Turning to smoking, researchers surveyed 916 junior high school students in Grade 7 and two years later in Grade 9.54 7th graders who smoked thought that relatively more people smoke, and 7th graders who did not smoke thought that relatively fewer people smoked.Specifically, adolescents who were most involved with smoking believed that half or more than half of all adults or peers smoked, while those least involved believed that fewer than half of adults or peers smoked. Projection bias could explain this data. Students in 9th grade were more likely to smoke than in 7th grade. The study showed which 7th grade non-smokers were likely to become 9th grade smokers. Specifically, non-smokers in the 7th grade who thought that others smoke were relatively likely to smoke became smokers in the 9th grade. Thus the non-smokers who failed to project their behavior onto were likely to become smokers. In contrast, 7th graders who thought that others do not smoke were relatively unlikely to smoke themselves in the 9th grade. Thus non-smokers who projected their behavior onto others were unlikely to become smokers. These facts are consistent with our conclusion that projection bias stabilizes behavior. From these facts, the authors of the study concluded that projection bias caused the increase in smoking. If our model is correct, their conclusion is mistaken. According to our model, projection bias does not change the number of wrongdoers, but it increases the stability of behavior. We predict that providing accurate information about actual smoking to 7th grader non-smokers would reduce their resistance to smoking,cannabis indoor growing and providing accurate information to 7th grade smokers would reduce their resistance to quitting.As soon as the ban was lifted, other students were seen as taking fewer showers than implied by self-reports — 70% versus 77% on day 4, 72% versus 84% on day 5.

This fact is consistent with the theory that moral pessimism only applies to morally relevant behavior. Not showering ceased to be altruistic after the ban was lifted. In another study on altruism, subjects were asked whether or not they would perform hypothetical acts to help others, such as aiding an aging couple stranded in a storm with a flat tire, and whether or not they thought that other people would perform those acts.The study found a gap suggesting moral pessimism. Pessimism was greatest for people who reported that they would not help others, which suggests social projection. Similarly, in the context of blood donations, Goethals found that 60% of a student sample said they would be willing to donate blood but estimated that only 39% of heir peers would do so.In contexts like these, people have difficulty getting information about actual behavior, so bias is likely too have long-term effects. These studies would be more valuable if they predicted the effect of bias on actual behavior and tested their predictions. Advent of the coronavirus 2019 disease pandemic was associated with changes in drinking and drug use among young adults. For alcohol, most studies found increases in the number of days drinking and decreases in the number of drinks consumed per occasion , though other studies have found no significant change or a decrease in the number of days drinking. Studies found no change in the number of days using nicotine and no change or increases in the number of days using cannabis during the pandemic. The emergent literature has three key limitations. First, it is unclear whether the initial effects of the pandemic on drinking and nicotine use in the Spring-Summer of 2020 persisted over time. Most published work has focused on the immediate impact of public health policies to reduce the impact of the pandemic in March 2020. Second, those studies with more extended follow-up have not been designed to distinguish pandemic effects from maturation effects , leaving it unclear to what extent the observed changes in drinking or nicotine use are specifically due to the COVID-19 pandemic. Developmental increases in drinking and drug use are expected as young adults mature, even absent a pandemic. 

Thus, characterizing the effects of the pandemic in the medium- and long-term requires a design that can subtract out the developmental change that would be expected outside the pandemic context. Third, initial evidence regarding an important potential moderator of the pandemic’s impact—its impact on financial security—has been mixed. One study found financial strain was linked to greater pandemic-related increases in nicotine use during March and April 2020 while another study found loss of income did not moderate pandemic-related changes in drinking during June 2020. The financial impact of the pandemic on U.S. adults has been heterogenous and time-varying , so both replication and extension of these findings with a longer period follow up is warranted. Procedures were approved by Institutional Review Boards at each study site. The NCANDA Study was designed to investigate the impact of heavy alcohol use on neurodevelopment. 831 participants ages 12–21 years old were recruited into NCANDA in 2012–2014 and have been followed prospectively at five study sites across the U.S: Duke University, University of Pittsburgh Medical Center , Oregon Health & Science University , University of California San Diego , and SRI International. Exclusion criteria were intentionally minimized: participants lived within 50 miles of the study site, had no MRI contraindications, had no reported prenatal or perinatal exposures or complications, had no pervasive developmental disorder, had no current or persistent major psychiatric disorder that would interfere with the protocol, and were not taking medications known to affect brain function or blood flow. Each site aimed to recruit a community sample representative of the racial/ethnic distributions of their county. Participants were recruited through announcements at local schools and colleges, public notices, and targeted catchment-area calling. The current study draws data from 348 participants ages 12–15 years old at study entry—older participants were excluded to minimize the potential for cohort effects on drinking and nicotine use. 49% of participants were female. 13% identified as Hispanic; 68% as White, 12% as Black, 7% as Asian, and 8% as Alaskan Native or Pacific Islander. 84% of participants had 1 + parent who completed a Bachelor’s degree.

After completing their baseline assessment at study entry, participants were assessed every six months going forward with a combination of in-person assessments and phone interviews. The timing of follow-up visits was anchored to the date of the participant’s baseline assessment. “Pre-pandemic” observations were any assessment occurring between study entry and March 19, 2020, the date of the first state-issued stay-at-home order, so each youth could contribute multiple assessments. Among youth contributing pre-pandemic data to analyses ,cannabis grow racks there were an average of 3.0 pre-pandemic assessments. During the COVID-19 pandemic, participants were invited to complete three web-based surveys in June 2020 , December 2020 , and June 2021. Of the 348 participants included in analyses, 237 completed the June 2020 survey, 213 completed the December 2020 survey, and 195 completed the June 2021 survey. Completers of the pre pandemic and during-pandemic assessments were sociodemo graphically similar. Among the youth contributing during pandemic data to analyses , there were an average of 2.2 during-pandemic observations. Altogether, 60 youth contributed only pre-pandemic data, 67 youth contributed only during pandemic data, and 221 youth contributed both pre- and during pandemic data. Analyses were conducted in R v4.1.2. We estimated the impact of the COVID-19 pandemic by comparing obser vations of same-age youth assessed at four different timepoints: pre pandemic , June 2020, December 2020, and June 2021. Conceptually, we used the pre pandemic data to construct a reference curve for the expected drinking or nicotine use as a function of age, then compared that reference curve to the observed drinking and nicotine use as a function of age at each survey wave during the pandemic. In this way, we sought to distinguish the effects of the pandemic from age-related changes in drinking or nicotine use that would have occurred even outside the pandemic context. We restricted the sample to participants ≤ age 15.8 years at study entry to reduce potential cohort effects on drinking and nicotine use introduced by study entry criteria or by secular changes in drinking or nicotine use among U.S. young adults between 2016 and 2021. If cohort effects were present, they would be confounded with the effect of the COVID-19 pandemic. Preliminary analyses showed date of birth was not predictive of drinking or nicotine use in the restricted sample after controlling for age, suggesting any remaining cohort effects were minimal. In addition, we restricted observations to those of participants ages 18.8–22.4 years old at each time point, to ensure we had observations covering the same age span at each of the four assessment time points and avoid extrapolation beyond the common region of support. Outcomes included the proportion of young adults drinking or using nicotine, the number of days drinking or using nicotine among those reporting any use, and the typical number of drinks per drinking day.Regressions were fit in the geepack package , clustering observations on participant, specifying an exchangeable cor relation structure, and using robust standard errors. For dichotomous dependent variables, a logistic link function was used.

Model specification included fixed effects for sex, race, ethnicity, study site, age at observation, age-at-observation-squared, and time point of assessment. Participant sex, race, ethnicity, and study site were included as covariates given previous work has established they predict alcohol and nicotine use. Age at observation was included to implement our age-based identification strategy ; both linear and quadratic effects were included to account for nonlinear developmental changes in alcohol and nicotine use across this age range. Time point of assessment was a four-level categorical variable , represented by dummy variables with pre pandemic as the reference level. Follow-up models investigated whether the effect of the COVID-19 pandemic varied as a function the impact of the pandemic on participants’ financial security. We expanded the primary model described above by adding the main effect of financial impact and terms capturing the interaction of financial impact with time point. We then tested the statistical significance of the interaction via a Wald test. Regression models compared drinking and nicotine use at the three during-pandemic time points to drinking and nicotine use pre-pandemic. Fig. 1, Panel A graphs the model-estimated means for a 20-year-old participant across time points, which are inter preted next. Compared to pre-pandemic , significantly fewer participants reported any past-month drinking in June 2020 and December 2020 , with the difference no longer being statistically significant in June 2021. Compared to pre-pandemic, those reporting any past-month drinking drank on 1.83 more days in June 2020 , with the difference no longer being statistically significant in December 2020 or June 2021. Compared to pre-pandemic, there were no significant differences at any of the three during-pandemic time points in the number of drinks on a typical drinking day or the binge drinking or nicotine use outcomes. Tables 2 and 3 reports the corresponding effect sizes. Compared to pre-pandemic, 4–5% fewer participants engaged in past month binge drinking in June 2020 and December 2020, though neither difference was statistically significant. We did not find evidence that the degree to which the pandemic impacted participants’ financial security moderated the pandemic’s impact on drinking outcomes. We found evidence that the degree to which the pandemic impacted participants’ financial security moderated the pandemic’s impact on the number of days using nicotine among past-month users but not the prevalence of past-month nicotine use. Fig. 1, Panel B graphs the interactions for the nicotine use outcomes. Among those reporting any past-month nicotine use, participants who experienced moderate-to-extreme financial impact increased the number of days using nicotine while those with no financial impact decreased the number of days using nicotine in June 2020. We investigated changes in drinking and nicotine use from pre pandemic baseline over the first 15 months of the COVID-19 pandemic in a sample of 348 emerging adults ages 18–22 years old. Compared to pre-pandemic, in June 2020, fewer young adults reported past-month drinking, but those who did were drinking on more days. Compared to pre-pandemic, in December 2020, fewer young adults re ported past-month drinking, but those who did were no longer drinking on significantly more days.

To our knowledge, this is the first study conducted in the U.S. to demonstrate that a high school-centered, CPR educational intervention with a “pay-it-forward” component can disseminate CPR knowledge beyond the classroom and reach into low income, minority neighborhoods. High school participants and subsequently trained friends and family demonstrated a statistically significant improvement in aggregate scores. Moreover, students trained an average of 4.9 additional people, demonstrating the potential for a multiplier effect. In a study from Denmark, mass distribution of similar video self-instruction kits resulted in dissemination to an average of 2.5 additional people per student.In another study from Norway with a better survey response rate of 78%, an additional 2.8 people were trained per student participant.Students in our training intervention outperformed their Denmark and Norway counterparts. Our survey response rate was 97% , and students taught on average an additional 4.9 people. Moreover, all participants, students and family and friends, demonstrated significant CPR and AED knowledge increase compared to baseline.However, an investment of one 45- to 60-minute period every school year is sufficient to ensure widespread CPR knowledge.In our study, training was completed in a 45-minute physical education class period, with minimum loss of standard curriculum time, and at low cost. With a retail price of $38.50,pots for cannabis plants the estimated cost per person trained in our pilot program was $6.54. By using video-based learning with an inflatable mannequin, schools can teach Hands-Only CPR skills in a single class period at low cost and with good knowledge acquisition.

Financially restricted schools and communities may not be able to invest in individual training kits for each high school student to take home or even for use in school. A more cost-effective model may include video-based training with use of shared CPR mannequins in the classroom setting. Instead of taking kits home for skills training, students can pay it forward and instruct others by using video and web-based learning platforms without skills practice. Previous research in Arizona has demonstrated that bystanders who learned CPR by watching a 60-second video without skills practice had significantly improved responsiveness, chest compression rate, and decreased hands-off intervals compared to no training.The “pay-it-forward” model also provides an opportunity for high school students to reinforce their knowledge of the chain of survival. Medical students in Germany demonstrated that their own CPR skills improved by teaching schoolchildren.Another study from Belgium demonstrated that instructing schoolchildren to teach Basic Life Support to their relatives and friends led to a more positive attitude of the adults towards bystander CPR.A CPR educational intervention in which high school students become teachers to friends and family can reinforce student knowledge while empowering youth to become community health advocates. As of the drafting of this study,states including Illinois have made CPR a mandatory component of the public high school curriculum.The widespread adoption of CPR training in schools represents a long-term investment to ensure that multiple generations are trained and ready to act.An immediate benefit is the potential impact of adolescents as lay rescuers. Another short-term benefit not well investigated is the potential for an immediate multiplier effect by reaching out of the classroom and into the communities served by the schools.

One successful example of health information flowing from child to parent is the Hip Hop for Stroke program, a school-based, multimedia, stroke-literacy intervention targeting children aged 8-12 in Central Harlem.HHS improved knowledge of stroke symptoms and intent to activate 9-1-1 in children participants while increasing parental stroke literacy.While the concept of child-mediated health education is not new, its application to OHCA remains novel and untested as a major strategy to address significant disparities in outcome by community. Because schools provide large-scale, centrally organized settings accessed by people from all ranges of the social spectrum, a high school-centered, community wide CPR training program has remarkable potential for reach into communities that would otherwise be hard to reach by traditional CPR education efforts. There is significant evidence regarding the high efficacy of child-mediated CPR education. Previous survey studies of witnesses to OCHA have demonstrated that any previous CPR training is a predictor of CPR performance.Moreover, parallel efforts in faith-based, community-based, and employment organizations to teach Hands-Only CPR and share that knowledge with their constituents may have a ripple effect in communities with low bystander-CPR rates.Multifaceted, community-based approaches aimed at strengthening the link in the chain of survival have been successful at increasing bystander-CPR rates and, subsequently, cardiac arrest survival.To eliminate disparities in bystander CPR provision, public education campaigns must prioritize neighborhoods with the highest need as identified using public health surveillance tools such as registries. The effect in communities found to have a high incidence of cardiac arrest and little-to-no incidence of bystander CPR could be exponential. A significant limitation of this study was the inability to determine individual knowledge acquisition given that surveys did not include personal, identifiable information. However, the marked and statistically significant improvement in aggregate scores suggest that a video self-instruction, CPR-training program with a “pay-it forward” component can increase understanding of the indications for and the steps to perform CPR.

Another limitation was the inability to ensure quality control of the pay-it-forward component. It is uncertain whether students provided the answers to the people that they trained or if the increase in the post-intervention scores truly reflected knowledge increase. It is also unclear whether knowledge will translate into adequate technique or increased bystander CPR and AED use. Despite these limitations, our “pay-it-forward” model is an inexpensive,cannabis flood table novel strategy to disseminate CPR and AED knowledge in priority neighborhoods with limited access to traditional CPR training courses.Procedural sedation and analgesia is the use of sedative, analgesic, or dissociative drugs to relieve pain and anxiety associated with diagnostic and therapeutic procedures, while maintaining continuous and independent ventilation.Many procedures that were formerly performed under general anesthesia in the operating room are now successfully completed using PSA in locations outside the OR, including the emergency department.As a result, PSAs are now being performed more frequently by non-anesthesiologists , such as emergency physicians, and it is estimated that roughly a quarter of a million pediatric patients will receive PSA in the ED alone each year.Therefore, it is paramount that emergency physicians be prepared not only to administer proper PSA to children, but also to manage any complications or adverse events that may arise when PSA takes place in the pediatric ED. Adverse event rates during pediatric PSA in non-OR settings are reported between 2.3%-17.6%.6, 7 The definition of adverse events during PSA varies in the literature and has included the following: oxygen desaturation less than 90-93%; apnea; stridor; laryngospasm; bronchospasm; cardiovascular instability; paradoxical reactions; emergence reactions; emesis; and aspiration.Of these, the adverse events that pose the most significant risk to the safety of the patient are those that compromise the airway.Smaller studies have found rates of airway compromise during PSA ranging from 5-6%.Medications used for PSA varied in these studies and included chloral hydrate, propofol, ketamine, midazolam and fentanyl. Larger studies have also found significant but lower rates of airway compromise among pediatric patients undergoing PSA. The Pediatric Sedation Research Consortium found that among nearly 30,000 PSAs performed outside the OR, oxygen desaturation occurred 157 times per 10,000 sedations; stridor and laryngospasm both occurred in 4.3 per 10,000 sedations; and unexpected apnea occurred in 24 per 10,000 sedations.Finally, similar adverse event rates with oxygen desaturations were reported in a systematic meta-analysis of studies involving PSA in the ED.Thus, evidence shows that despite various medications used in pediatric PSAs in different settings, the risk of airway compromise remains. Because of the universal risk for airway compromise among PSA medications, further research has sought to identify patient factors that predict higher risk for adverse events during PSA. For example, studies have shown that patients of younger age or with higher American Society of Anesthesiologists classification may experience more adverse respiratory events during PSA.In light of the inherent airway risks of PSA and the potential ability to identify predisposing factors for adverse events prior to PSA, professional medical governing bodies have proposed guidelines and recommendations specifically for PSA performed by NAs.

The guidelines encompass risk assessment prior to PSA by performing a complete history and physical exam and determining ASA classification and nil per os status. They also stress the importance of appropriate monitoring during PSA and access to airway rescue equipment and pharmacological reversal agents. When implemented, these guidelines have proven to decrease the rate of respiratory adverse events.It is notable, however, that the guidelines cursorily, if at all, suggest using Mallampati scores in pre-PSA evaluations. Mallampati scores are obtained by visualizing a patient’s posterior oropharynx while the patient is seated and opening his mouth with his tongue protruded. The modified Mallampati classification scheme scores adequacy of visualization from I to IV, with I being full visualization and IV being visualization of only the hard palate. The Mallampati score is used to predict difficulty with intubation, with those who score III or IV being more difficult to intubate, and has been validated in children.Given that a higher Mallampati score may indirectly indicate children who have potentially difficult or anatomically different airways, this classification scheme may add important risk information to pediatric pre-PSA assessments. Thus, the objective of this study was to assess whether pre-PSA Mallampati score can predict adverse events during pediatric PSA. Our study found that there was not a significant difference in the proportion of adverse events between those individuals with Mallampati scores of III/IV vs. those with Mallampati scores of I/II. In fact, post-hoc power analysis showed that this study had a 95% power to detect a 15% difference in the proportion of adverse events between these two groups. Notably, a greater proportion of patients with Mallampati scores of III/IV compared with those of Mallampati scores of I/II required repositioning during PSA. This is not surprising since those with higher Mallampati scores likely have the body habitus, particularly increased neck girth and larger facies, that could predispose a patient to obstructive respiratory events during PSA. Hirsch et al. found that children who were obese and undergoing PSA experienced a greater desaturation rate compared with children who were not obese.Furthermore, Mallampati scores have also been shown to be an independent predictor of obstructive sleep apnea, thus highlighting the fact that these scores may be an indirect measurement of anatomical factors that should be considered in pre-PSA assessments.In this study, nearly 20% of the patients did not have a documented Mallampati score or the physician administering PSA was unable to obtain a score. Although the physicians who did not document a Mallampati score were not required to provide information on why these scores were not reported, we surmise that the primary reason for scores not obtained was secondary to patient compliance. The median age of those whose scores were either not obtained or unable to be obtained was 2.6 years, thus suggesting that age may limit the physician’s ability to obtain a Mallampati score. Mallampati scoring requires the patient to sit upright, voluntarily open his mouth and refrain from saying “ahh”. Koop et al. showed that children under the age of four are less likely to be able to cooperate with such maneuvers and may not have the cognitive ability to follow through with multi-step tasks that require greater attention.Similarly, other studies comparing Mallampati scores to other indirect methods predicting difficult endotracheal intubations, such as the Cormack and Lehane grading system, have also encountered difficulty in obtaining Mallampati scores for children ages 1-3 years.Furthermore, pediatric patients presenting to the PED for PSA are often suffering from painful injuries, and under these circumstances physical examinations, particularly oropharyngeal exams, can be viewed as distressing from the patient and parent perspectives.Thus, age, physical pain, and distress or anxiety may hinder the physician’s ability to obtain a Mallampati score. While this study was powered to detect differences in adverse events between those with Mallampati scores of III/IV vs. those with Mallampati scores of I/II, it is still rare for adverse, sedation-related events to occur, particularly with the use of ketamine. The adverse event rate during the study period was 11.6%, which is similar to previously reported PSA adverse event rates at this institution.