Perspectives on Electronic Nicotine Delivery System Use Cessation Among Adults in Rural Areas: Implications for Future Studies.

INTRODUCTION: More young adults (age 18-24 years) in rural areas versus urban areas use electronic nicotine delivery systems (ENDS) - also known as e-cigarettes. Little is known about young adults' perceptions toward ENDS use and cessation. The objective of this study was to examine barriers and facilitators to ENDS use cessation among young adults living in rural areas, as well as their perceptions about ENDS use and cessation and to determine implications for future cessation studies. METHODS: We administered cross-sectional online surveys to young adults living in rural Midwestern counties. A total of 100 individuals responded to the surveys. Descriptive statistics were used to report their perceptions of ENDS use as well as barriers and facilitators to ENDS use cessation. The content analysis method was used to analyze the answers to an open-ended question regarding perceptions about the ENDS use cessation in the context of rural areas. RESULTS: Barriers to ENDS use cessation included perceived advantages to ENDS use, high nicotine dependence, and the perception that ENDS use was less harmful cigarettes. Facilitators to ENDS use cessation included cost of ENDS use, perceived harm, and high confidence in ability to quit. Participants' perceptions about ENDS use cessation in the context of rural areas were conceptualized under the themes of (1) exposure to and initiation of ENDS use, (2) continuation of ENDS use, and (3) prevention and cessation of ENDS use. CONCLUSIONS: Health care providers, tobacco control researchers, and public health advocates should be aware of barriers and facilitators to ENDS use cessation among young adults for future cessation intervention studies relevant specifically to rural areas.

Experiences and Perceptions of E-Cigarette Cessation for Young Adults in Rural Communities.

BACKGROUND: Electronic nicotine delivery systems (ENDS), also known as e-cigarettes, are the most commonly used tobacco products among young adults in the United States. Young adults in rural areas have a higher prevalence of ENDS use compared to their urban counterparts, yet there is limited evidence regarding the in-depth understanding of experiences and perspectives directly from young adults. OBJECTIVES: The aim of this study was to explore individual experiences and perspectives about use and cessation of ENDS from young adults in rural areas. METHODS: This was a qualitative study using interpretive description for analysis. Young adults (18-24 years) who used ENDS every day but not other tobacco products (cigarettes, smokeless, etc.) in the past month and had an address in a rural county of Wisconsin were eligible; there were nine participants interviewed using Zoom. Interview questions focused on initial use, maintenance of use, experiences of quitting, and social and rural environmental contexts regarding ENDS. RESULTS: Three themes emerged with eight categories: (a) addiction to ENDS and health, (b) cessation and resources, and (c) rural environment and culture in ENDS addiction. DISCUSSION: Findings have implications for ENDS cessation interventions targeting young adults in rural areas.

Transcranial Direct Current Stimulation in Nicotine Use: Nursing Implications for Patient Outcomes.

ABSTRACT: Tobacco use is a leading cause of cancer, cardiovascular and respiratory disease, and preventable death in the United States. The brains of individuals with nicotine dependence are characterized by damaged mesolimbic pathways in the medial portion of the limbic and frontal lobes, creating positive reinforcing mechanisms. Transcranial direct current stimulation (tDCS) targets this neuroadaptation to improve smokers' nicotine-related outcomes, such as craving and smoking behavior, by depolarizing or hyperpolarizing the neurons of the brain. Recent literature reported promising outcomes in smokers after tDCS treatment interventions. tDCS has great potential for clinical nursing research for tobacco control given its multiple methodological advantages and few disadvantages. Nurse researchers can consider individualized and home-based tDCS interventions for community-based tobacco control research and may need to consider objective outcome measures (e.g., cotinine in urine) and addiction-related cognitive variables (e.g., self-regulation). Users of electronic nicotine delivery systems also need to be considered as participants in tDCS interventions. Additional considerations for nursing research are discussed.

Recruitment of Young Adults: Lessons Learned From Research on Rural E-Cigarette Use and Cessation.

Electronic nicotine delivery system (ENDS) use continues to grow in rural areas of the United States. In particular, young adults (18-24 years) in rural areas are a hard-to-reach population in regard to understanding the growing ENDS use trend. The purpose of this article was to describe recruitment strategies that were used for a series of ENDS-relevant projects for young adults in rural areas, report recruitment yields from these strategies, and provide methodological considerations to aid researchers in improving recruitment. We used descriptive statistical methods to characterize recruitment yields (responses to screening vs initial invites, and number of individuals who fully met eligibility criteria vs responses to screening) from 2 ENDS studies that focused on 3 main recruitment strategies, including student directories, leadership offices (eg, Student Affairs), and regional tobacco control support networks (eg, Area Health Education Centers) for reaching young adults in rural communities. The recruitment yield rates varied and ranged from 2% to 14% depending on strategy with leadership offices resulting in the highest recruitment yield. Methodological considerations by strategy are described in detail. Results of this study can be used to inform tailored recruitment strategies to increase the representation of rural young adults in ENDS or other tobacco research.

Simulation-based training program on patient safety management: A quasi-experimental study among new intensive care unit nurses.

BACKGROUND: Patient safety is an essential responsibility of nurses. However, newly graduated nurses experience patient safety incidents due to a lack of patient safety competency. In particular, intensive care unit nurses provide care to critical patients, making it difficult for new nurses to maintain patient safety. Therefore, it is necessary to improve the patient safety competency of newly graduated nurses working in the intensive care unit. OBJECTIVES: To analyze the effects of a simulation-based training program on patient safety management on the patient safety competency, patient safety management activity, communication self-efficacy, and teamwork of newly graduated nurses working in an intensive care unit. DESIGN: A quasi-experimental study. SETTINGS: The study was conducted at a university in Korea. PARTICIPANTS: A total of 44 newly graduated nurses working in the intensive care unit of a university hospital. METHODS: A simulation-based training program on patient safety management was applied to the experimental group (n = 22), while only the usual hospital training program was used for the control group (n = 22). A structured questionnaire survey comprising Patient Safety Competency Self-Evaluation, Patient Safety Management Activities, the Korean version of the self-efficacy questionnaire, and K-self assessment of teamwork was conducted at baseline test (T1), post test (T2), and follow-up test (T3). Data were analyzed using a repeated measures ANOVA. RESULTS: The experimental group showed significantly higher patient safety competency, patient safety knowledge, and patient safety skills, along with higher communication self-efficacy scores than the control group (p < .05) after the intervention and at four weeks after the intervention. CONCLUSIONS: The simulation-based training program on patient safety management effectively improved the patient safety competency, patient safety knowledge, and patient safety skills as well as communication self-efficacy of newly graduated nurses working in an intensive care unit.

Affected family members social support experiences when assisting an individual with substance use disorder.

INTRODUCTION: Social support is a factor in the health and well-being of all populations (WHO, 2018). Having a loved one with substance use disorder (SUD) negatively affects family members. Affected Family Members (AFM) providing support for individual with substance use disorder (ISUD) are at risk of losing their social support network. Losing social support negatively influences AFMs health and well-being. DESIGN: As part of a larger mixed methods study, the researchers used qualitative inquiry to explore the experiences and perceptions of social support of the AFM of an ISUD. METHODS: The thematic framework of social support was applied to this qualitative study to identify the conceptual determinants of the perceptions and experiences of the AFM and the development of emergent themes. Participants completed an anonymous electronic survey that included Open-ended questions. A total of 101 participants completed the open-ended questions with 1088 narrative responses received. The utilization of an audit trail, reflexive journal, and in-depth thematic analysis conducted by the researchers has ensured the rigor of the study. RESULTS: Three themes emerged from the AFMs perspective: (1) We are all alone, and we have to fend for ourselves, (2) No one understands what we are going through and (3) People cannot relate and recoil from us. CONCLUSION: Identification of the specific needs of the AFM was crucial, and the first step in designing programs in future research to provide social support for ensuring the health and well-being of the AFM. CLINICAL RELEVANCE: Nurses need to provide family-centred care to ISUD, including their AFMs, in order for the ISUD to continue to receive support to facilitate their recovery. This research highlights ways in which the nurse caring for the ISUD can provide supportive interventions for the AFMs.

Adolescent Characteristics, Suicide, and Bullying in High School.

Youth Risk Behavior Survey 2011-2017 data were examined for associations among high school population subsets who self-reported suicide risk behaviors and experiences with bullying. High-school students who reported suicidal risk behaviors were 4.64 times more likely to have experienced bullying electronically. Ninth grade and female students were more likely than others to experience suicide risk behaviors and bullying. At the interpersonal level, school nurses are able to identify students who are experiencing bullying and who exhibit suicide risk behaviors. At the systems level, bullying prevention efforts should target all students. School nurses, administrators, policy makers, and health providers should consider data-driven recommendations in bullying prevention programs.

Public health nurses' perceptions and experiences of emergency preparedness, responsiveness, and burnout during the COVID-19 pandemic.

OBJECTIVE(S): To describe PHNs' perceptions and experiences of the COVID-19 pandemic, including training, response activities, and work-related challenges. DESIGN: This was a qualitative study using interpretive description for analysis. SAMPLE: PHN participants who worked in public health departments in Wisconsin were recruited using purposive sampling. A total of 15 PHNs participated in the study, including both general and supervisor-level PHNs. MEASUREMENTS: Data were collected via semi-structured interviews from March to May 2021. Interview questions focused on PHNs' perceptions, experiences, response activities, and burnout in relation to the current pandemic as well as perceptions and experiences of emergency preparedness and response in general. RESULTS: Five themes emerged in the study. These were: (1) experiences and observations of the COVID-19 pandemic, (2) organizational changes and their impacts, (3) public health emergency preparedness and response, (4) public health emergency response activities, and (5) role strain and burnout. CONCLUSIONS: Findings presented here have important implications for PHN training and support in emergency preparedness and response. A wide array of strategies focused on developing and supporting the PHN workforce in response to the public health crisis this area need to be implemented at the organizational, community, and policy levels.

Cotinine Fluctuation in Maternal Saliva During and After Pregnancy: Implications for Perinatal Outcomes.

PURPOSE: The purpose of this study was to determine maternal cotinine levels in saliva at the first (T-1) and third trimesters of pregnancy (T-2), and postpartum (T-3) among women who reported smoking a consistent number of cigarettes. The goal was to generate data to provide suggestions about how nurses can improve patient outcomes for women who smoke. METHODS: Saliva cotinine values obtained from the randomized controlled trial (BabyBEEP) were used for this secondary analysis. We examined variations in saliva cotinine between the first and third trimesters of pregnancy and postpartum among light and heavy smokers. Cotinine values for pregnant smokers who were in the control group (not randomized to any intervention) and reported smoking the same range of cigarettes during and after pregnancy were used for the analyses (n = 43). Descriptive statistics and repeated-measures ANOVA were used for analyses. RESULTS: There were differences in maternal saliva cotinine levels across the different time points and between the groups. There was a significant interaction effect between time and group. Cotinine decreased from T-1 to T-2 in heavy smokers and increased from T-2 to T-3 among both light and heavy smokers. Cotinine at T-3 was higher than T-1 among light smokers. CLINICAL IMPLICATIONS: Findings support accelerated nicotine metabolism during pregnancy and need for smoking cessation efforts throughout pregnancy to help women stay smoke free during postpartum.

Public health nurses' workforce factors and population health outcomes in the United States.

OBJECTIVES: (a) To examine associations between public health nurse (PHN) workforce factors (PHNs' highest education and PHNs' mean years of employment) and health-risk behaviors (smoking and physical inactivity rates), and (b) to investigate the associations between PHN workforce factors and premature mortality rates across all counties of the United States. DESIGN: Secondary analysis. SAMPLE: A total of 5,705 PHNs from the 2015 National Nursing Workforce Survey and 2,977 U.S. counties from the 2016 County Health Rankings & Roadmaps data were included. METHODS: Multilevel linear regression was used. RESULTS: Bachelor's, and master's or doctorate-prepared PHNs accounted for 41.5% and 17.0%, respectively. The mean year of employment among PHNs was 17.3. The percentages of PHNs with bachelor's, master's, and doctoral degrees were significantly associated with decreased physical inactivity rates. The PHNs' mean year of employment was significantly associated with decreased physical inactivity rates and reduced premature age-adjusted mortality rates. CONCLUSIONS: The findings indicated that PHNs with higher levels of education and more years of employment were important in improving health outcomes (health-risk behavior and premature mortality). Policymakers need to consider strategies to encourage more PHNs to obtain advanced degrees and to retain PHNs longer in the public health field.

Assessment of Patient Safety and Cultural Competencies among Senior Baccalaureate Nursing Students.

This descriptive, correlational, cross-sectional study examined nursing students' educational experiences on self-reported perceptions of patient safety and cultural competence in terms of curriculum content and learning venues. We performed descriptive analyses and a one-way analysis of variance with a sample of senior-year nursing students (N = 249) attending three state universities in the United States. We used the Nurse of the Future Nursing Core Competency Model, the Patient Safety Competency Self-Evaluation Tool for Nursing Students, and The Cultural Competence Assessment Instrument. Overall, participants reported that patient safety and cultural competencies were addressed in their curricula primarily through classroom activities as opposed to laboratory/simulation or clinical settings. Among the required patient safety knowledge topics, elements of highly reliable organizations were covered the least. For patient safety competency, participants reported higher scores for attitude and lower scores for skill and knowledge. For cultural competency, participants scored much higher for cultural awareness and sensitivity than behavior. There was no statistically significant difference between scores for patient safety and cultural competencies by nursing school. The results support the need for curriculum development to include all important aspects of patient safety and cultural competencies in various teaching/learning venues.

Concept analysis of impressionability among adolescents and young adults.

AIM: To report a concept analysis of impressionability among adolescents and young adults. BACKGROUND: Adolescence and young adulthood are critical periods to establish health behaviour. Environmental determinants are associated with youth health risk behaviours. These populations are impressionable to a range of social and physical environmental factors. DESIGN: Concept analysis. METHODS: We selected 17 studies to review from Psych INFO, ERIC, MEDLINE, and Google Scholar as well as the University of Virginia library. We did not apply date limits. We included search terms: "adolescent"; "youth"; "young adult"; "impressionability"; and "impressionable." RESULTS: The defining attributes of impressionability among youths were a state where: (a) one is able to be susceptible to external stimuli; (b) one is incapable of reasonable judgement; and (c) one has a changeability to accept or modify one's attitude and behaviour. We identified antecedents, consequences, and cases of impressionability.

Telephone Support and Telemonitoring for Low-Income Older Adults.

The objective of the current pilot study was to determine whether nurse-led telephone counseling improves health behavior, self-care, and physiological indices for low-income older adults using a telemonitoring system. The control group (n = 15) was provided with weekly health education only, and the intervention group (n = 20) was given additional telephone support by nurses. At baseline and 8 weeks, data on health and self-care behaviors were collected using a self-reported questionnaire, and blood pressure and fasting blood glucose levels were assessed. Nurse-led telephone support had a medium effect on improving health behavior (Cohen's d = 0.58, 95% confidence interval [CI] [-0.10, 1.27]), reducing systolic blood pressure (Cohen's d = -0.61, 95% CI [-1.29, 0.08]), and improving self-care behavior for hypertension (Cohen's d = 1.16, 95% CI [0.05, 2.27]). Findings support that nurse-led telephone support may be effective for improvements in health behavior, systolic blood pressure, and hypertension self-care in disadvantaged older adults under remote monitoring. Further studies are needed to obtain a powered sample size and investigate the long-term effects of personalized elements surrounding telehealth in community-based settings. [Res Gerontol Nurs. 2018; 11(4):198-206.].

Density and Proximity of Licensed Tobacco Retailers and Adolescent Smoking.

Adolescent smoking prevention is an important issue in health care. This literature review describes the theoretical concept of ecological model for adolescent smoking and tobacco retailers and summarizes previous studies on the association between the density and proximity of tobacco retailers and adolescent smoking. We reviewed nine studies on tobacco retailer density and proximity in relation to adolescent smoking, published in peer-reviewed journals between 2004 and 2014. The tobacco retailer density and proximity were correlated with adolescent lifetime smoking, past 12-month smoking, past 30-day smoking, and susceptibility to smoking. School nurses or other school health professionals may need to include the density and proximity of tobacco retailer factors around schools in school-based tobacco-use prevention programs. Health policy makers may need to consider zoning or licensing restrictions of tobacco retailers around schools for adolescent smoking prevention.

[Factors Influencing Adolescent Lifetime Smoking and Current Smoking in South Korea: Using data from the 10th (2014) Korea Youth Risk Behavior Web-Based Survey].

PURPOSE: The purpose of this study was to investigate factors influencing lifetime smoking and current smoking among adolescents in South Korea. METHODS: Hierarchical logistic regression was conducted based on complex sample analysis using statistics from the 10th (2014) Korea Youth Risk Behavior Web-Based Survey. The study sample comprised 72,060 adolescents aged 12 to 18. RESULTS: The significant factors influencing adolescent lifetime smoking were female gender, older age, higher stress, higher weekly allowance, lower economic status, living apart from parents, parental smoking, sibling smoking, peer smoking, observation of school personnel smoking, and coed school compared to boys' school. The significant factors influencing adolescent current smoking were female gender, older age, higher stress, higher weekly allowance, both higher and lower economic status compared to middle economic status, living apart from parents, parental smoking, sibling smoking, peer smoking, observation of school personnel smoking, and coed school compared to boys' school. CONCLUSION: Factors identified in this study need to be considered in programs directed at prevention of adolescent smoking and smoking cessation programs, as well as policies.

Effect of Home Visiting with Pregnant Teens on Maternal Health.

PURPOSE: Determine the extent that participation in Resource Mothers Program (RMP) home visiting improves maternal health at 3 months postpartum. STUDY DESIGN AND METHODS: A randomized controlled trial using RMPs in two urban and one rural location in a mid-Atlantic state. Community health workers from these RMPs enrolled teens into the study and the research team assigned participants to either the intervention group or telephone support control group using computerized randomization assignments. Data collection from baseline and 3 months postpartum using the Edinburgh Postnatal Depression Scale (EPDS) and the Prenatal Psychosocial Profile (PPP) is reported. RESULTS: The sample included 150 pregnant teens with a mean age of 17 years. Mean self-esteem scores between groups were not significantly different at baseline, but the RMP group self-esteem scores improved significantly at the 3 months postpartum interview (36.40 ± 5.63 for RMP vs. 34.10 ± 4.29 telephone control group, p = 0.049). Neither group was at risk for depression at baseline or 3 months postpartum. Because 60% of the total sample identified as Hispanic, post hoc analysis revealed significantly different baseline stress mean scores between Hispanic and non-Hispanic teens (p = 0.038); however, these differences were no longer significant by 3 months postpartum (p = 0.073). The EPDS scores by ethnicity were not different at baseline (p = 0.875) but were significantly different at 3 months (p = 0.007). CLINICAL IMPLICATIONS: The RMP home-visiting intervention can lead to improved self-esteem scores in teens, particularly in Hispanic teens. Improved self-esteem has been shown to lead to better parenting.

[Factors that influence sexual intercourse among middle school students: using data from the 8th (2012) Korea Youth Risk Behavior Web-based Survey].

PURPOSE: The purpose of this study was to investigate factors that influence sexual intercourse among middle school students in South Korea. METHODS: Using statistics from the 8th (2012) Korea Youth Risk Behavior Web-based Survey, hierarchical logistic regression analysis was conducted. The study sample comprised 37,297 middle school students aged primarily 12 to 15. RESULTS: The significant predictors of sexual intercourse were grade, ever smoking, ever drinking, habitual or purposeful drug use, economic status, weekly allowance, cohabitation with family, and type of school. CONCLUSION: The results suggest that intensified sex education is needed not only in the 1st grade of middle school, but also in the upper grades of elementary school. Sexual health interventions for high-risk groups may be needed, given the factors predicting sexual intercourse.