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BACKGROUND: About 3.5 million trauma patients are hospitalized every year, but 35%–40% require further care after discharge. Nurses' ability to affect discharge disposition by minimizing the occurrence of nurse-sensitive indicators (catheter-associated urinary tract infection [CAUTI], central line-associated bloodstream infection [CLABSI], and hospital-acquired pressure injury [HAPI]) is unknown. These indicators may serve as surrogate measures of quality nursing care. OBJECTIVE: The purpose of this study was to determine whether nursing care, as represented by three nurse-sensitive indicators (CAUTI, CLABSI, and HAPI), predicts discharge disposition in trauma patients. METHODS: This study was a secondary analysis of the 2021 National Trauma Data Bank. We performed logistic regression analyses to determine the predictive effects of CAUTI, CLABSI, and HAPI on discharge disposition, controlling for participant characteristics. RESULTS: A total of n = 29,642 patients were included, of which n = 21,469 (72%) were male, n = 16,404 (64%) were White, with a mean (SD) age of 44 (14.5) and mean (SD) Injury Severity Score of 23.2 (12.5). We created four models to test nurse-sensitive indicators, both individually and compositely, as predictors. While CAUTI and HAPI increased the odds of discharge to further care by 1.4–1.5 and 2.1 times, respectively, CLABSI was not a statistically significant predictor. CONCLUSIONS: Both CAUTI and HAPI are statistically significant predictors of discharge to further care for patients after traumatic injury. High-quality nursing care to prevent iatrogenic complications can improve trauma patients' long-term outcomes. [ABSTRACT FROM AUTHOR]

Purpose: Those factors identified to increase the risk of suicide in rural dwellers were exacerbated by the SARS‐CoV‐2 pandemic, specifically economic factors, substance use, access to health care, and access to lethal weapons. Because the effects of SARS‐CoV‐2 on suicide ideation and attempts in rural populations have not been fully characterized in published literature, this study compares: (1) the rates of suicide ideation and attempts between the 6 months affected by SARS‐CoV‐2 to same months of the preceding year (3/18/2020‐9/18/20; 3/18/2019‐9/18/19), (2) demographics (ie, age, sex, residence, race, and ethnicity), and (3) the locations in which the encounters were billed (inpatient, outpatient, and emergency department). Methods: Deidentified claims data associated with patient encounters billed for Suicide Ideation and Suicide Attempt were grouped based on time period and analyzed using descriptive statistics, incidence rate ratio (IRR), 2‐sample t‐test, chi‐square test of association, or Fisher's exact test. Findings: Suicidal ideation encounters increased in the 6 months post‐SARS‐CoV‐2 when compared to the 6 months of the prior year (IRR = 1.19; P <.001). Males (IRR = 1.27, P <.001), those residing rural areas (IRR = 1.22, P =.01), and Black, non‐Hispanic (IRR = 1.24, P =.024) were found to have increased rates of suicide ideation post‐SARS‐Cov‐2. In adults, White, non‐Hispanics (IRR = 1.16; P <.001) had increased rates of post‐SARS‐CoV‐2. In the pediatric subset, those who were aged 14‐17 (IRR = 1.50; P <.001), resided in rural areas (IRR = 1.61, P =.009), and idenitifed as Hispanic (IRR = 1.89; P =.037) or Black, non‐Hispanic (IRR = 1.61, P =.009) had increased rates post‐SARS‐CoV‐2. Conclusions: Our study identified rural dwellers to be at increased risk for suicide ideation. [ABSTRACT FROM AUTHOR]

Objective: Assess the prevalence, perceptions, sociodemographic/personal factors that influence Juul use among incoming freshmen. Participants: Incoming undergraduate students (N = 1,706) attending a public university in the southeastern U.S. Methods: Cross-sectional survey administered August 2018. Bivariate relationships assessed using chi-square test of association. Multinomial logistic regression to determine factors associated with Juul use status. Results: 41% had ever used Juul, 24% had used within the past month. Among current users, one-third had used 20–30 days. Risk factors for current use: heterosexual orientation (relative to other sexual orientation) AOR = 2.16, 95% CI: 1.20–3.91), those who planned to join sorority/fraternity (relative to those who did not plan to; AOR = 2.15, 95% CI: 1.59–2.90), current smokers (relative to nonsmokers; AOR = 24.39, 95% CI: 7.52–76.92), current marijuana users (compared with nonusers of marijuana; AOR = 6.45, 95% CI: 3.92–10.64) and alcohol users (compared with nondrinkers; AOR = 7.81, 95% CI: 5.75–10.54). Conclusion: Prevention and treatment efforts are needed for emerging adults transitioning to college. [ABSTRACT FROM AUTHOR]

BACKGROUND: The lack of research on costrelated health literacy among colorectal cancer (CRC) survivors warrants further evaluation. OBJECTIVES: The objective of this study was to examine prevalence of low literacy (health, cancer, and insurance literacy), and numeracy and their association with sociodemographic factors in a group of Kentucky CRC survivors. METHODS: Based on data from the Kentucky Cancer Registry, this cross-sectional study evaluated survey results from January 2019 to November 2019 for the prevalence of low cost-related health literacy. FINDINGS: Overall, 104 participants had adequate health literacy (77%) and cancer health literacy (71%). However, fewer CRC survivors had high numeracy (16%) and confidence in choosing and using health insurance (18%). Thirty-one percent reported competence in their ability to select a health insurance plan and use it to access timely and appropriate healthcare services. Those with lower levels of education or those enrolled in a public health insurance plan were more likely to have lower health literacy, insurance literacy, and numeracy. [ABSTRACT FROM AUTHOR]

Background: Cardiovascular disease is a significant health problem in the United States, attributed to more than 30% of all deaths annually. Anxiety has been associated with cardiovascular disease risk and is thought to be associated with cardiovascular disease risk through inflammatory pathways. Objective: The purposes of this study were to examine the relationship between anxiety and systemic inflammation in individuals at risk for cardiovascular disease and to determine if single-nucleotide polymorphisms (SNPs) associated with inflammation moderate this relationship. Methods : A secondary analysis was conducted using baseline data from a study investigating the impact of genetics on response to a cardiovascular disease risk reduction intervention. Anxiety was measured using the Brief Symptom Inventory. Protein levels for C-reactive protein and interleukin-6 (IL-6) were measured in serum, and genomic DNA was assayed for SNPs in the C-reactive protein, IL-6, and IL-6R genes. Multiple linear regressions were performed to examine if anxiety predicted inflammation and if SNPs moderated associations. Results : Participants (N = 398) were white, aged 51 +/- 13 years, and 73% women. There was a significant interaction between rs4129267 genotype and anxiety (P =.010), with the association significant only for individuals with the CC genotype (b = 0.243, SE = 0.04, P <.001). No moderation effect existed for rs1205 or rs1800797. Conclusion : Anxiety was positively associated with IL-6 protein levels, but moderation analysis indicated that this was significant only for individuals with the rs4129267 CC genotype. This suggests that genotypic differences may exist in anxiety response, placing certain individuals at higher risk for inflammation and, subsequently, cardiovascular disease. [ABSTRACT FROM AUTHOR]

Background: Leptin and adiponectin, two adipokines involved in glucose and lipid metabolism, have been linked to regulation of growth in early infancy, energy balance, and metabolic disorders in childhood. The aim of this study was to determine if concentrations of leptin and adiponectin could be measured reliably in infants' saliva, to evaluate the degree of agreement with infant serum levels, and to explore their association with infant feeding status. Methods: A total of 34 infants were recruited after birth and followed for 20 weeks. After log-transformation of the values, a Bland-Altman graphical approach was used to summarize the direction of the difference between the serum and saliva values. Repeated measures mixed modeling was used to evaluate differences over time in these outcomes by feeding status. Results: Mean concentration of salivary leptin and adiponectin in infants was 3.7 (SD =.8) ng/mL and 2.9 (SD = 0.7) ng/mL, respectively. The degree of agreement between serum and saliva for log-transformed leptin and adiponectin values were relatively robust, albeit with a non-zero bias between the two methods, given that serum values were greater than corresponding saliva values for both adipokines in all infants. Each of the four repeated measures mixed models (one for each adipokine measure) had a significant main effect; however, the interaction between time and feeding status was not significant in any of the models. Conclusion: This study demonstrated that leptin and adiponectin can be measured in infant saliva, but in some cases leptin concentrations may be more difficult to detect. [ABSTRACT FROM AUTHOR]

Background: Over the past three decades, the number of female farmers in the United States has increased to nearly 1 million, yet research on this occupational group is limited. Job stress arising from job dissatisfaction in other occupations is associated with both acute and chronic diseases. The purpose of this study was to examine the associations of demographic characteristics, agricultural occupational factors, and health indicators with farm-work satisfaction among female farmers. Methods: Cross-sectional data from the Sustained Work Indicators of Older Farmers Study (2002–2006) was used to examine older female farmers (N = 332) from North Carolina and Kentucky. This secondary data analysis used farm-work questions adapted from the Kentucky Farm Health and Hazard Surveillance Project to measure demographics and occupational factors, the 20-item Center for Epidemiologic Studies-Depression Scale to measure depressive symptoms, and a single item from the National Health Interview Survey to measure self-perceived health status. Findings: Controlling for demographic characteristics, work factors, and health indicators, the female farmers were more likely to report satisfaction with farm work when they had performed a greater number of agricultural tasks in the past year and if they had lower levels of depressive symptoms. Conclusions/Application to Practice: This study provides an initial basis for further research with women working in agriculture. Occupational health nurses, particularly those practicing in agricultural areas, can enhance their quality of care by having a greater understanding of the factors associated with farming and farm life that affect female farmers' overall health. [ABSTRACT FROM AUTHOR]

Effective communication is the foundation of quality care in palliative nursing. As frontline palliative home care providers, nurses could foster more effective bereavement coping skills through therapeutic conversations. The purpose of this study was to evaluate the impact of a nursing intervention offered to bereaved family cancer caregivers. This was a quasi-experimental design, with a posttest-only comparison of the intervention and control groups receiving usual care. Bereaved caregivers (n = 51) receiving services from a specialized palliative home care unit participated and completed measures of depression, anxiety, stress, and grief reactions 3, 5, and 6 months after their close relative had died. There was a significant decrease in anxiety symptoms in the intervention group compared with the control group across all 3 time points. Anxiety and stress symptoms also decreased over time in the 2 groups combined, but this decrease was not observed for depression. When evaluating grief reactions, the intervention group had a lower mean of controlled grief responses, across the posttest period, than the control group. Results demonstrate that providing bereaved family caregivers the opportunity to participate in a therapeutic conversation intervention might reduce distressing symptoms in early bereavement. [ABSTRACT FROM AUTHOR]

Background: Trauma and management of injuries can result in reduction or loss of mobility, which can lead to skeletal muscle deconditioning and sustained disability. Prior investigators have examined changes in skeletal muscle due to injury and immobility separately. The muscular consequences of combined immobility and trauma have not been systematically investigated. Objective: The purpose of this study was to explore the association of time to first ambulation with skeletal muscle size and strength in patients after major trauma. Methods: Adults (N = 19) admitted for major trauma (Injury Severity Score [ISS] > 15) provided daily measures of muscle size (ultrasound) and strength (dynamometry) during hospitalization. Participants were grouped based on time to first ambulation. Repeated measures analysis of variance was used to compare muscle measures between the groups across 5 days while controlling for age and gender. Results: Participants were primarily male (63%) aged 40 ± 17 years with a mean ISS of 21 ± 4. Early ambulation was associated with a 10% increase from baseline in bicep size on Days 3 and 4 and a 15% increase from baseline on Day 5. There were no changes in rectus femoris size in either group. The early ambulation group was significantly stronger than the delayed ambulation group throughout the study in measures taken with the biceps (22%–37%) and quadriceps (26%–46%). Conclusion: Early ambulation following major trauma was associated with increased bicep size and greater muscle strength in the biceps and quadriceps muscles over time. [ABSTRACT FROM AUTHOR]

Purpose: Aspects of farming and farm life can contribute to higher levels of depressive symptoms resulting in an increased risk for injury and development of chronic disease and a decrease in overall quality of life. Rural farm women can be subjected to stressors from farming as an occupation, their role within the agrarian culture, and life in a rural area. The purpose of this study was to examine the associations of demographic characteristics, agricultural occupational factors, and health indicators with depressive symptoms among farm women aged 50 years and older. Methods: Secondary analysis of cross-sectional data from the Sustained Work Indicators of Older Farmers Study (2002-2006) was used to examine the influence of factors on depressive symptoms of older (> 50 years) female farmers (N= 358) from North Carolina and Kentucky. The study was framed by a modified version of the Biopsychosocial Model. Logistic regression was conducted to examine the relationships between demographics, perceived health status, active coping score, perceived stress, and factors specific to farm work and depressive symptoms. Findings: Participants' depressive symptoms status (high vs. low) was predicted by their race/ethnicity, years of education, adequacy of income for vacation, perceived health status, perceived stress, and active coping. Conclusion: This study increases our understanding of the factors associated with depressive symptoms in farm women, but also identifies significant gaps in our knowledge of depressive symptoms among this population. The multifaceted dimensions of depressive symptoms revealed indicate a crucial need to more fully explore the interrelationship among the dimensions of the conceptual model and the physical and mental health of farm women. Additional knowledge gained from these studies will assist in the development of assessment instruments, skills, and plan of care specific to the needs of farm women; thus optimizing the health care of farm women. [ABSTRACT FROM AUTHOR]

This study investigated the association between sociodemographic characteristics and public attitudes toward Tobacco 21 laws. Through a random telephone survey in 2017, 1,675 Kentucky adults were asked if they favored/opposed increasing the minimum legal age to purchase tobacco products from 18 to 21 years of age. Over half (57.9%) favored raising the minimum legal age for tobacco sales to 21 (95% confidence interval: [54.5, 61.2]). Multivariable logistic regression for weighted survey data was used to determine factors associated with support. In the adjusted analysis, older age, female sex, non-White, conservative political ideology (versus moderate), and support for a statewide smoke-free policy were each significantly associated with greater support for Tobacco 21. The results suggest multiple demographic and personal factors associated with support, even in a tobacco-growing state. Health care professionals, including nurses, must understand existing public attitudes to effectively advocate for tobacco policies in states with high tobacco use. [ABSTRACT FROM AUTHOR]

Background: Hypertensive disorders are common pregnancy complications in the United States. Although the exact mechanism underlying hypertensive disorders in pregnancy is unknown, there is evidence of involvement of a maladaptive maternal inflammatory response. Psychological maternal stress experienced during pregnancy can increase the risk of a hypertensive disorder by altering the maternal inflammatory response. Objectives: The purpose of this analysis was to evaluate the relationships of hypertensive status and stress with inflammatory biomarkers throughout pregnancy. Method: A 1:2 case–control design was used to analyze secondary data longitudinally with repeated measures of a multicenter, culturally and ethnically diverse pregnant population. Demographic data, psychological stress, and serum inflammatory data were analyzed. The sample consisted of 30 pregnant women with hypertension and 61 normotensive women. Measurements were taken once in each trimester of pregnancy. Results: Trimester-specific levels of inflammatory biomarkers varied based on stress and hypertensive status. IL-6 was elevated in the hypertensive, high-stress group, while IL-8 was greater among those with high stress, regardless of hypertensive status or trimester. For IL-1α and IL-1β, there was a significant stress-by-trimester interaction, while IL-10 was associated with a significant three-way interaction among stress level, hypertension status, and trimester. Conclusions: The associations of stress and hypertensive status with inflammatory biomarkers are complex. Stress and hypertension were associated with changes in inflammatory response. Hypertensive women with high stress experienced a heightened anti-inflammatory response, potentially a compensatory mechanism. To better understand this relationship, further longitudinal studies are warranted. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to elicit participants’ (N = 16) perceptions of a gardening activity at a juvenile justice center and to determine whether past exposure to gardening and farmers markets was associated with their perceptions of the gardening experience. Design: This cross-sectional, exploratory program evaluation was conducted in partnership with the Kentucky Department of Juvenile Justice. Adolescents completing the Cadet Leadership and Education Program participated in gardening in order to provide produce to a local farmers’ market. Method: After the growing season, participants were asked to complete a nine-item questionnaire about the gardening activity during one of their usual classes at the facility. The questionnaire assessed perception of the experience and past exposure to gardening and farmers’ markets. Findings: Participants reported favorably about their participation in the activity, knowledge gained from the activity, and their intent to garden in the future. Those who had previously gardened had more favorable perception of gardening than those who had never gardened. Gardening is an inexpensive means of teaching teamwork and delayed gratification and providing a sense of empowerment and may benefit at-risk adolescents during incarceration. [ABSTRACT FROM AUTHOR]

Background: Although hypertension (HTN) treatment rates are similar across age groups of women, effective control is significantly worse among older women. Only 20% of hypertensive women aged 70 to 79 years have controlled blood pressure. Objectives: The purpose of this longitudinal study was to test the effects of the quality of mother-daughter relationship, inner strength, and control on HTN self-management and health-related quality of life (HRQOL) for both members of the dyad at 6 months. The Actor-Partner Interdependence Model was used to examine the direct ("actor") and indirect ("partner") effects of 46 dyads. Results: The mothers' perceived relationship quality with daughters directly impacted their own self-management of HTN and HRQOL while also indirectly affecting their daughters' self-management. Similarly, the daughters' perceived strength of their relationship with their mothers directly influenced their self-management and HRQOL and indirectly affected their mothers' self-management and HRQOL. [ABSTRACT FROM AUTHOR]

Depressive symptoms and poor health perceptions are predictors of higher hospitalization and mortality rates (heart failure [HF]). However, the association between depressive symptoms and health perceptions as they affect event-free survival outcomes in patients with HF has not been studied. The purpose of this secondary analysis was to determine whether depressive symptoms mediate the relationship between health perceptions and event-free survival in patients with HF. A total of 458 HF patients (61.6 ± 12 years, 55% New York Heart Association Class III/IV) responded to one-item health perception question and completed the Patient Health Questionnaire-9. Event-free survival data were collected for up to 4 years. Multiple regression and Cox proportional hazards regression analysis showed that depressive symptoms mediated the relationship between health perceptions and event-free survival. Decreasing depressive symptoms is essential to improve event-free survival in patients with HF. [ABSTRACT FROM AUTHOR]

Purpose/Objectives: To examine the association of smoking in the home with lung cancer worry, perceived risk, and synergistic risk, controlling for sociodemographics, family history of lung cancer, and health-related self-concept. The hypothesis is that participants with smoking in the home would have higher scores for lung cancer worry, perceived risk, and synergistic risk. Design: Cross-sectional baseline survey. Setting: Participants recruited from an outpatient clinic and pharmacy at University of Kentucky HealthCare, an academic medical center. Sample: 515 homeowners from a larger randomized, controlled trial aimed at reducing exposure to radon and secondhand smoke (SHS). Methods: Homeowners were selected via quota sampling so that about half would have a smoker or smokers in the home. Main Research Variables: Lung cancer worry and perceived risk; perception of synergistic risk of radon and SHS exposure; demographics. Findings: Participants with smoking in the home had higher rates of lung cancer worry and perceived risk. In addition, those with less education and a family history of lung cancer and who were current smokers had higher lung cancer worry and perceived lung cancer risk scores. Predictors of perception of synergistic risk were marital status and health-related self-concept. Conclusions: Homeowners with smoking in the home, less education, and a family history of lung cancer had greater lung cancer worry and perceived lung cancer risk. Lung cancer risk reduction interventions with vulnerable populations are needed. Implications for Nursing: Nurses are in a unique position to target high-risk populations and identify opportunities to create teachable moments to reduce environmental risks of radon and tobacco smoke exposure. [ABSTRACT FROM AUTHOR]

Objective: This study determined whether having minor children in the home was associated with the teachable moment (TM) constructs of lung cancer worry, perceived risk, health‐related self‐concept, and the novel construct of synergistic risk. Design and Sample: Secondary data analysis of baseline data from a randomized controlled trial of an intervention to reduce home exposure to radon and secondhand smoke (SHS). Quota sample of adults recruited at a Central Kentucky academic medical center (N = 556). Measures: Survey items assessed lung cancer worry, perceived risk, synergistic risk perception, and health‐related self‐concept. Results: The presence of children in the home was not a significant predictor of any construct needed to create a TM for lung cancer prevention. Individuals with children living in the home were more likely to be younger, a racial/ethnic minority, a current smoker, and live with a smoker compared to those without children in the home. Conclusions: There is a critical need to raise parental awareness on child health inequities related to the home exposure to radon and SHS. Public health nurses can create TMs for lung cancer prevention through greater awareness of the risks posed by radon and SHS along with promoting home testing and low‐cost resources to reduce risk. [ABSTRACT FROM AUTHOR]

Background:Tobacco media campaigns are effective, but less is known regarding the impact on college students.Purpose:The purpose was to test the effects of an on-campus Tips television campaign on frequency and believability of ads recalled and to assess demographic and personal factors associated with believability.Methods:A quasi-experimental pre–post design was used to assess the 8-week campaign with 3 Tips ads. Two randomly selected cohorts of college students (N = 1593) from a large public university completed online surveys pre- and postcampaign. Group comparisons using chi-square tests, 2-samplettests, and logistic regression, controlling for residence or cohort, and predictors of believability using proportional odds modeling were examined.Results:Ads were recalled by significantly more students (68%) postcampaign. Believability for one or more ads was lower for males, undergraduates, those belonging to fraternity/sorority, and current polytobacco users (P < .05). Believability was greater for those who recalled seeing the ads more often (P < .05).Discussion:Subgroups of college students, including males and undergraduates, reported less ad believability, which should be considered when designing communication strategies.Translation to Health Education Practice:Considering the potential impact and cost-effective nature of on-campus TV media campaigns, these ads need to be integrated into current campus tobacco control strategies. [ABSTRACT FROM PUBLISHER]

Objectives: (1) Compare social norms and perceived peer use between college student cigarette, e-cigarette, and/or hookah users and nonusers; and (2) determine variables associated with social influences.Participants: Undergraduate students attending a large university in the Southeast United States (N= 511).Methods: An April 2013 online survey assessed use of 3 types of tobacco, social norms, perception of peer use, number of smokers in life, exposure to secondhand smoke, and demographic characteristics.Results: Participants indicated greater acceptance of emerging tobacco products than for cigarettes and consistently overestimated the percent of peers who use various tobacco products. Males and current users had higher social norm scores for all 3 forms of tobacco.Conclusion: To counter marketing of alternative tobacco products, education about the dangers of their use needs to be implemented across college campuses as part of a comprehensive tobacco control strategy that also includes tobacco-free campus policies. [ABSTRACT FROM PUBLISHER]

Objective To identify predictors of the receipt of medical care, including the receipt of pre-drug screening, for diagnostically targeted fungal or mycobacterial infections among patients prescribed a tumor necrosis factor inhibitor (TNFi). Methods We conducted a case-control study using deidentified patient health claims information from a data set representing a commercially insured US population of 15 million patients annually from January 1, 2007 to December 31, 2009. Descriptive statistics as well as a 2-sample t-test, chi-square test of association, Fisher's exact test, and multivariate logistic regression were used for data analysis. Results A total of 30,772 patients received a TNFi during the study period. Of these, 158 patients (0.51%) developed targeted fungal and/or mycobacterial infections (cases). The median number of infections per case was 1.0 (interquartile range 1.0-2.0). Tuberculosis was diagnosed in 61% of cases, followed by histoplasmosis in 60%, nontuberculous mycobacterial infections in 11%, coccidioidomycosis in 10%, unspecified fungal infection in 8%, blastomycosis in 4%, cryptococcal infection in 3%, and pneumocystosis in 2%. Compared to controls (n = 474), a higher proportion of cases were prescribed prednisone (55% versus 37%; P < 0.001). Patients who were prescribed prednisone during the study period were twice as likely as those not taking prednisone to seek medical care attributable to a targeted fungal or mycobacterial infection (odds ratio 2.03; P < 0.001). Conclusion Development of a targeted fungal or mycobacterial infection among patients taking a TNFi is rare. Concomitant use of prednisone predicted development of such infections. [ABSTRACT FROM AUTHOR]

Objective: To examine the association of secondhand smoke (SHS) exposure with susceptibility to smoking, perceived addiction, and psychobehavioral effects of exposure among never- and ever-smoking college students. Participants: Participants were 665 college students at a large, southeastern university in the United States. Methods: This study is a secondary analysis of online cross-sectional survey data from randomly selected students in April 2013. Results: Thirty-eight percent of the sample had moderate to high SHS exposure. Among never-smokers, SHS exposure was associated with increased susceptibility to initiating smoking. Among ever-smokers, SHS exposure was not associated with their perceived addiction to tobacco. In the total sample, SHS exposure was associated with greater psychobehavioral symptoms of exposure. Conclusions: SHS exposure may the increase risk of smoking, especially among never-smoking college students. This study strengthens the need for prevention strategies that limit SHS exposure in college environments. [ABSTRACT FROM AUTHOR]

Purpose A sample of 150 patients with rheumatoid arthritis (RA) participated in a predictive, descriptive, cross-sectional study which compared contextual factors of patients who perceived higher quality communication with those who perceived lower quality, and determined the predictive power of contextual factors for higher quality patient-provider communication. Data sources A validated, self-report scale measured patient perception of quality of patient-provider communication. Data were analyzed using chi-square tests of association, two-sample t-tests, and multiple linear regression. Conclusions/implications for practice There were no differences in external environmental or internal personal factors between those who perceived higher and lower quality of communication. From the linear regression, patients with fewer years of education ( p = .008), those taking a greater number of RA medications ( p = .03), and those living in an urban area ( p = .04) perceived the quality of communication more positively. The findings from this study suggest that contextual factors (years of education, residence, and the number of medications) may affect RA patient perception of the quality of patient-provider communication. This underscores the need for development of appropriate and effective interventions to improve communication and optimize RA patient outcomes. [ABSTRACT FROM AUTHOR]

Objective Tobacco use is the leading preventable cause of death, resulting in 443,000 US deaths per year. Rural adults have higher smoking prevalence and less access to tobacco dependence treatment than their urban counterparts. This study examined exposure to a culturally specific smoking cessation outreach intervention, assessing whether exposure was associated with cessation behaviors. Design and Sample Post-test only quasi-experimental study. Targeted adult smokers ( N = 251) living in a rural, economically distressed southeastern US county for at least 6 months. Measurements Five outreach elements (brochures/pushcards, posters, print and radio advertisements, quilt made by local artisans) based on themes from focus groups with current and former smokers and paired with brief tobacco cessation counseling, and were delivered over 6 months in 2009-2010. Exposure and cessation behavior indicators were collected via cross-sectional random-digit dial survey. The total intervention exposure score was 4.8 ( SD = 4.3, range 0-19). Results Intervention exposure was associated with having talked to a health care provider about quitting smoking in the past 6 months and planning to quit smoking in the next 6 months. Conclusions Culturally specific outreach materials based on personal narratives are a promising population-based intervention to motivate rural smokers to consider cessation. [ABSTRACT FROM AUTHOR]

Combined exposure to secondhand smoke (SHS) and radon increases lung cancer risk 10-fold. The authors assessed the feasibility and impact of a brief home screening and environmental feedback intervention to reduce radon and SHS (Freedom from Radon and Smoking in the Home [FRESH]) and measured perceived risk of lung cancer and synergistic risk perception (SHS x radon). Participants (N = 50) received home radon and SHS kits and completed baseline surveys. Test results were shared using an intervention guided by the Teachable Moment Model. Half of the participants completed online surveys two months later. Most (76%) returned the radon test kits; 48% returned SHS kits. Of the returned radon test kits, 26% were >4.0 pCi/L. Of the returned SHS kits, 38% had nicotine >.1 μg/m3. Of those with high radon, more than half had contacted a mitigation specialist or planned contact. Of those with positive air nicotine, 75% had adopted smoke-free homes. A significant increase occurred in perceived risk for lung cancer and synergistic risk perception after FRESH. [ABSTRACT FROM AUTHOR]

Purpose Older farmers experience a high rate of suicide, and depression is closely aligned with suicide among agricultural workers. Depressive symptoms may be influenced by work patterns, work satisfaction, stress, and health status. In addition, members of a couple may affect each other's depressive symptoms. The purpose was to determine whether depressive symptoms score is predicted by hours worked on the farm, satisfaction with work, number of health conditions, perceived stress, and demographics in a sample of older farm couples, and to assess the degree of influence on depressive symptoms spouses have on each other. Methods A total of 494 couples participated in the initial interview for a longitudinal study of farmers aged 50 and above. Data from husbands and wives were used together in a multilevel, dyad-based regression model to determine predictors of depressive symptoms. Findings Men's depressive symptoms scores were predicted by their own number of health conditions and stress and by their wives' stress and health conditions. Women's depressive symptoms scores were predicted by their own work satisfaction, stress, and number of health conditions and their husbands' time spent working on the farm and stress. Conclusions Stress management may be particularly important in older farm couples, since perceived duress of 1 member of the dyad impacts both. Work factors and health conditions also affect depressive symptoms in older rural couples, but these may be less easily modified. [ABSTRACT FROM AUTHOR]

Aims The purpose of this study was to explore the effects of nurse manager turnover on the occurrence of adverse events. Background Nurse managers create professional nurse practice environments to support the provision of quality patient outcomes. Inconsistent findings were reported in the literature testing the relationship between nurse managers and patient outcomes. All prior studies assumed stable nursing management. Methods A longitudinal quasi-experimental study of 23 nursing units in two hospitals was used to determine whether unit characteristics, including nurse manager turnover, have an effect on patient falls or pressure ulcers. Statistical analyses included repeated measures and hierarchical modelling. Results Patients in medical/surgical units experienced more falls than in intensive care units ( F1,11 = 15.9, P = 0.002). Patients in units with a nurse manager turnover [odds ratio: 3.16; 95% confidence interval: 1.49-6.70] and intensive care units (odds ratio: 2.70; 95% confidence interval: 1.33-5.49) were more likely to develop pressure ulcers. Conclusions Nurse manager turnover and intensive care unit status were associated with more pressure ulcers. Medical/surgical unit status was associated with more falls. The study was limited by a small sample size. Implications for nurse managers Nurse manager turnover may negatively impact patient outcomes. Stable nursing management, strategic interim management and long-term succession planning may reduce adverse patient events. [ABSTRACT FROM AUTHOR]

Objectives The purpose of this study was to assess attitudes and behaviors related to smoke-free policy among undergraduate student alcohol drinkers on a campus in a community with smoke-free bars. Design and Sample This was a secondary data analysis of a study in which participants completed mailed surveys assessing demographic characteristics, attitudes and behaviors related to alcohol and tobacco use and smoke-free policy ( n = 337). Opinion and behavior items were summarized descriptively; associations were examined using Kruskal Wallis tests and chi-square tests of association. Logistic regression tested for predictors of importance of smoke-free policy. Results Respondents were predominantly female and Caucasian; mean age 20.3 years. One fourth were current smokers. Seventy-nine percent said the community smoke-free law had no effect on frequency of visiting bars. Eighty-seven percent said smoke-free policy in campus buildings was 'somewhat' or 'very important.' Predictors of perceived importance of smoke-free policy included gender and smoking status. Conclusions Most smokers in this sample did not experience a change in their motivation to quit smoking or in number of cigarettes smoked daily. Implementation of a community smoke-free law did not reduce the likelihood of visiting bars. Women and nonsmokers were more likely to rate smoke-free campus policy as very important. [ABSTRACT FROM AUTHOR]

Objective. We examined gender differences in the incidence of acute myocardial infarction (AMI) after the passage of a smoke-free law in Lexington, Kentucky. The initial legislation had exemptions not covering manufacturing facilities and government buildings, which may have put men at greater risk for AMI. Methods. We examined the effect of Lexington's smoke-free public places law on hospitalizations for AMI (i.e., heart attack) among men and women 40 months prior to and 32 months after enactment of the law. We used the statewide administrative database (Comp Data) for all hospital billing records for the four health-care systems in Lexington-Fayette County. Cases were included in the analysis if (1) the patient was s:35 years of age; (2) the patient had a primary discharge diagnosis of AMI, with an International Classification of Diseases, Ninth Revision code in the range of 410.00 to 410.99; and (3) the date of service was between January 1, 2001, and December 31, 2006. Results. Among women, AMI hospitalizations declined 23% after the law took effect. The rate of AMI events among men did not change significantly. There was an overrepresentation of women in the hospitality industry and a disproportionate number of men working in manufacturing facilities and government worksites not mandated by the law. Conclusions. We found gender differences in the reduction of AMI hospitalizations following implementation of a smoke-free law that covered only some sectors of the workforce. Enacting smoke-free laws that cover all places of employment and strengthening existing partial laws may extend protection against AMIs to female and male workers. [ABSTRACT FROM AUTHOR]

The article presents a study which describes and compares perceptions of the student and principal for school tobacco policy enforcement in five public high schools in southeastern city in the U.S. The study explores on the perceived barriers to enforcement and factors relative to enforcement beliefs and perception of smoking. The study finds out that there is varied perception among student and principal on tobacco policy enforcement.

Kentucky homeowners requesting radon test kits through the Kentucky Radon Program and randomly selected homeowners (N = 129) completed a survey assessing factors related to their radon testing intentions and perceived severity of radon exposure, including social influence, perceived susceptibility, synergistic risk perception, and tobacco use. Perceived severity, social influence, and current smoking were the strongest predictors of radon testing intentions. Those with higher perceived severity were nearly eight times more likely to plan to test. Perceived severity was highest among females and those rating combined radon and tobacco smoke exposure as much riskier than tobacco smoke alone. Knowing someone who had tested for radon was associated with seven times greater likelihood of planning to test for radon. Current smokers were over six times more likely to plan to test than nonsmokers. The findings have implications for targeting interventions to improve residential radon testing and decrease lung cancer risk. [ABSTRACT FROM AUTHOR]

Background:The prevalence of electronic cigarette use grows. Amid increased e-cigarette use nationwide, this paper attempts to identify underlying risk factors for the most vulnerable populations. Objective: The purpose of the study was to assess predictors of e-cigarette use among female current and former tobacco users of childbearingage--specifically to determine whether demographic factors, pregnancy status, conventional cigarette smoking, and perceived e-cigarette harm are associated with e-cigarette use. Reasons for using e-cigarettes were also measured. Methods: A cross-sectional, correlational design was used; 194 current and former female tobacco users, 18-45 years of age, from two university-affiliated prenatal clinics and one women's health clinic in Kentucky took part. Slightly more than half were pregnant. Age, race/ethnicity, education, pregnancy status, use history for cigarettes and e-cigarettes, and perception of health hazard from e-cigarettes were measured, and associations with e-cigarette use were made with Mann-Whitney U-tests or Spearman's rank correlations. Predictors of e-cigarette use were determined using proportional odds modeling. Results: Most current e-cigarette users were also current cigarette smokers (88%). Nearly half of current and former e-cigarette users were pregnant. Most women perceived e-cigarettes as a minor (38%) or moderate (31%) health hazard. In the proportional odds model, younger women were at greater risk for e-cigarette use, whereas minority women and those who were pregnant were less likely to be e-cigarette users. Discussion: Pregnant women were less likely to be more recent e-cigarette users, compared with nonpregnant women. However, nearly all current e-cigarette users were dual tobacco users, including pregnant women. It is both imperative and timely to determine the impact of e-cigarette use on maternal and infant health, thus improving healthcare provider confidence to discuss the health implications of e-cigarette use with their patients. [ABSTRACT FROM AUTHOR]