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This paper challenges conventional understandings of how we think about consumer food waste by investigating the food purchasing/wasting views and practices of 102 Colorado (USA) residents (67 households). The methods used in this study included the triangulation of surveys, self-reported pictures of food waste and related daily reports over a two-week period, and focus groups. Understanding who is, and what are, driving food waste is important if the aim is to create policy interventions that meaningfully mitigate loss. This paper approaches concepts like consumer sovereignty and agency through a non-essentialist lens, which is to say it repositions food waste as a mode of ordering as opposed to an outcome of discrete, self-evident products-e.g., attitudes, autonomous consumers. Doing this opens the analysis up to connections that might otherwise go unrecognized when those categories are assumed to be absolute and obvious. After presenting numerical data gleaned from online surveys, findings are organized around the following themes: humans-as-assemblage; storage devices-as-assemblage; and mobility-as-assemblage. The paper concludes synthesizing these themes while suggesting interventions mindful of these fluid socio-material coming-togethers. [ABSTRACT FROM AUTHOR]

This article examined visitors' attitudes toward electric motorized bikes (ebikes) on natural surface trails and the reasons for support or opposition to ebikes. Onsite survey data (n = 536) were obtained from visitors to Devil's Backbone Open Space (DBOS) in Larimer County, Colorado in 2020. Findings suggested that visitors' ebike attitudes differed by demographics (i.e., age, gender, residence), and trip characteristics (i.e., survey location, visits per year, primary activity). We also observed a positive correlation between perceived ebike familiarity and support. A content analysis of responses to an open-ended question revealed that concerns over safety, crowding, and beliefs that ebikes do not belong in natural environment were major reasons for opposing ebikes. The potential to expand trail access to people with mobility difficulties was the main reason for a supportive attitude. Visitors' attitudes were also associated with misperceptions about ebikes (e.g., ebikes are noisy), suggesting the need for effective public communication. We suggested several practical recommendations for managing ebikes in natural areas. First, correct information regarding ebikes (e.g., ebikes are generally quiet) needs to be disseminated. Ebike demonstration sites at popular trailheads would allow visitors to personally experience ebikes and better understand the technology. Information boards could describe ebikes' mechanisms and environmental impact to clarify some misperceptions. Second, concerns with safety and speed could be addressed by developing comprehensive bike regulations (e.g., speed limits, trail etiquette education) for all bikers. Setting up speed limit signs and monitoring devices on trails might minimize some visitor concerns. Third, exceptions could be made for users with mobility disabilities; these exceptions should be advertised widely so all visitors were aware of and understand the exceptions. [ABSTRACT FROM AUTHOR]

Background Despite their efficacy in preventing unintended pregnancies, intrauterine devices (IUDs) are still relatively underutilized by American women. Although cost of these methods is clearly a barrier to use, IUDs have had a long and sometimes controversial history, and earlier versions were removed from the market. Methods This study explores the degree to which the length of licensure for providers is related to their attitudes toward or fears about these methods. Data come from a 2012 survey of 114 clinicians in Colorado and Iowa, collected as part of two, statewide initiatives to reduce unintended pregnancy. Providers were asked about service barriers to prescribing these methods and for which patients they perceived them to be suitable and safe. Results The most experienced clinicians were the least concerned about uterine perforation and history of the Dalkon Shield, but were more likely to fear a lawsuit over complications. More experienced clinicians were also less approving of Copper T IUDs for all 11 subgroups of women, including nulliparous women and those with histories of sexually transmitted infections. They were also less approving of hormonal IUDs for 10 groups of women, including those with histories of ectopic pregnancies. However, clinicians with the most recent licensure were more conservative in their approval of single rod implants than were the providers with the most years since licensure. Conclusions This paper explores potential reasons for these findings and suggests trainings to recognize and overcome these barriers so as to promote consistent and accurate practice across clinicians, regardless of years of experience. [ABSTRACT FROM AUTHOR]

State officials responsible for the regulation of hydraulic fracturing (fracking) operations used in the production of oil and gas resources will inevitably confront a key policy issue; that is, to what extent can statewide regulations be developed without reducing land use autonomy typically exercised by local officials? Most state regulators have historically recognized the economic importance of industry jobs and favor the adoption of uniform regulatory requirements even if these rules preempt local policymaking authority. Conversely, many local officials seek to preserve land use autonomy to provide a greater measure of protection for public health and environmental quality goals. This paper examines how public officials in three states--Colorado, Pennsylvania, and Texas--address the question of state control versus local autonomy through their efforts to shape fracking policy decisions. While local officials within Texas have succeeded in developing fracking ordinances with relatively little interference from state regulators, Colorado and Pennsylvania have adopted a tougher policy stance favoring the retention of preemptive oil and gas statutes. Key factors that account for between state differences in fracking policy decisions include the strength of home rule provisions, gubernatorial involvement, and the degree of local experience with industrial economic activities. [ABSTRACT FROM AUTHOR]

Introduction and Aims: Chronic pain is one of the most common health-related conditions experienced by Americans over the age of 65. In this study, we examine the intersection between pain, opioids and cannabis use among older adults in Colorado and Illinois and examine how medical needs and other variables associated with a persons' background and attitudes influence choices concerning the use of opioids and cannabis to treat pain.Design and Methods: Data were collected via a survey about cannabis and opioids use, and questions related to individual need factors (e.g. pain, quality of life) and contextual factors (e.g. sex, finances, personal attitudes, interaction with physicians) were included in this study. We built a logistic regression model to evaluate factors associated with drug use and a multinomial regression model to understand factors that influence drug choices between cannabis and opioids.Results: A total of 436 individuals completed the survey; 62 used opioids only, 71 cannabis only and 72 used both. When comparing drug users to non-drug users, pain was significantly associated with using cannabis and/or opioids when controlling for other covariates. However, when we compared cannabis users to opioid users, pain was no longer a determining factor. Instead, other contextual factors such as sex, personal beliefs and physician attitudes influenced an individual's choice between cannabis or opioids.Discussion and Conclusions: This study showed that contextual factors appear to have more influence on an individual's decision to use cannabis as an alternative to opioids than individual need or characteristics. [ABSTRACT FROM AUTHOR]

Objectives: Evidence‐based clinical practice guidelines (CPGs) for the treatment of pneumonia and sepsis have existed for many years with multiple studies suggesting improved patient outcomes. Despite their importance, little is known about variation in emergency department (ED) adherence to these CPGs. Our objectives were to estimate variation in ED adherence across CPGs for pneumonia and sepsis and identify patient, provider, and environmental factors associated with adherence. Methods: This was a multicenter retrospective study using standard medical record review methods. The population consisted of consecutive adults hospitalized for pneumonia or sepsis (identified by discharge ICD‐9 codes) at five Colorado hospitals (two academic, three community) who were admitted to the hospital from the ED and for whom the ED diagnosed or initiated treatment. The outcome measured was ED adherence to the CPG (primary) and in‐hospital mortality (secondary). Hierarchical generalized linear models were used for analysis. Results: Among 827 patients, ED care was 57% adherence to CPGs with significant variation in adherence across CPGs (sepsis 50%, pneumonia 64%, p < 0.001). Patients were less likely to receive adherent care if they presented with chief complaints that were associated but not typical of the diagnosis (odds ratio [OR] = 0.6, 95% confidence interval [CI] = 0.4–0.8), received an ED diagnosis that was not specific to the CPG (associated diagnosis OR = 0.3 [95% CI = 0.2–0.5]; unrelated diagnosis OR = 0.4 [95% CI = 0.2–0.6]) or presented to a community hospital (OR = 0.6, 95% CI = 0.4–0.9). ED CPG nonadherence was associated with higher in‐hospital mortality (OR = 2.4, 95% CI = 1.2–4.8). Conclusion: Adherence to ED infectious CPGs for pneumonia and sepsis varies significantly across diseases and types of institutions with significant room for improvement, especially in light of a significant association with in‐hospital mortality. [ABSTRACT FROM AUTHOR]

Risk multiplexity (i.e., overlap in drug-use, needle exchange and sexual relations) is a known risk factor for HIV. However, little is known about predictors of multiplexity. This study uses egocentric data from the Colorado Springs study to examine how individual, behavioral and social network factors influence engagement in multiplex risk behavior. Analyses revealed that compared to Whites, Hispanics were significantly more likely to engage in risk multiplexity and Blacks less so. Respondents who were similar to each other (e.g., in terms of race) had significantly higher odds of being in risk multiplex relationships, and respondents’ risk perceptions and network size were significantly associated with engaging in multiplex risk behaviors. Findings from interaction analysis showed the effect of knowing someone with HIV on the odds of multiplexity depends partly on whether respondents’ know their HIV status. Findings suggest that demographics, HIV behaviors and network factors impact engagement in multiplex risk behaviors, highlighting the need for multi-level interventions aimed at reducing HIV risk behavior. [ABSTRACT FROM AUTHOR]

Objective This qualitative study explored parent and patient navigator perspectives of home visitation as part of a childhood obesity program in a low-income, largely Latino population. Methods Three patient navigators and 25 parents who participated in a home-based, childhood obesity program participated in focus groups or interviews. Emergent themes were identified through content analysis of qualitative data. Results Three overall themes were identified. Patient navigators and parents perceived: (1) enabling characteristics of home-based program delivery which facilitated family participation and/or behavior change (i.e., convenience, increased accountability, inclusion of household members, delivery in a familiar, intimate setting, and individualized pace and content); (2) logistic and cultural challenges to home-based delivery which reduced family participation and program reach (i.e., difficulties scheduling visits, discomfort with visitors in the home, and confusion about the patient navigator’s role); and (3) remediable home-based delivery challenges which could be ameliorated by additional study staff (e.g., supervision of children, safety concerns) or through organized group sessions. Both patient navigators and participating parents discussed an interest in group classes with separate, supervised child-targeted programming and opportunities to engage with other families for social support. Conclusions for Practice A home visitation program delivering a pediatric obesity prevention curriculum in Denver was convenient and held families accountable, but posed scheduling difficulties and raised safety concerns. Conducting home visits in pairs, adding obesity prevention curriculum to existing home visiting programs, or pairing the convenience of home visits with group classes may be future strategies to explore. [ABSTRACT FROM AUTHOR]

Background: As of January 1, 2017, eight states have approved laws for recreationalmarijuana use. While the social impacts of these changes remain under debate, the influence on adolescent marijuana use is a key policy and health issue across the U.S. Objective: To examine changes in adolescent marijuanause behaviors in the first year after recreational marijuana implementation in Colorado, and to analyze the effect of retail marijuana store proximity on youth use and perceptions. Method: Secondary analysis of Healthy Kids Colorado Survey data from 40 schools surveyed before and after recreational marijuana sales were implemented (2013 student n = 12,240; 2014 student n = 11,931). Self-reported marijuana use, ease of access, and perceived harms were compared between years and by proximity of recreational marijuana stores to surveyed schools. Results: Adolescent marijuana use behaviors, wrongness of use, and perceptions of risk of harm were unchanged from baseline to one-year follow-up. Perceived ease of access to marijuana increased (from 46% to 52%). Proximity of recreational marijuana stores was not significantly associated with perceived ease of access to marijuana. Conclusions/Importance: In the first study of adolescent marijuana use and perceptions after state retail implementation of recreational marijuana, there was little change in adolescent marijuana use but a significant change in perception of ease of access. Public health workers and policymakers should continue to monitor these changes as essential for evaluating the impact of liberalization of marijuana policies. [ABSTRACT FROM AUTHOR]

Aims To evaluate how young adults perceive and compare harms and benefits of marijuana and tobacco products in the context of a legal marijuana market in Colorado. Design Semi-structured qualitative interviews. Setting Denver, CO, USA. Participants Thirty-two young adults (aged 18-26 years) who used tobacco/marijuana/vaporizers. Measurements Semi-structured interviews addressed perceived harms and benefits of various tobacco and marijuana products and personal experiences with these products. Findings Young adults evaluated harms and benefits using five dimensions: (1) combustion-smoking was considered more harmful than non-combustible products (e.g. e-cigarettes, vaporizers and edibles); (2) potency-edibles and marijuana concentrates were perceived as more harmful than smoking marijuana flower because of potential to receive too large a dose of tetrahydrocannabinol (THC); (3) chemicals-products containing chemical additives were seen as more harmful than 'pure' or 'natural' plant products; (4) addiction-participants recognized physiological addiction to nicotine, but talked primarily about psychological or life-style dependence on marijuana; and (5) source of knowledge-personal experiences, warning labels, campaigns, the media and opinions of product retailers and medical practitioners affected perceptions of harms and benefits. Conclusions Among young adults in Colorado, USA, perceived harms and benefits of tobacco and marijuana include multiple dimensions. Health educational campaigns could benefit from addressing these dimensions, such as the potency of nicotine and cannabis concentrates and harmful chemicals present in the organic material of tobacco and marijuana. Descriptors such as 'natural' and 'pure' in the promotion or packaging of tobacco and marijuana products might be misleading. [ABSTRACT FROM AUTHOR]

This research study explores the experience of first-generation immigrants of Mexican origin living in Denver, CO. Seven Mexican immigrants described their experiences through an in-depth interview process. The data were analyzed using a constant comparative method. The process described by the participants reflects ambivalence about living in the United States. This ambivalence stems from a conflict between their beliefs that the United States is the land of opportunity and their experiences of being unable to access opportunities because of their identity as immigrants—regardless of immigration status. [ABSTRACT FROM AUTHOR]

Background: Over the past two decades, state and local governments across the U.S. have been increasingly reforming marijuana laws. Despite growing support for marijuana as a medical treatment, little is known about medical students' perceptions of marijuana use.Objective: To assess Colorado medical students' personal and professional opinions on current and future marijuana use in a healthcare setting.Design: A voluntary, anonymous, online cross-sectional survey.Participants: Medical students (n = 624) at the University of Colorado School of Medicine between January and February 2014 were invited to participate.Main Measures: Numerical responses were quantified using counts and percentages, and Likert scale responses were collapsed for bivariate analysis. Items were gathered thematically and additively scored for each subscale. Internal consistency reliability statistics were calculated for each subscale to ensure that items were assessing similar constructs. Unadjusted t tests and one-way analysis of variance (ANOVA) were used to calculate mean differences in subscale scores between subgroups.Key Results: We received 236 responses (37%). Students indicated support for marijuana legalization (64%), and few believed that physicians should be penalized for recommending marijuana to patients (6%). Nearly all (97%) believed that further marijuana research should be conducted, and believed marijuana could play a role in the treatment of various medical conditions. Seventy-seven percent reported that they believed marijuana use had the potential for psychological harm, and 68% indicated concern for potential physical harm. Only a minority of students would recommend marijuana to a patient under current law (29%), or if it were legally available (45%). Acceptability of marijuana for treatment of approved conditions was not correlated with age or gender, but was positively correlated with living in Colorado prior to medical school (p < 0.001) and with prior marijuana use (p < 0.001).Conclusions: Medical students support marijuana legal reform, medicinal uses of marijuana, and increased research, but have concerns regarding risks of marijuana use, and appear hesitant to recommend marijuana to patients. [ABSTRACT FROM AUTHOR]

The aim of this study was to analyze dental students' descriptions of and reflections on the periodontal care they provided for their patients in dental school clinics. All students enrolled in the final year of the DDS program in 2011-14 at the University of Colorado School of Dental Medicine were required to complete a self-assessment of the periodontal care they provided for patients. Assessments from 263 students were compiled and qualitatively analyzed. The key reasons given for not providing good care were identified and then stratified as student/school-dependent or patient-dependent factors. Among these students, 63.1% reported that the periodontal care they provided for their patients was inadequate. Some of the student/school-dependent factors were multiple providers involved in patient care (22.8%), student oversight (21.3%), licensure and academic requirements (20.9%), limited clinic operator sessions (19.4%), clinical rotations to other sites (18.3%), and students' interest in/emphasis on other areas of dentistry (17.9%). Some of the patient-dependent factors were patient scheduling compliance (61.6%), patient finances (46.4%), medical status (20.5%), urgent dental needs (18.3%), emphasis only on restorative care (17.5%), periodontal care awareness (16.4%), and patients' oral hygiene compliance (11.5%). This analysis of students' attitudes, challenges they faced, and patient-related factors that influenced the delivery of periodontal care helped to facilitate changes in the curriculum and school policies to optimize clinical instruction and patient care in periodontics. [ABSTRACT FROM AUTHOR]

Purpose: Placentophagy (maternal consumption of the placenta) has become increasingly prevalent in the past decade among women seeking to promote health and healing during the postpartum period. The purpose of this study was to assess patient and provider familiarity with and attitudes toward placentophagy, as well as patients' willingness to try placentophagy. Methods: Two cross-sectional surveys with questions regarding placentophagy practice were distributed to healthcare providers and patients. The provider survey was distributed via email listservers to international perinatal professional organizations and to obstetrics and gynecology, nurse midwifery, family medicine, and psychiatry departments at three urban hospitals. Patient surveys were administered in person at an urban hospital in Chicago, Illinois. Results: Approximately two thirds (66%; n = 100) of patients and most (89%; n = 161) of providers were familiar with placentophagy. Patients with a history of a self-reported mental health disorder were more likely to be willing to consider placentophagy and to believe that healthcare providers should discuss it with their patients. Conclusions: Most providers and patients have heard of placentophagy but are unsure of its benefits and/or risks. Further research examining the potential therapeutic efficacy and/or risks of placentophagy is needed. [ABSTRACT FROM AUTHOR]

Infants with visual impairment often require additional interaction from adults to reinforce behaviors that lead to competency at mealtimes, but parental and professional confidence in teaching these skills is often limited. In the following collective case study, the authors, a speech/language pathologist (S/LP), occupational therapist (OT), and a teacher of students with visual impairment (TVI) questioned whether the level of a child’s visual impairment affected child/adult interactions, and if so, how? The authors followed 30 young children with visual impairment from ages 3 months to 3 years. Cases included two groups of participants identified by degree of vision loss. One case had no vision or light perception only and was identified as the Tactual Learners. The other case, identified as the Visual Learners, had some degree of usable vision, but still required some type of adaptation to be successful. Using interpretive observation, semi-structured interviews, and artifacts for triangulation, the authors identified results that indicate young children who have less vision and are Tactual Learners have specific concerns regarding the development of independent eating skills and that a protocol of family-centered mealtime strategies could benefit their parents. The authors independently reviewed and coded the videotapes, interviews, and artifacts to identify four themes to guide additional strategy implementation for families. The research showed improving caretaker confidence, providing adaptations for an individual child’s visual needs, encouraging sensory experiences around food, and teaching developmental expectations can potentially minimize difficulties in establishing good eating habits and promote independence at mealtime. [ABSTRACT FROM PUBLISHER]

Background: Almost half of US pregnancies are unintended, resulting in many abortions and unwanted or mistimed births. Contraceptive counseling is an effective tool to increase patients' use of contraception. Methods: Using an online 20-item questionnaire, we evaluated the frequency of contraceptive counseling provided to reproductive-age women during a prevention-focused visit by University of Colorado internal medicine resident and faculty providers. We also evaluated factors hypothesized to affect contraceptive counseling frequency. Results: Although more than 95% of the 146 medicine faculty and resident respondents agreed that contraceptive counseling is important, only one-quarter of providers reported providing contraceptive counseling 'routinely' (defined as ≥80% of the time) to reproductive-age women during a prevention-focused visit. Providing contraceptive counseling routinely was strongly associated with taking an abbreviated sexual history 'often'/'routinely' (odds ratio [OR]=11.6 [3.3 to 40.0]) and with high self-efficacy to provide contraceptive counseling (OR=6.5 [1.5 to 29.0]). However, fewer than two-thirds of providers reported taking an abbreviated sexual history 'often'/'routinely.' More than 70% of providers reported inadequate knowledge of contraceptive methods as a contraceptive counseling barrier. However, providers' perceived inadequate knowledge was not associated with traditional educational exposures, such as lectures and women's health electives. Conclusions: In prevention-focused visits with reproductive-age women, a minority of internal medicine faculty and residents reported routine contraceptive counseling. Future efforts to increase contraceptive counseling among internists should include interventions that increase provider contraceptive counseling self-efficacy and ensure that providers obtain an abbreviated sexual history. [ABSTRACT FROM AUTHOR]