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BackgroundChronic illness burdens some groups more than others. In studies of ethnic/racial groups with chronic illness, some investigators have found differences in health-related quality of life (HRQL), whereas others have not. Few such comparisons have been performed in persons with heart failure. The purpose of this study was to compare HRQL in non-Hispanic white, black, and Hispanic adults with heart failure.MethodsData for this longitudinal comparative study were obtained from eight sites in the Southwest, Southeast, Northwest, Northeast, and Midwest United States. Enrollment and 3- and 6-month data on 1212 patients were used in this analysis. Propensity scores were used to adjust for sociodemographic and clinical differences among the ethnic/racial groups. Health-related quality of life was measured using the Minnesota Living with Heart Failure Questionnaire.ResultsSignificant ethnic/racial effects were demonstrated, with more favorable Minnesota Living with Heart Failure Questionnaire total scores post-baseline for Hispanic patients compared with both black and white patients, even after adjusting for baseline scores, age, gender, education, severity of illness, and care setting (acute vs. chronic), and estimating the treatment effect (intervention vs. usual care). The models based on the physical and emotional subscale scores were similar, with post hoc comparisons indicating more positive outcomes for Hispanic patients than non-Hispanic white patients.ConclusionCultural differences in the interpretation of and response to chronic illness may explain why HRQL improves more over time in Hispanic patients with heart failure compared with white and black patients.

Background: Tobacco media campaigns are effective, but less is known regarding the impact on college students. Purpose: The purpose was to test the effects of an on-campus Tips television campaign on frequency and believability of ads recalled and to assess demographic and personal factors associated with believability. Methods: A quasi-experimental pre-post design was used to assess the 8-week campaign with 3 Tips ads. Two randomly selected cohorts of college students (N = 1593) from a large public university completed online surveys pre- and postcampaign. Group comparisons using chi-square tests, 2-sample t tests, and logistic regression, controlling for residence or cohort, and predictors of believability using proportional odds modeling were examined. Results: Ads were recalled by significantly more students (68%) postcampaign. Believability for one or more ads was lower for males, undergraduates, those belonging to fraternity/sorority, and current polytobacco users (P < 0.05). Believability was greater for those who recalled seeing the ads more often (P < 0.05). Discussion: Subgroups of college students, including males and undergraduates, reported less ad believability, which should be considered when designing communication strategies. Translation to Health Education Practice: Considering the potential impact and cost-effective nature of on-campus TV media campaigns, these ads need to be integrated into current campus tobacco control strategies.

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

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.

This paper projects the long term consequences of the rise in youth smoking in the1990s by updating the state estimates for projected smoking-related deaths among youthin the U.S. using information from the Behavioral Risk Factor Surveillance System(BRFSS) 2000 and the U.S. Census 2000. This analysis is similar to that from an earlierstudy published by the Centers for Disease Control and Prevention (CDC), Office onSmoking and Health (MMWR, 45[44], November 8, 1996). The 1996 analysis usedyoung adult smoking prevalence data from 1994 and 1995; whereas, the analysispresented here represents smoking prevalence data from 2000. The overall number ofpotential future smoking-attributable deaths among persons aged 0-17 years in 2000 was6,407,119 for the U.S., up from an estimated 5 million in 1995.Compared with the 1995 estimates, every state except Arizona shows increases inprojected smoking-related deaths among youth for 2000. This upsurge is attributable toboth increases in smoking prevalence among young adults and population aged 0-17years from 1995 to 2000. The increase in smoking prevalence among young adults wasstatistically significant in nine states including Alabama, District of Columbia, Iowa,Kentucky, Nevada, North Dakota, South Carolina, South Dakota, and Vermont.With increasing attention and funding for comprehensive, research-based tobaccocontrol programs in the U.S., one would expect smoking rates to decline over time,resulting in a reduction in projected smoking-related deaths among youth. The analysisreported here does not yet reflect this trend. This study clearly demonstrates that basedon recent smoking patterns, there will continue to be a huge public health toll fromtobacco. The results from this new analysis will be useful to states as they determine theoverall public health benefits from increasing the state excise tax and consider fundingfor comprehensive tobacco control programs.

Objective: Assess impact and feasibility of a Tobacco-Free Ambassador Program on campus policy compliance. Participants: Trained Ambassadors made 253 visits to campus sites over 15 months to observe and/or approach violators. Methods: Policy violators were observed at 23 locations during Wave 1 (April-June 2012) and/or Wave 2 (April-June 2013). For locations with at least 5 visits, average violators per visit were compared between the 2 waves using a paired t test. Attributes of violators were summarized. Cigarette butts were collected over 3-day periods in 4 campus hotspots during each wave. Personnel time and cost to implement the program were determined. Results: There were declines in observed violators per Ambassador visit and number of cigarette butts over time. Rate of violators per visit declined from 5.47 to 1.93, a 65% decrease. Personnel time was equal to 1.5 full-time equivalents annually. Conclusions: The Ambassador Program was a feasible and potentially effective strategy to increase policy compliance.

Examine the prevalence of concurrent cannabis/THC vaping among those transitioning from high school to college who had ever used e-cigarettes and identify sociodemographic and personal factors associated with risk of cannabis/THC vaping among students in this population. Incoming undergraduate students reporting ever using e-cigarettes (N = 529) attending a public university in the southeastern United States. Cross-sectional survey administered November 2018. Comparisons of sociodemographic and personal characteristics between those who had vaped cannabis/THC and those who had not were done using chi-square test of association, or Fisher's exact test or the two-sample t-test. Predictors of cannabis/THC vaping status were determined using logistic regression. Slightly more than a quarter had ever vaped cannabis/THC (26%). Of those who had ever vaped with cannabis/THC, most said they used cannabis/THC "sometimes" when they vaped (78%). The significant predictors of cannabis/THC vaping status included membership or planned membership in a fraternity or sorority, ever use of alcohol, level of stress, number of five closest friends who currently use marijuana, and whether family member(s) use marijuana. Collaborative tailored prevention and treatment efforts are needed on college campuses to curb vaping/use of cannabis and resulting polysubstance use. [ABSTRACT FROM AUTHOR]

Background: Radon is a leading cause of lung cancer, but few test their homes to determine radon levels. Purpose: The study assessed feasibility and success of a Test and Win Contest to promote radon testing in rural and urban communities. Methods: The prospective, quasi-experimental study tested a novel contest to raise radon awareness. Paid and earned media recruited homeowners who received a free test kit and were eligible to win free home mitigation. Urban homeowners with the 5 highest radon levels and rural participants with the 3 highest won free radon mitigation systems. Cross-sectional surveys were completed via Internet or phone at enrollment. Results: Most returned the radon test kits (71% urban; 86% rural). Participation was more prevalent in the rural location most likely due to longer media recruitment (6 weeks vs. 11 days) and more money spent on media advertising ($1.86 vs. $0.21 per eligible household). The contest attracted 102 per 10,000 households to test for radon in the rural area compared to 19 per 10,000 households in urban counties. Discussion: The contest was a feasible and successful population-based strategy in both locations. Translation to Health Education Practice: The Test and Win Contest is a promising health education strategy to promote radon testing.

Objective: The purpose is to describe psychometric testing and feasibility of the Tobacco-Free Compliance Assessment Tool (TF-CAT) to measure tobacco-free policy compliance at a public university and medical center. The aims are to (1) investigate concurrent validity by comparing the number of cigarette butts in areas covered by the policy with those on adjacent sidewalks; (2) evaluate the interrater reliability of the TF-CAT; and (3) describe the feasibility of using the TF-CAT. Methods: Phase I was a pilot study on the health care campus. Phase II was baseline of an intervention study on the main campus. Cigarette butts and smokers were counted in hot spots. Validity was assessed using Mann-Whitney U and Geographical Information System Analysis methods. Results: There was some support for the validity and high interrater reliability. Data collectors spent 1 hour per week for 8 weeks during Phase I, and 31 hours in 1 week during Phase II. Conclusion: TF-CAT is a feasible, time-intensive method to measure tobacco-free policy compliance. (Contains 3 tables and 2 figures.)

The study purpose was to test the effect of a school- and home-based alcohol, tobacco, and other drug (ATOD) prevention program on reducing environmental, parent, and child risk factors for ATOD use. The design was a three-group pretest-posttest with interviews at baseline and 1 and 6 months post-intervention. The sample was 126 parents and their 5- to 6-year-old children from three elementary schools serving high-risk children. The quality of the home environment, parents' depressive symptoms and school activity involvement, and parents' perception of child adjustment were measured. A school- and home-based version of Beginning Alcohol and Addictions Basic Education Studies (BABES) with a parent-child interaction component (BABES Plus) was compared to a classroom-only version of BABES (BABES Only) and a no-treatment control group. The quality of the home environment improved and depressive symptoms decreased over the post-intervention period for the BABES Plus group, but not for the other two groups. The BABES Only group had greater parent involvement in school activities at 6 months post-intervention, compared to the other groups. Children's anxiety/withdrawal decreased and social competence increased over time for all groups. The effect of the BABES Plus intervention was demonstrated at 6 months for environmental and parental risk factors.

Objectives: To examine the relationship of demographic and social influence with initiation of cigarette use among undergraduates. Methods: Students were mailed anonymous surveys including 437 participants who indicated that they had not smoked cigarettes before age 18. Of those, 107 became late initiators (24%), and 330 remained never smokers (76%). Results: Those who drank alcohol in college and had at least 1 parent with a college education were more likely to initiate smoking than were those who did not drink and neither parent had attended college. Conclusions: Strategies that focus on reducing alcohol and tobacco use need to be tested.

Purpose: The purposes of this pilot study were to examine prevalence of depressive symptoms among rural adolescents and identify related social and environmental variables. Methods: A convenience sample of 299 14- to 18-year-old agriculture class students at 5 rural high schools in Kentucky and Iowa completed a survey that included demographic information, family farm history, experience with suicide, perception of school environment, and indicators of farm injuries and risky behaviors. Participants also completed the Center for Epidemiologic Studies Depression Scale (CES-D) as well as scales to assess the number of major life events in the last year, active coping use, and family closeness. Findings: The prevalence of a high level of depressive symptoms (CES-D greater than 16) in this sample was 34%. Nine percent had seriously considered suicide in the last year. Unlike previous reports, boys reported as many depressive symptoms as girls. Although the literature reports that engaging in risky behavior is associated with depressive symptoms, the only risky behavior linked with depressive symptoms in this sample was operating a 4-wheel all-terrain vehicle. Other predictors of depressive symptoms included poor family relationships and poor active coping. Conclusions: Interventions to identify and prevent depressive symptoms in rural adolescents are needed. Boosting active coping and improving family function may also prevent the development of clinical depression in rural adolescents.

This study examined factors associated with tobacco-free policies and tobacco cessation in schools serving children in grades 6 to 12 in a tobacco-growing state using a cross-sectional telephone survey of school administrators from public and private middle and high schools (N = 691), representing 117 of the 120 Kentucky counties. Trained health department staff contacted 1028 schools; 691 (67%) participated in a phone survey, which lasted an average of 19 minutes. Variables of interest were indoor and outdoor smoking policies, fund-raising in Bingo halls, provision of cessation and prevention programs, owning or leasing a tobacco base, if the school received money from tobacco companies, type of school (public vs private), and school setting (urban vs rural). Only 20% of Kentucky schools reported comprehensive tobacco-free policies. Urban area schools were nearly twice as likely to have a tobacco-free campus than rural schools. Schools that did fund-raising in smoky Bingo halls were 30% less likely to have tobacco-free school policies. While few schools had a tobacco affiliation, those that received money from tobacco companies or grew tobacco were nearly 3 times as likely to provide cessation resources, compared to schools without tobacco affiliation. Rural schools were less likely to be tobacco free and provide cessation services. School-related, off-campus, extracurricular events might be considered as an element of tobacco-free school policy. Schools with tobacco affiliation may provide more cessation resources due to the increased prevalence of tobacco use in these areas.

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

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