Association Between Lifetime Interpersonal Violence and Post-COVID-19 Condition Among Women in Kentucky, 2020-2022.

OBJECTIVE: The COVID-19 pandemic increased the risk of interpersonal violence. We investigated the association between lifetime interpersonal violence experience and risk of post-COVID-19 condition (the persistence of symptoms of COVID-19 and severity of health problems associated with COVID-19 that last a few weeks, months, or years) among women with lifetime interpersonal violence experience. METHODS: Women participants aged ≥18 years in Kentucky's Wellness, Health & You-COVID-19 study completed online quantitative surveys about the impacts of the pandemic, developing COVID-19, and symptoms of post-COVID-19 condition. We conducted cross-sectional analyses estimating rate ratios of developing COVID-19 and symptoms of post-COVID-19 condition during the pandemic (October 13, 2020-February 28, 2022). RESULTS: Of the analytic sample (N = 938), 342 (36.5%) disclosed a history of lifetime interpersonal violence. Compared with women with no lifetime interpersonal violence experience, women with lifetime interpersonal violence experience had significantly more distress because of the pandemic, defined as family financial challenges (P = .001), symptoms of mental health challenges (P < .001), and negative coping behaviors (P < .001). While experiencing lifetime interpersonal violence was not significantly associated with either receiving COVID-19 vaccinations (adjusted rate ratio [aRR] = 1.10; 95% CI, 0.75-1.61) or developing COVID-19 (aRR = 1.15; 95% CI, 0.92-1.44), experiencing lifetime interpersonal violence was associated with an increased rate of developing symptoms of post-COVID-19 condition (aRR = 2.09; 95% CI, 1.19-3.65). CONCLUSION: Symptoms of post-COVID-19 condition may be linked to lifetime interpersonal violence experience, possibly through stress or violence-associated trauma. Future research is needed to assess the negative effects of the pandemic, prioritizing people with lifetime interpersonal violence experience.

Characteristics of K-12 Teachers Considering Leaving Due to COVID-19 and for Other Reasons.

BACKGROUND: The COVID-19 pandemic has had drastic effects on K-12 teachers. Researchers partnered with a teacher advisory board to identify factors associated with K-12 teachers' consideration of leaving teaching during Fall 2020. METHODS: A web-based survey focused on teachers' working experiences was emailed to school union membership listservs in Indiana, Kentucky, and Ohio. A logistic regression model was developed to identify working conditions associated with teachers considering leaving the profession. RESULTS: Among 5873 K-12 teachers, 27% (n = 1319) were considering leaving the profession either because of COVID-19 (10%), for other reasons (6%) or were undecided (11%). Teachers who were midcareer, having taught 6-10 years, who perceived less supervisor support, whose job duties had changed significantly, who were dissatisfied with the COVID-19 related decision-making, who reported poor or fair mental health, and who were mostly or extremely afraid that a household member would get COVID-19 had higher odds of considering leaving teaching or being undecided about future career plans. IMPLICATIONS FOR SCHOOL HEALTH POLICY, PRACTICE AND EQUITY: Understanding factors influencing teachers' career decisions will help school leaders improve teacher retention amid challenging circumstances. CONCLUSION: In this study in 3 midwestern US states, limited supervisor support, significant job duty change, dissatisfaction with COVID-19-related decision-making, poor or fair mental health, and fear that a household member would get COVID-19 were associated with teachers' consideration of leaving the profession or being undecided about future career plans.

Comparison of Implant-Retained Overdenture and Conventional Complete Denture: A Survey Study to Measure Patients' Satisfaction and Quality of Life in Dental School Clinics.

Patient satisfaction and quality of life are integral to assessing oral health care quality. For many Americans still using conventional complete dentures (CD) or Implant Retained-Overdentures (IOD), it remains essential to consider improving their oral health outcomes and quality of life. Due to inexperienced student dentists providing dental care to dental school patients, patient grievances are generally considered a problem. Patient feedback and satisfaction have proven valuable resources for monitoring and improving patient safety. While CD and IOD are the two leading treatment options for edentulism, more comparative studies in the literature need to compare their outcomes in a school setting. The research question that guided this comparative analysis was, "Is patient satisfaction and quality of life affected by the type of prostheses and provider?" A validated questionnaire was mailed to 520 individuals selected from records of patients who had received treatment for edentulous mandible at a student prosthodontic clinic at the [redacted for peer review] from 2014 to 2016 with at least one year of follow-up time. A validated questionnaire for edentulous patients based on the Oral Health Impact Profile (OHIP-19) was used. In addition, information on patients' oral health-related quality of life, including questions related to the edentulous patients' satisfaction with their dentures, was collected. The response rate was 33% (N = 171). The study's findings confirm previous findings, suggesting that IODs may significantly impact oral health-related quality of life. Data show that 76% of the IOD group reported improvement in experience when using the implants to retain the mandibular denture. However, there were no statistically significant differences in the OHIP scores between overall CD and IOD patient groups. Males with IOD had lower physical pain, limitations, and concerns associated with a social disability and handicap domains. Comparing users who had experiences with both treatment options, this study discerned essential characteristics that contribute to increased patient satisfaction with IOD and identified significance in outcomes by gender. These findings guide prosthodontic practitioners' patient care practices and identify a continuing need to discuss CD and IOD treatment protocols within dental school curricula.

Exploring the role of sex in the association of late chronotype on cardiorespiratory fitness.

Circadian rhythms differ between young adult males and females. For example, males tend to be later chronotypes, preferring later timing of sleep and activity, than females. Likewise, there are sex differences in body composition and cardiorespiratory fitness. Few studies have investigated the association between circadian rhythms, cardiorespiratory fitness, and body composition. We sought to determine whether chronotype and circadian phase were associated with cardiorespiratory fitness, body composition, and anthropometric measures in sedentary males and females. Fifty-nine adults participated in the study. Circadian phase and chronotype were measured using dim light melatonin onset (DLMO) and the Morningness-Eveningness Questionnaire (MEQ) score. We used peak oxygen uptake (VO2peak ) results from a maximal graded exercise test to assess cardiorespiratory fitness. Body composition, BMI, and circumferences were collected as markers of adiposity. We observed a sex difference in the association between DLMO and VO2peak . For males, a later DLMO was associated with a lower VO2peak . VO2peak did not vary based on DLMO in females. Later circadian phase was also associated with increased body fat percentage, fat mass index, and abdominal circumference in males, but not females. Collectively, these results suggest that males who are later chronotypes may be at risk of obesity and low cardiorespiratory fitness.

Effectiveness of a Bystander Intervention Program to Increase Bystander Behaviors Across Latent Risk Groups of High Schoolers.

Bystander intervention programs have established efficacy to increase bystander behaviors to prevent interpersonal violence (IPV). Little research has investigated intervention efficacy among latent risk classes among high school students. Data from a five-year randomized control trial were used to conduct multigroup path analyses to assess the association between type of training received and bystander outcomes moderated by risk groups identified via latent profile analysis (LPA). LPA was used to identify risk based on six indicators related to violence exposure, association with aggressive friends, and alcohol use. Bystander training received was the primary independent variable characterized as: no training, overview speech alone, or skills training. Outcomes included (a) observed bystander behaviors; (b) reactive bystander behaviors; or (c) proactive bystander behaviors. Three risk groups were identified via LPA: low risk, moderate risk witnesses of IPV, and highest risk victims and perpetrators. Of the bystander trainings received, overview speeches only increased reactive bystander behaviors among low risk students. The skills training was effective at increasing most bystander outcomes among all risk groups, with the largest effect sizes observed among the highest risk victims and perpetrators profile. Findings suggest that tailoring or modifying bystander training based on the risk profiles of youth may lead to greater potential to increase bystander behaviors to reduce risk of violence. Specifically, overview speech trainings should be targeted to low risk youth, while skills training primarily delivered to higher risk youth. These skills trainings could incorporate content related to trauma-informed care as well as associations with alcohol use, which may enhance their effectiveness further.

A Comparative Effectiveness Study on Opioid Use Disorder Prediction Using Artificial Intelligence and Existing Risk Models.

Opioid use disorder (OUD) is a leading cause of death in the United States placing a tremendous burden on patients, their families, and health care systems. Artificial intelligence (AI) can be harnessed with available healthcare data to produce automated OUD prediction tools. In this retrospective study, we developed AI based models for OUD prediction and showed that AI can predict OUD more effectively than existing clinical tools including the unweighted opioid risk tool (ORT). Data include 474,208 patients' data over 10 years; 269,748 were females with an average age of 56.78 years. Cases are prescription opioid users with at least one diagnosis of OUD or at least one prescription for buprenorphine or methadone. Controls are prescription opioid users with no OUD diagnoses or buprenorphine or methadone prescriptions. On 100 randomly selected test sets including 47,396 patients, our proposed transformer-based AI model can predict OUD more efficiently (AUC = 0.742 ± 0.021) compared to logistic regression (AUC = 0.651 ± 0.025), random forest (AUC = 0.679 ± 0.026), xgboost (AUC = 0.690 ± 0.027), long short-term memory model (AUC = 0.706 ± 0.026), transformer (AUC = 0.725 ± 0.024), and unweighted ORT model (AUC = 0.559 ± 0.025). Our results show that embedding AI algorithms into clinical care may assist clinicians in risk stratification and management of patients receiving opioid therapy.

Cross-Tailoring Integrative Alcohol and Risky Sexual Behavior Feedback for College Students: Protocol for a Hybrid Type 1 Effectiveness-Implementation Trial.

BACKGROUND: Underage drinking and related risky sexual behavior (RSB) are major public health concerns on United States college campuses. Although technology-delivered personalized feedback interventions (PFIs) are considered a best practice for individual-level campus alcohol prevention, there is room for improving the effectiveness of this approach with regard to alcohol-related RSB. OBJECTIVE: The aims of this study are to (1) evaluate the impact of a brief PFI that integrates content on alcohol use and RSB and is adapted to include a novel cross-tailored dynamic feedback (CDF) component for at-risk first-year college students and (2) identify implementation factors critical to the CDF's success to facilitate future scale-up in campus settings. METHODS: This study uses a hybrid type 1 effectiveness-implementation design and will be conducted in 3 phases. Phase 1 is a stakeholder-engaged PFI+CDF adaptation guided by focus groups and usability testing. In phase 2, 600 first-year college students who drink and are sexually active will be recruited from 2 sites (n=300 per site) to participate in a 4-group randomized controlled trial to examine the effectiveness of PFI+CDF in reducing alcohol-related RSB. Eligible participants will complete a baseline survey during the first week of the semester and follow-up surveys at 1, 2, 3, 6, and 13 months post baseline. Phase 3 is a qualitative evaluation with stakeholders to better understand relevant implementation factors. RESULTS: Recruitment and enrollment for phase 1 began in January 2022. Recruitment for phases 2 and 3 is planned for the summer of 2023 and 2024, respectively. Upon collection of data, the effectiveness of PFI+CDF will be examined, and factors critical to implementation will be evaluated. CONCLUSIONS: This hybrid type 1 trial is designed to impact the field by testing an innovative adaptation that extends evidence-based alcohol programs to reduce alcohol-related RSB and provides insights related to implementation to bridge the gap between research and practice at the university level. TRIAL REGISTRATION: ClinicalTrials.gov NCT05011903; https://clinicaltrials.gov/ct2/show/NCT05011903. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/43986.

Characterizing cancer and COVID-19 outcomes using electronic health records.

PURPOSE: Patients with cancer often have compromised immune system which can lead to worse COVID-19 outcomes. The purpose of this study is to assess the association between COVID-19 outcomes and existing cancer-specific characteristics. PATIENTS AND METHODS: Patients aged 18 or older with laboratory-confirmed COVID-19 between June 1, 2020, and December 31, 2020, were identified (n = 314 004) from the Optum® de-identified COVID-19 Electronic Health Record (EHR) derived from more than 700 hospitals and 7000 clinics in the United States. To allow sufficient observational time, patients with less than one year of medical history in the EHR dataset before their COVID-19 tests were excluded (n = 42 365). Assessed COVID-19 outcomes including all-cause 30-day mortality, hospitalization, ICU admission, and ventilator use, which were compared using relative risks (RRs) according to cancer status and treatments. RESULTS: Among 271 639 patients with COVID-19, 18 460 had at least one cancer diagnosis: 8034 with a history of cancer and 10 426 with newly diagnosed cancer within one year of COVID-19 infection. Patients with a cancer diagnosis were older and more likely to be male, white, Medicare beneficiaries, and have higher prevalences of chronic conditions. Cancer patients had higher risks for 30-day mortality (RR 1.07, 95% CI 1.01-1.14, P = 0.028) and hospitalization (RR 1.04, 95% CI 1.01-1.07, P = 0.006) but without significant differences in ICU admission and ventilator use compared to non-cancer patients. Recent cancer diagnoses were associated with higher risks for worse COVID-19 outcomes (RR for mortality 1.17, 95% CI 1.08-1.25, P<0.001 and RR for hospitalization 1.10, 95% CI 1.06-1.14, P<0.001), particularly among recent metastatic (stage IV), hematological, liver and lung cancers compared with the non-cancer group. Among COVID-19 patients with recent cancer diagnosis, mortality was associated with chemotherapy or radiation treatments within 3 months before COVID-19. Age, black patients, Medicare recipients, South geographic region, cardiovascular, diabetes, liver, and renal diseases were also associated with increased mortality. CONCLUSIONS AND RELEVANCE: Individuals with cancer had higher risks for 30-day mortality and hospitalization after SARS-CoV-2 infection compared to patients without cancer. More specifically, patients with a cancer diagnosis within 1 year and those receiving active treatment were more vulnerable to worse COVID-19 outcomes.

Ranked determinants of telemedicine diabetic retinopathy screening performance in the United States primary care safety-net setting: an exploratory CART analysis.

BACKGROUND: Diabetic retinopathy (DR) is a leading cause of blindness worldwide, despite easy detection and effective treatment. Annual screening rates in the USA remain low, especially for the disadvantaged, which telemedicine-based DR screening (TDRS) during routine primary care has been shown to improve. Screening rates from such programs have varied, however, pointing to inconsistent implementation and unaddressed barriers. This work seeks to identify and prioritize modifiable barriers for targeted intervention. METHODS: In this final phase of an exploratory mixed-methods study, we developed, validated, and administered a 62-item survey to multilevel stakeholders involved with TDRS in primary care safety-net clinics. Survey items were aligned with previously identified determinants of clinic-level screening and mapped to the Consolidated Framework for Implementation Research (CFIR). Classification and Regression Tree (CART) analyses were used to identify and rank independent variables predictive of individual-level TDRS screening performance. RESULTS: Overall, 133 of the 341 invited professionals responded (39%), representing 20 safety-net clinics across 6 clinical systems. Respondents were predominately non-Hispanic White (77%), female (94%), and between 31 and 65 years of age (79%). Satisfaction with TDRS was high despite low self-reported screening rates. The most important screening determinants were: provider reinforcement of TDRS importance; explicit instructions by providers to staff; effective reminders; standing orders; high relative priority among routine diabetic measures; established TDRS workflows; performance feedback; effective TDRS champions; and leadership support. CONCLUSIONS: In this survey of stakeholders involved with TDRS in safety-net clinics, screening was low despite high satisfaction with the intervention. The best predictors of screening performance mapped to the CFIR constructs Leadership Engagement, Compatibility, Goals & Feedback, Relative Priority, Champions, and Available Resources. These findings facilitate the prioritization of implementation strategies targeting determinants of TDRS performance, potentially increasing its public health impact.

Bystander Program to Reduce Sexual Violence by Witnessing Parental Intimate Partner Violence Status.

INTRODUCTION: Youth who witness parental intimate partner violence are at increased risk for sexual violence. Existing data from a cluster RCT were used to determine the effectiveness of Green Dot bystander intervention to reduce sexual violence among high-school students who did and did not witness parental intimate partner violence. STUDY DESIGN: A secondary analysis was conducted in 2021 of extant data from a 5-year cluster RCT. SETTING/PARTICIPANTS: A total of 26 high schools in Kentucky were randomized to intervention or control condition in 2010. A total of 15,863 surveys were analyzed from baseline, 30,014 from partial intervention implementation (Years 1 and 2), and 25,907 from full implementation (Years 3 and 4). The sample was stratified to include students who witnessed or did not witness parental intimate partner violence. INTERVENTION: The bystander intervention program was delivered in 2 stages. During partial implementation, a persuasive speech describing rates, risk factors, and bystander-based approaches to violence prevention was provided to most students in schools randomized to the intervention. During full implementation, an in-depth 5-hour skill-based bystander training was provided to popular opinion leaders among the students in intervention schools (10%-15%). MAIN OUTCOME MEASURES: The primary outcome was sexual assault measured as perpetration and victimization. Secondary outcomes included sexual harassment and stalking, measured as victimization and perpetration. RESULTS: During full implementation, among students who witnessed parental intimate partner violence, the intervention was associated with significant reductions in sexual assault perpetration (ß= -0.21, p<0.01), sexual harassment perpetration (ß= -0.29, p<0.001), sexual assault victimization (ß= -0.25, p<0.01), and sexual harassment victimization (ß= -0.45, p<0.001). For students who did not witness parental intimate partner violence, the intervention was only associated with reductions in sexual harassment (ß= -0.19, p<0.001) and stalking (ß= -0.09, p<0.01) victimization. CONCLUSIONS: As implemented in the parent RCT, the bystander training was more effective at reducing violent outcomes among those who witnessed parental intimate partner violence than in those who did not witness parental intimate partner violence. TRIAL REGISTRATION: This study is registered at www. CLINICALTRIALS: gov, under identifier NCT01878097.

Sexual Violence Perpetration as a Risk Factor for Current Depression or Posttraumatic Symptoms in Adolescents.

Sexual violence perpetration (SVP), including coerced, physically forced, and alcohol- or drug-facilitated unwanted sex, occurs frequently in adolescence and may represent a risk factor for future perpetration. Sexual violence victimization (SVV) has been found to be a risk factor for increased rates of depression and posttraumatic stress disorder (PTSD); however, the associations of SVP with depression or posttraumatic stress symptoms (PTSS) have been less well described. This study examined associations between symptoms of depression and PTSS with SVP in the prior 12 months among high school students. In this cross-sectional analysis, a representative sample of public high school students (ninth-12th grades) completed self-reported surveys on peer SVP and SVV within the past year. Among 16,784 students completing surveys, 7.2% disclosed SVP against another high school student in the past 12 months; 64.4% of students disclosing SVP also experienced SVV. Both SVP and SVV, alone or in combination, were associated with a greater likelihood of symptoms of depression or PTSS. These associations were similar by sex and sexual minority status (e.g., lesbian, gay, bisexual, transgender, and queer [LGBTQ+]). These findings highlight the need for continued primary prevention efforts. Additional screening to recognize adolescent SVP can allow both early treatment of depression and PTSD and address the individual risks of SVP to reduce subsequent repeated sexual assaults.

How Does Green Dot Bystander Training in High School and Beyond Impact Attitudes Toward Violence and Sexism in a Prospective Cohort?

Bystander interventions are recognized as "promising" programming to reduce sexual violence. Gaps in current evaluations include limited follow-up post-training (beyond 24 months) and knowledge of additional bystander training during follow-up.In this prospective cohort study, nested in a cluster randomized controlled trial (RCT), three cohorts of high school (HS) seniors were recruited (Fall 2013-2015) and followed through Spring 2018 (n = 1,831). Training was based on their school cluster RCT assignment and receipt of additional Green Dot (GD) training after HS. Training was hypothesized to be associated with lower scores indicating less acceptance of violence or sexism.Sixty percent reported GD training after HS (68.7% of 986 in intervention and 50% of 845 in control conditions). No significant differences (p < .05) were observed by GD training for four of the five violence acceptance or sexism attitudinal measures at recruitment or final surveys. For "ambivalent sexism" alone was there a significant reduction in scale scores over time in the intervention versus control condition. Additional GD training after the RCT significantly reduced neither violence acceptance nor sexism scores over time.GD training does not appear to have a consistent longer-term impact on reducing violence acceptance and sexism.

A Methodology Report for the Life's Snapshot Cohort Study to Investigate the Long-Term Efficacy of a Violence Intervention.

Engaged bystander interventions are recognized as "promising" programming to reduce sexual violence (SV), yet little is known of the long-term (>12-month) impact of programming on SV and related forms of gender-based violence. Funded by NIH as a prospective cohort study, Life's Snapshot recruited and followed three waves of high school seniors who had participated in a large high-school cluster-randomized controlled trial to evaluate the effectiveness of the Green Dot bystander intervention. This report provides the study design, recruitment methodology, recruitment and retention rates, survey items, and psychometric properties of measures included in the initial and annual electronic surveys with 24-48 months follow-up.

Bystander Intervention Efficacy to Reduce Teen Dating Violence Among High School Youth Who Did and Did Not Witness Parental Partner Violence: A Path Analysis of A Cluster RCT.

Youth who witness parental intimate partner violence (IPV) are at increased risk of teen dating violence (DV). This analysis of secondary data investigated whether a bystander intervention program, Green Dot, was effective at reducing physical and psychological DV victimization and perpetration among youth who had and had not previously witnessed parental IPV. The parent RCT assigned 13 schools to control and 13 schools to the Green Dot intervention. Responses from 71,797 individual surveys that were completed by high school students were analyzed across three phases of a 5-year cluster randomized control trial. Multigroup path analyses revealed that students in intervention schools who witnessed parental IPV had a reduction in psychological (p < .001) and physical DV (p < .01) perpetration and psychological DV victimization (p < .01) in Phase 2 of the intervention, while those who did not witness parental IPV had a significant reduction in psychological DV victimization (p < .01). Individuals in the intervention received more training (p < .001), which was associated with lower levels of violence acceptance (p < .001). Violence acceptance was positively associated with DV victimization and perpetration (p < .001), especially for individuals who previously witnessed parental IPV. Green Dot is an effective program at reducing DV victimization and perpetration among the high-risk group of youth who previously witnessed parental IPV, largely operating through violence acceptance norms. This underscores the bystander intervention approach as both a targeted and universal prevention program.

Disinfectant use by K-12 school staff to combat SARS-CoV-2.

K-12 school staff from Indiana, Kentucky and Ohio were asked about their use of disinfectants to mitigate the spread of COVID-19 in schools. Survey participants (n = 1,555) reported frequent use of disinfectants, often using unknown products, and were provided little to no training on safe and effective use. Participant concerns included student involvement in disinfection, inadequate ventilation, surface contact time, and potential health effects.

Effect sizes and intra-cluster correlation coefficients measured from the Green Dot High School study for guiding sample size calculations when designing future violence prevention cluster randomized trials in school settings.

PURPOSE: Cluster randomized controlled trials (cRCTs) are popular in school-based research designs where schools are randomized to different trial arms. To help guide future study planning, we provide information on anticipated effect sizes and intra-cluster correlation coefficients (ICCs), as well as school sizes, for dating violence (DV) and interpersonal violence outcomes based on data from a cRCT which evaluated the bystander-based violence intervention 'Green Dot'. METHODS: We utilized data from 25 schools from the Green Dot High School study. Effect size and ICC values corresponding to dating and interpersonal violence outcomes are obtained from linear mixed effect models. We also calculated the required number of schools needed for future studies utilizing available methods that do and do not consider variation in school size. RESULTS: Observed effect sizes for DV outcomes range from 0.06 to 0.11. Observed ICC values for DV outcomes range from 0.0006 to 0.0032. The upper limit of 95% CIs for the true ICCs range from 0.0023 to 0.0070. CONCLUSION: School-based evaluations with violence outcomes are expected to have small effect sizes. Observed ICCs are less than 0.005 and upper limit of of 95% CIs for the true ICCs are less than 0.01. Designing school-based cRCTs should account for the ICC, even if its value is assumed to be negligible. Furthermore, variation in school sizes should also be accounted for to avoid having too few schools to achieve the desired power.

Longitudinal Examination of Prenatal Tobacco Switching Behaviors and Birth Outcomes, Including Electronic Nicotine Delivery System (ENDS) and Dual Use.

INTRODUCTION: In the US, approximately 8% of pregnant women smoke, and 5-11.9% currently use ENDS products. The health effects of ENDS use are debated; however, most contain nicotine which is known to cause adverse perinatal outcomes. Studies have shown adult ENDS users significantly alter use behaviors over time (switch to conventional cigarettes-only or dual use) thus complicating efforts to examine health effects of ENDS use. The purpose of this study was to describe switching behaviors and associated birth outcomes among infants of women using conventional cigarettes only, ENDS-only, or both. METHODS: This was a multisite, longitudinal study of biologically confirmed perinatal tobacco users, with nicotine product use assessed each trimester. For the purpose of analysis, participants were defined as switchers, no-switchers, or quitters. Birth outcomes were abstracted from electronic medical records. Analysis included descriptive statistics, linear and multivariate logistic regression adjusted for age, preterm birth, smoking behavior in the first trimester, and an interaction between smoking switching behavior and smoking behavior in the first trimester. Analysis was conducted using SAS v9.4 with significance determined as p < 0.05. RESULTS: At enrollment, 48.6% of participants used only conventional cigarettes, 41.7% were dual users, and 10% used ENDS-only. While almost two-thirds of participants used the same tobacco product throughout pregnancy, 26% reported switching behaviors that were complex and not easily clustered. No differences were found in birth outcomes between switchers and no-switchers; however, a difference emerged in birth weight between no-switchers and quitters. DISCUSSION: Given the limited data on health effects of ENDS use, and the known harmful consequences of perinatal nicotine use, capturing and classifying product switching behaviors is imperative to inform public health, and remains a challenge requiring further research.

Can organizational efforts lead to less secondary traumatic stress? A longitudinal investigation of change.

Objectives: Current best practice approaches suggest that to address secondary traumatic stress (STS) a two-pronged perspective that considers individual and organizational factors over time is warranted. However, research documenting the impact of organizational efforts on individual experience with STS is lacking. In this study, it was hypothesized that as an organization becomes more STS informed, there would be decreases in reported levels of STS and burnout (BO) in individuals over time; and these changes would be associated with higher levels of implementation activity and increased use of interventions to improve physical and psychological safety. Methods: This study uses data from 2,345 responses, representing 7 groups involved in an organizational change process aimed at creating STS informed organizations in a department of health and human services. The Secondary Traumatic Stress Informed Organizational Assessment (STSI-OA), the Secondary Traumatic Stress Scale (STSS), and the Professional Quality of Life-5 BO subscales measured variables of interest. Using a longitudinal design, baseline, post, and follow-up data were collected. Results: One-way ANOVAs revealed significant improvements in STSI-OA, STSS, and BO scores across time (p-value < .05). Linear mixed models reveal that significant declines in STSS scores were associated with improved STSI-OA scores (p = <.001), after adjusting for age, gender, time, and level of implementation activity. Implications: These results support the hypothesis that organizational efforts can improve an individual's perceived level of distress, and that focused attention to the issue of secondary trauma in an organization can improve organizational and individual outcomes using a data-driven change approach. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Impact of the COVID-19 Shutdown on Mental Health in Appalachia by Working Status.

INTRODUCTION: To slow the spread of COVID-19 in the United States, businesses shutdown in Spring 2020. Research has indicated the impact on frontlines workers, yet little is known about the impact on those who were not working outside the home or switched to working remotely. PURPOSE: The purpose of this report is to identify the financial and healthcare issues and mental health impact of the COVID-19 shutdown on Appalachians by worker categories. METHODS: An online survey was administered from May 8 - June 6, 2020 to a convenience sample of previous research participants and shared through social media networks, i.e., snowball sampling. Questions investigated mental health, financial and healthcare issues, and employment status. Survey responses were summarized by percentages overall and by working categories. RESULTS: Of the 751 participants, 276 (42%) resided in Appalachia. After removing 17 who lost their job due to COVID-19, 59 (23%) indicated not working outside the home prior to COVID-19, whereas 111 (43%) and 89 (34%) switched to working remotely and continued working outside the home during the shutdown. Respondents were predominately Caucasian and female. Nearly a quarter of participants had lost or reduced income due to the shutdown. Approximately half missed or postponed healthcare appointments. Mental health impacts were similar across the groups, with half of the respondents reporting anxiety due to COVID-19. IMPLICATIONS: Further research is needed to explore health outcomes associated with missed healthcare appointments during the shutdown. Mental health support may be needed equally by those isolated at home and frontline workers.

The co-occurrence of smoking and alcohol use disorder in a hospital-based population: Applying a multimorbidity framework using geographic information system methods.

Tobacco and alcohol use are leading causes of premature mortality in the US and concurrent use is associated with even greater health risks. A cross-sectional study of 20,310 patients admitted to a Mid-Atlantic acute health care system between July 1, 2018 and June 30, 2019 were categorized according to smoking and alcohol use disorder (AUD) status. Of the total admissions, 1464 (7.2%) were current smokers with an AUD. These patients were younger (52.4 vs. 63.9), more likely to be male (64.1% vs. 38.0%) and covered by Medicaid (46.9% vs. 11.6%), and resided in proximity to higher counts of tobacco (10.3 vs. 4.72) and alcohol (2.24 vs. 1.14) retailers than never smokers without an AUD. Clinically, these patients had higher rates of other substance use disorders (60.4% vs. 6.1%), depression (64.6% vs. 34.8%), HIV/AIDS (3.3% vs. 0.6%), and liver disease (40.7% vs. 13.2%) than never smokers without an AUD. Patients who concurrently smoke and have an AUD face unique and serious health risks. A multimorbidity framework can guide clinical and community-based interventions for individuals with concurrent psychiatric and chronic medical conditions, complex social needs, and adverse environmental exposures.