Joshua S. Yang

Comparisons of online recruitment sources are rarely conducted under a unified protocol; literature-based comparisons confound recruitment mode with variation in eligibility criteria, survey instruments, incentives, and data-quality controls. We compared four concurrently fielded recruitment modes (text-message invitations, targeted digital advertising, social media advertising, and a commercial nonprobability panel) using a common screener, instrument, incentive, and quality-flagging system to establish a large cohort of a minority subpopulation: young adults (aged 18-25) in California who use electronic nicotine delivery systems. Screener completion per invitation/impression ranged from 0.8% to 11.1% with 12,547 completed screeners. Two quality-flagging systems were applied with 806 retained respondents. Screener fraud flags were 4 to 9 times more frequent for social media advertising than for any other mode (p < .001). Across all recruitment modes except social media, endorsing eligibility items was associated with a higher likelihood of screener flags, with one exception (ps < .008), a pattern consistent with eligibility fraud. Baseline assessment insufficient effort responding (IER) flags were most frequent among panel respondents (p < .001) and least frequent among respondents recruited via text-message and targeted digital advertising, the two probabilistic sampling modes. Paradata-based and content-based screening were complementary rather than interchangeable data-quality tools with weak overlap (Jaccard index = .20); most respondents exceeding the baseline threshold were already excluded via screener flags, whereas most screener-flagged respondents produced internally consistent reports, indicating the screenings captured distinct validity threats. Recruitment mode systematically shaped both fraudulent responding and response effort. Social media advertising yielded the largest and most demographically diverse sample but also the highest screener fraud rates; the commercial panel showed little evidence of fraud but the highest IER. Multi-modal recruitment of minority subpopulations into large longitudinal studies is feasible and, with layered quality controls, can yield cohorts with acceptable fraud and IER profiles.

Background: Reports of hospitalization associated with Diamond Shruumz–branded mushroom-containing products in October 2024 led to a manufacturer’s recall that restricted the sale, distribution, and accessibility of this new and emerging psychoactive product. Objective: This study seeks to assess the continuing online availability of a mushroom-containing edible product in a diverse e-commerce landscape, specifically aiming to identify and characterize its online availability before and after recall initiation. Methods: A retrospective online market surveillance of Diamond Shruumz products using structured and automated search queries was employed to identify online product marketing and availability. Online surveillance included the monitoring of multiple social media platforms, cannabis e-commerce websites, and search engine queries between June 22 and June 27, 2024, immediately preceding the manufacturer-initiated recall. Post-recall simulated purchases were then conducted on July 12, 2024, on platforms, websites and domains identified as continuing to actively market and sell the products through online product listings. Results: Prior to product recall, a total of 4117 product listings across 1600 (38.86%) social media posts and user-generated comments, 11 (0.27%) cannabis e-commerce websites, and 2509 (60.94%) hyperlinks from internet search queries were generated for further content analysis. Review of online sources revealed 49 social media posts, 8 e-commerce shops, and 67 domains that were identified as actively marketing and selling products prior to recall. Post-recall, we identified 45 (67.16%) remaining domains that continued to market the product from these different online sources. Simulated purchases revealed that 15 (33.33%) domains successfully transacted test purchases and 30 (66.66%) transactions failed because of account verification or payment failure. Conclusions: The Diamond Shruumz recall exemplifies the ongoing challenge of unknown consumer harm associated with new and emerging substances marketed and sold on the internet, which is especially concerning as these products appeal to younger audiences with a variety of edible flavored products. While a recall was initiated and products became unavailable, our study found that post-recall online vendors continued to market and sell the products. This indicates that there are ongoing challenges to effectuate recalls and online enforcement in a diverse e-commerce landscape that can rapidly bring new and novel psychoactive substances to the market.

Background: Certain populations are underrepresented in clinical trials, limiting the generalizability of new treatments and their efficacy and uptake in these populations. It is essential to identify and understand effective strategies for enrolling young adults in clinical trials, as they represent a vital and key demographic for future clinical trial participation. Objective: This study aimed to develop, test, and evaluate digital tools designed to encourage the participation of young adults in the clinical trial process. An interdisciplinary approach, incorporating social listening, qualitative focus groups, and co-design workshops, was used to achieve this goal. Methods: Digital tools were designed and evaluated using a 4-phase approach that included: (1) social listening to characterize lived experiences with COVID-19 trials as self-reported by online users, (2) qualitative focus groups with young adults to explore specific lived attitudes and experiences related to COVID-19 clinical research hesitancy and engagement, (3) a series of cocreation and co-design workshops to build digital tools aimed at encouraging clinical trial participation, and (4) a controlled intercept study to assess the usability and specific outcome measures of the co-designed digital tools among young adults. Results: A significantly higher change in the likelihood of participating in a clinical trial post exposure was observed among study participants when exposed to prototypes of a mobile app (Δ=0.74 on a 10-point scale, P<.01) and website (Δ=0.93, P<.01) compared to those exposed to a Facebook ad (Δ=0.21) but not a digital flyer (Δ=0.58). Furthermore, those exposed to the mobile app (x̅=5.76, P=.04) and electronic flier (x̅=5.72, P=.04), but not the website (x̅=5.55), exhibited significantly higher postexposure interest in learning about clinical trials when compared to participants exposed to the Facebook (Meta) ad (x̅=5.06). Participants in the intercept study were more likely to consider joining a clinical trial after seeing a mobile app (Δ=0.74, P<.01) or website (Δ=0.93, P<.001) compared to a Facebook ad (Δ=0.21), but the digital flyer (Δ=0.58) did not show a significant difference. In addition, those who saw the mobile app (x̅=5.76, P=.04) or the digital flyer (x̅=5.72, P=.04) showed more interest in learning about clinical trials than those who saw the Facebook ad (x̅=5.06), though the website (x̅= 5.55) did not significantly impact interest. Conclusions: Mobile apps and web pages co-designed with young diverse adults may represent effective digital tools to advance shared goals of encouraging inclusive clinical trials.

BACKGROUND Certain populations are underrepresented in clinical trials, limiting the generalizability of new treatments and their efficacy and uptake in these populations. It is essential to identify and understand effective strategies for enrolling young adults in clinical trials, as they represent a vital and key demographic for future clinical trial participation. OBJECTIVE This study aimed to develop, test, and evaluate digital tools designed to encourage the participation of young adults in the clinical trial process. An interdisciplinary approach, incorporating social listening, qualitative focus groups, and co-design workshops, was used to achieve this goal. METHODS Digital tools were designed and evaluated using a 4-phase approach that included: (1) social listening to characterize lived experiences with COVID-19 trials as self-reported by online users, (2) qualitative focus groups with young adults to explore specific lived attitudes and experiences related to COVID-19 clinical research hesitancy and engagement, (3) a series of cocreation and co-design workshops to build digital tools aimed at encouraging clinical trial participation, and (4) a controlled intercept study to assess the usability and specific outcome measures of the co-designed digital tools among young adults. RESULTS A significantly higher change in the likelihood of participating in a clinical trial post exposure was observed among study participants when exposed to prototypes of a mobile app (Δ=0.74 on a 10-point scale, P<.01) and website (Δ=0.93, P<.01) compared to those exposed to a Facebook ad (Δ=0.21) but not a digital flyer (Δ=0.58). Furthermore, those exposed to the mobile app (x̅=5.76, P=.04) and electronic flier (x̅=5.72, P=.04), but not the website (x̅=5.55), exhibited significantly higher postexposure interest in learning about clinical trials when compared to participants exposed to the Facebook (Meta) ad (x̅=5.06). Participants in the intercept study were more likely to consider joining a clinical trial after seeing a mobile app (Δ=0.74, P<.01) or website (Δ=0.93, P<.001) compared to a Facebook ad (Δ=0.21), but the digital flyer (Δ=0.58) did not show a significant difference. In addition, those who saw the mobile app (x̅=5.76, P=.04) or the digital flyer (x̅=5.72, P=.04) showed more interest in learning about clinical trials than those who saw the Facebook ad (x̅=5.06), though the website (x̅= 5.55) did not significantly impact interest. CONCLUSIONS Mobile apps and web pages co-designed with young diverse adults may represent effective digital tools to advance shared goals of encouraging inclusive clinical trials.

BackgroundSubstance use and mental health are highly correlated, though few studies assess the risk for depression and anxiety associated with dual and polysubstance use among college students. The purpose of this study was to characterize the relationship between alcohol, cannabis, and e-cigarette exclusive, dual, and polysubstance use and depression and anxiety among U.S. college students by racial and ethnic subgroup and stratified by sex.MethodsData from 83,467 undergraduate students participating in the 2020-2021 Health Minds Survey, a multi-campus, web-based survey, were used. Sex-stratified logistic regression models examined the effects of exclusive (past 30-day cannabis use, past 30-day e-cigarette use, past 2-week heavy alcohol use), dual (two among cannabis, e-cigarette, or alcohol use), and polysubstance (all three substances) use on anxiety (>= 10 GAD-7 score) and depression (>= 15 PHQ-9 score).ResultsThe study included 60,746 females and 22,721 males. Among females, compared to those who exclusively used alcohol, dual users of cannabis and e-cigarette had the largest odds for depression (adjusted odds ratio (aOR) = 1.92) and anxiety (aOR = 1.69) followed by polysubstance users (aORs = 1.85 and 1.53, respectively). Among males, compared to those who exclusively used alcohol, dual users of cannabis and e-cigarette had the largest odds for depression (aOR = 2.72) and anxiety (aOR = 2.23) followed by polysubstance users (aOR = 1.71 and 1.85, respectively). African American female and male students had lower odds of anxiety and depression compared to White students.ConclusionsThe results suggest that single, dual, and polysubstance use are associated with anxiety and depression among U.S. college students, though not necessarily in additive ways.

Introduction: Unregulated and potentially illegal sales of tobacco, nicotine, and cannabis products have been detected on various social media platforms, e-commerce sites, online retailers, and the dark web. New end-to-end encrypted messaging services are popular among online users and present opportunities for marketing, trading, and selling of these products. The purpose of this study was to identify and characterize tobacco, nicotine, and cannabis selling activity on the messaging platform Telegram.Methods: The study was conducted in three phases: (1) identifying keywords related to tobacco, nicotine, and cannabis products for purposes of detecting Telegram groups and channel messages; (2) automated data collection from public Telegram groups; and (3) manual annotation and classification of messages engaged in marketing and selling products to consumers.Results: Four keywords were identified (“Nicotine,” “Vape,” “Cannabis,” and “Smoke”) that yielded 20 Telegram groups with 262 506 active subscribers. Total volume of channel messages was 43 963 unique messages that included 3094 (7.04%) marketing/selling messages. The most commonly sold products in these groups were cannabis-derived products (83.25%, n = 2576), followed by tobacco/nicotine-derived products (6.46%, n = 200), and other illicit drugs (0.77%, n = 24). A variety of marketing tactics and a mix of seller accounts were observed, though most appeared to be individual suppliers.Conclusions: Telegram is an online messaging application that allows for custom group creation and global connectivity, but also includes unregulated activities associated with the sale of cannabis and nicotine delivery products. Greater attention is needed to conduct monitoring and enforcement on these emerging platforms for unregulated and potentially illegal cannabis and nicotine product sales direct-to-consumer.Implications: Based on study results, Telegram represents an emerging platform that enables a robust cannabis and nicotine-selling marketplace. As local, state, and national tobacco control regulations continue to advance sales restrictions and bans at the retail level, easily accessible and unregulated Internet-based channels must be further assessed to ensure that they do not act as conduits for exposure and access to unregulated or illegal cannabis and nicotine products.

Background Governments are passing laws to restrict the sale of flavoured tobacco products (FTPs), but retailer compliance with such policies may vary. This study compared tobacco retailer compliance with local ordinances restricting the sale of FTPs across various localities in Southern California. Methods Attempts to purchase FTPs from a random sample of tobacco retailers in a convenience sample of four cities in Southern California with FTP sales restrictions were made from June to August 2022. Trained shoppers of legal tobacco purchasing age entered tobacco retailers and purchased prohibited FTPs if they were on display or asked salespersons for menthol cigarettes or a flavoured e-cigarette, completing purchases if they were made available. Results Among 141 stores, 39.9% of stores were non-compliant with local ordinances. Non-compliance varied by city, occurring in 49.3%, 43.8%, 15.4% and 0% of stores across four cities. The highest proportion of non-compliance was among vape or tobacco shops (91.2%) followed by convenience and liquor stores (36.4%), grocery stores and pharmacies (15.4%), and gas stations (13.5%). Conclusion Prior to California’s statewide sales restriction on flavoured tobacco, compliance with local sales restrictions was variable across cities and store types.

Introduction: This study examined the association of four domains of human capital development (cognitive development, social and emotional development, physical health, and mental health) and exclusive and concurrent tobacco and cannabis use (TCU) among black youth. Aims and Methods: Nationally representative annual cross-sectional data for black adolescents (12–17 years; N = 9017) in the National Survey on Drug Use and Health 2015–2019 were analyzed. Analyses examined the influence of human capital factors (cognitive development, social and emotional development, physical health, and mental health) on exclusive and concurrent TCU. Results: In total, 50.4% were males; prevalence of 12-month tobacco use fluctuated insignificantly between 5.6% and 7.6% across survey years. Similarly, prevalence of 12-month cannabis use remained relatively stable around 13%, with no significant linear change. Prevalence of concurrent TCU also fluctuated insignificantly between 3.5% and 5.3%. Investment in cognitive development decreased the odds of tobacco (aOR = 0.58, p < .001), cannabis (aOR = 0.64, p < .001), and concurrent tobacco and cannabis (aOR = 0.58, p < .001) use. Similarly, investment in social and emotional development reduced the odds of tobacco (aOR = 086, p < .001), cannabis (aOR = 0.83, p < .001), and concurrent tobacco and cannabis (aOR = 0.81, p < .001) use. Good physical health reduced the odds of tobacco (aOR = 0.52, p < .1), cannabis (aOR = 0.63, p < .05), and concurrent TCU (aOR = 0.54, p < .05). Major depressive episodes increased the likelihood of cannabis use (aOR = 1.62, p < .001). Conclusions: Investment in cognitive, social, and emotional aspects of human capital development, and physical health among black youth is protective against TCU. Efforts to sustain human capital development among black adolescents may contribute to reducing TCU disparities. Implications: This is one of few studies to examine human capital development factors and their associations with TCU among black youth. Efforts to eliminate tobacco/cannabis-related disparities among black youth should also invest in social, emotional, cognitive, and physical health development opportunities.