Search

Purpose: Housing is essential to health. Governmental rental assistance is one way to increase access to affordable housing, but little is known about how it varies by rural/urban location. This paper seeks to address that gap by examining rural/urban and within‐rural differences in receipt of rental assistance, with particular attention differences by health and disability. Methods: We used data from the 2021 National Health Interview Survey (n = 28,254) to conduct bivariate analyses to identify significant differences in receipt of rental assistance by rural/urban location. We then conducted logistic regression analyses to generate odds ratios of receiving rental assistance, adjusting for self‐rated health, disability, sociodemographic characteristics, and the US Census region. Findings: When limiting the sample to those who rent (20.6% of rural residents and 29.6% of urban residents), rural residents were nearly 5 percentage points more likely to receive rental assistance (13.1% vs 8.2%, P<.001). Rural recipients of rental assistance were more likely to have a disability than urban residents (27.9% vs 20.3%, P<.05) and were more likely to report fair/poor health (41.6% vs 31.4%, P<.05). Conclusions: Rural residents are less likely to rent their homes, but, among those who rent, they are more likely to receive governmental rental assistance. This may be reflective of the greater need for rental assistance among rural residents, who were in poorer health and of lower socioeconomic status than urban renters. As housing is essential to good health, policy attention must prioritize addressing a persistent and growing need for affordable housing in rural and urban areas alike. [ABSTRACT FROM AUTHOR]

Objective: The purpose of this paper is to systematically and critically appraise the available scientific evidence concerning the prevalence of edentulism among diabetic patients compared to non‐diabetic people. Methods: MEDLINE‐PubMed and Cochrane‐CENTRAL databases were comprehensively searched up to April 2023 to identify appropriate studies. The inclusion criteria were observational studies conducted in human subjects ≥18 years of age with the primary aim of investigating the prevalence of edentulism among diabetic patients. Based on the extracted data, a meta‐analysis was performed. Recommendations based on the body of evidence were formulated using the GRADE approach. Results: Independent screening of 2085 unique titles and abstracts revealed seven publications that met the eligibility criteria. Study size ranged from 293 to 15,943 participants. Data from all seven studies were suitable for meta‐analysis. Overall, 8.3% of the studied population was edentulous. The weighted mean prevalence of edentulism among diabetic and non‐diabetics was 14.0% and 7.1%, respectively. The overall odds ratio for diabetic patients to be edentulous as compared to non‐diabetics was 2.39 (95% CI [1.73, 3.28], p < 0.00001). Conclusion: There appears to be moderate certainty that the risk of being edentulous for diabetic patients compared to non‐diabetic people is significant, but the odds ratio is estimated to be small. [ABSTRACT FROM AUTHOR]

Summary: To study the relationship between a sensitive binary response variable and a set of non‐sensitive covariates, this paper develops a hidden logistic regression to analyse non‐randomized response data collected via the parallel model originally proposed by Tian (2014). This is the first paper to employ the logistic regression analysis in the field of non‐randomized response techniques. Both the Newton–Raphson algorithm and a monotone quadratic lower bound algorithm are developed to derive the maximum likelihood estimates of the parameters of interest. In particular, the proposed logistic parallel model can be used to study the association between a sensitive binary variable and another non‐sensitive binary variable via the measure of odds ratio. Simulations are performed and a study on people's sexual practice data in the United States is used to illustrate the proposed methods. To study the relationship between a sensitive binary response variable and a set of non‐sensitive covariates, this paper develops a hidden logistic regression to analyze non‐randomized response data collected via the parallel model originally proposed by Tian (2014). This is the first paper to employ the logistic regression analysis in the field of non‐randomized response techniques. Both the Newton–Raphson algorithm and a monotone quadratic lower bound algorithm are developed to derive the maximum likelihood estimates of the parameters of interest. In particular, the proposed logistic parallel model can be used to study the association between a sensitive binary variable and another non‐sensitive binary variable via the measure of odds ratio. Simulations are performed and a study on people's sexual practice data in the United States is used to illustrate the proposed methods. [ABSTRACT FROM AUTHOR]

Introduction Collabo RATE is a brief patient survey focused on shared decision making. This paper aims to (i) provide insight on facilitators and challenges to implementing a real-time patient survey and (ii) evaluate Collabo RATE scores and response rates across multiple clinical settings with varied patient populations. Method All adult patients at three United States primary care practices were eligible to complete Collabo RATE post-visit. To inform key learnings, we aggregated all mentions of unanticipated decisions, problems and administration errors from field notes and email communications. Mixed-effects logistic regression evaluated the impact of site, clinician, patient age and patient gender on the Collabo RATE score. Results While Collabo RATE score increased only slightly with increasing patient age ( OR 1.018, 95% CI 1.014-1.021), female patient gender was associated with significantly higher Collabo RATE scores ( OR 1.224, 95% CI 1.073-1.397). Clinician also predicts Collabo RATE score (random effect variance 0.146). Site-specific factors such as clinical workflow and checkout procedures play a key role in successful in-clinic implementation and are significantly related to Collabo RATE scores, with Site 3 scoring significantly higher than Site 1 ( OR 1.759, 95% CI 1.216 to 2.545) or Site 2 (z=−2.71, 95% CI −1.114 to −0.178). Discussion This study demonstrates that Collabo RATE can be used in diverse primary care settings. A clinic's workflow plays a crucial role in implementation. Patient experience measurement risks becoming a burden to both patients and administrators. Episodic use of short measurement tools could reduce this burden. [ABSTRACT FROM AUTHOR]

Objectives: We examined the relationship between suicide risk and disability status, as well as risk and protective factors, adjusting for demographic characteristics, among students attending 22 Tribal Colleges and Universities (TCU; 20 rural and 2 urban) across the United States in fall 2015 and 2016. Methods: Tribal college students (N = 3,239) participated in a cross‐sectional online or paper survey assessing alcohol use patterns and mental health outcomes, yielding a response rate of 31.3%. Results: Of the students surveyed, 8.8% indicated moderate or high suicide risk. Hearing impairment was significantly associated with moderate/high suicide risk (OR = 2.11; 1.24‐3.61, P =.006), as was vision impairment (OR = 3.03; 1.92‐4.77, P <.001), having a physical/mental/or emotional condition (OR = 2.12; 1.75‐2.57, P <.001), experiencing critical appraisal (OR = 1.30; 1.24‐1.36, P <.001), and experiencing critical isolation (OR = 1.83; 1.66‐2.01, P <.001). Scoring high on resilience (OR = 0.93; 0.92‐0.95, P <.001), reporting higher emotional social support (OR = 0.75; 0.70‐0.79, P <.001), and reporting higher levels of instrumental social support (OR = 0.69, 0.62‐0.76, P <.001) were significantly associated with lower suicide risk. Conclusions: Students attending tribal colleges who experience hearing impairment, sight impairment, or a physical/emotional/mental condition have a greater risk of suicidality. Students experiencing critical appraisal and critical isolation may benefit from behavioral health interventions to reframe these experiences and develop resiliency skills. Developing avenues of emotional and instrumental social support within TCU settings offers key protective factors to buffer the risk of suicidality. Examining additional ways to build resiliency may also offer protection from suicide risk in this population. [ABSTRACT FROM AUTHOR]

Solid‐organ transplantation is the treatment of choice for end‐stage organ failure. Parents of pediatric transplant recipients who reported a lack of readiness for discharge had more difficulty coping and managing their child's medically complex care at home. In this paper, we describe the protocol for the pilot study of a mHealth intervention (myFAMI). The myFAMI intervention is based on the Individual and Family Self‐Management Theory and focuses on family self‐management of pediatric transplant recipients at home. The purpose of the pilot study is to test the feasibility of the myFAMI intervention with family members of pediatric transplant recipients and to test the preliminary efficacy on postdischarge coping through a randomized controlled trial. The sample will include 40 family units, 20 in each arm of the study, from three pediatric transplant centers in the United States. Results from this study may advance nursing science by providing insight for the use of mHealth to facilitate patient/family–nurse communication and family self‐management behaviors for family members of pediatric transplant recipients. [ABSTRACT FROM AUTHOR]

Background: Emergency departments (EDs) provide care to ethnically diverse populations with multiple health‐related risk factors, many of which are associated with intimate partner violence (IPV). This paper examines ethnic‐specific 12‐month rates of physical IPV by severity and their association with drinking and other sociodemographic and personality correlates in an urban ED sample. Methods: Research assistants surveyed patients at an urban ED regarding IPV exposure as well as patterns of alcohol and drug use, psychological distress, adverse childhood experiences (ACEs), and other sociodemographic features. Results: The survey (N = 1,037) achieved an 87.5% participation rate. About 23% of the sample reported an IPV event in the past 12 months. Rates were higher (p < 0.001) among blacks (34%), whites (31%), and multiethnic (46%) respondents than those among Asians (13%) and Hispanics (15%). Modeled results showed that black respondents were more likely than Hispanics (reference) to report IPV (adjusted odds ratio [AOR] = 1.69, 95% confidence interval [CI] = 1.98–2.66, p < 0.05) and that respondents' partner drinking was associated with IPV (AOR = 1.85, 95% CI = 1.25–2.73, p < 0.01) but respondents' drinking was not. Use of illicit drugs, younger age, impulsivity, depression, partner problem drinking, ACEs, and food insufficiency were all positively associated with IPV. Conclusions: There was considerable variation in IPV rates across ethnic groups in the sample. The null results for the association between respondents' drinking and IPV was surprising and may stem from the relatively moderate levels of drinking in the sample. Results for ethnicity, showing blacks as more likely than Hispanics to report IPV, support prior literature. [ABSTRACT FROM AUTHOR]

Research on job assignments has generally assumed employees will accept assignments when offered. In this study, we examine managerial preferences for potential job assignment opportunities conceptualized using human capital theory to provide a holistic understanding of this phenomenon. Using two pilot studies, we refine the list of reasons managers use when forming lateral assignment preferences. In the main study, we collected data from a representative sample of more than 1200 managers in a large US organization who provided preferences for all possible assignment locations (about 40) in their regions and reported reasons for their preferences. Results showed career development reasons (e.g., promotion potential, opportunity to learn) and social information reasons (e.g., location manager, customers) attracted managers to assignments, and health and well‐being reasons (e.g., commuting, stress) repelled managers. There were several differences in these relationships by managerial level such that health and well‐being reasons were more important than career development reasons for lower‐level managers than higher‐level managers, who seemed to generate their preferences based more evenly on both types of reasons. We ask whether gender moderates the relationship between health and well‐being reasons and preferences and find little support. We also explore whether manager racioethnicity moderates the relationship between community racioethnicity and preferences and find a few differences. Most findings were replicated when predicting actual movement 2 years later. Results suggest managerial preferences should consistently be considered in job assignment research and that organizations should obtain and use preference data when making internal staffing decisions. [ABSTRACT FROM AUTHOR]

The purpose of the meta‐analysis was to evaluate and compare the photodynamic therapy's effectiveness in treating infected skin wounds. The results of this meta‐analysis were analysed, and the odds ratio (OR) and mean difference (MD) with 95% confidence intervals (CIs) were calculated using dichotomous or contentious random‐ or fixed‐effect models. For the current meta‐analysis, 6 examinations spanning from 2013 to 2021 were included, encompassing 154 patients with infected skin wounds were the used studies' starting point. Photodynamic therapy had a significantly lower wound ulcer size (MD, −4.42; 95% CI, −7.56–−1.28, p = 0.006), better tissue repair (MD, −8.62; 95% CI, −16.76–−0.48, p = 0.04) and lower microbial cell viability (OR, 0.13; 95% CI, 0.04–0.42, p < 0.001) compared with red light exposure in subjects with infected skin wounds. The examined data revealed that photodynamic therapy had a significantly lower wound ulcer size, better tissue repair and lower microbial cell viability compared with red light exposure in subjects with infected skin wounds. However, given that all examinations had a small sample size, consideration should be given to their values. [ABSTRACT FROM AUTHOR]

Background Alcohol-related blackouts are periods of amnesia that reflect the failure of the brain to record memories of what transpires while drinking. This paper examined the incidence, predictors, and behavioral correlates of blackouts among emerging adults and examined whether questions about blackouts could serve as better markers of risk for other alcohol related harms than questions about levels of consumption. Methods In 2012 to 2013, 1,463 (68%) of 2,140 respondents 1-year past high school reported having consumed alcohol. They were asked whether, in the past 6 months because of drinking, they forgot where they were or what they did. The survey also explored demographics, substance use behaviors, and other alcohol-related problems in the past 6 months. Chi-square and logistic regression analyses explored bivariate and multivariate predictors of blackouts and other alcohol-related problems. Results Twenty percent of respondents who ever drank alcohol reported a blackout in the past 6 months. Blackouts were more prevalent among females and those who, in the past 30 days, used multiple drugs, more frequently binged, were drunk, smoked, had lower body weight, and lived in college dorms. After controlling for drinking levels, having a blackout was the strongest independent predictor of most other alcohol problems examined, including in the past 6 months because of drinking, missing class or work, getting behind in work or school, doing something respondents later regretted, arguing with friends, experiencing an overdose, and total number of alcohol problems reported. It was also an independent predictor of hangovers, damaging property, getting hurt, and trouble with police. Conclusions Because blackouts indicate drinking at levels that result in significant cognitive and behavioral impairment, questions about blackouts could serve as important, simple screeners for the risk of experiencing other alcohol related harms. Additional work on this subject is warranted. [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]

Background and Aims There has been insufficient research attention to the alcohol industry's use of corporate sponsorship as a marketing tool. This paper provides a systematic investigation of the nature and extent of alcohol sponsorship-at the brand level-in the United States. Methods The study examined sponsorship of organizations and events in the United States by alcohol brands from 2010 to 2013. The top 75 brands of alcohol consumed by underage drinkers were identified based on a previously conducted national internet-based survey. For each of these brands, a systematic search for sponsorships was conducted using Google. The sponsorships were coded by category and type of sponsorship. Results We identified 945 sponsorships during the study period for the top 75 brands consumed by underage drinkers. The most popular youth brands were far more likely to engage in sponsorship and to have a higher number of sponsorships. The identified sponsorships overwhelmingly associated alcohol brands with integral aspects of American culture, including sports, music, the arts and entertainment, and drinking itself. The most popular brands among underage drinkers were much more likely to associate their brands with these aspects of American culture than brands that were less popular among underage drinkers. Conclusions Alcohol brand sponsorship must be viewed as a major alcohol marketing strategy that generates brand capital through positive associations with integral aspects of culture, creation of attractive brand personalities, and identification with specific market segments. Alcohol research, practice and policy should address this highly prevalent form of alcohol marketing. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate how technology access affected substance use disorder (SUD) treatment prior to COVID‐19 for people who use drugs in rural areas. Methods: The Rural Opioid Initiative (January 2018‐March 2020) was a cross‐sectional study of people with prior 30‐day injection drug or nonprescribed opioid use from rural areas of 10 states. Using multivariable mixed‐effect regression models, we examined associations between participant technology access and SUD treatment. Findings: Of 3,026 participants, 71% used heroin and 76% used methamphetamine. Thirty‐five percent had no cell phone and 10% had no prior 30‐day internet use. Having both a cell phone and the internet was associated with increased days of medication for opioid use disorder (MOUD) use (aIRR 1.29 [95% CI 1.11‐1.52]) and a higher likelihood of SUD counseling in the prior 30 days (aOR 1.28 [95% CI 1.05‐1.57]). Lack of cell phone was associated with decreased days of MOUD (aIRR 0.77 [95% CI 0.66‐0.91]) and a lower likelihood of prior 30‐day SUD counseling (aOR 0.77 [95% CI 0.62‐0.94]). Conclusions: Expanding US rural SUD treatment engagement via telemedicine may require increased cell phone and mobile network access. [ABSTRACT FROM AUTHOR]

Background: Physical restraint use among patients hospitalized with dementia and behavioral disturbances has not been studied nationally in the United States. Methods: National Inpatient Sample database years 2016 through 2020 were used to compare physically restrained and unrestrained patients with dementia and behavioral disturbances. Multivariable regression analyses were used to assess patient outcomes. Results: There were 991,605 patients coded for dementia with behavioral disturbances. Among these, physical restraints were used with 64,390 (6.5%) and not with 927,215 (93.5%). Patients in the restrained group were younger (mean age ± standard error: 78.7 ± 0.25 vs. 79.9±0.34; p < 0.01) and more often male (59.0% vs. 45.8%; p < 0.01) compared to the unrestrained group. A higher proportion of Black patients were in the restrained group (15.2% vs. 11.8%; p < 0.01). Larger hospitals also made up a more significant proportion of restrained versus unrestrained patients (53.3% vs. 45.1%; p < 0.01). Those with physical restraints had longer lengths of stays (adjusted mean difference [aMD] = 2.6 days CI [2.2–3.0]; p < 0.01) and higher total hospital charges (aMD = $13,150 CI [10,827‐15,472]; p < 0.01). There were similar adjusted odds for in‐hospital mortality (adjusted odds ratio [aOR] = 1.0 [CI 0.95–1.1]; p = 0.28) and lower odds of being discharged to home after hospitalization (aOR = 0.74 [0.70–0.79]; <0.01) for patients with physical restraints compared to those without. Conclusion: Among patients hospitalized with dementia and behavioral disturbances, those with physical restraints had greater hospital resource utilization outcomes. Attempts to limit physical restraint use whenever possible may improve outcomes in this vulnerable population. [ABSTRACT FROM AUTHOR]

The cardiovascular and cerebrovascular safety of ranibizumab, bevacizumab, and aflibercept for ocular diseases is unclear. This study aimed to evaluate and compare the cardiovascular and cerebrovascular safety in patients receiving ranibizumab, bevacizumab, and aflibercept for ocular disease. A cross‐sectional study was conducted from 2017 (Q1) to 2021 (Q4) in the US Food and Drug Administration Adverse Event Reporting System (FAERS) database. The outcomes of interest were central nervous system vascular disorders, ischemic heart disease, hypertension, pulmonary hypertension, torsade de pointes/QT prolongation, embolic and thrombotic events, cardiac arrhythmias, cardiac failure, and cardiomyopathy. Data mining was performed by a disproportional method with a compression, using compressed reporting odds ratios (sRORs) with 95% confidence intervals (CIs) to measure signals. The results showed 1462 cardiovascular and cerebrovascular events associated with aflibercept, 834 with ranibizumab, and 150 with bevacizumab. Ranibizumab, bevacizumab, and aflibercept were linked to central nervous system vascular disorders (sROR, 5.57[95%CI, 4.95‐6.26] vs sROR, 2.23 [95%CI, 1.75‐2.85] vs sROR, 2.73[95%CI, 2.43–3.06]), ischemic heart disease (sROR, 3.31[95%CI, 2.65–4.13] vs sROR, 1.98 [95%CI, 1.24‐3.16] vs sROR, 3.00 [95%CI, 2.46‐3.65]), embolic and thrombotic (sROR, 3.36 [95%CI, 3.04‐3.72] vs sROR, 2.16 [95%CI, 1.70‐2.74] vs sROR, 5.25 [95%CI, 4.82‐5.72]). Both ranibizumab and bevacizumab produced hypertension (sROR, 1.73 [95%CI, 1.41‐2.12] vs sROR, 1.46 [95%CI, 1.03‐2.06]) and arrhythmias (sROR, 2.82 [95%CI, 1.99‐3.99] vs sROR, 2.13 [95%CI, 1.08‐4.22]) signals. The signals of heart failure were detected in ranibizumab (sROR, 5.64 [95%CI, 4.08‐7.79]) and aflibercept (sROR, 2.80 [95%CI, 2.03‐3.86]). Ranibizumab, bevacizumab, and aflibercept for ocular disease have different safety profiles in cardiovascular and cerebrovascular. The overall cardiovascular and cerebrovascular risk of the patient should be thoroughly assessed in order to select the safest drug for treatment. [ABSTRACT FROM AUTHOR]

Aims: This study investigated the association between serum calcium levels and the prevalence of T2D using a cross‐sectional study and Mendelian randomization analysis. Methods: Cross‐sectional data were obtained from the National Health and Nutrition Examination Survey (NHANES) from 1999 to 2018. Serum calcium levels were divided into three groups (low, medium and high groups) according to the tertiles. Logistic regression was used to estimate the association between serum calcium levels and T2D prevalence. Instrumental variables for serum calcium levels were obtained from the UK Biobank and a two‐sample MR analysis was performed to examine the causal relationship between genetically predicted serum calcium levels and the risk of T2D. Results: A total of 39,645 participants were available for cross‐sectional analysis. After adjusting for covariates, participants in the high serum calcium group had significantly higher odds of T2D (OR = 1.18, 95% CI = 1.07, 1.30, p = 0.001) than those in the moderate group. Restricted cubic spline plots showed a J‐shaped curve relationship between serum calcium level and prevalence of T2D. Consistently, Mendelian randomization analysis showed that higher genetically predicted serum calcium levels were causally associated with a higher risk of T2D (OR = 1.16, 95% CI: 1.01, 1.33, p = 0.031). Conclusions: The results of this study suggest that higher serum calcium levels are causally associated with a higher risk of T2D. Further studies are needed to clarify whether intervening in high serum calcium could reduce the risk of T2D. [ABSTRACT FROM AUTHOR]

Objective: To better understand the epidemiology of preterm birth among Pacific Islanders in the United States and the US‐Affiliated Pacific Islands. Methods: Systematic searches of MEDLINE, Embase, CINAHL, PsycINFO, two nonindexed regional journals, and gray literature were conducted and finalized in September 2021. Observational studies published since January 2010 that documented preterm birth outcomes among Pacific Islanders in the United States and the US‐Affiliated Pacific Islands were eligible for inclusion. Outcomes of interest included preterm birth prevalence, risk compared with white women, and risk factors for preterm birth among Pacific Islanders. Results: Fourteen of the 3183 screened articles were included in meta‐analyses. Random‐effects models were used for pooled estimates with 95% confidence intervals. The pooled prevalence of preterm birth among Pacific Islanders was 11.2%, 95% CI: 9.3%‐13.6%. Marshallese women had the highest pooled prevalence (20.7%, 95% CI 18.6%‐23.0%) among Pacific Islander subgroups. Compared with white women, Pacific Islander women had higher odds of experiencing preterm birth (OR = 1.40, 95% CI: 1.28‐1.53). Four risk factors for preterm birth could be explored with the data available: hypertension, diabetes, smoking, and pre‐pregnancy body mass index; hypertension and diabetes significantly increased the odds of preterm birth. Conclusions: Existing literature suggests that United States Pacific Islanders were more likely to experience preterm birth than white women, although the pooled prevalence varied by Pacific Islander subgroup. Data support the need for disaggregation of Pacific Islanders in future research and argue for examination of subgroup‐specific outcomes to address perinatal health disparities. [ABSTRACT FROM AUTHOR]

Background: The COVID‐19 pandemic has dramatically affected pregnant people's prenatal care, labor, and delivery experiences. Given these rapid changes, providers have needed to be proactive in sharing information about COVID‐19‐related care impacts. The purpose of this study was to investigate: (a) Whether patient demographics or disrupted care (eg, canceled appointments and rapid shift to telehealth) is associated with patient‐reported information sharing from the providers; and (b) Whether patient‐reported provider information sharing or disruptions to care are associated with patient satisfaction with provider. Methods: Data come from a convenience sample of 1999 pregnant people living in the United States who completed an online survey between April 16 and May 7 2020. Results: Thirty‐eight percent of participants said that their provider had not discussed how the pandemic would affect their care during pregnancy, labor, or delivery. Participants with lower education, less income, or whose appointments had been canceled or rescheduled because of the pandemic were significantly less likely to report information sharing. Provider satisfaction was significantly lower among participants who did not report information sharing, those who had appointments by way of telehealth, and those who reported that all their appointments had been rescheduled/canceled. Discussion: At the beginning of the pandemic, there were significant socioeconomic inequities in reported information sharing by the providers, which in turn was negatively associated with provider satisfaction. Providers need to be aware of the role implicit bias may play in information sharing—both generally and during public health crises—and consider ways to reduce the impacts of disrupted care delivery on patient satisfaction. If left unaddressed, perceived poor provider communication and associated low satisfaction with providers could contribute to adverse perinatal outcomes. [ABSTRACT FROM AUTHOR]

Background: Elder abuse is a major cause of injury, morbidity, and death. We aimed to identify the factors associated with interventions against suspected physical abuse in older adults. Methods: Analysis of the 2017–2018 ACS TQIP. All trauma patients ≥60 years with an abuse report for suspected physical abuse were included. Patients with missing information on abuse interventions were excluded. Outcomes were rates of abuse investigation initiation following an abuse report and change of caregiver at discharge among survivors with an abuse investigation initiated. Multivariable regression analyses were performed. Results: Of 727,975 patients, 1405 (0.2%) had an abuse report. Patients with an abuse report were younger (mean, 72 vs 75, p < 0.001), and more likely to be females (57% vs 53%, p = 0.007), Hispanic (11% vs 6%, p < 0.001), Black (15% vs 7%, p < 0.001), suffer from dementia (18% vs 11%, p < 0.001), functional disability (19% vs 15%, p < 0.001), have a positive admission drug screen (9% vs 5%, p < 0.001) and had a higher ISS (median [IQR], 9 [4–16] vs 6 [3–10], p < 0.001). Perpetrators were members of the immediate/step/extended family in 91% of cases. Among patients with an abuse report, 1060 (75%) had abuse investigations initiated. Of these, 227 (23%) resulted in a change of caregiver at discharge. On multivariate analysis for abuse investigation initiation, male gender, private insurance, and management at non‐level I trauma centers were associated with lower adjusted odds (p < 0.05), while Hispanic ethnicity, positive admission drug screen, and penetrating injury were associated with higher adjusted odds (p < 0.05). On multivariate analysis for change of caregiver, male gender, and private insurance were associated with lower adjusted odds (p < 0.05), while functional disability and dementia were associated with higher adjusted odds (p < 0.05). Conclusions: Significant gender, ethnic, and socioeconomic disparities exist in the management of physical abuse of older adults. Further studies are warranted to expand on and address the contributing factors underlying these disparities. Level of Evidence: III. Study Type: Therapeutic/Care Management. [ABSTRACT FROM AUTHOR]

Background: Older adults are underrepresented in most clinical trials. As the United States observes growth in the number of older adults over time, it will be critical to include them in clinical trials to improve the generalizability of results across age groups. Although clinical trial participation requires clinical trial knowledge, no study has assessed clinical trial knowledge among older adults. Using a national survey, this study aims to identify the prevalence and determinants of clinical trial knowledge among older adults. Methods: We used the 2020 Health Information National Trends Survey for secondary data analysis. We restricted the sample to older adults (aged 65 years and up). Our outcome variable was whether respondents reported having any clinical trial knowledge. We controlled for demographics, social determinants of health, healthcare utilization, and comorbidities through multivariable logistic regression models. Results: Using a weighted sample of 27,574,958 adults, we estimated that 61.1% of older adults reported having at least some knowledge of clinical trials. After controlling for other factors, those with one to two (OR = 1.80, 95% CI:1.14–2.84) or three to five (OR = 2.93, 95% CI:1.74–4.95) portal visits compared with no portal visits, those with cancer (OR = 1.92, 95% CI:1.22–3.02), and those with depression (OR = 2.27, 95% CI:1.23–4.20) had greater odds of having clinical trial knowledge. Inversely, those with hypertension (OR = 0.62, 95% CI:0.42–0.92) had lower odds of clinical trial knowledge. Conclusions: Patient portal recruitment may be a supplemental intervention to improve clinical trial knowledge among older adults. Further research on additional interventions for identifying eligible participants is needed to minimize the burden among clinicians amidst other competing demands during clinic visits. [ABSTRACT FROM AUTHOR]

Introduction: Risky sexual behavior has been explored in women living with HIV (WLHIV) internationally but is not well studied in WLHIV in the United States (U.S.). This merits further investigation due to the negative reproductive and HIV health outcomes associated with risky sexual behavior, such as the increased risk for HIV transmission and infertility from sexually transmitted infections (STIs). The aims of this study are to (1) describe sexual behaviors in a cohort of WLHIV in Florida, (2) determine whether demographic characteristics, substance use, and mental health symptoms are associated with risky sexual behavior in a cohort of WLHIV in Florida, and (3) explore whether the relationship between substance use and mental health symptoms and risky sexual behavior differs in reproductive‐age (age 18–49), compared to non‐reproductive‐age WLHIV (age 50+). Design: This was a cross‐sectional analysis of data from a multisite cohort study done in Florida. Methods: Data were collected from a sample of 304 participants who were recruited into the Florida Cohort Study from 9 clinical and community sites in Florida between 2014 to 2017. The predictor variables of interest were mental health symptoms, substance use, and demographic variables. The outcome variable of interest was risky sexual behavior which was defined as reporting ≥1 of the following: (1) at least one STI diagnosis in the past 12 months, (2) two or more sexual partners in the past 12 months, or (3) any inconsistent condom use in the past 12 months. Descriptive statistics, bivariate analysis, and logistic regression (p < 0.1) were conducted on the variables of interest. Results: The mean age of the sample was 47.8 years, and approximately half (51.6%) of the sample was of reproductive‐age. Reporting ≥1 risky sexual behavior was reported in over half (51.6%) of the reproductive‐age WLHIV in the sample and 32% of the non‐reproductive‐age WLHIV in the sample. Binge drinking, alcohol‐related problems, marijuana use, and age were all significantly associated with self‐reporting ≥1 risky sexual behaviors in all WLHIV. Self‐reporting binge drinking, marijuana use, and a high alcohol‐related problems score respectively were associated with increased odds of self‐reporting ≥1 risky sexual behavior in all WLHIV. Neither mental health symptoms nor race/ethnicity or education were significantly associated with self‐reporting ≥1 risky sexual behavior in all WLHIV. Self‐reporting severe anxiety symptoms and high alcohol‐related problems scores respectively were associated with increased odds of self‐reporting ≥1 risky sexual behavior only in reproductive‐age WLHIV from the sample. Conclusion: Marijuana use, binge drinking, and alcohol‐related problems appear to have a relationship with risky sexual behavior in WLHIV regardless of age. Reproductive‐age also appears to influence risky sexual behavior in WLHIV, and specific reporting severe anxiety symptoms and high alcohol‐related problems in reproductive‐age WLHIV increases the odds of engaging in risky sexual behavior. Clinical Significance: This study holds clinical significance for nurses and other clinicians working in reproductive health settings and clinics with WLHIV. Results indicate that it could be beneficial to do more screening for mental health symptoms (particularly anxiety) and alcohol use in younger reproductive‐age WLHIV. [ABSTRACT FROM AUTHOR]

Introduction: Substance use, including methamphetamine use, is a contributing factor in HIV acquisition and treatment. Stimulant use is linked to mental health yet there is limited data from youth in community‐based settings. Design: One hundred marginally housed or homeless transitional age youth (TAY) were recruited at Larkin Street Youth Services and completed a survey on mental health and substance use. Methods: We conducted secondary data analysis using multivariable logistic regression models to identify the correlates of methamphetamine use among TAY. Results: The participants' mean age was 22. Of those who reported methamphetamine use in the past 3 months, 64% were Gay, Bisexual, or Pansexual. Factors independently associated with methamphetamine use were; living with HIV (adjusted odds ratio [aOR] = 3.18, 95% CI = 1.11–9.15), depressive symptoms (aOR = 6.02, 95% CI = 1.46–24.78), symptoms of PTSD (aOR = 13.38, 95% CI = 1.59–112.73), polysubstance use in the past 3 months (aOR = 50.02, 95% CI = 9.72–257.46) and a history of injection drug use (aOR = 8.38, 95% CI = 1.87–37.53). Conclusions: Results from this study suggest a need to develop, adapt, and rapidly implement comprehensive interventions that address the combined epidemics of substance use, HIV, and mental health among TAY. Clinical Relevance: This article examines factors associated with methamphetamine use among transitional age youth (TAY) experiencing homelessness or housing instability. Several factors were associated with use, including depression, PTSD, HIV status, polysubstance use, and injection drug use. These findings highlight the need for nurses to assess for methamphetamine use among youth as well as associated mental health and physical health problems. Nurses should link TAY who are using methamphetamine to evidence‐based treatment programs to address substance use and comorbid conditions. [ABSTRACT FROM AUTHOR]

Aim: To investigate the relationship between plant‐based diet indices (PDIs) and periodontitis and serum IgG antibodies against periodontopathogens in the U.S. population. Materials and Methods: We analysed cross‐sectional data on 5651 participants ≥40 years of age from the Third National Health and Nutrition Examination Survey. Food frequency questionnaire data were used to calculate the overall PDI, healthy plant‐based diet index (hPDI), and unhealthy plant‐based diet index (uPDI). Periodontitis was defined using a half‐reduced Centers for Disease Control and Prevention and American Academy of Periodontology case definition. Serum antibodies against 19 periodontopathogens were used to classify the population into two subgroups using hierarchical clustering. Survey‐weighted multivariable logistic regressions were applied to assess the associations of PDI/hPDI/uPDI z‐scores with periodontitis and hierarchical clusters after adjusting for potential confounders. Results: A total of 2841 (50.3%) participants were defined as having moderate/severe periodontitis. The overall PDI z‐score was not significantly associated with the clinical and bacterial markers of periodontitis. By considering the healthiness of plant foods, we observed an inverse association between hPDI z‐score and periodontitis (odds ratio [OR] = 0.925, 95% confidence interval [CI]: 0.860–0.995). In contrast, higher uPDI z‐score (adherence to unhealthful plant foods) might increase the risk of periodontitis (OR = 1.100; 95% CI: 1.043–1.161). Regarding antibodies against periodontopathogens, the participants in cluster 2 had higher periodontal antibodies than those in cluster 1. The hPDI z‐score was positively associated with cluster 2 (OR = 1.192; 95% CI: 1.112–1.278). In contrast, an inverse association between uPDI z‐score and cluster 2 was found (OR = 0.834; 95% CI: 0.775–0.896). Conclusions: Plant‐based diets were associated with periodontitis, depending on their quality. A healthy plant‐based diet was inversely related to an increased risk of periodontitis but positively related to elevated antibody levels against periodontopathogens. For an unhealthy plant‐based diet, the opposite trends were observed. [ABSTRACT FROM AUTHOR]

Introduction: For most older adults with dementia, the short‐term harms and burdens of routine cancer screening likely outweigh the delayed benefits. We aimed to provide a more updated assessment of the extent that US older adults with dementia receive breast and prostate cancer screenings. Methods: Using the Health and Retirement Study (HRS) Wave 12 (2014–2015) linked to Medicare, we examine rates of breast and prostate cancer screenings in adults 65+ years by cognitive status. We used claims data to identify eligibility for screening and receipt of screening. We used a validated method using HRS data to define cognitive status. Results: The analytic sample included 2439 women in the breast cancer screening cohort and 1846 men in the prostate cancer screening cohort. Average ages were 76.8 years for women and 75.6 years for men, with 9.0% and 7.6% with dementia in each cohort, respectively. Among women with dementia, 12.3% were screened for breast cancer. When stratified by age, 10.6% of those 75+ and have dementia were screened for breast cancer. When stratified by predicted life expectancy, 10.4% of those with predicted life expectancy of <10 years and have dementia were screened for breast cancer. Among men with dementia, 33.9% were screened for prostate cancer. When stratified by age, 30.9% of those 75+ and have dementia were screened for prostate cancer. When stratified by predicted life expectancy, 34.4% of those with predicted life expectancy of <10 years and have dementia were screened for prostate cancer. Using multivariable logistic regression, dementia was associated with lower odds of receiving breast cancer screening (OR 0.36, 95% CI 0.23–0.57) and prostate cancer screening (OR 0.58, 95% CI 0.36–0.96). Discussion: Our results suggest potential over‐screening in older adults with dementia. Better supporting dementia patients and caregivers to make informed cancer screening decisions is critical. [ABSTRACT FROM AUTHOR]

Aim: To study the epidemiological association between periodontitis and low cognitive performance among older adults, within a representative sample of the U.S. population. Materials and Methods: Data from 2086 older adults (≥60 years old), representative of 77.1 million people, were retrieved from the NHANES 2011‐2014 database. Periodontitis cases were identified and classified according to the AAP/CDC criteria (mild, moderate, and severe). Cognitive function was assessed through the Consortium to Establish a Registry for Alzheimer's disease (CERAD), the animal fluency test (AFT), the digit symbol substitution test (DSST), and the global cognition score. The lowest non‐survey weighted quartile for each cognitive test was defined as low cognitive performance. Simple and multiple regression analyses were performed. Results: Moderate and severe periodontitis were significantly associated with a low DSST performance (OR = 1.66 and OR = 2.97, respectively). Each millimetre increase in mean CAL was associated with a lower AFT (OR = 1.44), DSST (OR = 1.86), and global cognition (OR = 1.50) performance. Conclusions: The findings of the present study suggest the existence of an independent association between periodontitis and low cognitive performance among older adults (≥60 years old). [ABSTRACT FROM AUTHOR]

The article focuses on the variation in firearm screening and access based on LGBT status among Veterans with the risk of firearm-related suicide in both LGBT individuals and Veterans. It mentions that the study aims to fill this gap by examining LGBTQI+ status, emergency department visits, and firearm screening and access using natural language processing and machine learning algorithms applied to clinical notes in the Veterans Affairs (VA) electronic health records.

Economists and political scientists have long debated the relations between economic inequality and corruption at the societal level. Extending this literature, we proposed and tested that economic inequality breeds the corrupt behaviour of individuals. Analyses of 45‐year archival data from the United States found that official corruption crimes were more prevalent in years and states with greater economic inequality. Three subsequent experiments (N = 776) using economic games showed that individuals exposed to greater economic inequality exhibited more corrupt behaviour in both Chinese and American cultures. Furthermore, the increased desire for wealth and the perception of reduced fairness accounted for this effect. These findings highlight that excessive economic inequality creates a competitive environment in which people give priority to themselves over others and suggest a vicious cycle between economic inequality and corruption. [ABSTRACT FROM AUTHOR]

Background: Social isolation is a key public health concern and has been associated with numerous negative health consequences. Technology is increasingly thought of as a solution to address social isolation. This study examines the longitudinal association between the access and use of technology and social isolation in older adults 65 and older, living in the United States. Methods: This observational cohort study included community‐dwelling older adults (N = 6704) who participated in the National Health and Aging Trends Study. Regression analyses were conducted using data from 2015 to 2019. Information about technology access and use was ascertained using self‐reported questionnaires. The primary outcome was the risk of social isolation. Results: At baseline, the majority of older adults that were not socially isolated had a working cell phone (88%) or computer (71%) and used email or text messaging (56%). Older adults that had access to (cell phone‐ incidence rate ratio [IRR] 0.62 [95% CI 0.48–0.81]; computer‐ IRR 0.63 [95% CI 0.51–0.78]), and used technology (email or text messaging‐ IRR 0.64 [95% CI 0.51–0.80]) in the year prior had a lower risk of social isolation than older adults who reported they did not access or use technology. Additionally, over four years, older adults who reported that they had access to a computer had a lower risk (0.69 [0.57, 0.84]) for social isolation than their counterparts. Conclusion: In this cohort study, technology access was associated with a lower risk for social isolation among community‐dwelling older adults. These findings suggest that technology has an important role in approaches that seek to prevent social isolation among older adults. [ABSTRACT FROM AUTHOR]

Objective: Assess the prevalence of headache in transgender and gender‐diverse adolescents, comparing prevalence with and without exposure to gender‐affirming hormone therapy. Background: Transgender and gender‐diverse youth are an understudied group in whom we can study the effects of sex steroids on adolescents' development of headache. We hypothesized that transfeminine adolescents treated with estrogen would have higher odds of headache than those not treated, and that transmasculine adolescents treated with testosterone would have lower odds of headache than those not treated. Methods: This retrospective case–control study analyzed all patients seen at the Boston Children's Hospital Gender Multispecialty Service clinic from 2007 to 2017. Cases were defined as patients with headache, controls as those without headache, and exposure as treatment with gender‐affirming hormone therapy (i.e., estrogen or testosterone). A computerized search identified cases that were then validated by chart review. Results: Fifty‐two of the 763 transgender and gender‐diverse patients seen were confirmed to have headache. Of 273 transfeminine patients 45% (123/273) received estrogen treatment. Transfeminine patients receiving estrogen were more likely to have headache than those not receiving estrogen (7% [9/123] vs. 1% [2/150]; odd ratio [OR] 5.84 (95% confidence interval [CI] 1.24–27.6), p = 0.026). Of 490 transmasculine patients, 46% (227/490) received testosterone. Transmasculine patients receiving testosterone were more likely to have headache than those not receiving testosterone (12% [28/227] vs. 5% (13/263); OR 2.71 (95% CI 1.37–5.4), p = 0.005). Conclusion: Among transfeminine and transmasculine youth, those who received gender‐affirming hormone therapy had higher odds of headache compared to those not taking gender‐affirming hormone therapy. Further prospective studies to guide headache care of transgender and gender‐diverse youth and adults are needed. Our results could be generalizable to other pediatric gender management clinics and may be worth discussing with patients considering treatment. [ABSTRACT FROM AUTHOR]

Background: The majority of the US population have poor knowledge of cancers related to human papillomavirus (HPV). Identifying best sources for communicating this information can guide strategies to promote HPV vaccination. Objectives: To assess the relationship between sources of health information and individuals' knowledge of HPV‐related cervical and oropharyngeal cancer. Methods: This study conducts logistic regression on the most recent wave (2019) of the Health Information National Trends Survey. Dependent variables are indicators for self‐reported awareness that HPV causes (a) cervical cancer and (b) oropharyngeal cancer. The primary indicator is a variable for different sources of health information: The Internet, professional sources, print materials, friends/family and never looked for health information. Results: Being female, young, non‐Hispanic White and having college education is associated with higher odds of knowing about HPV‐related cervical cancer. Controlling for demographic factors, individuals using professionals and the Internet are more likely to know that HPV causes cervical cancer (aOR: 2.65, 95% CI: 1.66, 4.25; aOR: 2.47, 95% CI: 1.75, 3.50, respectively) compared to those who have never looked for health information. Similar results were found for HPV‐related oropharyngeal cancer. Conclusion: Findings provide implications for targeted messaging through effective channels to improve HPV vaccination uptake. [ABSTRACT FROM AUTHOR]

Background and Aims: Recovery management checkups (RMC) have established efficacy for linking patients to substance use disorder (SUD) treatment. This study tested whether using RMC in combination with screening, brief intervention, and referral to treatment (SBIRT), versus SBIRT alone, can improve linkage of primary care patients referred to SUD treatment. Design: A randomized controlled trial of SBIRT as usual (n = 132) versus SBIRT plus recovery management checkups for primary care (RMC‐PC) (n = 134) with follow‐up assessments at 3 months post‐baseline. Setting: Four federally qualified health centers in the United States serving low‐income populations. Participants: Primary care patients (n = 266, 64% male, 80% Black, mean age, 48.3 [range, 19–53]) who were referred to SUD treatment after SBIRT. Interventions: SBIRT alone (control condition) compared with SBIRT + RMC‐PC (experimental condition). Measurement The primary outcome was any days of SUD treatment in the past 3 months. Key secondary outcomes were days of SUD treatment overall and by level of care, days of alcohol and other drug (AOD) abstinence, and days of using specific substances, all based on self‐report. Findings At 3‐month follow‐up, those assigned to SBIRT + RMC‐PC (n = 134) had higher odds of receiving any SUD treatment (46% vs 20%; adjusted odds ratio = 4.50 [2.49, 8.48]) compared with SBIRT only, including higher rates of entering residential and intensive outpatient treatment. They also reported more days of treatment (14.45, vs 7.13; d = +0.26), more days abstinent (41.3 vs 31.9; d = +0.22), and fewer days of using alcohol (27.14, vs 36.31; d = −0.25) and cannabis (19.49, vs 28.6; d = −0.20). Conclusions: Recovery management checkups in combination with screening, brief intervention, and referral to treatment are an effective strategy for improving linkage of primary care patients in need to substance use disorder treatment over 3 months. [ABSTRACT FROM AUTHOR]

Background: Causal explanations for the association of young motherhood with increased risk for child attention‐deficit hyperactivity disorder (ADHD) remain unclear. Methods: The ABCD Study recruited 11,878 youth from 22 sites across the United States between June 1, 2016 and October 15, 2018. This cross‐sectional analysis of 8,514 children aged 8–11 years excluded 2,260 twins/triplets, 265 adopted children, and 839 younger siblings. We examined associations of maternal age with ADHD clinical range diagnoses based on the Child Behavior Checklist and NIH Toolbox Flanker Attention Scores using mixed logistic and linear regression models, respectively. We conducted confounding and causal mediation analyses using genotype array, demographic, socioeconomic, and prenatal environment data to investigate which genetic and environmental variables may explain the association between young maternal age and child ADHD. Results: In crude models, each 10‐year increase in maternal age was associated with 32% decreased odds of ADHD clinical range diagnosis (OR = 0.68; 95% CI [0.59, 0.78]) and 1.09‐points increased NIH Flanker Attention Scores (β = 1.09; 95% CI [0.76, 1.41]), indicating better child visual selective attention. However, adjustment for confounders weakened these associations. The strongest confounders were family income, caregiver education, and ADHD polygenic risk score for ADHD clinical range diagnoses, and family income, caregiver education, and race/ethnicity for NIH Flanker Attention Scores. Breastfeeding duration, prenatal alcohol exposure, and prenatal tobacco exposure were responsible for up to 18%, 6%, and 4% mediation, respectively. Conclusions: Socioeconomic disadvantages were likely the primary explanation for the association of young maternal age with child ADHD, although genetics and modifiable environmental factors also played a role. Public policies aimed at reducing the burden of ADHD associated with young motherhood should target socioeconomic inequalities and support young pregnant women by advocating for reduced prenatal tobacco exposure and healthy breastfeeding practices after childbirth. [ABSTRACT FROM AUTHOR]

Background: The use of a new medication (e.g., potassium supplementation) for managing a drug‐induced adverse event (e.g., loop diuretic‐induced hypokalemia) constitutes a prescribing cascade. However, loop diuretics are often stopped while potassium may be unnecessarily continued (i.e., relic). We aimed to quantify the occurrence of relics using older adults previously experiencing a loop diuretic‐potassium prescribing cascade as an example. Methods: We conducted a prescription sequence symmetry analysis using the population‐based Medicare Fee‐For‐Service data (2011–2018) and partitioned the 150 days following potassium initiation by day to assess the daily treatment scenarios (i.e., loop diuretics alone, potassium alone, combination of loop diuretics and potassium, or neither). We calculated the proportion of patients developing the relic, proportion of person‐days under potassium alone, the daily probability of the relic, and the proportion of patients filling potassium after loop diuretic discontinuation. We also identified the risk factors of the relic. Results: We identified 284,369 loop diuretic initiators who were 8 times more likely to receive potassium supplementation simultaneously or after (i.e., the prescribing cascade), rather than before, loop diuretic initiation (aSR 8.0, 95% CI 7.9–8.2). Among the 66,451 loop diuretic initiators who subsequently (≤30 days) initiated potassium, 20,445 (30.8%) patients remained on potassium after loop diuretic discontinuation, and 9365 (14.1%) patients subsequently filled another potassium supplementation. Following loop diuretic initiation, 4.0% of person‐days were for potassium alone, and daily probability of the relic was the highest after day 90 of loop diuretic initiation (5.6%). Older age, female sex, higher diuretic daily dose, and greater baseline comorbidities were risk factors for the relic, while patients having the same prescriber or pharmacy involved in the use of both medications were less likely to experience the relic. Conclusions: Our findings suggest the need for clinicians to be aware of the potential of relic to avoid unnecessary drug use. [ABSTRACT FROM AUTHOR]

Background and Aims: Most population studies that evaluate the relationship between nicotine vaping and cigarette cessation focus on limited segments of the smoker population. We evaluated vaping uptake and smoking cessation considering differences in smokers' plans to quit. Design: Longitudinal International Tobacco Control (ITC) Four Country Smoking and Vaping Surveys were conducted in 2016, 2018 and 2020. Setting: This study was conducted in the United States, Canada, England and Australia. Participants: Participants of this study were adult daily cigarette smokers who had not vaped in the past 6 months at baseline and had participated in two or more consecutive waves of the ITC Four Country Smoking and Vaping Surveys (n = 2815). Measurements Plans to quit cigarette smoking was assessed at baseline (within 6 months, beyond 6 months, not planning to quit) and at follow‐up (within 6 months vs not within 6 months), cigarette smoking cessation was assessed at follow‐up (smoking less than monthly [including complete cessation] vs daily/weekly/monthly smoking) and inter‐wave vaping uptake was assesed between baseline and follow‐up (none, only non‐daily vaping and any daily vaping). Generalized estimating equations were used to evaluate whether inter‐wave vaping uptake was associated with smoking cessation at follow‐up and with planning to quit at follow‐up, each stratified by plans to quit smoking at baseline. Findings Overall, 12.7% of smokers quit smoking. Smokers not initially planning to quit within 6 months experienced higher odds of smoking cessation when they took up daily vaping (32.4%) versus no vaping (6.8%; adjusted odds ratio [AOR], 8.58; 95% CI, 5.06–14.54). Among smokers planning to quit, smoking cessation rates were similar between those who did and did not take up daily vaping (25.1% vs 16.8%; AOR, 1.91; 95% CI, 0.91–4.00), although we could not account for potential use of cessation aids. Daily vaping uptake was associated with planning to quit smoking at follow‐up among those initially not planning to quit (AOR,6.32; 95% CI, 4.17–9.59). Conclusions: Uptake of nicotine vaping appears to be strongly associated with cigarette smoking cessation among smokers with no initial plans to quit smoking. Excluding smokers not planning to quit from studies on vaping and smoking cessation may underestimate potential benefit of daily vaping for daily smokers. [ABSTRACT FROM AUTHOR]

Aims: To examine whether polyuse of cigarettes and other smoked products (polysmoking) is predictive of quit attempts and quit success. Design: A prospective multi‐country cohort design. Setting: Australia, Canada, England and the United States. Participants: A total of 3983 adult daily cigarette smokers were surveyed in 2016 (wave 1 of data collection) and were re‐contacted in 2018 (wave 2) (i.e. waves 1–2 cohort) in the International Tobacco Control Four Country Smoking and Vaping (ITC 4CV) surveys; and 3736 smokers were surveyed in 2018 and re‐contacted in 2020 (wave 3) (i.e. waves 2–3 cohort). Measurements Participants were asked about their cigarette smoking and use of cigars, cigarillos, pipes and waterpipes. Outcomes were quit attempts between two survey waves and success, defined as having quit smoking all the combustible tobacco at the subsequent survey for 1 month or more. Findings Levels of polysmoking were 12.7% in the waves 1–2 cohort and 10.5% for the waves 2–3 cohort. Compared with cigarette‐only smokers, polysmokers were more likely to attempt to quit between waves 1 and 2 [54.9 versus 42.7%, adjusted odds ratio (aOR) = 1.37, 95% confidence interval (CI) = 1.08–1.74, P < 0.01], but not between waves 2 and 3 (43.8 versus 40.1%, aOR = 0.94, 95% CI = 0.72–1.22). Polysmoking predicted reduced likelihood of success in both cohorts among attempters and the overall samples. Between waves 2 and 3 there were significantly more transitions to non‐daily smoking among the polysmokers (12.4 versus 5.3%, χ2 = 40.4, P < 0.001). Conclusions: There is a consistent association between polysmoking (use of cigarettes together with other smoked products) and reduced quit success for combustible tobacco, but it is probably due to increased likelihood of transitioning to non‐daily use rather than complete cessation. [ABSTRACT FROM AUTHOR]

Background: Attending healthcare appointments and participating in social activities are important for older adults, but these activities are often limited by transportation barriers. Public transportation may bridge these gaps, but little is known about older public transportation users. This study compares the characteristics of older adults who use public transportation to those who do not. Design: Cross‐sectional analysis of data from Round 5 of the National Health and Aging Trends Study (NHATS). We identified 5696 urban community dwelling older adults, and calculated national estimates of those who reported public transportation use in the last month and those who used transit to see their regular doctor. We evaluated the age and sex‐adjusted associations between economic and clinical characteristics and recent use of public transportation using survey‐weighted logistic regression. Results: Nearly 1 in 10 (n = 555/5696, weighted n = 3,122,583) urban‐dwelling older adults in the United States reported use of public transportation in the last month, and over 20% of users (weighted n = 658,850) relied on transit to see their regular doctor. Compared to non‐users, those who reported using transit were significantly more likely to be younger and identify as non‐Hispanic Black or Hispanic. Financially strained older adults were more likely to have recently relied on public transportation (adjusted odds ratio [aOR] 1.62, 95% confidence interval [CI] 1.07–2.44), but frailty (aOR = 0.61, 95% CI 0.41–0.91) and living in an area with cracked or broken sidewalks (aOR = 0.35, 95% CI 0.27–0.46) were both associated with lower odds of public transportation use. Conclusion: More than 3 million older adults in the United States reported recently using public transportation, with over 600,000 relying on these services to visit their doctor. With increasing investment in public infrastructure on the horizon, centering the unique medical, economic, and social needs of older transit users is critical to ensure urban communities remain age‐friendly. [ABSTRACT FROM AUTHOR]

Falls among the older adults (64+ years old [YO]) are considered public health issues. However, fall prevention in middle adulthood (age 45–64) has received less attention. We studied the associations between the number of falls and fall‐related injuries and indicators for socio‐demographics, chronic diseases, and difficulties in conducting activities in two age groups, 45–64 YO and 64+. In this secondary data analysis, we used the Behavioral Risk Factor Surveillance System (BRFSS) 2018 data. The study showed respondents in the 45–64 YO have higher average falls and fall‐related injuries than those 64+ (P <.001). Variables that link to more falls and fall‐related injuries in 64+ correspond to more falls and fall‐related injuries in 45–64 YO. The finding indicates that the odds of falls and fall‐related injuries are comparable across age groups when considering demographic characteristics. However, odds of falling in the presence of arthritis and asthma are higher for respondents in 45–64 YO than the 64+ YO. The risk of falls and fall‐related injuries are not specific to older adults. Factors that matter to the number of falls and fall‐related injuries in the older adults also count in the younger age group. Nurses are asked to validate available fall assessment tools for adults 45–64 years old and evaluate all clients over 45 for fall risk. [ABSTRACT FROM AUTHOR]

Objectives: Healthcare (including dental care) service use is influenced by predisposing, enabling and need factors. One area with limited research is the association of acculturation (defined as behavioural changes in the adaptation to another culture) as a predisposing factor for dental care preventive service use. Preventive service use is a primary objective of Healthy People, 2030. The purpose of this study was to determine the association of acculturation with the preventive dental service use of dental pit‐and‐fissure sealant placement, among children in the United States, ages 6‐18 years. Methods: A cross‐sectional, secondary data analysis study was completed using National Health and Nutrition Examination Survey (NHANES), 2013‐2016 data. NHANES is a nationally representative survey of noninstitutionalized individuals across the United States. In the data set, children, ages 6‐18 years, had been evaluated for pit‐and‐fissure dental sealant use. Information that served as proxies for acculturation was length of stay in the United States (a citizen at the time of the survey; not a citizen and in the country <5 years; or not a citizen and in the country ≥5 years) and whether English was spoken at home (yes; no). Data were analysed for descriptive statistics. Multivariable logistic regressions were used to examine strength of the associations. Odds ratios for pit‐and‐fissure sealants among groups were determined. Results: There were 2220 children participants whose data were used for this study. Less than half (45.5%) had received dental pit‐and‐fissure sealants. A majority (53.3%) were white and were ages 12‐18 years (51.6%). The mean number of dental pit‐and‐fissure sealants among all children was 5.5. There was a lower percentage of children living in the United States <5 years who had received pit‐and‐fissure sealants than children who were citizens of the United States (22.2% vs 48.9%, respectively). The adjusted odds ratio was lower for dental pit‐and‐fissure sealants among children who were in the United States <5 years than children who were citizens of the United States (adjusted odds ratio, 0.38; 95% Confidence Interval: 0.24, 0.58). Conclusions: In this study, children who had lived in the United States <5 years were less likely to have pit‐and‐fissure sealants than children who were citizens of the United States. There is a need to reach all children with preventive services to improve dental quality of life, reduce the need for dental restorations and decrease overall financial burden regardless of time in the United States. [ABSTRACT FROM AUTHOR]

Transgender and nonbinary young adults report frequent parental rejection was linked to poor mental health. There are limited data about transgender and nonbinary young adult sibling relationships following disclosure or discovery of gender identity. The purpose of this analysis is to compare transgender and nonbinary young adults' perception of parental and sibling support specifically for gender identity immediately after disclosure and in the present day. Eligible respondents were recruited via paid social media advertisements. Respondents provided data on demographics, family relationships, and perceived support for gender identity. The sample consisted of 348 transgender and nonbinary young adults (Mean age: 21.5 years) who lived in the United States, identified as White and were assigned female at birth. The majority reported on a nuclear family. Nearly three‐quarters (71.3%) had disclosed their identity to at least one parent and had done so within the past 3 years. Overall, respondents perceived a significant increase in family members' support from the time of disclosure to the time of the survey. Most respondents reported improved family relationships since disclosing their gender identity. Siblings were perceived as significantly more supportive than either parent at both time points. Siblings could be an essential source of support for transgender/nonbinary young people, particularly if parents are not accepting or do not yet know their child's gender identity. Nurses and other professionals working with transgender and nonbinary young people in school, community, and clinical settings should assess perceived support across familial relationships. [ABSTRACT FROM AUTHOR]

BACKGROUND: State recess laws are recommended to encourage adequate and equitable access to recess and its benefits, but the downstream effects of state recess laws are unknown. We examined the association of state recess laws with district‐level policy and school recess provision. METHODS: This is cross‐sectional analysis of the School Health Policies and Practices Survey, a US nationally representative sample of school districts (2016) and schools (2014). State‐level recess laws were coded as none, recommend, or require recess. Logistic and linear regression were used to examine the association between state law with district policies and school recess provision, respectively. Data from 2000 are presented to highlight changes in recess policy and provision over time. RESULTS: The odds of a district policy requiring recess were 2.22 and 2.34 times greater when state recess law recommended or required recess, respectively, compared to states with no recess policy. There were no significant differences in school‐level recess provision by state recess law but point estimates from 2000 indicated states without a law had the largest declines in recess provision over time. CONCLUSIONS: State recess laws are positively associated with district‐level policy. Effects at the school level are unclear and continued surveillance is needed. [ABSTRACT FROM AUTHOR]

Background: State‐level laws governing recess policies vary widely across the United States. We characterize the presence of such laws and assess their associations with child‐level outcomes. Methods: The presence of a state recess law was determined using the Classification of Laws Associated with School Students (CLASS) database. Parents of 6‐ to 11‐year‐old children reported physical activity, overall health, school absences, school‐related problems, and ability to make/keep friends as part of the National Survey of Children's Health (NSCH). Logistic regression was used to compare outcomes in states with and without recess laws cross‐sectionally in 2018 and between 2003 and 2011/2012 using a difference‐in‐differences analysis. Results: In 2018, 20 states had a law recommending or requiring recess. Cross‐sectionally, the odds of being physically active every day (odds ratio, 95% confidence interval: 2.8, 1.2‐6.5) and having no difficulty making or keeping friends (2.9, 1.2‐7.2) were significantly higher for children residing in states with versus without a recess law. There were no significant associations in the difference‐in‐differences model. Conclusions: Significant cross‐sectional associations in 2018 were not confirmed by a difference‐in‐differences analysis of two waves of the NSCH. Short follow‐up time and the apparent weakness of existing state laws warrant further assessment of state‐level recess law. [ABSTRACT FROM AUTHOR]

Background: Hospital visitation restrictions during the COVID‐19 pandemic prompted concerns about unintended consequences for older patients, including an increased incidence of delirium and agitation. While first‐line interventions for these conditions are non‐pharmacologic, a lack of family support could result in increased use of benzodiazepines and antipsychotics, which are associated with poor outcomes in older adults. Little is known about the association of visitation policies with use of these medications among older adults. Methods: We conducted a retrospective cross‐sectional study among adults aged ≥65 hospitalized from March 1 through May 31, 2020 at four hospitals in the Mid‐Atlantic. The dates of onset of visitation restrictions (i.e., hospital‐wide guidelines barring visitors) were collected from hospital administrators. Outcomes were use of benzodiazepines and antipsychotics, assessed using patient‐level electronic health record data. Using multivariable logistic regression with hospital and study‐day fixed effects, the quasi‐experimental study design leveraged the staggered onset of visitation restrictions across the hospitals to measure the odds of receiving each medication when visitors were versus were not allowed. Results: Among 2931 patients, mean age was 76.6 years (SD, 8.3), 51.6% were female, 58.6% white, 32.5% black, and 2.6% Hispanic. Overall, 924 (31.5%) patients received a benzodiazepine and 298 (10.2%) an antipsychotic. The adjusted odds of benzodiazepine use was lower on days when visitors were versus were not allowed (adjusted odds ratio [AOR], 0.62; 95% CI, 0.39, 0.99). Antipsychotic use did not significantly differ between days when visitors were versus were not allowed (AOR, 0.98; 95% CI, 0.43, 2.21). Conclusions: Among older patients hospitalized during the first wave of the pandemic, benzodiazepine use was lower on days when visitors were allowed. These findings suggest that the presence of caregivers impacts use of potentially inappropriate medications among hospitalized older adults, supporting efforts to recognize caregivers as essential members of the care team. [ABSTRACT FROM AUTHOR]

Background: It is not known whether older adults' willingness to deprescribe is associated with their health outcome priorities related to medications. Methods: A cross‐sectional survey was conducted from March–April 2020 using a nationally representative online panel. The survey presented two vignettes: (1) a preventive medicine; and (2) a symptom‐relief medicine. Participants were asked whether they would be willing to stop each medicine if their doctor recommended it, and to rate their level of agreement with two health outcome priorities statements: "I am willing to accept the risk of future side effects ... to feel better now," and "I would prefer to take fewer medicines, even if ... I may not live as long or may have bothersome symptoms sometimes." Ordinal logistic regression was used to examine associations between willingness to stop each medicine, baseline characteristics and health outcome priorities. Results: Of 1193 panel members ≥65 years invited to participate, 835 (70%) completed the survey. Mean (SD) age was 73 years; 496 (59%) had taken a statin and 124 (15%) a prescription sedative‐hypnotic. 507 (61%) were willing to stop preventive medicines; 276 (33%) were maybe willing. 419 (50%) were willing to stop symptom‐relief medicines; 380 (46%) were maybe willing. Prioritizing fewer medicines was associated with higher odds of being willing to stop symptom‐relief medicines (aOR 1.43 [95% CI 1.02–2.00]) and preventive medicines (aOR 1.52 [95% CI 1.05–2.18]). Prioritizing now over future was associated with lower odds of being willing to stop symptom‐relief medicines (aOR 0.62 [95% CI 0.39–1.00]). Current/prior use of statins was associated with lower willingness to stop preventive medicines (aOR 0.66 [95% CI 0.48–0.91]). Conclusions: Older adults' health outcome priorities related to medication use are associated with their willingness to consider deprescribing. Future research should determine how best to elicit patients' health outcome priorities to facilitate goal‐concordant decisions about medication use. [ABSTRACT FROM AUTHOR]

Background: Older adults have been disproportionately affected by the COVID‐19 pandemic. Despite the widespread availability and proved effectiveness of COVID‐19 vaccines, the issue of inequity in vaccine uptake in the United States is a potential concern among different populations. This study examined racial and ethnic and income disparities in COVID‐19 vaccination rate among Medicare beneficiaries. Methods: Data from the Medicare Current Beneficiary Survey (MCBS) COVID‐19 Winter 2021 Community Supplement were employed (n = 9606 Medicare beneficiaries, weighted N = 50,512,963). We fitted a logistic regression model to determine the association of vaccination status with beneficiary race and ethnicity and income, after controlled for a set of beneficiary characteristics. Results: Compared with non‐Hispanic White respondents, Hispanic respondents (OR = 0.72, 95% CI: 0.54–0.96, p = 0.02) and Black respondents (OR = 0.84, 95% CI: 0.67–1.04, p = 0.11) were less likely to receive COVID‐19 vaccine. In addition, the likelihood of COVID‐19 vaccine uptake for beneficiaries who earn less than $25,000 per year was more than 50% lower than that for those whose annual income was $25,000 or more (OR = 0.44, 95% CI: 0.37–0.53, p < 0.0001). Conclusions: Racial and ethnic and income disparities exist in COVID‐19 vaccination rate among Medicare beneficiaries nationally. Community‐based strategies to boost vaccine uptake may target racial and ethnic minorities and socioeconomically disadvantaged groups to reduce such disparities. [ABSTRACT FROM AUTHOR]

Background: Controversy exists on the acceptability of medical immobilization (MI). Aim: To identify regulations, professional conventions, and opinions on the acceptability of MI and to identify practice patterns through a pilot study of members of the International Association of Paediatric Dentistry (IAPD) and their colleagues. Design: A 22‐item questionnaire was developed and electronically distributed to 1191 members of the IAPD. Results: Responses were received from 182 dentists in 45 countries. The majority (74.9%) of respondents use MI, and 29.1% use an immobilization device. MI with an immobilization device was reported as professionally acceptable (58.1%) and permitted by medicolegal regulations (70.8%) in their countries of practice. Dentists rated acceptability of MI higher than they perceived parents would overall and perceived MI to be more acceptable by parents for emergency situations and for children with special healthcare needs but 19.8% of respondents found it totally unacceptable in all scenarios. Use and opinions of acceptability varied by geographical location with respondents from North America being more accepting of MI. Most dentists felt that the use of an immobilization device could lead to lasting psychological trauma (72.3%) and violation of the rights of the child (55.4%) but that it improves access to care (58.5%). Conclusion: The acceptability of MI remains an area of controversy for paediatric dentists internationally. [ABSTRACT FROM AUTHOR]

Background: The HEART Pathway is a validated protocol for risk stratifying emergency department (ED) patients with possible acute coronary syndrome (ACS). Its performance in different age groups is unknown. The objective of this study is to evaluate its safety and effectiveness among older adults. Methods: A pre‐planned subgroup analysis of the HEART Pathway implementation study was conducted. This prospective interrupted time series accrued adult ED patients with possible ACS who were without ST‐elevation across three US sites from 11/2013–01/2016. After implementation, providers prospectively used the HEART Pathway to stratify patients as low‐risk or non‐low‐risk. Patients were classified as older adults (≥65 years), middle‐aged (46–64 years), and young (21–45 years). Primary safety and effectiveness outcomes were 30‐day death or MI and hospitalization at 30 days, determined from health records, insurance claims, and death index data. Fisher's exact test compared low‐risk proportions between groups. Sensitivity for 30‐day death or MI and adjusted odds ratios (aORs) for hospitalization and objective cardiac testing were calculated. Results: The HEART Pathway implementation study accrued 8474 patients, of which 26.9% (2281/8474) were older adults, 45.5% (3862/8474) middle‐aged, and 27.5% (2331/8474) were young. The HEART Pathway identified 7.4% (97/1303) of older adults, 32.0% (683/2131) of middle‐aged, and 51.4% (681/1326) of young patients as low‐risk (p < 0.001). The HEART Pathway was 98.8% (95% CI 97.1–100) sensitive for 30‐day death or MI among older adults. Following implementation, the rate of 30‐day hospitalization was similar among older adults (aOR 1.25, 95% CI 1.00–1.55) and cardiac testing increased (aOR 1.25, 95% CI 1.04–1.51). Conclusion: The HEART Pathway identified fewer older adults as low‐risk and did not decrease hospitalizations in this age group. [ABSTRACT FROM AUTHOR]

Background and Aims: The growing body of research evidence on substance use and substance use disorder (SU/SUD) prevention could be leveraged to strengthen the intended impact of policies that address SU/SUD. The aim of the present study was to explore how research was used in United States federal legislation that emphasized SU/SUD prevention. Design: Using a mixed‐methods approach, we assessed whether the use of research predicted a bill's legislative progress. We randomly sampled 10 bills that represented different types of research keywords to examine how research was used in these bills, applying content analysis. Setting: United States Congress. Participants/Cases: Federal legislation introduced between the 101st and the 114th Congresses (1989–2017; n = 1866). Measurements The quantitative outcome measures were bills' likelihood of passing out of committee and being enacted. Qualitative outcomes included the ways research was used in legislation. Findings Bills that used any research language were 2.2 times more likely to pass out of committee (OR = 2.18; 95% CI, 1.75, 2.72) and 82% more likely to be enacted (OR = 1.82; 95% CI, 1.23, 2.69) than bills not using research language. Bills using dissemination words were 57% more likely to pass out of committee (OR = 1.57; CI, 1.08, 2.28) and analysis words were 93% more likely (OR = 1.93; 95% CI, 1.51, 2.47) than bills not using dissemination or analysis words. Research was used to (i) define the problem to justify legislative action, (ii) address the problem by providing funding, and (iii) address the problem through industry regulations. However, there was a lack of research use that targets underlying risk and protective factors. Conclusions: In the US Congress, substance use and substance use disorder prevention bills that use research language appear to be more likely to progress in the legislative cycle than bills that do not, suggesting that legislation using research may be viewed as more credible. [ABSTRACT FROM AUTHOR]

The Baby‐Friendly Hospital Initiative is a global health promotion intervention that outlines the Ten Steps hospitals should implement to support newborns' breastfeeding. This US‐based study aimed to determine which hospital characteristics and community factors are associated with hospitals' attainment of Baby‐Friendly designation. We used a cross‐sectional design and used 2018 data from the Baby‐Friendly, USA Inc. designation program merged with the American Hospital Association annual survey data set. Multilevel logistic regression analysis was used to assess hospital characteristics of interest among the sample consisting of 312 Baby‐Friendly hospitals and 1449 non‐Baby‐Friendly. Our results show that Baby‐Friendly hospitals are more likely to be government nonfederal hospitals, in the Midwest or South regions, serve communities with higher birth totals, and reside in competitive markets. Based on the results of this study, hospitals should seek further and examine their community's characteristics and structures to identify opportunities and encourage the attainment of improved breastfeeding initiatives such as Baby‐Friendly designation. Key messages: Organizational and community characteristics that contribute to Baby‐Friendly (BF) designation attainment remain unexplained.The BF concept as an innovative strategic choice assists health care leaders in better supporting breastfeeding and advanced maternity care.Our study indicates that BF hospitals are more likely to be government nonfederal hospitals and serve communities with a higher birth total.Our study indicates that BF hospitals are more likely to be in the South and Midwest regions of the United States and reside in competitive markets. [ABSTRACT FROM AUTHOR]

Background: Multiple factors may influence the risk of being homebound, including social isolation and race. This study examines the relationship between social isolation and homebound status by race over 9 years in a sample of adults. Methods: Utilizing a representative sample of 7788 Medicare beneficiaries aged 65+ from 2011–2019, we assessed the odds of becoming homebound by social isolation. We defined social isolation as the objective lack of contact with others. We defined severe social isolation as scoring a 0 or 1 on a social connection scale from 0 to 4. Homebound status was defined as never leaving home or only leaving home with difficulty. Utilizing a multivariate Cox proportional hazards model adjusting for age, gender, marital status, income, and education, we examined the association between social isolation at baseline and becoming homebound during the study in those who were not initially homebound. Results: Older adults in this study were on average 78 years old. Overall, most were white (69%), female (56.3%), and married (57.8%) and reported that they had a college education or higher (43.9%). Also, at baseline, approximately 25% of study participants were socially isolated, 21% were homebound, and 6.3% were homebound and socially isolated or severely socially isolated. Homebound status at baseline varied by race: Black, 23.9% and white, 16.6% (p < 0.0001). After 9 years, socially isolated black (hazard risk ratio, HRR 1.35, 95% confidence interval CI [1.05,1.73], p < 0.05) and white (HRR 1.25, 95% CI [1.09,1.42], p < 0.01) older adults were at higher risk of becoming homebound. Conclusion: Socially isolated black and white adults are more likely to be homebound at baseline and become homebound over time. Further research is needed to determine whether community‐based strategies and policies that identify and address social isolation reduce homebound status among community‐dwelling older adults. [ABSTRACT FROM AUTHOR]