3 months’ use of: (1) US branded packs without GWLs (US), (2) non-branded packs without GWLs (Blank), and (3) rotating non-branded packs with GWLs (gangrene; throat cancer; neonatal baby) covering >75% of pack (GWL).MethodsCalifornian adult daily smokers not planning to quit (n=287; 56% female; mean age=39.6) completed a discrete choice purchase task before and after 3 months’ experience using one of three packaging options. Conjoint analysis and pre-post modelling evaluated the change in importance of pack attributes and willingness to pay for US, Blank or GWL (blindness; teeth; gangrene) pack designs.ResultsPrice determined ~70% of purchase choices, while pack design determined ~22%. Irrespective of intervention arm, US packaging generated appeal valuations compared with Blank packaging, while GWLs consistently provoked strong aversive valuations at baseline and follow-up. Compared with the US pack arm, using GWL packs for 3 months decreased willingness to pay for US packaging (β=−$0.38, 95% CI −0.76 to 0.00). Wear-out effects were detected in the discount needed to willingly purchase the gangrene-GWL pack (β=$0.49, 95% CI 0.16 to 0.82) and Blank pack (β=$0.42, 95% CI 0.09 to 0.74) but not for GWLs (blindness, teeth) not used in trial.ConclusionCompared with US branded packs, the negative valuation of non-branded GWL packs attenuates with even 3 months’ use but does not generalise to non-used GWLs. This suggests that GWLs should be regularly refreshed. The appeal valuation of industry imagery suggests that the US plan to retain such imagery on packs may ameliorate the effect of GWLs.

PDF - 94K, Detailed mixed models analysis of self-reported and biomarker data.