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Background The burden of smokeless tobacco (ST) use disproportionally impacts males in rural Ohio Appalachia. The purpose of this study was to describe the cultural factors contributing to this disparity and to articulate the way in which culture, through interpersonal factors (i.e. social norms and social networks) and community factors (i.e. marketing and availability), impacts ST initiation and use of ST among boys and men in Ohio Appalachia. Methods Fifteen focus groups and twenty-three individual qualitative interviews were conducted with adult (n=63) and adolescent (n=53) residents in Ohio Appalachian counties to ascertain factors associated with ST use and the impact of ST marketing. Transcriptions were independently coded according to questions and themes. Results ST use appears to be a rite of passage in the development of masculine identity in Ohio Appalachian culture. Interpersonal factors had the greatest influence on initiation and continued use of ST. Ohio Appalachian boys either emulated current ST users or were actively encouraged to use ST through male family and peer networks. Users perceived their acceptance into the male social network as predicated on ST use. Community factors, including ST advertisement and access to ST, reinforced and normalized underlying cultural values. Conclusions In addition to policy aimed at reducing tobacco marketing and access, interventions designed to reduce ST use in Ohio Appalachia should incorporate efforts to 1) shift the perception of cultural norms regarding ST use and 2) address male social networks as vehicles in ST initiation.

Objectives The United States Department of Agriculture's Child and Adult Care Food Program (CACFP) provides meals and snacks to low-income children in child care. This study compared nutrition and physical activity practices and policies as well as the overall nutrition and physical activity environments in a sample of CACFP and non-CACFP child care settings. Methods A random stratified sample of 350 child care settings in a large Midwestern city and its suburbs, was mailed a survey on obesity prevention practices and policies concerning menu offerings, feeding practices, nutrition and physical activity education, activity levels, training, and screen time. Completed surveys were obtained from 229 of 309 eligible child care settings (74.1 % response rate). Chi square tests were used to compare practices and policies in CACFP and non-CACFP sites. Poisson and negative binomial regression were used to examine associations between CACFP and total number of practices and policies. Results Sixty-nine percent of child care settings reported CACFP participation. A significantly higher proportion of CACFP sites reported offering whole grain foods daily and that providers always eat the same foods that are offered to the children. CACFP sites had 1.1 times as many supportive nutrition practices as non-CACFP sites. CACFP participation was not associated with written policies or physical activity practices. Conclusions for Practice There is room for improvement across nutrition and physical activity practices and policies. In addition to food reimbursement, CACFP participation may help promote child care environments that support healthy nutrition; however, additional training and education outreach activities may be needed.

Objective As smokeless tobacco (ST) marketing increases and new products emerge on the market, very little is known about consumer perceptions of ST products. To inform development of future ST counter-marketing approaches, this qualitative study examined consumer perceptions of traditional and novel ST products and packaging. Methods Focus groups and qualitative interviews were held with adolescent (n=23; mean age of 17 years) and adult (n=38; mean age of 29 years) male ST users from rural Ohio counties. Participants were shown a variety of traditional (e.g., Copenhagen®, Timber Wolf®) and novel (e.g., Camel Snus®, Orbs®) ST products and asked about perceptions of these products and their packaging. Transcriptions were coded independently for common themes by two individuals. Findings Adolescents and adults generally had similar beliefs and reactions about ST products. While participants were familiar with a variety of traditional ST products, Copenhagen® was the most frequently used product. Perceptions of quality and price of traditional products were closely tied to product taste and packaging material. Colors, design, and size of ST packaging appealed to participants and influenced decisions to purchase. Adults believed novel ST products had a weak taste and were targeted to untraditional ST users. While the vast majority was unfamiliar with dissolvable tobacco, adolescents noted that they would be more convenient to use during school than traditional ST. Conclusions Packaging has a significant role in shaping perceptions of ST and consumer behavior. Regulation of product packaging such as shape, size, and images should be part of comprehensive tobacco control.

The recent growth in smokeless tobacco (ST) consumption has raised questions about consumer risk perceptions of ST products, especially in high-risk vulnerable populations. This qualitative study examined risk perceptions of ST among adolescent and adult users and non-users in Ohio Appalachia. Focus groups and interviews were held with adolescents (n=53; mean age of 17 years) and adults (n=63; mean age of 34 years) from four Ohio Appalachian counties. Participants were asked about their perceptions of ST-related health risks, ST safety, and the relative safety of ST compared to cigarettes. Transcriptions were coded independently by two individuals. Overall, participants were knowledgeable about health problems from ST use (e.g., oral cancers, periodontal disease). Nearly all participants stated that ST use is not safe; however, there was disagreement about its relative safety. Some perceived all tobacco products as equally harmful; others believed that ST is safer than cigarettes for either the user or those around the user. Disagreements about ST relative safety may reflect mixed public health messages concerning the safety of ST. Comprehensive consumer messages about the relative safety of ST compared to cigarettes are needed. Messages should address the effect of ST on the health of the user as well as those exposed to the user.

Purpose To describe U.S. youth harm perceptions of intermittent tobacco use. Methods Using data from the 2016 National Youth Tobacco Survey of U.S. students in grades 6–12 (n=20,575), we examined prevalence and correlates of harm perceptions of tobacco product use on “some days but not every day” for four tobacco products. Associations between current (past 30-day) use and harm perceptions were assessed using multivariable regression. Results Perceiving that intermittent use causes ‘no’ or ‘little’ harm was 9.7% for cigarettes, 12.0% for smokeless tobacco, 18.7% for hookah, and 37.5% for e-cigarettes. Perceptions were associated with past 30-day use, and more than half of past 30-day non-cigarette users perceived intermittent use as causing ‘little’ or ‘no’ harm. Conclusions One in ten youth perceived intermittent cigarette smoking as causing ‘no’ or ‘little’ harm; this perception was higher among current users. Efforts are warranted to educate youth about the risks of tobacco product use.

Objectives: In 2018, approximately 4.9 million US middle and high school students reported past 30-day use of any tobacco product. This study describes how and where youth obtained tobacco products and whether refusal of sale occurred during 2016-2018. Methods: Data from 3 annual waves (2016-2018) of the National Youth Tobacco Survey, a school-based survey of US youth in grades 6-12, were analyzed among current (past 30-day) tobacco product users aged 9 to 17 years. Results: During 2016-2018, youth tobacco product users most commonly obtained tobacco products from social sources. Although the percentage of users who reported buying tobacco products significantly decreased from 2016 to 2018 (2016: 15.6%; 2018: 11.4%), no significant differences in the prevalence of being refused sale were observed (2016: 24.7%; 2018: 25.5%). Conclusions: Whereas the number of youth users who report buying tobacco products has declined, sales of tobacco products to youth remain a public health concern, as only one in 4 youth who attempted to buy were refused sale in 2018. Monitoring youth tobacco product purchases, retailer compliance check inspections, and retailer penalties for sales to minors remain important for reducing youth access at retail sources.

Asymmetries of the sylvian fissure (SF) are believed to reflect an enlargement of the posterior temporal lobe, particularly a region that corresponds to part of Wernicke's area in humans. In nonhuman primates the homologue to the region may be involved in the discrimination and processing of species-specific vocalisations. As capuchin monkeys are large-brained, socially complex primates with a rich vocal repertoire, it was hypothesised that they would display asymmetry of the SF. We used high-resolution 3T MRI scans to investigate this asymmetry in 17 brown capuchin monkeys (Cebus apella; 9 males, 8 females). Results indicated a trend towards population-level leftward asymmetry in the lateral region of the SF. Post hoc analyses revealed significant sex differences in SF asymmetry, with females displaying a population-level leftward asymmetry of the lateral region of the SF. Age was a significant mediator of the effects of sex on asymmetry of the lateral region of the SF. These results provide evidence that capuchin monkeys display sex differences in the asymmetry of the SF and show developmental changes in hemispheric lateralisation.