The Effects of Social Support on Athlete Burnout and Well-Being in Female Collegiate Athletes.

CONTEXT: Psychological concerns, such as athlete burnout and diminished well-being, have become a more recognized problem among collegiate student-athletes due to substantial demands. The purpose of this study was to determine if (1) an association exists between athlete burnout and well-being in female collegiate student-athletes and (2) social support has a main or buffering-effect on well-being and athlete burnout. DESIGN: Cross-sectional. METHODS: 174 National Collegiate Athletic Association Division I female collegiate student-athletes were recruited from a single institution to participate. A web-based survey was distributed via Qualtrics during the middle of an academic semester. The following scales were utilized to evaluate social support, athlete burnout, and well-being: Perceived Available Support in Sport Questionnaire, Athlete Burnout Questionnaire, and Warwick Edinburgh Metal Well-Being Scale. RESULTS: Correlation analyses presented a significant negative, moderate correlation (r = -.58, P < .001) between athlete burnout and well-being as well as between social support and athlete burnout (r = -.526, P < .001). A moderate, positive correlation was identified between social support and well-being (r = .604, P < .001). Social support was a significant predictor for reduced sense of accomplishment (F1,172 = 68.32, P < .001), physical and emotional exhaustion (F1,172 = 22.00, P < .001), sport devaluation (F1,172 = 56.51, P < .001), and well-being (F1,172 = 115.3, P < .001). CONCLUSION: Findings provide new information on theory-based considerations for reducing athlete burnout and improving well-being in female collegiate student-athletes.

Examining the Relationship between Religious Coping and the Misuse of Prescription Stimulants among a Sample of Undergraduate Students.

BACKGROUND: There is a well-established inverse relationship in undergraduate samples between a person's religious coping and substance abuse. Positive religious coping (PRC) has been associated with decreases in the use of alcohol, tobacco, and marijuana. Investigations examining prescription drug misuse and PRC found that higher levels of PRC were related to a reduction in the misuse of some prescription drugs. However, the literature has yet to identify an inverse relationship between PRC and the misuse of prescription stimulants (MPS) among undergraduates. OBJECTIVE: Examine the association between religious coping and past-year MPS in a sample of undergraduate students. METHODS: Undergraduates were recruited to complete an anonymous online survey from three universities (1 private, 2 public) in the United States. RESULTS: The sample consisted of 908 undergraduates between the ages of 18 and 25. Statistical analyses revealed that higher levels of PRC were associated with a reduction in past-year MPS. A separate model found that attending religious events also decreased the behavior. Conversely older students, males, Greek organization affiliation, a lower GPA and having a current stimulant prescription all increased the odds of reporting past-year MPS. Negative religious coping and a student's race were not significantly associated with MPS. CONCLUSIONS: Findings indicate that PRC skills have the potential to reduce MPS in college students. Therefore, it is possible that the development of similar secular skills could have the same effect. Future studies should explore the role that positive coping skills having on the reduction of MPS among undergraduates regardless of religious conviction.

Exploring Symptom Management Experiences Among College Students With Type 1 Diabetes Mellitus Using a Theoretical Framework: A Qualitative Study.

PURPOSE: The purpose of this study was to explore symptom management experiences among college students with type 1 diabetes mellitus (T1DM). Limited qualitative data using a theoretical framework exist that explore the self-care behavior processes for symptom management. METHODS: A qualitative approach was used for this study. The middle-range theory of self care of chronic illness served as a framework for data collection and analysis procedures. Data collection included distributing a survey to collect participants' demographic and sociodemographic data and utilizing a semi-structured interview guide to conduct one-on-one interviews with 31 participants. Interviews occurred via Zoom (n = 28) and in person (n = 3). Interview transcripts were uploaded in NVivo for data management. The research team created a codebook using theoretical constructs to assist with thematic analysis. Data are representative of a sample whose characteristics include undergraduate students ages 18 to 23 living with T1DM for 2 years or more who attended large, public, 4-year universities located in the southeastern United States. RESULTS: Three main themes were created using theoretical constructs: symptom detection experiences, symptom interpretation experiences, and symptom response experiences. Two subthemes were identified for each theme. Participants engaged in symptom management for blood glucose regulation through detecting changes in their blood glucose physiologically and via technology. Additionally, symptom interpretation involved analyzing blood glucose trends and determining common causes of blood glucose changes. Symptom response included immediately addressing hypoglycemia but delayed responses addressing hyperglycemia. CONCLUSIONS: Challenges were present responding to hypoglycemia; therefore, additional research is warranted to improve symptom response skills.

Barriers and Facilitators Impacting Disease and Symptom Management Among College Students With Type 1 Diabetes: A Qualitative Study.

PURPOSE: This study aimed to explore barriers and facilitators impacting disease and symptom management among college students living with Type 1 Diabetes (T1D). DESIGN: A qualitative, phenomenological approach using semi-structured, one-on-one interviews. SETTING: Interviews conducted on Zoom (n = 28) and in-person (n = 3). PARTICIPANTS: Purposive sample of 31 college students living with T1D for at least 2 years who attended large, 4-year public universities in the Southeastern United States. METHOD: This study was theoretically informed using the Middle-Range Theory of Self-Care of Chronic Illness Integration of Symptoms to develop interview questions. Interviews were transcribed verbatim and uploaded in NVivo. Data were analyzed thematically using a codebook developed by the research team using the theory as a framework. Trustworthiness was established using an audit trail, memos, and negative case analysis. RESULTS: Four themes described barriers: diabetes burnout, challenges adjusting to a college lifestyle, difficulty receiving medical supplies, and insurance limitations. Five themes explained facilitators: years of experience managing T1D, tangible support with medical supplies, informational support for disease management, and emotional/technological support for disease and symptom management. CONCLUSION: Barriers and facilitators in this study should be addressed in future T1D interventions for college students. Findings can also guide healthcare professionals, health promotion practitioners, family, friends, and significant others on how to better support college students as they manage T1D.

Veterinary students' perceptions toward incorporating and expanding telehealth service delivery knowledge in curricula and future practice: a cross-sectional study.

OBJECTIVE: Telehealth is the use of technology to deliver medical services. Potential uses among veterinarians include consulting with specialists about complicated cases, sending in electronic prescriptions, or meeting with clients to discuss patient health. Although the coronavirus disease 2019 pandemic posed many challenges to the veterinary profession, it accelerated the adoption of telehealth among veterinarians. As many of these changes took place quickly in response to the pandemic, many of those in practice did not receive much training or guidance; therefore, this study explores veterinary students' perceptions regarding incorporating telehealth into the veterinary curriculum and the utilization of telehealth in the future. METHODS: An email survey was sent to students at a veterinary school. RESULTS: 80 students provided answers to the 11-question survey. Nearly 80% reported that it is either "important" or "very important" to incorporate telehealth training into the veterinarian curriculum, whereas almost 90% indicated that they would benefit from more telemedicine training prior to graduation. Almost 75% of participants had legal and malpractice concerns, which may present a barrier to using the technology upon graduation. CONCLUSIONS: This study suggests that veterinary schools should explore how to incorporate telehealth training into their curriculum, especially in regard to navigating the potential pitfalls that may be encountered when employing telehealth within the context of a veterinarian-client-patient relationship. CLINICAL RELEVANCE: Telehealth is a valuable tool, and its use has become commonplace. Educational programs that emphasize telehealth will better equip future clinicians to manage the nuances of this modality in practice.

Pre-Exposure Prophylaxis Care Cascade Among Men Who Have Sex with Men Engaging in Partner Notification Services at a Sexually Transmitted Infections Clinic.

Partner notification services (PNS) offers opportunities to discuss HIV pre-exposure prophylaxis (PrEP) and provide referrals. We evaluated the PrEP care cascade among men who have sex with men (MSM) engaging in PNS within a sexually transmitted infections clinic. Among 121 MSM eligible for PrEP during PNS, 21% subsequently initiated PrEP.

Feasibility of Using Mobile Standing Desks to Address Sedentary Behavior in Flexible Work Environments: A Mixed Methods Study.

OBJECTIVE: The purpose of this study was to determine the feasibility of using mobile standing desks to address work-related sedentary behavior for adults working in flexible positions. METHODS: University employees ( N = 20) in flexible positions used a mobile standing desk for 8 weeks and completed one focus group. Paired t tests were used to determine differences in workplace behavior. Focus group transcripts were analyzed using thematic analysis. RESULTS: Work-related sitting decreased ( P = 0.010, -45.88 minutes) and standing increased ( P = 0.016, +41.28 minutes). Advantages included mobility, enhanced attention to tasks, and ease of use. Disadvantages included the device's design, built environment barriers, and impact of work/life circumstances. CONCLUSIONS: The mobile standing desk resulted in a decrease in sitting consistent with traditional standing desk-based interventions. Future interventions should consider including goal setting, reminders, feedback, and incentives.

A Social Cognitive Assessment of Workplace Sedentary Behavior among a Sample of University Employees.

Sedentary behavior (SB) is an important public health concern. Adults working in desk-based occupations spend a considerable proportion of the workday sitting. More information is needed regarding the factors that contribute to occupational SB. The aim of this study was to assess the utility of social cognitive theory (SCT) to explain work-related SB using a quantitative, cross-sectional design by administering an online questionnaire. Participants included 381 full-time employees at a large, public university in the south-central United States. Hierarchical multiple linear regression was used to determine the relationship between SCT constructs and SB. Mean work-related SB was 5.95 (SD = 1.30) h/8 h workday. In model 1, 9.6% of the total variance in SB was accounted for by standing desk ownership and physical activity level (p = 0.001; R2 = 0.096). In model 2, SCT constructs led to a statistically significant R2 increase of 4.9% (p < 0.001), where standing desk ownership, physical activity, and self-efficacy explained 13.3% of the variance in work-related SB. Findings from this study suggest that self-efficacy may be an important factor in explaining variation in occupational SB. Public health researchers and practitioners should consider strategies to address self-efficacy when developing workplace interventions to target occupational SB.

Use of the multi-theory model (MTM) in explaining initiation and sustenance of indoor tanning cessation among college students.

Skin cancer, including melanoma, is the most common cancer worldwide and a significant public health concern. A significant risk factor for melanoma is through increased exposure to ultraviolet (UV) radiation through the use of indoor tanning beds. Although rates of indoor tanning bed use have decreased in recent years, young adults, particularly White, college-age women, comprise the majority of indoor tanning bed users in the United States. The purpose of this cross-sectional study was to explore and explain the initiation and sustenance of indoor tanning cessation among college students using the multi-theory model (MTM) of health behavior change. Data were collected from 254 college students who reported current indoor tanning use using a validated 46-item survey to assess demographics and the MTM constructs. Data were analyzed using multiple linear regression to determine the ability of the MTM constructs to predict the initiation and sustenance of indoor tanning cessation. For initiation of indoor tanning cessation, participatory dialogue: advantages (B = 0.038, p = 0.001), behavioral confidence (B = 0.129, p < 0.001) and changes in the physical environment (B = 0.088, p < 0.001) were significantly associated with indoor tanning cessation following covariate adjustment. For sustenance, only emotional transformation (B = 0.140, p < 0.001) demonstrated a significant relationship with indoor tanning cessation, following adjustment. Findings from this study demonstrate the utility of the MTM in explaining indoor tanning cessation and designing intervention strategies and clinical recommendations to encourage indoor tanning cessation among college students.

Predisposing, enabling and reinforcing factors associated with opioid addiction helping behaviour in tri-state Appalachian counties: application of the PRECEDE-PROCEED model-cross-sectional analysis.

OBJECTIVES: The overdose epidemic was designated a 'Public Health Emergency' in the USA on 26 October 2017, bringing attention to the severity of this public health problem. The Appalachian region remains substantially impacted by the effects from years of overprescription of opioids, and subsequently opioid non-medical use and addiction. This study aims to examine the utility of the PRECEDE-PROCEED model constructs (ie, predisposing, reinforcing and enabling factors) to explain opioid addiction helping behaviour (ie, helping someone who has an opioid addiction) among members of the public living in tri-state Appalachian counties. DESIGN: Cross-sectional study. SETTING: Rural county in the Appalachian region of the USA. PARTICIPANTS: A total of 213 participants from a retail mall in a rural Appalachian Kentucky county completed the survey. Most participants were between the ages of 18 and 30 years (n=68; 31.9%) and identified as men (n=139; 65.3%). PRIMARY OUTCOME MEASURE: Opioid addiction helping behaviour. RESULTS: The regression model was significant (F (6, 180)=26.191, p<0.001) and explained 44.8% of the variance in opioid addiction helping behaviour (R2=0.448). Attitude towards helping someone with opioid addiction (B=0.335; p<0.001), behavioural skills (B=0.208; p=0.003), reinforcing factors (B=0.190; p=0.015) and enabling factors (B=0.195; p=0.009) were all significantly associated with opioid addiction helping behaviour. CONCLUSIONS: PRECEDE-PROCEED model constructs have utility to explain opioid addiction helping behaviour among individuals in a region greatly impacted by the overdose epidemic. This study provides an empirically tested framework for future programmes addressing helping behaviour related to opioid non-medical use.

Grit, Athlete Burnout, and Well-Being in Female Collegiate Student-Athletes.

CONTEXT: Collegiate student-athletes are faced with significant athletic and academic demands, causing a substantial amount of stress, which can lead to athlete burnout. Problematically, little research has been done to find ways to prevent or mitigate the effect of athlete burnout in collegiate student-athletes. Grit is one characteristic that they could use as a coping mechanism to reduce the effects of burnout and to improve overall well-being. OBJECTIVE: To determine if grit had a main or buffering effect on well-being and athlete burnout in female collegiate student-athletes. DESIGN: Cross-sectional study. SETTING: National Collegiate Athletics Association Division I institution. PATIENTS OR OTHER PARTICIPANTS: A total of 174 female collegiate student-athletes. MAIN OUTCOME MEASURE(S): The Grit Scale, Athlete Burnout Questionnaire, and Warwick Edinburgh Mental Well-Being Scale were used to assess grit, athlete burnout, and well-being. RESULTS: Grit was a significant negative predictor for physical and emotional exhaustion (F1,172 = 28.25, P < .001), a reduced sense of accomplishment (F1,172 = 20.40, P < .001), and sport devaluation (F1,172 = 40.32, P < .001). Additionally, grit was a significant positive predictor of well-being (F1,172 = 29.68, P < .001). The moderated regression with grit did not reveal significant results. CONCLUSIONS: We provide new information on considerations for reducing athlete burnout and improving well-being in female collegiate student-athletes. Athletic trainers and sports medicine stakeholders should consider intervention strategies for improving grit to mitigate athlete burnout and diminished well-being while continuing to explore their effectiveness.

A multi-theory model based analysis of correlates for initiating and sustaining mammography screening behavior among Hispanic American women in the United States.

Background: Despite the known advantages of mammography, screening rates among Hispanic American women are lower compared to other ethnic groups. Therefore, this cross-sectional study aimed to explore correlates of mammography screening behavior among a sample of Hispanic women aged 45-54 years living in the United States using the multi-theory model (MTM). Methods: A 50-item web-based survey consisting of psychometrically valid tools based on MTM theoretical framework was administered through non-random sampling procedures using Qualtrics. Univariate, bivariate, and multivariate statistics were used to analyze the data. Results: Out of 370 participants, nearly 49% (n=189) reported not having a mammogram in the past two years. The mean age of the sample was 48.8±2.8 years. A greater proportion of participants who have had a mammogram reported having health insurance compared to those who have not had a mammogram (93.1% vs. 75.7%, P <0.001). Results of hierarchical regression suggest that all MTM constructs, including participatory dialogue, behavioral confidence, and changes in the physical environment explained 33.4% of variance in initiating mammography behavior among those who have not had a mammogram. Similarly, practice for change, emotional transformation, and changes in the social environment explained 53% of the variance in sustenance of the behavior change. Conclusion: Along with the MTM subscales, this study points to the important correlates such as health insurance and messaging by healthcare providers to promote the mammography seeking behavior among Hispanic women.

The relationship between trait emotional intelligence and problematic alcohol use among college students.

Background: Problematic alcohol use among college students is a significant public health concern. Emotional intelligence (EI), or the ability to detect one's own and others' emotions and to use this information to direct behavior, is suggested to mitigate problematic alcohol use. The purpose of this study was to examine the relationship between EI and problematic alcohol use among college students while controlling for drug use covariates. Methods: This cross-sectional study utilized an online survey comprised of previously validated measures to determine EI, problematic alcohol use, and drug use among college students from a large, public university in the south-central United States. Regression modeling and independent samples t-test were used to determine the relationship between EI and problematic alcohol use. Results: Problematic alcohol consumption was reported among 27.3% of participants (n=587). In regression modeling, EI demonstrated a significant, protective effect on problematic alcohol use (b =-0.050, P <0.001, 95% CI: -0.076 - -0.023), when adjusting for important covariates. Independent samples t-test showed that students who screened positive for harmful alcohol use reported significantly lower EI values than those who did not (Mean difference=4.53, t =2.98, P =0.003, 95% CI: 1.54-7.51). Conclusion: The findings from this study show that problematic alcohol use is prevalent among college students and EI may provide a protective effect against this deleterious behavior. Given the findings observed in this study, university officials should incorporate EI training into the university curriculum, such as in onboarding courses for freshman and transfer students, to target prevention of potentially harmful alcohol consumption and associated negative health impacts.

Systematic review of electronically delivered behavioral obesity prevention interventions targeting men.

Globally, obesity persists at epidemic rates. Men are underrepresented within behavior-based obesity prevention research. As men prefer individualized, self-guided interventions, electronic delivery of treatment modalities has potential to reach this population. The purpose of this study was to systematically review primary, secondary, or tertiary behavioral obesity prevention interventions that used controlled designs; targeted men; and incorporated at least one electronically delivered treatment modality explicitly designed to elicit an intervention effect. Literature searches were delimited to peer-reviewed articles; published between 2000 and 2021; in the English language; and indexed in PsycINFO, CINHAL, MEDLINE, CENTRAL, and WOS electronic databases. Interventions satisfying inclusion criteria were critiqued for methodological quality using the Jadad Scale (0 = lowest quality; 10 = highest quality). Eleven studies satisfied the inclusion criteria (n = 1748; total participants) with five reporting group-by-time intervention effects on the primary variable targeted. Jadad scale quality assessment scores ranged from 5.00 to 9.00 with a mean of 7.72. Majority of the interventions applied a randomized control trial design (n = 10). Most interventions were theory based, with eight rooted in social cognitive theory. Behavior change strategies included self-monitoring (n = 10), personalized feedback (n = 8), health counseling (n = 8), and goal setting (n = 9). Community-level theories have the potential to guide future obesity prevention interventions targeting men.

Factors Associated with Likelihood to Undergo Cosmetic Surgical Procedures Among Young Adults in the United States: A Narrative Review.

Introduction/Goals: Over the past decade, cosmetic surgical procedures have become increasingly popular. This trend has been driven by procedural innovations as well as access to Internet and social media. Consequently, patients have been seeking cosmetic surgical procedures at younger ages. In this narrative review, studies assessing attitudes towards cosmetic surgical procedures among college-aged young adults were evaluated. Methods: A search identified 20 studies published from 2002 to 2021 that focused on cosmetic surgical procedures among young adults. Each study used survey-based data to determine attitudes, acceptance, interests, perceptions, and beliefs about cosmetic surgical procedures among college-aged students in the United States. Results: The proportion of college-aged participants who had undergone cosmetic surgical procedures ranged from 1.3% to 6.4% with surveys reporting that between 21 and 43% were interested in procedures in the future. In general, young women were more likely to express interest in cosmetic surgical procedures than young men. Studies consistently demonstrated an inverse relationship between body satisfaction and use of aesthetic procedures among this patient population. Other factors associated with acceptance and approval of cosmetic surgical procedures included importance of appearance to self-worth, concern with social standing and attractiveness, investment in appearance, media influence on body image, and positive attitudes towards celebrities. Exposure to cosmetic surgery advertising was correlated with increased approval of cosmetic surgical procedures, especially the perception that advertising influences "others" more than survey respondents themselves. Conclusion: Interest in cosmetic surgical procedures continues to grow among young adults in the United States. In the future, this cohort is likely to become an increasingly important demographic to target for education, advertising, and research regarding cosmetic surgical procedures.

COVID-19 Vaccine Acceptance among College Students: A Theory-Based Analysis.

The severity and pervasiveness of the COVID-19 pandemic have necessitated the emergency use of COVID-19 vaccines. Three vaccines have been approved in the United States (USA). However, there is still some hesitancy in COVID-19 vaccine acceptability among some subgroups, including college students. While research is limited on vaccine acceptability behavior among college students, preliminary data suggests hesitancy as being high. This study aimed to explain the correlates of COVID-19 vaccine acceptance among college students who reported hesitancy toward the COVID-19 vaccine and those who did not using the initiation component of the multi-theory model (MTM) of health behavior change. Using a cross-sectional study design, data were collected from a Southern USA University (n = 282) utilizing a valid and reliable 27-item questionnaire in February and March 2021. Almost half (47.5%) of participants reported hesitancy to receive the COVID-19 vaccine. The three constructs of MTM's initiation model, behavioral confidence (b = 0.089, p < 0.001), participatory dialogue (b = 0.056, p < 0.001), and changes in the physical environment (b = 0.066, p = 0.001) were significantly associated with COVID-19 vaccine acceptance among those who were not hesitant to take the vaccine and accounted for 54.8% of the variance. Among those who were hesitant to take the COVID-19 vaccine, the MTM construct of behavioral confidence (b = 0.022, p < 0.001) was significant along with Republican Party political affiliation (b = -0.464, p = 0.004), which was negatively associated with vaccine acceptance. The model accounted for 60.6% of the variance in intention to take the COVID-19 vaccine. This study provides evidence for the utility of MTM as a timely intervention to design messages for college students to enhance COVID-19 vaccine acceptability.

"It Feels Unhealthy to be Sitting for 40 hours a Week": A Qualitative Analysis of Employee Perceptions of Standing Desk Use in the Workplace.

OBJECTIVE: Reducing sedentary behavior (SB) is an important public health concern. The purpose of this study was to explore motivation to acquire a standing desk and strategies for using a standing desk through one-on-one interviews. METHODS: Thirty-seven university employees (89% staff; 51% women) participated in the study. Data were collected using a semi-structured interview guide and brief demographic questionnaire. RESULTS: Data analysis yielded five themes about motivation to acquire a standing desk: (1) pain management; (2) health risk; (3) movement opportunity; (4) workspace flexibility; and (5) productivity and three themes about typical use strategy: (1) task-dependent; (2) time-dependent; and (3) threshold. CONCLUSIONS: Motivating factors for using a standing desk should be considered when encouraging standing desk use. Interventions should provide realistic strategies to establish a sit-stand routine that address employees' unique job demands and preferences.

Explaining Handwashing Behavior in a Sample of College Students during COVID-19 Pandemic Using the Multi-Theory Model (MTM) of Health Behavior Change: A Single Institutional Cross-Sectional Survey.

Amidst the COVID-19 pandemic, handwashing offers a simple and effective hygienic measure for disease prevention. Reportedly, a significant proportion of college students did not follow handwashing recommendations provided by the Centers for Disease Control and Prevention (CDC) in the pre-COVID era. The purpose of this cross-sectional study was to explore and explain the handwashing behavior among college students during the COVID-19 pandemic using a contemporary fourth-generation multi-theory model (MTM) of health behavior change. Data were collected from 713 college students at a large public university in the Southern U.S. in October 2020 using a validated 36-item survey. Statistical analyses included independent samples t-tests, Pearson correlation, and hierarchical regression modeling. Among students not following handwashing recommendations, the constructs of participatory dialogue (ß = 0.152; p < 0.05) and behavioral confidence (ß = 0.474; p < 0.0001) were statistically significant and accounted for 27.2% of the variance in the likelihood of initiation of the behavior. Additionally, the constructs of emotional transformation (ß = 0.330; p < 0.0001), practice for change (ß = 0.296; p < 0.0001), and changes in the social environment (ß = 0.180; p < 0.05) were statistically significant and accounted for 45.1% of the variance in the likelihood of sustaining handwashing behavior. This study highlights the applicability and usability of the MTM in designing and testing behavior change interventions and media messaging in campaigns targeting college students.

Conceptualization of college students' COVID-19 related mask-wearing behaviors using the Multi-Theory Model of health behavior change.

Background: Recommendations and policies, regarding the use of face coverings, have been instituted to control transmission of coronavirus disease 2019 (COVID-19). Understanding of psychosocial factors related to the use of face coverings within the context of COVID-19 is needed. This study aimed to conceptualize mask-wearing behavior among students using the Multi-theory Model (MTM) of behavior change. Methods: In October 2020, students (n = 595) enrolled in a large public southeastern US university were recruited to participate in a cross-sectional survey, using a valid and reliable instrument. Univariate, bivariate, and multivariate techniques described mask-wearing behavior and differentiated theoretical drivers of mask-wearing between individuals compliant and non-compliant with guidelines. Results: Compliant individuals reported significantly higher scores (P <0.05) for initiation and sustenance of mask-wearing, participatory dialogue, behavioral confidence, emotional transformation, practice for change, changes in the social environment, and significantly lower scores for disadvantage. Among multivariable models, all theoretical predictors exhibited significant relationships to their respective outcomes (initiation and sustenance). Specifically, MTM constructs explained approximately 35% of variance in initiation (R2 = 0.346, F(3,526) = 94.32, P <0.001) and 33% of variance in sustenance of mask wearing (R2 = 0.328, F(3,529) = 87.71, P <0.001) for compliant individuals. Behavioral confidence and emotional transformation exhibited the strongest relationships to initiation (ß = 0.403, P <0.001) and sustenance (ß = 0.450, P <0.001), respectively. Conclusion: Findings suggest a need to design educational programming based on the MTM to promote mask-wearing behavior among laggards who defy face mask guidelines, recommendations, and mandates.

Skin cancer knowledge, attitudes, and practices among non-medical skin care professionals: A narrative review of cross-sectional and interventional studies.

BACKGROUND: Skin cancers are the most common malignancies in the United States. Total body skin examination by a physician, especially a dermatologist, is the gold standard for detecting suspicious lesions that may require further evaluation. Non-medical professionals (NMPs) including massage therapists, estheticians, hairdressers, and cosmetologists have the unique opportunity to frequently examine their client's skin outside of a clinical setting. By evaluating their knowledge of and comfort with evaluation of suspicious lesions, multiple studies have gauged the utility of patient encounters with NMPs for skin cancer detection. Several studies have also focused on assessment of intervention strategies for assessing and improving NMPs ability to detect suspicious lesions and to refer for physician evaluation when necessary. AIMS: To conduct a narrative review of skin cancer knowledge, attitudes, and practices among NMPs. PATIENTS/METHODS: A systematic search of the databases yielded 16 studies for review. A total of 8 cross-sectional studies examined the knowledge and attitudes of NMPs toward skin evaluation, and 8 studies assessed interventional strategies for improving NMPs' ability to assess skin lesions for consideration of physician referral. RESULTS: This review finds that NMPs are open to the idea of examining the exposed body surfaces relevant to their work with clients and are willing to refer for physician evaluation when needed. Multiple interventional strategies have demonstrated success with educating NMPs on the importance of skin surveillance and the characteristic physical examination findings associated with skin cancers. CONCLUSION: Strengthening the readiness of NMPs to examine their client's skin offers an opportunity to reduce time to skin cancer diagnosis, improve patient outcomes, and lower healthcare-associated costs of skin cancer treatment.