Self-Efficacy to Drive While Intoxicated: Insights into the Persistence of Alcohol-Impaired Driving.

BACKGROUND: Scant research has examined event-level risk factors for impaired driving in natural drinking settings. This study assessed driving self-efficacy among intoxicated individuals to better understand decision-making about alcohol-impaired driving at night after exiting on-premise drinking establishments. METHODS: Interview and breath test data were collected from bar patrons (n = 512) exiting 2 college bar districts in Florida and Texas. RESULTS: Results from a multivariable linear regression model indicated that self-efficacy to drive while intoxicated was more strongly associated with situational variables, that is, perceived drunkenness and self-estimated blood alcohol concentration than patron traits, that is, past-year history of drinking, risk proneness, and sex. A large proportion of bar patrons, particularly men, expressed confidence in their ability to drive, despite being highly intoxicated. Moreover, the majority of legally intoxicated patrons who were confident in their ability to drive were aware of their high level of intoxication. CONCLUSIONS: Emphasis should be placed on the enactment and enforcement of policies and laws to prevent alcohol-impaired driving.

Exploring public health education's integration of critical race theories: A scoping review.

Introduction: Public health has declared a commitment toward diversity as a whole, with a commitment toward addressing and dismantling racism being at the forefront. Although public health has admirably taken on this mission, and the foundational principles of public health align with social justice and health equity, public health as a discipline is vastly behind other fields in integrating and utilizing critical race theorizations. Of particular concern is the lack of critical race theorization within public health education materials. Public health education serves as a precursor to public health practice and situates topics and competencies that are essential to one's foundational public health knowledge and skillset, thus the use of strong theoretical groundings is critical in public health education. Objectives: Therefore, to explore the current landscape of public health educational research that employs critical race theories, this study sought to conduct a scoping review investigating the current literature of public health pedagogical, instructional, and curricular efforts that utilize race and antiracist theorization principles as a means to administer public health education. More specifically, we sought to investigate how have faculty and instructors published their integration of race theorization in public health curriculum/instruction within the United States since 2011. Results: We found 18 examples from peer-reviewed literature of curricular, pedagogical, or instructional practices and strategies that integrate critical theories of race, including contemplative pedagogy (n = 1), antiracism (n = 3), Public Health Critical Race praxis (n = 4), Critical Race (n = 5), critical service-learning/community engagement (n = 2), ethnic studies (n = 1), and intersectionality (n = 2). Conclusion: These articles present a wide breadth of innovative approaches to infusing critical race studies within public health higher education, ranging from individual assignments to course design and implementation to institutional culture change, thus demonstrating the multifaceted nature of critical race studies within micro-learning communities and macro-discipline practices. Identifying theoretically grounded, exemplary models and scholarly recommendations of pedagogical, instructional, and curricular practices provides readers the opportunity to borrow from successful practices and implement concepts of race, racism, antiracism, intersectionality, and more into their classrooms.

Polytrauma and life care planning: managing the complex interaction of multiple injuries.

Military personnel, who have sustained multiple injuries, or polytrauma, are returning home with a novel set of challenging injuries and disabilities. These emerging injury patterns require specialized rehabilitation and continual coordination of care. One technique to assess the current and future disability-related needs of an individual who sustains polytrauma is life care planning. The life care plan (LCP) is a dynamic document based upon published standards of practice, comprehensive assessments, data analysis, and research. The purpose of this article is to introduce the life care plan as an established and successful approach for meeting the complex and comprehensive needs of individuals with polytrauma. Additionally this article includes multiple case examples to help illustrate the applicability of life care planning.

Multiple tobacco use and increased nicotine dependence among people with disabilities.

BACKGROUND: People with disabilities (PWD) are at greatest risk for tobacco use compared to people without disabilities. However, little is known about the use of multiple types of tobacco by PWD. OBJECTIVE/HYPOTHESIS: The purpose of this study was to examine nicotine dependence among a sample of PWD who use multiple types tobacco products. We hypothesized that individuals who used multiple forms of tobacco would have higher levels of nicotine dependence. METHODS: A tobacco survey was administered to clients who use tobacco and receive services from an organization that provides independent living services to PWD. The self-report brief survey included measures of nicotine dependence and items indicating the types of tobacco products participants used. A total of 113 male and female participants with disabilities (mean age = 51.7, SD = 10.1) participated in the study. RESULTS: Multiple tobacco use was reported by 16.8% of the participants and was significantly associated with nicotine dependence. Compared to single tobacco product users, multiple tobacco users were more likely to use tobacco within the first 30 min of waking, believe tobacco the first thing in the morning would be the most difficult to give up, and find it hard to not use tobacco in prohibited locations. CONCLUSIONS: The use of multiple types of tobacco products among PWD disability is relatively common and is associated with greater nicotine dependence. Tobacco cessation interventions targeting PWD should consider the addressing unique challenges of preventing different types of tobacco products.

Hookah and Alcohol Use among Young Adult Hookah Smokers: A Mixed Methods Study.

OBJECTIVES: Hookah tobacco smoking has grown steadily in popularity among young adults in the United States. Little attention has been given to the relationship between hookah smoking and another behavior that is common among young adults - alcohol use. The purpose of this study was to examine hookah and alcohol use among young adults. METHODS: Forty young adult hookah smokers (55% female) participated in focus group sessions on hookah use beliefs and a brief survey examining hookah and alcohol use including drinking alcohol before, during, or after smoking hookah. RESULTS: Quotes from the focus groups indicated that alcohol use may promote hookah use among individuals who have little or no hookah smoking experience. Alcohol use, binge drinking, and alcohol use before, during, and after hookah use were common among the participants regardless of legal drinking age status. Nearly half of the participants preferred to drink alcohol while smoking hookah due to the improved physical and social effects they associated with combining the 2 behaviors. CONCLUSIONS: For some young adult hookah smokers, alcohol appears to enhance the hookah smoking experience and may play a role in hookah smoking initiation. Future research and interventions should address the association between hookah and alcohol use.

Creating a Tobacco Cessation Program for People with Disabilities: A Community Based Participatory Research Approach.

Introduction: Smoking is the single most preventable cause of morbidity and mortality, accountable for one out of every five fatalities in the United States annually. Fifty million Americans (22%) suffer from some form of disability, with evidence suggesting that smoking rates within the disabled community are double that of the general population. Methods: The purpose of this study was to develop a tobacco cessation program designed by and for people with disabilities (PWD). Limited research data regarding tobacco interventions suggest that both adapting treatment methods and developing novel approaches may be effective in establishing cessation programs for low-income populations. Community-Based Participatory Research (CBPR) was conducted to develop a tobacco cessation group treatment program for PWD. Consumers with disabilities who use tobacco were recruited from a large population of PWD utilizing services at multiple centers for independent living (CIL) within North Central Florida. Results: Following qualitative interviews, multiple Community Advisory Board (CAB) meetings, and expert panel review, the tobacco cessation program was modified across several areas including: updating epidemiological data, decreasing text density, adding personal vignettes from PWD, adjusting for person-first language, adding disability-specific issues, and incorporating appropriate counseling strategies. Conclusions: Study findings suggest that CBPR-based methods are useful when developing tobacco cessation programs for persons with disability. Forty-two changes were recommended for the resulting LIFT Curriculum. Next steps include pilot testing the curriculum among individuals with disability and comparing results to a standard tobacco cessation curriculum.

Is there a misplaced focus on AmED? Associations between caffeine mixers and bar patron intoxication.

BACKGROUND: Previous research on alcohol mixed with energy drinks (AmED) suffers from measurement problems. Missing from the research literature are studies that assess caffeine-alcohol co-ingestion in natural drinking environments. METHODS: This field study collected data in a U.S. college bar district from 328 randomly selected patrons. Anonymous data were obtained from face-to-face interviews and self-administered surveys, and from breath tests. RESULTS: Cola-caffeinated alcoholic beverage consumers left bars in a more highly intoxicated state than those who consumed alcohol only. There was no significant difference between the intoxication level of the AmED group and the cola-caffeinated alcoholic beverage group. Results from a multivariate regression model indicated that quantity of caffeinated alcoholic beverage consumption had a significant, positive association with bar patron intoxication after adjusting for potential confounders. CONCLUSIONS: Findings indicate that caffeine may have a dose-dependent relationship with alcohol intoxication in the bar/nightclub setting. In addition, results revealed that cola-caffeinated alcoholic drinks may pose similar levels of risk to bar patrons as those associated with AmED beverage consumption. Product labeling requirements about alcohol risks may need to be extended not only to energy drinks, but to caffeinated soft drinks as well.