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The Sequential Intercept Model has helped conceptualize interventions for people with serious mental illness in the criminal/legal system. This paper operationalizes the Sequential Intercept Model into a 35-item scorecard of behavioral health and legal practices. Using interviews, survey, and observational methods, the scorecard assesses an exploratory sample of 19 counties over 27 independent data collections. A series of ordinary least squares regression models assessed the predictor scores on four jail outcomes: prevalence of serious mental illness, length of stay, connections to treatment, and recidivism. Increases in pre-booking scores showed significant decreases in jail prevalence of serious mental illness at the p < 0.05 level, and post-booking scores and overall scores showed significant positive associations with connections to treatment at the p < 0.05 level, though these were non-significant after correcting for multiple comparisons. Preliminary findings suggest a combination of practices across the Sequential Intercept Model could have synergistic impacts on key jail diversion outcomes. [ABSTRACT FROM AUTHOR]

Farming is one of the top industries in Michigan and has the highest fatality rate. National sources of non-fatal farm injuries underestimate the burden, especially among children. In this paper, we provide a more accurate estimate of non-fatal farm injuries in Michigan by using an ongoing multi-source surveillance system. Michigan's farm-injury surveillance system includes abstractions of hospital-based medical records, poison control center calls, ambulance runs, and workers' compensation claims for individuals with a farm-related injury. For this analysis, injury onset occurred in 2015 to 2021 and included all injuries regardless of age or occupation. We identified 4,306 injuries in adults and 336 injuries in youth. For those 0–13 years of age all but two were family members. For those 14–15 and 16–17 years of age, 19% and 45%, respectively were hired hands. For adults, 51% were owner/operators, 43% were hired hands, and 5% were family members. For all ages, the most frequent injury source was cattle. Lacerations/cuts/punctures were the most common type of injury for those < 14 years of age while for older individuals it was contusions/bruises. The plurality of injuries occurred in the summer months. Children working on a farm are in unique situation and tracking injuries and identifying injury sources provide necessary information to protect their health and well-being. Michigan's farm-injury surveillance system will continue to provide a comprehensive count of work-related injuries among Michigan's farming population. The information is used to direct public health intervention both at the individual and population level. [ABSTRACT FROM AUTHOR]

The primary purpose of this research is to determine influential indoor and outdoor environmental elements that affect senior households' perceptions of housing affordability. This paper proposes major considerations for indoor and outdoor environmental elements which could make homes for senior households to be affordable and thus support their ageing in place. Our research adopted an empirical approach based on a survey. Relevant research was reviewed to identify potential indoor and outdoor environmental elements that could affect senior residents' opinions about housing affordability. Sixteen indoor and outdoor environmental elements were selected. The survey targeted senior residents living in the central Michigan area in the United States. The results of this paper were based on descriptive statistics, mean difference tests, correlation coefficients and regression models to explain the relationships between indoor and outdoor environmental elements and senior residents' perceptions of their housing affordability. Major findings proved statistically significant correlations between interior environmental elements and senior households' perceived housing affordability. Most housing programmes and policies for housing affordability have focused on financial elements. Findings from this research, however, added several indoor and neighbourhood environmental elements for consideration to improve senior households' perceived housing affordability and support their ageing in place. [ABSTRACT FROM AUTHOR]

Abstract Recent expansions of Medicaid eligibility have come with increased experimentation with enrollee cost-sharing. In this paper, we exploit a discontinuous premium increase at the federal poverty level in Michigan's Medicaid expansion program to test low-income individuals' sensitivity to premiums using linked enrollment and claims data. At the cutoff, average premiums increase by $3.15 and the probability of disenrollment increases by 2.3 percentage points. Increased disenrollment occurs among those with fewer documented medical needs at baseline, but not among those with greater medical needs. These results suggest that healthier low-income individuals may be sensitive to even modest health insurance premiums, and that premiums may induce adverse selection in Medicaid plans. [ABSTRACT FROM AUTHOR]

Purpose Non-surgical periodontal therapy (NSPT) is considered to be fundamental in the treatment of periodontal disease. Advanced area specific instruments were designed to increase the clinician's ability to effectively access root furcation areas during NSPT. The purpose of this study was to explore clinical dental hygienists' familiarity, utilization, and perceived efficacy of advanced instruments in root furcation areas during NSPT. Methods A randomized sample (n=3,500) of licensed dental hygienists in Michigan was invited to participate in a paper-based, mail survey. The 10-item instrument consisted of demographic, multiple choice, Likert scale, and open-ended questions. Descriptive and inferential statistics were used to analyze the data. Results A total of 1,156 surveys were returned; 858 met the inclusion criteria for a response rate of 24.5%. Respondents who graduated between 2010-2020 than those who graduated between 1990-1999 were more likely to utilize advanced instruments and those who graduated in 1989 or earlier (16.0% and 19.9% respectively). Respondents familiar with advanced instruments were more likely to use them in furcation areas during NSPT than those less familiar with the instruments (95% CI [18.1, 29.6], p<0.001). Respondents who perceived advanced instruments to be effective in furcation areas were more likely to utilize them (95% CI [1.0, 8.0], p<0.05) during NSPT. Most respondents indicated that they became familiar with advanced instruments during their dental hygiene education or through continuing education courses. Conclusion Familiarity with advanced instruments and perceived efficacy of these instruments for accessing root furcations increased the likelihood of clinical dental hygienists utilizing them during NSPT. Dental hygiene education and continuing education programs should continue to provide opportunities for students and practicing clinicians to learn NSPT instrumentation techniques utilizing advanced instruments designed for furcation access. [ABSTRACT FROM AUTHOR]

Purpose: Arab Americans experience higher rates of mental illness and lower rates of treatment compared to the general population. While some factors leading to this disparity have been proposed, data in the literature remains lacking. This study aims to explore the mental health perspectives of Arab Americans living in Southeastern Michigan regarding barriers to mental health treatment, treatment resource preferences and telemental health preferences. Design/methodology/approach: Responses were collected through an anonymous bilingual Qualtrics survey from both Arab and non-Arab participants (n = 294, ages 18+) in Southeastern Michigan. Participants' perceptions regarding mental health barriers, resource preferences and telemental health were assessed. Comparisons were performed between Arabs and non-Arabs, and among Arabs. Findings: Compared to non-Arabs, Arabs were less likely to seek mental health treatment from a therapist or a primary care provider and were more likely to not seek treatment. Arabs were more likely than non-Arabs to list fear of being called crazy by others and cultural barriers. With regards to preferences on telemental health utilization, no significant differences between Arab and non-Arab participants were found. Originality/value: The results provide insights into Arab-American mental health perspectives, especially pertaining to mental health barriers, resources and telemental health preferences, adding a novel perspective on the mental health preferences of Arab-American subgroups, especially regarding gender and age differences. This study highlights the Arab-American population as a nuanced and diverse group, emphasizing the importance of future studies to show a more complete picture of Arab-American mental health. [ABSTRACT FROM AUTHOR]

Purpose: Mood and anxiety disorders affect 20–30 percent of school-age children, contributing to academic failure, substance abuse, and adult psychopathology, with immense social and economic impact. These disorders are treatable, but only a fraction of students in need have access to evidence-based treatment practices (EBPs). Access could be substantially increased if school professionals were trained to identify students at risk and deliver EBPs in the context of school-based support services. However, current training for school professionals is largely ineffective because it lacks follow-up supported practice, an essential element for producing lasting behavioral change. The paper aims to discuss these issues. Design/methodology/approach: In this pilot feasibility study, the authors explored whether a coaching-based implementation strategy could be used to integrate common elements of evidence-based cognitive behavioral therapy (CBT) into schools. The strategy incorporated didactic training in CBT for school professionals followed by coaching from an expert during co-facilitation of CBT groups offered to students. Findings: In total, 17 school professionals in nine high schools with significant cultural and socioe-conomic diversity participated, serving 105 students. School professionals were assessed for changes in confidence in CBT delivery, frequency of generalized use of CBT skills and attitudes about the utility of CBT for the school setting. Students were assessed for symptom improvement. The school professionals showed increased confidence in, utilization of, and attitudes toward CBT. Student participants showed significant reductions in depression and anxiety symptoms pre- to post-group. Originality/value: These findings support the feasibility and potential impact of a coaching-based implementation strategy for school settings, as well as student symptom improvement associated with receipt of school-delivered CBT. [ABSTRACT FROM AUTHOR]

The alveolar bone crest level is essential in determining the need for bone removal in subjects with altered passive eruption (APE). This study assessed the validity of CBCT and transgingival probing in determining the alveolar bone crest level. Patients presenting with APE were assessed. Transgingival probing was performed to clinically assess the distance between the cementoenamel junction (CEJ) and the bone crest at the midpoint of the maxillary anterior teeth. CBCT was used to assess this distance at the same point. Upon reflection of a full mucoperiosteal flap, the actual distance was measured. Similar actual and CBCT measurements of the distance between the CEJ and bone crest at teeth 13, 22, and 23 (FDI numbering system) were recorded (P > .05). However, in teeth 11, 12, and 21, the distance was significantly greater on CBCT scans (P < .05). No significant difference was detected between transgingival probing and the actual distance at all teeth assessed. Careful transgingival probing provides an accurate measure of the distance between the CEJ and bone crest. CBCT gives an accurate estimate, though it may not be justified for each patient in the presence of safer methods. [ABSTRACT FROM AUTHOR]

Introduction: Finite resources limit the amount of time EMS agencies can dedicate to continuing education in pediatric emergencies. EMS instructors need effective, efficient, and affordable educational strategies for these high-risk, low frequency events. Objective: To compare the effectiveness of four training methods in management of pediatric emergencies for paramedics. Methods: A validated, performance-based, simulated clinical assessment module was used to provide a baseline measurement of paramedics' resuscitation skills during three simulated pediatric emergencies. Educational modules were developed that targeted deficiencies identified by the baseline assessment, including advanced pediatric life support skills, airway management, use of the Broselow-Luten Tape®, pediatric drug dose calculations and drug delivery, seizure management, and trauma assessment. Paramedics from five EMS agencies in Michigan were randomized to four education intervention groups. The control group used an existing, online, continuing education course. Three experimental groups were exposed to the same content during five, one-hour sessions conducted over 2.5 years. Instruction was delivered using high-fidelity, simulated case-based training, low-fidelity simulation training, or lecture with procedural skills lab, based on group assignment. After the training, all groups were tested within 4–6 months using methods identical to baseline testing. Results: One hundred forty-seven subjects completed the study. There were no differences in baseline skill levels among the four groups. Only the low fidelity simulation training group demonstrated improvement of combined scenario scores (p = 0.0008). Scores for targeted skills improved in one scenario in the high-fidelity group, two in the low-fidelity group, one in the lecture/lab group, and none in the control group. Conclusions: Although improvements in those skills included in the training were found in three groups, two hours of training in pediatric emergencies per year was insufficient to produce a substantial improvement overall. Expensive, high-fidelity simulators were not necessary for teaching pediatric resuscitation skills to paramedics; instructive scenarios using low-fidelity manikins and debriefings appear to be adequate. The content delivered by an online refresher course did not provide any improvement in performance as measured by simulated, case-based assessments. [ABSTRACT FROM AUTHOR]

Background Michigan ranks as the sixth lowest state for registered organ donors. To increase enrollment, the Health Resources and Services Administration (HRSA) funded the addition of a social networking component to enhance the existing traditional Wolverine–Buckeye Challenge campaign. The goal for all campaign materials was to heighten students' social identification by featuring college images (football helmets) on materials directing students to a webpage where they could register as an organ donor and 'score a point' for their school. This paper reports the number of registrations for the campaign as well as the relative effectiveness of traditional materials (i.e. print) vs. social networking routes (i.e. Facebook). Method The number of registrations in which individuals 'credited' the University of Michigan for their online registration during the campaign periods was recorded by the Michigan Secretary of State to determine the source through which individuals learned of organ donation. These daily registration values were used to compare the registrations in different time periods of the campaign. In addition, data from Google Analytics were used to determine whether visitors clicked on a link to the signup page from a networking route or whether they visited the webpage directly. The mean number of visits to the signup pages for the various portions of the campaign was compared. Results In the baseline year of the Wolverine–Buckeye Challenge, there were 224 signups, 451 in the second year, and 1756 in the third. There was no significant difference between direct and social network routes for visits to the organ donation registration page. Discussion Social networking was effective in enhancing the campaign. This paper presents lessons learned to benefit others running social networking-enhanced health campaigns including partnerships with existing Facebook fan pages. [ABSTRACT FROM AUTHOR]

Accessible summary: What is known on the subject?: Many psychiatric inpatients use tobacco, but most psychiatric hospital units prohibit tobacco use. Psychiatric nurses do not receive adequate education about how to teach patients to best manage tobacco withdrawal symptoms. What does this paper add to existing knowledge?: Psychiatric nurses who receive a brief educational intervention about tobacco withdrawal symptoms and best practices for using nicotine gum may be more prepared to teach patients about these topics. In turn, patients may use nicotine gum more often during their hospitalization, leading to improved outcomes for them as well as for staff. What are the implications for practice?: A simple educational intervention aimed at psychiatric nurses can result in positive outcomes for psychiatric inpatients who use tobacco. Patients who have a positive experience with stopping tobacco use while hospitalized may be more likely to commit to lifelong tobacco cessation afterwards. The results of this feasibility study demonstrate that additional research that builds on the work presented here is warranted. Introduction: Tobacco use is prohibited in most psychiatric facilities in the United States, yet many psychiatric inpatients are tobacco users. Psychiatric nurses have reported inadequate education about best practices for managing tobacco dependence. Aim: To explore the feasibility of an educational intervention for psychiatric nurses designed to improve their ability to educate patients about best practices for managing tobacco dependence, as well as effective use of nicotine gum. Method: Fourteen nurses on a psychiatric inpatient unit at a community hospital were educated about the targeted topics. Chart reviews of nonequivalent pre‐intervention and post‐intervention patient groups were conducted to explore the outcomes of the intervention. Results: Patients received more teaching, and used nicotine gum more often, following the intervention. However, no statistically significant differences between the pre‐intervention and post‐intervention patient groups were found. Discussion: Educating nurses about best practices for managing tobacco withdrawal symptoms may have positive outcomes. Existing research suggests that such interventions may be most effective when support and structure are provided to ensure long‐term practice changes. Implications for practice: This feasibility study demonstrates that a brief nurse education intervention has the potential to improve the experience of tobacco withdrawal for psychiatric inpatients. Future research that expands upon the current project is warranted. [ABSTRACT FROM AUTHOR]

Background: Suicide is a leading cause of death in the United States with rates increasing over the past two decades. The rate of suicide is higher in rural areas, but a greater number of people in urban areas die by suicide; understanding risk factors for suicide in this context is critically important to public health. Additionally, while many studies have focused on individual-level risk factors, few studies have identified social or structural features associated with suicide or firearm suicide, especially among young people. Methods: Study outcomes included total firearm suicide, total youth (age 10–29) firearm suicide, total suicide, and total youth suicide in Detroit, Michigan from 2012 through 2019. The predictors in this study included 58 census-tract level variables characterizing the physical features, residential stability, socioeconomic status, and demographics of neighborhoods in Detroit over the study period. We used random forest, extreme gradient boosting (XGBoost), and generalized linear mixed models to predict the four outcomes. Results: We found that the tract-level variables used in all three modeling approaches performed poorly at predicting the suicide outcomes, with area under the curve values at times exceeding 0.60 but with extremely low sensitivity (ranging from 0.05 to 0.45). However, the percentage of parcels sold in arms-length transfers in the previous 5 years, the count of vacant lots per square mile, and the percentage of children aged three and older who were enrolled in preschool each demonstrated associations with at least two of the outcomes studied. Conclusions: Our findings suggest place-based factors at the tract level do not provide meaningful insight into the risk of suicide or firearm suicide among youth or the general population in Detroit, Michigan. Future practice and study should consider focusing on both larger and smaller areas, including city and individual-level factors. For example, studies might benefit from the use of both neighborhood and individual-level measures and their interactions to improve our understanding of place-based risk factors and suicide risk. [ABSTRACT FROM AUTHOR]

BACKGROUND: Previous epidemiological studies have repeatedly found per- and polyfluoroalkyl substances (PFAS) exposure associated with higher circulating cholesterol, one of the greatest risk factors for development of coronary artery disease. The main route of cholesterol catabolism is through its conversion to bile acids, which circulate between the liver and ileum via enterohepatic circulation. Patients with coronary artery disease have decreased bile acid excretion, indicating that PFAS-induced impacts on enterohepatic circulation may play a critical role in cardiovascular risk. OBJECTIVES: Using a mouse model with high levels of low-density and very low-density lipoprotein (LDL and VLDL, respectively) cholesterol and aortic lesion development similar to humans, the present study investigated mechanisms linking exposure to a PFAS mixture with increased cholesterol. METHODS: Male and female Ldlr-/- mice were fed an atherogenic diet (Clinton/Cybulsky low fat, 0.15% cholesterol) and exposed to a mixture of 5 PFAS representing legacy, replacement, and emerging subtypes (i.e., PFOA, PFOS, PFHxS, PFNA, GenX), each at a concentration of 2 mg/L, for 7 wk. Blood was collected longitudinally for cholesterol measurements, and mass spectrometry was used to measure circulating and fecal bile acids. Transcriptomic analysis of ileal samples was performed via RNA sequencing. RESULTS: After 7 wk of PFAS exposure, average circulating PFAS levels were measured at 21.6, 20.1, 31.2, 23.5, and 1.5 μg/mL in PFAS-exposed females and 12.9, 9.7, 23, 14.3, and 1.7 μg/mL in PFAS-exposed males for PFOA, PFOS, PFHxS, PFNA, and GenX, respectively. Total circulating cholesterol levels were higher in PFAS-exposed mice after 7 wk (352 mg/dL vs. 415 mg/dL in female mice and 392 mg/dL vs. 488 mg/dL in male mice exposed to vehicle or PFAS, respectively). Total circulating bile acid levels were higher in PFAS-exposed mice (2,978 pg/μL vs. 8,496 pg/μL in female mice and 1,960 pg/μL vs. 4,452 pg/μL in male mice exposed to vehicle or PFAS, respectively). In addition, total fecal bile acid levels were lower in PFAS-exposed mice (1,797 ng/mg vs. 682 ng/mg in females and 1,622 ng/mg vs. 670 ng/mg in males exposed to vehicle or PFAS, respectively). In the ileum, expression levels of the apical sodium-dependent bile acid transporter (ASBT) were higher in PFAS-exposed mice. DISCUSSION: Mice exposed to a PFAS mixture displayed higher circulating cholesterol and bile acids perhaps due to impacts on enterohepatic circulation. This study implicates PFAS-mediated effects at the site of the ileum as a possible critical mediator of increased cardiovascular risk following PFAS exposure. [ABSTRACT FROM AUTHOR]

Using multiple pharmacies has been linked to negative outcomes including increased inappropriate drug use, toxicity, and mortality, yet up to half of all patients in the US use multiple pharmacies. A pilot survey was administered to measure pharmacy use in people living with HIV (PWH) and examine the associated attitudes and outcomes. In a midwestern HIV clinic, a convenience sample was surveyed based on using single (SPU) versus multiple pharmacies (MPU). One hundred forty-two subjects participated (69 SPU; 73 MPU): 75% male, 59% white, and > 70% being ≥ 40 years old. There was a trend towards increased recall of self-reported CD4 and viral load status for SPUs vs MPUs [OR 2.26 (95%, 0.91–5.64)]. SPU participants indicated acquiring all meds in one place [Likert Scale weighted average (LS WA) = 4.45], proximity (LS WA = 3.64), the identification of adverse effects (LS WA = 4.17), and concerns about missing potential drug-drug interactions (LS WA = 4.06) as reasons for preferring a single pharmacy. The desire to keep HIV status private (LS WA = 3.65) was noted as a significant reason for using a separate pharmacy specifically for acquiring antiretrovirals in MPU participants. Results indicate patients often have justifiable reasons for using single versus multiple pharmacies. [ABSTRACT FROM AUTHOR]

The goal of this paper was to investigate the possible trade-off between peak hand acceleration and accuracy and consistency of hand strikes performed by martial artists of different training experiences. Ten male martial artists with training experience ranging from one to nine years volunteered to participate in the experiment. Each participant performed 12 maximum effort goal-directed strikes. Hand acceleration during the strikes was obtained using a tri-axial accelerometer block. A pressure sensor matrix was used to determine the accuracy and consistency of the strikes. Accuracy was estimated by the radial distance between the centroid of each subject's 12 strikes and the target, whereas consistency was estimated by the square root of the 12 strikes mean squared distance from their centroid. We found that training experience was significantly correlated to hand peak acceleration prior to impact (r2=0.456,p =0.032) and accuracy (r2=0. 621,p=0.012). These correlations suggest that more experienced participants exhibited higher hand peak accelerations and at the same time were more accurate. Training experience, however, was not correlated to consistency (r2=0.085,p=0.413). Overall, our results suggest that martial arts training may lead practitioners to achieve higher striking hand accelerations with better accuracy and no change in striking consistency. [ABSTRACT FROM AUTHOR]

Pediatric vision screening is important because approximately 80% of visual impairments, including amblyopia, can be prevented or cured, especially if caught early. This retrospective study aims to determine whether the implementation of a machine photoscreener improves vision outcomes in 1- to 4-year-old children in an urban clinic. Before the vision screener, 91 patients were seen (control group), while 205 were seen following its implementation (study group). The number of children screened increased by 27.4% after implementing the photoscreener (57.1% study, 29.7% control, P <.001). All patients who failed the screening, 14.6% in the study period, were referred to ophthalmology (n = 30); 40% (n = 12) were evaluated, and 9 were diagnosed with a true vision abnormality. Instrument vision screening allows children as young as 1 year to be screened and allows for early intervention for potential vision-threatening pathologies in a vulnerable urban population. [ABSTRACT FROM AUTHOR]

The Kick and Cook-a-Palooza program was an interprofessional partnership between the Grand Valley State University Public Health Department and the therapeutic recreation (TR) program to provide a physical activity and nutrition program at three after-school sites in Grand Rapids, Michigan. Working with children classified as youth at risk, the purpose of the program was to teach children healthy habits related to nutrition and physical activity that they can continue and share with their families. In addition, interprofessional education occurred among university students as they experienced interprofessional collaboration between two health professions and a community agency. This paper presents a practice perspective on developing, implementing, and evaluating the results of the physical activity component of a program with youth at risk in an interprofessional collaborative environment. The program was funded by grants from the General Mills Foundation and the Academy of Nutrition and Dietetics Foundation and the Recreational Therapy Foundation. [ABSTRACT FROM AUTHOR]

States are struggling to assure an adequate number of registered nurses are active in the clinical workforce to serve patients and communities. Nurse compact legislation—enacted in 39 states—facilitates interstate recognition of nurse licensure. We used a cross-sectional email survey of registered nurses in Michigan to measure their opinions on compact licensure legislation and examined differences in compact licensure opinions by nurses' personal characteristics. Primary analyses reported herein are from 7,098 Michigan nurses with complete data. Most respondents felt that the compact would make it easier to redeploy nurses in an emergency (76.6%), improve access to nursing care (66.6%), and boost their personal career options (55.1%). Most nurses disagreed that compact legislation would weaken patient protections (60.7%). The majority expressed neutral feelings on whether compact licensure would make disciplinary actions more difficult to enforce (50.9%) and a plurality that current licensure policies were satisfactory (44.0%). The majority were supportive of Michigan joining the compact (72.3%). In multivariable analysis, stronger support for joining the compact was associated with advanced degrees, male sex, and younger age. Less support was associated with membership in a collective bargaining unit. Policymakers who wish to ease acute nurse vacancies should consider enacting nurse licensure compact legislation. Careful attention to patient protections and disciplinary review would address potential safety concerns. [ABSTRACT FROM AUTHOR]

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Objetives: The major objective of our paper was to test and validate the nutritional literacy scale (NLS) in a pre-dominantly African-American geriatric population. Design: Completion of the 2 literacy scales Short Test of Functional Health Literacy in Adults (STOHFLA) and nutritional literacy scale (NLS) during a 5-month period from September 2008 to January 2009. Setting: The Rosa Parks Geriatric Center at Detroit Medical Center/Wayne State University. Participants: The study cohort consisted of elderly (>65years old) 150 patients that had presented to the geriatric clinic. Measurements: NLS and STOHFLA were simultaneously given to the patients. The NLS consists of 28 questions regarding organic foods; calorie intake etc. and questions in each section were arranged from easier to more difficult ones. The baseline characteristics were stratified according to the NLS (< 25 and ≥ 25) and STOHFLA (< 35 and ≥ 35) scores. Additionally we also collected data on demographic information, educational experience, blood pressure recordings from 3 consecutive clinic visits. Results: The patients with a higher NLS score were younger (72 ± 9) as compared to those with lower NLS score (76 ± 9) (p = 0.005), and also had more years of education (16 ± 3 years v/s 13 ± 3 years; p <0.001). A higher proportion of patients with lower score on NLS had hypertension (95.10 % for NLS < 25 v/s 77.08 % for NLS > 25; p =0.001). Conclusion: We validated a potentially useful nutritional literacy tool that might prove to be useful intervention aimed at identifying individuals with lower levels of education and insight regarding their nutritional behaviors. [ABSTRACT FROM AUTHOR]

A four-step, streamlined process to adapt a large battery of measures for a study of mother-child adjustment in Arab Muslim immigrants and the lessons learned are described. The streamlined process includes adapting content, translation, pilot testing, and extensive psychometric evaluation but omits in-depth qualitative inquiry to identify the full content domain of the constructs of interest and cognitive interviews to assess how respondents interpret items. Lessons learned suggest that the streamlined process is not sufficient for certain measures, particularly when there is little published information about how the measure performs with different groups, the measure requires substantial item revision to achieve content equivalence, and the measure is both challenging to translate and has little to no redundancy. When these conditions are present, condition-specific procedures need to be added to the streamlined process. [ABSTRACT FROM AUTHOR]

Background: It is generally accepted that obesity and depression are positively related in women. Very little prior research, however, has examined potential variation in this relationship across different racial/ethnic groups. This paper examines the association between obesity and depression in non-Hispanic White, non-Hispanic Black, and Mexican American women. Methods: The sample included women aged 20 years and older in the 2005-2008 National Health and Nutrition Examination Surveys ( n=3666). Logistic regression was used to assess the relationship between obesity and depression syndrome (assessed using the Patient Health Questionnaire-9), after adjusting for covariates. We then investigated whether this association varied by race/ethnicity. Results: Overall, obese women showed a 73% greater odds of depression (odds ratio [OR]=1.73; 95% confidence interval [CI]=1.19, 2.53) compared with normal weight women. This association varied significantly, however, by race/ethnicity. The obesity-depression associations for both Black and Mexican American women were different from the positive association found for White women (ORBlack*obese=0.24; 95% CI=0.10,0.54; ORMexican American*obese=0.42; 95% CI=1.04). Among White women, obesity was associated with significantly greater likelihood of depression (OR=2.37; 95% CI=1.41, 4.00) compared to normal weight. Among Black women, although not statistically significant, results are suggestive that obesity was inversely associated with depression (OR=0.56; 95% CI=0.28, 1.12) relative to normal weight. Among Mexican American women, obesity was not associated with depression (OR=1.01; 95% CI=0.59, 1.72). Conclusions: The results reveal that the association between obesity and depression varies by racial/ethnic categorization. White, but not Black or Mexican American women showed a positive association. Next research steps could include examination of factors that vary by race/ethnicity that may link obesity to depression. [ABSTRACT FROM AUTHOR]

Despite the growing knowledge of posttraumatic growth, only a few studies have examined personal growth in the context of cardiac health. Similarly, longitudinal research is lacking on the implications of religion/spirituality for patients with advanced cardiac diseases. This paper aims to explore the effect of preoperative religious coping on long-term postoperative personal growth and potential mediation in this effect. Analyses capitalized on a preoperative survey and medical indices from the Society of Thoracic Surgeons' National Database of patients undergoing cardiac surgery. Participants in the current follow-up study completed a mailed survey 30 months after surgery. Hierarchical regression analysis was performed to evaluate the extent to which preoperative use of religious coping predicted growth at follow-up, after controlling for key demographics, medical indices, mental health, and protective factors. Predictors of posttraumatic growth at follow-up were positive religious coping and a living status without a partner. Medical indices, optimistic expectations, social support, and other religious factors were unrelated to posttraumatic growth. Including religious factors diminished effects of gender, age, and race. Including perceived spiritual support completely eliminated the role of positive religious coping, indicating mediation. Preoperative positive religious coping may have a long-term effect on postoperative personal growth, explainable by higher spiritual connections as a part of significance-making. These results suggest that spirituality may play a favorable role in cardiac patients' posttraumatic growth after surviving a life-altering operation. The elimination of demographic effects may help explain previously mixed findings concerning the association between these factors and personal growth. [ABSTRACT FROM AUTHOR]

Recent policy shifts in the United States have resulted in an increase in the number of older workers remaining in the labor force. Increases in the retirement age for receiving full Social Security benefits coupled with declining pension funds and the erosion of employer retiree health benefits, mean that current cohorts of older workers may fully expect to work longer than previous generations. Yet, working longer may not always be possible due to health problems, outdated skills, economic insecurity, and competing obligations. We examine the consequences of unmet expectations for full time work after age 62 for life satisfaction in a nationally representative sample of older Americans. With longitudinal data from the Health and Retirement Study (1998-2008), this paper uses repeated measures of expectations for later life work among a cohort of Americans ( N = 1684) gathered prospectively over an 8-year period, and examines the effects of unfulfilled expectations on subsequent life satisfaction. Using generalized growth mixture modeling three latent classes of individuals were identified with distinct trajectories of later life work expectations (low expectations, high expectations, and neutral expectations for full time work after age 62). A majority of men had generally high expectations to work full time past age 62, whereas the majority of women reported a low probability of working full time after age 62. When comparing expectations to actual full time work past age 62, we found no effects of unmet expectations for women. However, men with less job stability (reflected by shorter job tenure and lower incomes) generally had high expectations to work longer, and their life satisfaction scores were significantly lower when these expectations were not realized. The hazards of missed expectations for later life work have consequences for subjective well-being in older adults. [ABSTRACT FROM AUTHOR]

This retrospective study examined whether practice in computer-based tests (CBTs) in student registered nurse anesthetists improved scores on the National Certification Examination (NCE). A group of students with extensive practice in CBTs was compared with a group of students whose tests were administered primarily on paper. Groups were matched on age, grade point average (GPA), and gender (n = 73 each). Higher GPA was associated with higher NCE scores overall. Adjusted for GPA (with analysis of covariance), the mean NCE proficiency score (Φ) in the CBT group was 2.68 (95% confidence interval, 2.54-2. 82), which was higher than the mean score in the paper-based group of 2.36 (95% confidence interval, 2.22-2.50), with an effect size of 0.52. When subgroups were examined, CBT practice improved NCE scores only in those students with graduate GPA less than or equal to 3.50, with an effect size of 1.1. It was concluded that, controlling for GPA, student registered nurse anesthetists at a university with greater exposure to CBTs had higher scores on the NCE than a comparison group with less practice in CBTs. This difference was significant only in students with GPA of 3.50 or less, consistent with a beneficial effect of practice in CBTs. [ABSTRACT FROM AUTHOR]

The Building Healthy Communities (BHC) initiative addresses inadequate physical activity in Michigan using a population-based approach to prevent chronic disease. Eighteen local health departments through 2010 received $1,505,179 to plan and implement community-based interventions to increase physical activity among low-income and minority populations. This paper examines park user demographics, compares park user demographics to the demographic characteristics and examines physical activity behaviors of park users in these parks. BHC Park usage was examined from 2008 to 2010 using the System for Observing Play and Recreation in Communities (SOPARC). One sample binomial tests were used to examine if the proportion of male and female park users was different than the proportion of males and females in Michigan and to examine if the proportion of white and other park users was different than the proportion of whites and others in Michigan. A chi-square goodness-of-fit test was used to examine whether the observed proportions for age groups observed using the park differed from the actual proportions for age groups in Michigan. The majority of BHC park users were white. More children were observed than other age groups. Park users were most often observed engaging in walking or vigorous activity rather than sedentary activities. When comparing the proportion of whites (54.7%) and others (42.8%) observed using the parks to the proportion of whites (79%) and others (21%) residing in Michigan, there was a significant difference ( P < 0.001) with a greater proportion of whites and smaller proportion of persons of other ethnicities expected to be observed using the parks. This chi square goodness of fit test showed a significant difference in the observed and expected number of persons observed using the trail in each age group (χ = 4,897.707, df = 3, P < 0.001) with a greater number of children (n = 1,939) and teens (n = 1,116) observed than the number of children (n = 828) and teens (n = 305) expected based on 2010 Michigan census data. A greater proportion of non-whites (compared to whites) were observed using the park than would be expected. In Michigan, 60% of blacks, 37% of Hispanics, and 53% of other minority groups do not meet national physical activity recommendations. Perhaps developing additional parks in Michigan can increase physical activity behaviors among minorities. [ABSTRACT FROM AUTHOR]

The objectives of the project were (1) to determine the extent to which HIV-positive persons living in Michigan were aware of and understood Michigan's criminal HIV exposure law, (2) to examine whether awareness of the law was associated with seropositive status disclosure to prospective sex partners, and, (3) to examine whether awareness of the law was associated with potential negative effects of the law on persons living with HIV (PLWH) including heightened HIV-related stigma, perceived societal hostility toward PLWH, and perceived need to conceal one's HIV infection. The study design was cross-sectional. A statewide sample of 384 PLWH in Michigan completed anonymous pen and paper surveys in 1 of 25 data collection sessions. A majority of participants were aware of Michigan's HIV exposure law. Awareness of the law was not associated with increased seropositive status disclosure to all prospective sex partners, decreased HIV transmission risk behavior, or increased perceived responsibility for HIV transmission prevention. However, awareness of the law was significantly associated with disclosure to a greater proportion of sex partners prior to respondents’ first sexual interaction with that partner. Awareness of the law was not associated with increased HIV-related stigma, perceived societal hostility toward PLWH, or decreased comfort with seropositive status disclosure. Evidence of an effect of Michigan's HIV exposure law on seropositive status disclosure was mixed. Further research is needed to examine the various forms of HIV exposure laws among diverse groups of persons living with or at increased risk of acquiring HIV. [ABSTRACT FROM PUBLISHER]

Background: Despite high levels of clinically significant persistent cancer related fatigue in breast cancer survivors few treatments are currently available and most pose a significant burden on the part of the woman. Acupressure, a component of Traditional Chinese Medicine, has been shown to decrease fatigue levels by as much as 70% in cancer survivors while being inexpensive, non-toxic and an easy to use intervention. The primary aim of this study was to determine the efficacy of two types of self-administered acupressure (relaxation acupressure and stimulating acupressure), compared to standard of care on fatigue severity. Secondary aims were to evaluate the efficacy of two types of acupressure on sleep and kinetic parameters required for implementation of acupressure in a clinical setting; The purpose of this paper is to share the methodology used including challenges and insights. Methods/design: This study is a three group, randomized clinical trial. 375 breast cancer survivors at least 12 months after completion of cancer treatments, with moderate to severe persistent fatigue, are being randomized to one of 3 groups: self-administered relaxation acupressure; self-administered stimulating acupressure; or standard of care. Participants are assessed at baseline, 3 weeks, and 6 weeks followed by a 4-week follow-up period. The primary aim is to examine the effect of 6-weeks of relaxation acupressure compared to stimulatory acupressure or standard of care on fatigue as assessed by: weekly self-report using the Brief Fatigue Inventory; objective daytime physical activity on actigraph; or fatigue patterns assessed 4-times daily using a visual analog scale. Secondary endpoints include depression, anxiety, self-efficacy, and sleep quality. Discussion: This study has the potential to develop a low-cost, self-care intervention for the most troubling of late-term effects in breast cancer populations, fatigue. The methods used may lend constructive ideas to other investigators working with this population and/or intervention. Trial registration: ClinicalTrial.Gov Trials Register NCT01281904 [ABSTRACT FROM AUTHOR]

Purpose: Strict eligibility criteria exclude a majority of the veteran population from receiving oral healthcare benefits through the Veterans' Administration Dental Care program (VADC). The purpose of this study was to examine perceptions of oral health status, and access/barriers to dental care of veterans who are ineligible for VADC benefits. Methods: This cross-sectional study was conducted using a 24-item paper survey, disseminated in person to 227 veterans across the state of Michigan over a period of two months. Items included socio-demographic information, questions regarding perceptions of oral health, access to dental care, and perceived barriers. Descriptive statistics were collected to provide an overview of the data. Results: A response rate of 80% (n=182) was achieved. Veterans who perceived themselves as having a poor oral health status were less likely to have a dental home (p=.000) or receive dental care (p=.001). Respondents were more likely to report cost as a barrier (p=.000), and to report having had a toothache during the past 12-months (p=.000). Conclusion: Results from this study indicate that while veterans in general value the importance of oral healthcare, cost and time are significant barriers to accessing dental care for individual's ineligible for VADC benefits. Veterans who perceive themselves as having poor oral health are more likely to report oral health disparities. Further research is needed to impact Veterans Administration policy and decrease oral health disparities. [ABSTRACT FROM AUTHOR]

Food insecurity and smoking commonly co-occur in underserved populations, exacerbating health disparities. This study assesses smoking and its associations with mental health and health risk behaviors among residents of Flint, Michigan in the early phase of COVID lockdowns. The survey captured smoking status, mental health indicators, and health risk behaviors among 106 who had financial needs and limited mobility and received community nutritional services. Comparisons by demographics showed that those who lived alone, used marijuana, and had frequent alcohol drinking tended to smoke more than their counterparts. Results from logistic regression showed that those with high levels of stress, marijuana use, and alcohol consumption were more likely to smoke. Living alone was associated with smoking and health risk behaviors. This research suggests the need for smoking prevention and community health practices addressing stress, health risk behaviors, and circumstances that might drive the association with living alone such as loneliness. [ABSTRACT FROM AUTHOR]

Rural residents experience higher rates of perinatal depression (PND) than non- rural peers; yet are less likely to receive screening. The Supplemental Special Nutrition Program for Women, Infants, and Children (WIC) offers a potential screening site. Using sequential mixed methods, we surveyed rural Michigan WIC clinics about PND screening. Then randomly selected providers completed qualitative interviews. Nineteen of 26 clinics completed the survey (73.3%). Eighty-three percent indicated interest in PND screening if barriers were reduced (n = 15). Eleven providers completed interviews, resulting in five core codes. Rural Michigan WIC clinics are promising sites for PND screening if implementation barriers are addressed. [ABSTRACT FROM AUTHOR]

Objectives: Studies on immigration have shown that cultural changes can positively or negatively affect psychological, behavioral, and physical outcomes when different cultures settle into a new host community or country. The majority of research done in the United States and North America has focused on these changes for larger immigrant and minority groups such as Hispanics/Latinos and Asians. However, in the United States, there is a sub-group of immigrants that is largely understudied, resulting in misunderstood data on mental and physical health: Arab Americans. This study assesses mental health disparities between immigrant and non-immigrant populations, before and after COVID-19 restrictions, in Dearborn, MI, a city that has one of the largest concentrations of Arab immigrants in the nation. Design: Using an online survey instrument, this study assessed mental health disparities before and since COVID-19 restrictions, and stressors induced since the pandemic for immigrants and non-immigrants in Dearborn, MI. Results: Through inferential statistics and logistic regressions, results indicate that immigrants are less likely to have healthcare coverage, have lower annual incomes, lower educational attainment, and experience continuously higher mental health issues before the pandemic than non-immigrants faced during the pandemic. Conclusion: This study reinforces that the Arab-American immigrant population is a disadvantaged sub-group and faces considerable stress and mental health concerns as an acculturating population. This stress gets exacerbated when a worldwide event such as the COVID-19 pandemic strikes. Oversight of this population's health issues results in the inability to receive appropriate social services and healthcare that is vital to address this community's concerns. [ABSTRACT FROM AUTHOR]

BACKGROUND: Polybrominated biphenyls (PBB) and polychlorinated biphenyls (PCB) are persistent organic pollutants with potential endocrine-disrupting effects linked to adverse health outcomes. OBJECTIVES: In this study, we utilize high-resolution metabolomics (HRM) to identify internal exposure and biological responses underlying PCB and multigenerational PBB exposure for participants enrolled in the Michigan PBB Registry. METHODS: HRM profiling was conducted on plasma samples collected from 2013 to 2014 from a subset of participants enrolled in the Michigan PBB Registry, including 369 directly exposed individuals (F0) who were alive when PBB mixtures were accidentally introduced into the food chain and 129 participants exposed to PBB in utero or through breastfeeding, if applicable (F1). Metabolome-wide association studies were performed for PBB- 153 separately for each generation and ΣPCB (PCB-118, PCB-138, PCB-153, and PCB-180) in the two generations combined, as both had direct PCB exposure. Metabolite and metabolic pathway alterations were evaluated following a well-established untargeted HRM workflow. RESULTS: Mean levels were 1.75 ng/mL [standard deviation (SD). 13.9] for PBB-153 and 1.04 ng/mL (SD. 0.788) for ΣPCB. Sixty-two and 26 metabolic features were significantly associated with PBB-153 in F0 and F1 [false discovery rate (FDR) 푝<0.2], respectively. There were 2,861 features associated with ΣPCB (FDR 푝<0.2). Metabolic pathway enrichment analysis using a bioinformatics tool revealed perturbations associated with ΣPCB in numerous oxidative stress and inflammation pathways (e.g., carnitine shuttle, glycosphingolipid, and vitamin B9 metabolism). Metabolic perturbations associated with PBB-153 in F0 were related to oxidative stress (e.g., pentose phosphate and vitamin C metabolism) and in F1 were related to energy production (e.g., pyrimidine, amino sugars, and lysine metabolism). Using authentic chemical standards, we confirmed the chemical identity of 29 metabolites associated with ΣPCB levels (level 1 evidence). CONCLUSIONS: Our results demonstrate that serum PBB-153 is associated with alterations in inflammation and oxidative stress-related pathways, which differed when stratified by generation. We also found that ΣPCB was associated with the downregulation of important neurotransmitters, serotonin, and 4-aminobutanoate. These findings provide novel insights for future investigations of molecular mechanisms underlying PBB and PCB exposure on health. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to assess dentists' and dental hygienists' current motivation, attitudes, and knowledge regarding volunteering in a non-profit dental setting and the opportunity for earning continuing education (CE) credits. Methods: This cross-sectional study surveyed a convenience sample of dental and dental hygiene professionals from the state of Michigan. A 20-question paper survey was developed and pilot tested. The survey was disseminated to attendees at various component meetings of the dental and dental hygienists' associations in southeastern Michigan. Results: Out of the 274 surveys that were distributed, 182 (n=182) were completed, yielding a 66% response rate. Eighty percent of the participants were unaware of the opportunity for earning CE by volunteering and 79% were unaware of the volunteering site approval requirement by the Michigan Board of Dentistry. Thirty percent of participants were unable to determine how many unpaid days per year they were willing to volunteer and a similar percentage, (28%), were unable to determine how many paid days. The most common motivating factor to volunteer was to give back to the community (60%) while the greatest barrier was lack of time (62%). Conclusion: The opportunity to earn CE credit for volunteerism is seen as a benefit, however, it needs to be better promoted to potential volunteers, through dissemination of information by professional associations and in educational settings. Community-based clinics also need to be made aware of how to become a CE provider. Further research on the longitudinal impact of CE for volunteerism in community-based clinics is warranted. [ABSTRACT FROM AUTHOR]

Suicide is a leading cause of death among schizophrenia spectrum disorder populations. This open pilot study examined a modified cognitive-behavioral suicide prevention treatment for clients in community mental health. Providers (n = 5) were trained to deliver the treatment and clients (n = 5) received it in 10 individual therapy sessions. Clients experienced improvements in suicide ideation, depression, hopelessness, general symptoms of psychosis, entrapment, defeat, approaches to coping, psychological stress, impulsivity, and the number of treatment barriers from baseline to post-treatment. Qualitative findings reinforced quantitative results of client improvements and provided important suggestions to strengthen the intervention and its delivery in community mental health. [ABSTRACT FROM AUTHOR]

Sexual harassment and participation in extracurricular activities are two common experiences for adolescents, yet little research examines the interplay between these two phenomena, particularly among low-income, racial/ethnic minority adolescents. This study examined whether participation in four types of extracurricular activities—school-based, structured community-based, unstructured community-based, and home-based—was associated with adolescents' PTSD and depressive symptoms over time, and whether those relations were mediated by neighborhood-based sexual harassment. Participants were 537 adolescents who were on average 15.6 years old, 54% girls, and majority Latino/a (n = 416; 77.5%). Path analyses revealed a significant indirect effect between unstructured community-based activities, but not structured community-based, school- nor home-based extracurricular activities and PTSD symptoms via sexual harassment. The findings point to the importance of examining how unstructured community-based extracurricular activities may increase neighborhood risks for adolescents, and the need for creating opportunities for adolescents to engage in structured and well supervised after-school extracurricular activities. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic may have a negative impact on mental health, especially among older adults with chronic conditions who are more vulnerable to severe illness. In this qualitative study, we evaluated how the pandemic has impacted the ways that adults aged 50 and older with chronic conditions managed their mental health. A total of 492 adults (M = 64.95 years, SD = 8.91, range = 50–94) who lived in Michigan (82.1%) and 33 other U.S. states completed one anonymous online survey between 14 May 14 and 9 July 2020. Open-ended responses were coded to ascertain relevant concepts and were reduced to develop major themes. We determined four main themes. The COVID-19 pandemic impacted how participants took care of their mental health through: (1) pandemic-related barriers to social interaction; (2) pandemic-related routine changes; (3) pandemic-related stress; and (4) pandemic-related changes to mental health service use. This study indicates that older adults with chronic conditions experienced various challenges to managing their mental health in the early months of the COVID-19 pandemic, but also showed considerable resilience. The findings identify potential targets of personalized interventions to preserve their well-being during this pandemic and in future public health crises. [ABSTRACT FROM AUTHOR]

Background: Multimorbidity management can be extremely challenging in patients with dementia. This study aimed to elucidate the approaches of primary care physicians in Japan and the United States (US) in managing multimorbidity for patients with dementia and discuss the challenges involved. Methods: This qualitative study was conducted through one-on-one semi-structured interviews among primary care physicians, 24 each from Japan and Michigan, US. Thematic and content analyses were performed to explore similarities and differences among each country's data. Results: Primary care physicians in Japan and Michigan applied a relaxed adherence to the guidelines for patients' chronic conditions. Common challenges were the suboptimal consultation time, the insufficient number or ability of care-coordinating professionals, patients' conditions such as difficulties with self-management, living alone, behavioral issues, and refusal of care support. Unique challenges in Japan were free-access medical systems and not being sure about the patients' will in end-of-life care. In Michigan, physicians faced challenges in distance and lack of transportation between clinics and patients' homes and in cases where patients lacked the financial ability to acquire good care. Conclusions: To improve the quality of care for patients with multimorbidity and dementia, physicians would benefit from optimal time and compensation allocated for this patient group, guidelines for chronic conditions to include information regarding changing priority for older adults with dementia, and the close collaboration of medical and social care and community resources with support of skilled care-coordinating professionals. [ABSTRACT FROM AUTHOR]

Timely linkages are necessary for people with dementia and other disabling conditions to reduce caregiver burnout, prevent unnecessary hospitalization, or placement in alternate care settings. To identify needs, the Caregiver Resource Collaborative conducted a needs assessment of Michigan's sixteen area agencies on aging (AAA). Responses by the sixteen AAAs to an online questionnaire provided a point-in-time picture of current caregiver assessment and services conducted by AAAs. Fifteen AAAs responded there would definitely or probably be an increase in the number of caregivers. Fifteen responded that they purchase or contract out respite care services. Fourteen stated that they provide some type of direct caregiving resources. Twelve utilize staff to develop and monitor care plans. While some provide training, none of the AAAs provides supportive services. The AAAs anticipate rapidly increasing needs for caregiver supports and services. While each provides different services, demand will continue to grow as the older adult population increases. [ABSTRACT FROM AUTHOR]

This study characterizes the impact of the COVID-19 pandemic on the mental and physical health of nurses. Qualitative data (collected using semi-structured interviews) were integrated with quantitative data (collected concurrently using the SF-12 Health Survey). Nurses (N = 30) compared their health prior to and during the first pandemic wave (March–May 2020). Interviews were analyzed thematically; descriptive statistics and t -tests compared pre-pandemic to current SF-12 scores. Qualitative findings demonstrated an impact on nurses' mental health expressed as isolation, loss, intense emotions, and feelings of being expendable. Impact on nurses' physical health included exhaustion, personal protective equipment skin breakdown, limited breaks from work, and virus exposure. Quantitative results show nurses' experienced declines in overall mental health (p <.001), and multiple physical health domains: role limitations due to physical problems (p <.0001), bodily pain (p <.0001), and general health (p <.0001). Promotion of nurses' well-being and safety, as well as education in emergency preparedness, must be given precedence to protect nurses' health. [ABSTRACT FROM AUTHOR]

Background: Understanding the self-management practices of persistent symptoms of SARS-Cov-2 (COVID-19) is critical given the misinformation that has been presented about this disease in the U.S. The purpose of this descriptive study is to assess the self-management of persistent symptoms of COVID-19 with commonly used and misused substances (i.e., alcohol, marijuana and commonly prescribed medications) among adults in the U.S. Methods: The data for this study comes from a cross-sectional survey of U.S. adults that was designed to broadly assess symptom burden, persistent symptom patterns, self-efficacy for symptom management and self-management strategies among people who experienced persistent/Long COVID. Multiple logistic regression analyses were used to assess how symptom length of COVID-19 was associated with the use of several substances to manage these persistent symptoms. Results: The analysis found that adults who had COVID-19 symptoms that persisted for 13 weeks or longer had higher rates of using alcohol (27.3%), marijuana (30.9%) and prescription tranquilizers (21.4%) to manage these symptoms when compared to their adult peers who had COVID-19 symptoms persist for only 4 weeks or less. For instance, the odds of indicating the use of marijuana (AOR = 4.21 95% CI = 1.68,10.5) to manage COVID-19 related symptoms was roughly four times higher for respondents who had COVID-19 symptoms persist for 13 weeks or longer when compared to respondents whose COVID-19 symptoms persisted for only 4 weeks or less. Conclusion: The findings suggest that screening of substance use disorders should be considered among healthcare providers who are treating adults who have persistent symptoms of COVID-19. [ABSTRACT FROM AUTHOR]

Anti-immigrant rhetoric and immigration policy enforcement in the United States over the last 2 decades has increased attention to fear of deportation as a determinant of poor health. We describe its association with mental health outcomes among Middle East and North African (MENA) residents of Michigan. Using a convenience sample of MENA residents in Michigan (n = 397), we conducted bivariate and multiple variable regression to describe the prevalence of deportation worry and examine the relationship between deportation worry and depressive symptoms (PHQ-4 scores). We found that 33% of our sample worried a loved one will be deported. Deportation worry was associated with worse mental health (p < 0.01). Immigration policies are health policies and deportation worry impacts mental and behavioral health. [ABSTRACT FROM AUTHOR]

Parent-to-parent mental health treatment approaches demonstrate a solid evidence base, though a tool to measure changes associated with this innovative service delivery approach has yet to appear in the literature. The Parent Support Partner (PSP) Outcome Tool was developed to evaluate a statewide parent-to-parent service for families of children presenting severe emotional and behavioral challenges. This study explored the factor structure and reliability of the PSP Outcome Tool. Participants were 1,502 Medicaid-eligible parents of children between the ages of 5–19 with SED (82%), I/DD (12%), or both SED and I/DD (5%) who enrolled in and participated in PSP Services across the state of Michigan from 2017 to 2020. Exploratory factor analysis revealed a three-factor solution (Bridging Collaborative Relationships, Empowerment, Navigating Resources). Cronbach's alpha was high (0.95) for the resulting 23-item outcome tool, and the three factors (i.e. Bridging Collaborative Relationships = 0.91, Empowerment = 0.90, Navigating Resources = 0.84). The factor structure of the scale and the need to establish additional validity support (i.e. predictive, convergent, divergent validity) for its use with diverse groups of parents are discussed. [ABSTRACT FROM AUTHOR]

The use of numerous social media formats (SMFs) has grown exponentially over the past several years. In many cases it has become the sole source of communication, the sole source of entertainment, and, unfortunately in many instances it exhibits the characteristics of a disruptive behavior. As a result, it has interfered with fundamental relationships. The following research sought to examine if there is a negative correlation between the disruptive use of SMFs and an individual's early life attachments to parents and/or other adults. In order to determine if a correlation existed, the research participants completed 4 standardized questionnaires of which 3 measured early life attachments to mothers, fathers, and/or other adults and a single questionnaire that measured their later life disruptive use of a variety of SMFs. This research did identitfy a significant negative correlation does exist between the positive protective factor of early childhood attachments when measured against the risk factor of later life disruptive use of SMFs. This finding was true for research participants who identified only parental attachment figures but the strength of the correlation was enhanced when a research participant also identified an other adult as an early attachment figure. The research further identified that certain of the 9 subcategories of the Disruptive Use Scale were more significant for female research participants while other subcategories were more significant for male research participants. This research clearly establisheda robust negative correlation between research participants' early childhood attachment experiences and their later life disruptive use of SMFs. However, to generalize the above findings, additional research needs to be conducted that is more inclusive of a variety of research participants. [ABSTRACT FROM AUTHOR]

Identifying the consumption patterns of toddlers and preschool children is critical to evaluating their potential for healthy development and future heath trajectories. The purpose of this longitudinal cohort study was to describe breastfeeding, nutritional trends, and dietary diversity in 12-to-36-month-old children in a Michigan cohort. Mothers completed surveys when their children were 12 (n = 44), 24 (n = 46) and 36 months old (n = 32). Mothers reported their child's dietary intake in the past 24 h and intake of specific foods in the past year. About 95% of 12-to-24-month-old children in the study population were ever breastfed, with 70% consuming human milk at 6 months and just over 40% at 12 months. Over 90% of participants gave their child a bottle since birth, with 75% providing human milk and 69% giving formula. Consumption of juice significantly increased with age and ~55% of the 36-month-old children consumed juice. A larger proportion of children consumed soda, chocolate, and candy as they aged. Though dietary diversity numerically increased with child age, this did not reach significance. Gut microbiota composition and structure was not associated with diet diversity. This research lays the foundation for future work to determine which nutritional interventions may be most effective in this population. [ABSTRACT FROM AUTHOR]

Despite the fact that intimate partner violence (IPV) occurs within intimate relationships, we know relatively little about the characteristics of those intimate relationships, and even less about how IPV changes across time within different relationships. We use the Relationship Dynamics and Social Life (RDSL) study, based on a random sample of 1003 18–19-year-old women residing in a Michigan county. Women were interviewed weekly for 2.5 years, resulting in an age range of 18 through 22. We estimate hybrid "within-between" regression models, which allows us to directly compare the same woman's risk of experiencing IPV across her different relationships, varied in terms of resources, balance of power, conflict, childbearing, relationship type, and duration. Our analyses demonstrate that power imbalance in intimate relationships, non-monogamous and unstable relationships, relationships with men who are not the father of a woman's existing children, and serious relationships (especially stayover and cohabiting) place young women in their late teens and early twenties at particularly high risk of multiple dimensions of IPV. Our fixed-effects modeling strategy isolated the increase in IPV risk that is due to these characteristics and experiences within intimate relationships from the risk due to young women being at high risk of IPV for other reasons who might tend to choose these types of relationships. The elevated risk of IPV in relationships with these characteristics and experiences supports a causal link between them. Our research supports the potential efficacy of interventions that reduce conflict, equalize power within relationships, and encourage women—especially young mothers—to delay serious relationships. [ABSTRACT FROM AUTHOR]

Objectives. To examine how redlining, a historical racially discriminatory housing policy implemented by the Home Owners' Loan Corporation (HOLC), is associated with current neighborhood determinants of health in the Detroit Metropolitan Area. Methods. We analyzed associations between census tract‒level HOLC color grades (red = "hazardous"; yellow = "declining"; blue = "desirable"; and green = "best") and a developed neighborhood determinants of health index (DOHI) consisting of 8 indicators of economic, social, governance, and physical environment characteristics using spatial regression analysis and controlling for change in the census tract's percentage of White residents. Results. A total of 484 Detroit Metropolitan Area census tracts had HOLC grades. The mean redlining score across all census tracts was 3.02 (min = 1.0; max = 4.0). The mean contemporary DOHI was 19.11 (min = 8.0; max = 36.0). Regression models show significantly higher DOHI scores in yellowlined (b = 2.71; 95% confidence interval [CI] = 1.52, 3.91), bluelined (b = 5.33; 95% CI = 3.65, 7.01), and greenlined (b = 9.25; 95% CI = 6.86, 11.64) neighborhoods compared with redlined neighborhoods. Conclusions. Historical redlined neighborhoods experience contemporary determinants of health conditions that are less conducive to health compared with those in nonredlined neighborhoods. These differences also reflect the accumulation of resources essential for health in greenlined neighborhoods. Public Health Implications. Neighborhood development initiatives should consider the impacts of historical redlining on contemporary neighborhood conditions. (Am J Public Health. 2023;113(S1): S49–S57. https://doi.org/10.2105/AJPH.2022.307162) [ABSTRACT FROM AUTHOR]

Recreational therapists in Michigan and Pennsylvania were interviewed on their perceptions of the impact of COVID-19 on practice with older adults, including changes to their roles and responsibilities as well as the impact on older adults. Social distancing requirements, limitations on visitors and restrictions on groups transformed programming and practice, as well as negatively impacted older adults living in a variety of residential and community-based settings. This qualitative study included 14 recreational therapists. Related to practice, identified themes included the impact on programming, changing roles and responsibilities, how recreational therapists coped with adversity, and their considerations for future practice. Regarding impact on older adults, the resulting themes noted: 1) lack of socialization, 2) emotional and behavioral responses, 3) physical decline, and 4) cognitive decline. The challenges of working with clients living with cognitive impairments and barriers for older adults living in the community are discussed. Recommendations for practice and research to address the long-term effects of COVID-19 in recreational therapy with older adults are presented. [ABSTRACT FROM AUTHOR]

Objective: Describe trends in usage and shoppers of Eastern Michigan University's (EMU) food pantry over four academic years. Participants: Shoppers of EMU's pantry between September 2015 and April 2019. Methods: Data come from shopper questionnaires and pantry records of daily visits and food distribution. Descriptive statistics, t-tests, and chi-square analyses were used to explore shopper characteristics and pantry use over time. Results: Pantry use increased over four academic years (from 1,021 to 3,080 visits/year). An increasing proportion of shoppers use the pantry ≥ once/month (6.1% in 2015/2016; 15.1% in 2018/2019). Compared to irregular shoppers (≤7 visits/year), regular shoppers (≥8 visits) reported higher rates of housing instability and were less likely to have a university meal plan. Conclusion: Data revealed substantial growth of the campus pantry, likely reflecting greater awareness and greater need. The findings highlight financial and social challenges faced by Michigan's college students. Recommendations for pantry establishment/maintenance are indicated. [ABSTRACT FROM AUTHOR]

Economically disadvantaged communities experience disproportionate health and social challenges relative to more affluent areas. This study describes ways women support and give back to their community in a minority-majority community experiencing social, economic and health challenges. We conducted qualitative interviews with 100 women and human service providers serving women in Flint, Genesee County, Michigan. Using methods aligned with community-based participatory research, a group of community and academic partners analyzed the data. Participants noted several personal characteristics of women they identified as assets including resilience, strength, resourcefulness, creativity, determination, tenacity, wisdom and the ability to nurture others. We think these personal characteristics represent individual assets that help women in Flint survive and build social capital. Women reported developing their social capital through giving, collaborating and sharing their skills with people in their personal networks. Significant personal assets in the form of individual characteristics already exist within Flint. Even in an area characterized as having health and economic challenges, women in this study were able to leverage their personal assets to build social capital and to mobilize resources for their benefit and the benefit of the community. [ABSTRACT FROM AUTHOR]