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While perinatal marijuana use is increasing, limited research exists related to its use during pregnancy among vulnerable subpopulations of women with disabilities. The purpose of this study is to assess marijuana use in pregnant U.S. women with disabilities.The analytic sample using 2015-2019 National Survey on Drug Use and Health (NSDUH) data included 3657 pregnant women. Descriptive statistics were performed and adjusted logistic regression models estimated the size and direction of the association between the type of disability and marijuana use.Approximately 13.0% of pregnant women with disabilities used marijuana in the past month, which was higher than pregnant women without disabilities (4.4%). The highest prevalence of past month marijuana use was observed among pregnant women with sensory disabilities (17.2%) followed by women with cognitive disabilities (14.6%) and daily living limitations (11.7%). Marijuana use was also associated with younger age (≤ 25 years old), Black non-Hispanic, high school education or less, non-married, and past month alcohol/tobacco use. Overall, pregnant women with any disability, and particularly those with sensory disabilities (AOR 2.32, 95% CI 1.21, 4.47), were significantly more likely (AOR 1.65, 95% CI 1.02, 2.69) to use marijuana than their counterparts without disabilities.The higher prevalence of marijuana use among pregnant women with disabilities in this study supports the American College of Obstetricians and Gynecologists recommendations for universal screening of maternal substance use. Screening for marijuana use in vulnerable populations is crucial and it may require training of health care providers to administer such screenings to women with disabilities.

Despite the high prevalence of depression among older Korean Americans (KAs), there has been very little research on depression literacy among older KAs. This study identified specific areas of improvement in depression literacy to address mental health promotion among KAs. Twenty-two items on the depression literacy scale were grouped under five key themes: incidence and prognosis, differential symptoms, symptom recognition, non-pharmacological effectiveness, and pharmacological knowledge. This study aimed to assess the level of understanding depression literacy based on five domains and identify factors associated with depression literacy and its domains among older KAs.A cross-sectional study with 178 KAs aged 60 years and older was conducted in the Washington DC Metro area. Interviewer and self-administered questionnaires were used to collect data. Multiple linear regression analyses were conducted to identify factors associated with depression literacy and its domains. Statistical significance was set at p .05 for analyses.Knowledge pertaining to all 5 depression literacy domains was low, particularly on pharmacological treatment and differential symptoms were noticeably low. The majority of participants had misconceptions about antidepressants. 86% believed that antidepressants can have a rapid effect on symptoms, 82.6% believed people with depression should stop taking antidepressants as soon as they feel better, and 66.3% believed antidepressants were addictive.Misperception about depression and antidepressants may be associated with poor mental health outcomes among older KAs. Culturally-tailored education for older KAs with limited English proficiency could be beneficial in promoting depression literacy and reducing stigma or misconceptions regarding depression and treatments.

The popularity of e-cigarette use among young adults is a growing concern. However, little is known about factors associated with e-cigarette use in pregnant women and birth outcomes. In this retrospective cohort study, we evaluated the influence of several factors on behavioral changes in e-cigarette use before and during pregnancy, and assessed the association between e-cigarette use and subsequent birth outcomes among pregnant women. The Population Assessment of Tobacco and Health (PATH) study, a government-sponsored national longitudinal study based in the US, Waves 1 through 4 (2013-2018) were used. Multivariate logistic regressions were conducted to estimate behavioral changes in e-cigarette use during pregnancy and subsequent influence on high-risk birth (e.g., preterm birth, low birth weight, birth defects, etc.) and fetal death. Although pregnant women who quit vaping before pregnancy (OR = 1.14, 95% CI 0.54-2.40) or had any use during pregnancy (OR = 1.19, 95% CI 0.38-3.73) showed non-differential risk of having a high-risk birth in comparison to women who did not initiate vaping, we observed that the usage of mint/menthol flavor was correlated with higher risk of fetus death (OR = 3.27, 95% CI 1.17-9.19). Healthcare providers should encourage e-cigarette users to quit prior to and during early pregnancy.

Hospice care facilities are required to provide prescription drugs related to a hospice patient’s terminal illness. From October 2010 to present, the Center for Medicare and Medicaid Services (CMS) has issued a series of communications regarding Medicare paying for hospice patients’ prescription drugs under Part D that should be covered under the hospice Medicare Part A benefit. On April 4, 2011, CMS issued specific policy guidance to providers aimed at preventing inappropriate billing. While CMS has documented Part D prescription decreases in hospice patients, no research exists that connects these decreases and the policy guidance. This study aims to evaluate the effect of the April 4, 2011, policy guidance on hospice patients’ Part D prescriptions. This study employed generalized estimating equations to assess (1) total monthly average prescriptions of all medications and (2) four categories of commonly prescribed hospice medications in pre-and-post policy guidance. This research used the Medicare claims of 113,260 Part D-enrolled Medicare male patients aged 66 and older between April 2009 and March 2013, including 110,547 non-hospice patients and 2713 hospice patients. Hospice patients’ monthly average total Part D prescriptions decreased from 7.3 pre-policy guidance to 6.5 medications following the issuing of the guidance, while the four categories of hospice-specific medications decreased from .57 to .49. The findings of this study show that CMS’s guidance issued to providers to prevent the inappropriate billing of hospice patients’ prescriptions to the Part D benefit may lead to Part D prescription decreases as observed in this sample.

Evidence-based practice (EBP) is crucial in keeping nurses aware of the current knowledge and improving clinical decision-making. The integration of nurses’ EBP competencies and organizational support has been suggested to create an effective arena in implementing EBP. The purpose of the study was to examine organizational factors influencing nurses’ EBP knowledge, attitudes, and implementation and identify staff nurses’ perceptions of EBP nursing leadership and hospital supports in Saudi Arabia. Data were collected from a convenience sample of staff nurses (N = 227) working in four hospitals using a cross-sectional, correlational descriptive design. Level of education (p < 0.05), EBP training (p < 0.05), unit type (ICU (p < 0.001) and ER (p < 0.01)), perceived nursing leadership (p < 0.001), and work environment (p < 0.05) supports were found significantly associated with nurses’ knowledge. Magnet recognition (p < 0.01) and knowledge (p < 0.001) had significant influence on nurses’ attitudes. Unit type (ER) (p < 0.05), knowledge (p < 0.001), and attitudes (p < 0.001) were associated with implementation. Encouragement to attend EBP trainings from nursing leadership was perceived by most nurses (51.1%). Nurses reported their hospitals support EBP through training (68.2%). Findings support the need for healthcare systems to create a culture that facilitates EBP implementation to enhance nurses’ EBP competencies and improve patients’ outcomes. Nursing managers may consider preparing nurses through education.

The objectives of this study were to estimate the prevalence of sexually transmitted infections in women of reproductive age by disability type and examine the association between disability types, participant characteristics, and the prevalence of sexually transmitted infections (STIs).Pooled data from 2015 to 2019 National Survey on Drug Use and Health were analyzed in 2022. The analytic sample included 90,233 women of reproductive age (18-49 years). Disability was defined as having any sensory, cognitive, physical, or ≥2 disabilities.. A total of 15% of women reported having a disability. Descriptive analyses were used to estimate the prevalence of STI, and logistic regression analyses were conducted to examine the association of disability type and other participant characteristics with the odds of having STIs..The prevalence of STIs was more than twice as high for women of reproductive age with cognitive disabilities (6.8%) or ≥2 disabilities (6.7%) as for those without disabilities (2.7%). Women with sensory disabilities (AOR=1.47; 95% CI=1.17, 1.85), cognitive disabilities (AOR=1.89; 95% CI=1.65, 2.17), or ≥2 disabilities (AOR=1.78; 95% CI=1.49, 2.14) had greater odds of STIs than those without disabilities. Bisexual women had higher odds (AOR=1.31; 95% CI=1.14, 1.50) of STIs than straight women, whereas lesbian/gay women had lower odds (AOR=0.41; 95% CI=0.27, 0.63). The odds of STIs were higher among non-Hispanic Blacks (AOR=1.42; 95% CI=1.24, 1.63) and lower among Asian women (AOR=0.62; 95% CI=0.43, 0.90) than among non-Hispanic Whites. The odds of STIs were also greater among participants having any alcohol, cannabis, or illicit drug use.Women of reproductive age with disabilities have a higher prevalence of sexually transmitted infections. In addition to disability type, the odds of sexually transmitted infections varied by race/ethnicity, sexual orientation, and substance use.

The purpose of this study was to examine associations between opioid use and the degree of mental health-related disability due to emotional/behavioral problems as measured by the World Health Organization Disability Assessment Schedule (WHODAS) instrument in a national sample of pregnant women. We used data from the National Survey on Drug Use and Health 2014–2017 which included 2,888 pregnant women 18 years or older. The WHODAS instrument was utilized to measure disability as the degree of functional impairment due to emotional/behavioral problems experienced by the respondent. Multinomial logistic regression models were built to assess the magnitude and direction of the association between severity of mental health-related disability with opioid use and abuse/dependency in the past year. Approximately 30% of pregnant women suffered from moderate/severe mental health-related disability, and 2% reported opioid abuse/dependency. Compared to those with no opioid use, the odds of opioid use in the past year for individuals with moderate/severe mental health-related disability were 1.73 (95% CI 1.36, 2.21) times higher than those with no/mild disability. Similarly, the odds of opioid abuse/dependency were at least three times higher (OR 3.51; 95% CI 1.80, 6.84) among those with moderate/severe mental health-related disability relative to pregnant women with no/mild disability. Clinicians should consider screening for both opioid use and mental health conditions and related disabilities using screening tools such as the WHODAS during the initial prenatal visits.

BACKGROUND: Workplace burnout among healthcare professionals is a critical public health concern. Few studies have examined organizational and individual factors associated with burnout across healthcare professional groups. OBJECTIVE: The purpose of this study was to examine the association between practice adaptive reserve (PAR) and individual behavioural response to change and burnout among healthcare professionals in primary care. DESIGN: This cross-sectional study used survey data from 154 primary care practices participating in the EvidenceNOW Heart of Virginia Healthcare initiative. PARTICIPANTS: We analysed data from 1279 healthcare professionals in Virginia. Our sample included physicians, advanced practice clinicians, clinical support staff and administrative staff. MAIN MEASURES: We used the PAR instrument to measure organizational capacity for change and the Change Diagnostic Index© (CDI) to measure individual behavioural response, which achieved a 76% response rate. Logistic regression analysis was used to estimate the effects of PAR and CDI on burnout. KEY RESULTS: As organizational capacity for change increased, burnout in healthcare professionals decreased by 51% (OR: 0.49; 95% CI, 0.33, 0.73). As healthcare professionals showed improved response toward change, burnout decreased by 84% (OR: 0.16; 95% CI, 0.11, 0.23). Analysis by healthcare professional type revealed a significant association between high organizational capacity for change, positive response to change and low burnout among administrative staff (OR: 2.92; 95% CI, 1.37, 6.24). Increased hours of work per week was associated with higher odds of burnout (OR: 1.07; 95% CI, 1.05, 1.10) across healthcare professional groups. CONCLUSION: As transformation efforts in primary care continue, it is critical to understand the influence of these initiatives on healthcare professionals’ well-being. Efforts to reduce burnout among healthcare professionals are needed at both a system and organizational level. Building organizational capacity for change, supporting providers and staff during major change and consideration of individual workload may reduce levels of burnout. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s11606-020-06367-z.

Suicidal behaviors during pregnancy are prevalent and have the potential to adversely affect a woman's health and her developing infant. The purpose of this study was to examine prevalence and correlates of suicidal behaviors in a national sample of pregnant women. Using data from the 2009-2018 National Survey on Drug Use and Health, a sample of 7479 pregnant women was analyzed. Multiple logistic regression was used to examine associations between sample characteristics and suicidal behaviors overall and by pregnancy trimester. In this sample, 3.4% of women exhibited suicidal behaviors such as ideation, planning, and attempt. Suicidal behaviors were more prevalent at 4.4% among women in the first trimester compared to the second/third trimesters (2.9%). Of those exhibiting suicidal behavior, 63.0% were ideators, 18.9% planned suicide, and 18.1% attempted suicide. Logistic regression analyses revealed that all racial/ethnic groups of women in the third trimester were less likely to be suicidal relative to black non-Hispanic women. Alcohol abuse (OR 3.70, 95% CI 1.97, 6.81) and major depressive episode (OR 4.91, 95% CI 3.10, 7.84) in the past year significantly increased the odds of suicidality for all pregnant women. Perceived unmet need for treatment increased the likelihood (OR 5.64, 95% CI 3.55, 8.97) of suicidal behavior regardless of trimester. These findings underscore the importance of screening for suicidal behaviors in the first trimester, especially among those with existing mood disorders and substance abuse. Racial/ethnic differences should be considered in targeted interventions for suicide prevention.

This study was designed to examine prenatal marijuana use in pregnant women with disabilities related to mental health. Almost one-third (28.8%) of 3805 pregnant women reported a mental hea...

AIMS To examine prevalence of bullying among nurses and explore associations of organizational betrayal and support with well-being among nurses exposed to bullying. BACKGROUND Bullying is a problem in many nursing workplaces, and organizations have an obligation to support nurses who are bullied. Support or betrayal after bullying could affect nurse well-being, including burnout. METHODS In this cross-sectional study among U.S. nurses, data were collected in a survey using the Negative Acts Questionnaire-Revised for Nursing, the Institutional Betrayal Questionnaire for Health, the Well-Being Index, a job satisfaction scale and demographic questions. RESULTS Prevalence of weekly/daily bullying was 31% (N = 242). Among nurses exposed to any bullying (N = 173), organizational betrayal increased odds of burnout (OR 2.62, p = .02), job dissatisfaction (OR 2.97, p = .04) and absenteeism (OR 6.11, p

Objective: The main objective of this work was to characterize the prevalence of acute medical needs by examining emergency department (ED) and outpatient wound care clinic (WCC) visits before, during, and after the 2017 Hurricanes Irma and Maria, in St. Thomas, United States (U.S.) Virgin Islands. Methods: Descriptive statistics and logistic regression were used to assess associations between the occurrence of the storms and visits due to injuries and chronic conditions presented to the ED and WCC from September 1, 2016 to May 31, 2018. Results: ED visits increased and the rate of injury care was higher during the storms (12 patient visits per day) than before or after the storms (9 patient visits per day). WCC visits increased during (12%) and after the storms (45%), and were associated with patients 60 years and older. The odds of ED and WCC visits due to injury during the storms were significantly higher (odds ratio [OR]: 1.28, 95% confidence interval [CI]: 1.17, 1.40) than prior to the storms. The odds for visits due to injuries were 1.19 (95% CI: 1.12, 1.28) times higher after the storms. Conclusions: Increases occurred in ED and WCC visits for injury care during the storms and in WCC visits after the storms. Public health preparedness mandates understanding how major hurricanes impact the prevalence of acute medical needs, and the factors that influence decisions to seek medical care, in their wake.

Introduction Breastfeeding rates among women participating in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) are lower compared with those of nonparticipants. The objective of this study was to assess racial and ethnic differences in self-reported reasons for breastfeeding cessation during the first year postpartum. Methods This was a secondary analysis of data from women participating in the WIC Infant and Toddler Feeding Practices Study-2. Women specified reasons that influenced their decision to stop breastfeeding during telephone interviews between 1 and 13 months postpartum. Logistic regression models for each racial and ethnic group explored the effects of sociodemographic variables on each reason. Results The sample for this analysis included 4095 women (34.1% non-Hispanic white, 25.5% non-Hispanic black, and 40.4% Hispanic). Across all race and ethnic groups, food security status was a predictor of some but not all reasons for breastfeeding cessation. Compared with their counterparts who were food secure, white women with low food security and black women with very low food security were more likely (odds ratio [OR], 1.86; 95% CI, 1.04-3.35 and OR, 1.86; 95% CI, 1.19-2.90, respectively) to stop breastfeeding because they wanted or needed someone else to feed their infants. Hispanic women with very low food security were more likely to stop breastfeeding because they felt they did not have enough milk. Compared with their multiparous counterparts, primiparous black and white women were almost twice as likely to stop breastfeeding because of trouble sucking or latching. Hispanic and black women born outside the United States had significantly higher odds of breastfeeding cessation because of the infant losing interest compared with US-born women. Education and marital status significantly predicted reasons for breastfeeding cessation among Hispanic and white women. Discussion Among women participating in WIC, food security, parity, country of birth, education, and marital status were significant predictors of reasons for breastfeeding cessation across racial and /ethnic groups. Incorporating these findings in education, counseling, and interventions may help overcome breastfeeding barriers.

Objective The purpose of this study was to examine the association between respiratory syncytial virus (RSV) infection in early infancy and health conditions such as asthma and respiratory allergies at 6 years of age in a cohort of US children born at term with no medical issues at birth. Methods Data (1542 records) from the Infant Feeding Practices Study II and the Year Six Follow-Up study were used in the analysis. Descriptive statistics and logistic regression were conducted to estimate the magnitude and direction of potential associations between children's health conditions such as asthma, hay fever, or respiratory allergy, and RSV infection during infancy. Results A substantial proportion of children with RSV infection in infancy were reported to have developed asthma (10.3%) and hay fever or respiratory allergy (9.4%) by 6 years of age. Analyses revealed that children with RSV infection in infancy were more likely to develop asthma (odds ratio 1.99, 95% confidence interval 1.06-3.74), and hay fever or respiratory allergy (odds ratio 2.13, 95% confidence interval 1.28-3.57) by 6 years of age. In addition, the risk of developing asthma and hay fever or respiratory allergy by 6 years of age increased considerably with a family history of these conditions. Conclusions Our findings support the need for understanding and monitoring the long-term health outcomes of RSV infection in infancy. Appropriate prevention and treatment measures for RSV infection during infancy may reduce the incidence of associated long-term adverse health outcomes. Knowledge of the long-term complications of RSV infection in infancy, such as asthma, hay fever, or respiratory allergy, can aid in the prevention and better management of these health conditions.

Introduction Military veterans continue to struggle with addiction even after receiving treatment for substance use disorders (SUDs). Identifying factors that may influence SUD relapse upon receiving treatment in veteran populations is crucial for intervention and prevention efforts. The purpose of this study was to examine risk factors that contribute to SUD relapse upon treatment completion in a sample of U.S. veterans using logistic regression and classification tree analysis. Materials and Methods Data from the 2017 Treatment Episode Data Set—Discharge (TEDS-D) included 40,909 veteran episode observations. Descriptive statistics and multivariable logistic regression analysis were conducted to determine factors associated with SUD relapse after treatment discharge. Classification trees were constructed to identify high-risk subgroups for substance use after discharge from treatment for SUDs. Results Approximately 94% of the veterans relapsed upon discharge from outpatient or residential SUD treatment. Veterans aged 18-34 years old were significantly less likely to relapse than the 35-64 age group (odds ratio [OR] 0.73, 95% confidence interval [CI]: 0.66, 0.82), while males were more likely than females to relapse (OR 1.55, 95% CI: 1.34, 1.79). Unemployed veterans (OR 1.92, 95% CI: 1.67, 2.22) or veterans not in the labor force (OR 1.29, 95% CI: 1.13, 1.47) were more likely to relapse than employed veterans. Homeless vs. independently housed veterans had 3.26 (95% CI: 2.55, 4.17) higher odds of relapse after treatment. Veterans with one arrest vs. none were more likely to relapse (OR 1.52, 95% CI: 1.19, 1.95). Treatment completion was critical to maintain sobriety, as every other type of discharge led to more than double the odds of relapse. Veterans who received care at 24-hour detox facilities were 1.49 (95% CI: 1.23, 1.80) times more likely to relapse than those at rehabilitative/residential treatment facilities. Classification tree analysis indicated that homelessness upon discharge was the most important predictor in SUD relapse among veterans. Conclusion Aside from numerous challenges that veterans face after leaving military service, SUD relapse is intensified by risk factors such as homelessness, unemployment, and insufficient SUD treatment. As treatment and preventive care for SUD relapse is an active field of study, further research on SUD relapse among homeless veterans is necessary to better understand the epidemiology of substance addiction among this vulnerable population. The findings of this study can inform healthcare policy and practices targeting veteran-tailored treatment programs to improve SUD treatment completion and lower substance use after treatment.

OBJECTIVE: To report and examine associations with infant vitamin D intake and meeting recommendations among a national sample participating in WIC. DESIGN: Secondary analysis from the 2013–2015 WIC Infant Toddler Feeding Practices Study-2. PARTICIPANTS: US Infants. VARIABLES MEASURED: Total reported vitamin D intake from diet and supplementation at the time of data collection. ANALYSIS: Descriptive statistics and generalized estimating equations. RESULTS: The median total vitamin D intake ranged from 5.43 (95% CI: 5.40, 5.46) mcg/day at month 1 to 8.18 (95% CI: 8.11, 8.20) mcg /day at month 13, with 16–36% of infants meeting the infant vitamin D recommendation over that time. Overall 6 to 12% of all participants reported supplementation, across all time points. Although most (between 78–98%) of supplemented breastfed infants met the recommendation, very few were supplemented as a group. Hence, breastfed infants were less likely to meet the recommendation as compared to those who were formula fed across at time points except month 1 (P < 0.001 for all). Whereas infant age, feeding type, and/or their interaction were significant predictors of both receiving supplementation and meeting the recommendation, maternal nativity (P = 0.006) and parity (P = 0.01 and P < 0.001) predicted receiving supplementation, and child sex (P < 0.001) and maternal race/ethnicity (P < 0.001) predicted meeting the recommendation. CONCLUSIONS AND IMPLICATIONS: Among a national sample of infants participating in WIC between 2013–2015, a high proportion were not meeting the current vitamin D recommendation. The WIC program is one resource for promoting strategies for increasing the number of American infants meeting D recommendations yet, a coordinated approach involving other health care providers is likely needed. Future research exploring the reason for lack of supplementation, from both the perspective of parents and providers, as well as the clinical impact of low vitamin D intake is warranted.

Introduction Despite the increasing prevalence and potential adverse health outcomes associated with marijuana use, limited research exists related to its use in women of reproductive age with disabilities. The purpose of this study is to examine the past-month marijuana use in women of reproductive age with disabilities. Methods Data from the 2015–2019 National Survey on Drug Use and Health included 76,765 women of reproductive age (18–44 years). Descriptive statistics and adjusted logistic regression analyses were conducted to assess the associations between past-month marijuana use and overall disability, including the type of disability. Results In this sample, 12.6% of women reported past-month marijuana use. Approximately, 21% of women with disabilities reported past-month marijuana use, compared with only 11.1% of women without a disability. Marijuana use was more prevalent in women with disabilities who were younger (aged ≤25 years), who were non-Hispanic White, who were nonmarried, who had at least some college education, and who used alcohol or tobacco. Women with disabilities had 1.68 (95% CI=1.57, 1.80) higher odds of reporting past-month marijuana use than those with no disabilities. The odds of past-month marijuana use were higher among those with cognitive (AOR=1.78, 95% CI=1.64, 1.94), sensory (AOR=1.30, 95% CI=1.12, 1.51), and daily activities–related (AOR=1.64, 95% CI=1.49, 1.80) disabilities than among their counterparts without disabilities. Conclusions This study found an increased prevalence of past-month marijuana use among women of reproductive age with disabilities. Enhanced screening and counseling using evidence-based practices during routine care for women with disabilities may be necessary to mitigate marijuana use.

Introduction: Second-generation Arab Americans may be at risk for poor cardiovascular health behaviors, but these behaviors are poorly understood. The purpose of this study was to examine the effects of acculturative stress and psychological flexibility on cardiovascular health behaviors among second-generation Arab Americans. Method: In a cross-sectional study, survey data were collected in 2018 at local mosques, churches, and a university campus. Cardiovascular health behaviors were measured with a questionnaire based on the American Heart Association Life’s Simple 7. Acculturative stress and psychological flexibility were assessed using reliable and valid measures. Results: Participants ( n = 325) with higher acculturative stress were significantly more likely to report intermediate overall cardiovascular health behaviors ( p = .01) and poor to intermediate diet ( p = .00). Psychological flexibility partially mediated poor/intermediate smoking ( p = .02) and intermediate diet ( p = .00) scores. Discussion: Nurses may consider the role of acculturation when designing culturally sensitive interventions to promote cardiovascular health in second-generation populations.

Objective Women of childbearing age are encouraged not to smoke because of well-documented adverse health outcomes. This study examines the association between e-cigarette use and respiratory conditions (asthma and chronic obstructive pulmonary disease [COPD]) among women of childbearing age. Methods The study used data from the Behavioral Risk Factor Surveillance System 2016-2017. The sample consisted of 131,965 women of childbearing age (18-44 years old). The main independent variable was smoking status and the primary outcomes were self-reported respiratory conditions such as asthma and COPD. Data were analyzed using descriptive statistics and multivariate logistic regression to assess the effects of e-cigarettes on asthma and COPD. Results In this sample of childbearing-age women, 2.79% were current e-cigarettes users with or without a history of combustible cigarette smoking and 3.02% were current dual users. Compared with nonsmokers, current e-cigarette users without a history of combustible cigarette smoking were associated with 74% higher odds of having asthma (adjusted odds ratio [AOR] 1.74, 95% confidence interval [CI] 1.29-2.35), whereas results were not significant for COPD. The odds of having COPD, however, were 3 times higher (AOR 3.28, 95% CI 2.62-4.12) for current e-cigarette users with a history of cigarette smoking, whereas current dual users showed 5 times higher odds (AOR 5.07, 95% CI 3.91-6.56) of COPD compared with nonsmokers. Conclusion Policies related to e-cigarettes need to be reevaluated and clearly communicated to improve prevention efforts for women of childbearing age.

The purpose of this study was to examine associations between opioid use and the degree of mental health-related disability due to emotional/behavioral problems as measured by the World Health Organization Disability Assessment Schedule (WHODAS) instrument in a national sample of pregnant women.We used data from the National Survey on Drug Use and Health 2014-2017 which included 2,888 pregnant women 18 years or older. The WHODAS instrument was utilized to measure disability as the degree of functional impairment due to emotional/behavioral problems experienced by the respondent. Multinomial logistic regression models were built to assess the magnitude and direction of the association between severity of mental health-related disability with opioid use and abuse/dependency in the past year.Approximately 30% of pregnant women suffered from moderate/severe mental health-related disability, and 2% reported opioid abuse/dependency. Compared to those with no opioid use, the odds of opioid use in the past year for individuals with moderate/severe mental health-related disability were 1.73 (95% CI 1.36, 2.21) times higher than those with no/mild disability. Similarly, the odds of opioid abuse/dependency were at least three times higher (OR 3.51; 95% CI 1.80, 6.84) among those with moderate/severe mental health-related disability relative to pregnant women with no/mild disability.Clinicians should consider screening for both opioid use and mental health conditions and related disabilities using screening tools such as the WHODAS during the initial prenatal visits.

OBJECTIVES: To explore vitamin D intake and adherence with current recommendations among a national sample of infants participating in the Special Supplemental Nutrition Program for Women, Infants and Children (WIC). METHODS: Data were analyzed from the WIC Infant Toddler Feeding Practices Study-2, the most recent longitudinal assessment of mother-child dyads participating in WIC around the time of childbirth. Only data collected from 1, 3, 5, 7, 9, 11- and 13-months post-partum interviews were included in the current analysis. Total vitamin D intake was measured from a 24-hour dietary recall, which included supplementation. Infant feeding was categorized at each time point as only breastmilk, only formula, both breastmilk and formula (mixed feeding) and neither. A generalized estimating equation was constructed to assess predictors of meeting the infant vitamin D recommendation of ≥400 IU/day. RESULTS: A total of 3398 infants were included in this study at 1 month. The median total vitamin D intake ranged from 217 (95% CI: 210, 226) IU/day at 1 month to 324 (314, 333) IU/day at 13 months, with 16–36% of infants meeting the infant vitamin D recommendation. There were significant differences (P

The purpose of this study was to examine the contribution of maternal financial, emotional, traumatic, and partner-associated stressors on breastfeeding initiation and duration.Data (216,756 records) from the Pregnancy Risk Assessment Monitoring System surveys were used in the analysis. Logistic regressions were conducted to estimate the magnitude and direction of associations between maternal stressors occurring in the 12 months prior to infant birth and both breastfeeding initiation and duration up to 4 weeks infant age.A substantial proportion of mothers (42%) reported having experienced one or two major stressors during the 12 months prior to the birth of their infant. Mothers who reported at least one major life stressor in the year before their baby was born were less likely to initiate breastfeeding and more likely to cease by 4 weeks infant age. Emotional and traumatic stressors were found to have the greatest impact on breastfeeding outcomes.Findings support the design and implementation of screening protocols for major maternal life stressors during regularly scheduled prenatal and newborn visits. Screening for at-risk mothers may lead to more targeted anticipatory guidance and referral with positive effects on breastfeeding outcomes and overall well-being of the mothers and their families.

Aim and objectives To examine the influence of staff nurses' individual factors on knowledge, attitudes and implementation of evidence-based practice in Saudi Arabia and to identify facilitators and barriers to evidence-based practice implementation. Background Evidence-based practice has been considered as a key for healthcare quality measure. The literature, however, shows that nurses worldwide are not implementing evidence-based practice as expected and recommended by governing agencies. In Saudi Arabia, evidence-based practice implementation has not been addressed sufficiently. Design A cross-sectional, correlational design was used. We have complied with the guidelines of STROBE Checklist in presenting this research. A convenience sample of staff nurses (n = 227) was selected from four hospitals in Riyadh, Saudi Arabia. The survey questions included the Evidence-based Practice Questionnaire and individual factors. Data were analysed using multiple linear regression models. Results Attitudes towards evidence-based practice had the highest mean followed by evidence-based practice knowledge and implementation means. Evidence-based practice training and research involvement were associated with knowledge in the bivariate and multivariate analyses. None of the individual factors were associated with attitudes. However, knowledge was associated with attitudes. Knowledge and attitudes influenced evidence-based practice implementation positively. Unexpectedly, receiving evidence-based practice training made it more difficult for nurses to participate in evidence-based practice implementation process. We found that attitudes partially mediated the relationship between knowledge and evidence-based practice implementation. Conclusion Nurses in Saudi Arabia are willing to be involved in the evidence-based practice process. However, nurses identified that they need to improve their knowledge and skills in order to be active participants in the process. Relevance to clinical practice Organisations and nursing leadership may benefit from developing a comprehensive strategy to promote staff nurses' involvement in the evidence-based practice process through providing continuing education and mentoring programmes about evidence-based practice.

Objective: The purpose of this study was to review studies and reports examining maternal mortality and quality of maternal health care in the USA, which has the highest maternal mortality rate among its peers.Methods: Electronic search of current literature on maternal mortality and quality of care in the USA and Europe was conducted. Findings were summarized according to the Donabedian's structure-process-outcomes conceptual model.Results: Standards and protocols, effective communication and hospitalist care indicated positive maternal outcomes, including a reduction in maternal mortality. However, lack of coordination of care among providers for pregnant women with chronic disease, fragmentation, or substandard of care and late prenatal care initiation are among the domain of processes of care that were noted to negatively influence maternal health outcomes. Further, the absence of a national forum committee to gather and systematically use research findings and data to guide change constitutes a serious obstacle in improving quality of care in the obstetric field.Conclusions: Providing good quality of care and eliminating health disparities in obstetrics and gynecology are important elements in preventing maternal deaths. Future research regarding patient-centered care and health disparities in maternal health will provide guidance to policymakers in our efforts to reduce maternal mortality.

Prior research has shown a relationship between falls, hospitalizations, and depression among older adults in nursing home settings, but few studies have explored these relationships for younger and older adults in residential care facilities. This study examined risk factors for hospitalizations among assisted living residents. Using the 2010 National Survey of Residential Care Facilities, the study found that 24% of residents had a hospital stay in the past year. Residents with falls were more than twice as likely to have a hospitalization. For younger residents, depression was a key risk factor (OR = 1.74, p

Nurse residency programs have been adopted by health care organizations to assist new graduate nurses with daily challenges such as intense working environments, increasing patient acuity, and complex technologies. Overall, nurse residency programs are proven beneficial in helping nurses transition from the student role to independent practitioners and bedside leaders. The purpose of this study was to assess the impact of residency programs on leadership skills of new Saudi graduate nurses who completed a residency program compared to new Saudi graduate nurses who did not participate in residency programs. The study design was cross-sectional involving a convenience sample (n = 98) of new graduate nurses from three hospitals in Saudi Arabia. The Clinical Leadership Survey was used to measure the new graduate nurses' clinical leadership skills based on whether they completed a residency program or not. Descriptive statistics, correlation, and multiple linear regression analyses were conducted to examine leadership skills in this sample of new Saudi graduate nurses. A significant difference was found between residents and nonresidents in their leadership skills (t = 10.48, P = .000). Specifically, residents were significantly more likely to show higher levels of leadership skills compared to their counterparts. Attending a residency program was associated with a significant increase in clinical leadership skills. The findings of this study indicate that there is a need to implement more residency programs in hospitals of Saudi Arabia. It is imperative that nurse managers and policy makers in Saudi Arabia consider these findings to improve nurses' leadership skills, which will in turn improve patient care. Further research should examine how residency programs influence new graduate nurses' transition from student to practitioner with regard to clinical leadership skills in Saudi Arabia.

ObjectiveDespite emerging evidence of the detrimental effects of natural disasters on maternal and child health, little is known about exposure to tornadoes during the prenatal period and its impact on birth outcomes. We examined the relationship between prenatal exposure to the spring 2011 tornado outbreak in Alabama and Joplin (Missouri) and adverse birth outcomes.MethodsWe conducted a retrospective, cross-sectional cohort study using the 2010-2012 linked infant births and deaths data set from the National Center for Health Statistics for tornado-affected counties in Alabama (n=126,453) and Missouri (Joplin, n=6,897). Chi-square and logistic regression analyses were performed to estimate associations between prenatal exposure to tornadoes and birth outcomes.ResultsPrenatal exposure to the tornado incidents did not influence birth weight outcomes. Women exposed to Alabama tornadoes were less likely to have a preterm birth compared to unexposed mothers (OR: 0.93, 95% CI: 0.91, 0.96). Preterm births among Joplin-tornado exposed mothers were slightly higher (13%) compared with unexposed mothers (11.2%). Exposed mothers from Joplin were also more likely to have a cesarean section compared to their counterparts (OR: 1.14, 95% CI: 1.02, 1.26).ConclusionsWe found no association between tornado exposure and adverse birth weight and infant mortality rates. Our findings suggest that prenatal exposure can amplify the odds for a cesarean section. (Disaster Med Public Health Preparedness. 2019;13:279–286)

Introduction This study examined postpartum depression, food insecurity, and underestimation of infant size as potential early life factors for overweight risk at 12 months among infants of Hispanic immigrant mothers. Method Weight-for-length (WFL) measurements and face-to-face interviews were completed during well child visits. Regression models estimated the impact of early life factors (0-6 months) on overweight risk at 1 year. Results WFL ≥ 85th percentile was found among 2.4% at birth and 42.7% at 1 year. Most mothers (78.6%) experienced food insecurity, a factor that increased the likelihood of infant overweight risk by 2.29 times (1.03–5.09). Maternal underestimation of infant size increased the likelihood of overweight risk 5.07 times (2.57–9.99). Postpartum depression risk did not contribute to infant weight status. Discussion Assessment for maternal food insecurity and underestimation of infant weight status during early infancy may help reduce overweight risk and subsequent obesity for this vulnerable population.

Purposes Describe implementation of Institute of Medicine (IOM) early infant feeding recommendations for child obesity prevention by immigrant mothers from Central America; examine potential relationships with food insecurity and postpartum depressive symptoms. Design and Methods Using a cross-sectional, descriptive design, face-to-face interviews were conducted with 318 mothers of 2 month old infants at a large pediatric setting for low income families. Logistic regression models assessed feeding practices, food insecurity and postpartum depressive symptoms. Results Exclusive breastfeeding rates were low (9.4%); most mothers (62.7%) both breastfed and bottle fed their infants. Mothers who bottle fed at moderate and high intensity were twice as likely to affirm that if you give a baby a bottle, you should always make sure s/he finishes it (OR = 2.30, 95% CI = 1.13, 4.69; OR = 2.29, 95% CI = 1.26, 4.14). Food insecurity was experienced by 57% of mothers but postpartum depressive symptoms were low (Possible range = 0–30; M = 2.96, SD =3.6). However, for each increase in the postpartum depressive symptoms score, the likelihood of affirming a controlling feeding style increased by 11–13%. Conclusions Immigrant mothers from Central America were more likely to both breastfeed and bottle feed (las dos cosas) than implement exclusive breastfeeding. Bottle feeding intensity was associated with a controlling feeding style. Practice Implications Infant well visits provide the ideal context for promoting IOM recommendations for the prevention of obesity among children of immigrant mothers from Central America.

This study assessed children’s unmet health-care needs within different family types (two-parent biological/adoptive, two-parent stepfamily, and single-mother family type) using data from the 2011/2012 National Survey of Children’s Health. Findings indicate that 10.4% of children in single-mother family types had unmet health-care needs compared to 8.7% of children from a two-parent stepfamily and 5.3% for those from two-parent biological/adoptive families. Further analyses revealed racial/ethnic disparities with Black children from two parent-biological/adoptive families being 1.54 (95% confidence interval 1.13, 2.05) times more likely to have unmet health-care needs, while Hispanic children were less likely to have unmet health-care needs relative to their white counterparts. Children from lower income two-parent families had a higher likelihood of unmet health-care needs. The noncontinuous insurance coverage was a risk factor for increasing unmet health-care needs across all three different family types. These findings show major differences in unmet health-care needs among children living in different family structure types. It is recommended that interventions for increasing access to care need to be tailored differently across various family types in order to achieve continuous and sufficient health-care services for our children.

The purpose of this study was to examine the association between asthma diagnosis and obesity among adolescents exposed to environmental tobacco smoke (ETS).The sample included 28,807 adolescents (13-17 years old) from the National Survey of Children's Health (NSCH) (2011-2012).The NSCH is a US cross-sectional telephone survey that included at least one child between the ages of 0 and 17 years residing at a household during the time of the interview. Descriptive statistics were used to describe sample characteristics and assess the prevalence of asthma among adolescents with obesity exposed to ETS. Logistic regression models were built to assess the effect of obesity on asthma diagnosis within the context of ETS exposure.The prevalence of asthma among adolescents was 10.4% and the obesity was 13.2%. Adolescents with obesity exposed to ETS within the home were significantly (p0.05) more likely to have an asthma diagnosis (23%) compared with non-obese (10.9%) residing in similar households. Adjusted odds ratios showed that adolescents with obesity were 2.07 (95% CI, 1.15, 3.70) times more likely to have asthma if they were exposed to ETS inside their homes.The findings indicate that adolescents with obesity are more likely to be diagnosed with asthma if they are exposed to ETS in the household. It is important that the association between obesity and asthma is examined within the context of environmental risk factors in future studies, as this may shed some light to underlying mechanisms between these two serious public health issues.

Introduction This study examined the association between early weight gain (0–6 months) and risk for overweight, as defined by the Institute of Medicine, at 1 year among infants of low-income Hispanic immigrant mothers. Method Weight-for-age data were extracted from electronic medical records of 335 infants with gestations of 37 weeks or longer and birthweights appropriate for gestational age and without medical problems likely to interfere with growth or feeding. Logistic regression models were constructed to examine the impact of early weight changes on weight status at 1 year. Results By 12 months, 36.7% of infants had crossed weight-for-age of 84.1% or greater on World Health Organization growth charts. In adjusted models, infants had 20.8 (95% confidence interval = [19.8, 44.0]) times the odds of reaching this benchmark at 1 year for each z score increase at 0 to 6 months. Discussion The study highlights a time-sensitive opportunity for interventions to reduce risk for overweight for this vulnerable population.