E-cigarettes, also called “vapes” or “hookah” are now front and center as a form of tobacco product use by youth. Many epidemiological studies reinforce the use of e-cigs is increasing rapidly and in one study, e-cigarettes led to marijuana use a year later (Unger et al., 2016). Recently, LARS completed secondary analyses of the 2014 National Youth Tobacco Survey, a nationally representative survey that uses a multi-stage cluster design with appropriate sampling (non-response and selection) weights to improve the precision of prevalence estimates. We applied “latent class analysis” a type of “clustering” technique to derive unique classes of youth based on their smoking patterns (N=4812). Interestingly, we obtained four clearly distinct classes of smokers including a low level user group (41.5%), a group characterized by only e-cig use (25.8%), a combustible smoker group that used primarily cigarettes (14.1%), and a heavy smoker group that engaged all forms of tobacco use (18.6%). We then predicted class membership from several “external” risk markers including nicotine dependence, quit attempts, perceived harm, media exposure, and perceived benefits of tobacco use. We also included dummy-coded measures of age, sex, and race. Interestingly, heavy smokers (compared to the low use group) were much more likely to report quit attempts and dependence and more likely to be older (9th-12th grade). Members of the e-cig only class were also more likely to report quit attempts and dependence as well as perceive “harm” associated with their tobacco product use and more likely to have seen media ads showing e-cigarettes. These patterns persisted for the combustible cigarette user group as well. Overall, the findings reinforce two important points: (1) not all smokers are the same with many different patterns or combinations of tobacco product use, and (2) the need to continue implementing evidence-based prevention practices and extend their reach to include e-cigarettes. This latter effort can include many of the current “media-based health promotion” messages that target youth as well as efforts to support cessation and reinforce the “harms” of e-cigarettes. More information on this study can be found in our eNEWS Issue #2, which can be found on the website www.larsri.org.
A key goal in the development of virtual reality games (virtual environment, simulation, and edutainment are all included) is to increase presence of the player. This is usually accomplished by reinforcing the player’s sense of spatially “being there” or what is termed immersion in the technological aspects of the game. Interestingly, there are not many well validated measures of “presence” (nor immersion) and there is considerable debate in the field as to how presence should be assessed; using behavioral markers like galvanic skin response or eye movement versus self-report. Several recent studies propose psychometrically refined instruments (paper-and-pencil) to assess presence. LARS is currently working in this area to assess presence in youth as they engage in a virtual environment drug prevention program.
LARS offers a full line of strategic planning consultation services to customers. This service is based on over 30 years of experience conducting research and implementation studies in the field of school- and community-based research. We began by conducting some of the largest to date school- and community-based studies in the field of drug prevention and health promotion. In one case, we tracked over 6,000 urban youth annually for over 10 years. In another study, we longitudinally tracked middle school students from age 13 to 26, assessing them using several different modalities (survey, phone interview and ACASI). We have now expanded this work to include family-based studies involving dyadic studies (parent and child) and also the Outcome Evaluation of the National Youth Anti-Drug Media Campaign, where we worked closely with Westat, Inc. to develop a sampling frame and assessment strategy following almost 4,000 families tracked over four years. Our expertise includes spider-linked batch trace methods, implementing unique follow-up methods, and multi-method survey designs including CAPI, ACASI, RDD, telephone, paper-and-pencil, mailed, and Interactive Voice Recording (IVR). We expanded our work to include the design of community-based participatory research studies, developing randomized clinical trials working with physicians using the chronic care model (practice reorganization) and developing self-management training for patients living with genetic blood disorders. This work includes trial design, developing human subjects’ protocols, curriculum development, execution and logistics planning, cost accounting, and execution in the field (training providers and conducting process evaluations to assess intervention fidelity and adherence).
It is not easy to mount RCTs in schools and likewise the same pitfalls exist in community-based studies. There are recruitment concerns, sampling issues, and problems that arise with retention (or conversely with attrition bias), all of which must be considered prior to implementation. There are also measurement concerns as unreliable instruments can affect estimation of treatment effects (lack of model precision). Many of the different steps required to mount large trials of this nature take years of experience to develop and understand the implications and this is part of the service we bring to clients, basing our expertise on the combination of accumulated wisdom and practical experience. We also assist clients by helping them address some of the methodological and statistical issues that crop up with longitudinal studies, some which are design related (when to stage assessments and what methods to use for data collection) and some that address statistical concerns (how to treat missing data and what is the best way to analyze data). Again, we offer a full line of consultation services, helping clients address these “concerns” before they become logistical nightmares and compromise the research findings.
There is also an extremely exciting addition to our portfolio of services that includes technology-based studies. This focus involves helping clients develop Small Innovative Research Grants (SBIR) funded through the National Institutes of Health. SBIR grants, which can be funded up to 1,150,000 involve testing a commercial product that fits with the overall mandate of the NIH to improve the quality of people’s lives, including their mental or physical health. We have been working closely with several partners to develop these applications from the ground up, including lending our expertise in study design, research methodology, curriculum development, and program evaluation. While many of these studies involve the same technical criteria as RCTs, they differ because of the “technology” being tested. In the case of SBIR grants, we work closely with clients that wish to test the efficacy of a web-based or smartphone application as part of a behavioral change intervention. Examples of several projects include developing applications for mental health, hearing disorders, lupus awareness, dental hygiene, HIV risk reduction, e-cigarette prevention, alcohol and drug education, training professionals working with childhood autism spectrum disorders, and pediatric rheumatic diseases. In all of these cases, we apply our research skills to augment existing “technological” services provided by other collaborators; framing the grants with solid research designs and implementing rigorous evaluation plans. This type of handshaking of skills has resulted in several millions of dollars of NIH funded grants to develop products with commercial market potential. In several instances, we follow-up the commercial venture with introductions to the venture capital community for additional investment advice.