Objectives Waterpipe (WP) smoking has surged among young adults in the US. However, it presents serious health risks that can equal or exceed those of cigarettes. Pictorial warning labels (PWLs) can effectively educate consumers about WP risk. This study engaged young WP users through a mixed-methods approach, including survey and focus group discussions, to evaluate 24 WP-specific PWLs. Methods We conducted 17 mixed-gender focus groups with 44 WP smokers (50% females, aged 21-35 years) via HIPAA-compliant Zoom. Guided by the Message Impact Framework, participants completed an anonymous rating survey of the PWLs, assessing their attention, emotional reactions, and perceived effectiveness, followed by in-depth discussions of each warning. Descriptive statistical analysis was conducted for the rating survey. Focus group sessions were audio-recorded, transcribed, and analyzed using the constant comparative method. Results PWLs highlighting severe diseases (e.g., cancer) and WP-specific risks (e.g., transmitted infections) were perceived as the most impactful, while nicotine addiction PWLs were perceived as less compelling. Group discussions revealed visceral and emotional reactions, such as disgust and fear, alongside cognitive responses to PWLs clarity (e.g., realistic images, direct text) and relevance, substantially shaped participants' harm perception. Furthermore, the elicitation of these multiple reactions to each PWL appeared sufficient to decisively motivate participants’ intentions to avoid, or entirely quit, WP smoking. Conclusions This study identified potential warnings for young WP users and provided insights to further tailor them based on their feedback. Using graphics in the warnings enhances their visual impact. Clarity and relevance of the warnings were important attributes that enhanced their perceived effectiveness, indicating the need to diversify themes to effectively engage different segments of society. Practice implications The resulting warnings can be used in health promotion campaigns, patient counseling, or as warning labels. They can also be tailored and tested across diverse US populations (e.g., adolescents).

BACKGROUND:Opioid misuse and opioid use disorder (OUD) remain critical public health concerns. Pharmacological and psychosocial treatment methods do not always fully address craving, emotional dysregulation, pain-related distress, and other recovery processes associated with opioid misuse/OUD. Mindfulness-based interventions (MBIs), including yoga- and meditation-based approaches, may help address these gaps. This systematic review evaluated randomized controlled trials (RCTs) examining the effectiveness of mindfulness-based interventions for opioid misuse and OUD. METHODS:Following PRISMA 2020 guidelines, we searched five databases (PubMed, Scopus, PsycINFO, CINAHL, and Ovid) for peer-reviewed RCTs published in English between 2010 and 2025 that evaluated MBIs in adults with opioid misuse or OUD. Seventeen articles representing 14 distinct RCTs met inclusion criteria from a pool of 293 records. We applied the Cochrane Risk of Bias 2 tool and conducted a descriptive synthesis of outcomes (PROSPERO: CRD420261382140). RESULTS:Ten studies evaluated Mindfulness-Oriented Recovery Enhancement (MORE), while seven examined other mindfulness-based approaches. Most studies included treatment-as-usual or active comparison conditions. Across studies, MBIs were associated with reductions in opioid craving and opioid misuse/use outcomes, alongside improvements in pain-related functioning, emotional regulation, psychological distress, and quality of life. MORE demonstrated the strongest and most consistently developed evidence base, while findings from other MBIs were promising but more variable in methodological quality and outcome consistency. CONCLUSIONS:MBIs appear to be promising adjunctive approaches for opioid misuse/OUD treatment and recovery, particularly for craving, pain-related functioning, emotional regulation, and psychological distress. However, study heterogeneity and variability in methodological quality warrant cautious interpretation. Future research should explore scalability, durability of effects, and implementation across diverse treatment settings.

Background The use of electronic nicotine delivery systems (ENDS) has risen significantly among US young adults, mainly driven by marketing, product design, and addictive nicotine. Pictorial warning labels (PWLs) effectively inform consumers about the risks associated with ENDS use, yet young users were rarely involved in their development. A set of 24 PWLs, categorized into three themes, was developed by a panel of international tobacco control experts via a Delphi study: ENDS toxicity, health risks, and specific harm. In this study, we involved young ENDS users through a mixed-methods approach, including a rating survey to identify the most effective warnings and focus group discussions to gather their feedback on the PWLs design, content, and needed improvements.Methods We conducted 22 HIPAA-compliant Zoom focus groups with 61 ENDS users (57% females, aged 21-29). Guided by the Message Impact Framework, participants completed an anonymous rating survey of the PWLs to assess attention, reactions, and perceived effectiveness, followed by in-depth discussions of each PWL. Descriptive statistical analysis was conducted for the rating survey. Focus group sessions were audio-recorded, transcribed, and thematically analyzed.Results Survey results showed toxicity-focused PWLs outperformed those on health effects and specific harm across most outcomes. Focus group results showed warnings depicting human suffering were most impactful. Relevance to participants (e.g., pregnancy, health experiences) emerged as influential factors shaping perceptions of warning effectiveness. Metaphorical images were often perceived as confusing or less believable, thereby diminishing their persuasive potential. Participants recommended applying clear, simple visual and verbal explanations.Conclusions This study identified promising PWLs for young adult ENDS users and provides practical guidance to strengthen warning design and regulatory efforts. Warnings featuring clear, literal imagery and human health consequences elicited greater fear, perceived severity, and motivation to reconsider ENDS use, whereas metaphor-based images were often viewed as less credible or confusing. The convergence of quantitative and qualitative findings underscores the importance of targeting emotional and cognitive message responses to enhance warning effectiveness. Since personal relevance varies per individual, using a rotating, diverse portfolio of ENDS warnings targeting different health risks likely improves subgroup resonance and maximizes population impact.

Substance use, inclusive of alcohol and other drugs, has been associated with severe male-to-female physical intimate partner violence (IPV), with most studies focusing on male perpetrators and female survivors both experiencing substance misuse. The present study explored IPV perpetrated by men with substance use issues from the perspectives of minoritized women survivors without substance use issues. We conducted 22 in-depth interviews with women self-identifying as Black or Hispanic and analyzed the interview transcripts inductively, using constructivist grounded theory methodology. Findings indicated that many participants were aware of their perpetrator's alcohol use from the outset, but did not discover their drug use until well after committing to the relationship. Once they became aware of the substance use, women attempted to address it with their perpetrator, but were met largely with anger and physical violence. As their perpetrator's substance use continued, participants described experiencing heightened financial burden accompanied by their own emotional withdrawal from the relationship. Participants responded to these stressors by becoming more financially and emotionally independent from their perpetrator, which led to an escalation in IPV. Increased IPV severity and risks to their children's safety brought participants to a turning point, at which time they reported leaving or escaping their perpetrator. Some participants found that their financial independence and emotional withdrawal facilitated leaving their perpetrator. For others, however, the burden of sole responsibility for managing the household, generating income, and raising children appeared to delay their leaving. Trauma recovery programs should address the dual traumas women experience when surviving both IPV and a perpetrator's substance use.

A central component of the Public Health 3.0 model is building partnerships between local public health departments and other community organizations/stakeholders, including public and private hospitals, as a means of promoting data sharing, service coordination, and collective action. Evidence suggests that such partnerships remain challenging and infrequent. This qualitative study used in-depth interviews to identify barriers and facilitators to building effective collaboration between local health departments (LHDs) and hospitals. We purposively recruited LHD officials (n = 12) across the United States. A directed qualitative content analysis of the interview transcripts revealed five barriers and five facilitators to building effective collaboration between the two entities. Perceived barriers included competition, inconsistent participation and engagement, communication breakdown, time constraints, and lack of financial and human resources. Perceived facilitators included finding common ground, well-established relationships, aligning and leveraging resources, open communication, and leadership commitment. Findings highlight challenges and opportunities to promote effective collaboration between LHDs and hospitals.

Background:An estimated 2.7 million people in the United States ages 12 years and older suffered from opioid use disorder (OUD) in 2020; during the same period, approximately 68,000 people died due to an opioid overdose. In recent years, with support from federal funding, medication for opioid use disorder (MOUD) has emerged as a viable treatment option. The partial-opioid-agonist buprenorphine/naloxone (brand name, Suboxone) is the most used MOUD and is commonly administered as a daily oral dose. Naltrexone is an opioid antagonist primarily administered as a slow-release monthly injection formulation (brand name, Vivitrol). Objective:This study aimed to explore clients' perceptions and experiences of using oral Suboxone and injectable Vivitrol for OUD treatment. Design:This was a cross-sectional qualitative study. Methods:We conducted semi-structured interviews with 65 clients from 2 residential treatment facilities in Tennessee between August 2019 and October 2020. Data were analyzed in Dedoose qualitative software using thematic analysis. Results:Clients shared perspectives on facilities' tapering protocols for Suboxone and generally considered the lack of tapering a favorable attribute for Vivitrol. Both prescriptions were praised for reducing opioid cravings. Pharmacological side effects sometimes hindered clients' ability to continue MOUD treatment and were more common with Suboxone. Clients reported that MOUD gave them confidence and helped them focus on treatment, though concerns were raised about Suboxone's capacity for diversion, the cost of continuing Vivitrol, and the possibility of backsliding when the MOUD prescription was complete. Participants' views on MOUD ranged from enthusiastic to stigmatizing. Conclusion:Our study provides valuable insights drawn from clients' experiences using oral and injectable MOUD in substance use treatment facilities. The findings will be useful for healthcare providers and policymakers to consider the pros and cons of these medications in substance use treatment settings.

Background This study reports on the development of pictorial health warning labels for electronic nicotine delivery system (ENDS) using the Delphi approach with a panel of tobacco control experts. Twenty-four evidence-based ENDS-specific warnings corresponding to three themes (toxicity, health risks and specific harm) were developed and used in the Delphi study. Methods We conducted a three-round online Delphi study among 60 experts (55% female) between June 2022 and April 2023. We balanced the panel in areas of expertise and positions relevant to ENDS (risks, benefits). In round 1, participants rated the warnings on attention, relevance to evidence and perceived effectiveness (harm perception, motivation to quit) and provided suggestions for improvement. In rounds 2 and 3, participants ranked the revised warnings based on importance in each theme. We assessed levels of agreement between participants using interquartile deviations and medians. Results Warnings in theme 1, toxicity, received the highest ratings for perceived effectiveness on harm perception and encouraging quitting ENDS (p<0.05). Experts recommended using clear and affirmative text paired with emotion-provoking pictures and avoiding the rare side effects of ENDS. Most of the top-ranked warnings were from theme 3, ENDS-specific harm, pertained to lung damage, dual use of ENDS and cigarettes, nicotine addiction among youth, anti-ENDS industry sentiment and toxicity. Discussion This study developed 24 evidence-based ENDS health warning labels using a systematic process that included several rounds of expert panel feedback. These warnings can be used to advance ENDS prevention and tobacco control policies and further target different populations.

Introduction Pictorial health warning labels (HWLs) on waterpipe (WP) tobacco packages represent a better strategy for communicating the health risks associated with WP use and promoting quit intention than text-only. However, the mechanism by which these warnings lead to higher intentions to quit remains unknown.Aims and Methods This study explores how pictorial warnings versus text-only induces higher quit intention among a sample of young adult WP smokers in Lebanon. An online randomized cross-over experimental study was conducted in August 2021 among 276 young adult WP smokers who were exposed to two conditions: pictorial HWLs and text-only warnings on WP tobacco packages in random order. After each image, participants completed post-exposure assessments of health communication outcomes (eg, attention and negative affect). Using serial and parallel mediation analysis, we examined the role of attention, negative affect, cognitive elaboration, and perceived harm in mediating the relationship between exposure to HWLs and intention to quit.Results Using serial mediation, exposure to pictorial warnings versus text-only was found to affect intention to quit through the following pathways: attention and negative affect, which accounted for 17.28% of the total effect, and through negative affect and cognitive elaboration, which accounted for 21.53% of the total effect. Results of parallel mediation showed that the indirect effect pathways via negative affect (beta = 0.063; [95% bootstrap CI = 0.004 to 0.149]) and cognitive elaboration (0.047; [0.001 to 0.114]) were statistically significant.Conclusions The findings call on designing and implementing attention-grabbing, emotionally evocative, and cognitively persuasive pictorial warnings in Lebanon and other countries to curb WP tobacco smoking.Implications This is among the first experimental studies looking at multiple mediators underlying the effect of exposure to pictorial HWLs on intention to quit in a sample of current WP smokers in Lebanon. The findings showed that using attention-grabbing, emotionally evocative, and persuasive pictures with a clear textual warning is crucial to maximizing the impact of implementing WP-HWLs regulations in Lebanon and other countries to curb WP tobacco smoking.

Introduction Youth represent a high-priority group for e-cigarette health communication. This study examined youth exposure to the Food and Drug Administration (FDA) e-cigarette warning label over 4 years and its association with change in youth harm perception and intention.Aims and Methods We pooled data from the 2018-2021 National Youth Tobacco Survey (age 10-17; n = 67 159). Participants were divided into four groups: never users (58.5%), susceptible nonusers (16.3%), former users (12.7%), and current users (12.5%). We examined the prevalence, time-trend, correlates, and association of youth exposure to the warning with addictiveness and harm perception, intention to use e-cigarettes, and intention to quit all tobacco products.Results Only 24.5% of youth were exposed to the warning. Exposure increased from 14.9% in 2018 to 30.8% in 2019, then declined to 25.2% in 2021. Hispanic (adjusted odds ratio (aOR) = 0.76 [95% CI = 0.641 to 0.89]) and non-Hispanic black current users (0.53 [0.40 to 0.69]) were less likely to be exposed to the warning than white current users. Youth exposure was positively associated with a higher perception of e-cigarette addictiveness (1.12 [1.04 to 1.19]) and intention to quit all tobacco products (1.28 [1.13 to 1.46]). However, exposure was negatively associated with harm perception (0.91 [0.85 to 0.96]) and the intention to use e-cigarettes among e-cigarette nonusers (2.38 [1.99 to 2.84]).Conclusions The decline in youth exposure to the warning indicates wear-out effects. Strengthening the label by using compelling designs, adding themes on e-cigarette harm to youth, periodically rotating warning content, and using culturally tailored messaging may improve its impact on youth and address racial/ethnic disparities.Implications The FDA e-cigarette label reached only 24.5% of youth, and exposure to the warning declined to indicate wear-out effects. Exposure was significantly lower among minorities. Exposure was associated with a higher perception of e-cigarette addictiveness and intention to quit all tobacco products. Still, it did not increase harm perception or reduce intention to use e-cigarettes among nonusers. Strengthening the label by using more compelling designs, including diverse themes focusing on e-cigarette harm relevant to youth, and periodically rotating warning content may improve its impact on youth. Continued surveillance of the implementation of e-cigarette policies is needed to ensure that they equally affect youth across racial/ethnic subpopulations.

While much attention has been given to methamphetamine's wake-promoting properties and the concept of using methamphetamine to increase energy, little is known about the ways people who use methamphetamine manage their use to pursue their functional goals or the challenges they encounter doing so. This qualitative study explores the experiences of people who used methamphetamine to manage wakefulness and reduce sleep as a means to achieve functional goals. We conducted a grounded theory analysis of 202 anonymous letters submitted to an online forum. Five themes emerged from this process: (1) Using methamphetamine to extend wakefulness and reduce the need for sleep; (2) Losing control over wakefulness and the need for sleep; (3) Managing wakefulness and the need for sleep while on methamphetamine; (4) Getting caught in a cycle of wakefulness and sleep; and (5) Sleep disruptions even after ceasing methamphetamine use. Participants believed methamphetamine was critical to meeting their functional goals, and they went to great lengths to try to manage the substance's ill effects. Thus, clients in treatment for methamphetamine use disorder may benefit from interventions addressing their underlying motivations and perceived associations between methamphetamine and meeting functional goals.

Background Waterpipe (WP) use is rapidly increasing among young people worldwide due to the widespread misperception that it is safer than cigarette smoking. Health warning labels (HWLs) can effectively communicate tobacco-related health risks but have yet to be developed for WP. This study aimed to optimize and adapt a set of 16 pictorial WP-specific HWLs, developed by an international Delphi study, to the Tunisian context. HWLs were grouped into four themes: WP health risks, WP harm to others, WP-specific harms, and WP harm compared to cigarettes. Methods Using a mixed method approach, we conducted ten focus groups combined with a survey among young WP users and nonusers (N = 63; age 18–34 years). In the survey, participants rated the HWLs on several communication outcomes (e.g., reaction, harm perception, effectiveness) and were then instructed to view all HWLs in each theme and rank them in the order of overall perceived effectiveness, from the most to the least effective. Afterward, participants provided in-depth feedback on HWLs and avenues for improvement. Mean effectiveness rating scores and percentages of participants’ top-ranked HWLs were calculated. Discussions were audio-taped, transcribed verbatim, and analyzed thematically. Results The top-ranked HWLs were those showing oral cancers, orally transmitted diseases, and a sick child. Focus group discussion illustrated that these selections were based on participants’ reactions to the direct impact of WP on a person’s physical appearance and evoking guilt over children’s exposure to WP smoke. Suggestions for improvement highlighted the need to use the local dialect and more affirmative statements (e.g., avoiding "may" or "can"). Conclusions This study is the first in North Africa to attempt to advance HWLs policy as the World Health Organization recommended. The results of this study can be used as a basis for implementing WP-specific health messages in the Eastern Mediterranean Region.

Women exposed to intimate partner violence (IPV) often rely on support from their informal support networks to obtain resources that may mitigate IPV. This study explored the challenges women of color encounter in seeking advice and information from their informal support networks (i.e., family, friends, neighbors, community members) regarding IPV support services. In-depth interviews were conducted with 29 IPV survivors who self-identified as Black or Hispanic. Data were analyzed using grounded theory methodology. Results showed that participants lacked informational support, both in their communities and in their interpersonal relationships with family and friends. Communities treated IPV as normal and propagated the belief that women’s responsibilities were to men and family. Family and friends discouraged IPV information seeking and advised that IPV should be kept private to avoid community shaming. The community environments also lacked information about resources for women experiencing IPV. The lack of information from their informal support networks appeared to delay participants’ help-seeking. As the frequency and severity of violence escalated, some participants engaged in independent information searching, using social media and online information sources as well as conventional media like radio and newspapers. Others received information from first responders in the wake of a violent emergency. Participants described the information they received online or from first responders as empowering, encouraging them to engage in support services. Similarly, they felt empowered by the information they received from social workers, counselors, and victims’ advocates, and they wished to use what they learned to help other women in similar circumstances. Women experiencing IPV and their communities need more information regarding IPV support services. Successful interventions for IPV survivors and their support networks may necessitate community-level education and altering biased perceptions of gender-appropriate behaviors.

INTRODUCTION:Waterpipe (WP) smoking is the leading tobacco use method among young adults in Lebanon. WP use is harmful, yet misperceptions about its safety exist. Implementing pictorial health warning labels (HWLs) on WP products is a promising strategy to correct this misperception. This study aimed to culturally adapt a set of 12 pictorial HWLs recently developed by an international expert panel to young adults in Lebanon. HWLs were grouped into four themes: WP health risks, WP harm to others, WP-specific harms, and WP harm compared to cigarettes. AIMS AND METHODS:We conducted nine focus groups among WP smokers and nonsmokers (N = 77; 52% females; age 18-34 years) to explore participants' perceptions of the developed HWLs on attention, reaction (fear, avoidance), effectiveness (harm perception), and improvement (design/content, relatedness). Sessions were audio-taped, transcribed verbatim, and analyzed using directed qualitative content analysis. RESULTS:Emotionally provocative warnings were perceived as most effective, while symbolic and abstract warnings were found not believable. Warnings depicting visible bodily health effects and harm to babies seemed most promising. Participants were generally skeptical about Theme 4 because it might encourage switching to cigarettes. For cultural adaptation, participants recommended using shorter text with affirmative phrases, increasing the picture's size and improving their quality, adding the WP device picture to enhance HWLs' relatability, and develop testimonial messages that depict real people and stories. CONCLUSIONS:Results will provide Lebanon and perhaps other countries in the Eastern Mediterranean Region with evidence-based HWLs that they can further develop, test, and implement within their specific culture. IMPLICATIONS:Results provide Lebanon with evidence-based WP-specific pictorial HWLs that can be further developed and tested. HWLs provoking negative affect, with visible health consequences, and depicting harm to babies are promising. Participants recommended using definitive scientific claims presenting the health risks in numerical form. However, this needs to be balanced against protecting the credibility of HWLs scientifically and legally. Increasing the HWLs size and adding the WP device picture to the HWLs can enhance their relatability. Further research can help address some questions raised by this study, such as the potential of testimonial warnings that depict real people.

The Compact Muon Solenoid collaboration is designing a new high-granularity endcap calorimeter, HGCAL, to be installed later this decade. As part of this development work, a prototype system was built, with an electromagnetic section consisting of 14 double-sided structures, providing 28 sampling layers. Each sampling layer has an hexagonal module, where a multipad large-area silicon sensor is glued between an electronics circuit board and a metal baseplate. The sensor pads of approximately 1.1 cm 2 are wire-bonded to the circuit board and are readout by custom integrated circuits. The prototype was extensively tested with beams at CERN's Super Proton Synchrotron in 2018. Based on the data collected with beams of positrons, with energies ranging from 20 to 300 GeV, measurements of the energy resolution and linearity, the position and angular resolutions, and the shower shapes are presented and compared to a detailed Geant4 simulation.

This report was prepared on behalf of three Energy Frontier Topical Groups of the Snowmass 2021 Community Planning Exercise. It summarizes the status and implications of studies of strong interactions in high-energy experiments and QCD theory. We emphasize the rich landscape and broad impact of these studies in the decade ahead. Hadronic interactions play a central role in the high-luminosity Large Hadron Collider (LHC) physics program, and strong synergies exist between the (HL-)LHC and planned or proposed experiments at the U.S. Electron-Ion Collider, CERN forward physics experiments, high-intensity facilities, and future TeV-range lepton and hadron colliders. Prospects for precision determinations of the strong coupling and a variety of nonperturbative distribution and fragmentation functions are examined. We also review the potential of envisioned tests of new dynamical regimes of QCD in high-energy and high-density scattering processes with nucleon, ion, and photon initial states. The important role of the high-energy heavy-ion program in studies of nuclear structure and the nuclear medium, and its connections with QCD involving nucleons are summarized. We address ongoing and future theoretical advancements in multi-loop QCD computations, lattice QCD, jet substructure, and event generators. Cross-cutting connections between experimental measurements, theoretical predictions, large-scale data analysis, and high-performance computing are emphasized.