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Background: Patients rarely dispose of left-over opioids after surgery. Disposal serves as a primary prevention against misuse, overdose, and diversion. However, current interventions promoting disposal have mixed efficacy. Increasing disposal in rural communities could prevent or reduce the harms caused by prescription opioids. Aims: Identify barriers and facilitators to disposal in the rural communities of the United States Mountain West region. Methods: We conducted a qualitative description study with 30 participants from Arizona, Idaho, Montana, Nevada, Oregon, Utah, and Wyoming. We used a phronetic iterative approach combining inductive content and thematic analysis with deductive interpretation through the Precaution Adoption Process Model (PAPM). Results: We identified four broad themes: (a) awareness, engagement, and education; (b) low perceived risk associated with nondisposal; (c) deciding to keep left-over opioids for future use; and (d) converting decisions into action. Most participants were aware of the importance of disposal but perceived the risks of nondisposal as low. Participants kept opioids for future use due to uncertainty about their recovery and future treatments, breakdowns in the patient-provider relationship, chronic illness or pain, or potential future injury. The rural context, particularly convenience, cost, and environmental contamination, contributes to decisional burden. Conclusions: We identified PAPM stage-specific barriers to disposal of left-over opioids. Future interventions should account for where patients are along the spectrum of deciding to dispose or not dispose as well as promoting harm-reduction strategies for those who choose not to dispose.

Ecological momentary assessment (EMA), a data collection method commonly employed in mHealth studies, allows for repeated real‐time sampling of individuals' psychological, behavioral, and contextual states. Due to the frequent measurements, data collected using EMA are useful for understanding both the temporal dynamics in individuals' states and how these states relate to adverse health events. Motivated by data from a smoking cessation study, we propose a joint model for analyzing longitudinal EMA data to determine whether certain latent psychological states are associated with repeated cigarette use. Our method consists of a longitudinal submodel—a dynamic factor model—that models changes in the time‐varying latent states and a cumulative risk submodel—a Poisson regression model—that connects the latent states with the total number of events. In the motivating data, both the predictors—the underlying psychological states—and the event outcome—the number of cigarettes smoked—are partially unobservable; we account for this incomplete information in our proposed model and estimation method. We take a two‐stage approach to estimation that leverages existing software and uses importance sampling‐based weights to reduce potential bias. We demonstrate that these weights are effective at reducing bias in the cumulative risk submodel parameters via simulation. We apply our method to a subset of data from a smoking cessation study to assess the association between psychological state and cigarette smoking. The analysis shows that above‐average intensities of negative mood are associated with increased cigarette use. [ABSTRACT FROM AUTHOR]

Introduction Recruiting special populations to smoking cessation trials is challenging and approaches beyond in-clinic recruitment may be beneficial. This secondary analysis of data from a smoking cessation RCT for individuals with a history of cervical cancer or cervical intraepithelial neoplasia (CIN) explored differences associated with in-clinic vs. online recruitment. Aims and Methods Participants were recruited from clinics within a university-based NCI-designated cancer center (n  = 87) and online nationally via Facebook (n  = 115). Baseline measures included sociodemographics, smoking history, and cancer or CIN history. Study retention and smoking abstinence were assessed 12 months post-baseline. Group differences in baseline characteristics were evaluated. Retention and abstinence were evaluated while controlling for group differences and predictors. Results Participants recruited online (vs. in-clinic) had higher educational attainment (p  = .01) and health literacy (p  = .003). They were more likely to have CIN versus cancer, to be further from the time of diagnosis, and to have completed active treatment (p values < .001). While controlling for these group differences and independent predictors, retention was higher among participants recruited online (log-likelihood χ2(1) = 11.41, p  < .001). There were no recruitment differences in self-reported (p  = .90) or biochemically confirmed smoking abstinence (p  = .18). Conclusions Compared to individuals recruited in-person, individuals recruited online were more educated, had higher health literacy, and presented with a different clinical profile (ie, more likely to have CIN vs. cancer and to have completed active treatment). There were few differences in participant characteristics between recruitment approaches, and no differences on any smoking-related variables. Online recruitment has the potential to improve enrollment of cancer survivors in smoking cessation trials. Implications People with a history of CIN or cervical cancer recruited to a smoking cessation RCT online (vs. in-clinic) were more likely to have a diagnosis of CIN versus cancer and were more educated and health literate. Participants recruited online were more likely to be retained in the study and there were no differences in smoking abstinence rates at 12 months. Incorporating online recruitment increased the reach of tobacco treatment efforts to a larger and more diverse sample. This could reduce the burden of tobacco-related disease, improve CIN and cancer treatment outcomes, and reduce secondary malignancies and morbidity among this underserved group. [ABSTRACT FROM AUTHOR]

Monoclonal Gammopathy of Undetermined Significance (MGUS) is a clonal plasma cell disorder that is considered preneoplastic, asymptomatic, and only requiring observation. However, MGUS may result in cutaneous complications, which are poorly understood, causing treatment delays and patient suffering. We present 30 patients with cutaneous findings associated with MGUS, characterizing clinical presentations, isoforms, treatments, and outcomes. These included: MGUS-associated 'rashes' (pruritic eczematous rashes), reactive and mucin-depositional conditions (pyoderma gangrenosum, scleromyxedema), M-protein-related deposition disorders (POEMS syndrome, Waldenstrom macroglobulinemia), and cutaneous lymphomas. Twelve of 30 (40%) patients received multiple myeloma drugs (MMDs). Eleven (92%) patients improved, and those not receiving MMDs rarely improved, suggesting that MMDs have efficacy for cutaneous manifestations of MGUS. Therefore, trialing MMDs may be warranted for patients with MGUS not responding to other therapies. Moreover, evaluation for monoclonal gammopathy in elderly patients with intractable pruritus or other chronic skin conditions that are non-responsive to skin-directed therapies should be considered. [ABSTRACT FROM AUTHOR]

Within the last decade, needs for building control systems that reduce cost, energy, or peak demand, and that facilitate building-grid integration, district-energy system optimization, and occupant interaction, while maintaining thermal comfort and indoor air quality, have come about. Current PID and schedule-based control systems are not capable of fulfilling these needs, while Model Predictive Control (MPC) could. Despite the critical role MPC-enabled buildings can play in future energy infrastructures, widespread adoption of MPC within the building industry has yet to occur. To address barriers associated with system setup and configuration, this paper introduces an open-source software platform that emphasizes use of self-tuning adaptive models, usability by non-experts of MPC, and a flexible architecture that enables application across projects.

Hispanics have the lowest colorectal cancer (CRC) screening rates of all racial/ethnic groups and comprise the largest proportion of low-income manual laborers in the nation. We partnered with businesses to implement a community health worker (CHW)-led intervention among Hispanic workers in service-related and manual labor occupations, which often pay low wages and do not provide health insurance. CHWs measured knowledge, screening adherence and perceptions of CRC risk before and after educational interventions via interview. CHWs provided fecal immunochemical tests (FITs) to participants aged =50 years. Chi-square tests and logistic regression identified pre-intervention predictors of CRC knowledge of all participants and adherence among eligible participants. Adherence among participants increased from 40% (n = 307) pre-intervention to 66% post-intervention. Knowledge about CRC was associated with age =50 years (OR = 8.90 [95% CI = 2.61-30.35]; ref = 18-30) and perceived personal risk for CRC (Likely, OR = 3.06 [95% CI = 1.40-6.67]; ref = Not likely). Insurance status was associated with screening adherence pre-intervention (OR = 3.00 [95% CI 1.10-8.12]; ref = No insurance). Improvement in adherence post-intervention was associated with income between $25 000 and =$55 000 (OR = 8.49 [95% CI 1.49-48.32]; ref = $5000-<$10 000). Community-based health programs can improve CRC screening adherence among Hispanic workers in service-related and manual labor positions, but lowest-income workers may need additional support.

We investigated class clustering patterns of four behaviors--physical activity, fruit and vegetable (F&V) intake, smoking, and alcohol use--in a faith-based African American cohort. Guided by socio-ecological models, we also examined the psychosocial and neighborhood social environmental factors associated with the clustering patterns. Participants were 1,467 African American adults recruited from a mega church in the metropolitan Houston, TX, in 2008-2009. They completed a survey and health assessment. Latent class analysis and multinomial regression analysis were conducted. Results supported a three-class model: Class 1 was characterized by low physical activity, low F&V intake, and low substance use (smoking and alcohol use). Class 2 was characterized by high physical activity, low F&V intake, and mild drinking. Class 3 seemed to be the healthiest group, characterized by high physical activity, moderate-to-high F&V intake, and low substance use. The probabilities of being included in Classes 1, 2, and 3 were 0.33, 0.48, and 0.19, respectively. Participants in Class 1 (vs. Class 3) reported lower physical activity norm (p < 0.001) and higher smoking norm (p = 0.002) and lower neighborhood social cohesion (p = 0.031). Participants in Class 2 (vs. Class 3) reported higher cancer risk perception (p < 0.001), lower F&V norm (p = 0.022), lower physical activity norm (p < 0.001), higher smoking norm (p < 0.001), and lower social cohesion (p = 0.047). As health behaviors are clustered together, future interventions for African Americans may consider targeting multiple health behaviors instead of targeting a single health behavior. Interventions addressing social norm and neighborhood social cohesion may enhance multiple health behaviors engagement in this population.

Aims: Three smoking cessation studies (CARE, Break Free, Por Nuestra Salud [PNS]) were used to measure changes in average alcohol consumption, binge drinking and alcohol‐related problems during a smoking cessation attempt and to explore co‐action with smoking abstinence. Design: CARE and PNS were longitudinal cohort cessation studies; Break Free was a two‐arm randomized clinical trial. Setting: Texas, USA. Participants: Participants were current smokers who were recruited from the community and received smoking cessation interventions. All participants received nicotine replacement therapy and smoking cessation counseling. CARE included 424 smokers (1/3 White, 1/3 African American and 1/3 Latino); Break Free included 399 African American smokers; PNS included 199 Spanish‐speaking Mexican‐American smokers. Measurements Weekly alcohol consumption was collected multiple times pre and post‐quit, and binge drinking and alcohol‐related problems were collected at baseline and 26 weeks post‐quit. Analyses included only those who indicated current alcohol use. Findings Average alcohol consumption decreased from baseline to 26 weeks post‐quit in CARE (F = 17.09, P < 0.001), Break Free (F = 12.08, P < 0.001) and PNS (F = 10.21, P < 0.001). Binge drinking decreased from baseline to 26 weeks post‐quit in CARE (F = 3.94, P = 0.04) and Break Free (F = 10.41, P < 0.001) but not PNS. Alcohol‐related problems decreased from baseline to 26 weeks post‐quit in CARE (Chi‐sq = 6.41, P = 0.010) and Break Free (Chi sq = 14.44, P = 0.001), but not PNS. Conclusions: Among current drinkers, alcohol use/problems appear to decrease during a smoking cessation attempt and remain low through 26 weeks after the quit attempt. Little evidence was found for co‐action, with smoking abstainers and relapsers showing similar change in alcohol use/problems. [ABSTRACT FROM AUTHOR]

Objectives: To pilot and assess the feasibility, acceptability, and preliminary effects of the Rural Adult and Youth Sun (RAYS) protection program, a multilevel skin cancer preventive intervention for young children living in rural U.S. communities, delivered through community-organized team sports. Method: Three rural counties inUtah participated with two receiving the intervention and the third serving as a control. Youth sports leagues were recruited through recreation departments and the study took place from May through October 2021. Intervention leagues received sun protection supplies for players and coaches, educational materials for parents, and coaches were offered trainingon skincancerand sun protection behaviors. Results: TheRAYS program is both feasible to deliver and acceptable to coaches, parents, and players. The intervention also demonstrates beneficial preliminary effects on components of observed child sun-protective behaviors, coach sun protection behaviors, knowledge of skin cancer prevention recommendations, and self-efficacy in skin cancer prevention. Conclusions: Multilevel interventions for skin cancer prevention among young children can be successfully delivered through community organizations and their settings. A priority moving forward is the identification of ways to optimize delivery of such programs to positively influence skin cancer preventive behaviors among children living in diverse rural areas. [ABSTRACT FROM AUTHOR]