Exploring Patterns of the Use of Electronic Nicotine Delivery Systems among Adolescents in High-Risk Appalachian (U.S.A) Communities.

Background: Electronic nicotine delivery systems (ENDS) use among adolescents in the United States (U.S.) has surpassed conventional tobacco products (CTPs), including cigarettes. Increasingly, ENDS are used concurrently with CTPs and substances such as cannabis. However, few studies involve Central Appalachia, a region with historically high rates of tobacco and other substance use. Objective:  To examine prevalence of concurrent use of ENDS and cannabis among school-going adolescents in Appalachian Tennessee and delineate associations between ENDS use and substance-related risk behavior (cannabis use), social relations (peer use), and school-related risk behavior (academic performance). Methods: Data were obtained from a survey conducted with youth aged 13-17 years in 2018 in a county in Appalachian Tennessee (n = 280). A multivariable logistic regression model was fit to evaluate associations between ENDS and cannabis use, and other factors. Results: Overall, lifetime ENDS and cannabis prevalence estimates were 31.1% and 18.6%, respectively. Lifetime ENDS users had increased odds of also being lifetime cannabis users [OR = 9.22, 95% confidence interval (CI): 3.44-24.75]. Lifetime ENDS users had increased odds of reporting ENDS use among peers [OR = 12.11; 95% CI: 5.40-27.12] and lower academic performance (OR associated with mostly C or D vs. A grades was 4.28, 95% CI: 1.68-10.90). Conclusion: This study found an association between ENDS and cannabis use among adolescents in Appalachian Tennessee exists. Additionally, peer use and academic performance were associated with ENDS use. The findings have implications for public health intervention planning to address not only ENDS but also substance use among Appalachian youth.

From Africa to the USA: A Combined Strategy for Nursing Education.

Engaging students in class when first-hand experience is not available is challenging. Three teaching strategies, flipped classroom, a guest speaker, and technology, engaged students during a global health class. Students were given a graded preclass assignment, which was used to guide the class session when an expert physician from Zambia joined us using technology. On the day of class, students were engaged and asked questions of the physician related to global health and culture. Combining the three strategies was an innovative and effective way to engage students, with many sharing with faculty that this was their favorite class day.

Tobacco Use and Attachment Style in Appalachia.

Tobacco has been recognized as the number one cause of preventable death in America and results in almost 5.2 million years of potential life lost each year. The use of tobacco products is highly correlated with pulmonary disease, cardiovascular disease, and other forms of chronic illness in America. New tobacco products are trending in the tobacco market such as the water pipe/hookah and e-cigarettes. With e-cigarettes and other newer forms of tobacco on the rise, it is important to look at the underlying factors for using all kinds of tobacco products as a means of prevention. Certain adult attachment styles (secure, preoccupied, dismissing-avoidant, and fearful-avoidant) in emotionally meaningful relationships could be indicators for physical illness, mental illness, and even addiction. This study investigated whether or not there is a relationship between tobacco use and attachment style. Based on a university-wide survey that was sent out at a university in Appalachia with 522 participants, demographic data revealed 68.5% (n = 358) did not currently use tobacco products. Of those who did currently use tobacco products 54.5% (n = 90) were male, 84.8% (n = 140) were undergraduate students, and 66.7% (n = 110) were between the ages of 18-25. For individuals who used tobacco 23.5% (n = 38) were in the secure attachment group, 27.8% (n = 45) were in the dismissing-avoidant attachment group, 30.2% (n = 49) were in the fearful-avoidant attachment group, and 18.5% (n = 30) were in the preoccupied attachment group. Chi Square analysis demonstrated that attachment style was significantly (p < 0.001) different between tobacco users and non-users revealing that there is a possibility for prevention of smoking initiation through the development of a secure attachment style.

Factors Associated with COVID-19 Vaccine Hesitancy in South Central Appalachia.

Introduction: The newly emergent COVID-19 virus reached pandemic levels in March 2020. By the middle of August 2020, there were over 1 million deaths attributed to COVID-19 in the U.S., with those in rural areas outpacing urban counterparts. Prior to emergency approval of the Pfizer, Moderna and Johnson & Johnson vaccine formulations, mitigation efforts addressing individual behavior were challenging. However, even with the entrance of these three new vaccines, herd immunity was not achieved in rural areas, as vaccine uptake remained low there. Although there has since been an abundance of COVID-19-related research addressing health literacy, vaccine hesitancy and overall medical mistrust, few of these studies focus on Appalachia. Purpose: This study identifies barriers and facilitators to adherence with COVID-19 mitigation, focusing specifically on vaccine hesitancy in South Central Appalachia. Methods: A secondary data study was conducted with a subset of Appalachian residents from the COVID-19 Public Health survey. Participants were grouped by county using ARC economic county designations for analysis. The dependent variable, vaccine hesitancy, was explored in relation to five categories of independent variable: (1) demographics (with four conceptual areas); (2) belief; (3) action; (4) medical mistrust; and (5) health literacy. Results: Findings indicate vaccine hesitancy attributes include beliefs addressing COVID-19 threat, overstatement of severity of illness, risk of vaccines, vaccine safety information not present from manufacturer, and independent decision to vaccinate. Findings from this study are comparable to HPV vaccine studies in Appalachia. Implications: As interventions are developed for Appalachia, it is paramount to focus vaccine administration at the individual and population level.

The prevalence of metabolic conditions before and during the COVID-19 pandemic and its association with health and sociodemographic factors.

BACKGROUND: There is a dearth of evidence on the relationship between COVID-19 and metabolic conditions among the general U.S. population. We examined the prevalence and association of metabolic conditions with health and sociodemographic factors before and during the COVID-19 pandemic. METHODS: Data were drawn from the 2019 (N = 5,359) and 2020 (N = 3,830) Health Information National Trends Surveys on adults to compare observations before (2019) and during (2020) the COVID-19 pandemic. We conducted weighted descriptive and multivariable logistic regression analyses to assess the study objective. RESULTS: During the pandemic, compared to pre-pandemic, the prevalence of diabetes (18.10% vs. 17.28%) has increased, while the prevalence of hypertension (36.38% vs. 36.36%) and obesity (34.68% vs. 34.18%) has remained similar. In general, the prevalence of metabolic conditions was higher during the pandemic (56.09%) compared to pre-pandemic (54.96%). Compared to never smokers, former smokers had higher odds of metabolic conditions (AOR = 1.38, 95% CI = 1.01, 1.87 and AOR = 1.57, 95% CI = 1.10, 2.25) before and during the pandemic, respectively. People with mild anxiety/depression symptoms (before: AOR = 1.52, 95% CI = 1.06, 2.19 and during: AOR = 1.55, 95% CI = 1.01, 2.38) had higher odds of metabolic conditions relative to those with no anxiety/depression symptoms. CONCLUSION: This study found increased odds of metabolic conditions among certain subgroups of US adults during the pandemic. We recommend further studies and proper allocation of public health resources to address these conditions.

COVID-19 vaccine hesitancy and health literacy in US Southern states.

OBJECTIVES: COVID-19 vaccination in the United States has stalled, with some of the lowest rates in the South. Vaccine hesitancy is a primary contributor and may be influenced by health literacy (HL). This study assessed the association between HL and COVID-19 vaccine hesitancy in a population residing in 14 Southern states. STUDY DESIGN: Cross-sectional study using a web-based survey conducted between February and June 2021. METHODS: The outcome was vaccine hesitancy, and the main independent variable was HL, assessed as an index score. Descriptive statistical tests were performed, and multivariable logistic regression analysis was conducted, controlling for sociodemographic and other variables. RESULTS: Of the total analytic sample (n = 221), the overall rate of vaccine hesitancy was 23.5%. Vaccine hesitancy was more prevalent in those with low/moderate HL (33.3%) vs those with high HL (22.7%). The association between HL and vaccine hesitancy, however, was not significant. Personal perception of COVID-19 threat was significantly associated with lower odds of vaccine hesitancy compared with those without perception of threat (adjusted odds ratio, 0.15; 95% CI, 0.03-0.73; P = .0189). The association between race/ethnicity and vaccine hesitancy was not statistically significant (P = .1571). CONCLUSIONS: HL was not a significant indicator of vaccine hesitancy in the study population, suggesting that general low rates of vaccination in the Southern region may not be due to knowledge about COVID-19. This indicates a critical need for place-based or contextual research on why vaccine hesitancy in the region transcends most sociodemographic differences.

Examining Disparities in Current E-Cigarette Use among U.S. Adults before and after the WHO Declaration of the COVID-19 Pandemic in March 2020.

This paper aims to estimate the prevalence of e-cigarette use before and after the COVID-19 pandemic declaration and to delineate disparities in use across subpopulations. Data were derived from the 2020 Health Information National Trends Survey (N = 3865) to conduct weighted multivariable logistic regression and marginal analyses. The overall prevalence of current e-cigarette use increased from 4.79% to 8.63% after the COVID-19 pandemic declaration. Furthermore, non-Hispanic Black people and Hispanic people had lower odds of current e-cigarette use than non-Hispanic White people, but no significant differences were observed between groups before the pandemic. Compared to heterosexual participants, sexual minority (SM) participants had higher odds of current e-cigarette use after the declaration, with insignificant differences before. People who had cardiovascular disease conditions, relative to those without, had higher odds of current e-cigarette use after the declaration, but no group differences were found before the declaration. The marginal analyses showed that before and after the pandemic declaration, SM individuals had a significantly higher probability of using e-cigarettes compared to heterosexual individuals. These findings suggest the importance of adopting a subpopulation approach to understand and develop initiatives to address substance use, such as e-cigarettes, during pandemics and other public health emergencies.

Setting Patient-Centered Priorities for Cardiovascular Disease in Central Appalachia: Engaging Stakeholder Experts to Develop a Research Agenda.

The disproportionate burden of cardiovascular diseases (CVD) and associated risk factors continues to exist in the Central Appalachian Region (CAR) of the United States. Previous studies to gather data about patient-centered care for CVD in the region were conducted through focus group discussions. There have not been any studies that used a collaborative framework where patients, providers, and community stakeholders were engaged as panelists. The objective of this study was to identify patient-centered research priorities for CVD in the CAR. We used a modified Delphi approach to administer questionnaires to forty-two stakeholder experts in six states representing the CAR between the fall of 2018 and the summer of 2019. Their responses were analyzed for rankings and derived priorities by research gaps. Six of the fifteen research priorities identified were patient-centered. These patient-centered priorities included shorter wait times for appointments; educating patients at their level; empowering patients to take responsibility for their health; access to quality providers; heart disease specialists for rural areas; and lifestyle changes. The participants' commitments to identify patient-centered research priorities indicate the potential to engage in community-based collaboration to address the burden of CVD in the CAR.

Correction: Perceptions of risk for COVID-19 among individuals with chronic diseases and stakeholders in Central Appalachia.

[This corrects the article DOI: 10.1057/s41599-021-00906-7.].

Nursing research and participant recruitment: organizational challenges and strategies.

Hospitals as research environments are crucial in advancing evidence-based practice and translational research. The authors discuss issues related to hospital-based nursing research such as institutional review board approval, the HIPAA, structure, unit characteristics, and nurse staffing as well as research-related issues such as study purpose and design, participant recruitment, and research personnel. Strategies and suggestions for nurse executives to assist researchers in overcoming recruitment challenges are presented.

Exploring Associations between Susceptibility to the Use of Electronic Nicotine Delivery Systems and E-Cigarette Use among School-Going Adolescents in Rural Appalachia.

Electronic nicotine delivery systems (ENDS) use, including e-cigarettes, has surpassed the use of conventional tobacco products. Emerging research suggests that susceptibility to e-cigarette use is associated with actual use among adolescents. However, few studies exist involving adolescents in high-risk, rural, socioeconomically distressed environments. This study examines susceptibility to and subsequent usage in school-going adolescents in a rural distressed county in Appalachian Tennessee using data from an online survey (N = 399). Relying on bivariate analyses and logistic regression, this study finds that while 30.6% of adolescents are ever e-cigarette users, 15.5% are current users. Approximately one in three adolescents are susceptible to e-cigarettes use, and susceptibility is associated with lower odds of being a current e-cigarette user (OR = 0.03; CI: 0.01-0.12; p < 0.00). The age of tobacco use initiation was significantly associated with decreased current use of e-cigarettes (OR = 0.89; CI: 0.83-0.0.97; p < 0.01). Overall, the results of this exploratory study suggest the need for larger studies to identify unique and generalizable factors that predispose adolescents in this high-risk rural, socioeconomically disadvantaged region to ENDS use. Nevertheless, this study offers insight into e-cigarette usage among U.S adolescents in rural, socioeconomically disadvantaged environments and provides a foundation for a closer examination of this vulnerable population.

Community resources for older adults with chronic illness.

Elders with chronic diseases frequently have problems with activities of daily living and instrumental activities of daily living. This article describes a holistic, elder-friendly community model. The review of the nursing, healthcare, and social science literature offers insight into the complexity of community resources for elders.

Rural Community Case Management Experience for Bachelor of Science in Nursing Students: A Focus Group Evaluation.

BACKGROUND: This presentation concerns the evaluation of an additional clinical experience in case management for senior baccalaureate students. During their final leadership course, nursing students can elect to do an additional 80-hour precepted clinical experience focusing on case management in primary care clinics. As part of that experience, they rotate through seven nurse-managed rural primary health clinics in Tennessee. METHOD: As part of the evaluation process, students and preceptors were asked to review the experiences that students had participating in the clinical. RESULTS: For the most part, students were highly satisfied with the case management experience and thought it provided an additional skill set for them as they were completing their final year in nursing school and preparing to enter the nursing workforce as graduates of the Bachelor of Science in Nursing program. CONCLUSION: A community case management clinical opportunity in primary care allows a community experience for students that provides them with an opportunity to witness an RN practicing to the full scope of the license. [J Nurs Educ. 2018;57(9):557-560.].

A Model of Health for Family Caregivers of Elders.

Family members who provide care to their loved ones experience changes in their own health. The caregiver health model (CGHM) is a new model that identifies health holistically and identifies four determinant(s) that contribute to the health status of the family caregiver. The purpose is to introduce the CGHM: Hypothesis 1: the determinants of health in the CGHM contribute to the health of the Caregiver, Hypothesis 2: the determinants of health contribute to changes in the caregivers' health at 8 and 16 weeks, and Hypothesis 3: a change in health occurs from baseline to 8 and 16 weeks. METHODS: A descriptive, longitudinal design used three data collection points and five survey instruments. Community recruitment (N = 90) occurred through word of mouth and newspapers. Inclusion criteria consisted of being a family caregiver, living in a rural residence, and providing care to elders with necessary activities of daily living (ADLs) and/or instrumental ADLs (IADLs). Following a participant generated phone call to provide consent, caregivers received an initial study packet, additional packets were sent upon return of the previous packet. Analysis for the three hypotheses included multiple backwards stepwise linear regression, generalized estimating equations (GEE), and analysis of variance (ANOVA) α = 0.05. RESULTS: A significant decrease in mental (p < 0.01) but not physical health at 8 weeks (p = 0.38) and 16 weeks (p = 0.29) occurred over time. Two determinants displayed significant (p < 0.05 or less) changes in mental and/or physical health at one or more time points. Study limitations include caregiver entry at varying times and self-report of elder nursing needs and medical conditions. CONCLUSIONS: Findings support two of the four determinants contributing to caregiver health.

Family and friends to the rescue: experiences of rural older adults with heart failure.

The purpose of this study was to describe the experiences of rural community-dwelling older adults with heart failure who required assistance with activities of daily living (ADLs) and instrumental ADLs (IADLs). The context of the study was a rural area in a southern U.S. state. Twenty older adults with ADL/IADL needs living in the rural area were recruited during hospitalization and interviewed in their homes after discharge. The semi-structured interview focused on ADLs/IADLs and community resources. This qualitative descriptive study used hermeneutic methods for analysis. Four themes were identified: Accepting Limitations, Disappointments and Unmet Expectations, Figure It Out, and Complex Connections. The findings indicate that despite the older adults' medical conditions, they were able to set up complex arrangements, which allowed them to remain in their homes. Understanding the help older adults require after discharge will assist nurses in developing programs that are available, accessible, and acceptable to older adults who live in rural areas.

Public health nursing competencies 1953-1966: effective and efficient.

The Quad Council of Public Health Nursing Organizations developed public health nursing competencies in 2003. They are guides for determining skills at two levels, and they identify public health nurses as providing care to individuals and families or to populations and systems with the nurse having proficiency, awareness, or knowledge. The primary purpose of this paper is to discuss historical nursing roles and qualifications as judged by the 2003 competencies, including educational preparation and experience for the administrative and staff nurse. The historical exemplar for the nursing roles is a combination public/private nursing association, referred to as the partnership, that took place in 1953-1966. Primary sources include archived material from the Instructive Visiting Nurse Association, Richmond, VA. Administrative responsibilities were divided between the chief nurse and the nursing supervisors. Staff nurse responsibilities included clinic activities, home visitation, and referral coordination between health care organizations. The delineation of nursing roles demonstrates nurses' meeting the 2003 competencies. Based on the Quad Council's 2003 public health nursing competencies, the partnership nurses were competent.

Talking about talk: the experiences of boys who survived intraparental homicide.

This article describes the experiences of men who experienced intraparental homicide (one parent killing the other parent) when they were boys. Twenty-one men were interviewed twice and data were analyzed using a hermeneutic approach. In this article we examine a topic that emerged as a core problem for these men, specifically, how they talked (or did not talk) about the homicide. Understanding intraparental homicide may provide information to guardians and professionals about what some male children need after such an event.