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Elizabeth A Claydon,1 Jenna M Kahwash,1 Christa L Lilly,2 Yahya Alamir,3 Keith J Zullig1 1Department of Social and Behavioral Sciences, West Virginia University School of Public Health, Morgantown, WV, USA; 2Department of Epidemiology and Biostatistics, West Virginia University School of Public Health, Morgantown, WV, USA; 3Department of Health Education & Promotion, Faculty of Public Health & Tropical Medicine, Jazan University, Jazan, Saudi ArabiaCorrespondence: Elizabeth A Claydon, West Virginia University School of Public Health, 64 Medical Center Drive, P.O. Box 9190, Morgantown, WV, 26505, USA, Email elizabeth.claydon@hsc.wvu.eduBackground: Research has shown that university students engage in behaviors that are associated with poor sleep quality, such as higher caffeine and alcohol intake. Yet studies exploring eating habits and weight loss mechanisms related to sleep quality have generally been inconclusive. This study explored total daily caffeine consumption (along with different sources of caffeine) as well as dieting and exercising to lose weight in the last 30 days as risk factors for poor sleep quality among an undergraduate university population.Methods: Full-time undergraduate students (n = 400) participated in an anonymous online survey about various health behaviors at a large, mid-Atlantic university. Multivariable linear regressions were run to consider subjective sleep quality in relation to caffeine consumption and dieting behavior along with other covariates. A sensitivity analysis was run to explore how different types of caffeinated beverages were associated with sleep quality as well. All analyses were conducted using SAS JMP Version 16.Results: A stepwise multivariable linear regression controlling for alcohol use, grade point average, biological sex, and stress showed significant increases in sleep quality scores (indicating worsening sleep quality). Total caffeine consumption remained significant through the models until psychosocial factors were added (B = 0.003, p = 0.0035). The sensitivity analysis indicated that total caffeine consumption from soda remained significant across all models, significantly increasing sleep quality scores (B = 0.01; p = 0.0054).Discussion: Higher amounts of caffeine from sodas were associated with more significant decreases in sleep quality than other types of caffeine, including energy drinks, coffee, and tea. Dieting or exercising to lose weight was not significantly associated with sleep quality. The results of this study can help to refine intervention efforts designed to improve sleep quality among undergraduate university students. Behavioral interventions specific to reducing caffeine intake, specifically from caffeinated sodas, may prove to be beneficial with this population.Plain Language Summary: In college, students face risks for worse sleep quality, like consuming more caffeine and feeling more stressed. When scientists studied how eating habits affect sleep, the results were mixed. This study was conducted to see how much caffeine and weight-loss methods affect sleep quality for college students.Researchers used a survey to ask college students about their sleep, caffeine, weight-loss methods, and other behaviors. This study found that drinking more soda was associated with worse sleep quality when compared to drinking coffee, tea, or energy drinks. Drinking alcohol and being stressed also was connected with poorer sleep quality worse. However, researchers did not find a link between weight-loss methods and sleep quality.For college students to have better sleep, interventions should try to lower caffeine intake (especially from soda), alcohol intake, and stress levels.Keywords: caffeine, sleep quality, university students, disordered eating

PURPOSE: Studies have substantiated a relationship between drug use, depression, and suicidality. However, little research has examined this relationship with prescription drugs. Given the prevalence of non-medical prescription drug use (NMPDU) among college students, this study explored the association between general and specific NMPDU, depressive symptoms, and suicidality. METHODS: Data from the Fall 2008 National College Health Assessment (NCHA) was utilized (N=22,783). Five separate logistic regression models were employed, with the first combining any NMPDU (antidepressants, painkillers, sedatives, and stimulants) followed by four additional regressions for each drug, and then separated by gender. Models were estimated before and after control for key covariates. RESULTS: Approximately 13% of participants reported NMPDU. After covariate adjustment, those who reported feeling hopeless, sad, depressed, or considered suicide were 1.22-1.31 times more likely to report NMPDU (p<.05). Those who reported feeling hopeless, sad, or depressed were 1.18-1.43 times more likely to report opioid painkiller use; those who reported feeling sad, depressed, or considered suicide were 1.22-1.38 times more likely to report stimulant use; those who reported being depressed were 1.36 times more likely to report sedative use; and those who reported feeling hopeless or depressed were 1.44 and 1.91 times more likely to report antidepressant use (p<.05). When the adjusted models were repeated separately by gender, results were more pronounced for females, especially for females who reported painkiller use. CONCLUSIONS: Depressive symptoms and suicidality were significantly associated with greater odds of any NMPDU, with painkiller use (especially for females) representing the greatest correlate among college students. Results suggest that students may be inappropriately self-medicating psychological distress with prescription medications. [ABSTRACT FROM AUTHOR]

OBJECTIVES: To investigate the psychometric properties of the BMSLSS-College among 723 college students. METHODS: Internal consistency estimates explored scale reliability, factor analysis explored construct validity, and known-groups validity was assessed using the National College Youth Risk Behavior Survey and Harvard School of Public Health College Alcohol Study. Criterion-related validity was explored through analyses with the CDC's health-related quality of life scale and a social isolation scale. RESULTS: Acceptable internal consistency reliability, construct, known-groups, and criterion-related validity were established. CONCLUSIONS: Findings offer preliminary support for the BMSLSS-C; it could be useful in large-scale research studies, applied screening contexts, and for program evaluation purposes toward achieving Healthy People 2010 objectives. [ABSTRACT FROM AUTHOR]

OBJECTIVES: To evaluate the performance of the US Centers for Disease Control's health-related quality of life (HRQOL) scale among 522 college students. METHODS: Chi-square analysis assessed scale construct validity and analysis of variance (ANOVA) with selected tobacco, alcohol, and substance use variables assessed known-groups validity of the scale's Healthy Days index. RESULTS: Patterns of association among scale items were consistent with those hypothesized. ANOVA analyses revealed significant (P<.05) associations between the Healthy Days index and selected variables in predicted directions. CONCLUSIONS: Preliminary evidence is provided that the HRQOL scale could serve as part of program evaluation, intervention, and surveillance efforts among college students. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To investigate the psychometric properties of the BMSLSS among 522 college students. METHODS: Internal consistency reliability explored scale reliability, factor analysis explored construct validity, known-groups validity was assessed by use of items from the National College Youth Risk Behavior Survey and Harvard National Survey of Alcohol Use, and criterion-related validity was explored through analyses with the CDC's Health-Related Quality of Life Scale. RESULTS: Acceptable internal consistency reliability, construct, known-groups, and criterion-related validity were established. CONCLUSIONS: These findings offer preliminary support for the BMSLSS; it could serve as part of comprehensive evaluations of subjective QOL for program evaluation and/or policy purposes among college students. [ABSTRACT FROM AUTHOR]

The contribution of the construct of perceived quality of life (PQOL) to adolescent health assessment and promotion is discussed. Theory, measurement, and correlates of PQOL in adolescence are reviewed, with a focus on the incremental validity of PQOL data in relationship to more traditional pathology-based health indices. Similar to Diener's proposal, which pertained exclusively to adults, we call for the inclusion of PQOL data in national databases that monitor adolescent health outcomes. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To explore relationships between life satisfaction and violent behaviors among 5,032 adolescents. METHODS: Adjusted polychotomous logistic regression analyses and multivariate models were used via SUDAAN with the 1997 CDC YRBS. RESULTS: Carrying a weapon; carrying a gun; carrying a weapon at school; physical fighting; physical fighting at school; physical fighting that required physician treatment; drinking and driving; riding with a drinking driver; having property stolen/damaged at school; feeling unsafe while at, going to or returning from school; and being injured/threatened with a weapon were associated (p=.05) with reduced life satisfaction. CONCLUSION: Measures of life satisfaction as a component of comprehensive assessments of adolescent violence/aggression in field-work, research, and program-evaluation efforts should be considered. [ABSTRACT FROM AUTHOR]

Bystander-based sexual violence (SV) prevention trainings are offered on college campuses across the United States to meet federal Title IX requirements, as they have proven to be an effective strategy for violence prevention. Greek-affiliated students (fraternity and sorority members) are at a higher risk of sexual assault than their peers; however, few trainings consider the specific needs of this population, and program adaptations for this high-risk group may be needed. This scoping review identifies and describes the bystander trainings delivered to Greek-affiliated students in the US and Canada. An eight-database search was conducted following PRISMA-ScR guidelines. The review identified 81 unique sources, with 18 meeting the inclusion criteria. Eleven specific training programs were identified, encompassing qualitative, quantitative, and mixed-method studies. The thematic analysis revealed best practices, including the importance of peer leaders, interactive sessions, and tailored content to Greek culture, as well as barriers such as a lack of engagement and an inadequate session length. The review underscores the need for tailored interventions to effectively address the unique cultural characteristics and high-risk nature of Greek-affiliated students. These findings provide valuable insights for improving the design and implementation of bystander interventions to enhance their efficacy in preventing sexual violence within this population.

Background: Elevated mental illness prevalence complicates efforts designed to address the opioid crisis in Appalachia. The recovery community acknowledges that loneliness impacts mood and engagement in care factors; however, the predictive relationship between loneliness and retention in medication-assisted outpatient treatment programs has not been explored. Our objectives were to identify associations between mental health factors and retention in treatment and elucidate treatment retention odds. Data were collected from eighty participants ( n = 57 retained, n = 23 not retained) of a mindfulness-based relapse prevention (MBRP) intervention for individuals receiving medication for opioid use disorder (MOUD) in Appalachia. Loneliness, depression, and anxiety did not differ between the retained and not retained, nor did they predict not being retained; however, mindfulness was significantly lower among those not retained in treatment compared to those retained (OR = 0.956, 95% CI (0.912-1.00), and p < 0.05). Preliminary findings provide evidence for mindfulness training integration as part of effective treatment, with aims to further elucidate the effectiveness of mindfulness therapies on symptom reduction in co-occurring mental health disorders, loneliness, and MOUD treatment retention.

Poor sleep confers significant morbidities and is highly prevalent among college students in the United States. This research assessed sleep quality and its association with health-related quality of life (HRQOL). Further, because sleep quality research often lacks a theoretical foundation, we applied a theoretical model using selected constructs from the Theory of Planned Behavior (TPB) and Health Belief Model (HBM). A random, stratified sample of undergraduate students participated in an online survey (N = 494). Structural equation modeling assessed the association between theoretical constructs, sleep quality, and HRQOL. The final model fit was acceptable, with ~ 20% of the variance in sleep quality explained by the theoretical constructs and control variables. HBM constructs were indirectly and negatively related to sleep quality, mediated through behavioral intention, and also positively and directly associated with behavioral intention. Behavioral intention was strongly and negatively associated with sleep quality. Approximately 31% of the variance in HRQOL was explained by poor sleep quality, behavioral intention, and gender. Poor sleep was most strongly associated with reduced HRQOL. HBM constructs and behavioral intention from TPB were significantly associated with poor sleep quality, and poor sleep was significantly related to poor HRQOL., (© 2022. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Loneliness is a significant risk factor for substance use, however, impacts of treatments on loneliness are relatively unexplored. Living in a rural location is a greater risk factor for loneliness. This study examined data from a quasi-experimental study in rural Appalachia, comparing the effectiveness of Mindfulness-Based Relapse Prevention (MBRP) versus Treatment as Usual (TAU) among adults receiving MOUD in outpatient therapy. Our objective was to determine whether observed reductions in self-reported craving, anxiety, depression, and increased perceived mindfulness would also improve loneliness reports. Eighty participants (n = 35 MBRP; n = 45 TAU) were included in the analysis from a group-based Comprehensive Opioid Addiction Treatment program. Outcomes tracked included craving, anxiety, depression, mindfulness, and loneliness as measured by the Revised UCLA Loneliness Scale (R-UCLA). A linear mixed model ANOVA determined the significance of the treatments on changes in loneliness scores at baseline, 12 weeks, 24 weeks, and 36 weeks post-recruitment. Both groups reported significantly reduced loneliness over the course of the study (F = 16.07, p < 0.01), however there were no significant differences between groups. Loneliness was also significantly positively ( p < 0.01) correlated with anxiety (0.66), depression (0.59), and craving (0.38), and significantly ( p < 0.01) inversely correlated (-0.52) with mindfulness. Results suggest that participation in MOUD group-based outpatient therapy has the potential to diminish loneliness and associated poor psychological outcomes. Thus, it is possible that a more targeted intervention for loneliness would further diminish loneliness, which is important as loneliness is linked to risk for relapse.

Objectives: In this paper, we explore differences in demographics, mask wearing attitudes and behaviors, and vaccination perceptions among students who reported that mask mandates violate their civil liberties compared to those who did not. Methods: Participants completed an online survey in April 2021 (N=619). Results: Students who reported that mask mandates violate their civil liberties were more likely to identify as male, report good health, attend in-person classes, and less likely to report being vaccinated (p<.05). These students were also more likely to endorse not wearing masks because masks make it difficult to breathe, provide a false sense of security, and because they value their independence; in addition, they were more likely to endorse not being vaccinated because they are at low perceived risk for infection, because of the unknown side effects of vaccines, and because vaccines were rushed into production (p<.05). Whereas students who reported that mask mandates violate their civil liberties were about 5.2 times more likely (p<.0001) to report being unvaccinated, vaccine status was only modestly positively correlated (r=.36, p<.0001). Conclusions: Although students who reported mask mandates violate their civil liberties were also more likely to be unvaccinated, these individuals are not necessarily the same, suggesting different public health messaging may be required to increase both mask use and vaccine uptake.

This study examined the interrelationship of intimate partner violence (IPV), sexual assault (SA), and eating disorder (ED) symptomatology among a sample of college students ( n = 1,580). Students reporting a history of SA were 2.5 times more likely to screen positively for further ED assessment. A history of IPV also increased odds of having a positive ED screener. The model showed that 6% of the variance in ED symptomatology was explained by IPV and SA. Results did not differ based on gender. This study furthers our understanding of the relationship between IPV, SA, and ED to guide future prevention and treatment efforts. Specifically, the use of trauma-informed ED treatment could assist with full ED recovery and other comorbid mental health conditions., (© Copyright 2022 Springer Publishing Company, LLC.)

Women with substance use disorder (SUD) often have experienced adverse childhood experiences (ACEs). The intergenerational nature of ACEs also put their children at risk for experiencing ACEs. However, no research has explored the prevalence of ACEs in children whose mothers have SUD. This study assessed ACE scores in mothers with SUD and their children and compared them with non-SUD participants. Females with SUD were recruited from a treatment center (n = 50) and compared to females without SUD from the same area (n = 50). The ACE scores of the participants and their children were measured as well as sociodemographic variables. ANOVA and Fisher's Exact tests were used to examine univariate differences. Multivariate regression models assessed the difference in ACE scores between the groups and their children and the relationship between maternal and child ACE scores while including sociodemographic confounders. The mean ACE score was significantly higher in SUD participants (4.9, SD  = 2.9) when compared to non-SUD participants (1.9, SD  = 2.0) after controlling for sociodemographic variables (p < .01). Children of treatment participants also had significantly higher mean ACE scores (3.9, SD  = 2.3) than children of comparison participants (1.3, SD  = 2.0, p < .01). Maternal ACE score was positively related to children's ACE score after controlling for sociodemographic variables. Given the intergenerational nature of ACEs and their high burden in both mothers and children in substance use treatment, these preliminary findings suggest that mother-child trauma-informed interventions may be appropriate for this population., 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., (© 2021 The Authors.)

Approximately 41% of adults aged 18-24 years in the United States are enrolled in a college or university (1). Wearing a face mask can reduce transmission of SARS-CoV-2, the virus that causes coronavirus disease 2019 (COVID-19) (2), and many colleges and universities mandate mask use in public locations and outdoors when within six feet of others. Studies based on self-report have described mask use ranging from 69.1% to 86.1% among adults aged 18-29 years (3); however, more objective measures are needed. Direct observation by trained observers is the accepted standard for monitoring behaviors such as hand hygiene (4). In this investigation, direct observation was used to estimate the proportion of persons wearing masks and the proportion of persons wearing masks correctly (i.e., covering the nose and mouth and secured under the chin*) on campus and at nearby off-campus locations at six rural and suburban universities with mask mandates in the southern and western United States. Trained student observers recorded mask use for up to 8 weeks from fixed sites on campus and nearby. Among 17,200 observed persons, 85.5% wore masks, with 89.7% of those persons wearing the mask correctly (overall correct mask use: 76.7%). Among persons observed indoors, 91.7% wore masks correctly. The proportion correctly wearing masks indoors varied by mask type, from 96.8% for N95-type masks and 92.2% for cloth masks to 78.9% for bandanas, scarves, and similar face coverings. Observed indoor mask use was high at these six universities with mask mandates. Colleges and universities can use direct observation findings to tailor training and messaging toward increasing correct mask use., Competing Interests: All authors have completed and submitted the International Committee of Medical Journal Editors form for disclosure of potential conflicts of interest. No potential conflicts of interest were disclosed.

Objectives: This study aimed to explore the effectiveness of mindfulness-based relapse prevention (MBRP) with individuals receiving medication for opioid use disorder (MOUD) in a naturalistic, open-ended outpatient group treatment setting., Methods: Eighty participants (mean age 36.3) who had at least 90 consecutive days substance free self-selected into treatment (MBRP, n  = 35) or comparison groups (treatment as usual, TAU, n  = 45). Outcomes tracked included treatment retention and relapse, and self-reported craving, anxiety, depression, and mindfulness at baseline, 12 weeks, 24 weeks, and 36 weeks post-recruitment. MBRP group participants attended biweekly 60-min sessions for 24 weeks. A linear mixed model analysis of variance determined the significance of the MBRP intervention on changes in craving, anxiety, depression, and mindfulness., Results: No significant differences in sex, education level, insurance status, relationship status, or employment status were detected at baseline between groups. The 36-week retention (74%, MBRP/MOUD; 71%, TAU/MOUD) and relapse rates (43%, MBRP/MOUD; 47%, TAU/MOUD) were similar for the groups. There were only four relapses on opioids. Significant reductions ( p  < .05) were observed in the MBRP/MOUD group for craving, anxiety, and depression in addition to significant increases in mindfulness compared to those in TAU/MOUD., Conclusions: Although state and federal resources are available to expand MOUD, no standard of behavioral therapy has been established as most complimentary to MOUD. The current study results suggest MBRP can be implemented as an outpatient therapy for individuals in MOUD., Competing Interests: Conflict of InterestThe authors declare no competing interests., (© The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature 2021.)

Background: The primary objective was to understand life satisfaction (LS) of patients with eating disorders (EDs) in relation to eating pathology severity, personal/familial ED history, and key demographic and anthropometric variables., Methods: Participants ( N  = 60) completed the Satisfaction with Life Scale (SWLS), the Eating Pathology Severity Index (EPSI), and demographic questionnaires. Bivariate associations via correlations and multiple linear regression models were used to explore these relationships., Results: The SWLS mean score was 3.7 out of 7, suggesting it is below the population-based norm. LS was positively statistically significantly associated with private insurance, past ED, EPSI muscle building, EPSI restricted eating, and EPSI negative attitudes. When included in multiple linear regression, the model explained 33% of the variability of LS [F (7, 56) = 3.4, p  = 0.0054, R 2  = 0.33]. EPSI muscle building remained the strongest predictor (β = 0.13, p  = 0.04)., Conclusions: Based on the data, individuals who have/have had EDs scored lower on the SWLS than the general population. Individuals scoring within this range typically experience significant issues in several areas of life or a substantial issue in one area., Competing Interests: Competing interestsNo conflicts of interest to report., (© The Author(s) 2020.)

An Exploratory Study on the Intergenerational Transmission of Dieting Proneness within an Eating Disorder Population (IRB Protocol Number: 160928271)., Purpose: Parents and families are not the sole factor in eating disorder (ED) development and their involvement in recovery is crucial. However, parents provide a social and environmental context for a child's eating and weight that cannot be completely discounted. The purpose of this study was to explore the intergenerational transmission of dieting behavior within an ED sample., Methods: Participants (N = 65) were recruited for this cross-sectional study through four distinct ED treatment sites. Participants completed a questionnaire that was developed previously to examine parental feedback as predictor variables, as well as completing the Eating Pathology Severity Index (EPSI) as an outcome variable. A total of 60 completed the questionnaire items of interest to be included in the analyses. SAS JMP ® 13.0 was used for descriptive analyses, correlations, and multivariable linear regressions., Results: Results of the multivariable linear regression showed that the amount of variance explained by the final model for eating pathology severity (via the EPSI) doubled when parental feedback was included (Model 1: R 2 = 0.09, Model 2: R 2 = 0.20). Additionally, there was a significant relationship between the "Negative Direct Parental Feedback Subscale" and EPSI total scores (ß = 14.1; SD = 7.0; p = 0.05)., Conclusion: These findings of increased eating pathology associated with direct parental feedback in a clinical population of ED participants even when controlling for parental ED history suggests greater attention is needed within the ED literature on social and environmental factors and their potential associations with eating pathology., Level of Evidence: Level V, descriptive study.

Purpose: Addressing adolescent sexual risk behaviors in the STI/HIV prevention literature is well documented; however, intervention impacts on life satisfaction are relatively unexplored. This study is a secondary analysis of data (N = 1,658) from a randomized, multisite, multilevel safer sex media campaign (Project iMPPACS) analyzing life satisfaction across baseline and follow-up data collected from 2006 to 2008 among participants (mean age 15.08 years) who reported never having had vaginal sex at baseline (n = 787)., Methods: Participants were separated into groups based on whether they reported having vaginal sex (yes/no) at baseline. Then taking into account the nested study design and controlling for confounders, a mixed model repeated measures analysis of variance assessed whether differences in mean total life satisfaction (LS) were associated across time in the media and nonmedia study conditions separately by gender., Results: A significant interaction between time and media condition was detected (p = .039) where mean total LS increased +.065 units from baseline (M = 5.364) to last contact in media cities and decreased -.084 units from baseline (M = 5.557) to last contact in nonmedia cities when controlling for the effect of initiating vaginal sex. No significant differences in LS at baseline were observed between media and nonmedia intervention cities. Results by gender suggest most positive change in LS was observed for females with mixed findings for males., Conclusions: Although Project iMPPACS was not designed with the intent on improving participants' life satisfaction, results advance the LS literature by demonstrating a temporal sequence for sexual risk taking and LS over time., (Copyright © 2019 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.)

This article reviews evidence for the public health impacts of coal across the extraction, processing, use, and waste disposal continuum. Surface coal mining and processing impose public health risks on residential communities through air and water pollution. Burning coal in power plants emits more nitrogen oxides, sulfur dioxide, particulate matter, and heavy metals per unit of energy than any other fuel source and impairs global public health. Coal ash disposal exposes communities to heavy metals and particulate matter waste. Use of coal in domestic households causes public health harm concentrated in developing nations. Across the coal continuum, adverse impacts are disproportionately felt by persons of poor socioeconomic status, contributing to health inequities. Despite efforts to develop renewable energy sources, coal use has not declined on a global scale. Concentrated efforts to eliminate coal as an energy source are imperative to improve public health and avert serious climate change consequences.

Objective : There is a paucity of research exploring eating disorders (EDs) and academic performance (AP). This study aimed to understand the effect of ED treatment on AP, hypothesizing that students receiving treatment for EDs would have a higher GPA. Participants: The Spring 2010 - Spring 2011 National College Health Assessment data ( N  = 231,586) was utilized. Methods: Ordinal logistic regressions, controlling for key confounders, analyzed the association between those diagnosed with anorexia or bulimia and GPA. Results: Students diagnosed with anorexia or bulimia and treated with medication and psychotherapy were respectively 1.49 (1.24, 1.80; p  < .0001) or 1.35 (1.13, 1.61; p  = .0009) times more likely to have a higher GPA ( p  < .0001) compared to students without EDs. Conclusion : Findings expand the literature on EDs and AP among college students. Additional research is needed to determine whether the combination of medication and psychotherapy is the most effective way to improve AP among students with EDs.

Addressing adolescent sexual risk behaviors in the STI/HIV prevention literature is well documented; however, impacts from interventions on life satisfaction are relatively unexplored. This study examined data (n = 1658) from a randomized, multi-site, multi-level STI/HIV prevention intervention trial (Project iMPAACS) to determine whether increased protective and reduced sexual risk-taking behaviors associated with STI/HIV would also improve self-reported life satisfaction. Taking into account the nested study design and controlling for confounders, a mixed model ANOVA was performed where Total mean life satisfaction scores were analyzed at baseline and 3, 6, 12, and 18 months post-recruitment. Significance levels of 0.05 were used to determine significance and η 2 was used to assess effect size. We hypothesized that as intervention participants engaged in the intentional activity associated with increasing protective behaviors and reducing sexual risk-taking behaviors associated with STI/HIV, life satisfaction reports would also improve over the course of the intervention. A significant main effect for sex was detected ( F = 5.19, p = .02, η 2 = .03), along with three interactions: between experimental condition and media intervention ( F = 7.96, p = .005, η 2 = .04); experimental condition, sex, and media intervention ( F = 6.51, p = .01, η 2 = .04); and experimental condition, sex, assessment point, and media intervention ( F = 3.23, p = .01, η 2 = .02). With the exception of the control condition, female life satisfaction reports improved from baseline assessments to 18-months post-recruitment, whereas male reports decreased. Project iMPPACS was not designed with the intent on improving participants' life satisfaction. However, study results suggest incorporating strategies to address subjective well-being into future adolescent STI/HIV risk-reduction interventions is beneficial for females and additional research is necessary for males., Competing Interests: Conflict of interest This work was partially supported through the iMPPACS network supported by the National Institutes of Mental Health (Grant Number 1-UO1-MH66802; Pim Brouwers, NIMH Project Officer) at the following sites and local contributors: Columbia, SC (MH66803; Robert F. Valois [PI], Naomi Farber, Andre Walker); Macon, GA (MH66807; Ralph J. DiClemente [PI], Gina Wingood, Laura Salazar, Rachel Joseph, Delia Lang); Philadelphia, PA (MH66809; Daniel Romer [PI], Sharon Sznitman, Bonita Stanton, Michael Hennessy, Susan Lee, Eian More, Ivan Juzang, Thierry Fortune); Providence, RI (MH66785; Larry K. Brown [PI], Christie Rizzo, Nanetta Payne); and Syracuse, NY (MH66794; Peter A. Vanable [PI], Michael P. Carey, Rebecca Bostwick).

Objective/Background : Poor sleep and nonmedical use (NMU) of prescription drugs (NMUPD) are both common among college students. Since lack of sleep adversely influences academic performance, this study examined the association between NMUPD and subjective sleep quality among college students. Participants : Students who completed the American College Health Association-National College Health Assessment data (Fall 2010, Spring 2011; N  = 135,874). Methods : Associations were examined between NMUPD in four classes over the past 12 months (antidepressant, painkillers, sedatives, and stimulants), and five aspects of sleep quality (Enough Sleep, Early Awakening, Daytime Sleepiness, Difficulty Falling Asleep, and Problem With Daytime Sleepiness) in the past seven days. Results : Any NMUPD (at least one class), NMU of stimulants specifically, and NMU of painkillers specifically were associated with getting fewer days of Enough Sleep (OR: 0.86, 0.93, and 0.84 respectively), more days of Early Awakening (OR: 1.28, 1.10, and 1.28 respectively), Daytime Sleepiness (OR: 1.23, 1.13, and 1.16 respectively), and Difficulty Falling Asleep (OR:1.32, 1.10, and 1.27 respectively; p  < .0001, each). NMU of sedatives was significantly associated with having Problem With Daytime Sleepiness (OR: 1.10), more days of Early Awakening (OR: 1.12), and Difficulty Falling Asleep (OR: 1.17; p  < .0001). Conclusions : NMUPD is associated with poor sleep among college students. Therefore, behavioral medicine screening and treatment of this vulnerable population should consider sleep health, NMUPD, and the potential that these problems may be comorbid.

Purpose: To investigate the relationship between selected disordered eating behaviors and self-reported sexual minority status (gay/lesbian, bisexual, and unsure) among a representative sample of high school adolescents., Methods: The 2013 Centers for Disease Control and Prevention (CDC)-sponsored Connecticut Youth Risk Behavior Survey was utilized (N = 2242). Unadjusted and adjusted logistic regression analyses, separated by gender, examined sexual minority adolescents (gay/lesbian, bisexual, and unsure) and selected eating behaviors. Analyses adjusted for race, age, cigarette use, binge drinking, organized school activity participation, body mass index (BMI), and depression., Results: Gay males were significantly more likely to report exercising or eating less to lose weight in the unadjusted models (p < 0.05) and fasting, vomiting, and taking diet pills in both adjusted (p < 0.05) and unadjusted models (p < 0.01) when compared to the referent heterosexual males. Bisexual females were significantly more likely to report fasting, vomiting, and taking diet pills in the unadjusted model (p < 0.05) when compared to the referent heterosexual females and significantly less likely to report exercising or eating less to lose weight in the adjusted models (p < 0.05)., Conclusions: Although additional studies are needed owing to small sample sizes, preliminary findings support previous research suggesting that high school-aged sexual minority youth subgroups are a priority target population for increased efforts to prevent disordered eating.

Objectives: In this study, we examined the co-occurrence of multiple health-risk behaviors to determine whether there are any differences in the pattern of co-occurrence by sex. Methods: We conducted latent class analysis using the national 2013 Youth Risk Behavior Survey data for the overall sample, and separately by sex (N = 13,583). Results: Over half of the sample (53%) belonged to the low risk subgroup (Class 1). Class 2 accounted for 15% of adolescents, and over 40% in this subgroup reported riding with a drunk driver, and 63% reported texting while driving a vehicle. Over 14% belonged to Class 3, which had a higher probability of being depressed and suicidal (81% and 64%, respectively). Class 4 accounted for over 9% of adolescents who reported high probabilities for current cigarette (97%), tobacco (99%), and alcohol use (73%); and over half reported current marijuana use (52%). Class 5 accounted for 8.5% of adolescents identified as high-risk polysubstance users. Analyses showed differences by sex in the pattern of co-occurrences. Conclusion: Several adolescent risk behaviors are interrelated regardless of sex. However, sex differences in the higher probability of depressive symptoms and suicidality among girls highlight the need for interventions that consider the demographic composition of adolescents.

Background: Emergent evidence suggests a positive school climate may be a promising population-level intervention to promote academic achievement and student well-being. However, researchers have called for expanding the school climate evidence-base to better describe how the construct is associated with student outcomes. The purpose of this study was to determine the associations between 10 school climate domains and academic achievement among middle and high school students., Methods: ANOVAs were used to analyze survey data from 6-12 grade students in a Mid-Atlantic US state (n = 2405, response rate: middle school = 82.4%, 50.5% female; high school = 62.5%, 56.1% female)., Results: Significant main effects were found for all school climate domains and varied between middle and high school students apart from academic support. Effect sizes ranged from small to medium, with academic support demonstrating the strongest effects among both middle and high school students., Conclusions: Findings suggest school climate is associated with academic achievement for both middle and high school students. Correctly identifying the role of key aspects of school climate by grade-level may provide improved and developmentally appropriate recommendations for the delivery of instruction and school-based interventions that promote positive school well-being and student performance., (© 2019, American School Health Association.)

Purpose: There is a paucity of research exploring individuals' memories of parental dieting behavior, engagement in "fat talk", or criticism of weight or eating behavior in childhood. This exploratory study utilized a community sample to further characterize the retrospective report of parenting dieting behavior., Methods: A total of 507 participants (78.1% females; 20.7% males; and 1.2% transgender) were recruited to participate in an online, self-administered survey., Results: Forty percent (216) of participants reported maternal dieting in their family of origin and 34% (182) reported maternal fat talk, 24% (120) reported paternal dieting, and 11% recalled paternal 'fat talk' (58). Subgroup analyses suggest that both male and female participants had greater odds of remembering maternal rather than paternal weight or shape criticism and encouragement to diet (OR = 58.1; and OR = 3.12; p < 0.0001 for male and female participants, respectively). Retrospective report of indirect parental behaviors (e.g. parental dieting) also appears to be associated with direct parental behaviors (e.g. encouraging children to diet). Additionally, participants who recalled maternal encouragement to diet reported a significantly higher adult BMI (β = 1.31, SE = 0.32, p < 0.0001)., Conclusion: Results provide preliminary evidence that a sizeable percentage of both adult male and female participants recalled that their parents engaged in fat talk and dieting. In addition, participants recalled parental criticism of their own weight or eating behaviors, which was associated with recall of parental dieting and fat talk., Level of Evidence: Level V, Descriptive Study.

Background: Health promotion/education strive to promote healthful conditions that improve quality of life 1 based on the perceptions of those whose lives are affected. 2-4 Though health promotion/education might have instrumental value in reducing risks for premature morbidity and mortality, their ultimate value lies in contributions to quality of life. 1 Life satisfaction (LS) has been defined as an individual's assessment of their quality of life based upon personal criteria 5,6 and linked to adolescent health risk behaviors 7,8 and developmental assets. 9 ., Purpose: We investigated the psychometrics of the Brief Multidimensional Students' Life Satisfaction Scale [BMSLSS] with an adolescent sample of African Americans (N=1,658) from four mid-sized cities in the United States (US). Reliability and validity of the BMSLSS has not been determined for samples of exclusively African American adolescents., Methods: Data analysis included calculating mean ratings, standard deviations and effect sizes (Cohen's d ) and inspecting the scale's internal structure, reliability, and relationships to other variables., Results: Evidence of internal structure, internal consistency reliability, and hypothesized relationships to other variables for participants were determined., Translation to Health Education Practice: The BMSLSS is a useful indicator of LS for research and health education assessment purposes among African American adolescents where brevity of psychometric measures is imperative.

Background: Women with eating disorders are more likely to negatively react to finding out they are pregnant, although this difference in attitudes between women with eating disorders and controls disappears at 18-weeks' gestation. Those with anorexia also are twice as likely to have an unplanned pregnancy and those with bulimia have a 30-fold increased chance compared with healthy controls. Therefore, due to these considerations, pregnancy and the transition to motherhood can be an extremely challenging time for these women both psychologically and physically. The purpose of this qualitative descriptive study was to understand the intersection between eating disorders and pregnancy from the lived experience of women who have been pregnant or want to or do not want to become pregnant., Methods: A total of 15 women with a current or past history of an eating disorder were recruited, including nine women who have had previous pregnancies as well as six nonparous women. Interviews were the primary unit of data collection, in addition to document analysis of diaries or blogs. Data analysis was based on verbatim transcripts from audio recordings. NVIVO 11© was used to manage the data from these interviews and thematic analysis was then conducted for emergence of major and sub themes., Results: A total of six themes emerged from the iterative process of coding and categorizing. They were: Control, Disclosure to Others, Battle between Mothering & Eating Disorder, Fear of Intergenerational Transmission, Weight and Body Image Concerns, and Coping Strategies. One theme, Battle between Mothering & Eating Disorder also had three sub-themes: Decision to Have Child, Emotions Towards Pregnancy, and Focus on Child/Greater Good., Conclusions: It is hoped that quotes and themes derived from this study will help inform both prenatal and postnatal care and interventions, as well as addressing intergenerational transmission concerns among mothers with eating disorders.

Although extreme weight control behavior (EWCB) is associated with substance use, no research has examined the association between the nonmedical use of prescription drugs (NMUPD) and EWCB. Self-report data were collected from a sample of 4,148 students in Grades 9-12 enrolled in 5 high schools across the United States. Logistic regression models were constructed to examine the nonmedical use of prescription pain relievers, depressants, stimulants, and a composite measure for any NMUPD, and the EWCB of fasting, use of diet pills, powders, or liquids, and vomiting or laxative use. Models were estimated before and after controlling for key covariates for males and females. Approximately 16% of respondents reported any EWCB during the past 30 days, while 11% reported any NMUPD during the past 30 days. After covariate adjustment, any NMUPD was associated with any EWCB in both males and females (p < .05), and all EWCB remained significant in females who reported prescription pain reliever use (p < .01), with 2 out of 3 remaining significant for prescription stimulant and depressant use (p < .01). The only significant association detected for males was between prescription pain reliever use and using diet pills, powders, or liquids (OR = 2.2, p < .01). Results suggest significant associations between NMUPD and EWCB, with variations by sex. These findings provide directions for additional research and point to several potential identification and intervention efforts. (PsycINFO Database Record, ((c) 2017 APA, all rights reserved).)

Background: In this cross-sectional study we explored relationships between aggressive and violent behaviors and emotional self-efficacy (ESE) in a statewide sample of public high school adolescents in South Carolina (N = 3836)., Methods: The US Centers for Disease Control and Prevention Youth Risk Behavior Survey items on aggressive and violent behavior items and an adolescent ESE scale were used. Logistic regression analyses and multivariate models constructed separately, revealed significant race by sex findings., Results: Results suggest that carrying a weapon to school (past 30 days) and being threatened or injured with a gun, knife, or club at school (past 12 months) were significantly associated (p < .05) with reduced ESE for specific race/sex groups., Conclusions: Results have implications for school- and community-based mental health services and social and emotional learning and aggression/violence prevention programs for adolescents. Measures of ESE as a component of comprehensive assessments of adolescent mental health, social and emotional learning and aggressive/violent behaviors in fieldwork, research, and program-evaluation efforts should be considered., (© 2017, American School Health Association.)

Researchers examined the association between perceptions of harm from substance use and social self-efficacy (SSE) in a sample of early adolescents in public middle schools ( n = 4,122). One-way analysis of covariance and post hoc tests were used to assess the relationships between perceptions of harm from tobacco, alcohol, marijuana, and cocaine use and SSE while controlling for the effects of grade, sex, race, and socioeconomic status. Effect sizes were calculated from the post hoc comparisons to estimate practical importance. Results suggest that lower perceptions of harm from each examined substance were significantly associated with lower SSE ( p < .0001). Effect sizes were of medium practical importance. Enhancing SSE in early adolescents may be an effective component of interventions designed to reduce perceptions of harm associated and subsequent substance use.

Although emotional disorders and disordered eating behaviors are known to be related, the relationship between emotional self-efficacy (ESE) and disordered eating is unknown. This study examined the relationship between ESE and disordered eating in a statewide sample of public high school adolescents (n=2566). The Centers for Disease Control Youth Risk Behavior Survey and an adolescent ESE scale were utilized. Logistic regression adjusted for key covariates explored the relationship between low ESE and disordered eating among selected race and gender groups. Self-perceived weight as underweight or overweight; and dieting, vomiting or taking laxatives, taking diet pills, and fasting to lose weight were each associated (p<.05) with lower levels of ESE for certain race/gender groups. Findings provide increased justification for tailoring disordered eating interventions and treatments to accommodate the highest risk groups. Measures of ESE should be considered for adolescent mental health assessments in fieldwork, research, and evaluation efforts., (Copyright © 2015 Elsevier Ltd. All rights reserved.)

Objectives: The association between deliberate self-harm (DSH) and domain-based life satisfaction reports and health-related quality of life (HRQOL) was explored simultaneously among college students., Methods: Randomly selected participants (N = 723) completed an online survey. Relationships among DSH, 7 life satisfaction domains, and HRQOL (as assessed by mean good physical and mental health days, GHDs) were examined through correlational and general linear modeling procedures with post hoc analyses., Results: DSH was a significant predictor for all life satisfaction domains, overall life satisfaction, and mean GHDs, even after controlling for covariates (p < .0001), with greatest dissatisfaction with friendships and selves. Effect sizes ranged from .42 (living environment) to 1.18 (overall). Students who engaged in DSH reported 15.2 mean GHDs during the past 30 days compared to 20.4 for the referent group (Cohen's d = .63)., Conclusions: Those engaging in DSH report greatest dissatisfaction with friendships and selves compared to those not engaging in DSH. Surprisingly, DSH was only weakly associated with satisfaction with family, and behind that of satisfaction with physical appearance, school, and romantic relationships. Lastly, those engaging in DSH experience on average 60 fewer GHDs each year than those not engaging in DSH.

The School Climate Measure (SCM) was developed and preliminarily validated in 2010 and extended upon in 2013 in response to a dearth of psychometrically sound school climate instruments. This study sought to further validate the SCM on a large diverse sample of Arizona public school adolescents (N = 1,643) with two new domains. The eight original SCM domains (Positive Student-Teacher Relationships, School Connectedness, Academic Support, Order and Discipline, Physical Environment, Social Environment, Perceived Exclusion, and Academic Satisfaction) and two newly developed domains (Parental Involvement and Opportunities for Student Engagement) were subjected to psychometric analysis. The sample was randomly split into exploratory and confirmatory halves and subjected to factor analytic and structural equation modeling techniques. Factor analysis confirmed a 10-factor solution (loadings with absolute values > .40). Item factor loadings ranged from .47 to .95. Coefficient alphas ranged from .70 to .92. Fit statistics indicated a good fitting model (χ2 = 1452.67 [df = 734, p < .01], CFI = .94, TLI = .93, RMSEA = .039). This process eliminated some original SCM items, but the overall SCM increased only from 39 to 42 items with the newly developed domains. This investigation adds to the existing evidence for the SCM and offers support for a more comprehensive version of the SCM. The addition of the Parental Involvement and Opportunities for Student Engagement domains should further enhance the usefulness of the SCM. The SCM can facilitate data-driven decisions and may be incorporated into evidenced-based processes designed to improve important student learning and well-being outcomes., ((c) 2015 APA, all rights reserved.)

We conducted a cross-sectional, correlational analysis of the West Virginia Birth Score Program database examining the relationship between maternal self-rated health (SRH) and infant low birth weight (LBW), preterm birth, and small for gestational age (SGA). We found that, after controlling for covariates, mothers reporting fair/poor SRH were more likely to deliver an LBW infant (OR = 1.35, 95% CI = 1.14, 1.59), to deliver preterm (OR = 1.38, 95% CI = 1.17, 1.63), and to deliver an SGA infant (OR = 1.20, 95% CI = 1.05, 1.38). Given these results, further research is warranted to analyze maternal SRH during pregnancy, thereby exploring its potential predictive ability in regards to adverse birth outcomes.

Background: Although the link between drug abuse and suicide risk is established, few studies have examined the relationship between the nonmedical use of prescription drugs (NMUPD) and suicide risk, particularly among adolescents., Objectives: To explore the relationship between NMUPD and suicide risk among 4,148 adolescents in grades 9-12 enrolled in five public high schools., Methods: Logistic regression models were constructed for the nonmedical use of prescription pain relievers, depressants, stimulants, and a composite measure for any NMUPD. Models were estimated before and after controlling for key covariates., Results: About 21% of respondents reported lifetime NMUPD. After covariate adjustment, students who had reported any NMUPD were between 1.7 and 2.3 times more likely to report suicidal ideation, but not a suicide attempt (p < .0001). When stratified by sex and drug, nonmedical use of pain relievers, stimulants, and depressants were significantly associated with greater odds of suicidal ideation and behavior for both males and females (p < .05). However, NMUPD of pain relievers were not associated with greater odds of suicide attempts for males or females or among males who reported nonmedical use of stimulants. Nonmedical use of depressants was associated with greater odds of suicide attempts for both males and females (OR = 1.61 and 2.25, respectively) and among females who reported nonmedical use of stimulants (OR = 2.06, p < .01)., Conclusions/importance: Results suggest that some adolescents may be inappropriately self-medicating psychological distress with prescription medications or NMUPD may promote suicide risk, especially for males and females who use depressants and females who use stimulants.

Adolescence represents a vulnerable time for the development of both drug use/abuse and mental illness. Although previous research has substantiated a relationship between drug use and suicidal behavior, little research has examined this relationship with non-medical prescription drug use. Given the growing prevalence of non-medical prescription drug use (NMPDU) among adolescents, this study explored the association between NMPDU and suicidal behavior. Nationally representative data were derived from 16, 410 adolescents who completed the 2009 National Youth Risk Behavior Survey. Approximately 19.8% of participants reported lifetime NMPDU. NMPDU was associated with significantly increased odds of suicidal behavior ( P < 0.01), with seriously considering attempting suicide and making a plan about attempting suicide representing the strongest correlates for males and females. Results suggest the importance of 1) continued reinforcement of drug education programs in high school begun at earlier ages and 2) mental health care and screenings among adolescents.

This study compared the risk of a) clinically diagnosed eating disorders, and b) disordered eating behaviors, separately among three groups of United States college students, controlling for known covariates. These groups included college students self-identifying as: 1) gay/lesbian; 2) bisexual; and, 3) unsure, with self-identified heterosexuals as the reference. Data from the American College Health Association's National College Health Assessment II (2008-2009) were utilized (N=110,412). Adjusted logistic regression analyses, stratified by self-reported gender, examined the effect of self-identified sexual identity on clinical eating disorder diagnosis and disordered eating behaviors. Covariates included self-reported binge drinking (past 2 weeks), stress (last 12 months), smoking (past 30 days), depression (past 12 months), fraternity/sorority membership, college athletics participations, and race. Additional logistic regression sub-analyses examined sexual minorities only, with gay/lesbian as the referent. Gay, unsure, or bisexual men were at significantly increased odds to report both clinical eating disorders and disordered eating behaviors when compared to heterosexual men in both the unadjusted and adjusted models (p<.002). All sexual minority men and women were significantly more likely to report dieting to lose weight compared to heterosexual men and women (p<.002). Targeted disordered eating and eating disorder prevention efforts are needed for those who are sexual minorities, particularly for sexual minority men., (Copyright © 2014 Elsevier Ltd. All rights reserved.)

Objectives: Low birth weight outcomes result from multiple potential risks. The present study used latent class analysis to identify subgroups of women with multiple co-occurring risks and to examine the relationship of these risk classes to low birth weight outcome., Methods: Data were analyzed on all live singleton births in 2010 and 2011 in West Virginia (N = 28,820). Ten risks were examined including marital status, stress, mother's age, parity status, reported smoking and drug use during pregnancy, delayed prenatal care, Medicaid coverage, uninsurance, and low education., Results: Six latent classes were identified that ranged from a low-risk referent group to higher risk classes characterized by unique constellations of risk factors. Compared with the low-risk referent, all of the remaining five latent classes were significantly associated with increased odds of low birth weight. However, one class was at especially high risk; this class was characterized by unmarried women in the Medicaid program who reported drug use, smoking, stress, and late prenatal care (odds ratio, 4.78; 95% confidence interval, 4.07-5.61)., Conclusions: The person-centered approach identified subgroups of women with unique risk profiles. The results suggest that eliminating a single risk would not resolve the low birth weight problem. Smoking, for example, co-occurs with higher stress and higher levels of drug use among a Medicaid population. It may be beneficial to develop and test tailored interventions to groups with specific co-occurring risks to reduce low birth weight outcomes. Programs targeted to women in the Medicaid program who also engage in substance use and experience stress are especially indicated., (Copyright © 2014 Jacobs Institute of Women's Health. Published by Elsevier Inc. All rights reserved.)

Background: The School Climate Measure (SCM) was developed and validated in 2010 in response to a dearth of psychometrically sound school climate instruments. This study sought to further validate the SCM on a large, diverse sample of Arizona public school adolescents (N = 20,953)., Methods: Four SCM domains (positive student-teacher relationships, academic support, order and discipline, and physical environment) were available for the analysis. Confirmatory factor analysis and structural equation modeling were established to construct validity, and criterion-related validity was assessed via selected Youth Risk Behavior Survey (YRBS) school safety items and self-reported grade (GPA) point average., Results: Analyses confirmed the 4 SCM school climate domains explained approximately 63% of the variance (factor loading range .45-.92). Structural equation models fit the data well χ(2) = 14,325 (df = 293, p < .001), comparative fit index (CFI) = .951, Tuker-Lewis index (TLI) = .952, root mean square error of approximation (RMSEA) = .05). The goodness-of-fit index was .940. Coefficient alphas ranged from .82 to .93. Analyses of variance with post hoc comparisons suggested the SCM domains related in hypothesized directions with the school safety items and GPA., Conclusions: Additional evidence supports the validity and reliability of the SCM. Measures, such as the SCM, can facilitate data-driven decisions and may be incorporated into evidenced-based processes designed to improve student outcomes., (© 2014, American School Health Association.)

This study examined relationships between emotional self-efficacy (ESE) and alcohol and tobacco use in a statewide sample of public high school adolescents (n = 2,566). The Center for Disease Control Youth Risk Behavior Survey and an adolescent ESE scale were utilized. Logistic regression analyses indicated the presence of any significant race by gender associations between lower ESE and alcohol and tobacco use. Results suggest that alcohol and cigarette use was significantly associated (p ≤ .05) with lower levels of ESE for certain race/gender groups. Results have implications for school- and community-based mental health services and substance use prevention/education programs for adolescents. Measures of ESE as a component of comprehensive assessments of adolescent mental health in fieldwork, research, and substance abuse prevention/education program evaluation efforts should be considered., (© The Author(s) 2015 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.)

Background: Preliminary data were collected to evaluate the psychometric properties of an emotional self-efficacy (ESE) measure in a sample of 3836 public high school adolescents who completed the Centers for Disease Control and Prevention (CDC) Youth Risk Behavior Survey in South Carolina., Methods: Principal axis factor analysis was followed by a 4-way between-groups analysis of variance (ANOVA) testing for differences in total score means on selected demographic estimates and their interactions. Relationships between total score and selected risk behaviors were examined through a series of 1-way ANOVA procedures and subsequent Tukey Honest Significant Difference (HSD) tests., Results: Factor analysis results suggested that a 1-factor model best explained factor structure of the scale items (factor loadings .64 to .71, eigenvalue = 3.24, h(2)  = .46). Girls reported a significantly higher mean total ESE rating than boys; White students reported a significantly higher mean total ESE rating than Black students. Statistically significant lower mean total ESE ratings were also noted for those who reported physical fighting, lifetime alcohol use, and sexual intercourse., Conclusion: This 7-item scale is a reliable measure and could aid school health researchers and mental health practitioners in psychosocial screening and as an outcome of social and emotional learning as a brief measure of adolescent ESE., (© 2013, American School Health Association.)

Objectives: We examined the association between environmental quality measures and health outcomes by using the County Health Rankings data, and tested whether a revised environmental quality measure for 1 state could improve the models., Methods: We conducted state-by-state, county-level linear regression analyses to determine how often the model's 4 health determinants (social and economic factors, health behaviors, clinical care, and physical environment) were associated with mortality and morbidity outcomes. We then developed a revised measure of environmental quality for West Virginia, and tested whether the revised measure was superior to the original measure., Results: Measures of social and economic conditions, and health behaviors, were related to health outcomes in 58% to 88% of state models; measures of environmental quality were related to outcomes in 0% to 8% of models. In West Virginia, the original measure of environmental quality was unrelated to any of the 8 health outcome measures, but the revised measure was significantly related to all 8., Conclusions: The County Health Rankings model underestimates the impact of the physical environment on public health outcomes. Suggestions for other data sources that may contribute to improved measurement of the physical environment are provided.

Objectives: The authors compared rates of tooth loss between adult residents of Appalachian coal-mining areas and other areas of the nation before and after control for covariate risks., Methods: The authors conducted a cross-sectional secondary data analysis that merged 2006 national Behavioral Risk Factor Surveillance System data (BRFSS) (N = 242 184) with county coal-mining data and other county characteristics. The hypothesis tested was that adult tooth loss would be greater in Appalachian mining areas after control for other risks. Primary independent variables included main effects for coal-mining present (yes/no) residence in Appalachia (yes/no), and their interaction. Data were weighted using the BRFSS final weights and analyzed using SUDAAN Proc Multilog to account for the multilevel complex sampling structure. The odds of two measures of tooth loss were examined controlling for age, race\ethnicity, drinking, smoking, income, education, supply of dentists, receipt of dental care, fluoridation rate, and other variables., Results: After covariate adjustment, the interaction variable for the residents of Appalachian coal-mining counties showed a significantly elevated odds for any tooth loss [odds ratio (OR) = 1.19, 95% CI = 1.02, 1.38], and greater tooth loss measured by a 4-level edentulism scale (OR = 1.20, 95% CI = 1.05, 1.36). The main effect for Appalachia was also significant for both measures, but the main effect for coal mining was not., Conclusions: Greater risk of tooth loss among adult residents of Appalachian coal-mining areas is present and is not explained by differences in reported receipt of dental care, fluoridation rates, supply of dentists or other behavioral or socioeconomic risks. Possible contributing factors include mining-specific disparities related to access, behavior or environmental exposures., (© 2012 John Wiley & Sons A/S.)

The West Virginia Prescription Drug Abuse Quitline (WVPDAQ) is a resource that offers education and support to individuals and families affected by prescription drug abuse. The WVPDAQ began functioning September 11, 2008, through the use of mobile phone and laptop technology. Although some helplines and quitlines use some aspects of remote technology, most function through traditional call center and landline technology, making the WVPDAQ unique. This article describes the process evaluation of the WVPDAQ and outlines both the positive findings and challenges faced by the WVPDAQ. Lessons learned and future recommendations for remote quitline endeavors are also presented. It is hoped that the experiences and information regarding the WVPDAQ presented can provide best-practice insight for public health practitioners and evaluation personnel who are considering using alternative technologies to deliver quitline services.

Objective: To evaluate the self-rated health (SRH) status among college students who reported receiving the majority of their health-related information from health educators., Participants: Students (n = 49,921) who completed the 2006 National College Health Association survey., Methods: Bivariate associations between SRH and the believability of health information received were analyzed. Multiple logistic regression tested the relationship after covariate adjustment., Results: Although a modest correlation (r = .06, p < .0001) existed between the variables, SRH declined as the believability of health information received from health educators ratings became increasingly unfavorable (χ(2) = 110.96, p < .0001). After covariate adjustment, the relationship persisted with increased odds of reporting fair/poor health for those who reported the health information received from health educators as "neutral" (odds ratio [OR] = 1.31) or "unbelievable" (OR = 2.25) when compared to those who reported the health information received as "believable" (p < .0001)., Conclusions: The field of health education, and health educators, may positively influence college student SRH.

Preliminary data were collected to evaluate the performance of a social self-efficacy measure among 4,061 public high school adolescents. Principal-axis factor analysis was followed by a 4-way between-groups analysis of variance (ANOVA) to test for differences in the Total score means on selected demographic estimates and their interactions. Relations between the Total score and selected risk behaviors were examined through a series of one-way ANOVAs and the Tukey HSD test. Factor analysis results suggested a one-factor model best explained the factor structure of the scale items (factor loading range = .64 - .77, eigenvalue = 4.05, h(2) = .51). Females reported a significantly higher mean Total social self-efficacy rating than males, while White students reported a significantly higher mean Total social self-efficacy rating than Black and Asian students. Statistically significant lower mean Total social self-efficacy ratings were also noted for those who reported physical fighting, avoiding school, and being bullied.

Birth defects are examined in mountaintop coal mining areas compared to other coal mining areas and non-mining areas of central Appalachia. The study hypothesis is that higher birth-defect rates are present in mountaintop mining areas. National Center for Health Statistics natality files were used to analyze 1996-2003 live births in four Central Appalachian states (N=1,889,071). Poisson regression models that control for covariates compare birth defect prevalence rates associated with maternal residence in county mining type: mountaintop mining areas, other mining areas, or non-mining areas. The prevalence rate ratio (PRR) for any birth defect was significantly higher in mountaintop mining areas compared to non-mining areas (PRR=1.26, 95% CI=1.21, 1.32), after controlling for covariates. Rates were significantly higher in mountaintop mining areas for six of seven types of defects: circulatory/respiratory, central nervous system, musculoskeletal, gastrointestinal, urogenital, and 'other'. There was evidence that mountaintop mining effects became more pronounced in the latter years (2000-2003) versus earlier years (1996-1999.) Spatial correlation between mountaintop mining and birth defects was also present, suggesting effects of mountaintop mining in a focal county on birth defects in neighboring counties. Elevated birth defect rates are partly a function of socioeconomic disadvantage, but remain elevated after controlling for those risks. Both socioeconomic and environmental influences in mountaintop mining areas may be contributing factors., (Copyright © 2011 Elsevier Inc. All rights reserved.)