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ABSTRACT BACKGROUND The Healthy, Hunger-Free Kids Act of 2010 ( HHKA) required schools to make changes to meals provided to children. Rural school districts have limited resources, with increased obesity rates and local food insecurity. In this study we sought to understand the perceptions of rural food service directors and the barriers to implementing the changes. METHODS Food service directors from rural school districts were invited to complete a semistructured telephone interview and online survey. A total of 51 respondents completed both, 6 completed only the online survey, and 16 completed only the telephone interview. Qualitative interview data were analyzed through open thematic coding; descriptive statistics were calculated for the quantitative data. RESULTS Food service directors mostly perceived the changes as negative, challenging, and burdensome. They believed that the changes resulted from concern about childhood obesity, which they did not view as a problem for their students. Diverse challenges were reported related to cost, preparation, and student preference. CONCLUSIONS Food service directors in isolated, rural areas need support to enhance understanding of HHKA requirements, build professional networks to learn from one another, and communicate with students, families, and other stakeholders. Future efforts should focus on changing perceptions and supporting directors in order to make implementation a success. [ABSTRACT FROM AUTHOR]

Earlier pubertal onset has been associated with increased disordered eating symptoms in cisgender girls. Although this finding has been replicated across studies of disordered eating, most studies have focused on white samples. The lack of studies is surprising given that early pubertal timing may impact disordered eating risk in Black and Latinx girls differently due to trends of earlier pubertal onset in these groups and increased stressors related to interpersonal and structural racism and economic marginalization. Current methods of examining pubertal timing among Black and Latinx girls may also not fully capture their experience. Contextual factors (e.g., neighborhood and school racial/ethnic composition) may influence how minoritized girls both perceive and are affected by their pubertal timing. Moreover, factors such as ethnic–racial identity development and experiences of discrimination may be important mechanisms explaining the association between pubertal timing and disordered eating risk. This paper aims to provide a brief overview of studies examining pubertal timing and disordered eating risk among Black and Latinx girls in the US and to discuss recommendations for future research that integrate contextual factors in the examination of pubertal timing and its effects. Public significance: Early pubertal timing has been associated with increased risk of disordered eating symptoms among cisgender girls; however, studies have been limited due to the use of predominantly white samples. The article provides a brief overview of findings related to pubertal timing effects among Black and Latinx girls, discusses considerations for the measurement of pubertal timing, and highlights the need for inclusion of contextual factors in future research. [ABSTRACT FROM AUTHOR]

Background: As of 2017, American Indian/Alaska Natives (AI/AN) had the highest prevalence of illicit drug use of any ethnic group in the United States, with 17.6% of the population aged 12 and older reporting using illicit drugs in the last month. Studies have shown the positive correlation between a history of trauma and substance use disorder. In fact, the majority of youth in treatment for substance misuse reported a history of trauma. Intergenerational trauma, systematic discrimination, and displacement are downstream effects of colonization, and experiences of racism often define the life experiences of AI/ANs who use substances. This paper describes the process of designing a developmentally and culturally appropriate primary prevention supplement for an evidence‐based program to prevent substance use and increase cultural identity among AI/AN youth. [ABSTRACT FROM AUTHOR]

This essay introduces Analyses of Social Issues and Public Policy's collection of papers on the social psychology of the 2012 election, framing it in terms of two prior collections. The papers are described as reflecting four themes: President or Barack Obama's path from outsider to incumbent, the nation's shift toward increasingly racialized politics, contemporary perceptions of 'Americanness,' and the role of moral values in political engagement. [ABSTRACT FROM AUTHOR]

On January 6th, 2021, Donald Trump's speech during a 'Save America' rally was followed by mass violence, with Trump's supporters storming the U.S. Capitol to prevent the certification of Joe Biden's victory in the presidential election. In its wake, there was a great deal of debate around whether the speech contained direct instructions for the subsequent violence. In this paper, we use a social identity perspective on leadership (and more specifically, on toxic leadership) to analyse the speech and see how its overall argument relates to violence. We show that Trump's argument rests on the populist distinction between the American people and elites. He moralises these groups as good and evil respectively and proposes that the very existence of America is under threat if the election result stands. On this basis he proposes that all true Americans are obligated to act in order prevent Biden's certification and to ensure that the good prevails over evil. While Trump does not explicitly say what such action entails, he also removes normative and moral impediments to extreme action. In this way, taken as a whole, Trump's speech enables rather than demands violence and ultimately it provides a warrant for the violence that ensued. [ABSTRACT FROM AUTHOR]

Objectives: In 2019 the United States experienced the largest outbreak of measles in 27 years, 19 years after the United States declared measles eliminated. The purpose of this paper was to present a population study of a measles outbreak within Orthodox Jewish communities in New York that led to the elimination of religious exemption for school mandated vaccines. Methods: Peer reviewed articles, news media, health department, and government resources were used to investigate environmental factors that led to this outbreak. State, county, and city immunization records were accessed to explore measles compliance rates before and after policy change. Results: Rockland County had low compliance rates compared to the rest of the state, and the elimination of religious exemptions raised compliance rate almost to state level. In all but one affected New York City zip codes, compliance following policy change rose to 97.95%–99.15%. Conclusions: Overall, changes in measles compliance rates reflect policy goals, but localized differences imply a need for more customized interventions for each unique community. Public health planning to promote vaccination should be sensitive to the concerns and perceptions of each community in order for health interventions to have a positive effect. [ABSTRACT FROM AUTHOR]

Abstract: This paper analyzes the effect of a change in the status of housing equity as a protected asset for Medicaid long‐term care payment eligibility. A difference‐in‐difference‐in‐differences strategy is employed to estimate the effect of the policy on the housing equity holdings of potentially treated individuals. Using a panel of unmarried homeowners, the policy induced treated individuals who were likely to require long‐term care to hold less housing equity by values of $82,000 to $193,000 relative to control individuals. This equates to relative reductions of 12 to 29 percent for treated individuals after the policy change. Similar effects are not observed when considering health measures less predictive of long‐term care services and for a sample of married households who were unlikely affected by the policy. These estimates confirm the importance of the housing asset as a shelter for Medicaid eligibility. [ABSTRACT FROM AUTHOR]

The COVID‐19 pandemic has impacted routine health care services including immunization delivery. The most common sexually transmitted infection in the United States is the human papillomavirus (HPV), and its sequelae may be prevented by vaccination. Sequelae that can develop if one's immune system is not able to clear the infection include warts, precancerous lesions, and cancer. The American College of Obstetricians & Gynecologists (ACOG) reports almost everyone who is sexually active will encounter the virus at some time during their life. Most of the estimated 79 million infections occur among people who are in their late teens or early 20s. Since 2006, there has been a vaccine available to prevent HPV infections in both males and females; however, administration of this vaccine has only been about half the rate of other vaccines and vaccine hesitancy may play a role. Public health nurses are vital in providing accurate and nonjudgmental vaccine education to their clients, especially unaccompanied minors seeking care in public health department clinics. This paper will explore the recommendations for providing this vaccine as well as a snapshot of current practice in two health departments in the Southeast region of the United States during the COVID‐19 pandemic. [ABSTRACT FROM AUTHOR]

Purpose: In 2018, the Centers for Disease Control and Prevention (CDC) released an evidence‐based guideline on pediatric mild traumatic brain injury (mTBI) to educate health care providers on best practices of mTBI diagnosis, prognosis, and management/treatment. As residents living in rural areas have higher rates of mTBI, and may have limited access to care, it is particularly important to disseminate the CDC guideline to rural health care providers. The purpose of this paper is to describe rural health care providers' experience with pediatric mTBI patients and their perceptions on incorporating the guideline recommendations into their practice. Method: Interviews with 9 pediatric rural health care providers from all US regions were conducted. Interview transcripts were coded and analyzed for themes for each of the main topic areas covered in the interview guide. Findings: Common causes of mTBI reported by health care providers included sports and all‐terrain vehicles. While health care providers found the guideline recommendations to be helpful and feasible, they reported barriers to implementation, such as lack of access to specialists. To help with uptake of the CDC guideline, they suggested the development of concise implementation tools that can be referenced quickly, integrated into electronic health record‐based systems, and that are customized by visit type and health care setting (eg, initial vs follow‐up visits and emergency department vs primary care visits). Conclusion: Length, accessibility, and usability are important considerations when designing clinical tools for busy rural health care providers caring for pediatric patients with mTBI. Customized information, in both print and digital formats, may help with uptake of best practices. [ABSTRACT FROM AUTHOR]

Context Few qualitative findings have been published that explore and identify the challenges experienced by independent abortion providers during the COVID‐19 pandemic in the United States (US). In this paper, we explore these themes while expanding the concept of "abortion exceptionalism" beyond its original legal meaning to address the impact of abortion stigma. Methods: Twenty abortion providers from independent abortion clinics throughout the US South and Midwest participated in semi‐structured interviews in June and July 2020. Interviews explored the challenges of providing abortion care in the wake of the COVID‐19 pandemic and sought to identify how clinics strategized and amended their clinical practices to continue providing abortion care during this time. Results: All providers we spoke to noted significant challenges to providing abortion care in the early days of COVID‐19. In addition to experiencing the same concerns as other health care institutions, abortion clinics also faced additional, unique burdens that can only be attributed to the politics of abortion exceptionalism. Examples of this abortion exceptionalism include abrupt orders to close clinics, the need to rely on traveling physicians, legislature‐imposed limits on telemedicine, heightened activities of protesters, and non‐evidence‐based regulation of medication abortion. Conclusion: Despite major challenges and differential treatment, independent abortion clinics in the US persevered to continue to provide abortion care throughout the COVID‐19 pandemic. [ABSTRACT FROM AUTHOR]

White, politically conservative males in the United States have been widely found to maintain petro‐masculine attitudes that include aspects of racism, misogyny, and climate change denial. These beliefs and their associated behaviors, including climate destructiveness, can be conceptualized as compensatory reactions to modern‐day racial, gender, and climate‐related anxieties that are experienced as threats to traditional white male privilege and power. They then manifest as and energize authoritarian desires and their associated sociopolitical movements, including the current Republican effort to Make American Great Again. This paper utilizes psychoanalytic concepts concerning individual and large‐group identity, group psychodynamics and processes, and the intergenerational transmission of idealized myth and fantasy to further elucidate and expand upon these complex phenomena. It then suggests specific strategies for disentangling the strong links between white hegemonic masculinity, fossil fuel use, and climate change denial, thus opening doors to alternative, non climate‐destructive yet still empowering notions of individual, large‐group, and national identity that are, instead, based in communal concern and climate care. [ABSTRACT FROM AUTHOR]

Objectives To prioritize research topics relevant to the care of the growing population of older adults with multiple chronic conditions ( MCCs). Design Survey of experts in MCC practice, research, and policy. Topics were derived from white papers, funding announcements, or funded research projects relating to older adults with MCCs. Setting Survey conducted through the Health Care Systems Research Network ( HCSRN) and Claude D. Pepper Older Americans Independence Centers ( OAICs) Advancing Geriatrics Infrastructure and Network Growth Initiative, a joint endeavor of the HCSRN and OAICs. Participants Individuals affiliated with the HCSRN or OAICs and national MCC experts, including individuals affiliated with funding agencies having MCC-related grant portfolios. Measurements A 'top box' methodology was used, counting the number of respondents selecting the top response on a 5-point Likert scale and dividing by the total number of responses to calculate a top box percentage for each of 37 topics. Results The highest-ranked research topics relevant to the health and healthcare of older adults with MCCs were health-related quality of life in older adults with MCCs; development of assessment tools (to assess, e.g., symptom burden, quality of life, function); interactions between medications, disease processes, and health outcomes; disability; implementation of novel (and scalable) models of care; association between clusters of chronic conditions and clinical, financial, and social outcomes; role of caregivers; symptom burden; shared decision-making to enhance care planning; and tools to improve clinical decision-making. Conclusion Study findings serve to inform the development of a comprehensive research agenda to address the challenges relating to the care of this 'high-need, high-cost' population and the healthcare delivery systems responsible for serving it. [ABSTRACT FROM AUTHOR]

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Suboptimal maternal nutrition and excessive gestational weight gain (GWG) establish in mothers and their offspring a weight gain trajectory towards overweight and obesity. Therefore, pregnancy may be the best opportunity to disrupt the generational cycle of obesity. More than half of women in the UK now enter pregnancy overweight or obese, highlighting that if interventions are not targeted towards women in higher weight categories before conception they are likely to 'miss the mark'. To address issues of suboptimal maternal nutrition and excessive GWG in antenatal care, health professionals need to consider how women's requirements and expectations may have changed in recent years and the impact of weight stigma on the care of women who are obese. This paper aims to drive changes in clinical practice guidelines, medical curricula, the language used by health professionals, and ultimately promote maternal nutrition and weight management in pregnancy as key priorities during antenatal care. Evidence indicates that women want non-judgemental, simple and encouraging guidance in these areas. Small changes to health professionals' practice can improve how advice regarding nutrition and weight management in pregnancy is delivered, and has the potential to reduce overweight and obesity prevalence in women and their children in the years to come. Surely that goal is worth pursuing. [ABSTRACT FROM AUTHOR]

This paper examines why overconfident CEOs issue more debt than equity within US Real Estate Investment Trusts (REITs) and the value implications of this debt preference. Consistent with a demand-side story, the paper finds that overconfident CEOs choose to issue more debt than equity than their non-overconfident counterparts. The findings also rule out the supply-side story that overconfident CEOs are screened out of the equity market. CEO preference for debt is associated with a decline in shareholder wealth. Specifically, using an event study, the paper finds that overconfident CEOs suffer an approximately $67 million loss associated with debt issues in market capitalization. Further analysis suggests that the loss stems from the higher default risk induced by overconfident REIT CEOs' debt preference. The demand-side explanation remains robust even after considering several CEO demographics, estimation methods, and the following five possible alternative drivers of the main results: (1) insider information; (2) risk tolerance; (3) past performance; (4) dividends; and (5) board pressure. [ABSTRACT FROM AUTHOR]

Involvement in terrorism has traditionally been discussed in relatively simplistic ways with little effort spent on developing a deeper understanding of what involvement actually entails, and how it differs from person to person. In this paper, we present the results of a three-year project focused on 183 individuals associated with the global jihadist movement who were convicted in the United States, for terrorist offenses, between 1995 and 2012. These data were developed by a large-scale, open-source data collection activity that involved a coding dictionary of more than 120 variables. We identify and explore the diversity of behaviors that constitute involvement in terrorism. We also compare lone actors and those who acted as part of a group, finding that lone actors differed from group-based actors in key demographic attributes and were more likely to be involved in attack execution behaviors. Implications for counterterrorism are then discussed. [ABSTRACT FROM AUTHOR]

This paper analyzes the relationship between individuals' attitudes towards risk and their decision to migrate. We consider migration in the United States across metropolitan statistical areas (MSAs) between 1997 and 2015, based on data from the Panel Study of Income Dynamics (PSID). Using random‐effects specifications, we find that being relatively more willing to take risks is positively and significantly related to cross‐MSA migration. For cross‐state migration and migration across larger distances, risk attitudes are slightly more important. A recursive bivariate probit model of simultaneous equations addresses the potential endogenous nature of attitudes towards risk and allows ruling out reverse causality. [ABSTRACT FROM AUTHOR]

Context There exists a disparity between the views of physicians and the views of their patients on end-of-life decisions. However, the timing of when the end-of-life preferences of physicians and non-medically-trained individuals diverge is currently unknown. The objective of this paper is to characterise how preferences for medical interventions change throughout medical education and residency or fellowship training when confronted with scenarios of critical or terminal illness. Methods This is a single-centre cross-sectional study that enrolled medical students at Sidney Kimmel Medical College and residents and fellows at Thomas Jefferson University Hospital. Through an online survey we determined the preferences of medical trainees for specific interventions throughout medical training when presented with different clinical scenarios. Interventions were organised into three categories: standard, intermediate and aggressive. We analysed responses to questions regarding different scenarios in separate repeated measures logistic regression models. The probability of declining medical interventions was modelled, and significant predictors of refusal of interventions were identified. Results Years of training was a significant predictor of declining interventions for several scenarios. When faced with permanent physical disability, increased years of training led to a higher rate of refusal of intermediate ( OR = 1.14 [1.02-1.28], p = 0.02) and aggressive interventions ( OR = 1.15 [1.03-1.28], p = 0.01). For the scenario of terminal illness with associated physical disability, years of training significantly influenced refusal of intermediate ( OR = 1.14 [1.04-1.26], p = 0.006) and aggressive ( OR = 1.20 [1.08-1.34], p = 0.001) interventions. For the scenario of permanent cognitive impairment, increased years of training led to a higher rate of refusal of standard ( OR = 1.14 [1.01-1.29], p = 0.03), intermediate ( OR = 1.30 [1.13-1.50], p < 0.001) and aggressive ( OR = 1.38 [1.14-1.66], p = 0.001) interventions. Conclusion Changes in end-of-life preferences occur throughout medical training. Years of training influenced the likelihood of declining medical interventions when faced with scenarios of terminal illness and physical or cognitive disability. [ABSTRACT FROM AUTHOR]

Career research has focused on the changing structures of careers, mainly in the private sector. Recent literature on employment patterns in the public sector suggests that career structures are evolving, gradually moving away from their signature traditional structures to contemporary ones. However, empirical evidence of this change is scarce and inconclusive. This qualitative study examines the changes currently unfolding in the career structure of the civil service by eliciting the experiences and views of senior Foreign Offices (FOs) staff in four countries: 198 state ambassadors from the United States, the United Kingdom, Israel, and Denmark were interviewed about their career trajectories. The data were analyzed using a thematic analysis framework. The findings revealed a gradual breakdown of the structures and policies that support traditional careers, and the emergence of new principles and practices that characterize contemporary careers. However, as they were captured midway through the process of change, all FOs display a combination of traditional and contemporary career structures at this point. The findings offer unique insights into the drivers of this evolution and highlight some of the consequences. [ABSTRACT FROM AUTHOR]

Objective: This virtual issue of the International Journal of Eating Disorders highlights recently published research that aligns with the broad themes of the 2019 International Conference on Eating Disorders (ICED), held in New York, NY, USA. Methods and results: We selected articles that were published between 2017 and 2019 that complement the content of the keynote and plenary sessions. We also curated additional articles from early career scholars, given that an important component of the annual ICED is to foster the development and training of the next generation of eating‐disorder clinicians and researchers. Discussion We hope that this virtual issue will spark more in‐depth discussion and reflection on the topics, questions, and critical advances in the field of eating disorders that were presented at the 2019 ICED. [ABSTRACT FROM AUTHOR]

Since the introduction of commercial video games in the 1970s, video game players have attracted the perhaps undeserving but negative stereotype of being unpopular and socially dysfunctional. However, with gamers increasing in numbers that now reach billions worldwide, the contents of gamer stereotypes may be in flux. The current study investigated the content of gamer stereotypes along the dimensions of physical/social attractiveness, warmth, competence, and morality as a function of genre violence level and gamer identity. Male and female participants (656 U.S. and 428 Indian) completed an online survey on the MTurk platform, rating social stereotypes of gamers in high‐violence and low‐violence genres on 22 adjective pairs and answering questions about gamer identity. Results revealed positive gamer stereotypes, especially in the low‐violence genres in both the United States and India. Low‐identifiers' stereotypes were less favourable in the high‐violence than in the low‐violence genres; this tendency diminished among high‐identifiers. This study suggests that, whereas once gamers were seen negatively, they are now seen remarkably positively. The implications of such positive views of those engaging in violent gaming are discussed. [ABSTRACT FROM AUTHOR]

Aims: Severe hypoglycaemia among people with diabetes who use insulin can be a life‐threatening complication if left untreated. Although glucagon has been approved for treatment of hypoglycaemia since the 1960s, it has been underutilized. We aimed to understand the perceptions of people with diabetes and their caregivers about glucagon. Methods: We conducted in‐depth, one‐on‐one telephone interviews with people with diabetes and their caregivers in the United States. The interviews included questions around general awareness of glucagon, reasons for owning or not owning glucagon, and suggestions for improving understanding of glucagon as treatment for severe hypoglycaemia. Initial synopsis and inductive codebook schema were used to analyse the responses by two independent researchers. Themes were developed from the codes, and codes were re‐mapped back to the themes. Results: There were 60 dyads of people with diabetes and their caregivers (N = 120). Four themes developed from the interviews: (1) for most participants, the stated reasons for not owning or renewing a prescription for glucagon included unawareness of the medication, its advantages and its value; (2) misperceptions about glucagon occurred frequently; (3) caregivers often lacked confidence in administering reconstituted injectable glucagon; and (4) education and training from healthcare providers about glucagon would be welcomed. Conclusions: This study emphasizes the need for healthcare providers to discuss hypoglycaemia prevention and events at each clinical visit, including the use of glucagon in the case of severe hypoglycaemia. Healthcare providers are encouraged to assess the knowledge of people with diabetes and their caregivers regarding treatment and prevention of hypoglycaemia. [ABSTRACT FROM AUTHOR]

Long COVID is a novel chronic illness with a variety of symptoms that people who have labelled themselves 'long‐haulers' experience for an extended duration following a COVID‐19 infection. We draw on in‐depth interviews conducted in March–April 2021 with 20 working‐aged adults in the U.S. who self‐identified as long‐haulers to understand the consequences for identities. The results demonstrate that Long COVID has important consequences for identities and sense of self. Long‐haulers described experiencing three stages of biographical disruptions: realising their illness experience as misaligned with sense of self and embodied, age‐based expectations; facing challenges to identities and changes in social roles; and reconciling illness and identity in the context of an uncertain prognosis. It remains unclear how long‐haulers will resolve biographical disruptions and identity conflicts, especially as scientific insights about this novel condition emerge. Such outcomes may depend largely on whether Long COVID remains a contested illness or medical knowledge progresses to improve their quality of life. For now, healthcare providers may approach Long COVID holistically to address the identity disruptions that long‐haulers face as they manage the consequences of this chronic illness. [ABSTRACT FROM AUTHOR]

The article offers information on a survey of healthcare professional and parental experience in accessing support for breastfeeding during an acute hospital admission in the U.S. The topics addressed include details on the factors which impact on the parental experience of breastfeeding in a hospital setting comprising modes of feeding, maternal stress or anxiety, and access to support and equipment.

We use self‐determination (SDT) and worldview defence theories (WDT) to explicate the psychological roots of identitarian voting in recent US, UK and EU elections. We test our theory using the 2016 US election as a case study, data from a representative sample of nearly half a million Americans, and a measure of racial animus derived from Google search data. We find that worry has a strong and significant positive association with Trump's vote share, as predicted by WDT. However, this is reversed in counties with high levels of relatedness—one of the three basic psychological needs emphasised by SDT. The positive relationship between racial animus and Trump also loses significance once an interaction between racial animus and relatedness is introduced. These results imply that identitarianism is driven at least in part by a desire for in‐group affiliation emerging out of worldview defence and unmet basic psychological needs. [ABSTRACT FROM AUTHOR]

The present research examined the perspectives of both White and Black racial justice activists on the roles of White allies in the struggle for justice for Black people in the United States. Study 1 used Q methodology, a mixed‐methods approach, which identified four distinct perspectives about the role of White allies from a sample of activists (33 White and 22 Black Americans): (1) mobilize to support Black leadership, (2) interpersonal activism, (3) avoid dominating Black people's efforts, and (4) lifelong learning. In Study 2, we interviewed activists (22 White and 12 Black Americans) to understand their evaluation of, and preference for, each of perspective identified in Study 1. Thematic analyses showed that each perspective had its pros and cons regarding considerations of how to best use ingroup advantages without dominating the movement. Our findings contribute to our understanding of potential tensions in solidarity‐based social movements. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study is to examine whether Americans have a latent attitude toward comprehensive electoral reform the determinants of this attitude. Methods: The article creates and validates an index of election reform attitudes; examines the independent and interactive roles of partisanship, political interest, electoral fortunes, and satisfaction with democracy on these attitudes. Results: While a majority of Americans favor comprehensive election reform, this desire is strongest among Democrats, independents, people who feel they regularly lose in elections, and individuals who are dissatisfied with democracy, with no independent effect of political interest. Multivariate results find the effect of partisanship is conditioned by whether the respondent feels they generally win or lose in elections and satisfaction with democracy. Partisanship also interacts with political interest. More interested Democrats (Republicans) are more (less) supportive of comprehensive reform. Independents who are electoral losers or dissatisfied with government strongly favor election reform and resemble Democrats, while independents who feel they regularly win or are more satisfied are more opposed and resemble Republicans. Conclusion: Two‐thirds of Americans favor modernizing and updating U.S. election laws, but these attitudes are colored by partisanship, with evidence suggesting both elite messaging and expected electoral advantage as potential influences. Additionally, asymmetric partisan interactive effects are uncovered. [ABSTRACT FROM AUTHOR]

It has been estimated that medical errors are the third highest‐ranking cause of death in the United States. A patient safety culture has been touted for many years as best practice to reduce medical error. While there is a general agreement of its importance, it has remained elusive for many. This study sought to learn how strengthening leadership skills within a health care organization could catalyze patient safety culture improvement. The research asked the following to gain an appreciation for that question: How does a leader ensure consistency in policies, practices, and protocols to create a patient safety culture? What attitudes, beliefs, and collective efficacy are needed to produce a patient safety culture? What leadership characteristics are needed to create a patient safety culture? The research participants were the employees who make up the patient safety department in a large academic health care system. Information was gathered to capture their view of leadership's role in patient safety culture and to gain knowledge relative to their individual experiences following a medical error. [ABSTRACT FROM AUTHOR]

As recent as 2019, individuals residing within the United States were not protected from employment termination on the basis of their sexual orientation. It is unsurprising, then, that a large percentage of non‐heterosexual individuals remain 'closeted' about their sexual identity both at home and work, which takes a psychological and physical toll. The purpose of this study was to document perceptions, feelings, and experiences among women who have sex with women in regard to social and emotional well‐being. Thirty‐seven women between the ages of 20 and 64 participated in 6 focus groups held in three states in the United States. The purpose of these focus groups was to gather data about the experiences of living in a heteronormative world and the factors that might influence social and emotional well‐being. Responses were transcribed and thematically coded. Results offer insights into main themes that can assist community members, health professionals, and scientists to better appraise the disparities and struggles of sexual minorities who experience minority stress and have to compartmentalize in order to feel safe at home, work, and their third places. Please refer to the Supplementary Material section to find this article's Community and Social Impact Statement. [ABSTRACT FROM AUTHOR]

Policy PointsHospital‐at‐Home (HaH) is a home‐based alternative for acute care that has expanded significantly under COVID‐19 regulatory flexibilities.The post‐pandemic policy agenda for HaH will require consideration of multistakeholder perspectives, including patient, caregiver, provider, clinical operations, technology, equity, legal, quality, and payer.Key policy challenges include reaching a consensus on program standards, clarifying caregivers' issues, creating sustainable reimbursement mechanisms, and mitigating potential equity concerns.Key policy prescriptions include creating a national surveillance system for quality and safety, clarifying legal standards for care in the home, and deploying payment reforms through value‐based models. [ABSTRACT FROM AUTHOR]

This study focused on young people's perspectives about family relationships and how they can be strengthened or weakened through digital media practices. Located in Melbourne, Australia, 20 participants aged between 13 and 17 years were interviewed about how digital devices and practices shaped the way they interacted with family. The thematic analysis points to the young people's commitment to family cohesion. This was demonstrated through responsible use of social media, admitting the need for device‐free time, acknowledging the challenges of being online, and their sense of responsibility as a family member, which informed and shaped the way they individually acted. [ABSTRACT FROM AUTHOR]

The objective of this study was gather pilot data from informal caregivers regarding the potential for a training program to assist current or past caregivers in reentering the job market, and thus offering a pathway to economic resilience. In an effort that could foster a sustainable and competent caregiving market to help meet the needs of an aging America, whether training informal caregivers might help them transition into a paid caregiving or other health service role was explored. Caregivers (N = 55) of a chronically or terminally ill family member or friend in a suburban county near Chicago were interviewed. The interview guide addressed household economic effect of illness, emotional burden, and training program interest. Fifty-six percent of caregivers were interested in training to work outside the home, caring for people in other households, 84% indicated a desire to learn more about health care, and 68% reported a desire to explore job possibilities in health care. Eighty-two percent were experienced in working with an individual aged 50 and older. Informal caregivers' interest in a training program to bolster their qualifications for a role in the healthcare workforce, including the option of a formal caregiver position, supports the demand for such a program. Considering the need for healthcare workers to serve the growing elderly population and the desire of informal caregivers to find gainful employment, these informal caregivers could provide the impetus to invest in informal caregiver training. [ABSTRACT FROM AUTHOR]

Background Speech and language therapists (SLTs) working in schools worldwide strive to deliver evidence-based services to diverse populations of students. Many suggestions have been made in the international professional literature regarding culturally competent delivery of speech and language services, but there has been limited qualitative investigation of practices school SLTs find to be most useful when modifying their approaches to meet the needs of culturally and linguistically diverse (CLD) students. Aims To examine perceptions of nine school SLTs regarding modifications of usual practices when interacting with CLD students and their families; to compare reported practices with those suggested in professional literature; to draw clinical implications regarding the results; and to suggest future research to build a more extensive evidence base for culturally competent service delivery. Methods & Procedures For this qualitative research study, nine school SLTs in a diverse region of the USA were recruited to participate in a semi-structured interview designed to answer the question: What dominant themes, if any, can be found in SLTs' descriptions of how they modify their approaches, if at all, when interacting with CLD students and their family members? Outcomes & Results Analysis of data revealed the following themes: (1) language-a barrier and a bridge, (2) communicating through interpreters, (3) respect for cultural differences, and (4) positive experiences interacting with CLD family members. Conclusions & Implications Participants reported making many modifications to their usual approaches that have been recommended as best practices in the international literature. However, some practices the SLTs reported to be effective were not emphasized or were not addressed at all in the literature. Practical implications of results are drawn and future research is suggested. [ABSTRACT FROM AUTHOR]

Operationalizing social group identification as political partisanship, we examine followers' (i.e., US residents') affective experiences and behavioral responses during the initial COVID‐19 outbreak in the United States (March to May 2020). In Study 1, we conducted content analyses on major news outlets' coverage of COVID‐19 (N = 4319) to examine media polarization and how it plays a role in shaping followers' perceptions of the pandemic and leadership. News outlets trusted by Republicans portrayed US President Donald Trump as more effective, conveyed a stronger sense of certainty with less negative affective tone, and had a lower emphasis on COVID‐19 prevention compared to outlets trusted by Democrats. We then conducted a field survey study (Study 2; N = 214) and found that Republicans perceived Trump as more effective, experienced higher positive affect, and engaged in less COVID‐19 preventive behavior compared to Democrats. Using a longitudinal survey design in Study 3 (N = 251), we examined how emotional responses evolved in parallel with the pandemic and found further support for Study 2 findings. Collectively, our findings provide insight into the process of leadership from a social identity perspective during times of crisis, illustrating how social identity can inhibit mobilization of united efforts. The findings have implications for leadership of subgroup divides in different organizational and crisis contexts. [ABSTRACT FROM AUTHOR]

Rural residents in the United States do not always agree on local development priorities, yet understanding and accounting for their preferences is a step towards more effective and equitable community development. We use survey data spanning different types of rural Intermountain West communities to gauge residents' preference weights for economic and environmental rural development goals. Given that community tenure and age are often related to development preferences, respondents are divided into three groups based on these factors using a classification tree approach. Long‐term residents (>36 percent of life spent in the community) have the strongest economic preferences, while older newcomers have the strongest environmental preferences. The Leti heterogeneity index reveals that long‐term residents also displayed the greatest homogeneity of preferences. Ordered probit analysis shows that goal preferences are also related to sex, education, household income, community financial security, and the share of county income derived from wealth assets. These findings provide a more nuanced and methods‐based understanding of residential tenure in a community and its relationship to development attitudes across a variety of rural place types, all valuable information for rural community and economic development practitioners. [ABSTRACT FROM AUTHOR]

Policy PointsMass vaccination is essential for bringing the COVID‐19 pandemic to a close, yet substantial disparities remain between whites and racial and ethnic minorities within the United States.Online messaging campaigns featuring expert endorsements are a low‐cost way to increase vaccine awareness among minoritized populations, yet the efficacy of same‐race/ethnicity expert messaging in increasing uptake remains unknown.Our preregistered analysis of an online vaccine endorsement campaign, which randomly varied the racial/ethnic identity of the expert, revealed no evidence that information from same race/ethnicity experts affected vaccine interest or the intention to vaccinate.Our results do not rule out the possibility that other low‐cost endorsement campaigns may be more effective in increasing vaccine uptake, but do suggest that public health campaigns might profitably focus on issues of access and convenience when targeting minoritized populations in the United States. Context: The COVID‐19 pandemic in the United States has been unequally experienced across racial and ethnic groups. Mass vaccination is the most effective way to bring the pandemic to an end and to manage its public health consequences. But the racialization of public health delivery in the United States has produced a sizable racial/ethnic gap in vaccination rates. Closing this gap in vaccine uptake is therefore essential to ending the pandemic. Methods: We conducted a preregistered, well‐powered (N = 2,117) between‐subjects survey experiment, fielded March 24 to April 5, 2021, in which participants from YouGov's online panel—including oversamples of Black (n = 471), Hispanic/Latino/a (n = 430), and Asian American (n = 319) participants—were randomly assigned to see COVID‐19 vaccine information endorsed by same‐ or different‐race/ethnicity experts or to a control condition. We then measured respondents' vaccination intentions, intention to encourage others to get vaccinated, and interest in learning more information and sharing information with others. Findings: Same‐race/ethnicity expert endorsements had no measurable effect on nonwhite or white respondents' willingness to get the COVID‐19 vaccine, to encourage others to get the vaccine, or to learn more or share information with others. Conclusions: Our study provides empirical evidence suggesting online endorsements from same‐race/ethnicity experts do not increase vaccine interest, advocacy, or uptake, though same‐race/ethnicity endorsements may be effective in other venues or mediums. [ABSTRACT FROM AUTHOR]

Previous research on coronavirus disease 2019 (COVID‐19) vaccine hesitancy lacks a gender perspective, and it is unclear whether gender intersects with socioeconomic status to co‐produce inequalities in people's intent to take vaccines. The current study draws on intersectionality theory and uses data from the 2021 US Household Pulse Survey (n = 50,359). Both bivariate and multivariate statistical analyses were conducted. The results suggest that American women had a higher vaccine hesitancy rate than men. Gender interacts with socioeconomic status to shape people's vaccine hesitancy in a complex way. Specifically, women living in poverty or currently working were more vaccine‐hesitant, while poverty and employment status did not affect men's vaccine hesitancy. However, not having a college education contributed to both women's and men's COVID‐19 vaccine hesitancy. Moreover, women were more worried about the safety of the vaccine, but men's hesitancy tended to be driven by lower perceptions of COVID‐19 dangers and belief in conspiratorial claims. [ABSTRACT FROM AUTHOR]

To understand and predict the consumer patterns of generational groups within a highly technological world, it is critical to study their experiences, social views, and attitudes about music. Today, limited information is available to the research community about "Gen Z," a population group that recently entered college life and the next largest consumer group after the Millennials. This study aims at closing this gap by exploring and comparing distinctive patterns and consumer behavior in the music market between Gen Z and Millennials. Using a group of 1624 college students from two universities in the United States, we found that Gen Z is less prone to music piracy than Millennials, and those who pirate music tend to share similar social norms, a limited understanding of copyright infringements, and poor views about the music industry. New technologies are also transforming the way future generations are drawn into music piracy. We conclude that music infringement will continue to be an ethical dilemma and the industry should continue in its effort to design consumer policies to assist young generations. [ABSTRACT FROM AUTHOR]

Aims To discuss an historical episode in which obesity was conceptualized as an addictive disorder and declared to be a major epidemic in the early postwar United States. This history illuminates past consequences of framing obesity as an addiction in ways that may inform constructive policy responses today. Methods Review of secondary and primary sources, including archival documents, relating to obesity in biomedical and popular thought of the 1940s and 1950s. Results In the United States in the late 1940s and 1950s, new medical thinking about obesity reinterpreted overweight and obesity as chiefly the consequence of addiction (understood in the then dominant psychodynamic theory as a psychological defect, oral fixation). This new conception was rapidly taken up in popular discourse and clinical practice, with adverse effects through amplification of weight stigma. Further, in the conservative political context, the addiction concept contributed to an ineffective policy response to the alarming new epidemiological evidence about obesity's consequences. Despite a lack of evidence for efficacy of the intervention, public health efforts focused on correcting individual eating behaviour among obese people by encouraging self-help in lay groups modelled, in part, on Alcoholics Anonymous. Population-level intervention was neglected. Conclusions Current public health policy initiatives must be mindful of the risks of reframing obesity as an addiction. These include inadvertently reinforcing stigma, narrowing responses to those aiming to modify individual behaviour and biology and neglecting population policies aiming to reduce the consumption of energy-dense foods, as all occurred in the 1950s United States. [ABSTRACT FROM AUTHOR]

Summary: Despite decades of research and a multitude of prevention and treatment efforts, childhood obesity in the United States continues to affect nearly 1 in 5 (19.3%) children, with significantly higher rates among Black, Indigenous, and People of Colour communities. This narrative review presents social foundations of structural racism that exacerbate inequity and disparity in the context of childhood obesity. The National Institute of Minority Health and Health Disparities' Research Framework guides the explication of structurally racist mechanisms that influence health disparities and contribute to childhood obesity: biologic and genetic, health behaviours, chronic toxic stress, the built environment, race and cultural identity, and the health care system. Strategies and interventions to combat structural racism and its effects on children and their families are reviewed along with strategies for research and implications for policy change. From our critical review and reflection, the subtle and overt effects of societal structures sustained from years of racism and the impact on the development and resistant nature of childhood obesity compel concerted action. [ABSTRACT FROM AUTHOR]

BACKGROUND Being bullied online is associated with being bullied in school. However, links between online bullying and violence‐related experiences are minimally understood. We evaluated potential disparities in these associations to illuminate opportunities to reduce school‐based violence. METHODS: We used five cohorts of Youth Risk Behavior Survey national cross‐sectional data (2011‐2019, Ntotal = 73 074). We used survey‐weighted logistic and multinomial models to examine links between online bullying and five school‐based violence‐related experiences: offline bullying, weapon carrying, avoiding school due to feeling unsafe, being threatened/injured with a weapon, and physical fighting. We examined interactions by sex, race/ethnicity, and sexual identity. RESULTS: Being bullied online was positively associated with all offline violence‐related behaviors. Groups with stronger associations between online bullying and physical fighting, including boys, adolescents whose sexual identity was gay/lesbian or unsure, and many adolescents of color (Black, Hispanic/Latino, and Asian/Pacific Islander adolescents), had stronger associations between online bullying and either weapon carrying or avoiding school. CONCLUSIONS: Online bullying is not an isolated harmful experience; many marginalized adolescents who experience online bullying are more likely to be targeted in school, feel unsafe, get in fights, and carry weapons. Reduction of online bullying should be prioritized as part of a comprehensive school‐based violence prevention strategy. [ABSTRACT FROM AUTHOR]

Human papillomavirus (HPV) vaccination behaviors among Chinese college students (CCS) in the United States are affected by social determinants of health. Using a self‐report questionnaire and a snowball sampling technique, this cross‐sectional study investigated (a) HPV vaccination practices; (b) primary social networking platforms and preferred means of receiving HPV information; and (c) the influence of acculturation on HPV vaccination, HPV information sources, and social networking use among 213 CCS aged 18–26 in the United States. About half (50.7%) had received one to three doses of an HPV vaccine, and 91.7% had received their first dose. The most popular social networking platforms were WeChat (69.5%), Instagram (58.7%), text messaging (55.4%), and Facebook (47.4%). Preferred means of receiving future HPV information included the internet, online social networking, and health professionals. Participants with high Asian identification (AI) were less likely to receive the HPV vaccine than those with high Western identification. Participants with high AI were more likely to use WeChat for their social networking but less likely to use US‐based social media platforms. Acculturation, preferred social networking platforms, and sources and communication of HPV (i.e., health professionals, family members, schoolteachers, friends) influenced participants' HPV vaccination. To promote equity of access to health messages and increase HPV vaccination, future efforts should pay attention to CCS with high AI and incorporate their cultural beliefs and practices. Given that nonprofessionals (e.g., family, friends) were influential factors in HPV vaccination, it is critical to tailor interventions for CCS to the recipients and their social circles. [ABSTRACT FROM AUTHOR]

Background and aims: Whether expanded access to naloxone reduces perceptions of risk about opioid use has been subject to debate. Our aim was to assess how implementation of naloxone access laws shapes perceived risk of heroin use. Design: Using data from the restricted-access National Survey on Drug Use and Health, Prescription Drug Abuse Policy System and the US Census, we applied two-way fixed-effects models to determine whether naloxone access laws decreased perceived risk of any heroin use or regular heroin use. We used Bayes factors (BFs) to confirm evidence for null findings. Setting: United States. Participants: A total of 884 800 respondents aged 12 and older from 2004 to 2016. Measurements: A binary indicator of whether a state implemented naloxone access laws was regressed on respondent-perceived risk of (1) any heroin use and (2) regular heroin use. Ratings of perceived risk were assessed on a scale of 1 (none) to 4 (great risk). Findings: In all instances, the BFs support evidence for the null hypothesis. Across models with three distinct specifications of naloxone access laws, we found no evidence of decreased risk perceptions, as confirmed by BFs ranging from 0.009 to 0.057. Across models of specific vulnerable subgroups, such as people who use opioids (BFs = 0.039-0.225) or young people (BFs = 0.009-0.158), we found no evidence of decreased risk perceptions. Across diverse subpopulations by gender (BFs = 0.011-0.083), socio-economic status (BFs = 0.015-0.168) or race/ethnicity (BFs = 0.016-0.094), we found no evidence of decreased risk perceptions. Conclusions: There appears to be no empirical evidence that implementation of naloxone access laws has adversely affected perceptions of risk of heroin in the broader US population or within vulnerable subgroups or diverse subpopulations. [ABSTRACT FROM AUTHOR]

Purpose: This study explored and documented rural adults' perceptions of family roles in prescription opioid misuse prevention and the predisposing, reinforcing, and enabling factors that influence family members from taking those roles. Methods: Nine focus groups with rural adults (n = 55) were conducted to evoke discussion about family roles in prescription opioid misuse prevention. Transcripts were coded based on common ideas that arose during the focus groups, previous literature, and the PRECEDE‐PROCEED program planning model. Findings: Findings suggest that rural adults perceive the opioid epidemic as partially a family problem. Additionally, rural adults perceive themselves as having a critical role in preventing prescription opioid misuse among family members. Participants identified specific predisposing, reinforcing, and enabling factors that influence whether or not family members take responsibility in preventing prescription opioid misuse within their families. Rural adults also perceive that family‐based education is important in preventing prescription opioid misuse. Conclusions: These results suggest that there is an interest in family‐based approaches that enable or foster the skills and resources necessary to engage in prescription opioid misuse prevention behaviors. Specifically, family‐based prevention programming should include efforts to shape knowledge and attitudes about prescription opioid misuse, increase resources to facilitate prevention behaviors, and build skills related to prevention. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to conduct a psychometric evaluation of a new 35‐item survey developed in the United States to measure rural identity. Methods: Factor structure, reliability, convergent validity, and incremental validity of the Rural Identity Scale (RIS) were examined using two datasets. Study 1 examined RIS psychometric properties using survey data collected from substance use treatment counselors in a southeastern state (n = 145), while Study 2 used data collected from women incarcerated in rural jails (n = 400). Findings: A one‐factor structure containing 15 items was identified in the RIS, with acceptable internal reliability (α =.72–.83). In Study 1, participants from rural counties had significantly higher RIS scores than their urban counterparts. In both studies, convergent validity was evaluated and the RIS scores were significantly associated with other measures relevant to identity and rurality at the bivariate level. Incremental validity was supported in multivariable models as the RIS scores were significantly and uniquely associated with primary rural place variables in each sample. Conclusions: This study is an initial step toward a reliable, valid scale measuring rural identity. RIS may be especially beneficial to health research as a methodological tool that can contextualize health behaviors among rural populations and highlight potential interventions to promote health equity. [ABSTRACT FROM AUTHOR]

What motivated Trump Supporters to storm the US Capitol in protest of the US Election results? We examined how different dimensions of an identification (Trump, Republican) predicted intentions to engage in activism or radicalism in the wake of the 2020 US Presidential Election. We sampled self‐identified Republicans 3 weeks before (N = 273), and 10 days after (N = 277), the US Capitol Insurrection. We separately measured identification as a Republican and Trump Supporter before assessing people's perception that the 2020 Election was illegitimate. We then assessed two emotions (anger, contempt) and two forms of collective action intentions (activism, radicalism). Both studies showed that stronger Trump identification, but weaker Republican identification, predicted perceptions that the 2020 US Election was illegitimate. Perceptions of illegitimacy predicted feelings of anger and contempt, which differently predicted normative and nonnormative collective action. Results suggest that different dimensions of identification predispose people to different perceptions of events and, consequently, harbor different action intentions. [ABSTRACT FROM AUTHOR]

We examined how racial‐ethnic identity centrality, or the importance of race/ethnicity in people's self‐perceptions, affected peoples' support for the Democratic and Republican candidates in the 2020 US election. We explored this association by examining the mediating role of trust in important social institutions. In Study 1, we examined these effects by comparing the pattern of relationships among people of color (POC) and white people, using a sample of 177 Amazon Mechanical Turk (MTurk) participants. In Study 2, we expanded our focus on different racial‐ethnic groups, by comparing effects for Black, Latinx, Asian American/Pacific Islander (AAPI), and white participants, using a sample of 530 MTurk workers. Although there were a few findings that ran contrary to our expectations, the two studies generally found that trust in institutions that challenge the status quo, such as the media, explained the relationship between identity centrality and support for candidates among POC, especially Black and Latinx participants. We also found that trust in institutions that uphold the status quo, such as police and courts, explained the relationship between racial‐ethnic identity centrality and support for candidates among white people. [ABSTRACT FROM AUTHOR]

Background and aims: The vaping rate among US teenagers has doubled in the last 2 years, which may be explained in part by teenagers' optimism that they would have relatively little trouble in quitting. The aim of this study was to estimate the extent to which teenagers exhibited optimism bias, what characteristics are associated with optimism bias and which factors are related to respondents' perceptions of how hard it would be for them to quit. Design A national, on‐line, cross‐sectional survey in 2018 using quota sampling. Setting: United States. Participants: Respondents were 1610 teenagers aged 14–18 years who had ever tried or heard of JUULs or e‐cigarettes generally. Measurements Optimism bias was defined as respondents' perceptions of their own difficulty quitting vaping compared with that of an average US person of their own age. Linear regression was used to examine associations between respondents' characteristics with both optimism bias and their own perceived difficulty quitting vaping. Findings More than 60% of teenagers were optimistically biased about their ability to quit vaping. Smoking (b = −0.69, P < 0.01) and JUULing (b = −0.62, P < 0.01) were negatively associated with optimism bias but reduced‐price school lunch eligibility (0.27, P = 0.02) and school satisfaction were positively associated (b = 0.05, P = 0.02). Smoking (b = 0.85, P < 0.01) was associated with an increased perception of the difficulty of quitting. That association was negative for black respondents (b = −0.81, P = 0.01) and those eligible for reduced‐priced lunches (b = −0.48, P = 0.01), and positive for Hispanic respondents (b = 0.47, P = 0.04). Conclusions: On average, US teenagers appear to show optimism bias about their ability to quit vaping, which decreases with smoking and vaping and increases with eligibility for reduced‐price school lunches. [ABSTRACT FROM AUTHOR]

Women and their newborns are at risk of delayed or withheld skin‐to‐skin care (SSC) during a caesarean, which is about one‐third of births, worldwide. To date, no instrument exists to assess health professionals' (HPs) beliefs, and potential barriers and strategies for implementing SSC during a cesarean. The study aims were to (1) develop an instrument, Health Professionals' Beliefs about Skin‐to‐Skin Care During a Cesarean (SSCB), (2) establish its validity and reliability and (3) describe HPs' beliefs about SSC during a caesarean. Quantitative and qualitative analyses were used to test the SSCB and describe HPs' beliefs. SSCB analysis yielded a content validity of 0.83 and reliability of α = 0.9. We grouped all practice roles as either nurses or physicians. The mean rank score for nurses (n = 120, M = 90) was significantly higher (p = 0.001) than physicians (n = 46, M = 79). Despite this difference, scores for both roles reflected support for SSC. Participants identified hospital readiness to implement SSC and maintaining maternal and newborn safety as major issues. SSCB is a valid, reliable instrument to measure HPs' beliefs about SSC during a caesarean birth. HPs can use the SSCB during quality improvement initiatives to improve access to immediate SSC for women who have a caesarean birth. Improved access can enhance breastfeeding outcomes and promote optimal maternal and child health. [ABSTRACT FROM AUTHOR]