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Background and aims Design, setting and participants Measurements Findings Conclusion Disposable electronic cigarette (e‐cigarette) use is becoming more popular among US youth, given the shifting landscape in product marketing, availability and regulation. This study aimed to estimate the prevalence of and test factors associated with the most used e‐cigarette product (disposable versus other) among US youth aged 9–18 years who currently use e‐cigarettes.This was an observational study using cross‐sectional data from the US‐based 2021 and 2022 National Youth Tobacco Surveys (n = 48 704). We restricted our analytical sample to youth who currently use e‐cigarettes (n = 4137). The sample ranged from 9 to 18 years old and was 53.0% female.We dichotomized e‐cigarette device type to disposable versus all other types (e.g. refillable pods/cartridges). We conducted logistic regression to estimate whether age, sex, race/ethnicity, sexual orientation, frequency of e‐cigarette use, nicotine vaping, flavored e‐cigarette use and current combustible/non‐combustible tobacco use were associated with disposable e‐cigarette use, compared with other e‐cigarette use.Among youth who currently use e‐cigarettes, 54.5% used disposable e‐cigarettes. Older age (17–18 years), relative to younger age (9–14 years) [odds ratio (OR) = 1.43, 95% confidence interval (CI) = 1.07–1.91], non‐Hispanic Black (versus non‐Hispanic White) race/ethnicity (OR = 1.47, 95% CI = 1.01–2.15), any nicotine (versus non‐nicotine) vaping (OR = 2.51, 95% CI = 1.96–3.23) and flavored (versus non‐flavored) e‐cigarette use (OR = 1.93, 95% CI = 1.46–2.56) were associated with increased odds of mainly using disposable e‐cigarettes, compared with using other e‐cigarette products, whereas current combustible tobacco use (versus non‐current) (OR = 0.65, 95% CI = 0.53–0.80) and current non‐combustible tobacco use (versus non‐current) (OR = 0.58, 95% CI = 0.43–0.78) were associated with lower odds.Disposable e‐cigarettes appear to be the most used type of e‐cigarette product among US youth. Older age, non‐Hispanic Black race/ethnicity, nicotine vaping and flavored e‐cigarette use are associated with mainly using disposable e‐cigarettes, relative to other e‐cigarette products. [ABSTRACT FROM AUTHOR]

Introduction: Because medication adherence is essential to the management of rheumatoid arthritis (RA), identifying (1) subgroups at high risk for low medication adherence and (2) modifiable factors potentially contributing to low adherence can impact patient outcomes. This study aims to describe the relationships between anxiety, trust in the provider, quality patient‐provider communication, fatigue, RA knowledge, adverse medication effects, disease activity, RA medications, disease duration, patient satisfaction, and medication intolerance and cluster factors to differentiate RA‐patient subgroups. Methods: This observational study used correlation analysis, linear regression, and cluster analysis with determination decisions based on Schwarz's Bayesian Criterion. Results: Medication adherence was higher in non‐Hispanic, White participants, inversely correlated with disease activity and pain intensity, and positively correlated with trust in the provider. Patient satisfaction was higher among those with a shorter time since diagnosis, and was negatively associated with disease activity, pain intensity and interference, fatigue, and anxiety. It was positively associated with RA knowledge, trust in provider and quality of patient‐provider communication. Medication intolerance differed by disease duration and was positively correlated with disease activity, pain interference, and fatigue. Of the two clusters, Cluster 1 participants had greater medication adherence and patient satisfaction, and lower medication intolerance. They were of higher income, employed, and non‐Hispanic, White persons with a shorter disease duration and lower perceived pain intensity/interference, fatigue, and anxiety. They were more knowledgeable about RA with higher trust in their provider and perceived quality of patient‐provider communication. Discussion/conclusion: A low medication adherence RA‐patient subgroup‐highly affected by social determinants of health and with unique relational and clinical characteristics was identified. [ABSTRACT FROM AUTHOR]

Background. Almost 2,000 campuses have adopted tobacco-free (TF) policies across the United States. However, there is not a systematic process to help campuses implement successful policies. Readiness assessments can help provide assistance as campuses work to implement successful policies. Purpose. We assessed readiness for TF policies among campuses of a statewide university system and determined factors associated with readiness. Participants. Stakeholders from 23 campuses without 100% TF policies were invited to participate in an online survey. Method. System administrators provided contacts for five to eight stakeholders per campus. Included in the analysis were 10 of 23 campuses (43.5%) with at least three stakeholders completing the survey. Results. Of the 10 campuses, one was in Preplanning, five were in Preparation, and four were in the Initiation stage of readiness. Political Climate was the highest scored dimension on seven campuses (0.74–1.0); Resources was the lowest on eight campuses (0.0–0.67). Campus size and county rurality were each associated with one dimension score. Conclusions. Despite being part of a statewide university system, campuses are in varying stages of readiness for TF policies. Stage-based strategies to advance TF campus policies must be implemented to set campuses up for successful policies. [ABSTRACT FROM AUTHOR]

Purpose: To examine the association between strength of policy and self-reported tobacco use behavior, controlling for demographic characteristics, polytobacco use, knowledge of campus tobacco policy, and perceived policy compliance by others.Design: Cross-sectional, online survey.Setting: Ten participating State University of New York (SUNY) campuses; 5 with designated smoking/tobacco use areas and 5 with 100% tobacco-free policies.Subjects: Convenience sample of students from SUNY campuses: only tobacco users (N = 576 students) included for analysis.Measures: Items assessing tobacco use behaviors on campus, policy knowledge, and observation of others using tobacco on campus.Analysis: T tests and chi-square tests of association used to compare responses between tobacco users across campuses. Generalized estimating equations modeling used to evaluate predictors of tobacco use on campus; model estimated with students nested within campus.Results: Those on campuses without a comprehensive policy were more likely to report (in the past week) having seen others smoke on campus (98% vs 69%, P < .001), having personally smoked on campus (65% vs 36%, P < .001), and seeing others use tobacco products on campus (88% vs 67%, P < .001), compared to those on tobacco-free campuses.Conclusion: Tobacco-free campus policies provide numerous protective factors for tobacco users and nonusers. However, compliance strategies are imperative for intended policy success. [ABSTRACT FROM AUTHOR]

Purpose: To examine the short-term impact of a personalized environmental report-back intervention to reduce home exposure to tobacco smoke and radon on perception of synergistic risk for lung cancer. Radon-induced lung cancer is more common among those exposed to tobacco smoke.Design: Randomized controlled trial.Setting: Primary care clinics and a pharmacy waiting area at a University Medical Center in the Southeastern United States and community events.Participants: Five hundred sixty adult homeowners and renters (3-month follow-up, n = 334).Intervention: Personalized environmental report back.Measures: Single-item synergistic risk perception measure using 5-point Likert-type scale.Analysis: Change in synergistic risk from baseline to 3 months was evaluated using a generalized estimating equation model containing main effects of treatment group and time. Covariates in the model included age, gender, education, and home smoking status.Results: For treatment and control groups combined, there was a significant increase in perception of synergistic risk from baseline to 3 months, but the study groups did not differ. There was no association between perceived synergistic risk and whether or not there were smokers at home.Conclusion: Learning about combined risks for lung cancer, with or without dual home screening for secondhand smoke and radon and environmental report-back, may enhance perceived risk for combined environmental exposures. Evaluation of perceived synergistic risk with a single item is a study limitation. [ABSTRACT FROM AUTHOR]

Purpose: Examine predictors of short- and long-term adherence to a tobacco-free policy prohibiting all tobacco use inside and outdoors on Executive Branch property in Kentucky.Design: Cross-sectional online surveys administered at 2 time points.Setting: Commonwealth of Kentucky.Participants: 27 000 employees of the Kentucky Executive Branch were invited to participate in 2 online surveys: March 2015, 4 months postpolicy (N = 4854) and August 2015, 9 months postpolicy (N = 3522).Intervention: Executive order prohibiting tobacco use on Executive property implemented November 2014.Measures: Tobacco use, tobacco users' adherence to the tobacco-free policy, and personal characteristics were assessed.Analysis: Two separate logistic regression models used to determine predictors of short- and long-term adherence to the policy.Results: In the short term, employees who had seen others violate the policy ( P < .001) and had more tobacco-using friends ( P = .020) were less likely to adhere to the policy. At 9 months after the policy, employees who were older ( P = .038) and those who had seen others violate the policy ( P < .001) were less likely to report adherence to the policy. Tobacco-using employees who worked in a county with a comprehensive smoke-free ordinance ( P = .047) were more likely to adhere to the policy.Conclusion: This study indicates the need for strong policy compliance procedures, employer-based tobacco treatment programs accompanying tobacco-free policy change, and smoke-free workplace laws to promote prohealth norms. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented in response to the article “Clean Indoor Air Ordinance Coverage in the Appalachian Region of the United States,’’ by Ferketich et al. in a 2010 issue. A response by the authors is noted.

Background: The Patient Activation Measure (PAM) is used clinically and in research to measure an individual's knowledge, skills, and confidence related to their health management engagement. Despite the use of "patient" in the title, the instrument can be used in nonpatient populations. A group at high risk for low activation concerning their own health is family caregivers of patients with chronic illnesses. The psychometric properties of the PAM have not been established in family caregivers. Objectives: This study aimed to examine the psychometric properties of the PAM 10-item version (PAM-10) in a sample of family caregivers of patients with chronic illnesses. Our focus was on family caregivers' health activation of their own healthcare needs. Methods: We evaluated the internal consistency reliability of the PAM-10 in a sample of 277 family caregivers. Item-total correlations and interitem correlations were used to assess item homogeneity. Construct validity of the PAM-10 was examined using exploratory factor analysis and testing hypotheses on known relationships. Results: The PAM-10 demonstrated adequate internal consistency. Item-total correlation coefficients and interitem correlation coefficients were acceptable. Construct validity of the instrument was supported. Factor analysis yielded two factors that explained 62.3% of the variance in the model. Lower levels of depressive symptoms were significantly associated with better activation, providing evidence of construct validity. Caregivers with high activation levels were significantly more likely to engage in and adhere to self-care behaviors such as regular exercise, eating a healthy diet, and engaging in stress reduction strategies. Discussion: This study demonstrated that the PAM-10 is a reliable and valid measure for family caregivers of patients with chronic illnesses to measure caregivers' health activation of their own healthcare needs. [ABSTRACT FROM AUTHOR]

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

Rates of neonatal abstinence syndrome/neonatal opioid withdrawal syndrome (NAS/NOWS), a withdrawal syndrome from opioids and other substances resulting from intrauterine exposure, have been increasing exponentially in the U.S. To improve health outcomes, it is important to understand population health risks, including rehospitalization and related diagnoses, using current data. This study will compare and describe the rates of rehospitalization, the demographic characteristics and the rehospitalization diagnoses and age at diagnosis between the infants affected by NAS/NOWS to those sampled who were unaffected. This study will also describe the frequency of NAS/NOWS births per year along with a yearly comparison of readmissions in those affected by NAS/NOWS to those who were not (2016–2020). Health claims data were used to conduct a case/control study. Diagnosis codes for neonatal withdrawal syndrome/NAS/NOWS (P04.49 or P96.1 and P96.1 alone) from 1 October 2015 to 1 June 2021 were extracted, and controls were case-matched based on month/year of birth. Rehospitalizations following birth and the related diagnoses were described and grouped using the Agency of Healthcare Research Quality Clinical Classifications Software Refined Frequency distribution. The chi-square test of association and generalized estimating equation modeling were used for data analysis. Infants affected by NAS/NOWS are 2.7 times more likely to have a rehospitalization. White, non-Hispanic neonates (OR = 1.5; p =.007) and those infants residing in rural areas (OR = 1.9; p <.001) were disproportionately affected. We identified a host of admission diagnoses with increased prevalence in infants affected by NAS/NOWS when compared to those who were not affected (e.g. infectious diseases, feeding disorders). Infants with NAS/NOWS are at increased risk of rehospitalization with a host of diagnoses, and specific demographic groups (White, rural) are more highly affected. [ABSTRACT FROM AUTHOR]

OBJECTIVE: The aim of this study was to explore the influence of the practice environment on nurse managers' (NMs') job satisfaction and intent to leave. BACKGROUND: Nurse managers are a ready pool of talent to fill impending strategic leadership vacancies. Job satisfaction as an NM is a deciding factor for senior leadership aspirations. METHODS: This study used a secondary analysis of 2012 survey data of 355 NMs. The Nurse Manager Practice Environment Scale was used to identify organizational features that influence NMs' job satisfaction and intent to leave. RESULTS: Mean (SD) job satisfaction was 4.5 (1.1) on a 6-point scale. Mean (SD) intent to leave was 5.0 (2.1) on a scale ranging from 3 to 9. The Nurse Manager Practice Environment Scale was a significant predictor of both job satisfaction and intent to leave. CONCLUSIONS: Features of the organizational context can be modified to improve job satisfaction and reduce intent to leave among NMs. [ABSTRACT FROM AUTHOR]

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

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

Fungal infections cause substantial rates of illness and death. Interest in the association between demographic factors and fungal infections is increasing. We analyzed 2019 US hospital discharge data to assess factors associated with fungal infection diagnosis, including race and ethnicity and socioeconomic status. We found male patients were 1.5-3.5 times more likely to have invasive fungal infections diagnosed than were female patients. Compared with hospitalizations of non-Hispanic White patients, Black, Hispanic, and Native American patients had 1.4-5.9 times the rates of cryptococcosis, pneumocystosis, and coccidioidomycosis. Hospitalizations associated with lower-income areas had increased rates of all fungal infections, except aspergillosis. Compared with younger patients, fungal infection diagnosis rates, particularly for candidiasis, were elevated among persons >65 years of age. Our findings suggest that differences in fungal infection diagnostic rates are associated with demographic and socioeconomic factors and highlight an ongoing need for increased physician evaluation of risk for fungal infections. [ABSTRACT FROM AUTHOR]

Introduction/Objective: To develop a scale to measure methotrexate intolerance for use in adult rheumatoid arthritis (RA) patients and to describe its psychometric properties. Methods: A three‐phase study was conducted. During Phase 1, we conducted individual interviews with RA patients (n = 14) to inform our item development process. During Phase 2, we asked for RA patients' (n = 10) feedback on item readability, clarity and the scale's ability to measure methotrexate intolerance. During Phase 3, we had patients with RA (n = 204) complete the scale to develop a final version and to describe the scale's internal validity (Cronbach's alpha), test–retest reliability (intra‐class correlation coefficients), construct validity and discriminant validity and the ability of the scale to discriminate between past and present methotrexate users. Results: The newly developed, weighted scale (Patient‐Perceived Methotrexate Intolerance Scale [PPMIS]) includes four subscales: Methotrexate Benefits, Methotrexate Risks‐Side Effect Considerations, RA Risks and Methotrexate Risks‐Willingness to Take Methotrexate Despite Risks. Cronbach's alpha ranged from 0.79 to 0.94. Test–retest reliability at 2 weeks was 0.73–0.88. Construct validity was supported with significant logical relationships between subscale scores and the existing methotrexate intolerance scale and past/present methotrexate use. The PPMIS was able to correctly classify RA patients as a past versus present methotrexate user 77% of the time. At the cut point of 3.29, the sensitivity of the PPMIS is 74% and specificity is 72% to correctly classify patients into past/present methotrexate use. Conclusion: This is the first known scale with favourable measurement properties to evaluate methotrexate intolerance using a patient‐centred perspective. [ABSTRACT FROM AUTHOR]

Background: Because effective treatment for rheumatoid arthritis (RA) is dependent on medication use, medication optimization is critically important. Medication adherence, patient satisfaction with care and medication adverse events are core concepts of medication optimization that are either a significant problem and/or understudied in patients with RA. Objective: To (1) evaluate treatment effects from a medication optimization intervention; (2) assess treatment differences and changes over time in medication adherence, patient satisfaction, and medication adverse events; and (3) to determine whether age, gender, provider trust, and disease activity affect these outcomes. Methods: We conducted a prospective, longitudinal intervention study (N = 143 RA patients) using repeated measures models. Results: We did not identify significant intervention effects. For both the medication adherence and patient satisfaction models, the significant predictors in the model included age, gender and trust in provider. Older age, female gender (relative to male), and greater trust in the provider were associated with increased medication adherence scores and patient satisfaction. For the adverse events model, the only significant predictor in the model was gender. Compared with males, females were more likely to report experiencing adverse events. Time was significantly associated with decreased experiences of adverse events. Conclusion: This study has identified important predictors of medication adherence, patient satisfaction and medication adverse events in a sample of patients with RA which can facilitate targeted approaches to improve adherence in those high‐risk groups. [ABSTRACT FROM AUTHOR]

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

Exposure to radon is a leading cause of lung cancer worldwide. However, few test their homes for radon. There is a need to increase access to radon testing and decrease radon exposure. This longitudinal, mixed-methods study using a citizen science approach recruited and trained a convenience sample of 60 non-scientist homeowners from four rural Kentucky counties to test their homes for radon using a low-cost continuous radon detector, report back findings, and participate in a focus group to assess their testing experience. The aim was to evaluate changes in environmental health literacy (EHL) and efficacy over time. Participants completed online surveys at baseline, post-testing, and 4-5 months later to evaluate EHL, response efficacy, health information efficacy, and selfefficacy related to radon testing and mitigation. Mixed modeling for repeated measures evaluated changes over time. Citizen scientists reported a significant increase in EHL, health information efficacy, and radon testing self-efficacy over time. While there was a significant increase in citizen scientists' confidence in their perceived ability to contact a radon mitigation professional, there was no change over time in citizen scientists' beliefs that radon mitigation would reduce the threat of radon exposure, nor was there a change in their capacity to hire a radon mitigation professional. Further research is needed to understand the role of citizen science in home radon mitigation. [ABSTRACT FROM AUTHOR]

Objective: To examine the relationship among nicotine, alcohol, and marijuana use; level of sensation seeking (SS); and pubertal development. Method: Subjects were early and middle adolescent males and females recruited from a psychiatric clinic (n = 77) and two general pediatric clinics (n = 131). SS was measured by using the Sensation Seeking Scale for Children. Pubertal development was measured with a modified Pubertal Development Scale that was completed by the adolescent and his/her parent about the adolescent. Adolescent self-reports of nicotine, alcohol, and marijuana use were also obtained using questionnaires. Results: SS was higher in males and females who reported nicotine and alcohol use and in males who reported marijuana use. SS was positively associated with pubertal development in males and females, even when controlling for age. Furthermore, SS mediated the relationship of pubertal development and drug use in males and females. Conclusions: The observation that SS mediates the relationship between pubertal development and drug use in males and females may contribute to understanding changes in drug use that are seen during adolescence. In addition, SS is associated with drug use and is easily measured in a variety of clinical settings. Jo Am. Acad. ChildAdolesc. Psychiatry, 2002, 41 (12):1495-1502. [ABSTRACT FROM AUTHOR]

Though e-cigarette aerosol has been associated with altered lung cell function, few studies have examined the effects of use on immune response and respiratory symptoms. The purpose of this study was to examine if recent persistent cough or cytokine levels are related to Electronic Nicotine Delivery Systems (ENDS) use in college students. In April 2019, 61 undergraduate students at the University of Kentucky completed surveys and provided a salivary sample to evaluate cytokine levels (Interleukin (IL-) 2, 4, 6, 8, 10, 12, 13 and TNFα, INFγ), using quota sampling to obtain comparable numbers of ENDS users and non-ENDS users. Data analysis included chi-square tests and multivariable logistic and linear regression. All ENDS users reported JUUL as their primary product. ENDS users were more likely to be younger, use cigarettes and marijuana, and report a persistent cough. Controlling for cigarette and marijuana use, there was a trend toward greater likelihood of persistent cough among ENDS users. Compared with nonusers, salivary IL-2 and INFγ were elevated and IL-4 was decreased, controlling for cigarette and marijuana use. There was a trend toward lower IL-12p70 values among ENDS users with these covariates. Findings reveal dysregulation of salivary immune profiles toward a TH1 phenotype in emerging adult ENDS users and short-term immune function may be dysregulated in young adult e-cigarette users. [ABSTRACT FROM AUTHOR]

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

Objective: Examine Juul use patterns, sociodemographic and personal factors associated with Juul use, and reasons for Juul initiation and current use, among college students. Participants: Convenience sample of 371 undergraduates at a large university in the southeast; recruited April 2018. Methods: Cross-sectional design using an online survey. Logistic regression identified the personal risk factors for current use. Results: Over 80% of participants recognized Juul; 36% reported ever use and 21% past 30-day use. Significant risk factors for current Juul use were: male, White/non-Hispanic, lower undergraduate, and current cigarette smoker. Current Juul users chose ease of use and lack of a bad smell as reasons for use. Ever Juul users most commonly endorsed curiosity and use by friends as reasons for trying Juul. Conclusions: Given the propensity for nicotine addiction among youth and young adults, rates of Juul use are alarming and warrant immediate intervention. [ABSTRACT FROM AUTHOR]

Background: Radon exposure is the second leading cause of lung cancer worldwide and represents a major health concern within and outside the United States. Mitigating exposure to radon is especially critical in places with high rates of tobacco smoking (e.g., Kentucky, USA), as radon-induced lung cancer is markedly greater among people exposed to tobacco smoke. Despite homes being a common source of radon exposure, convincing homeowners to test and mitigate for radon remains a challenge. A new communication strategy to increase radon testing among Kentucky homeowners utilizes fine-scale geologic map data to create detailed radon risk potential maps. We assessed the health benefits of this strategy via avoided lung cancer and associated premature mortality and quantified the economic value of these benefits to indicate the potential utility of using geologic map data in radon communication strategies.Methods: We estimated the change in radon testing among all 120 counties in Kentucky following a new communication strategy reliant on geologic maps. We approximated the resultant potential change in radon mitigation rates and subsequent expected lung cancer cases and mortality avoided among smokers and non-smokers exposed to 4 pCi/L of radon in the home. We then applied the value of a statistical life to derive the economic value of the expected avoided mortality.Results: The new communication strategy is estimated to help 75 Kentucky residents in 1 year avoid exposure to harmful radon levels via increased testing and mitigation rates. This equated to the potential avoidance of approximately one premature death due to lung cancer, with a net present value of $3.4 to $8.5 million (2016 USD).Conclusions: Our analysis illustrates the potential economic value of health benefits associated with geologic map data used as part of a communication strategy conveying radon risk to the public. Geologic map data are freely available in varying resolutions throughout the United States, suggesting Kentucky's radon communication strategy using geologic maps can be employed in other states to educate the public about radon. As this is only a single application, in a single state, the economic and health benefits of geologic map data in educating the public about radon are likely to exceed our estimates. [ABSTRACT FROM AUTHOR]

Radon exposure is the second leading cause of lung cancer, yet few Americans test their homes for radon, particularly in rural areas. The academic team and community partners engaged the public library systems in four rural counties to offer digital radon detectors for check-out as a means of increasing the public's access to free radon testing. The check-out procedures and instructional materials were created through an iterative process, and library personnel were educated on radon and home radon testing prior to launching the lending program. Library patrons reported high usability, feasibility, and acceptability of the program. Library patron-staff interactions mainly included discussions about the logistics of radon testing. Given that public libraries are invested in making communities thrive and promoting health, providing library lending programs for radon detectors is a novel, feasible, and acceptable way to reduce the risk of lung cancer in the community. • The radon detector library loan program was designed and evaluated using citizen science methods. • The radon detector library loan program was usable, feasible and acceptable to library patrons. • Library patrons were appreciative of having access to radon detector kits at no cost. • Public libraries can serve as partners to promote the health of communities. • Radon detector loan programs are innovative and attract community members who may not have otherwise utilized the library. [ABSTRACT FROM AUTHOR]

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

Objective The study examined the relationship between exposure to e-cigarette advertising and e-cigarette use by pregnancy status, including use of flavored e-cigarette products, among women of childbearing age. Design A cross-sectional, correlational design was used. Subjects Female current or former tobacco users in Central and Eastern Kentucky, 18-45 years old ( N = 194, 52% pregnant). Measures Demographics, pregnancy status, cigarette and e-cigarette use, and exposure to e-cigarette advertising. Results Younger age, white non-Hispanic race, and greater exposure to e-cigarette advertising were associated with a higher likelihood of ever using e-cigarettes ( p < .05 for each variable). Pregnancy was not associated with ever use ( p = .11). Younger age was associated with use of flavored e-cigarettes ( p = .0027). Among e-cigarette users, those who used flavored products were more likely to have seen advertisements or information about e-cigarettes on social media, compared to those who used unflavored e-cigarettes only ( p = .016). Conclusion There is a link between advertising exposure and ever use of e-cigarettes. Pregnancy status is not significantly associated with ever use. Use of flavored e-cigarettes is associated with younger age. E-cigarette users with greater exposure to advertising on social media were more likely to use flavored products. [ABSTRACT FROM AUTHOR]

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

Introduction: Tobacco use during pregnancy is the most modifiable risk factor associated with poor pregnancy outcomes. Self-reported tobacco use has been demonstrated to have high misclassification rates. The aims were to examine misclassification rates of perinatal tobacco use during each trimester of pregnancy and 8 weeks postpartum, and to evaluate characteristics associated with misclassification of tobacco use status.Methods: This is secondary analysis of a prospective, multicenter trial of pregnant women, and it includes participants who were biochemically identified as tobacco users during their first trimester (N = 103). Each trimester and once postpartum, tobacco use was assessed via self-report and validated using a cutoff of 100 ng/mL for urine cotinine via NicAlert test strips to indicate current use. Those who self-reported as nonusers but were identified as users via urine cotinine were considered misclassified; misclassification rates were determined for each time period. Logistic regression assessed maternal factors associated with misclassification status.Results: Misclassification rates declined from 35.0% at first trimester to 31.9% and 26.6% at the second and third; the postpartum rate was 30.4%. These rates did not differ significantly from each other at the 0.05 level. Race/ethnicity was associated with misclassification status; white/non-Hispanic women were 87% less likely to be misclassified (p < .001).Conclusion: Misclassification of prenatal smoking status decreases as pregnancy progresses, though the observed rate change was not significant. Minority women may be at particular risk for non-disclosure of tobacco use. Biochemical validation should be considered when assessing perinatal tobacco use via self-report, given high misclassification rates throughout the perinatal period.Implications: These results demonstrate that regardless of trimester, more than one-quarter of tobacco-using pregnant women may not disclose tobacco use throughout pregnancy and early postpartum. Although the rate of misclassification decreased from first to third trimester and then increased in the immediate postpartum, these changes in misclassification rates were not significant. Minority groups may be at particular risk of misclassification compared with white/non-Hispanic women. Biochemical validation is warranted throughout pregnancy to encourage cessation as tobacco use is one of the most easily-modified risk factors for poor birth outcomes. [ABSTRACT FROM AUTHOR]

Obesity is a key risk factor for Type 2 diabetes (T2D). Alarmingly, 87% of US adults have overweight or obesity, with non-Hispanic black adults having higher obesity and T2D prevalence than non-Hispanic white. The Diabetes Prevention Program (DPP) demonstrated the clinical benefits of lifestyle intervention (LI). While the DPP LI is effective, some participants don't achieve clinically significant weight loss in the current group-based translation paradigm. Black adults have the lowest adjusted weight loss (3.2%) among all racial/ethnic groups. Early intervention nonresponse defined as ≤1% weight loss at intervention week 4 is linked to lower probability of achieving weight loss goals. This paper describes the design and methods of a cluster randomized controlled trial among black weight loss nonresponders nested in 20 community sites (primarily churches). Descriptions of the adaptations made to transition the program to virtual format during the COVID-19 pandemic are also included. Trained community health workers deliver a group-based, 6-month long DPP over 18 sessions via Zoom. Additionally, nonresponders in the enhanced group receive weekly telephone support to provide individual-level intervention to help overcome weight loss barriers. Outcomes include weight, physical activity level, blood pressure, and dietary behaviors; these are compared between nonresponders in the enhanced intervention group and nonresponders in the active control group. Cost, mediators, and moderators are explored. If found to efficacious, these enhanced strategies could be standardized as a supplement for use with DPP nonresponders. [ABSTRACT FROM AUTHOR]

To achieve equity in protection from poor health outcomes due to tobacco use, tobacco control policies and interventions need to affect socially disadvantaged groups more strongly than advantaged groups. Flavored tobacco bans have been seen as a policy with this potential. However, tobacco control researchers, in close concert with policy advocates, need to consider how to center equity throughout the policy process to achieve equitable outcomes from banning flavored tobacco. In this commentary, we outline the rationale for how and why tobacco control researchers should consider equity throughout the policy process to help fully achieve the potential of flavored tobacco ban policies. These recommendations emerged from a presentation at the Vermont Center on Behavior and Health 2021 Conference. Specifically, we focus on recommendations for tobacco control researchers to center equity including partnering with communities in agenda setting, examining how various policy formulations or exemptions may increase or decrease disparities, determining where flavor policies need to reach and whether policies are equitably reaching all populations disproportionately burdened by flavored tobacco, assessing whether policy implementation/enforcement is carried out equitably to maximize policy benefits, and evaluating policy impact with as much granularity as possible. Considering the entire policy process is central to enhancing equitable outcomes from banning flavored tobacco. Tobacco control researchers can play a key role in ensuring that these policies are viewed through an equity lens to, not just improve population health, but also to reduce harms to those disproportionately burdened by use of flavored products. [ABSTRACT FROM AUTHOR]

Poor self-care is common among adults with heart failure and leads to poor health outcomes. Low self-efficacy, depression, and low social support are associated with poor self-care, but knowledge about these relationships in heart failure is limited. Secondary data analysis of cross-sectional data from 346 adults with heart failure measuring self-efficacy, depressive symptoms, social support, and self-care adherence was conducted. Tests of mediation using multiple linear regressions indicate that self-efficacy fully mediates the relationships between depression and adherence, and social support and adherence. Bolstering self-efficacy may have a greater impact on self-care adherence than targeting either depression or social support alone. [ABSTRACT FROM AUTHOR]

Purpose Patient triage systems have been used to prioritize referred patients to facilitate timely treatment of acutely ill patients, but there is limited data to support the effectiveness of these systems as implemented in the clinic setting. Therefore, the purpose of this study was to evaluate the accuracy of a specialty provider triage system. Data sources A prospective study design was conducted ( N = 103) to compare the pre- and postappointment provider-assigned, prioritization system acuity scores. The intraclass correlation coefficient (ICC), paired t-test, and the Bland-Altman plotting method were used to summarize and analyze the data. Conclusions The ICC between the pre- and postappointment acuity scores was 0.50 ( p < .001) with no significant difference between the average means ( t = −1.17; p = .24). The Bland-Altman plot suggests scores were typically within the limits of agreement. Our findings suggest the specialty provider triage system was effective at accurately classifying rheumatologic patient acuity in this sample. Implications for practice When resources are limited and delayed evaluations and treatments result in negative health outcomes, the use of triage systems is likely an effective strategy to reduce the impact of limited provider availability relative to patient census. [ABSTRACT FROM AUTHOR]

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

Purpose. To compare the retail distribution and density per population of electronic and conventional cigarettes in smoke-free communities with and without e-cigarette restrictions. Design. A cross-sectional study with field observations of retail tobacco stores. Setting. Two Central Kentucky counties with 100% smoke-free workplace regulations; counties selected on the basis of whether e-cigarette use was restricted. Subjects. Fifty-seven tobacco retailers in two counties, including conventional retailers and stand-alone e-cigarette stores. Measures. Type and location of store and products sold; addresses of stores and schools geocoded with ArcGIS. Analysis. Bivariate comparisons between counties, rates and confidence intervals for frequency of tobacco retailers and e-cigarette stores per population. Results. Fifty-three percent of tobacco retailers sold e-cigarettes. E-cigarette availability did not differ by whether smoke-free regulation covered e-cigarettes. Rates of tobacco retailers and e-cigarette distributors per 10,000 were 8.29 and 4.40, respectively, in the two-county area. Of the 40 schools, 88% had a tobacco retailer and 68% had an e-cigarette distributor within 1 mile. Conclusion. In this exploratory study, e-cigarette use restriction was not related to store availability. For a relatively new product, e-cigarettes were readily available in retail outlets and close to schools. [ABSTRACT FROM AUTHOR]

The article presents the study regarding the determination of secondhand smoke (SHS) exposure and its association with smoke-free laws in rural and urban communities. The methods for the assessment of particulate matter (PM) level to measure the indoor air quality in public places were developed. The results were outlined and concludes that the compliance with the smoke-free air laws is significant to protect the community population from SHS.

Background: Depressive symptoms and anxiety are common in heart failure patients as well as their spousal caregivers. However, it is not known whether their emotional distress contributes to their partner's quality of life (QoL). This study examined the effect of patients' and partners' depressive symptoms and anxiety on QoL in patient-spouse dyads using an innovative dyadic analysis technique, the Actor-Partner Interdependence Model (APIM).Method: A total of 58 dyads (patient: 43% in males, mean age 62 years, mean ejection fraction 34% +/-11, 43% in New York Heart Association III-IV) participated in the study. Depressive symptoms and anxiety were assessed using the Brief Symptom Inventory. QoL was assessed using the Minnesota Living with Heart Failure Questionnaire. Dyadic data were analyzed using the APIM with distinguishable dyad regression model. In APIM, actor effect is the impact of a person's emotional distress on his/her own QoL. Partner effect is the impact of a person's emotional distress on his/her partner's QoL.Result: Depressive symptoms exhibited actor effect of both patients (P<.001) and spouses (P<.001) and only partner effect of patients (P<.05) on QoL. Patients and spouses with higher depressive symptoms had poorer QoL. Patients whose spouses had higher depressive symptoms were more likely to indicate their own QoL was poorer. Anxiety has similar actor and partner effects on QoL as depressive symptoms.Conclusion: Interventions to reduce depression and anxiety and to improve patients' QoL should include both patients and spouses. [ABSTRACT FROM AUTHOR]

Physical activity behaviors of a cohort of college students were identified, along with environmental and institutional factors impacting physical activity. A cross-sectional survey of students (n = 531) was conducted. Environmental and institutional factors were examined including campus design, opportunity for physical activity, and emphasis on physical activity. In this study, 39% of students participated in vigorous physical activity compared to 42% nationally. A variety of institutional and environmental factors discouraging physical activity were identified. This study identified factors influencing physical activity, which is critical for making an impact at the population level. [ABSTRACT FROM AUTHOR]

Introduction: Many injury prevention interventions require changes in human behavior to reduce self-risk or risk to others. Promising injury prevention interventions may be discarded if they lack power to create a significant difference in outcomes when judging their ability to “move a person from nonaction or negative action to positive action (safety).” The transtheoretical model of change (TMC) allows greater sensitivity in detecting along the change process where an intervention may be effective. The stages of change consist of precontemplation, contemplation, preparation, action, maintenance, and termination. Change is not viewed as an “all or none phenomenon.” Method: Use of the TMC was examined using a quasiexperimental, cross-over design involving high school agriculture students enrolled in 21 schools in Kentucky (n=9), Iowa (n=7), and Mississippi (n=5). A series of physical and narrative simulations (safety training exercises) were developed with a focus on preventing amputation, spinal cord injury, hypersensitivity pneumonitis, and noise-induced hearing loss. Contemplation and action, as part of the TMC, were measured using a 10-item, Likert-type, stages of change (SOC) instrument comprised of two subscales (reliability coefficients were .88 and .81, respectively). The final sample consisted of 790 students (373 treatment and 417 control). Results: There was a significant group effect for both contemplation, F(1,732)=197.4; p<.0001, and action, F(1,730)=106.1; p<.0001. A convenience sample of 29 of the participating students was selected for follow-up farm visits 1 year postparticipation. Of these students, 25 (86%) had made safety behavior changes in their farm work. Impact on Industry: The use of the TMC model can provide researchers with greater precision in examining intervention effectiveness in promoting change. [Copyright &y& Elsevier]

Risk factors for child abuse and neglect and commonly used reporting mechanisms were highly affected by SARS-Cov-2 pandemic; yet, little is known about the effects of SARS-Cov-2 on rates of child abuse and neglect. To compare overall rates, demographics, types of abuse and acuity of child abuse and neglect encounters seen at one university health system for the 6 months before and after school closings due to the SARS-Cov-2 pandemic. Data was extracted from a database of billed ICD10 codes for child abuse and neglect including sexual abuse codes. There were 579 encounters for patients <18 years of age and 476 unique patients. In addition to ICD10 code and pre/post school closing, each encounter was identified to be inpatient, outpatient and/or emergency department. Demographic data such as age, gender, ethnicity, and race were extracted. Incident rate ratios in addition to descriptive statistics, Mann-Whitney U test, two-sample t -test, or the chi-square test of association were used in the analysis. No significant differences were identified for total rates of child abuse and neglect encounters (p =.08), physical abuse (p =.91) nor child maltreatment (p =.86) codes or in the age (p =.46), gender (p =.58), and race/ethnicity (p =.15) of patient encounters pre- versus post-school closings. The sexual abuse incidence and inpatient encounters increased by 85% (IRR = 1.85, p <.0001; IRR = 1.85, p =.004, respectively). Our findings provide a unique contribution to the existing literature in that we identified a significant increase in the incidence of sexual abuse and higher patient acuity as evidenced by higher rates of inpatient encounters after school closing due to SARS-Cov-2. • Overall rates, demographics and types and acuity of child abuse encounters were compared before and after the SARS-Cov-2 pandemic. • The sexual abuse incidence increased by 85% (IRR=1.85, p <.0001). • Total inpatient encounters for all types of child abuse and neglect increased by 85% (IRR=1.85, p =.004, respectively). • The increased rates of child sexual abuse after school closing due to SARS-Cov-2 are unreported in published literature. [ABSTRACT FROM AUTHOR]

Background: To compare relative rates of pediatric poisoning before and after COVID-19, including by demographic and urban-rural status, and by agent identified, using data from one university healthcare system and children's hospital., Methods: Using retrospective, cross sectional design from deidentified healthcare claims data, we extracted all encounters with the ICD-10-CM for Poisoning by, Adverse effects of, and Underdosing of drugs, medicants and biological substances (T36-T50) and grouped the encounters as those after state mandates regulating activity came into effect (Post-COVID-19 (3/17/2020-3/18/2021)) Pre-COVID-19 (3/18/2019-3/17/2020). We then compared poisoning agent, age at the time of the encounter, recorded sex, race, ethnicity, rural/urban residence, and visit type using Mann-Whitney U test, chi-square test of association, incidence rates and incident rate ratios between the time periods., Findings: The sample included 1608 unique patients 0-17 years of age and 4216 encounters. We also identified IRRs >1 in nearly every demographic subgroup with the exception of Non-Hispanic Blacks. The comparison of specific drugs or medicants identified a significant decrease in poisoning by Systemic antibiotics (T36); but an increase in Hormones and their synthetic substitutes and antagonists (T38), Non opioid analgesics antipyretic and antirheumatic (T39), Psychotropic Drugs (T39) and Systemic and hematologic agents (T45)., Conclusion: This study identifies pediatric subgroups highly affected by pediatric poisoning during the time-period immediately after the identification of COVID-19 and characterizes the drugs commonly associated with poisonings., Application to Practice: With a further understanding nursing has the potential to impact pediatric poisoning in the inpatient, outpatient and public health setting., Competing Interests: Declaration of competing interest Authors do not have any interests to report related to this work., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Background: Family caregivers are at higher risk for developing cardiovascular disease (CVD) than non-caregivers. This risk is worse for those who live in rural compared to urban areas. Health activation, an indicator of engagement in self-care, is predictive of health outcomes and CVD risk in several populations. However, it is not known whether health activation is associated with CVD risk in rural caregivers of patients with chronic illnesses nor is it clear whether sex moderates any association., Objectives: Our aims were to determine (1) whether health activation independently predicts 10-year CVD risk; and (2) whether sex interacts with health activation in the prediction of 10-year CVD risk among rural family caregivers (N = 247) of patients with chronic illnesses., Methods: Health activation was measured using the Patient Activation Measure. The predicted 10-year risk of CVD was assessed using the Framingham Risk Score. Data were analyzed using nonlinear regression analysis., Results: Higher levels of health activation were significantly associated with decreased risk of developing CVD (p < 0.028). There was no interaction of sex with health activation on future CVD risk. However, male caregivers had greater risk of developing CVD in the next 10 years than female caregivers (p < 0.001)., Conclusions: We demonstrated the importance of health activation to future CVD risk in rural family caregivers of patients with chronic illnesses. We also demonstrated that despite the higher risk of future CVD among male, the degree of association between health activation and CVD risk did not differ by sex., (© 2024 National Rural Health Association.)