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Azithromycin susceptibility of Neisseria gonorrhoeae in the USA in 2017: a genomic analysis of surveillance data

The Lancet Microbe 2020年第4期1卷 e154-e164页

作者： Gernert, Kim M Seby, Sandra Schmerer, Matthew W Thomas, Jesse C Pham, Cau D St Cyr, Sancta Schlanger, Karen Weinstock, Hillard Shafer, William M Raphael, Brian H Kersh, Ellen N Hun, Sopheay Hua, Chi Ruiz, Ryan Soge, Olusegun O Dominguez, Catherine Patel, Ami Loomis, Jillian Leavitt, John Zhang, Jenny Baldwin, Tamara Wang, Chun Moore, Christina Whelen, Christian Harvey, Alesia Laboratory Reference and Research Branch Division of STD Prevention National Center for HIV/AIDS Viral Hepatitis STD and TB Prevention Centers for Disease Control and Prevention Atlanta GA United States Surveillance and Data Management Branch Division of STD Prevention National Center for HIV/AIDS Viral Hepatitis STD and TB Prevention Centers for Disease Control and Prevention Atlanta GA United States Epidemiology and Statistics Branch Division of STD Prevention National Center for HIV/AIDS Viral Hepatitis STD and TB Prevention Centers for Disease Control and Prevention Atlanta GA United States Oak Ridge Institute for Science and Education Research Participation and Fellowship Program Oak Ridge TN United States Department of Microbiology and Immunology and Emory Antibiotic Resistance Center Emory University School of Medicine Atlanta GA United States Laboratories of Bacterial Pathogenesis Veterans Affairs Medical Center Decatur GA United States

Background: The number of cases of gonorrhoea in the USA and worldwide caused by Neisseria gonorrhoeae is increasing (555 608 reported US cases in 2017, and 87 million cases worldwide in 2016). Many countries report declining in vitro susceptibility of azithromycin, which is a concern because azithromycin and ceftriaxone are the recommended dual treatment in many countries. We aimed to identify strain types associated with decreased susceptibility to azithromycin. Methods: We did a genomic analysis of N gonorrhoeae isolates obtained by the US Gonococcal Isolate Surveillance Project. Isolates were whole-genome sequenced based on decreased susceptibility to azithromycin (minimal inhibitory concentration [MIC] ≥2 μg/mL, using agar dilution antibiotic susceptibility testing) and geographical representation. Bioinformatic analyses established genomic diversity, strain population dynamics, and antimicrobial resistance profiles. Findings: 410 isolates were sorted into more than 20 unique phylogenetic clades. One predominant persistent clade (consisting of 97 isolates) included the most isolates with azithromycin MICs of 2 μg/mL or higher (61 of 97 [63%] vs 59 of 311 [19%];p<0·0001) and carried a mosaic mtr (multiple transferable resistance) locus (68 of 97 [70%] vs two of 313 [1%];p<0·0001). Of the remaining 313 isolates, 57 (18%) had decreased susceptibility to azithromycin (MIC ≥4 μg/mL), which was attributed to 23S rRNA variants (56 of 57 [98%]) and formed phylogenetically diverse clades, showing various levels of clonal expansion. Interpretation: Reduced azithromycin susceptibility was associated with expanding and persistent clades harbouring two well described resistance mechanisms, mosaic mtr locus and 23S rRNA variants. Understanding the role of recombination, particularly within the mtr locus, on the fitness and expansion of strains with decreased susceptibility has important implications for the public health response to minimise gonorrhoea transmission. Funding:

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1528. Retrospective cohort study of factors associated with non-initiation of antiretroviral therapy among adults newly diagnosed with HIV in Andijan, Uzbekistan, 2018-2021

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Open Forum Infectious Diseases 2023年第SUPPLEMENT_2期10卷

作者： Shokhruh Usmanov Roberta Horth Alfiya Denebayeva Saya Gazezova Sanam Zikriyarova Botirjon Kurbanov Feruza Nasirova Dilyara Nabirova Central Asia Field Epidemiology Training Program Andizhan Andijon Uzbekistan US Centers for Disease Control and Prevention Dulles Virginia Almaty City Center for Prevention and Control of AIDS HIV Center Kazakhstan Almaty Almaty Kazakhstan Kazakh National Medical University named after S.D. Asfendiyarov Almaty Almaty Kazakhstan Sanitary-Epidemiological Tranquility and Public Health Committee Tashkent Uzbekistan Tashkent Toshkent Uzbekistan Andizhan State Medical Institute Andizhan Uzbekistan Tashkent Surkhondaryo Uzbekistan CDC Central Asia office Almaty Almaty Kazakhstan

Background Immediate uptake of antiretroviral therapy (ART) by people newly diagnosed with HIV reduces morbidity and viral transmission. Since 2018, in Uzbekistan people newly diagnosed with HIV are immediately offered ARVs, but just over half of people living with HIV are estimated to be on ART. To reach global targets, we assessed factors associated with ART non-initiation.

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Frailty and Other Factors Associated With Early Outcomes in Middle-to Older Age Trauma Patients: A Prospective Cohort Study

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American Journal of Geriatric Psychiatry 2024年第2期32卷 244-255页

作者： Yeh, Tian-Shin Kang, Jiunn-Horng Littlejohns, Thomas J. Wu, Chia-Chieh Chen, Jin-Hua Piravej, Krisna Chiu, Wen-Ta Lam, Carlos Department of Physical Medicine and Rehabilitation School of Medicine College of Medicine Taipei Medical University Taipei Taiwan Department of Physical Medicine and Rehabilitation Wan Fang Hospital Taipei Medical University Taipei Taiwan Department of Epidemiology and Nutrition Harvard T. H. Chan School of Public Health Harvard University Boston MA United States Department of Physical Medicine and Rehabilitation National Taiwan University Hospital Taipei Taiwan Department of Physical Medicine and Rehabilitation College of Medicine National Taiwan University Taipei Taiwan Department of Physical Medicine and Rehabilitation Taipei Medical University Hospital Taipei Taiwan Graduate Institute of Nanomedicine and Medical Engineering College of Biomedical Engineering Taipei Medical University Taipei Taiwan International Ph.D. Program in Medicine College of Medicine Taipei Medical University Taipei Taiwan Professional Master Program in Artificial Intelligence in Medicine College of Medicine Taipei Medical University Taipei Taiwan Nuffield Department of Population Health University of Oxford Oxford United Kingdom Emergency Department Wan Fang Hospital Taipei Medical University Taipei Taiwan Department of Emergency School of Medicine College of Medicine Taipei Medical University Taipei Taiwan Graduate Institute of Data Science College of Management Taipei Medical University Taipei Taiwan Institutional Research Center Office of Data Science Taipei Medical University Taipei Taiwan Biostatistics Center Department of Medical Research Wan Fang Hospital Taipei Medical University Taipei Taiwan Department of Rehabilitation Medicine Faculty of Medicine Chulalongkorn University Bangkok Thailand Department of Chula Neuroscience Center King Chulalongkorn Memorial Hospital Bangkok Thailand Graduate Institute of Injury Prevention and Control College of Public Health Taipei Medical University Taipei Taiwan AHMC Health System Alhambra CA United States

Objectives: To prospectively investigate associations of frailty and other predictor variables with functional recovery and health outcomes in middle-aged and older patients with trauma. Design: Single-center prospective cohort study. Setting: Emergency department of Wan Fang Hospital in Taiwan. Participants: Trauma patients aged 45 and older. Measurements: Frailty was assessed with the Clinical Frailty Scale (CFS). Injury mechanisms, pre-existing diseases, and fracture locations were recorded at baseline. The primary outcome was functional recovery assessed using the Barthel Index (BI). Secondary outcomes were new care needs, unscheduled return visits, and falls 3 months postinjury. Results: A total of 588 participants were included in the final analysis. For every one-point increase in the CFS, the multivariable-adjusted odds ratio (OR, 95% confidence interval [CI]) of failure to retain the preinjury BI was 1.34 (1.16–1.55);associations were consistent across levels of age and injury severities. Significant joint associations of frailty and age with poor functional recovery were observed. CFS was also associated with new care needs (OR for every one-point increase, 1.36, 95% CI, 1.17–1.58), unscheduled return visits (OR 1.26, 95% CI, 1.04–1.51), and falls (OR 1.23, 95% CI, 1.01–1.51). Other variables associated with failure to retain preinjury BI included road traffic accident and presence of hip fracture. Conclusion: Frailty was significantly associated with poor functional and health outcomes regardless of injury severity in middle-aged and older patients with trauma. Injury mechanisms and fracture locations were also significant predictors of functional recovery postinjury. © 2023 American Association for Geriatric Psychiatry

关键词： Clinical Frailty Scale Frailty functional recovery injury middle-to older age

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Journal of Inflammation Research 2021年 14卷 1437-1445页

作者： Chen, Wen Mo’Ez Al-Islam, E. Luigi, Faris Nicola Haifa, Bragazzi Algahtani, M.S. Jahrami, Zahra Saif Ahmed Shivappa, Nitin Hebert, James R. Jahrami, Haitham Department of Psychiatry Xiamen Xianyue Hospital Xiamen 361000 China Department of Clinical Nutrition and Dietetics College of Health Sciences/Research Institute for Medical and Health Sciences (RIMHS) University of Sharjah Sharjah United Arab Emirates Laboratory for Industrial and Applied Mathematics (LIAM) Department of Mathematics and Statistics York University Toronto ON Canada College of Medicine and Medical Sciences Arabian Gulf University Manama Bahrain Renewal and Reward Center Dammam Saudi Arabia Ministry of Health Manama Bahrain Bahraini Association for Intellectual Disabilities and Autism Sanad Bahrain Cancer Prevention and Control Program University of South Carolina Columbia 29208 SC United States Department of Epidemiology and Biostatistics Arnold School of Public Health University of South Carolina Columbia SC United States

Purpose: This case-control study aimed to examine the association between the inflammation potential of the diet and depression. Patients and Methods: Ninety-six patients with major depression disorder were matched with 96 age-and sex-matched healthy controls. Energy-adjusted DII (E-DII™) scores were calculated based on the participants’ responses to a detailed nutritional assessment using a quantitative food frequency questionnaire. Descriptive results were reported. Logistic regression was used to estimate odds ratios and 95% confidence intervals associated with E-DII scores and depression adjusting for covariates including age, sex, body mass index, comorbidities, level of education, and employment. Results: The mean E-DII score of participants in the study was 1.32±1.08, indicating a generally pro-inflammatory diet. Patients with depression had elevated E-DII scores compared to age-and sex-matched controls with E-DII scores of 1.72± 1.09 vs 0.90±0.90, respectively (P=0.001). Results of logistic regression analysis revealed that patients with depression were nearly three times more likely to be in the extreme ends of pro-inflammatory diet (OR 2.75;95% CI 1.82–4.15). Conclusion: Adult Bahraini patients with depression have higher dietary inflammation potential compared to the general population controls. Further research is needed to confirm these results and provide effective interventions to reduce the burden of this dietary inflammation. © 2021 Chen et al.

关键词： Arabian population groups Case-control study Depression Inflammation Mental health

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Mass Distribution Campaign of Long-Lasting Insecticidal Nets in the Democratic Republic of Congo from 2018 to 2021 in the Context of the Emergence of COVID-19: Results and Lessons Learned

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Journal of Biosciences and Medicines 2022年第2期10卷 136-159页

作者： Joris Losimba Likwela Adrien N’siala Kumbi Michèle Luntadila Kiamenga Mireille Lusiense Zena Daniela Mundele Iris Simon-Pierre Kazadi Mutuba Eric Mukomena Sompwe Patrick Kanku-Ka-Lukusa Albert Kalonji Ntumba Ghislain Makhan Yav Didier Gasigwa Baneti Eric Tsasa Mbuku Charlotte Ndolerire Isingoma Muriel Nzazi Nsambu Philippe Lukanu Ngwala SANRU Asbl Kinshasa Democratic Republic of the Congo Public Health Department Faculty of Medicine and Pharmacy University of Kisangani Kisangani Democratic Republic of the Congo National Malaria Control Program Kinshasa Democratic Republic of the Congo School of Public Health University of Lubumbashi Lubumbashi Democratic Republic of the Congo Financial Support and Management Unit Ministry of Public Health Prevention and Hygiene Kinshasa Democratic Republic of the Congo Interchuch Medical Assistance World Heath Kinshasa Democratic Republic of the Congo World Health Organisation Kinshasa Sub-Office Democratic Republic of the Congo Department of Family Medicine et Primary Health Care Protestant University of Congo Kinshasa Democratic Republic of the Congo

Introduction: The DRC had planned 23 mass distribution campaigns distribution of long-lasting insecticidal nets (LLIN) for the years 2018-2020, the implementation of which spanned from 2018 to July 2021. This article reviews the campaign’s planning process, the results, challenges, and lessons learned. Methods: A descriptive method was used to postpone the planning and implementation process according to the National Malaria control program (NMCP) standards adapted to the COVID-19 context. The changes and adaptations implemented as well as the challenges encountered are described. Results: Between January 2018 to June 2021, 23 LLIN mass distribution campaigns were organized in the DRC with the financial support of The Global Fund to Fight against Tuberculosis, AIDS and Malaria (GFTAM) and Against Malaria Foundation (AMF) allowing the distribution of 55,273,473 LLINs to 19,048,372 households at risk of malaria transmission with an average of 2.9 LLINs per household. The enumerated population (111,081,191) exceeded 7% of the micro plans projected population (102,790,391) while the number of households enumerated (19,311,629) was 3% lower compared to the micro planning projection households (19,862,417). Compared to a reported household coverage of 96% of households achieved over the expected households, the independent monitoring carried out revealed 91% of households served in the intervention areas. The main reasons for not reaching households mentioned by the respondents were absence at the time of distribution (26%) followed by the loss of vouchers (16%). Several communication channels were used among which, community workers were the most frequently mentioned (63.1%), followed by radios (18.5%) and churches (12.4%). Conclusion: Good planning, effective coordination of stakeholders, and revision of the implementing campaigns methods following the COVID-19 were factors in the success of this campaign. An effort to respect the schedules for renewing LLINs in househo

关键词： Vector control LLIN Campaigns COVID-19 Lessons Democratic Republic of Congo

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Determinants of viral load suppression failure among HIV adults on ARV attending health care facilities: a retrospective study in Tanga region, Tanzania

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BMC infectious diseases 2024年第1期24卷 312页

作者： Eric Mboggo Expeditho Mtisi Stella E Mushy Simon Mkawe Frida Ngalesoni Aisa Muya Edwin Kilimba Denice Kamugumya Boniface Silvan Mlay AMREF Health Africa Dar es Salaam Tanzania. Eric.Mboggo@***. Department of General Studies Dar Es Salaam Institute of Technology Dar es Salaam Tanzania. Department of Community Health Nursing Muhimbili University of Health Science Dar es Salaam Tanzania. AMREF Health Africa Dar es Salaam Tanzania. Center for Disease Control and Prevention Dar es salaam Tanzania. National AIDS Control Program Ministry of Health Dodoma Tanzania.

BACKGROUND:Availability and accessibility of Antiretroviral drugs (ARV's) improve the lives of People living with HIV (PLHIV) by improving client's immune system to overcome infections and prevent the development of AIDS and other HIV complications. Combination therapy, early initiation of ART, newer ART drugs, single dosage and drug affordability significantly contribute in the reduction of viral multiplication and suppression of HIV to undetectable plasma levels. METHODS:A retrospective longitudinal study design study was conducted from 1 October, 2018 to 30 June 2022 in all supported HIV care and treatment health facilities in Tanga region which were supported by Amref Health Africa, Tanzania. The participants were HIV adult patients aged 15 years and above on ART and attended the clinic at least once after ART initiation. Viral load suppression levels are defined with viral load <1,000 HIV RNA copies/ml (viral load suppression). Cox proportional hazard regression models were employed to identify risk factors for virological failure. P values were two-sided, and we considered a P<0.05 to be statistically significant. RESULTS:Fifty-nine thousand five hundred three adult clients >15 years whom were on ART were included in the analysis to determine the level of plasma Viral Load suppression after being on ART. Female 41,304 (69.4%) and male 18,199 (30.6%). Only four percent (2,290) were found to be unsuppressed i.e having plasma Viral Load >1,000cp/ml while 96% (57,213) were virally suppressed. Several factors were independently associated with virologic failure that included; age between 15 - <25 years (HR: 2.82, 95% CI 1.96 - 4.04), BMI <18.5 (HR: 1.69, 95% CI 1.23 - 2.30), advanced WHO stage IV (HR: 1.60, 95% CI 1.12 - 2.24), CD4 cell count <350 (HR: 2.61, 95% CI 2.12 - 3.23), poor adherence (HR: 1.98, 95% CI 1.80 - 2.18) and not using DTG based drug (HR: 11.8, 95% CI 9.74 - 14.3). CONCLUSION:Virologic failure was observed in this study among clients with young a

关键词： Adult HIV positive Africa Antiretroviral therapy DTG based therapy HIV/AIDS Predictors Tanzania Viral load suppression

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1875. Factors associated with unfavorable tuberculosis treatment outcomes, Almaty, Kazakhstan, 2018-2021

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Open Forum Infectious Diseases 2023年第SUPPLEMENT_2期10卷

作者： Malika Gabdullina Saya Gazezova Gulzhan Ayapova Manar Smagul Roberta Horth Dilyara Nabirova Central Asia Field Epidemiology Training Program Almaty Almaty Kazakhstan Scientific and practical center of sanitary-epidemiological examination and monitoring branch of the National Center for Public Health Almaty Kazakhstan Almaty Almaty Kazakhstan US Centers for Disease Control and Prevention Dulles Virginia CDC Central Asia office Almaty Almaty Kazakhstan

Background The COVID-19 pandemic negatively influenced the availability of TB related services around the world, including detection, diagnosis and treatment. The purpose of this research is to assess the impact of the COVID-19 pandemic on TB treatment outcomes in Almaty, and to determine risk factors associated with said outcomes by examining data from before (2018-2019) and during the pandemic (2020-2021).

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The Association between Sexual Satisfaction and Interest with Quality of Life and Psychological Distress in Hematopoietic Stem Cell Transplant Recipients

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Transplantation and Cellular Therapy 2024年第2期30卷 S347-S348页

作者： Markovitz, Netana H., MD Reese, Jennifer Barsky, PhD Traeger, Lara, PhD Dizon, Don, MD Vanderklish, Julie, CNP Horick, Nora Newcomb, Richard Andrew, MD DeFilipp, Zachariah, MD Chen, Dr. Yi-Bin, MD Temel, Jennifer, MD El-Jawahri, Areej R., MD Department of Internal Medicine Beth Israel Deaconess Medical Center Boston MA Cancer Prevention and Control Program Fox Chase Cancer Center Philadelphia PA Psychology Massachusetts General Hospital Boston MA Rhode Island Hospital Rhode Island RI Hematopoietic Cell Transplant and Cellular Therapy Program Massachusetts General Hospital Boston MA Massachusetts General Hospital Boston MA Medicine Division of Hematology & Oncology Massachusetts General Hospital Boston MA Medicine Massachusetts General Hospital Boston MA

BackgroundTreatment-related sexual dysfunction affects the majority of hematopoietic stem cell transplant (HSCT) survivors. Data regarding the relationship between sexual health domains and patient-reported quality of life (QOL) and psychological distress are limited, particularly in this population. MethodsWe conducted a secondary analysis of a cross-sectional study that included 125 autologous and allogeneic HSCT survivors. All were at least 3 months post-HSCT and endorsed sexual dysfunction causing distress. This was based on the two-question approach from the 2015 National Comprehensive Cancer Network (NCCN) survivorship guidelines assessing 1) problems with sexual functioning and 2) whether these problems were causing distress. We assessed global satisfaction with sex and interest in sex (PROMIS), QOL (Functional Assessment of Cancer Therapy-Bone Marrow Transplant [FACT-BMT]), and psychological distress (Hospital Anxiety and Depression-Scale [HADS]). We used multivariate regression analyses, adjusting for age, race, and gender, to examine the association between the sexual health domains with QOL and psychological distress. ResultsStudy participants had a median age of 55.0 (SD 14), and the majority were male (67.2%; 84/125). Female sex was associated with lower global satisfaction with sex (B= -2.14, P=0.019) and lower interest in sex (B= - 1.69, P<0.001). In multivariable regression analyses, global satisfaction with sex was associated with better QOL (B=0.86, P=0.015) but not with depression (B= -0.12, P=0.056) or anxiety (B= -0.10, P=0.180) symptoms. Patient's interest in sex was associated with their QOL (B=3.28, P<0.001), depression (B= -0.51, P=0.002), and anxiety (B= -0.39, P=0.032) symptoms. ConclusionsSexual health domains including global satisfaction with sex and interest in sex were associated with QOL and psychological distress at baseline in HSCT survivors. These findings underscore the need for supportive care interventions to improve sexual sat

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Expanding access to cancer peer support: Development of a website to deliver written peer support that meets patients' individual emotional and informational needs while reducing potential harms 11

Expanding access to cancer peer support: Development of a we...

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11th Scientific Meeting of the International Society for Research on Internet Interventions, ISRII 2022

作者： Bovbjerg, Katrin Graves, Kristi Waltz, Margaret Farrell, David Yanez, Betina Chicaiza, Anthony Omar, Rahma Thompson, Rebecca Kop, Mariska Van Denburg, Alyssa N. Lorch, Danielle Rowley, Scott D. Rini, Christine Northwestern University Feinberg School of Medicine Dept of Medical Social Sciences 625 N. Michigan Ave 21-00 ChicagoIL60611 United States Georgetown University Lombardi Comprehensive Cancer Center Cancer Prevention and Control Program 2115 Wisconsin Ave N Ste. 300 WashingtonDC20007 United States University of North Carolina School of Medicine Department of Social Medicine 333 S Columbia St Chapel HillNC27516 United States People Designs Inc. 1304 Broad Street DurhamNC27705 United States Robert H. Lurie Comprehensive Cancer Center of Northwestern University 675 N St Clair St. Floor 21 Suite 100 ChicagoIL60611 United States John Theurer Cancer Center Hackensack University Medical Center 92 2nd Street HackensackNJ07601 United States

Cancer patients often want information from "peers"with the same diagnosis or treatment. To increase access to this valuable resource, we developed a website to deliver written peer support to cancer patients undergoing stem cell transplant. Because little evidence describes how to optimize benefits or reduce potential harms of written peer support, we gathered multiple forms of stakeholder feedback to inform the website's ethical approach, personalization, design, function, and content: a Community Advisory Board;a longitudinal study of patients' written peer support needs and motivations;focus groups;semi-structured interviews;and usability testing. Findings provide a rich foundation for website development. © 2022 The Author(s).

关键词： Websites

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Adverse Childhood Experiences are Associated With e-Cigarette Abstinence in a Vaping Cessation Randomized Clinical Trial Among Adolescents

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Journal of Adolescent Health 2025年

作者： Graham, Amanda L. Cha, Sarah Jacobs, Megan A. Edwards, Giselle Funsten, Anna L. Papandonatos, George D. Innovations Center Truth Initiative Washington D.C. United States Department of Medicine Mayo Clinic College of Medicine and Science Rochester Minnesota United States Department of Oncology Georgetown University Medical Center/Cancer Prevention and Control Program Lombardi Comprehensive Cancer Center Washington D.C. United States Center for Statistical Sciences Brown University Providence Rhode Island United States

Purpose: Adverse childhood experiences (ACEs) are linked to e-cigarette use. To date, no studies have examined the association between ACEs and e-cigarette cessation. This study examined the relationship between ACEs and vaping cessation outcomes among adolescent e-cigarette users. Methods: Participants were n = 1,248 adolescent (13–17 years) e-cigarette users recruited nationally to a randomized clinical trial of vaping cessation who completed the PEdiatric ACEs and Related Life Events Screener at baseline. The primary outcome was 30-day point prevalence abstinence from nicotine vaping at 7 months (missingness = vaping). Analyses examined associations between vaping cessation and individual ACEs items, risk strata (low: 0 ACEs;intermediate: 1–3 ACEs;high: ≥4 ACEs), and domains of adversity using inverse probability of retention weighted logistic regression adjusted for baseline confounders. Results: Most participants (90.1%) reported at least 1 ACE, with 55.8% classified as high risk (≥4 ACEs). High-risk participants showed 20% lower abstinence rates compared to combined low or intermediate-risk groups (risk ratio = 0.79, 95% confidence interval = 0.69–0.91, p < .001). Each additional abuse experience was associated with a 7% decrease in abstinence rates (risk ratio= 0.93, 95% confidence interval = 0.87–0.99, p = .028), while neglect and household dysfunction domains showed no significant associations with cessation outcomes. Discussion: This study provides the first evidence of an inverse relationship between ACEs and vaping cessation success among adolescents. The results suggest that trauma-informed approaches may be valuable additions to youth vaping cessation interventions. © 2025 Society for Adolescent Health and Medicine

关键词： Adolescent Adverse childhood experiences Cessation Electronic nicotine delivery systems Vaping

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