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PURPOSE: The aim of this study was to determine oral health habits and educational needs of children as reported by their parents or guardians attending a health fair in West Virginia. METHODS: Parents and/or guardians completed a questionnaire about the oral hygiene care, food and beverage consumption of their children. They also demonstrated the amount of toothpaste applied to their children's toothbrush. Toothpaste samples were then weighed. RESULTS: Eighty-seven parents or guardians participated. An average of 0.53 mg of toothpaste was dispensed per brushing, almost double the recommended amount. Most of the parents or guardians (75%) indicated their children had brushed twice the day prior to completing the questionnaire. Only 21% reported that their children's teeth had been flossed. Most children had a limited soda, sweet drinks, and fruit juice intake. CONCLUSIONS: Participants were apparently knowledgeable about prevention, the need to limit sugary beverages, and the importance of brushing twice a day. They were not as knowledgeable about the need for flossing, providing fruits and vegetables to their children, the significance of not skipping a meal, or the appropriate amount of toothpaste use. [ABSTRACT FROM AUTHOR]

Objective: To report the first examples of ectopic salivary glands of TMJ ligaments & capsules., Methods and Materials: Nine subjects with chronic TMJ disorders were found incidentally to have ectopic salivary glands (choristomas) within or near damaged TMJ ligaments and capsules. Clinicopathologic characteristics of 12 TMJs are summarized., Results: The 9 subjects were ages 22-64 years (average = 43.0); 6 were female. Microscopic examination revealed major, almost complete ligament replacement by dense, avascular fibrous scar tissue in all but 1 sample. Chronic inflammatory cells were present in the stroma of 3 samples. A total of 33 lobular, independent salivary structures of variable sizes were embedded in or near ligaments and/or capsules. Half were multiple in the same joint; 13 were bilaterally located in the joints of a single subject, with 8 small glandular lobules in one TMJ. All glands consisted of histologically normal serous acini except 1 which showed a focal lobule of mucus acini and another comprised only of mucus acini. Serial sections showed no connection to parotid glands. Some choristomas showed the aging phenomena of fatty infiltrates (n = 7) and oncocytosis (n = 7). Additionally, 3 of the 12 TMJ samples contained preauricular lymph nodes, with 3 nodes in 1 joint and bilateral involvement in 1 subject. Of the 5 identified nodes, all but one was hyperplastic, with nonspecific inflammatory histiocytosis., Conclusions: We report, for the first time, independent salivary gland choristomas (n = 33) within the soft tissues of the TMJ (n = 12), with one joint containing 8 such choristomas. All consisted of normal serous tissue except one, a mucus gland. Additionally, a fourth of TMJ surgical samples contained hyperplastic preauricular lymph nodes., Competing Interests: Declaration of interests None., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Objective: Orthodontic treatment often involves four first premolar extractions. There is concern that the retraction of the anterior teeth due to extraction of first premolars may constrict tongue space and will reduce oral cavity and oropharynx space. Constricted airways are often associated with sleep disordered breathing (SDB) and sleep disruption. The aim of this study was to determine if there is an association of SDB factors with the absence of first premolars., Methods: A cross-sectional study was conducted using National Health and Nutrition Examination Survey (NHANES) 2017-March 2020 data on participants, aged 18-65 years (n = 4742). Variables of interest included self-reports of SDB (symptoms of disrupted sleep such as snoring, snorting, daytime sleepiness, and inappropriate number of hours of sleep). Data for the presence/absence of first premolars were gathered from the oral examination section of NHANES. An assumption was made that absence of four first premolars in dentate participants indicated extractions for orthodontic treatment. Data analyses were conducted with Rao Scott chi squared test., Results: There were no significant associations of SDB and symptoms of disrupted sleep associated with the absence of four first premolars in dentate participants., Conclusion: Concerns of the impact of first premolar extractions on SDB were not supported with this study., (© 2024 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

There is a need to determine the role of smoking/vaping related products in Emergency Department (ED) product-related injuries by age and sex to determine if interventions are warranted. These products include the combustible tobacco products' paraphernalia to light them (CTPP), electronic nicotine delivery systems (ENDS), and electronic non-nicotine delivery system (ENNDS). Data from the National Electronic Injury Surveillance System (NEISS), years 2012-2022, were examined for injury data associated with CTPP and ENDS/ENNDS. Bivariate comparisons were conducted. There were an estimated 3,142 (95%CI: 2,384-3,975) ED-treated ENDS/ENNDS product-related injuries and 46,116 (95%CI: 38,712-53,520) CTPP product-related injuries. Males were more likely to have an ED-treated ENDS/ENNDS product-related injury than females (proportion 0.93 [95%CI: 0.82, 0.98] versus 0.70 [95%CI: 0.02, 0.19]) as well as a CTPP product-related injury than females (proportion, 0.60 [95%CI: 0.56, 0.64] versus 0.40 [95%CI: 0.37, 0.44]). There were more ED-treated ENDS/ENNDS product-related injuries among persons ≥18 years than <18 years (proportion, 0.89 [95%CI: 0.75, 0.96] versus 0.11 [95% CI: 0.4, 0.35]). There were also more ED-treated CTPP product injuries among persons ≥ 18 years than <18 years (proportion, 0.73 [95%CI: 0.68, 0.78] versus 0.27 [95%CI: 0.22, 0.32]). No change in the proportion of injuries in our sample associated with END/ENNDS over time were observed. There is a need to consider injuries related to ENDS/ENNDS and CTPP product-related injuries in the discussion of the risks associated with smoking/vaping. Although ENDS/ENNDS have had fewer ED-treated injuries, the number of such injuries has remained stable, rather than declined over the previous decade. Injury prevention is a public health imperative and targeted interventions by healthcare providers during routine care, and the use of public service announcements could specifically target adults ≥18 years. Providing peer-to-peer educational programs, and initiating similar programs targeted at males who use CTP and ENDS/ENNDS have the potential to decrease injury risk., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Wiener, Lundstrom. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Introduction: People make oral healthcare decisions regardless of having partial information, misinformation, sources that deliberately mislead, or information that is culturally influenced. This is particularly true in the Appalachian culture where oral healthcare decision-making practices are not well understood by researchers and dental professionals. Despite efforts to improve dental care utilization, the Appalachia region remains low in oral healthcare utilization. There is a need for a theory to identify concepts in decision-making when seeking oral healthcare. The theory could be useful in creating oral health interventions. The study objective is to develop a theory to identify concepts that influence oral healthcare decision-making in Appalachia (OHDA)., Methods: The researchers used a grounded theory qualitative study design to explain data for a theory of OHDA. Participants from Appalachia, in 20-minute interviews, provided insights into concepts that influence OHDA from August 22, 2017 to May 26, 2022. Notes/memos were written during and after the interviews and coding was conducted after the interviews. Open coding categories emerged through constant comparison of responses., Results: Five overarching concepts that embody OHDA were discovered: Affect (Level of Pain/Emotion/Stress involvement), Awareness, Trust/belief, Resources, and Risk Perception. All participants discussed the impact of social media toward these concepts., Conclusion: To influence a person's OHDA, public health officials and researchers need to address the person's affect, level of awareness, trust/belief, available resources, and risk perception. Social media is very important in awareness concerning oral health information. These factors are important to consider for similar research in oral healthcare utilization at the population level., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Wiener et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Introduction: Many factors influence preventive dental health service access for children. The objective of this research was to examine one factor, general anxiety, in accessing at least one preventive dental examination in the past 12 months in children with special healthcare needs (CSHCN) and children without special healthcare needs (CWSHCN)., Methods: National Survey of Children's Health (NSCH) 2021 were obtained for this cross-sectional research. Chi-square and logistic regression analyses were used to determine association of anxiety and past 12-month preventive dental examinations., Results: The sample included 10 493 CSHCN, and 35 675 CWSHCN. Overall, 72.7% had past 12-month preventive dental examinations, and 9.9% had a healthcare provider indicate they had general anxiety. CSHCN with anxiety, CWSHCN with anxiety, and CSHCN without anxiety were more likely to have a past 12-month preventive dental examination visit than CWSHCN without anxiety (Adjusted Odds Ratios: 1.86, 1.39, 1.32, respectively)., Conclusion: Our results suggest children with general anxiety (both CSHCN and CWSHCN) are more likely to have had at least one regular preventive dental visit within the past 12 months than CWSHCN and without general anxiety. There is a need for further understanding the relationship of general anxiety and dental health to improve the health of all children., Practical Implications: CWSHCN without anxiety need individualized, comprehensive care with enough time, attention, instruction, and rewards to demonstrate to parents/guardians the importance of making routine preventive dental examinations a priority for their child., (© 2024 Special Care Dentistry Association and Wiley Periodicals LLC.)

Background: A large proportion of United States (U.S.) youth play basketball, baseball, softball, or T-ball. Each of the activities poses a documented risk of craniofacial and neck injuries. However, few studies have assessed the national prevalence of pediatric craniofacial and neck injuries in this population, particularly following the COVID-19 pandemic., Methods: The National Electronic Injury Surveillance System (NEISS) dataset was used to identify pediatric craniofacial and neck injuries associated with basketball, baseball, softball, or T-ball from 2003-2022 in a cross-sectional study. The annual number of injuries before and after the onset of the COVID-19 pandemic with 95% confidence intervals were calculated. Interrupted time series analysis (ITSA) was used to estimate the pandemic's impact on the monthly number of injuries incurred nationally., Results: Both overall and stratified by sport involvement, the annual number and rate of injuries identified in NEISS decreased significantly after the COVID-19 pandemic. ITSA demonstrated that the monthly number of injuries decreased -4094.4 (95% CI = -5100, -3088.7) immediately after the beginning of the pandemic. The number of injuries began increasing towards pre-pandemic levels at a rate of 110.6 (95% CI = 64, 157.2) injuries per month after the initial plunge., Conclusion: Prior to the-pandemic, there was a steady decline in craniofacial and neck injuries due to basketball, baseball, softball and T-ball among children, aged <18 years. The shutdown during the initial months of the COVID-19 pandemic resulted in a precipitous drop in such injuries. Current rates are approaching pre-pandemic levels and may exceed them. Continued efforts are needed to keep the pre-pandemic progress., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Wiener, Lundstrom. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Objective: Oral cavity and oropharyngeal cancer (OOPC) is a devastating disease often caught in late stages. People who use tobacco are at higher risk of OOPC. Tobacco cessation discussions and OOPC screenings are important factors in decreasing the risk of OOPC or its late stage diagnosis. As research on sex differences has been increasing-from research on biomedical to psychological and sociological determinants-there is a potential difference, by sex, as to whom is more likely to have a tobacco cessation discussion and OOPC screening. The objective of this study is to determine if there is an association of sex with tobacco cessation discussions and OOPC screenings conducted by dental healthcare professionals among participants who currently use tobacco., Method: Data from 8 years of the National Health and Nutrition Examination Survey (2011-2018) were merged. Data from participants, ages 30 years and above, who self-reported current use of tobacco, a dental visit within the previous year and responsed to questions about oral cancer screening were analysed for frequency determination and logistic regression analysis. Having the combination of neither OOPC screening nor discussion about the benefits of not using tobacco was the outcome in the analysis., Results: There were 22.1% who had an OOPC screening by a dental professional within the previous year. Of the 41% who reported having had a conversation with a dental professional within the previous year about the benefits of tobacco cessation, 9.8% reported having both the conversation and OOPC screening. Males were less likely than females to have the combination of neither OOPC screening nor advice about tobacco cessation than females (adjusted odds ratio: 0.74; 95%CI: 0.57, 0.96)., Conclusion: There is an increased need for OOPC screening and the discussion of tobacco use by dental professionals among their patients who use tobacco, particularly for female patients., (© 2023 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Purpose It has been suggested that compassion may decrease as students progress through their health care education and into clinical practice. The purpose of this pilot study was to determine whether an immersive curriculum thread of tobacco use disorder (TUD) cessation methodology, including behavioral techniques and communication skills, was associated with any change in dental hygiene and dental students perceived levels of compassion. Methods Dental hygiene (DH) and dental (DS) students (n=300) who had experienced an immersive TUD curriculum from West Virginia University were invited to complete the Sussex-Oxford Compassion Scale-Toward Others (SOC-O) online survey during the academic years 2022-2023. Possible scores on the SOC-O ranged from 20 (no or low compassion) to 100 (high compassion). The SOC-O scores for students who did not have clinical experience and limited TUD content (first- and second-year DH and DS students) were compared with SOC-O scores of students who had clinically applied the immersive tobacco cessation curriculum thread (third and fourth year DH and DS students) using t-tests. Results A total of seventy DH and DS students completed the SOC-O survey for a response rate of 23.3%. The overall mean SOC-O score was 83.0 for participants who lacked clinical experience (DH1, DH2, DS1, DS2) and 85.8 for participants with clinical experience using the TUD content (DH3, DH4, DS3, DS4) ( p >0.05). For the SOC-O subscale analysis, both groups were similar in the recognition of suffering, universality of suffering, empathy/compassion for a person suffering, tolerance of uncomfortable feelings, and action/motivation to act to alleviate suffering. Conclusion A high level of perceived compassion among dental hygiene and dental students was associated with an immersive behavioral sciences curriculum thread for the assessment/treatment of TUD. Perceived levels of compassion were maintained for participants with and without clinical experience. Additional focus on compassion philosophy research within educational methodology is needed to maintain and improve compassion outcomes in the health care professions., (Copyright © 2024 The American Dental Hygienists’ Association.)

Background: During the COVID-19 pandemic, the annual US inflation rate increased from 1.2% in July 2020 to 8% in July 2022. It has since declined to 3.4% (December 2023). This study examined the prevalence of stress due to inflation during a period when it declined from 8.2% in September 2022 to 3% in June 2023 and its association with demographic and social determinants of health (SDOH)., Methods: We conducted a cross-sectional analysis of the online Household Pulse Survey (HPS), which surveils the experiences of US households. Beginning September 2022, HPS initiated data collection on "stress due to inflation" through a question on how stressful the increase in prices in the last 2 months has been. Participants could respond: very, moderately, a little, or not stressful. We analyzed data on working-age adults (18-64 years) who responded to the above question of stress due to inflation during 14-26 September 2022 (N = 32,579) and 7-19 June 2023 (N = 36,229). We used replicate weights in chi-squared tests and ordinal logistic regression analyses controlling for gender, age, race and ethnicity, COVID-19, COVID-19 vaccination, health insurance, and SDOH, including education, lost employment income, poverty status, marital status, food affordability, and region., Results: The prevalence of stress due to inflation (price increases being very or moderately stressful) significantly increased from 76.9% in September 2022 to 78.9% in June 2023. The odds of stress due to inflation were higher for individuals with the following characteristics: female, transgender, having income below 400% of the federal poverty line, having lost employment income, not being able to afford food, had long or acute COVID-19, and did not have a COVID-19 vaccine., Conclusions: More than three quarters of working-age adults in the US experienced stress due to inflation. Despite a declining national inflation rate in recent months, stress due to inflation has significantly increased among working-age adults. Inflation-related stress warrants further research and policy attention.

Background: Patient-centered communication (PCC) is an important metric related to patient health outcomes. Non-Hispanic Asian (NHA) individuals reported lower PCC scores with healthcare providers than individuals of other races and ethnicities. We aim to determine the ethnic disparities in PCC and further investigate the association between PCC, individual's confidence in obtaining health-related information (health literacy), and confidence in taking care of themselves (health self-efficacy) among NHA in comparison to the Non-Hispanic White (NHW) population., Methods: This is a cross-sectional study. We used data from the Health Information National Trends Survey 5 (HINTS) cycles 1 and 3. PCC was measured using seven validated survey questions with scores ranging from 7 to 28. Individuals' health literacy and self-efficacy were accessed using two-item survey questions. Multivariable logistic regression analyses were performed to determine the association of independent factors (e.g., self-efficacy, health literacy, and race and ethnicity) with PCC., Results: We included 3,831 participants. Fewer NHAs (35.43%) reported high PCC scores compared to NHWs (48.99%, p = 0.0184). In fully adjusted logistic regression model, although NHAs were less likely to have high PCC scores (aOR = 0.78, 95% CI 0.46-1.32) compared to NHWs, the association was not statistically significant (p = 0.350). However, the aOR of confidence in self-efficacy associated with high PCC scores was 2.27 (95% CI 1.68-3.07, p < 0.001) and the aOR of confidence in health literacy with high PCC scores was 2.13 (95% CI 1.64-2.76, p < 0.001)., Conclusions: High PCC scores reported by NHA were not significantly different from those of NHW individuals in adjusted comparisons. Individual's confidence in self-efficacy and health literacy was positively associated with high PCC regardless of race and ethnicity., (© 2024. W. Montague Cobb-NMA Health Institute.)

Background: Smoking cessation is difficult. A potential gap based on sex exists in the tobacco cessation aid that dental care professionals provide to patients. The purpose of this research was to examine whether there is a sex difference in dental patients' reports of having a direct conversation about the benefits of giving up cigarettes or other types of tobacco products with their oral health care provider., Methods: National Health and Nutrition Examination Survey 2017-March 2020 prepandemic data were used in this cross-sectional study for participants 18 years and older who reported that they "now smoke cigarettes," had a dental visit within the previous year, self-reported their sex, and responded whether their oral health care provider had a direct conversation about the benefits of giving up cigarettes or other types of tobacco products to improve dental health at their last visit (n = 582). Multivariable logistic regression analysis was conducted to compare data according to sex., Results: Overall, 50.7% of patients (59.2% of men, 42.9% of women; P = .0037) reported having a conversation about tobacco cessation at their dental visit. The odds of women reporting having no such discussion were twice those of men (odds ratio, 2.17; 95% CI, 1.10 to 4.28; P = .0270)., Conclusions: One-half of the participants reported having no tobacco cessation conversation about the benefits of giving up cigarettes or other types of tobacco with their dental care provider. Women were twice as likely to report no such discussion., Practical Implications: Oral health care providers need to ensure that primary and secondary prevention information and intervention programs about the benefits of giving up cigarettes or other types of tobacco products are provided equitably to all patients., (Copyright © 2023 American Dental Association. Published by Elsevier Inc. All rights reserved.)

Background: Infective endocarditis (IE) has increased in rural states such as West Virginia (WV) with high injection drug use. IE is medically managed with antimicrobial treatment alone or combined with surgical treatment. This study aimed to characterize the predictors associated with surgical treatment and rates of inpatient mortality and readmission among IE patients in WV's rural centers., Methods: This retrospective review of electronic health records includes all adults hospitalized for IE at major rural tertiary cardiovascular centers in WV during 2014-2018. Descriptive statistics were presented on demographics, history of injection drug use, clinical characteristics, and hospital utilization by surgery status, and multivariable logistic regression examined the association of surgery with key predictor variables, generating odds ratios (OR)., Results: Of the 780 patients with IE, 38% had surgery, with a 26-fold increase in patients undergoing surgery between 2014-2018. Comparing surgery and non-surgery patients revealed significant differences. Surgery patients were significantly younger (median age 35.6 vs. 40.5 years; p<0.001); had higher rates of drug use history (80% vs. 65%; p<0.001), psychiatric disorders (57% vs. 31%; p<0.001), and readmissions (18% vs.12%; p = 0.015). Surgery patients had lower rates of discharge against medical advice (11% vs.17%; p = 0.028) and in-hospital mortality (5% vs.12%; p<0.001). In the multivariable logistic regression, surgery was associated with injection drug use (OR: 1.9; 95% CI:1.09-3. 3), indications for surgery (OR: 1.68; 95% CI:1.48-1.91), left-sided IE (OR: 2.14; 95%CI:1.43-3.19) and later years (OR:3.75; 95%CI:2.5-5.72)., Conclusion: This study characterizes the predictors associated with surgical treatment and rates of inpatient mortality and readmission among IE patients across rural WV. The decision to perform cardiac surgery on IE patients is complex. Results with increased injection drug use-associated IE emphasize the importance of comprehensive care by a multidisciplinary team for optimal management of patients with IE., Competing Interests: The authors have declared that no competing interests exist., (Copyright: This is an open access article, free of all copyright, and may be freely reproduced, distributed, transmitted, modified, built upon, or otherwise used by anyone for any lawful purpose. The work is made available under the Creative Commons CC0 public domain dedication.)

Background: Whole health is a holistic approach encompassing integrative medicine, emotional, and spiritual health and is critical to improving health outcomes among individuals with multimorbidity., Objective: To examine the prevalence of Whole Health activities and the association of multimorbidity and Whole Health activities using nationally representative datasets., Methods: As no single dataset has information on Whole Health self-care activities, data from the 2017 National Health Interview Survey (n = 25 134) was used to measure participants' mind-body therapy usage, sleep, mental health, and physical activity. We used the 2017 Behavioral Risk Factor Surveillance System (n = 347 029) to assess regular vegetable and/or fruit consumption., Results: A significantly lower percentage of adults with multimorbidity had adequate sleep (58.2%vs.67.1%), no psychological distress (71.8%vs.82.1%), adequate physical activity (48.2%vs.62.1%), and regular vegetable and/or fruit consumption (54.2%vs.56.6%) compared to those without multimorbidity. Although lower percentages of adults with multimorbidity utilized mind-body therapies (22.9%vs.25.2%), the association was reversed when adjusted for socioeconomic factors. In the fully adjusted models, adults with multimorbidity were more likely to use mind-body therapies (AOR = 1.19, 95%CI = 1.09, 1.31). Furthermore, when adjusting for other independent variables, the associations of multimorbidity with sleep, psychological distress, and diet were exacerbated, and the association of multimorbidity with physical activity was attenuated., Conclusion: Adults with multimorbidity were less likely to engage in most of the Whole Health activities except mind-body therapies compared to the no multimorbidity group. Findings suggest that adjustment for other factors such as age and socioeconomic status changed the magnitude and direction of the association of multimorbidity with Whole Health activities., Competing Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2023.)

Objective: To examine the association of multimorbidity with health information technology use among adults in the USA., Methods: We used cross-sectional study design and data from the Health Information National Trends Survey 5 Cycle 4. Health information technology use was measured with ten variables comprising access, recent use, and healthcare management. Unadjusted and adjusted logistic and multinomial logistic regressions were used to model the associations of multimorbidity with health information technology use., Results: Among adults with multimorbidity, health information technology use for specific purposes ranged from 37.8% for helping make medical decisions to 51.7% for communicating with healthcare providers. In multivariable regressions, individuals with multimorbidity were more likely to report general use of health information technology (adjusted odds ratios  =  1.48, 95% confidence intervals  =  1.01-2.15) and more likely to use health information technology to check test results (adjusted odds ratios  =  1.85, 95% confidence intervals  =  1.33-2.58) compared to adults with only one chronic condition, however, there were no significant differences in other forms of health information technology use. We also observed interactive associations of multimorbidity and age on various components of health information technology use. Compared to younger adults with multimorbidity, older adults (≥ 65 years of age) with multimorbidity were less likely to use almost all aspects of health information technology., Conclusion: Health information technology use disparities by age and multimorbidity were observed. Education and interventions are needed to promote health information technology use among older adults in general and specifically among older adults with multimorbidity., Competing Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2023.)

The effects of the COVID-19 period among people who smoke (compared by sex) are largely unknown. The purpose of this study was to compare body mass index (BMI) increase among men and women who smoked during the pandemic. We used a retrospective longitudinal, observational study design of secondary data. We used electronic health records from TriNetX network (n = 486,072) from April 13, 2020-May 5, 2022 among adults aged 18-64 who smoked and had a normal BMI prior to the pandemic. The main measure was a change of BMI from < 25 to ≥25. Risk ratio was determined between men and women with propensity score matching. Overall, 15.8% increased BMI to ≥25; 44,540 (18.3%) were women and 32,341 (13.3%) were men (Risk Ratio = 1.38, 95% CI: 1.36, 1.40; p < .0001). Adults with diabetes, hypertension, asthma, COPD or emphysema or who were women, were more likely to develop BMI≥25 during the pandemic. Women who smoked were more likely to have an increase in BMI than men who smoked during the COVID-19 period., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2023 R. Constance et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

It is important to determine access to preventive care among vulnerable populations. The purpose of this research is to compare preventive dental utilization between children with special healthcare needs (CSHCN) and children without special healthcare needs (CWSHCN) using National Survey of Children's Health, 2020 (NSCH, 2020) data. A cross-sectional study design was used in this secondary data analysis of data from June 2020 to January 2021, NSCH, 2020, a publicly available data set with demographic and healthcare information. Parents/guardians responded to validated questions including one asking them to recall preventive dental services received during the previous year (June 2019 to January 2021). This was a critical time of transition from normal, pre-pandemic activities (June 2019 to March 2020) to the pandemic period (March 2020 to January 2021) with restrictions and no available vaccinations for children. Data analyses for the NSCH, 2020 data included frequency determinations, Chi Square analyses by preventive dental visit, and logistic regression analyses. There were 40,140 children in the sample, and 20.6% were CSHCN. Overall, 75.0% of children received a dental preventive visit. This study had an interaction of CSHCN status and medical visits within the previous year in which having had a medical visit was associated with CSHCN status also having a dental visit; while the CSHCN who did not have a medical visit were less likely to have a dental visit in unadjusted analysis. However, the pattern for CSHCN and the medical visit reversed in adjusted analysis. In adjusted analysis, CWSHCN and a medical visit were the most likely to also have a dental visit during this period. Many factors influenced access to preventive dental care in the months leading up to and including the COVID-19 pandemic. CSHCN with or without a medical visit were less likely to have preventive dental care than CWSHCN with a medical visit in logistic regression analysis adjusted for sex, race/ethnicity, age, smoking in the household, medical visits within the year, insurance coverage, and highest level of education in the household., Competing Interests: The author has declared no competing interests exist., (Copyright: © 2023 R. Constance Wiener. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Introduction: The purpose of this research was to determine if there is a difference in dental visits or missing teeth among Indigenous people in the USA (American Indian/Alaska Native (AI/AN) adults) by geographic and metropolitan settings., Methods: Data were obtained from the Behavioral Risk Factor Surveillance System (BRFSS), 2020, limited to AI/AN adults ≥18 years, n=6640. Participants self-identified as AI/AN adults, and provided information about residence, dental status, and dental visits within the previous year., Results: There were significantly more adults with missing teeth among rural AI/AN adults as compared with urban AI/AN adults. In adjusted analysis, adjusted odds ratio was 1.33 (95%CI: 1.02-1.73; p=0.04) for missing teeth in rural AI/AN adults as compared to urban AI/AN adults. AI/AN adults had similar percentages of dental visits within the previous year regardless of their rural/urban status or region of the country. Overall, there were 3738 (54.7%) who had a dental visit within the previous year., Conclusion: Interventions addressing rural AI/AN adults in maintaining teeth are critically needed.

Purpose Detergent pod-related aerodigestive/ocular chemical burns/ingestion poisoning injuries are a group of injuries of concern to parents/guardians of young children as well as oral healthcare professionals. Each year detergent pod injuries result in thousands of emergency department (ED) visits and significant oral, eye, airway, and digestive trauma. The purpose of this study was to investigate trends in detergent pod injuries resulting in ED visits in children ages >0 to <18 years from 2016-2020. Methods This cross-sectional study used data collected from the National Electronic Injury Surveillance System (NEISS). A secondary data analysis was performed on the NEISS data from 2016-2020 for children ages >0 to <18 years. Injuries were identified as detergent pod-related oral-aerodigestive/ingestion poisonings, detergent pod-related ocular injuries, or other product-related injuries among children. Time trends and demographic characteristics were analysed by age, sex, and race. Results There were an estimated 13,176 detergent pod-related oral-aerodigestive injuries/ingestion poisonings and 8,654 detergent pod-related ocular injuries with ED visits during 2016 - 2020. In adjusted logistic regression, white children were more likely to have oral-aerodigestive injuries/ingestion poisonings than black children ( p =0.0006). Time trend ( p =0.4358), and sex ( p =0.3905) failed to reach significance. Children, ages 5 to<18 years, were less likely to have ED visits for oral-aerodigestive injuries/ingestion poisonings, or any detergent pod-related injury than younger children. Children, ages 3 to ≤5 years, were more likely to have detergent pod-related ocular injuries than younger or older children. Conclusion Time trends for detergent-pod related injuries requiring ED visits remained unchanged from 2016-2020 for oral-aerodigestive injuries/ingestion poisonings. Given the significant health risks associated with detergent pods and the fact that the injuries have not declined, there is a need for improved parent/guardian education and practices in safeguarding detergent pods from children. Dental hygienists are well positioned to provide anticipatory guidance on this safety issue., (Copyright © 2023 The American Dental Hygienists’ Association.)

Background: The Whole Health model is a holistic approach to facilitate whole health practices by addressing (1) the physical, mental, and social health of individuals and (2) associated support systems. Several national organizations such as the Institute for Healthcare Improvement's (IHI) Age-Friendly Health Systems (AFHS) movement and, the U.S. Department of Veterans Affairs have implemented whole health frameworks with many common elements and promoted whole health practice and skills. However, implementing a Whole Health model across communities and health systems will require evidence of effectiveness. Generating evidence on the effectiveness of the Whole Health model's effect on health outcomes requires data-driven intelligence. Methods: We identified the national public-use data sets that are most often used in health research with a machine-assisted literature search of PubMed and Scopus for peer-reviewed journal articles published from 2010 through the end of 2021, including preprints, using Python [3.7]. We then assessed if the 8 most commonly used datasets include variables associated with whole health. Results: The number of publications examining whole health has increased annually in the last decade, with more than 2800 publications in 2020 alone. Since 2010, 24,811 articles have been published using 1 of these data sets. However, we also found a lack of data (ie, data set includes all of the whole health variables) to examine whole health in national data sets. Conclusions: We support a call to expand data collection and standardization of critical measures of whole health.

Background: Many people who have recently delivered a baby (puerperae) experience postpartum depression. The aim of this study is to examine nicotine dependence within the 5 years prior to delivery (ND5y) as a factor., Methods: Data from TriNetX Research Network platform were used. Analysis involved determining risk ratios of postpartum depression among puerperae with/without ND5y in umatched cohorts and propensity score matched cohorts., Results: The unmatched sample included 1,460 (13.8%) postpartum puerperae with diagnosed ND5y and 9,138 (86.2%) postpartum puerperae without ND5yt. The matched sample included 1,362 participants with and 1,362 participants without ND5y diagnosis. The unmatched and matched risk ratios were 1.75 (95% Confidence Interval [CI]: 1.55, 1.98; p  < 0.0001) and 0.68 (95% [CI]: 0.59, 0.79; p  < 0.0001), respectively., Conclusion: Postpartum depression was associated with ND5y in the unmatched sample analysis, but not in the matched sample analysis. As a potential mechanism is unknown, it is possible that some of the matched variables have a shared mechanism with post-partum depression and matching may have masked the true relationship. Therefore, both the unmatched and propensity matched analyses are presented as both have important relevance and may spur future research with non-clinical-based data.

Newborn screening tests (NST) are important public health procedures with potential to improve quality of life, and decrease morbidity/mortality by identifying metabolic, genetic, enzymatic, and endocrinological diseases/conditions. In the United States (U.S.), Hawaii conducts the fewest NST (28) and Connecticut conducts the most (75). The purpose of this research is to determine if difficulty receiving specialty care for children with genetic diseases is associated with NST determination of the genetic condition. The research hypothesis is that parents/guardians of children with determination of genetic disease from NST are more likely to report no/slight difficulty accessing specialty care versus parents/guardians of children with genetic diseases whose determination was other than NST. This study has a cross-sectional design with National Survey of Children's Health, 2020 data. Data were analyzed for frequency, Rao Scott Chi square, and logistic regression analyses. Of 833 children with genetic diseases, most parents/guardians reported no/slight difficulty in receiving needed specialty care; however, children whose determination of a genetic condition was other than NST were 4.82 times as likely (95%CI: 1.66, 14.02; p = 0.0040) to have difficulty. In analysis adjusted for sex, race, age, premature birth, and birthweight, the adjusted odds ratio was 6.71 (95% CI:1.91, 23.60 p = 0.0031). Parents/guardians of children screened with a positive NST reported less difficulty in receiving needed specialist care as compared with reports of parents/guardians of children with genetic conditions who were diagnosed later. The implication is there would be greater population level benefits realized in the U.S. if NST were expanded in states conducting minimal testing., Competing Interests: The author has declared that no competing interests exist., (Copyright: © 2022 R. Constance Wiener. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Tobacco use impacts every organ in the body. Dental professionals observe the detrimental oral and systemic consequences of tobacco use. Routine dental hygiene and dental appointments are an ideal opportunity for tobacco cessation discussions. Oral health care professionals can take the lead in assisting patients with evidence-based tobacco cessation strategies. Incorporation of tobacco cessation treatment within the curriculum of dental and dental hygiene programs will promote interprofessional tobacco cessation services. The purpose of this short report is to describe the process of introducing a Tobacco Treatment Specialist (TTS) program into the curricula of four health professional programs (dentistry, dental hygiene, pharmacy, and physician assistant) within a university health sciences center. Upon graduation, all involved students may qualify for TTS credentials. This report describes the importance of the interprofessional team, particularly dentists and dental hygienists, in the implementation of the first dental school-based certified tobacco treatment training program and incorporation of tobacco treatment content into interprofessional healthcare program curricula., (Copyright © 2022 The American Dental Hygienists’ Association.)

Objectives: Healthcare (including dental care) service use is influenced by predisposing, enabling and need factors. One area with limited research is the association of acculturation (defined as behavioural changes in the adaptation to another culture) as a predisposing factor for dental care preventive service use. Preventive service use is a primary objective of Healthy People, 2030. The purpose of this study was to determine the association of acculturation with the preventive dental service use of dental pit-and-fissure sealant placement, among children in the United States, ages 6-18 years., Methods: A cross-sectional, secondary data analysis study was completed using National Health and Nutrition Examination Survey (NHANES), 2013-2016 data. NHANES is a nationally representative survey of noninstitutionalized individuals across the United States. In the data set, children, ages 6-18 years, had been evaluated for pit-and-fissure dental sealant use. Information that served as proxies for acculturation was length of stay in the United States (a citizen at the time of the survey; not a citizen and in the country <5 years; or not a citizen and in the country ≥5 years) and whether English was spoken at home (yes; no). Data were analysed for descriptive statistics. Multivariable logistic regressions were used to examine strength of the associations. Odds ratios for pit-and-fissure sealants among groups were determined., Results: There were 2220 children participants whose data were used for this study. Less than half (45.5%) had received dental pit-and-fissure sealants. A majority (53.3%) were white and were ages 12-18 years (51.6%). The mean number of dental pit-and-fissure sealants among all children was 5.5. There was a lower percentage of children living in the United States <5 years who had received pit-and-fissure sealants than children who were citizens of the United States (22.2% vs 48.9%, respectively). The adjusted odds ratio was lower for dental pit-and-fissure sealants among children who were in the United States <5 years than children who were citizens of the United States (adjusted odds ratio, 0.38; 95% Confidence Interval: 0.24, 0.58)., Conclusions: In this study, children who had lived in the United States <5 years were less likely to have pit-and-fissure sealants than children who were citizens of the United States. There is a need to reach all children with preventive services to improve dental quality of life, reduce the need for dental restorations and decrease overall financial burden regardless of time in the United States., (© 2021 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Objective: To assess whether COVID-19 vaccine approval and availability was associated with reduction in the prevalence of depression and anxiety among adults in the United States., Methods: We adopted cross sectional and quasi-experimental design with mental health measurements before vaccine availability (June 2020, N = 68,009) and after vaccine availability (March 2021, N = 63,932) using data from Census Pulse Survey. Depression and anxiety were derived from PHQ-2 and GAD-2 questionnaires. We compared rates of depression and anxiety between June 2020 and March 2021. Unadjusted and adjusted analysis with replicate weights were conducted., Results: Depression prevalence was 25.0% in June 2020 and 24.6% in March 2021; anxiety prevalence was 31.7% in June 2020 and 30.0% in March 2021 in the sample. In adjusted analysis, there were no significant differences in likelihood of depression and anxiety between June 2020 and March 2021., Conclusion: Depression and anxiety were not significantly different between June 2020 and March 2021, which suggests that the pandemic effect continues to persist even with widespread availability of vaccines., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Shen, Rashiwala, Wiener, Findley, Wang and Sambamoorthi.)

Introduction: Life-threatening infections such as infective endocarditis (IE) are increasing simultaneously with the injection drug use epidemic in West Virginia (WV). We utilized a newly developed, statewide database to describe epidemiologic characteristics and healthcare utilization among patients with (DU-IE) and without (non-DU-IE) drug use-associated IE in WV over five years., Materials and Methods: This retrospective, observational study, incorporating manual review of electronic medical records, included all patients aged 18-90 years who had their first admission for IE in any of the four university-affiliated referral hospitals in WV during 2014-2018. IE was identified using ICD-10-CM codes and confirmed by chart review. Demographics, clinical characteristics, and healthcare utilization were compared between patients with DU-IE and non-DU-IE using Chi-square/Fisher's exact test or Wilcoxon rank sum test. Multivariable logistic regression analysis was conducted with discharge against medical advice/in-hospital mortality vs. discharge alive as the outcome variable and drug use as the predictor variable., Results: Overall 780 unique patients had confirmed first IE admission, with a six-fold increase during study period (p = .004). Most patients (70.9%) had used drugs before hospital admission, primarily by injection. Compared to patients with non-DU-IE, patients with DU-IE were significantly younger (median age: 33.9 vs. 64.1 years; p < .001); were hospitalized longer (median: 25.5 vs. 15 days; p < .001); had a higher proportion of methicillin-resistant Staphylococcus aureus (MRSA) isolates (42.7% vs. 29.9%; p < .001), psychiatric disorders (51.2% vs. 17.3%; p < .001), cardiac surgeries (42.9% vs. 26.6%; p < .001), and discharges against medical advice (19.9% vs. 1.4%; p < .001). Multivariable regression analysis showed drug use was an independent predictor of the combined outcome of discharge against medical advice/in-hospital mortality (OR: 2.99; 95% CI: 1.67-5.64)., Discussion and Conclusion: This multisite study reveals a 681% increase in IE admissions in WV over five years primarily attributable to injection drug use, underscoring the urgent need for both prevention efforts and specialized strategies to improve outcomes., Competing Interests: The authors have declared that no competing interests exist.

Infectious diseases like infective endocarditis (IE) may manifest or progress differently between sexes. This study sought to identify the differences in demographic and clinical characteristics among male and female patients with IE. Data were obtained from a newly developed registry comprising all adult patients with first IE admission at the four major tertiary cardiovascular centers in West Virginia, USA during 2014−2018. Patient characteristics were compared between males and females using Chi-square test, Fisher’s exact test, and Wilcoxon rank-sum test. A secondary analysis was restricted to IE patients with drug use only. Among 780 unique patients (390 males, 390 females), significantly more women (a) were younger than males (median age 34.9 vs. 41.4, p < 0.001); (b) reported drug use (77.7% vs. 64.1%, p < 0.001); (c) had tricuspid valve endocarditis (46.4% vs. 30.8%, p < 0.001); and (d) were discharged against medical advice (20% vs. 9.5%, p < 0.001). These differences persisted even within the subgroup of patients with drug use-associated IE. In a state with one of the highest incidences of drug use and overdose deaths, the significantly higher incident IE cases in younger women and higher proportion of women leaving treatment against medical advice are striking. Differential characteristics between male and female patients are important to inform strategies for specialized treatment and care.

Background: Epidemiologic patterns of all-terrain vehicle (ATV)-related emergency department (ED) visits by male and female individuals may vary at different ages. To our knowledge, this has not been researched previously., Objective: The purpose of this study was to determine the interaction of sex and age differences in their association with ATV-related ED visits., Methods: Data from the 2019 National Electronic Injury Surveillance System were extracted for ATV-related ED visits, including sex, age, race, location of crash, injured body part, and whether alcohol was involved. Descriptive statistics and logistic regression analyses were conducted. We modeled sex in separate multivariable models, adjusting for the same independent variables., Results: There were an estimated 95,995 (unweighted n = 1999) ATV-related ED visits. There was a significant age-by-sex interaction in the association between ATV-related ED visits vs. other ED injuries, indicating that the effect of age on ATV-related ED visits differed by sex and vice versa. Overall, male individuals were 1.7 times as likely to have an ATV-related ED visit as female individuals. In the stratified analysis for female individuals, odds were substantially greater for girls younger than 18 years (adjusted odds ratio [AOR] 2.33; 95% confidence interval [CI] 1.61-3.69) and women aged 18-35 years (AOR 4.76; 95% CI 3.48-6.51) compared with woman older than 35 years. For men, odds were significant for ages 18-35 years (AOR 2.21; 95% CI 1.72-2.85) compared with men older than 35 years., Conclusions: As newer ATVs become more powerful and faster, there is a need to know who is at greatest risk for ATV-related ED visits to develop policies and safety measures., (Copyright © 2022. Published by Elsevier Inc.)

There is a need for program evaluations associated with educating healthcare professionals about the treatment of patients who use tobacco. The purpose of this study was to evaluate a Tobacco Treatment Specialist Training program with a pre-test and post-test (provided six months after the program) to determine if participants-maintained knowledge and practices to help patients with tobacco cessation in a mixed-model analysis. A pre-test survey was administered to attendees of a three-day tobacco treatment training continuing education certification program. After 6 months, the attendees were provided a post-test survey with open-ended and Likert-style questions. There were 98 participants who completed the pre-test and 16 who completed the post-test. Responses to the knowledge, confidence, and skills post-test indicated that there was significant improvement and maintenance at the six-month post-test. For example, knowledge improved from a mean of 61.1% (SD: 25.6%) to a mean of 87.9% (SD: 14.4%); medians of 66.7% and 77.7%, respectively, p < 0.001. The in-depth, intensive, three-day TTS training program had a lasting impact. Providers reported greater commitment to helping their patients quit and maintain tobacco cessation habits.

Objectives: During the coronavirus 2019 (COVID-19) pandemic, increased anxiety and depression were reported, with mixed findings among individuals of different races/ethnicities. This study examines whether anxiety and depression increased during the COVID-19 pandemic compared to the pre-COVD-19 period among different racial/ethnic groups in the US., Methods: The Health Information National Trend Surveys 5 (HINTS 5) Cycle 4 data was analyzed. We used the time when the survey was administered as the pre-COVID-19 period (before March 11, 2020, weighted N  = 77,501,549) and during the COVID-19 period (on and after March 11, 2020, weighted N  = 37,222,019). The Patient Health Questionnaire (PHQ) was used to measure anxiety/depression and further compared before and during COVID-19. Separate multivariable logistic regression analyses were used to determine the association of the COVID-19 pandemic with anxiety/depression after adjusting for age, sex, insurance, income, and education., Result: A higher percentage of Non-Hispanic whites (NHW) with chronic conditions reported anxiety (24.3% vs. 11.5%, p  = 0.0021) and depression (20.7% vs. 9.3%, p  = 0.0034) during COVID-19 than pre-COVID-19. The adjusted odds ratio (AOR) of anxiety and depression for NHWs with chronic conditions during the COVID-19 pandemic was 2.02 (95% confidence interval of 1.10-3.73, p  = 0.025) and 2.33 (1.17-4.65, p  = 0.018) compared to NHWs who participated in the survey before the COVID-19., Limitations: Limited to the NHW US population. PHQ can only be used as the initial screening tool., Conclusion: The COVID-19 pandemic was associated with an increased prevalence of anxiety and depression among NHW adults with chronic conditions, but not among people of color., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2022 The Authors. Published by Elsevier B.V.)

Objectives: Adverse childhood experiences (ACEs) often have consequences beyond the immediacy of any specific event. The purpose of this study is to identify if ACEs in children with special healthcare needs (CSHCN) are associated with oral problems and dental care utilization., Methods: The data source for this cross-sectional, secondary data analysis study was the 2017-2018 National Survey of Children's Health. Children were categorized as CSHCN or children with no special healthcare needs (CNSHCN) who had no, 1, 2, or ≥3 ACEs. Rho-Scott Chi-Square tests and bivariate and multivariable logistic regression analyses were conducted., Results: CSHCN who have had 1, 2, or ≥3 ACEs were significantly more likely to have had an oral problem or dental caries within the previous year as compared with CNSHCN who did not have any ACE. For no dental visits for any reason and no preventive visits, CSHCN at all levels of ACE were not significantly different from CNSHCN and no ACE in adjusted analyses. However, CNSHCN who had ≥3 ACEs were significantly more likely to not have had a preventive dental or any dental visit within the previous year., Conclusions: In this nationally representative study of children and adolescents in the United States, CSHCN who have had ACE were more likely to have oral health problems within the previous year as compared with CNSHCN who did not have ACE., (© 2021 American Association of Public Health Dentistry.)

Purpose: Face-touching behavior has the potential for self-inoculation and transmission of the SARS-2 Coronavirus. The purpose of this study was to observe unconscious face-touching behaviors of dental hygiene and dental students in a non-clinical setting. Methods: Twenty minutes of archived proctoring videos of dental and dental hygiene students (n=87) while taking final examinations were watched for incidents of face-touching behavior. Data were analyzed for descriptive frequencies; independent sample t-tests were used to determine differences between dental and dental hygiene students and between males and females. Results: There was a significant difference in face touching behaviors between the student groups. Dental hygiene students (n=42) were observed 11.9 times (SD. 11.4) and dental students (n=45) were observed 8.9 times (SD, 7.9) touching the nose, mouth, and eyes (T-zone) (p=0.049). Differences in frequencies of touching the T-zone failed to reach significance between genders. Conclusion: Findings suggest both dental hygiene and dental students frequently touch their faces in non-clinical settings and need to be aware of this unconscious behavior. Given the significance of the COVID-19 pandemic, it is important to identify and quantify known risk factors that can be easily addressed to prevent/reduce infection transmission., (Copyright © 2021 The American Dental Hygienists’ Association.)

Background: Mobile applications related to health and wellness (mHealth apps) are widely used to self-manage chronic conditions. However, research on whether mHealth apps facilitate self-management behaviors of individuals with chronic conditions is sparse. We aimed to evaluate the association of mHealth apps with different types of self-management behaviors among patients with chronic diseases in the United States., Methods: This is a cross-sectional observational study. We used data from adult participants (unweighted n = 2340) of the Health Information National Trends Survey in 2018 and 2019. We identified three self-management behaviors: (1) resource utilization using electronic personal health records; (2) treatment discussions with healthcare providers; and (3) making healthcare decisions. We analyzed the association of mHealth apps to self-management behaviors with multivariable logistic and ordinal regressions., Results: Overall, 59.8% of adults (unweighted number = 1327) used mHealth apps. Adults using mHealth apps were more likely to use personal health records (AOR = 3.11, 95% CI 2.26-4.28), contact healthcare providers using technology (AOR = 2.70, 95% CI 1.93-3.78), and make decisions on chronic disease management (AOR = 2.59, 95% CI 1.93-3.49). The mHealth apps were associated with higher levels of self-management involvement (AOR = 3.53, 95% CI 2.63-4.72)., Conclusion: Among individuals with chronic conditions, having mHealth apps was associated with positive self-management behaviors.

Introduction: West Virginia is a state in which most counties are rural, as well as a state with multiple health disparities among its population. The purpose of this study was to determine the association of sleep duration and falls for non-institutionalized West Virginia adults, aged 40 years and above, using the National Sleep Foundation's definition of "may be appropriate" and "not recommended" sleep durations for specific ages., Methods: Behavior Risk Factor Surveillance System (BRFSS) 2018 data concerning West Virginia residents were extracted for sleep duration and number of falls within the previous year. Data were analyzed with Chi square and logistic regression analyses on falls., Results: There were 2780 participants, aged 45 years and above. Slightly more than half (51.0%) were female. In adjusted logistic regression analysis, the adjusted odds ratio for falls in participants who did not have the recommended sleep duration was 1.77; 95%CI: 1.38, 2.27; p <0.0001 as compared with participants who did have the recommended sleep duration., Conclusion: Inadequate sleep duration, based on age, was associated with ≥1 falls within the previous year in a West Virginia Appalachian population., (Copyright © 2021 R. Constance Wiener and Christopher Waters.)

Background: Unhealthy substance use is a public health challenge. Much of the focus of interventions is upon narcotics, stimulants, hallucinogens, central nervous system depressants, and alcohol. However, inhalants are also commonly used in an unhealthy manner and are under-recognized. The purpose of this study is to describe incident emergency department visits for volatile substance use to induce euphoria (VSUIE) injuries in the U.S. Methods: Data were obtained from the National Electronic Injury Surveillance System (NEISS) for the years 2015 to 2018. Descriptive frequencies, bivariate analyses using Rao-Scott Chi-Square, and multivariable logistic regression analyses were conducted to describe and examine the association between ED visits and VSUIE. Results: The estimated (weighted) number of VSUIE ED visits during 2015-2018 was 13,130 (95% Confidence Interval, CI: 8,383-17876; Coefficient of variation, CV = 0.18) and accounted for 0.02% of all ED visits. Males were more likely than females ( p < .0001), and young adults (ages ≥18 to ≤ 35 years) were more likely than older adults to have a VSUIE ED visit ( p <.0001). Conclusion: VSUIE ED visits occur more commonly in young adults than older adults and adolescents. The widespread use of volatile substances to induce euphoria is an under-reported public health issue with life-threatening consequences. Use of volatile substances by adolescents is a particular concern which needs attention and interventions to prevent its initiation.

The objective of this research was to determine if the engagement/participation in health promotion activities of cancer survivors in the United States (US) changed between 2006 and 2015. We pooled two independent cross-sectional data of cancer survivors using Medical Expenditure Panel Surveys from 2006 (N = 791; weighted N = 9,532,674) and 2015 (N = 1067; weighted N = 15,744,959). Health promoting activities consisted of past year influenza immunization, routine physical examination, and dental visit. Self-care included maintaining normal weight, not smoking, and engagement in recommended vigorous physical activity. We conducted unadjusted and adjusted logistic regression analyses to examine the change in engagement in health promoting activities over time. We found rates of annual influenza immunization (66.8% vs 70.3%), dental visit (71.8% vs 70.3%), and normal weight (33.9% vs 33.5%) did not change from 2006 to 2015. The percent with physical examination (90.8% vs 93.8%; P = .03) and non-smokers increased (87.9% vs 91.2; P = .04). Between 2006 and 2015, despite guidelines and recommendations for personalized cancer survivorship health plans, health promoting activities among cancer survivors did not change significantly.

Opioid use has the potential to influence infectious respiratory diseases. The purpose of this research is to examine if there is an association of deaths from the respiratory infection, COVID-19, and unhealthy opioid use in older adults., Data about patients, ages ≥65   years, who had a COVID-19 infection between 1/20/2020 to 12/23/2020 ( n   =   533,153) were extracted using the TriNetX system. Mortality incidence between initial diagnosis and ninety days after contracting COVID-19 were determined. Comparisons were made between people with and without unhealthy opioid use., There were 7,547 COVID-19 patients with unhealthy opioid use (mean age, 71.8   years; standard deviation 6.3   years) and 525,606 COVID-19 patients (mean age, 74.1   years; standard deviation 7.3   years) without unhealthy opioid use. Of the total, 15,852 (3.0%) died within 3   months of COVID-19 diagnosis. The unadjusted risk ratio of the cohort with unhealthy opioid use compared with the cohort that did not have unhealthy opioid uses was 1.18 (95% CI: 1.05,1.33); p   =   0.0069. The relationship failed to remain significant in analysis with propensity score matching (risk ratio = 0.96; 95% CI: 0.82, 1.14; p   =   0.6606, ns)., The public health implication is that although older adults are more vulnerable to COVID-19 than younger adults, a difference between older adults with or without unhealthy opioid use did not increase vulnerability to death from COVID-19 and should be not be considered if rationing of care becomes necessary.

Background: Exposure of toxic metals from e-cigarette use is a cause for public health concern because youth, young adults, and non-smokers are the target population rapidly adopting e-cigarette use. The purpose of this research is to determine the association of the body burden of heavy metals with e-cigarette use using NHANES (U.S.) 2015-2016 data., Methods: Blood lead (N = 1899) and urinary cadmium, barium, and antimony (N = 1302) data were extracted from NHANES, 2015-2016; geometric means were calculated and bivariate and multivariable linear regression analyses were conducted. Participants were categorized as having neither e-cigarette nor cigarette use; smoking history (including dual use with e-cigarettes); and only e-cigarette (current or former)., Results: In multivariable analyses adjusted for sex, race/ethnicity, age, and poverty levels, current or former e-cigarette use failed to reach a statistical significance in the association with metals. However, participants with a smoking history were more likely to have higher blood lead and urinary cadmium than participants who neither used e-cigarettes nor cigarettes., Conclusion: Blood lead levels, and urinary cadmium, barium, and antimony levels were similar between participants who used e-cigarettes and participants who did not., (Copyright © 2020 Elsevier GmbH. All rights reserved.)

Background: Adults with chronic respiratory conditions, specifically asthma or chronic obstructive pulmonary disease (COPD), may be at risk of experiencing poor oral health due to systemic inflammation, challenges in routine oral health care, and adverse effects of medications used to treat these conditions. The authors examined the association of asthma, COPD, and coexisting asthma and COPD (asthma-COPD overlap syndrome [ACOS]) with tooth loss among US adults., Methods: The authors conducted a cross-sectional study using 2016 Behavioral Risk Factor Surveillance System data (N = 387,217). The authors categorized the participants with missing permanent teeth into 4 groups: asthma only (n = 38,817), COPD only (n = 19,819), ACOS (n = 13,494), no asthma, no COPD (n = 315,087). The authors used adjusted multinomial logistic regressions to examine the associations between asthma and COPD categories and tooth loss., Results: According to the authors, 5.3% of study participants reported they were edentulous; 10.7% reported 6 or fewer missing teeth. Participants with asthma only, COPD only, and ACOS had higher odds of reporting tooth loss (6 or more teeth) than those in the no asthma, no COPD group; adjusted odds ratios were 1.12 (95% confidence interval, 1.00 to 1.26) to 2.04 (95% confidence interval, 1.85 to 2.26). A lower percentage of participants with COPD and ACOS visited dentists in the past year than those with no asthma and no COPD. Interactive associations suggested participants with asthma or COPD with dental visits were less likely to report edentulism than those with neither asthma nor COPD and no dental visits., Conclusions: Participants with asthma or COPD had higher odds of tooth loss compared with those with neither asthma nor COPD., Practical Implications: People with asthma or COPD should maintain routine dental visits to reduce the risk of experiencing tooth loss., (Copyright © 2020 American Dental Association. Published by Elsevier Inc. All rights reserved.)

Toxoplasma gondii (T. gondii) causes chronic, latent infections of global concern. Its subclinical influence on behavior and cognition are poorly understood. The objective of this research is to determine the relationship of T. gondii IgG with cognition using National Health and Nutrition Examination Survey data, 2013-2014 in older adults ≥60 years. A composite cognitive function score was created by adding the scores of the memory test, language/verbal fluency, and working memory test. T. gondii IgG was dichotomized at <33 IU/mL (negative) and ≥33 IU/mL (positive). There were 19.2% of the participants who were T. gondii IgG + . The memory function and language/verbal fluency subtests failed to reach significance; however, the difference in the working memory test was significant. In the multivariable ordinal logistic regression analysis, controlling for potential confounders, the odds of cognitive function scores decreasing in quartiles among people with positive vs. negative T. gondii IgG are 1.55 (95% CI: 1.08, 2.21; p = .0170). Establishing an evidence base for the association of T. gondii IgG and cognition is complex, but essential., Competing Interests: Declaration of Competing Interest The authors have no conflicts of interest to report., (Copyright © 2020 Elsevier B.V. All rights reserved.)

Purpose: Tobacco use initiated during adolescence often leads to continued use in adulthood. There are multiple factors influencing initiation, including low perceived risk of harm. Adolescents involved in school-based extracurricular activities have opportunities to interact with coaches, leaders, and group supervisors who may influence their perception of risk. The purpose of this study was to examine the role of extracurricular activities and adolescents' perceived risks of harm of tobacco use, utilizing an existing dataset. Methods: The 2016 National Survey on Drug Use and Health (NSDUH) dataset was used for a cross-sectional study of youth, ages 12 to <18 years. Adolescents involved in one or more school-based, extracurricular activities were compared with adolescents involved in no activities. The key variable was the response to the NSDUH question regarding perceived risk of harm from daily smoking (≥1 packs of cigarettes). Chi-square tests and multinomial logistic regression were used to analyze the data. Results : At the time of the 2016 NSDUH study period, among the adolescents aged 12 to <18 years (n=4,308), 17.5% indicated that they did not participate in any extracurricular activities and 10.6% reported no/slight perceived risk of harm associated with tobacco use. Adolescents who did not participate in extracurricular activities were more likely to report no/slight risk of harm from smoking (Adjusted Odds Ratio, AOR= 2.21 [95%CI: 1.62, 3.02]) as opposed to the perception of great risk of harm. Conclusion: Adolescents who are not involved in extracurricular activities are more likely to endorse the perception that cigarettes have no/slight risk of harm. School-based extracurricular activities may provide unintended benefits to adolescents; health care professionals, including dental hygienists, should be aware of this associated health benefit., (Copyright © 2020 The American Dental Hygienists’ Association.)

Human papillomavirus (HPV) vaccination acceptance is hampered by fears and conflicting attitudes about the need for and safety of vaccine. There are also ethical dilemmas associated with vaccinating adolescents for a sexually transmitted disease despite future cancer risk. The purpose of this research was to determine HPV vaccination acceptance/hesitancy among young adults. Behavioral Risk Factor Surveillance System 2015 data were used. During 2015, 83.1% of adults ages 25-29 years did not receive any HPV vaccination; the UOR was 3.47; 95% CI = 2.11, 5.70) compared to adults 18-24 years. There is a need to accelerate public health messaging/campaigns to increase HPV vaccination rates., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

Purpose: Many school-aged children have not received dental care in West Virginia, despite mandated statewide requirements of a dental evaluation and dental treatment before entering school, and the provision of Medicaid/CHIP insurance coverage for children from families below the federal poverty level. An innovative mobile oral health program to educate children, provide preventive care, and bring technology to public schools was developed for West Virginia children in a need shortage area. It was unknown if the unmet dental needs challenge was greater for male or female children residing in that area. The purpose of this study was to determine whether there was a difference by sex in the number of attendees and the incidence of dental caries for children who visited a school-based mobile dental facility. Methods: School-aged children who had not had a dental examination within the previous year were offered school-based examinations/assessments, preventive care, and oral health education via a mobile oral health program following parental/guardian consent. Data were collected concerning the number of current carious teeth in need of restoration. Descriptive statistics and chi square analyses were conducted to analyze the data. Results: There were 429 students evaluated at the school-based mobile dental facility. Half (50.3%) were male. Referrals for additional necessary oral/medical care were made for 214 (50.1%) children; 45.9% of males and 53.3% of females ( p = 0.287) had dental caries. Conclusion: Results from this study indicate that sex was not a statistically significant factor in school-based mobile dental facility attendance nor in current dental caries incidence among school-aged children in an underserved area of West Virginia., (Copyright © 2020 The American Dental Hygienists’ Association.)