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Background and Aims: Disposable electronic cigarette (e-cigarette) use is becoming more popular among US youth, given the shifting landscape in product marketing, availability and regulation. This study aimed to estimate the prevalence of and test factors associated with the most used e-cigarette product (disposable versus other) among US youth aged 9-18 years who currently use e-cigarettes., Design, Setting and Participants: This was an observational study using cross-sectional data from the US-based 2021 and 2022 National Youth Tobacco Surveys (n = 48 704). We restricted our analytical sample to youth who currently use e-cigarettes (n = 4137). The sample ranged from 9 to 18 years old and was 53.0% female., Measurements: We dichotomized e-cigarette device type to disposable versus all other types (e.g. refillable pods/cartridges). We conducted logistic regression to estimate whether age, sex, race/ethnicity, sexual orientation, frequency of e-cigarette use, nicotine vaping, flavored e-cigarette use and current combustible/non-combustible tobacco use were associated with disposable e-cigarette use, compared with other e-cigarette use., Findings: Among youth who currently use e-cigarettes, 54.5% used disposable e-cigarettes. Older age (17-18 years), relative to younger age (9-14 years) [odds ratio (OR) = 1.43, 95% confidence interval (CI) = 1.07-1.91], non-Hispanic Black (versus non-Hispanic White) race/ethnicity (OR = 1.47, 95% CI = 1.01-2.15), any nicotine (versus non-nicotine) vaping (OR = 2.51, 95% CI = 1.96-3.23) and flavored (versus non-flavored) e-cigarette use (OR = 1.93, 95% CI = 1.46-2.56) were associated with increased odds of mainly using disposable e-cigarettes, compared with using other e-cigarette products, whereas current combustible tobacco use (versus non-current) (OR = 0.65, 95% CI = 0.53-0.80) and current non-combustible tobacco use (versus non-current) (OR = 0.58, 95% CI = 0.43-0.78) were associated with lower odds., Conclusion: Disposable e-cigarettes appear to be the most used type of e-cigarette product among US youth. Older age, non-Hispanic Black race/ethnicity, nicotine vaping and flavored e-cigarette use are associated with mainly using disposable e-cigarettes, relative to other e-cigarette products., (© 2024 Society for the Study of Addiction.)

Background: Black race, inadequate health literacy, and poor perceived control are predictors of increased cardiovascular disease (CVD) risk. The purpose of this study was to explore the relationships among race, health literacy, perceived control, and CVD risk while controlling for known risk factors in incarcerated men., Methods: We included data from 349 incarcerated men to examine race and CVD risk (Framingham Risk Score) using a serial mediation model with health literacy and perceived control using 95% confidence intervals (CIs) from 5000 bootstrap samples., Results: Of the participants (age, 36 ± 10; education, 12 ± 2; body mass index, 28.3 ± 5.0), 64.2% were White and 35.8% were Black. Black incarcerated men were younger ( P = .047) with lower levels of health literacy ( P < .001). All 3 indirect effects of race on CVD were significant, whereas the direct effect of race was not. Black incarcerated men had higher levels of CVD risk through health literacy ( a1b1 = 0.3571; 95% CI, 0.0948-0.7162) and lower levels of CVD risk through perceived control ( a2b2 = -0.1855; 95% CI, -0.4388 to -0.0077). Black incarcerated men had higher levels of CVD risk through health literacy influenced by perceived control ( a1b2d21 = 0.0627; 95% CI, 0.0028-0.1409), indicating that despite the protective effect of higher levels of perceived control in Black incarcerated men, CVD risk remained higher compared with their White counterparts., Conclusion: Future CVD risk reduction interventions in incarcerated men, specifically Black incarcerated men, should include goals of improving health literacy and perceived control as modifiable risk factors., Competing Interests: The authors have no conflicts of interest to disclose., (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)

Background: To compare relative rates of pediatric poisoning before and after COVID-19, including by demographic and urban-rural status, and by agent identified, using data from one university healthcare system and children's hospital., Methods: Using retrospective, cross sectional design from deidentified healthcare claims data, we extracted all encounters with the ICD-10-CM for Poisoning by, Adverse effects of, and Underdosing of drugs, medicants and biological substances (T36-T50) and grouped the encounters as those after state mandates regulating activity came into effect (Post-COVID-19 (3/17/2020-3/18/2021)) Pre-COVID-19 (3/18/2019-3/17/2020). We then compared poisoning agent, age at the time of the encounter, recorded sex, race, ethnicity, rural/urban residence, and visit type using Mann-Whitney U test, chi-square test of association, incidence rates and incident rate ratios between the time periods., Findings: The sample included 1608 unique patients 0-17 years of age and 4216 encounters. We also identified IRRs >1 in nearly every demographic subgroup with the exception of Non-Hispanic Blacks. The comparison of specific drugs or medicants identified a significant decrease in poisoning by Systemic antibiotics (T36); but an increase in Hormones and their synthetic substitutes and antagonists (T38), Non opioid analgesics antipyretic and antirheumatic (T39), Psychotropic Drugs (T39) and Systemic and hematologic agents (T45)., Conclusion: This study identifies pediatric subgroups highly affected by pediatric poisoning during the time-period immediately after the identification of COVID-19 and characterizes the drugs commonly associated with poisonings., Application to Practice: With a further understanding nursing has the potential to impact pediatric poisoning in the inpatient, outpatient and public health setting., Competing Interests: Declaration of competing interest Authors do not have any interests to report related to this work., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Background: Family caregivers are at higher risk for developing cardiovascular disease (CVD) than non-caregivers. This risk is worse for those who live in rural compared to urban areas. Health activation, an indicator of engagement in self-care, is predictive of health outcomes and CVD risk in several populations. However, it is not known whether health activation is associated with CVD risk in rural caregivers of patients with chronic illnesses nor is it clear whether sex moderates any association., Objectives: Our aims were to determine (1) whether health activation independently predicts 10-year CVD risk; and (2) whether sex interacts with health activation in the prediction of 10-year CVD risk among rural family caregivers (N = 247) of patients with chronic illnesses., Methods: Health activation was measured using the Patient Activation Measure. The predicted 10-year risk of CVD was assessed using the Framingham Risk Score. Data were analyzed using nonlinear regression analysis., Results: Higher levels of health activation were significantly associated with decreased risk of developing CVD (p < 0.028). There was no interaction of sex with health activation on future CVD risk. However, male caregivers had greater risk of developing CVD in the next 10 years than female caregivers (p < 0.001)., Conclusions: We demonstrated the importance of health activation to future CVD risk in rural family caregivers of patients with chronic illnesses. We also demonstrated that despite the higher risk of future CVD among male, the degree of association between health activation and CVD risk did not differ by sex., (© 2024 National Rural Health Association.)

Background: About 3.5 million trauma patients are hospitalized every year, but 35%-40% require further care after discharge. Nurses' ability to affect discharge disposition by minimizing the occurrence of nurse-sensitive indicators (catheter-associated urinary tract infection [CAUTI], central line-associated bloodstream infection [CLABSI], and hospital-acquired pressure injury [HAPI]) is unknown. These indicators may serve as surrogate measures of quality nursing care., Objective: The purpose of this study was to determine whether nursing care, as represented by three nurse-sensitive indicators (CAUTI, CLABSI, and HAPI), predicts discharge disposition in trauma patients., Methods: This study was a secondary analysis of the 2021 National Trauma Data Bank. We performed logistic regression analyses to determine the predictive effects of CAUTI, CLABSI, and HAPI on discharge disposition, controlling for participant characteristics., Results: A total of n = 29,642 patients were included, of which n = 21,469 (72%) were male, n = 16,404 (64%) were White, with a mean (SD) age of 44 (14.5) and mean (SD) Injury Severity Score of 23.2 (12.5). We created four models to test nurse-sensitive indicators, both individually and compositely, as predictors. While CAUTI and HAPI increased the odds of discharge to further care by 1.4-1.5 and 2.1 times, respectively, CLABSI was not a statistically significant predictor., Conclusions: Both CAUTI and HAPI are statistically significant predictors of discharge to further care for patients after traumatic injury. High-quality nursing care to prevent iatrogenic complications can improve trauma patients' long-term outcomes., Competing Interests: The authors have no conflicts of interest or funding to declare., (Copyright © 2024 Society of Trauma Nurses.)

Background: In 2019, over 459,000 persons in the United States survived sexual assault, and 21%-26% sought medical treatment. Ideally, trained medical professionals who understand the unique physical and mental health needs of this patient population, such as forensic nurses, would provide care. Yet, the care that forensic nurses and other healthcare providers can offer to sexual violence/abuse survivors is hindered by the lack of understanding of the demographics of those who seek care. With the delineation of highly affected demographic groups, barriers to care can be addressed., Purpose: This study compared rates, demographic characteristics, acuity, and codes for sexual violence/abuse encounters experienced by those patients residing in rural versus urban counties of Kentucky (KY). This included encounters before and after SARS-CoV-2., Methods: Deidentified claims data were extracted for patient encounters billed with the International Classification of Diseases, 10th Revision, Clinical Modification for sexual violence/abuse seen at a university healthcare center serving the Northeastern, Southeastern, and Central regions of KY from October 2015 to February 2021. Analysis comprised descriptive statistics, independent samples t tests, and chi-square tests of association., Results: Significant demographic differences were identified between the two groups. The mean age of those residing in rural areas was significantly younger than those living in urban areas. Similarly, the percentage of male survivors was significantly higher in the rural population. The racial composition also differed, with higher percentages of survivors being Black and Hispanic in the urban population, relative to rural dwellers., Conclusion: Findings suggest that rural youth (especially boys aged 10 years and younger) and urban minorities are at a higher risk for sexual violence/abuse in KY when compared with their counterparts (i.e., urban youth and rural minorities)., Competing Interests: The authors declare no conflict of interest., (Copyright © 2023 International Association of Forensic Nurses.)

Background and Purpose: We utilized the Perceived Racism Scale-Racism on the Job subscale-to assess how frequently Black nurses experienced racism on the job in the past year (ROTJ-Y) and throughout their lifetime (ROTJ-L). We aimed to assess the reliability and assess construct validity of each subscale in a sample of 53 nurses. Methods: Reliability was evaluated using coefficient alphas, item correlations, and interitem correlations. Construct validity was examined using exploratory factor analysis. Results: Results demonstrated that the subscales are reliable and valid. Coefficient alphas for the ROTJ-Y and ROTJ-L were .93 and .91, respectively. Exploratory factor analysis revealed a unidimensional factor for both subscales. Conclusion: This study demonstrated that the Racism on the Job subscales are psychometrically sound measures of workplace racism among Black nurses., (© Copyright 2024 Springer Publishing Company, LLC.)

Introduction: Because medication adherence is essential to the management of rheumatoid arthritis (RA), identifying (1) subgroups at high risk for low medication adherence and (2) modifiable factors potentially contributing to low adherence can impact patient outcomes. This study aims to describe the relationships between anxiety, trust in the provider, quality patient-provider communication, fatigue, RA knowledge, adverse medication effects, disease activity, RA medications, disease duration, patient satisfaction, and medication intolerance and cluster factors to differentiate RA-patient subgroups., Methods: This observational study used correlation analysis, linear regression, and cluster analysis with determination decisions based on Schwarz's Bayesian Criterion., Results: Medication adherence was higher in non-Hispanic, White participants, inversely correlated with disease activity and pain intensity, and positively correlated with trust in the provider. Patient satisfaction was higher among those with a shorter time since diagnosis, and was negatively associated with disease activity, pain intensity and interference, fatigue, and anxiety. It was positively associated with RA knowledge, trust in provider and quality of patient-provider communication. Medication intolerance differed by disease duration and was positively correlated with disease activity, pain interference, and fatigue. Of the two clusters, Cluster 1 participants had greater medication adherence and patient satisfaction, and lower medication intolerance. They were of higher income, employed, and non-Hispanic, White persons with a shorter disease duration and lower perceived pain intensity/interference, fatigue, and anxiety. They were more knowledgeable about RA with higher trust in their provider and perceived quality of patient-provider communication., Discussion/conclusion: A low medication adherence RA-patient subgroup-highly affected by social determinants of health and with unique relational and clinical characteristics was identified., (© 2024 John Wiley & Sons Ltd.)

Svavarsdottir EK, Rayens MK (2005) Hardiness in families of young children with asthma. Journal of Advanced Nursing. 50, 4, 381-390. Aims: This research focused on two aspects of the concept [...]

Background: Pediatric, adolescent, and young adult patients with cancer and their caregivers are at high risk of financial toxicity, and few evidence-based oncology financial and legal navigation programs exist to address it. We tested the feasibility, acceptability, and preliminary effectiveness of Financial and Insurance Navigation Assistance, a novel interdisciplinary financial and legal navigation intervention for pediatric, adolescent and young adult patients and their caregivers., Methods: We used a single-arm feasibility and acceptability trial design in a pediatric hematology and oncology clinic and collected preintervention and postintervention surveys to assess changes in financial toxicity (3 domains: psychological response/Comprehensive Score for Financial Toxicity [COST], material conditions, and coping behaviors); health-related quality of life (Patient-Reported Outcomes Measurement Information System Physical and Mental Health, Anxiety, Depression, and Parent Proxy scales); and perceived feasibility, acceptability, and appropriateness., Results: In total, 45 participants received financial navigation, 6 received legal navigation, and 10 received both. Among 15 adult patients, significant improvements in FACIT-COST (P = .041) and physical health (P = .036) were noted. Among 46 caregivers, significant improvements were noted for FACIT-COST (P < .001), the total financial toxicity score (P = .001), and the parent proxy global health score (P = .0037). We were able to secure roughly $335 323 in financial benefits for 48 participants. The intervention was rated highly for feasibility, acceptability, and appropriateness., Conclusions: Integrating financial and legal navigation through Financial and Insurance Navigation Assistance was feasible and acceptable and underscores the benefit of a multidisciplinary approach to addressing financial toxicity., Clinicaltrials.gov Registration: NCT05876325., (© The Author(s) 2024. Published by Oxford University Press.)

Objective: Relatively few dyad-based studies have evaluated the shared psychosocial and financial toxicity (FT) experiences of hematologic patients and their caregivers, especially those undergoing bone marrow transplantations (BMTs). This study evaluated the association of FT with health-related quality of life (QOL) among BMT patient-caregiver dyads., Methods: Survey and electronic health record data were collected between April 2021 and January 2022 from BMT patients and their caregivers pre- (T1) and post-intervention (T2). Thirty-four patient-caregiver dyads completed surveys; all dyads included a patient experiencing elevated T1 FT. The effect of the total FT score (i.e., the combination of psychological response, coping behaviors, and material conditions domain scores) on physical health, mental health, anxiety, depression and distress scores was evaluated using Actor-Partner Interdependence Modeling (APIM)., Results: Patients and caregivers who reported lower total FT scores had better physical and mental health, and lower anxiety, depressive symptoms, distress (APIM actor effects). None of the partner effects were significant in the APIM models. Other model findings indicated that compared with caregivers, patients had lower reported physical health; mental health scores were higher, on average, for all participants at the T2 compared with T1; and members of dyads whose caregiver took time off work reported better physical health and lower depressive symptoms and distress than those whose caregiver did not., Conclusions: Our study addresses a significant gap in dyad-based cancer FT studies; the findings underscore the need for additional research to help develop tailored dyad-level FT interventions for improving health-related QOL among BMT patients., (© 2024 The Authors. Psycho-Oncology published by John Wiley & Sons Ltd.)

Radon exposure is the second leading cause of lung cancer, yet few Americans test their homes for radon, particularly in rural areas. The academic team and community partners engaged the public library systems in four rural counties to offer digital radon detectors for check-out as a means of increasing the public's access to free radon testing. The check-out procedures and instructional materials were created through an iterative process, and library personnel were educated on radon and home radon testing prior to launching the lending program. Library patrons reported high usability, feasibility, and acceptability of the program. Library patron-staff interactions mainly included discussions about the logistics of radon testing. Given that public libraries are invested in making communities thrive and promoting health, providing library lending programs for radon detectors is a novel, feasible, and acceptable way to reduce the risk of lung cancer in the community., Competing Interests: Declaration of interest: none.

Objective: To evaluate the psychometric properties of the Breastfeeding and Employment Scale (BES)., Design: Secondary analysis of data from the Infant Feeding Practices Study II survey, a longitudinal study on infant feeding practices., Setting: United States., Participants: Women who were employed, breastfeeding, and completed the Infant Feeding Practices Study II BES at the 3-month postpartum assessment (N = 508)., Methods: Participants reported their perceived level of breastfeeding support in the workplace by responding to the nine binary items on the BES. We evaluated the instrument's internal consistency reliability (Kuder-Richardson 20), test-retest reliability (Cohen's kappa), construct validity (principal component analysis), and convergent validity (relationship with a similar item)., Results: The internal consistency of the BES (Kuder-Richardson 20 = 0.72) supported the reliability of scale. The test-retest reliability was moderate (0.41-0.60). The Spearman's rho correlation coefficient was 0.66, indicating adequate test-rest reliability for the total BES score between the 3-month and 6-month assessments (p < .01). The factor analysis demonstrated that the items cluster into one factor (psychosocial and structural barriers to breastfeeding in the workplace). Participants who reported more barriers to breastfeeding in the workplace also reported a less supportive workplace environment, which supported the convergent validity of the scale., Conclusion: The psychometric testing of the BES provided initial support for the reliability and validity of the instrument. It may be a useful tool for measuring workplace lactation support in a concise manner., Competing Interests: Conflict of Interest The authors report no conflicts of interest or relevant financial relationships., (Copyright © 2023 AWHONN, the Association of Women’s Health, Obstetric and Neonatal Nurses. Published by Elsevier Inc. All rights reserved.)

Objective: Rates of neonatal abstinence syndrome/neonatal opioid withdrawal syndrome (NAS/NOWS), a withdrawal syndrome from opioids and other substances resulting from intrauterine exposure, have been increasing exponentially in the U.S. To improve health outcomes, it is important to understand population health risks, including rehospitalization and related diagnoses, using current data. This study will compare and describe the rates of rehospitalization, the demographic characteristics and the rehospitalization diagnoses and age at diagnosis between the infants affected by NAS/NOWS to those sampled who were unaffected. This study will also describe the frequency of NAS/NOWS births per year along with a yearly comparison of readmissions in those affected by NAS/NOWS to those who were not (2016-2020)., Methods: Health claims data were used to conduct a case/control study. Diagnosis codes for neonatal withdrawal syndrome/NAS/NOWS (P04.49 or P96.1 and P96.1 alone) from 1 October 2015 to 1 June 2021 were extracted, and controls were case-matched based on month/year of birth. Rehospitalizations following birth and the related diagnoses were described and grouped using the Agency of Healthcare Research Quality Clinical Classifications Software Refined Frequency distribution. The chi-square test of association and generalized estimating equation modeling were used for data analysis., Results: Infants affected by NAS/NOWS are 2.7 times more likely to have a rehospitalization. White, non-Hispanic neonates (OR = 1.5; p  = .007) and those infants residing in rural areas (OR = 1.9; p  < .001) were disproportionately affected. We identified a host of admission diagnoses with increased prevalence in infants affected by NAS/NOWS when compared to those who were not affected (e.g. infectious diseases, feeding disorders)., Conclusions: Infants with NAS/NOWS are at increased risk of rehospitalization with a host of diagnoses, and specific demographic groups (White, rural) are more highly affected.

Purpose: The purpose of this study was to determine whether COVID-19 impact and Diabetes Self-Management Education and Support (DSMES) service attendance predicted diabetes distress among individuals with type 2 diabetes during the pandemic., Methods: Eighty-six adults with type 2 diabetes who either attended (n = 29) or did not previously attend (n = 57) DSMES services completed a cross-sectional survey. Participants' mean age was 57 ± 12.3 years, 50% were female, and 71.3% were diagnosed with diabetes >5 years. The Coronavirus Impact Scale was used to measure impact of the pandemic on daily life. The Diabetes Distress Scale was used to measure distress overall and within 4 subscales (emotional burden, interpersonal distress, physician-related distress, regimen distress). Separate multiple linear regressions were conducted for each outcome, controlling for age, sex, marital status, financial status, and time since diabetes diagnosis., Results: Higher COVID-19 impact predicted higher diabetes-related distress for all subscales and overall. Only the subscale for interpersonal distress was predicted by DSMES attendance, which decreased with DSMES attendance., Conclusion: This study identifies a link between the effects of the COVID-19 pandemic and diabetes distress. The findings highlight the negative impact of the pandemic on diabetes distress and the importance of DSMES services for diabetes-related distress. Interventions are needed to reduce psychological distress among this population during public health crises.

The first Doctor of Nursing Practice (DNP) program was opened at the University of Kentucky College of Nursing (UKCON) in 2001. As the CON celebrates 20 plus years of DNP education, leaders decided to do an assessment of the accomplishments and outcomes from the work of graduates. The purpose of this study was to delineate the achievements, outcomes and perception of the impact of graduates from the UKCON DNP program and assess the correlations of specific "perception of impact" variables. DNP graduates from 2005 to 2021 (n = 348) received an email about the study and a link to the survey. Ninety graduates who resided in 14 states responded. Over 84 % of participants indicated that their DNP degree helped them stand out as a leader. Participants reported that having a DNP education increased their knowledge and expertise in multiple areas, including how to lead, to influence, and to improve outcomes within their organizations. Narrative feedback related to top achievements since graduation included career advancement/promotion (n = 22), improving patient care quality/implementation of evidence-based initiatives (n = 21), and becoming a better leader (n = 19). This study illustrated the broad return on investment and the quantification of value that a DNP education brings, both to practice and academia., (Copyright © 2023. Published by Elsevier Inc.)

Background: The Patient Activation Measure (PAM) is used clinically and in research to measure an individual's knowledge, skills, and confidence related to their health management engagement. Despite the use of "patient" in the title, the instrument can be used in nonpatient populations. A group at high risk for low activation concerning their own health is family caregivers of patients with chronic illnesses. The psychometric properties of the PAM have not been established in family caregivers., Objectives: This study aimed to examine the psychometric properties of the PAM 10-item version (PAM-10) in a sample of family caregivers of patients with chronic illnesses. Our focus was on family caregivers' health activation of their own healthcare needs., Methods: We evaluated the internal consistency reliability of the PAM-10 in a sample of 277 family caregivers. Item-total correlations and interitem correlations were used to assess item homogeneity. Construct validity of the PAM-10 was examined using exploratory factor analysis and testing hypotheses on known relationships., Results: The PAM-10 demonstrated adequate internal consistency. Item-total correlation coefficients and interitem correlation coefficients were acceptable. Construct validity of the instrument was supported. Factor analysis yielded two factors that explained 62.3% of the variance in the model. Lower levels of depressive symptoms were significantly associated with better activation, providing evidence of construct validity. Caregivers with high activation levels were significantly more likely to engage in and adhere to self-care behaviors such as regular exercise, eating a healthy diet, and engaging in stress reduction strategies., Discussion: This study demonstrated that the PAM-10 is a reliable and valid measure for family caregivers of patients with chronic illnesses to measure caregivers' health activation of their own healthcare needs., Competing Interests: The authors have no conflicts of interest to report., (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)

Exposure to tobacco smoke and radon cause lung cancer. Radioactive decay of naturally occurring uranium in bedrock produces radon. Seasonality, bedrock type, age of home, and topography have been associated with indoor radon, but the research is mixed. The study objective was to examine the relationships of geologic (soil radon and bedrock) and seasonal (warm and cold times of the year) factors with indoor home radon values in citizen scientists' homes over time, controlling for atmospheric conditions, topography, age of home, and home exposure to tobacco smoke. We collected and analyzed indoor radon values, soil radon gas concentrations, and dwelling- and county-level geologic and atmospheric conditions on 66 properties in four rural counties during two seasons: (1) summer 2021 ( n = 53); and (2) winter/spring 2022 ( n = 52). Citizen scientists measured indoor radon using Airthings radon sensors, and outdoor temperature and rainfall. Geologists obtained soil radon measurements using RAD7 instruments at two locations (near the dwelling and farther away) at each dwelling, testing for associations of indoor radon values with soil values, bedrock type, topography, and atmospheric conditions. Bedrock type, near soil radon levels, home age, and barometric pressure were associated with indoor radon. Dwellings built on carbonate bedrock had indoor radon values that were 2.8 pCi/L (103.6 Bq m -3 ) higher, on average, compared to homes built on siliclastic rock. Homes with higher near soil radon and those built <40 ago were more likely to have indoor radon ⩾4.0 pCi/L (148 Bq m -3 ). With higher atmospheric barometric pressure during testing, observed indoor radon values were lower. Seasonality and topography were not associated with indoor radon level. Understanding relationships among bedrock type, soil radon, and indoor radon exposure allows the development of practical predictive models that may support pre-construction forecasting of indoor radon potential based on geologic factors., Competing Interests: Conflict of interest The authors declare they have nothing to disclose.

Purpose: This study examined the feasibility, acceptability, and preliminary effectiveness of an oncology financial navigation (OFN) intervention, Coverage and Cost-of-Care Links ( CC Links ), among patients with hematologic cancer and their caregivers who are at increased risk of experiencing financial toxicity (FT)., Methods: All patients who presented to the Division of Hematology and Bone and Marrow Transplant (BMT) at an National Cancer Institute-designated cancer center between April 2021 and January 2022 were screened for FT during inpatient and outpatient visits. Patients who screened positive for FT and met the inclusion criteria were recruited to participate in CC Links that provided financial navigation and assistance via a financial navigator. Caregivers of patients undergoing BMTs were also recruited to participate. Primary outcomes were defined as improvements in FT, distress, and physical and mental quality of life., Results: Fifty-four patients and 32 caregivers completed the intervention and pre-/postintervention surveys. CC Links resulted in statistically significant decreases in the Comprehensive Score for FT for both patients (| t | = 2.42, P = .019) and caregivers (| t | = 2.43, P = .021) and total FT (| t | = 2.13, P = .041) and material conditions scores (| t | = 2.25, P = .031) for caregivers only. Only 27% of eligible patients participated in the study, whereas 100% of eligible caregivers participated. The majority of participants rated the intervention highly for acceptability (89%) and appropriateness (88%). An average of $2,500 (USD) in financial benefits was secured per participant via CC Links., Conclusion: CC Links was effective in decreasing FT among patients with hematologic cancer and their caregivers while demonstrating high acceptability and appropriateness ratings.

Nursing is a highly stressful and demanding profession that can negatively affect mental health, as shown by nurses' high rate of depression. Furthermore, Black nurses may experience additional stress due to race-based discrimination in the work environment. This research aimed to examine depression, experiences of race-based discrimination at work, and occupational stress among Black nurses. To better understand associations between these factors, we conducted multiple linear regression analyses to assess whether (1) past-year or lifetime experiences of race-based discrimination at work and occupational stress predicted depressive symptoms; and (2) controlling for depressive symptoms, past-year and lifetime experiences of race-based discrimination at work predicted occupational stress in a cohort of Black registered nurses. All analyses controlled for years of nursing experience, primary nursing practice position, work setting, and work shift. The results indicated that both past-year and lifetime experiences of race-based discrimination on the job were significant predictors of occupational stress. However, experiences of race-based discrimination at work and occupational stress were not significant predictors of depression. The results of the research highlighted the predictive effect of race-based discrimination on occupational stress in Black registered nurses. This evidence can inform the development of organizational and leadership strategies to improve the well-being of Black nurses in the workplace., Competing Interests: The authors declare no conflict of interest., (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)

Background: Sudden Unexpected Infant Deaths (SUID) can occur between 1 month and 1 year of age and are inequitably distributed with a greater burden in populations with numerous health disparities. Modifying the infant sleep environment to promote safe sleep is the most effective risk reduction strategy to reduce SUID. The provision of baby boxes with a mattress and infant supplies has been part of a larger anti-poverty social justice maternity package for decades in Finland. While infant mortality rates have generally improved after the maternity package was introduced, little is known about whether the provision of the baby box increased safe sleep practices. The purpose of the study was to evaluate whether the provision of a Finnish-style baby box reinforced safe infant sleep practice in the home in a low-resource community in Ecuador., Methods: In this longitudinal randomized controlled trial all participants received the same safe sleep education in their third trimester of pregnancy (n = 100). This was followed by randomization into two groups; the control received a diaper bag and newborn gifts, and the intervention group received a baby box and the same gifts at each timepoint. Four infant sleep practices (room sharing, bed sharing/co-sleeping, position, and soft items in the sleep environment) were assessed at 1 month and 1 months post-delivery during a home visit where safe sleep education was also reinforced with both groups., Results: Those in the baby box group were 2.5 times more likely to report safe sleep practices compared with mothers in the diaper bag group at 1 month (odds ratio [OR] = 2.45 and 95% confidence interval [CI]: 1.03-5.86; χ 2  = 4.1, p = .043). The group difference was also present at 6-months post-birth: those in the baby box group were 2.9 times more likely to report safe sleep practices compared with those in the diaper bag group (OR = 2.86 and 95% CI: 1.16-7.05; χ 2  = 5.2, p = .022)., Conclusions: While not all participants used the box regularly, the mothers who received the box were more likely to practice safe sleep at 1 month and 6 months. This suggests the baby box may have served as an important prompt towards safer infant sleep practice., Trial Registration: (Clinical Trial Registry, per clinicaltrials.gov : not applicable under 42 CFR 11.22(b) as the study Facility Location was not in the United States (took place in Ecuador), does not involve FDA IND or IDE, and does not involve a drug, biological or device product that is manufactured in and exported from the US for study in another country. The University of San Francisco Quito, Research Ethics Committee in Human Beings approved the study, #2017- 127 M. The University of Kentucky Office of Research Integrity also approved the study, IRB # 42965)., (© 2023. The Author(s).)

Purpose: Those factors identified to increase the risk of suicide in rural dwellers were exacerbated by the SARS-CoV-2 pandemic, specifically economic factors, substance use, access to health care, and access to lethal weapons. Because the effects of SARS-CoV-2 on suicide ideation and attempts in rural populations have not been fully characterized in published literature, this study compares: (1) the rates of suicide ideation and attempts between the 6 months affected by SARS-CoV-2 to same months of the preceding year (3/18/2020-9/18/20; 3/18/2019-9/18/19), (2) demographics (ie, age, sex, residence, race, and ethnicity), and (3) the locations in which the encounters were billed (inpatient, outpatient, and emergency department)., Methods: Deidentified claims data associated with patient encounters billed for Suicide Ideation and Suicide Attempt were grouped based on time period and analyzed using descriptive statistics, incidence rate ratio (IRR), 2-sample t-test, chi-square test of association, or Fisher's exact test., Findings: Suicidal ideation encounters increased in the 6 months post-SARS-CoV-2 when compared to the 6 months of the prior year (IRR = 1.19; P < .001). Males (IRR = 1.27, P < .001), those residing rural areas (IRR = 1.22, P = .01), and Black, non-Hispanic (IRR = 1.24, P = .024) were found to have increased rates of suicide ideation post-SARS-Cov-2. In adults, White, non-Hispanics (IRR = 1.16; P < .001) had increased rates of post-SARS-CoV-2. In the pediatric subset, those who were aged 14-17 (IRR = 1.50; P < .001), resided in rural areas (IRR = 1.61, P = .009), and idenitifed as Hispanic (IRR = 1.89; P = .037) or Black, non-Hispanic (IRR = 1.61, P = .009) had increased rates post-SARS-CoV-2., Conclusions: Our study identified rural dwellers to be at increased risk for suicide ideation., (© 2022 National Rural Health Association.)

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

Purpose: The purpose of this study was to determine if a web-based educational intervention increased knowledge, attitudes, and intention of perianesthesia nurses regarding opioid discharge education (including safe use, storage, and disposal of opioids). Secondary outcomes were to determine Perceived Behavioral Control, subjective norms, and familiarity with American Society of PeriAnesthesia Nurses (ASPAN) guidance on opioid education., Design: A pre-test, post-test longitudinal design., Methods: An email described the study and had a link for those choosing to participate. The intervention was a web-based voiceover module with patient education scenarios focused on information required for patients before discharge home. Responses to the evidence-based pre-survey, post-survey one, and post-survey two were collected. The survey was developed using components of the Theory of Planned Behavior. Data analysis included descriptive summary and evaluation of changes in knowledge and domains of Theory of Planned Behavior using repeated measures mixed modeling., Findings: The participants were invited to complete a pre-test survey (n = 672), the immediate post-test (n = 245), and the 4-week post-test (n = 172). The analysis presented is limited to 245 who completed at least the first post-survey. Most were staff nurses (82%), and the majority had a BSN (62%); participants most typically worked in a hospital-based PACU (73%). For all outcomes, there was an immediate increase in the measure following the intervention; this pairwise difference (between pretest and the immediate post-test) was significant in all but one of the models. The immediate and 4-week post-test scores exceeded the corresponding pre-test score, though for Perceived Behavioral Control, attitude, and intention, the degree of increase between baseline and week 4 was not significant., Conclusions: In all cases, both the immediate and 4-week post-test scores exceeded the corresponding pre-test score, though, for three of the TPB constructs, the difference between baseline and week 4 was not significant, while nearly all of the increases between baseline and immediately following the intervention were significant. These findings suggest a more intensive intervention, possibly with the inclusion of booster sessions, may be needed., (Copyright © 2022 American Society of PeriAnesthesia Nurses. Published by Elsevier Inc. All rights reserved.)

To achieve equity in protection from poor health outcomes due to tobacco use, tobacco control policies and interventions need to affect socially disadvantaged groups more strongly than advantaged groups. Flavored tobacco bans have been seen as a policy with this potential. However, tobacco control researchers, in close concert with policy advocates, need to consider how to center equity throughout the policy process to achieve equitable outcomes from banning flavored tobacco. In this commentary, we outline the rationale for how and why tobacco control researchers should consider equity throughout the policy process to help fully achieve the potential of flavored tobacco ban policies. These recommendations emerged from a presentation at the Vermont Center on Behavior and Health 2021 Conference. Specifically, we focus on recommendations for tobacco control researchers to center equity including partnering with communities in agenda setting, examining how various policy formulations or exemptions may increase or decrease disparities, determining where flavor policies need to reach and whether policies are equitably reaching all populations disproportionately burdened by flavored tobacco, assessing whether policy implementation/enforcement is carried out equitably to maximize policy benefits, and evaluating policy impact with as much granularity as possible. Considering the entire policy process is central to enhancing equitable outcomes from banning flavored tobacco. Tobacco control researchers can play a key role in ensuring that these policies are viewed through an equity lens to, not just improve population health, but also to reduce harms to those disproportionately burdened by use of flavored products., 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 © 2022 The Authors. Published by Elsevier Inc. All rights reserved.)

Obesity is a key risk factor for Type 2 diabetes (T2D). Alarmingly, 87% of US adults have overweight or obesity, with non-Hispanic black adults having higher obesity and T2D prevalence than non-Hispanic white. The Diabetes Prevention Program (DPP) demonstrated the clinical benefits of lifestyle intervention (LI). While the DPP LI is effective, some participants don't achieve clinically significant weight loss in the current group-based translation paradigm. Black adults have the lowest adjusted weight loss (3.2%) among all racial/ethnic groups. Early intervention nonresponse defined as ≤1% weight loss at intervention week 4 is linked to lower probability of achieving weight loss goals. This paper describes the design and methods of a cluster randomized controlled trial among black weight loss nonresponders nested in 20 community sites (primarily churches). Descriptions of the adaptations made to transition the program to virtual format during the COVID-19 pandemic are also included. Trained community health workers deliver a group-based, 6-month long DPP over 18 sessions via Zoom. Additionally, nonresponders in the enhanced group receive weekly telephone support to provide individual-level intervention to help overcome weight loss barriers. Outcomes include weight, physical activity level, blood pressure, and dietary behaviors; these are compared between nonresponders in the enhanced intervention group and nonresponders in the active control group. Cost, mediators, and moderators are explored. If found to efficacious, these enhanced strategies could be standardized as a supplement for use with DPP nonresponders., 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 © 2022 The Authors. Published by Elsevier Inc. All rights reserved.)

Background: Smoking during pregnancy and prenatal secondhand smoke exposure increase the risk of preterm birth. As Kentucky has the second highest rate of smoking in the United States and no statewide smoke-free law, an examination of the effect of municipal smoke-free legislation on preterm birth is warranted., Objective: This study used state-level live birth data and county-level municipal smoke-free legislation status to assess the association between the presence and strength of smoke-free laws and the likelihood of preterm birth. Moreover, this study hypothesized that pregnant persons living in counties with comprehensive municipal smoke-free laws prohibiting smoking inside all workplaces and enclosed public places would exhibit a lower likelihood of preterm birth than those living in counties with weak or moderate laws (ie, smoke-free laws with exemptions that do not cover all workplaces and enclosed public places) or no smoke-free law., Study Design: Using live birth data from the Kentucky Office of Vital Statistics with birth years ranging from 2004 to 2020, a total of 894,372 live births were recorded that indicated that a childbearing person was between the ages of 18 and 49 years and a resident of Kentucky; these live births formed the sample for the study. Municipal ordinances implemented during a given calendar year were coded in the model as present starting with the following calendar year, as the birth records were time deidentified except for the year of birth. This lagged law convention maximized the likelihood that pregnant persons included in the study were exposed to the smoke-free policy for at least a portion of their pregnancy. Multilevel logistic regression was used to assess the effect of smoke-free ordinances on the likelihood of preterm birth, with personal- and county-level variables included as potential covariates and pregnant persons nested within the county of residence. Data analysis was conducted using SAS (version 9.4; SAS Institute, Cary, NC), with an alpha level of .05., Results: Nearly all personal-level variables were associated with preterm birth status. Personal factors associated with an increased likelihood of preterm birth included being older (relative to 18-24 years old; odds ratios [95% confidence intervals]: 1.02 [1.01-1.04] and 1.27 [1.24-1.31] for ages 25-34 and 35-49 years, respectively); having a history of preterm birth (odds ratio, 4.65; 95% confidence interval, 4.53-4.78); and smoking before pregnancy (odds ratio, 1.14; 95% confidence interval, 1.12-1.16). Pregnant persons living in counties with comprehensive laws were 9% less likely to have a preterm birth than those living in counties without a smoke-free ordinance (odds ratio, 0.91; 95% confidence interval, 0.89-0.94; P<.001). There was no difference in the likelihood of preterm birth between those living in counties with moderate or weak laws and those unprotected by any smoke-free ordinance in their county of residence., Conclusion: This study demonstrated that comprehensive municipal smoke-free laws are associated with reduced risk of preterm birth and that moderate or weak smoke-free laws are not. The findings have major implications for public health policy and underscore the potential influence of healthcare providers' advocacy for strong smoke-free policies, prohibiting smoking in all workplaces (including restaurants, bars, and casinos), to support healthy pregnancies., (Copyright © 2022 Elsevier Inc. All rights reserved.)

Introduction: Multiple recent critical societal/world events have impacted nurses' beliefs and emphasized the importance of the standards of behavior that frame nurses' professional values., Objectives: This study focused on the professional values of students in a Doctor of Nursing program (DNP), including the relationship between professional values, time in program, and intentions to participate in professionalism-focused activities., Methods: From fall 2019 through Spring 2021, 227 participants were invited to participate in this study through the completion of an online survey at several points in time. The survey contained various demographic variables, items from the Nurses Professional Values Scale-3 representing the dimensions of caring, activism, and professionalism, and Likert scale items that measured intentions to participate in professionalism-focused activities., Results: The overall mean NPVS-3 score was 118.30 (out of a possible range of 28-140). The highest mean score among the three dimensions was for caring (45.38), followed by activism (40.20) and then professionalism (32.71). Students indicated high intentions to participate in activities focused on professionalism (5.77 on a scale of 1 to 7). A moderate correlation between intentions and professionalism ( r  = .44, p  < .0001) was noted. The association of intentions to caring and activism was weaker but significant ( r  = 0.26; p  = .012 ) and ( r  = 0.37; p  = .0003), respectively., Conclusion: DNP curricular efforts can strengthen nurses' professional values by focusing on the development of critically important professional attributes. Nurses, especially those who have a doctoral-level education, need to have strong professional values and understand the importance of their voice and impact as a leader in the profession., Competing Interests: Declaration of Conflicting 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) 2022.)

Introduction/objective: To develop a scale to measure methotrexate intolerance for use in adult rheumatoid arthritis (RA) patients and to describe its psychometric properties., Methods: A three-phase study was conducted. During Phase 1, we conducted individual interviews with RA patients (n = 14) to inform our item development process. During Phase 2, we asked for RA patients' (n = 10) feedback on item readability, clarity and the scale's ability to measure methotrexate intolerance. During Phase 3, we had patients with RA (n = 204) complete the scale to develop a final version and to describe the scale's internal validity (Cronbach's alpha), test-retest reliability (intra-class correlation coefficients), construct validity and discriminant validity and the ability of the scale to discriminate between past and present methotrexate users., Results: The newly developed, weighted scale (Patient-Perceived Methotrexate Intolerance Scale [PPMIS]) includes four subscales: Methotrexate Benefits, Methotrexate Risks-Side Effect Considerations, RA Risks and Methotrexate Risks-Willingness to Take Methotrexate Despite Risks. Cronbach's alpha ranged from 0.79 to 0.94. Test-retest reliability at 2 weeks was 0.73-0.88. Construct validity was supported with significant logical relationships between subscale scores and the existing methotrexate intolerance scale and past/present methotrexate use. The PPMIS was able to correctly classify RA patients as a past versus present methotrexate user 77% of the time. At the cut point of 3.29, the sensitivity of the PPMIS is 74% and specificity is 72% to correctly classify patients into past/present methotrexate use., Conclusion: This is the first known scale with favourable measurement properties to evaluate methotrexate intolerance using a patient-centred perspective., (© 2021 John Wiley & Sons Ltd.)

Background: Make It POP (Pathway Optimizing Professionalism) Series (MIPS) leadership educational sessions were developed and taught by the Dean as a curricular focus on professionalism for Doctor of Nursing Practice (DNP) students., Purpose: Evaluating the association between Behavioral Beliefs, Normative Beliefs, Control Beliefs, and Intention to advance professional identity and values was a focus of this study. A secondary focus was to discern whether these Belief measures and attendance to the MIPS education series were predictive of Intention to increase professional identity and values., Method: Over a two-year period, 227 students were invited to attend the MIPS courses, which included four once per semester sessions. Students were invited to complete a survey structured around the tenants of the Theory of Planned Behavior prior to attending the MIPS and following each session; 91 students completed the survey at least once., Results: A significant relationship was not noted between attendance to one or more MIPS sessions and Intention to advance professional identity and values. Behavioral Beliefs and Control Beliefs had the strongest associations with Intentions, but normative beliefs were not significantly associated with Intentions., Conclusion: Integrating curricular innovation with meaningful engagement and reflection in DNP education may advance DNP student's commitment for sustained professional growth., (Copyright © 2022 Elsevier Inc. All rights reserved.)

Objective: This study sought to determine if targeted drug screening of newborns was effective in identifying a positive drug test result., Study Design: This was a retrospective cross-sectional study. A total of 340 infants met criteria for drug screening. Sensitivity and specificity were used to evaluate each of the potential risk factors in terms of their ability to predict a positive drug test result. Two-sample t-tests were used to compare differences in Finnegan scores between babies with a positive drug test result and those with a negative one., Result: The risk factor with the highest sensitivity was maternal history of drug use. The difference in the Finnegan scores between groups was statistically significant., Conclusion: The risk factors associated with this study were not very sensitive. The only way to identify all infants at risk of NAS is to standardize the screening process and apply to all infants., (© 2022. The Author(s), under exclusive licence to Springer Nature America, Inc.)

Background: The lack of research on cost-related health literacy among colorectal cancer (CRC) survivors warrants further evaluation., Objectives: The objective of this study was to examine prevalence of low literacy (health, cancer, and insurance literacy), and numeracy and their association with sociodemographic factors in a group of Kentucky CRC survivors., Methods: Based on data from the Kentucky Cancer Registry, this cross-sectional study evaluated survey results from January 2019 to November 2019 for the prevalence of low cost-related health literacy., Findings: Overall, 104 participants had adequate health literacy (77%) and cancer health literacy (71%). However, fewer CRC survivors had high numeracy (16%) and confidence in choosing and using health insurance (18%). Thirty-one percent reported competence in their ability to select a health insurance plan and use it to access timely and appropriate healthcare services. Those with lower levels of education or those enrolled in a public health insurance plan were more likely to have lower health literacy, insurance literacy, and numeracy.

Home radon testing is a primary lung cancer prevention strategy, yet the majority of Americans have not tested their home. This descriptive, ecological study uses 54,683 observed radon values collected in Kentucky homes from 1996 to 2016 to examine the association of county-level social determinants of health and environmental exposures on home radon testing rates. Multivariate linear regression analysis indicates that as median home value, rurality, and radon risk potential increased, counties experienced an increase in annual home radon testing rates. As adult smoking prevalence increased, counties experienced a decrease in annual rates of residential radon testing. These findings indicate that counties with low median home values, high adult smoking prevalence, and high incidence of lung cancer may benefit most from prevention interventions aimed at promoting home radon testing, adopting radon- and smoke-free home policies, and integrating radon risk reduction messaging into tobacco cessation and lung cancer screening programs.

Background and Objectives: Several subgroups of the International Council of Nurses Nurse Practitioner/Advanced Practice Nurse Network (ICN NP/APNN) have periodically analyzed APN (nurse practitioner and clinical nurse specialist) development around the world. The primary objective of this study was to describe the global status of APN practice regarding scope of practice, education, regulation, and practice climate. An additional objective was to look for gaps in these same areas of role development in order to recommend future initiatives., Methods: An online survey was developed by the research team, and included questions on APN practice roles, education, regulation/credentialing, and practice climate. The study was launched in August 2018 at the 10 th Annual ICN NP/APNN Conference in Rotterdam, Netherlands. Links to the survey were provided there and via multiple platforms over the next year., Results: Survey results from 325 respondents, representing 26 countries, were analyzed through descriptive techniques. Although progress was reported, particularly in education, results indicated the APN profession around the world continues to struggle over titling, title protection, regulation development, credentialing, and barriers to practice., Conclusions and Practice/policy Relevance: APNs have the potential to help the world reach the Sustainable Development Goal of universal health coverage. Several recommendations are provided to help ensure APNs achieve these goals., Competing Interests: The authors have no competing interests to declare., (Copyright: © 2022 The Author(s).)

Background: Because effective treatment for rheumatoid arthritis (RA) is dependent on medication use, medication optimization is critically important. Medication adherence, patient satisfaction with care and medication adverse events are core concepts of medication optimization that are either a significant problem and/or understudied in patients with RA., Objective: To (1) evaluate treatment effects from a medication optimization intervention; (2) assess treatment differences and changes over time in medication adherence, patient satisfaction, and medication adverse events; and (3) to determine whether age, gender, provider trust, and disease activity affect these outcomes., Methods: We conducted a prospective, longitudinal intervention study (N = 143 RA patients) using repeated measures models., Results: We did not identify significant intervention effects. For both the medication adherence and patient satisfaction models, the significant predictors in the model included age, gender and trust in provider. Older age, female gender (relative to male), and greater trust in the provider were associated with increased medication adherence scores and patient satisfaction. For the adverse events model, the only significant predictor in the model was gender. Compared with males, females were more likely to report experiencing adverse events. Time was significantly associated with decreased experiences of adverse events., Conclusion: This study has identified important predictors of medication adherence, patient satisfaction and medication adverse events in a sample of patients with RA which can facilitate targeted approaches to improve adherence in those high-risk groups., (© 2021 John Wiley & Sons Ltd.)

Purpose: Determine associations of strength of local smoke-free laws and urban/rural location with cigarette and smokeless tobacco use among high school students in grades 10 and 12., Design: Secondary data analysis from the 2004-2018 biennial Kentucky Incentives for Prevention Survey., Setting: Public high schools in Kentucky., Sample: N = 353502 10 th /12 th graders., Measures: County-level smoke-free law status from the Kentucky Center for Smoke-free Policy; Rural Urban Continuum Codes; self-reported last 30-day alcohol, marijuana, cigarette, and smokeless tobacco use., Analysis: Generalized estimating equations modeling assessed the association of law status and urban/rural location with tobacco use across cohorts, controlling for demographics and other substance use., Results: Students in counties with a comprehensive smoke-free law were 23% less likely to smoke cigarettes and 16% less likely to use smokeless, compared to those in counties without a law. Students in counties with moderate/weak laws did not differ in likelihood of use for either product, compared to those in counties without a law. Students in urban counties were 14% less likely to smoke, but there was no difference in likelihood of smokeless use by urban/rural location., Conclusion: Comprehensive smoke-free laws are associated with a lower likelihood of youth cigarette and smokeless use. Rural youth may be at increased risk of cigarette smoking relative to youth in urban areas.

Older adults in long-term care (LTC) facilities suffer disproportionately from health conditions caused or worsened by secondhand smoke. Long-term care facilities in many states and municipalities permit smoking. Americans for Nonsmokers' Rights compiles data on smoke-free policies only in institutional facilities (e.g., nursing homes), but not in transitional (e.g., independent living) or community-based settings (e.g., adult day). A cross-sectional, observational study was conducted of smoke-free policies using cluster random sampling in Kentucky to compare differences in policy location of coverage and strength of smoke-free policies in institutional, transitional, and community-based LTC facilities by rural/urban status. Online or phone surveys of LTC administrators representing 306 facilities were conducted. Of the facilities sampled, 35.5% were institutional, 33.4% transitional, 25.1% community-based, and 6.0% multi-type. Only one in five (19.6%) facilities restricted smoking indoors and outdoors. Only 17.3% of the policies were comprehensive (i.e., prohibiting use of all tobacco products by all persons living, frequenting, or working in LTC facilities). Compared to transitional facilities, institutional and community-based facilities were more likely to have comprehensive policies and restrict smoking indoors and outdoors. Facilities located in rural communities were less likely to restrict smoking indoors or outdoors and less likely to have comprehensive smoke-free policies, reflecting a disparity in policy protections. Strong, consistent smoke-free policies and policy enforcement are needed to reduce the disparity in smoke-free protections for older adults, LTC employees, and visitors. More research is needed to investigate the best strategies for implementing and enforcing policies that completely restrict smoking in all LTC facilities.

Purpose: Rural adolescents engage in higher smoking and smokeless tobacco use rates than those from urban communities; urban adolescents are more likely to use e-cigarettes. The study investigated whether place of residence (rural vs urban) is associated with tobacco use prevalence and change in prevalence among middle and high school students over time., Methods: We analyzed data from the National Youth Tobacco Survey (2011-2016). Multiple logistic regression methods for weighted survey data assessed the relationship of place of residence with current tobacco product use over time, adjusting for demographics., Findings: There was no difference in rate of change in use of any tobacco product between rural and urban middle or high school students. Adjusting for age, sex, race/ethnicity, and survey year, both middle and high school rural students were more likely to use cigarettes and smokeless tobacco, whereas urban high school students were more likely to use hookah. Significant polynomial trends were observed for e-cigarette and hookah use patterns, whereas linear changes in use patterns were detected for cigarette and smokeless tobacco use over time., Conclusions: Rural high school students are more likely to smoke cigarettes and use smokeless tobacco than their urban counterparts, although prevalence rates have decreased over time. However, use of hookah and e-cigarettes among middle and high school students has increased over time regardless of place of residence. To stem the rapid increase in use of hookah and e-cigarettes, comprehensive tobacco control policies are needed regardless of rural or urban location., (© 2019 National Rural Health Association.)

Purpose: This study compared differences in sociodemographic characteristics, personal risk perception of lung cancer, lung cancer worry, and synergistic risk perception among rural Appalachia residents who completed home radon testing with those who did not, after receiving a free long-term test kit at a rural primary care clinic. The study also examined the association between the Teachable Moment Model constructs and home radon testing., Methods: The study was an exploratory correlational design with a convenience sample of (N = 58) adult participants recruited from 2 rural primary care clinics in Appalachia Kentucky. Participants completed a brief survey and were given a free long-term home radon test kit. Multiple logistic regression was used to determine characteristics associated with home radon testing., Findings: Twenty-eight participants (48%) completed home radon testing. There were no differences in personal risk perception of lung cancer, lung cancer worry, or synergistic risk perception between those who completed home radon testing and those who did not. Age was the only significant factor associated with completion of radon testing (B = 0.077, P = .005). For every 5-year increase in age, participants were 47% more likely to test their home for radon., Conclusion: Providing free home radon test kits in the primary care setting shows promise in prompting radon testing in rural Appalachia. As radon-induced lung cancer risk increases with exposure over time, health care providers in rural Appalachia need to encourage patients of all ages to test their home for radon, especially those who smoke or report smoking in the home., (© 2020 National Rural Health Association.)

Purpose: Caring for a family member with chronic illness increases cardiovascular disease (CVD) risk by 82%, and rurality imparts additional CVD disparities. The purpose of this study was to describe a profile of rural caregivers of patients with chronic illnesses to determine the prevalence of CVD risk factors, and psychosocial and socioeconomic burden, as well as to compare these variables across gender., Methods: Baseline data from a trial of CVD risk reduction in rural caregivers of patients with chronic illnesses were used. We measured depression and anxiety with the PHQ-9 and Brief Symptom Inventory; social, economic, and environmental factors using the MOS-Social Support and Economic and Environmental surveys; body mass index (BMI); blood pressure (BP); and lipid profile., Results: Of 181 caregivers (age 53±14 years, 80% female), 69% were married; 88% were caring for a family member, including 46% caring for a spouse and 18% for a parent. A total of 51% were anxious, 25% depressed, and 25% reported lack of social support. Most (51%) caregivers had one or more types of CVD; and 49% were smokers. By examination, 76% had elevated BP; 35% had total cholesterol >200; 50% low-density lipoprotein >100; 56% triglycerides >150; and 79% high-density lipoprotein <60. Based on BMI, 91.5% were overweight or obese. Gender comparisons revealed that women reported higher levels of depressive symptoms than men., Conclusions: Rural caregivers, regardless of gender, are at increased risk of CVD and struggle with factors that make caregiving burdensome and contribute to their own poor cardiac health., (© 2021 National Rural Health Association.)

Background: Cardiovascular disease is a significant health problem in the United States, attributed to more than 30% of all deaths annually. Anxiety has been associated with cardiovascular disease risk and is thought to be associated with cardiovascular disease risk through inflammatory pathways., Objective: The purposes of this study were to examine the relationship between anxiety and systemic inflammation in individuals at risk for cardiovascular disease and to determine if single-nucleotide polymorphisms (SNPs) associated with inflammation moderate this relationship., Methods: A secondary analysis was conducted using baseline data from a study investigating the impact of genetics on response to a cardiovascular disease risk reduction intervention. Anxiety was measured using the Brief Symptom Inventory. Protein levels for C-reactive protein and interleukin-6 (IL-6) were measured in serum, and genomic DNA was assayed for SNPs in the C-reactive protein, IL-6, and IL-6R genes. Multiple linear regressions were performed to examine if anxiety predicted inflammation and if SNPs moderated associations., Results: Participants (N = 398) were white, aged 51 ± 13 years, and 73% women. There was a significant interaction between rs4129267 genotype and anxiety (P = .010), with the association significant only for individuals with the CC genotype (b = 0.243, SE = 0.04, P < .001). No moderation effect existed for rs1205 or rs1800797., Conclusion: Anxiety was positively associated with IL-6 protein levels, but moderation analysis indicated that this was significant only for individuals with the rs4129267 CC genotype. This suggests that genotypic differences may exist in anxiety response, placing certain individuals at higher risk for inflammation and, subsequently, cardiovascular disease., Competing Interests: The authors have no conflicts of interest to disclose., (Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.)