Background: Electronic cigarette (e-cigarette) use and vaping tobacco have increased rapidly worldwide, raising concerns about their health effects, social acceptability, and regulatory challenges. In many countries, e-cigarettes are more commonly used by individuals from higher socioeconomic status (SES) backgrounds, who, in theory, should have greater knowledge about e-cigarettes and their associated risks. However, it remains unclear why a group with more knowledge about e-cigarette risks would also hold more positive attitudes toward vaping and exhibit higher usage rates — a phenomenon that may represent a knowledge-behavior paradox. Understanding this paradox, along with the complex relationships between e-cigarette knowledge, attitudes, and behaviors, is critical for informing effective public health interventions, campaigns, social media messaging, and regulatory policies. Objectives: This study aimed to evaluate the complex relationship between SES, e-cigarette knowledge, pro-vaping attitudes, and e-cigarette use. Methods: The SMOKES Study (Study of Measurement of Knowledge and Examination of Support for Tobacco Control Policies) used a multi-center, cross-sectional design, collecting data from 2,403 college and university students across 15 provinces in Iran (covering nearly half of the country's provinces). The survey measured family income, age, sex, ethnicity, e-cigarette use, knowledge, and attitudes. Structural Equation Modeling (SEM) was employed to examine the interrelations between SES, knowledge, attitudes, and behavior, while adjusting for age, sex, and ethnic minority status. Results: SEM analysis confirmed the hypothesized paradox. Although greater knowledge about e-cigarettes was linked to less favorable attitudes toward vaping and lower use, pro-vaping attitudes emerged as the strongest predictor of vaping behavior, while knowledge played a weaker protective role. Notably, individuals with higher SES simultaneously showed higher knowledge and, paradoxically, more pro-e-cigarette attitudes and greater usage. Female students and ethnic minority students reported higher correct knowledge and lower pro-vaping attitudes and use. Although age and higher family income were associated with more favorable attitudes, they did not directly predict vaping behavior. These results suggest that for higher SES individuals, poor knowledge is not the main driver of e-cigarette use; rather, their pro-e-cigarette attitudes, which seem to outweigh the influence of knowledge, play a key role. Conclusions: Although individuals from higher SES backgrounds report greater correct knowledge about e-cigarettes, this knowledge does not necessarily translate into reduced positive attitudes or lower usage. This study highlights the complexity of these paradoxical effects and suggests that public health strategies need to go beyond simple education and knowledge-based interventions. Targeted approaches should address industry messaging, challenge misconceptions, and strengthen regulatory efforts to reduce e-cigarette use among young adults, including those from higher SES backgrounds.Full article

Background: While the link between depression and smoking is known, less is known about the relationship between hopelessness and smoking in large national community-based sample of Black people. Aims: This study investigates the association between hopelessness and smoking status, using data from the National Survey of American Life (NSAL), which is the only ethnically diverse nationally representative sample of Black adults. Methods: Data from the NSAL were analyzed. Hopelessness and smoking status were assessed using structured interviews. Logistic regression was employed to assess the link between hopelessness and smoking status, controlling for potential confounders such as demographic factors and socioeconomic indicators as well as depression. Results: 4,939 participants entered our analysis. Hopelessness was significantly associated with higher odds of smoking status. This association remained robust after adjusting for confounders such as demographic factors, socioeconomic status, and depression. Conclusions: Hopelessness may be a critical risk factor for smoking in Black adults. Promoting hope as a component of targeted tobacco cessation programs may help reduce tobacco use of Black populations.Full article

Pembrolizumab, an immune checkpoint inhibitor targeting the programmed cell death 1 (PD-1) protein, is widely used for renal cell carcinoma but rarely causes central nervous system adverse events such as myelitis. A 58-year-old woman with stage IV renal clear cell carcinoma developed radiating hip pain, paresthesia, hypoesthesia (T10 and below), constipation, urinary retention, and sudden right-eye blurred vision one month after her sixth cycle of pembrolizumab and lenvatinib. Neurologic examination revealed asymmetrical inferior paraparesis, upper motor neuron signs, and right eye papilledema. MRI demonstrated patchy hyperintensity on C2-C6 and T2-T5, supportive of myelitis. Intravenous methylprednisolone was initiated, leading to pain relief and motor improvement. This is the first reported case of pembrolizumab-induced myelitis in Indonesia, emphasizing the importance of early recognition and corticosteroid therapy for optimal recovery.Full article

Background: Proper umbilical cord care prevents neonatal infections and reduces neonatal mortality. Despite global recommendations for evidence-based cord care practices, traditional beliefs, and inadequate maternal knowledge often lead to unsafe practices, particularly in low-resource settings like Bangladesh. This study aimed to assess the understanding of umbilical cord care among mothers of neonates in Sherpur District, Bangladesh, and identify factors associated with knowledge levels. Methods: A descriptive cross-sectional study was conducted from July to October 2020 at Sherpur Sadar Hospital. A total of 193 mothers of neonates were recruited using a non-randomized purposive sampling method. Data was collected through a pre-tested, semi-structured, interviewer-administered questionnaire. Knowledge levels were categorized as "Good" (>6) or "Poor" (≤6) based on responses to 10 structured questions. Statistical analyses, including chi-square tests and crude odds ratios (COR), were performed to identify socio-demographic factors associated with knowledge levels. Results: Of the 193 participants, 48.7% demonstrated "Good" knowledge, while 51.3% had "Poor" knowledge. Education level (p = 0.01), occupation (p = 0.02), family type (p < 0.001), and family size (p = 0.04) were significantly associated with knowledge levels. Mothers with higher education and those from joint families exhibited better knowledge. However, 28.5% of respondents were unaware of the typical umbilical cord-shedding timeframe, and 44% could not identify signs of infection. Unsafe practices, such as using medications (14.5%) or hot compression (7.2%) for drying the cord, were reported. Conclusion: The study reveals significant gaps in maternal knowledge regarding umbilical cord care in Sherpur District, driven by socio-demographic disparities and cultural practices. Targeted health education programs, emphasizing evidence-based cord care practices and leveraging local social structures, are urgently needed to improve neonatal health outcomes in similar resource-limited settings. Future research should evaluate the effectiveness of these interventions to inform policy and practice.Full article

Background: Emotional problems have been associated with substance use, yet longitudinal research examining this relationship during childhood and adolescence in large, diverse, community-based samples remains limited. Aims: This study investigates the prospective associations between three emotional problems—hopelessness, depression, and suicide attempts—before ages 9–10 and the subsequent initiation of tobacco and marijuana use before ages 14–15, using data from the Adolescent Brain Cognitive Development (ABCD) study. Methods: Data from the ABCD study were analyzed. Baseline emotional problems, including hopelessness, depression, and suicide attempts, were assessed at ages 9–10 through structured parent interviews. Substance use outcomes (tobacco and marijuana initiation) were tracked from baseline to follow-up at ages 14–15 using structured self-report measures. Structural Equation Modeling (SEM) was employed to assess the predictive roles of these early-life emotional problems, controlling for potential confounders such as demographic factors and family and neighborhood socioeconomic status. Results: Baseline hopelessness, depression, and suicide attempts at ages 9–10 were significant predictors of tobacco and marijuana use initiation at ages 14–15. These associations remained robust after adjusting for confounders, indicating the independent effects of early emotional problems on adolescent substance use initiation. Conclusions: Emotional problems in early childhood, including hopelessness, depression, and suicidal behavior, are critical predictors of substance use initiation during adolescence. These findings underscore the importance of early identification and targeted mental health interventions to reduce the risk of substance use among vulnerable youth.Full article

Introduction: Pain is considered as the fifth vital sign that should be considered in assessing patients. For clinicians to evaluate and determine the right pain interventions, there should be parameters such as pain scale. Our objective in this study is to determine factors affecting pain scale preferences in suburban and rural populations. The pain scales used in this study are FPS-R (Faces Pain Scale-Revised), VRS (Verbal Rating Scale), VAS (Visual Analogue Scale), and NRS (Numering Rating Scale). Method: This study uses observational design with an interview approach and a cross-sectional study. Areas covered are within Indonesia, which are marginal areas of Tangerang district border, and two rural areas in Serukam, West Kalimantan, and Soe, East Nusa Tenggara. Data collected will be analyzed using SPSS 25 software. Result: Populations within the suburban areas prefer NRS (52.08%) as their pain scale, and populations in rural areas prefer FPS-R 76.92%). Factors affecting pain scale preferences are location areas, as well as last education, with statistical significance of p<0.05. Discussion: Our study showed that the choice of several pain scales is not appropriate for specific demographics due to the complexity of these scales. Factors that should be considered are the location areas and education level, as some population in remote areas have better understanding of simpler pain scales. Conclusion: Complexity or simpler components may be an underlying reason for the preference of score selection to assess pain scales in some population. Therefore, the selection of pain scales should be adjusted to specific demographics so that clinicians can provide appropriate management with appropriate pain scales.Full article

Background: Chronic medical conditions are major drivers of healthcare spending, morbidity, and mortality in the United States, as well as critical indicators of health disparities. The disproportionately high rates of chronic medical conditions among Black, Latino, and American Indian and Alaska Native adults compared to non-Latino Whites highlight the urgent need to examine the factors contributing to these disparities. While higher socioeconomic status is generally associated with better health outcomes, this benefit may be diminished for racialized and minoritized populations. Objective: This study investigates the protective effects of educational attainment and income-to-poverty ratio on the prevalence of chronic medical conditions and examines whether these effects vary across racial and ethnic groups, specifically among Black, Latino, and American Indian and Alaska Native adults compared to non-Latino White adults. Methods: Using data from the 2023 National Health Interview Survey (NHIS), this cross-sectional study analyzed the association between educational attainment and chronic medical conditions across racial and ethnic groups. Logistic regression models were employed to assess whether the strength of the relationship between education and chronic medical conditions differed by racial/ethnic group, controlling for key demographic and socioeconomic covariates. Sample size was 29,373 which was reflective of 256,566,689 US population. Results: Consistent with the theory of Minorities' Diminished Returns, findings showed that the protective effects of higher educational attainment on chronic medical conditions were significantly weaker for Black, Latino, and American Indian and Alaska Native adults than for their non-Latino White counterparts. Even among individuals with higher education, Black, Latino, and American Indian and Alaska Native adults faced elevated risks of chronic medical conditions. Conclusion: While educational attainment generally reduces the prevalence of chronic medical conditions, this protective effect is moderated by racial and ethnic background. Structural barriers limit the health benefits of educational attainment. This underscores the need for policies that address structural inequities—such as low-quality education and occupational segregation—that constrain the protective health effects of educational attainment for minoritized groups.Full article