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The preparedness of community facilities offering exercise programs to older adults is unknown. On-site evaluations were conducted by trained professionals to assess compliance of community older adult exercise programs with fitness-industry standards. Fourteen facilities were evaluated whose clientele (N = 2,172) were predominantly White (98%) women (87%) over 75 years of age (66%). Few of the 14 facilities required exercise participants to complete preactivity health questionnaires (n = 5), 3 administered informed consents, and none adhered to a medical-clearance policy. Only 2 facilities had defined emergency policies, and none conducted emergency drills. One site conducted exercise programs with instructors trained in cardiopulmonary resuscitation. Professionally certified exercise instructors leading all exercise programs were observed in 1 facility. Most facilities evaluated were noncompliant with existing professional health and fitness standards. The practicality of imposing such standards on community exercise programs for older adult requires further examination. [ABSTRACT FROM AUTHOR]

Purpose: To identify and compare the determinants of different types of tobacco use among rural youths and discuss the implication of these differences for youth tobacco use cessation.Methods: Ninth grade participants (n = 883) were 95% white, between 13 and 19 years old with a mean age of 14.6 years. Students were classified into four exclusive groups: non-tobacco use, smoking only, smokeless tobacco (ST) use only, and conjoint smoking and ST use. The influences of 14 specific risk factors on tobacco use were investigated for each group using separate multiple logistic regression analyses.Results: Among participants, 20% were smokers only, 6% were ST users only, and 10% were conjoint users. Students who had more friends (odds ratio [OR] =] 2.75) and siblings (OR = 1.96) who smoke, family problems (OR = 1.70), and favorable attitudes toward tobacco use (OR = 1.12) were more likely to smoke than were other students. Among students who used only ST, gender was a primary determinant (95% were male). Excluding gender, sibling ST use (OR = 4.28), friends' ST use (OR = 1.71), and favorable attitudes (OR = 1.11) were the most significant risk factors. Male students were also more likely to use both cigarettes and ST (OR = 8.62). In addition, among students who used both tobacco products, siblings' and friends' ST use were significant (OR = 3.09 and 2.13, respectively), as well as family problems (OR = 2.41) and attitude (OR = 1.15). Unlike smokers only or ST users only, lack of knowledge about tobacco was a significant determinant among conjoint users (OR = 1.39).Conclusions: Findings revealed that 7 of 14 factors were significant predictors of tobacco use. Some factors predicted smoking only, ST only, and conjoint use; however, the pattern of predictors varied for these three categories. Implications for these findings as they relate to tobacco use interventions are discussed. [ABSTRACT FROM AUTHOR]

Background and Objectives: This study examined young adults' tobacco use transitions based on their past 30-day use states, and identified factors associated with their transitions., Methods: Participants (N = 12377) were young adults aged 18-29 years at Wave 1 of the Population Assessment of Tobacco and Health (PATH) study. Self-reported tobacco use states were categorized by the number of past-month use days (0, 1-4, 5-8, 9-12, 13-30 days) for cigarettes, electronic cigarettes [e-cigarettes], traditional cigars, filtered cigars, cigarillos, smokeless tobacco (SLT), and hookah. Multistate Markov models examined transitions between use states across Waves 1-5 of unweighted PATH data and multinomial logistic regressions examined predictors of transitions., Results: Most young adults remained nonusers across adjacent waves for all products (88%-99%). Collapsed across waves, transitioning from use at any level to nonuse (average 46%-67%) was more common than transitioning from nonuse to use at any level (average 4%-10%). Several factors that predicted riskier patterns of use (i.e., transitioning to use and/or remaining a user across adjacent waves) were similar across most products: male, Black, Hispanic, lower education levels, and lower harm perceptions. In contrast, other factors predicted riskier patterns for only select products (e.g., e-cigarette and SLT use among Whites)., Discussion and Conclusions: Few sampled young adults escalated their tobacco use over time, and escalations for many products were predicted by similar factors., Scientific Significance: Prevention and regulatory efforts targeted towards adolescents should continue, but also be expanded into young adulthood. These same efforts should consider both shared and unique factors that influence use transitions., (© 2024 The American Academy of Addiction Psychiatry (AAAP).)

Aims: This study aims to identify adolescent patterns of polytobacco use and measure transitions between patterns over time., Design: Longitudinal analysis using data derived from waves 1-4 (2013-18) of the Population Assessment of Tobacco and Health (PATH) study. Transitions in tobacco use patterns were examined via latent transition analysis, and then, socio-demographic characteristics were used to predict transitions via logistic regression., Setting: United States., Participants: Participants included 975 adolescents who used at least one tobacco product at any wave (W1 mean age = 13.29, standard deviation = 0.86; W4 54.2% male; 54.5% white, 25.9% Hispanic)., Measurements: Measurements included past 30-day use of cigarettes, electronic cigarettes (e-cigs), traditional cigars, cigarillos, filtered cigars, snus, smokeless tobacco (SLT) or hookah., Findings: Six latent classes were identified. Cigarette users (43.5-58.8%) and SLT users (50.8-79.6%) tended to persist in their use over time. E-cig users began to probably transition to non-users (80.0%), but became more likely to persist in this use over time (31.1%). Non-users at a given wave were most likely to transition to e-cig users (8.5-43.7%) or cigarette users (6.7-28.6%). Cigarillo/poly-users and hookah/poly-users displayed more variable transition patterns. Adolescents were more likely to transition to non-use (versus become/remain e-cig users) if they were older (cigarette users, SLT users), younger (e-cig users), other race (SLT users), male (SLT users) or had less-educated parents (SLT users) compared with their counterparts. Hispanic (versus white) cigarette users were more likely to transition to non-users than to persist in this use., Conclusions: Among adolescents in the United States, patterns of tobacco use characterized by the use, mainly, of single, specific products appear to be stable, particularly by late adolescence. In contrast, patterns characterized by polytobacco use appear to be more variable and may represent experimentation without specialization., (© 2022 Society for the Study of Addiction.)

Background: Despite decreases in adolescents' cigarette use over the past decade, overall rates of adolescent tobacco use have increased. Research examining adolescents' changes across a range of tobacco products reflective of the current market, as well as multilevel predictors of use trajectories is needed., Methods: Data derive from Waves 1-4 (W1-4; 2013-2018) of the Population Assessment of Tobacco and Health (PATH) study. Participants included 975 adolescents who used ≥1 tobacco product (cigarettes, electronic cigarettes [ECIGs], traditional cigars, cigarillos, filtered cigars, snus, smokeless tobacco [SLT], hookah) at any wave (W1 M age  = 13.29 [0.86], 54.2% male; 54.5% White, 25.9% Hispanic)., Results: Utilizing latent growth curve modeling (separate models per product), adolescents displayed increases in their past 30-day use of all tobacco products from W1-4. Greater W1 use was predicted by identifying as non-Hispanic (cigarettes); lower parent education (SLT); greater externalizing problems (cigarillos); greater motives (all products except cigarillos); greater youth-reported household smoking rules (cigarillos); and greater isolation (ECIGs). More use across time (i.e., higher slope) was predicted by older age (cigarettes); identifying as male (ECIGs, SLT), Black (vs. White; cigarillos), White (vs. Black, Hispanic; ECIGs, SLT); fewer externalizing problems (SLT); fewer motives (ECIGs); fewer youth-reported rules (cigarillos, SLT); and greater geographic isolation (cigarettes, SLT)., Discussion: Although some individual-level factors (i.e., motives, externalizing problems) predicted greater W1 use (i.e., intercept) only, interpersonal- (parent rules) and community-level (geographic isolation) factors were associated with changes in use over time (i.e., slope). Intervention efforts may address such factors to reduce adolescents' escalations in use., (Copyright © 2022. Published by Elsevier Inc.)

Rural health disparities have attracted increased national attention, compelling an expanded focus on rural health research. In this article, we deconstruct the definitions and narratives of "rural" communities and suggest that a paradigm shift is needed that centers the complexity and strength of rural places. We discuss the relevance of health equity frameworks, implementation science, and community-engaged approaches to promote rural well-being. Focusing on rural in its own right will lead to intervention innovations and reinvention with implications beyond rural areas. We conclude with suggestions for research and practice to inspire renewed interest in partnering with rural communities to promote health equity.

Introduction: Despite increases in adolescents' polytobacco use, little work has utilized recent national data to examine transitions in polytobacco use over time or predictors of such transitions., Methods: Data derived from the Population Assessment of Tobacco and Health (PATH) study. Participants used at least one tobacco product (cigarettes, electronic cigarettes [ECIGs], traditional cigars, cigarillos, filtered cigars, snus, smokeless tobacco [SLT], hookah) at Wave 3 (W3; 2015-2016) or 4 (W4; 2016-2018) and had Wave 1 (W1) data (N = 1072; M age = 13.71, SD =1.71, 46.4% female; 56.6% White, 23.2% Hispanic). Latent transition analysis (LTA) examined probabilities of transitioning between classes across waves and sociodemographic correlates of transitions., Results: Five latent classes were identified: Low Users (n = 372, 34.7% W3; n = 249, 23.3% W4), ECIG Users (n = 256, 23.8% W3; n = 286, 26.7% W4), Cigarette Users (n = 215, 20.1% W3; n = 293, 27.3% W4), SLT Users (n = 91, 8.5% W3; n = 92, 8.6% W4), and Polytobacco Users (n = 138, 12.9% W3; n = 152, 14.1% W4). Cigarette Users and SLT Users displayed the highest probabilities for class stability. Low Users were most likely to transition to ECIG Users or Cigarette Users, whereas Polytobacco Users were most likely to transition to Low Users. ECIG Users were likely to transition to Low Users or Cigarette Users. Older and White adolescents were more likely to display riskier transitions., Conclusions: Although Cigarette Users and SLT Users remained largely stable in membership, findings demonstrate greater movement across polytobacco use classes relative to previous research and suggest that ECIGs may be the most common entry point to tobacco use., (Copyright © 2022 Elsevier B.V. All rights reserved.)

Background: Limited specialty care access is a major contributor to rural health disparities. Extensions for Community Healthcare Outcomes (ECHO) is an innovative training and education strategy to address the need for trained specialty care in rural areas, such as West Virginia (WV). This article describes the successful implementation of ECHO projects in diverse subject areas facilitated by unique partnerships between the WV Clinical and Translational Science Institute (WVCTSI) and its practice partners. WV Project ECHO aims to provide education and training in specialty areas through the use of technology and partnerships., Methods: A case-based session coupled with a brief relevant didactic presentation is used to amplify rural provider specialty expertise through education of primary care physicians (PCPs) in specific clinical areas. Foundational partnerships and impact are described., Conclusions: Key lessons learned include leveraging existing partnerships and implementing projects based on provider needs. A unique result of WV Project ECHO is WV Medicaid's decision to accept case presentations made during the Hepatitis C ECHO session as the specialty consultation requirement (e.g., hepatologist or infectious diseases) for Medicaid coverage of hepatitis C drugs, thus increasing the number of patients receiving Hepatitis C treatment. A multi-partnered community approach facilitated by the widespread use of a technology-based provider education platform has facilitated the availability of curative therapy for a potentially fatal disease.

Background: Despite well-established gender differences in adult smoking behaviors, relatively little is known about gender discrepancies in smoking behaviors among adolescents, and even less is known about the role of gender in smoking cessation among teen populations., Method: The present study examined gender differences in a population of 755 adolescents seeking to quit smoking through the American Lung Association's Not-On-Tobacco (N-O-T) program. All participants enrolled in the N-O-T program between 1998 and 2009. All participants completed a series of questionnaires prior to and immediately following the cessation intervention. Analyses examined gender differences in a range of smoking variables, cessation success and direct and indirect effects on changes in smoking behaviors., Results: Females were more likely to have parents, siblings and romantic partners who smokes, perceive that those around them will support a cessation effort, smoke more prior to intervention if they have friends who smoke, and to have lower cessation motivation and confidence if they have a parent who smokes. Conversely, males were more likely to have lower cessation motivation and confidence and be less likely to quit if they have a friend who smokes., Conclusions: Gender plays an important role in adolescent smoking behavior and smoking cessation. Further research is needed to understand how these differences may be incorporated into intervention design to increase cessation success rates among this vulnerable population of smokers., (Copyright © 2012 Elsevier Ltd. All rights reserved.)